Influence of Glycemic Control on Endogenous Circulating Ketone Concentrations in Adults Following Traumatic Brain Injury.

Abstract:

BACKGROUND:The objective was to investigate the impact of targeting tight glycemic control (4.4-6.1 mM) on endogenous ketogenesis in severely head-injured adults. METHODS:The data were prospectively collected during a randomized, within-patient crossover study comparing tight to loose glycemic control, defined as 6.7-8.3 mM. Blood was collected periodically during both tight and loose glycemic control epochs. Post hoc analysis of insulin dose and total nutritional provision was performed. RESULTS:Fifteen patients completed the crossover study. Total ketones were increased 81 μM ([38 135], p < 0.001) when blood glucose was targeted to tight (4.4-6.1 mM) compared with loose glycemic control (6.7-8.3 mM), corresponding to a 60 % increase. There was a significant decrease in total nutritional provisions (p = 0.006) and a significant increase in insulin dose (p = 0.008). CONCLUSIONS:Permissive underfeeding was tolerated when targeting tight glycemic control, but total nutritional support is an important factor when treating hyperglycemia.

journal_name

Neurocrit Care

journal_title

Neurocritical care

authors

Wolahan SM,Prins ML,McArthur DL,Real CR,Hovda DA,Martin NA,Vespa PM,Glenn TC

doi

10.1007/s12028-016-0313-3

subject

Has Abstract

pub_date

2017-04-01 00:00:00

pages

239-246

issue

2

eissn

1541-6933

issn

1556-0961

pii

10.1007/s12028-016-0313-3

journal_volume

26

pub_type

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