Ever wondered why a serious infection can make your blood sugar go on a rollercoaster ride? In sepsis, the body's response to infection can push glucose levels either sky-high or dangerously low, and both extremes can change the course of recovery. Below, I'll walk you through why this happens, what it means for people with diabetes, and how you can stay a step ahead if you or someone you love are fighting sepsis.## Why Sepsis Affects Sugar### Inflammation Drives HyperglycemiaWhen an infection spirals into sepsis, your body releases a flood of stress hormonescortisol, adrenaline, and inflammatory cytokines. These chemicals act like a sneaky saboteur, making your cells ignore insulin and forcing the liver to dump more glucose into the bloodstream. The result? Blood sugar can climb to 140-250 mg/dL or even higher, a condition doctors call
stress-induced hyperglycemia. Understanding the impact of sepsis on blood sugar is crucial, especially when assessing
sepsis severity and using scoring systems like
sepsis scoring to evaluate the severity of the condition.### How Sepsis Can Cause HypoglycemiaIt may sound odd, but sepsis isn't just about high sugar. In severe shock, the liveryour main glucose factorycan become impaired, and some bacteria actually consume glucose for fuel. Add aggressive insulin therapy or prolonged fasting, and you might see blood sugar dip below 70 mg/dL, sometimes sliding into the dangerous
hypoglycemia zone.## Hyperglycemia Risks & Treatment### Short-Term ComplicationsHigh glucose isn't just a numberit actually hampers your immune system. Neutrophils, the foot soldiers that gobble up bacteria, become less effective. Fluid shifts become unpredictable, and the risk of organ swelling (edema) climbs. Organ dysfunction can be evaluated using the
SOFA score to predict the risk of organ failure, which is critical in managing sepsis.### Long-Term OutcomesStudies show that septic patients with persistent hyperglycemia have higher ICU mortality, increased risk of acute kidney injury, and longer hospital stays. In short, keeping that blood sugar in check isn't just a nice-to-haveit's a lifesaving move. Understanding how to accurately calculate the
SOFA score and using it effectively can help in managing organ failure assessment and in making informed decisions about patient care.### Current Treatment TargetsThe 2021 Surviving Sepsis Campaign recommends aiming for a glucose range of
144-180 mg/dL. Attempts to force tight control (90-110 mg/dL) haven't shown extra benefit and actually raise the chance of hypoglycemia.### Target Ranges vs. Outcomes| Target Range (mg/dL) | Mortality Reduction | Hypoglycemia Risk ||-----------------------|----------------------|-------------------|| 90-110 (tight) | No significant change | High || 144-180 (moderate) | Improved | Low-Moderate || >180 (uncontrolled) | Worse | Low |### Practical Tips for Patients & Caregivers- Ask the ICU team how often glucose will be checked (every 4-6 hours is typical).- Know the target range; ask for the exact numbers on your chart.- If you're on insulin, confirm the dose adjustments when stress hormones start to fall.- Keep a simple log: time, reading, insulin given, and any symptoms.## Hypoglycemia Risks & Management### Who's at Risk?Severe shock, liver failure, aggressive insulin therapy, and poor nutritional intake are the main culprits. People who already have diabetes and are on insulin are especially vulnerable because their medication can overshoot once the stress response eases.### Warning SignsFeelings of shakiness, sweating, confusion, or even a sudden seizure are red flags. In an ICU setting, nurses monitor for these, but if you're caring for a loved one at home, stay alert for any sudden changes in behavior.## ConclusionSepsis can turn your blood sugar into a wild pendulumsoaring high, plunging low, and sometimes both at once. Understanding why these swings happen, knowing the safe glucose targets, and being proactive about monitoring can dramatically influence recovery, especially for anyone living with diabetes. If you or a loved one are navigating this storm, talk openly with your care team, keep a simple log, and never hesitate to ask for clarification. Your questions matter, and staying informed is one of the strongest tools you have.
FAQs
Can sepsis cause both high and low blood sugar?
Yes. The stress response to infection often raises glucose, but severe shock, liver failure, or aggressive insulin can drive it down.
What glucose range should be targeted for septic patients?
Current guidelines recommend keeping blood glucose between 144‑180 mg/dL; tighter control hasn’t shown added benefit and raises hypoglycemia risk.
Why is hyperglycemia harmful during sepsis?
High glucose impairs neutrophil function, promotes fluid shifts, and is linked to higher ICU mortality, AKI, and longer hospital stays.
Which patients are most at risk for hypoglycemia in sepsis?
Those in severe shock, with liver dysfunction, receiving aggressive insulin, or with poor nutritional intake—especially diabetics on insulin.
How should a low glucose episode be treated in a septic patient?
Administer a rapid 25‑gram glucose bolus (e.g., dextrose tablets) and adjust insulin dosing; continuous dextrose may be needed if levels stay low.
