ReviewGlycemic control after brain injury: Boon and bane for the brain

- Hyperglycemia is common in patients with BI.
- Intensive glucose-lowering therapy results in an increased rate of hypoglycemia.
- The acutely injured brain is prone to energetic undersupply.
- Careful insulin application without an adherence to strict euglycemia seems beneficial for the injured brain.

Hyperglycemia is a common phenomenon in the early phase of brain injury (BI). The management of blood glucose levels after BI, however, is subject of a growing debate. The occurrence of elevated blood glucose concentrations is linked to increased mortality and worse neurologic outcomes indicating the necessity for therapeutic glucose-lowering. Intensive glucose-lowering therapy, on the other hand, inevitably results in an increased rate of hypoglycemic episodes with detrimental effects on the injured brain. In this review, we give an overview on the current knowledge about causes and pathophysiological consequences of dysglycemia in patients with BI and offer some suggestions for clinical glucose management.