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Randomized Controlled Trial
. 2017 Apr;26(2):239-246.
doi: 10.1007/s12028-016-0313-3.

Influence of Glycemic Control on Endogenous Circulating Ketone Concentrations in Adults Following Traumatic Brain Injury

Free PMC article
Randomized Controlled Trial

Influence of Glycemic Control on Endogenous Circulating Ketone Concentrations in Adults Following Traumatic Brain Injury

Stephanie M Wolahan et al. Neurocrit Care. .
Free PMC article


Background: 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.

Methods: 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.

Results: 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).

Conclusions: Permissive underfeeding was tolerated when targeting tight glycemic control, but total nutritional support is an important factor when treating hyperglycemia.

Keywords: Glucose; Glycemic control; Insulin; Ketone bodies.


Figure 1
Figure 1
Nutritional therapy was reduced and insulin therapy was increased under tight glycemic control. A. Total nutritional provision in the preceding 24 hours decreased 8.3 kcal/kg ([3.0 13.6], p=0.006) between loose and tight. B. Enteral nutritional provision decreased 5.5 kcal/kg ([−0.5 11.4], p=0.066) between loose and tight. C. Insulin dose increased 1.3 IU/hr ([0.4 2.1], p=0.008) between loose and tight glycemic control. Data are presented as violin plots where the outside border estimates the shape of the data distribution; the horizontal black line plots the mixed effects model corrected estimate; the top and bottom of the rectangles the upper and lower 95% confidence intervals for the estimate, respectively; and the grey horizontal lines the Harrell-Davis estimates of first, second, and third quartiles from lowest to highest.

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