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