Cardiac dysfunction observed in patients with critical illness is associated with increased levels of blood glucose and insulin, and the appearance of cardiac dysfunction coincides with increased glucose and insulin levels (insulin resistance) (42–44) Further, ischemia-reperfusion endured before the onset of ESHP has the opportunity to interact with hyperglycemia-induced stressors on the apparatus to worsen the degree of pathology endured (44, 45). This evidence concerns the gene INS and Insulin resistance.