“Moderate intensive insulin therapy” is associated with remission of high intracranial pressure in patients with vascular or infectious central nervous system diseases

• Published in: Journal of clinical neuroscience Vol. 19; no. 5; pp. 727 - 732
• Main Authors: Birnbaum, Tobias, Schmid, Stephanie Pia, Feddersen, Berend, Schankin, Christoph Josef, Straube, Andreas
• Format: Journal Article
• Language: English
• Published: Scotland Elsevier Ltd 01.05.2012
• Subjects: Adult; Aged; Blood; Central nervous system diseases; Central Nervous System Infections - complications; Central Nervous System Infections - metabolism; Central Nervous System Infections - physiopathology; Cerebrovascular Disorders - complications; Cerebrovascular Disorders - metabolism; Cerebrovascular Disorders - physiopathology; Female; Glucose; Glycemic control; Humans; Hyperglycemia - drug therapy; Hyperglycemia - physiopathology; Hypoglycemia; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - adverse effects; Insulin; Insulin - administration & dosage; Insulin - adverse effects; Intensive insulin therapy; Intracranial hypertension; Intracranial Hypertension - drug therapy; Intracranial Hypertension - physiopathology; Intracranial pressure; Male; Middle Aged; Nervous system; Neurological ICU; Neurology; Pressure; Remission; Retrospective Studies; Risk factors; Standard deviation; Glycemic control; Intensive insulin therapy; Intracranial pressure; Intracranial hypertension; Neurological ICU
• ISSN: 0967-5868; 1532-2653
• DOI: 10.1016/j.jocn.2011.04.041

Abstract Intensive insulin therapy (IIT), targeting blood glucose between 80 mg/dL and 110 mg/dL (“strict IIT”), has been associated with rapid remission of high intracranial pressure (ICP), but its use is limited due to a high risk of hypoglycemia. The aim of this retrospective study was to assess whether “moderate IIT” (target range for blood glucose: 80–140 mg/dL) could have the same beneficial effect on ICP with a lower risk of hypoglycemia. We retrospectively analyzed the records of 64 patients with high ICP due to vascular or infectious central nervous system diseases. Patients treated with moderate IIT ( n = 32) after 2005 were compared with patients treated with a conventional approach ( n = 32, target <180 mg/dL) before 2005. We assessed daily ICP during the first 14 days. Secondary endpoints were the rate of hypoglycemic events and outcome. ICP was significantly lower during the second week in patients treated with moderate IIT (mean ± standard deviation [SD] daily ICP on days 8–14: 16 ± 5 mmHg compared to 12 ± 4 mmHg, p < 0.001). The risk of hypoglycemic events (<40 mg/dL) did not differ significantly between the groups (0 vs . 1 patient, p = 0.5). Moderate IIT is associated with remission of high ICP. In contrast to strict IIT, its use seems not to be limited by an increased risk of severe hypoglycemia.