All right, so welcome back to the Internet Book of Critical Care podcast.

I'm here with Adam Thomas and we're going to talk about stress hyperglycemia in the ICU.

Only you could make something as simple as blood glucose controversial or spike contours because

we know that this is going to cause a Twitter storm of anchor.

I did start the fire out of. Don't play this on me.

But you highlight the fire nicely. The pendulum has been swinging about this for decades,

and people get pretty fired up about this. There's three camps, right? The tight control,

the do whatever you want, and then this weird

gray zone where we artificially just pick some numbers for trials and stick to them. So today,

we're going to cover all those camps, what the rationale for them are. But Josh, let's step back

and give me the 360 view, that high level. Why do we even care about the blood sugar level?

What are the arguments about whether hyper or hypoglycemia are the

badness? There are a lot of theoretical reasons that hyperglycemia could be beneficial or it could

be harmful and we'll kind of try to discuss them a bit. But I think the caveat here is that this is

not something where you can predict based on physiology what the answer is going to be.

There are so many different ramifications of glucose level on all the different organ systems

in the immune system and cytokine levels and autophagy and everything that you just can't predict

the answer.

Wait, wait, wait, got to come back to it.

This is like pharcusism since pronouncing Asian.

Autophagy?

Which one is it? I don't know. I've quite

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