title: Influence of Glycemic Control on Endogenous Circulating Ketone Concentrations in Adults Following Traumatic Brain Injury.
abstract: The objective was to investigate the impact of targeting tight glycemic control (4.4-6.1 mM) 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 6.7-8.3 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.
  
  
  
  Fifteen 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).
  
  
  
  Permissive underfeeding was tolerated when targeting tight glycemic control, but total nutritional support is an important factor when treating hyperglycemia.
authors.affiliation: 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.
authors.forename: Stephanie M
authors.initials: SM
authors.lastname: Wolahan
authors.affiliation: Department of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine at UCLA, University of California - Los Angeles, Los Angeles, CA, USA.
authors.forename: Mayumi L
authors.initials: ML
authors.lastname: Prins
authors.affiliation: Department of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine at UCLA, University of California - Los Angeles, Los Angeles, CA, USA.
authors.forename: David L
authors.initials: DL
authors.lastname: McArthur
authors.affiliation: Department of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine at UCLA, University of California - Los Angeles, Los Angeles, CA, USA.
authors.forename: Courtney R
authors.initials: CR
authors.lastname: Real
authors.affiliation: Department of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine at UCLA, University of California - Los Angeles, Los Angeles, CA, USA.|Department of Molecular and Medical Pharmacology, University of California - Los Angeles, Los Angeles, CA, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Hovda
authors.affiliation: Department of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine at UCLA, University of California - Los Angeles, Los Angeles, CA, USA.
authors.forename: Neil A
authors.initials: NA
authors.lastname: Martin
authors.affiliation: Department of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine at UCLA, University of California - Los Angeles, Los Angeles, CA, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Vespa
authors.affiliation: Department of Neurosurgery, UCLA Brain Injury Research Center, David Geffen School of Medicine at UCLA, University of California - Los Angeles, Los Angeles, CA, USA.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Glenn
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000032:analysis*; D000070642:Brain Injuries, Traumatic / Q000097:blood* / Q000628:therapy*; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000628:therapy*; D007657:Ketone Bodies / Q000097:blood*; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007657:Ketone Bodies
keywords: Glucose; Glycemic control; Insulin; Ketone bodies