What factors increase insulin requirements during an acute illness?

• A. Counter-regulatory hormones (glucagon, cortisol, catecholamines), inflammatory cytokines, dehydration, decreased oral intake causing stress.
• B. Vitamin D levels and calcium.
• C. Sleep duration only.
• D. Increased insulin production.

Answer: (A)

During acute illness, the body's stress response drives up insulin needs. A surge of counter-regulatory hormones—glucagon, cortisol, and catecholamines like epinephrine and norepinephrine—pushes the liver to make more glucose and promotes breakdown of fat and protein, so blood glucose rises even when intake is reduced. Inflammatory cytokines such as TNF-alpha and IL-6 worsen insulin signaling, creating resistance to insulin and further increasing hepatic glucose production. Dehydration compounds the effect by concentrating glucose in the bloodstream and reducing kidney perfusion, which can impair glucose clearance. Even with lower oral intake, the body remains in a catabolic, stress-driven state that requires more insulin to keep glucose in target range and to blunt ketogenesis.

Vitamin D and calcium levels don’t drive acute-illness insulin needs, sleep duration alone doesn’t account for the metabolic stress, and simply “increased insulin production” doesn’t explain why insulin is required more—the dominant issue is insulin resistance and increased glucose production from stress responses.