• Stephanie M Wolahan, Mayumi L Prins, David L McArthur, Courtney R Real, David A Hovda, Neil A Martin, Paul M Vespa, and Thomas C Glenn.
• Department of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine at UCLA, University of California - Los Angeles, Los Angeles, CA, USA. swolahan@mednet.ucla.edu.
• Neurocrit Care. 2017 Apr 1; 26 (2): 239246239-246.

BackgroundThe objective was to investigate the impact of targeting tight glycemic control (4.4-6.1 mM) on endogenous ketogenesis in severely head-injured adults.MethodsThe 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.ResultsFifteen 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).ConclusionsPermissive underfeeding was tolerated when targeting tight glycemic control, but total nutritional support is an important factor when treating hyperglycemia.

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