Insulin and the burned patient.

Severe burns lead to insulin resistance, which is associated with hyperglycemia and muscle wasting. Investigators showed relatively recently that control of hyperglycemia with intensive insulin treatment is associated with improved outcomes for those in the intensive care unit, including patients with severe burns. In this article, we review the actions of insulin in terms of glycemic control and muscle metabolism, biochemical and clinical effects of insulin treatment in the severely burned, and the vagaries of glucose control.