The Evaluation and Management of the Blood Glucose for the Intracranial Disease

Abstract

The usefulness of intensive insulin therapy to keep blood glucose levels tightly controlled has been reported. Since then, the usefulness of intensive insulin therapy has been studied in various serious diseases including sepsis that should be controlled in an intensive care setting. Studies in central nervous system disease have involved traumatic brain injury or subarachnoid hemorrhage with ruptured cerebral aneurysm. It is clear that hyperglycemia leads to poor prognosis; however, as to how tightly blood glucose should be controlled in an intensive care setting, some researchers have described that blood glucose control levels should be slightly higher in patients with central nervous system disease than in those with sepsis or other illnesses not complicated by central nervous system disease. It is difficult in the clinical setting to determine to what extent low blood glucose levels are acceptable without any sequelae. Monitoring of brain tissue using microdialysis shows that the institution of intensive insulin therapy appears to lead to the elevation of concentrations of extracellular glutamate, an excitatory amino acid, and lactate/pyruvate ratio, which is highly sensitive and specific to cerebral ischemia. Microdialysis has the potential to gain maximum benefit without these abnormalities in achieving blood glucose control.