Insulin Resistance in a Hospitalized COVID-19 Patient: A Case Review

C.R., a 59-year-old White man presented to the emergency room with fever, cough, shortness of breath, and diaphoresis for 4 days. His medical history was significant for hypertension treated with bisoprolol-hydrochlorothiazide 10 mg/6.25 mg daily and type 2 diabetes treated with metformin 1,000 mg nightly. He reported recent travel to Florida for 1 month before returning to Colorado 1 week before admission. His vital signs on admission (day 1), which took place 7 days after social distancing was instituted statewide, included blood pressure of 135/73 mmHg, pulse of 98 bpm, BMI of 38.46 kg/m2 (weight 126 kg, height 181 cm), oxygen saturation of 65% on room air, 76% on 3 L/min high-flow nasal cannula, and 85% on 15 L/min high-flow nasal cannula. His presenting blood glucose was 324 mg/dL, with an A1C of 9% on admission. C.R. was admitted to the intensive care unit (ICU) after intubation. On hospital day 3, continuous renal replacement therapy (CRRT) was initiated because of worsening acute kidney injury (glomerular filtration rate on admission was >60 mL/min/1.73 m2 and decreased to a nadir of 14 mL/min/1.73 m2). He was also placed on veno-venous extracorporeal membrane oxygenation (VV ECMO) for worsening hypoxia despite proning, high positive end-expiratory pressure, and 100% fraction of inspired oxygen. C.R. remained on VV ECMO from day 3 to day 11 and on CRRT from day 3 to day 23. He intermittently required pressor therapy after discontinuation of ECMO from day 12 to day 19. In addition, nutritional therapy with enteral nutrition (EN), parenteral nutrition (PN), or a combination was started on day 3. There was an interruption of EN between day 9 and day 10 for ∼24 hours due to high volume residuals. C.R. did not receive corticosteroid therapy during his hospital stay. He was extubated successfully on …