Glycemic Control and the Injured Brain

Gentile, Nina; Siren, Karen

doi:10.1016/j.emc.2008.08.010

Cited by 9 publications

(9 citation statements)

References 96 publications

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“…The mechanisms that underlie this deleterious effect of dysglycaemia on ischaemic neuronal tissue remain to be established, although in vitro research, functional imaging, and animal work have provided some clues. However, the interaction between glycaemic control and critical neurological illness and injury is complex [37]. Hyperglycaemia can be either the cause or the result of severe brain injury.…”

Section: Diabetes Stroke and Control Of Glycaemiamentioning

confidence: 99%

Central nervous system: a conductor orchestrating metabolic regulations harmed by both hyperglycaemia and hypoglycaemia

Scheen

2010

Diabetes & Metabolism

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SUMMARYRecent evidence suggests a key role for the brain in the control of energy metabolism, body fat content and glucose metabolism. Neuronal systems, which regulate energy intake, energy expenditure, and endogenous glucose production, sense and respond to input from hormonal and nutrient-related signals that convey information regarding both body energy stores and current energy availability. In response to this input, adaptive changes occur that promote energy homeostasis and the maintenance of blood glucose levels in the normal range. Defects in this control system are implicated in the link between obesity and type 2 diabetes mellitus. Central nervous system may be considered as the conductor of an orchestra implicating many peripheral organs involved in these homeostatic processes. However, brain is mainly a glucose-dependent organ, which can be damaged by both hypoglycaemia and hyperglycaemia. Hypoglycaemia unawareness is a major problem in clinical practice and is associated with an increased risk of coma. Stroke is another acute complication associated with diabetes mellitus, especially in elderly people, and control of glucose level in this emergency situation remains challenging. The prognosis of stroke is worse in diabetic patients and both the prevention management of at risk patients should be improved. Finally, chronic diabetic encephalopathies, which may lead to cognitive dysfunction and even dementia, are also recognized. They may result from recurrent hypoglycaemia and/or from chronic hyperglycaemia leading to cerebral vascular damages. Functional imaging is of interest to explore diabetes-associated cerebral abnormalities. Thus, the intimate relationship between brain and diabetes is increasingly acknowledged in both research and clinical practice. Key-words

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Section: Diabetes Stroke and Control Of Glycaemiamentioning

confidence: 99%

Central nervous system: a conductor orchestrating metabolic regulations harmed by both hyperglycaemia and hypoglycaemia

Scheen

2010

Diabetes & Metabolism

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“…Alternatively, treating hyperglycaemia with intravenous insulin therapy only (without concomitant glucose infusion) requires frequent control of blood glucose concentrations to adapt rates of insulin in order to avoid hypoglycaemia. Ideally, clinicians should not infuse any glucose solution during the management of such patients (except to correct hypoglycaemia) in order to avoid acute hyperglycaemia, which may be deleterious for the injured brain [7]. Even if CGMS has only been used to carefully evaluate post-stroke hyperglycaemia yet, this technology will probably be interesting in the future to manage hyperglycaemia in stroke unit in a more effective and safer manner [33], as in other critically ill patients [34][35][36].…”

Section: Practical Implications Regarding Glucose Management During Smentioning

confidence: 99%

“…How is it achieved remains, however, unclear. One may hypothesize that closed monitoring and maintenance of physiological homeostasis, including glucose levels, could contribute to this benefit [7].…”

Section: Introductionmentioning

confidence: 99%

“…Indeed, patients with acute stroke may have heightened susceptibility to hyperglycaemia and hypoglycaemia [13]. Therefore, considering the well known susceptibility of cerebral tissue to glucose changes [14,15], the influence of acute variations of plasma glucose levels in patients with brain injuries certainly deserves careful investigation [7]. If there is evidence that hyperglycaemia can increase the likelihood of poor outcomes after stroke, including among patients receiving tissue plasminogen activator [16], the role of diabetes and hyperglycaemia is difficult to investigate due to the heterogeneous nature of diabetes/hyperglycaemia in regard to the site of ischaemia, the degree of vasculopathy, and the state of reperfusion.…”

Section: Introductionmentioning

confidence: 99%

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Management of blood glucose in patients with stroke

Radermecker

Scheen

2010

Diabetes & Metabolism

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SUMMARYStroke is a leading cause of death worldwide and the commonest cause of long-term disability amongst adults, more particularly in patients with diabetes mellitus and arterial hypertension.Increasing evidence suggests that disordered physiological variables following acute ischaemic stroke, especially hyperglycaemia, adversely affect outcomes. Post-stroke hyperglycaemia is common (up to 50 % of patients) and may be rather prolonged, regardless of diabetes status. A substantial body of evidence has demonstrated that hyperglycaemia has a deleterious effect upon clinical and morphological stroke outcomes. Therefore, hyperglycaemia represents an attractive physiological target for acute stroke therapies.However, whether intensive glycaemic manipulation positively influences the fate of ischaemic tissue remains unknown. One major adverse event of management of hyperglycaemia with insulin (either glucose-potassium-insulin infusions or intensive insulin therapy) is the occurrence of hypoglycaemia, which can also induce cerebral damages. Novel insights into post-stroke hyperglycaemia management are derived from continuous glucose monitoring systems (CGMS). This article aims to describe the adverse effects of hyperglycaemia following acute ischaemic stroke and the risk associated to iatrogenic hypoglycaemia, to summarise the evidence from current glucose-lowering treatment trials and to show the usefulness of CGMS in both nondiabetic and diabetic patients with acute stroke. Key-words Mots-clé :Accident vasculaire cérébral -Diabète -Hyperglycémie -Hypoglycémie - Insulinothérapie -CGMS

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“…En cuanto a hipoglucemias, la anticipación de la tendencia a caer de la glucosa podría prevenirse realizando segundas revisiones (19,20) . El elemento más importante en la implementación de un régimen de administración de insulina es la aceptación y colaboración por parte del grupo de enfermería.…”

Section: Protocolo De Control Glucémicounclassified

Bases para realizar un protocolo de control glucémico

Tovar

2012

RFS

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Resumen INTRODUCCIÓNEs claro que desde hace varios años se estableció que estados hiperglucémicos como la pre diabetes (hiperglucemia de ayuno e intolerancia a los hidratos de carbono) y la llamada hiperglucemia de estrés se relacionan a condiciones mórbidas que deben identificarse y tratarse oportunamente (1,2) .La hiperglucemia, en pacientes con o sin Diabetes Mellitus (DM) está asociada con alta morbilidad, aumento de la mortalidad, estancia hospitalaria prolongada y costos elevados. Hoy se sabe que un nivel de hemoglobina glucosilada mayor a 6,5% en un paciente sin DM es diagnóstico de la enfermedad (3)(4)(5) .Los altos niveles de glucemia puede afectar el curso de procesos infecciosos causando disminución en la quimiotaxis de leucocitos y afectando la fagocitosis. La literatura sugiere que la hiperglucemia no es una condición fisiológica benigna, por el contrario, es un marcador de pobre evolución clínica y de mortalidad en cualquier paciente. Los médicos

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Glycemic Control and the Injured Brain

Cited by 9 publications

References 96 publications

Central nervous system: a conductor orchestrating metabolic regulations harmed by both hyperglycaemia and hypoglycaemia

Central nervous system: a conductor orchestrating metabolic regulations harmed by both hyperglycaemia and hypoglycaemia

Management of blood glucose in patients with stroke

Bases para realizar un protocolo de control glucémico

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