INS and Sepsis: Blood glucose levels in sepsis are maintained by a complex interaction between the proinflammatory mediators (TNF-α, IL-1, and IL-6) and the counter-regulatory hormones (glucagon, cortisol, catecholamine, and growth hormone). Hyperglycemia occurs when there is an increase in mechanisms such as hepatic gluconeogenesis, hepatic glycogenolysis, lipolysis, and muscle glycolysis, combined with increased insulin resistance.