Figure 3 Temporal changes in blood glucose concentrations, serum osmolality, and insulin administration following VA-ECMO and CRRT initiationBlood glucose concentrations (solid blue line, left axis) and serum osmolality (dashed red line, right axis) during the first 72 h are shown. Continuous insulin infusion (Humulin R, green line) was initiated at 12.5 U/h and titrated according to the glycemic response. Rapid correction of hyperglycemia (52.2 to 12.1 mmol/L) and hyperosmolality (392 to 327 mmol/kg) was achieved within 72 h through continuous insulin therapy, supported by hemodynamic stabilization with VA-ECMO and metabolic correction with CRRT. Metabolic parameters stabilized by day 3. VA-ECMO and CRRT support periods are indicated by horizontal bars. CRRT – continuous renal replacement therapy; VA-ECMO – veno-arterial extracorporeal membrane oxygenation.