Glycemic control

Disruptions in blood glucose homeostasis are commonly observed in neuro-critically ill patients and are strongly associated with an increased risk of morbidity and mortality. Despite this association, there is currently a lack of consensus regarding the optimal target blood glucose concentration for these patients and how to best achieve this target. In this chapter, we discuss the pathophysiology of stress-induced hyperglycemia and review the evidence-based recommendations for glycemic control in neuro-critically ill patients. In recent years, aggressive insulin therapy regimens have failed to confer clear outcomes benefits over a more conventional insulin therapy approach and are associated with an increased risk of hypoglycemia. For these reasons, the current evidence supports the maintenance of blood glucose concentrations < 180mg/dL with a target blood glucose concentration between 140 and 180mg/dL.