Diabetes patients especially for diabetes mellitus type 1 who no longer produce hormone internally, their survival depends on external insulin. In rare cases, this is including patient with diabetes type 2 if their blood glucose level controlling fail treated by any medication.

One of the treatment often used is Intensive Insulin therapy.
However for patients who treated by hydrocortisone for septic shock treatment in intensive insulin therapy showed no significant improvement.
In other words, mortality patients in hospital still showed no significant improvement.

Recent study of COIITSS (Corticosteroids and Intensive Insulin Therapy for Septic Shock) by Djillali Annane, M.D., from the Hosptial Raymound Pointcare in Garches, France, and colleagues, reported, “The current study showed no evidence to support a strategy of intensive insulin therapy aimed at maintaining blood glucose levels in the range of 80 to 110 mg/dL for treating septic shock with corticosteroids. The current data do not support the routine use of oral fludrocortisone in addition to hydrocortisone when physicians decide to introduce corticosteroids in the management of a patient with septic shock.”

Based on the study data from January 2006 to January 2009 at 11 intensive care unit in France, Of 509 adults with septic shock who presented with multiple organ dysfunction.

With routine dosage every 6-7 hours by 50-mg bolus of hydrocortisone for 7 days and dosage of fludrocortisone at 50-?g oral tablets per day for 7 days showed;

- 117 of 255 patients deaths (45%) who treated by Intensive insulin therapy.
- 109 of 254 patients deaths (42.9%) who treated by conventional inslin therapy.
- Also compared between those therapy, group in intensive insulin therapy had significant more episodes of severe hypoglycemia (<40 mg/dL).

All those unsignificant result same with secondary outcomes including median number of days spent in the ICU, median length of hospital stay, median vasopressor-free days, and median days free of mechanical ventilation.

The author said, “Corticosteroid therapy induces potentially detrimental hyperglycemia in septic shock. In addition, the benefits of adding fludrocortisone in this setting is unclear.”

The author study wrote, “Compared with conventional insulin therapy, intensive insulin theraoy did not improve in-hospital morality among patients who were treated with hydrocortisone for septic shocl. The addition of oral fludrocortisone did not result in a statistically significant improvement in-hospital mortality.”

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