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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.004 |
| Meta-epidemiology (narrow) | 0.002 | 0.001 |
| Meta-epidemiology (broad) | 0.002 | 0.002 |
| Bibliometrics | 0.003 | 0.002 |
| Science and technology studies | 0.003 | 0.002 |
| Scholarly communication | 0.002 | 0.003 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.007 | 0.005 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
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 source (direct Gemma or distilled Codex), 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".