Transient extreme insulin resistance in a patient requiring extracorporeal membrane oxygenation for cardiogenic shock: A case report
Bibliographic record
Abstract
BACKGROUND: Acute and extreme insulin resistance with persistent hyperglycemia requiring excessively high doses of insulin before rapidly resolving is rare and has been referred to as transient and extreme insulin resistance (TEIR). The underlying pathophysiology and optimal management of TEIR are poorly understood, and previous reports of TEIR in the literature are sparse. This report is the first description of TEIR in a patient requiring mechanical circulatory support (MCS). CASE SUMMARY: A 62-year-old male developed cardiogenic shock and was placed on veno-arterial extracorporeal membrane oxygenation following percutaneous coronary intervention and successful revascularization. Over the next 24 hours, glucose levels rose and remained markedly elevated despite increasing insulin infusion rates and repeated boluses. The insulin infusion rate peaked at 450 units/hour, and the patient received 4300 units (33 units/kg) of insulin over the 24-hour period of peak insulin resistance. Insulin resistance resolved rapidly, necessitating an abrupt decrease in the insulin infusion rate and development of rebound hypoglycemia. CONCLUSION: Onset of TEIR did not seem to correlate with end-organ hypoperfusion or vasoactive drug dosing.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".