TNF and Hyperglycemia: Hyperglycemia in these children therefore is due to the combined effects of insulin resistance, glucose intolerance, increased gluconeogenesis, counter-regulatory hormone release(epinephrine, norepinephrine, glucagon, cortisol, growth hormone) and cytokines (tumor necrosis factor-α [TNF-α], interleukin-1 [IL-1], interleukin-6 [IL-6]) [8, 10, 12].