The effect of prolonged euglycemic hyperinsulinemia on lean body mass after severe burn

Background. The hypermetabolic response to burn increases protein catabolism. Euglycernic hyperinsulinemia with exogenous insulin maintains muscle protein by continued stimulation of net protein synthesis. Our aim was to determine the effect of euglycemic hyperinsulinemia over the entire hospitalization on muscle anabolism by investigating lean body mass (LBM) as the primary endpoint. Methods. Eighteen subjects between the ages of 2 and 18 with burns of more than 40% were prospectively randomized into 2 groups, a control (n = 9) and a treatment group (n = 9). The treatment group was given continuous intravenous insulin at a rate of at least 1.5 μU/kg/min to maintain serum glucose levels between 100 to 140 mg/dL. Treatment was instituted 24 to 48 hours after arrival and continued until the patient's injury was 95% healed. All patients received continuous enteral feeding. Patients underwent body composition studies by dual-energy x-ray absorptiometry (DEXA) scan on postoperative day 6 after initial burn excision and when 95% healed. Results. Nutritional intakes were not different between groups. In the control, subjects continued catabolism resulted in peripheral muscle wasting and centripetal obesity with diminished truncal LBM. The treatment group had improvement in lean body mass (P = .004) and bone mass (P = .025). The treatment group also had less peripheral muscle wasting with overall increases in upper/lower extremity LBM (P = .005). Hospital length of stay in days per percent of total body surface area burned was decreased in the insulin group (control = 1.03 ± 0.1 vs 0.7 ± 0.9 for insulin patients; P < .05). Conclusions. Euglycemic hyperinsulinemia throughout the hospital course mitigates muscle catabolism and preserves lean body mass.