Glycemic control in traumatic head injury

[hepatocyte62]

I'm writing an assignment about glycemic control in traumatic head injury. Our guidelines are to keep blood sugars to 4.5-8.3mmol/L. This level concurs with the international guidelines recommended by the Surviving Sepsis Campaign 2008 but there seems to be very little research about the use of insulin in the context of head injury, i.e do high blood sugars cause, or simply reflect, bad outcome ? I understand the theory behind high glucose levels and secondary damage but is it actually happening ? Are these levels appropriate for head injury ?

I'd be grateful if anyone could shine more light on the subject, particularly if you could point be in the direction of recent research. Many thanks.

[ghillbert, MSN, NP]

Have you tried searching medline, ovid etc? A quick search brought up several studies which looked like what you're after.

[hepatocyte62]

Thanks for your reply Ghillbert. Yes I've spent quite a lot of time searching via 'pubmed' and various individual journal sites etc, I can find relevant articles but nothing that is very up-to-date and measures the relationship between high serum glucose and how this is metabolised in the brain - I mean, is high serum glucose causing ischemia, or is it simply a good prognostic indicator regardless of its effect on brain ? In some units microdialysis is used but to be honest although I have some vaguely relevant articles in this respect, the information is so complex it's difficult to unravel the facts for my purposes. Please let me know of any sources you've come across, all contributions welcome :-) Cheers H

[XB9S, BSN, MSN, EdD, RN, APN]

Not sure if these links will be of any use but here is what I have come up with

http://www.springerlink.com/content/gpv5146wcj4828xk/

http://linkinghub.elsevier.com/retrieve/pii/S1521690X0190168X

http://www.bhhsol.com/presents/diabetes.ppt

[XB9S, BSN, MSN, EdD, RN, APN]

Another suggestion, I seem to remember that you are a UK nurse, it may be worth doing a search in the RCN database.

I used search terms: hyperglycaemia in head injuries

[XB9S, BSN, MSN, EdD, RN, APN]

I have quized a doctor friend about this, you got me thinking and it's one of those thought processes that keeps you awake at night.

His explaination for mainating normal blood sugars in head injuries is that because the high glucose will cause increased energy / stimulation it is not good for the injured brain and if anything a hypoglycaemia (obviously not a coma causing one) is a bit cerebral protective because it reduces the brains excitability.

You may get high blood sugars because of some of the therapeutic interventions such as steriod use