What is the recommended glycemic target in the acute phase of traumatic brain injury?

• A. Keep glucose above 200 mg/dL
• B. No target
• C. Maintain euglycemia; avoid hyperglycemia (>180 mg/dL) and hypoglycemia; insulin to keep glucose around 140-180 mg/dL per many protocols
• D. Keep glucose below 60 mg/dL

Answer: (C)

In the acute phase after traumatic brain injury, the brain is vulnerable to secondary injury from energy failure, so keeping blood glucose in a safe range is important. Hyperglycemia after brain injury is linked to worse outcomes because it can worsen edema, lactate production, and neuronal injury. But pushing glucose too low is dangerous because the injured brain relies on glucose as its primary energy source; hypoglycemia can precipitate further neuronal damage when demands are high.

Because of this balance, the goal is to maintain euglycemia rather than chase very tight glucose control. Insulin is often used to prevent excessive hyperglycemia while avoiding hypoglycemia, aiming for a moderate target range. Many protocols suggest keeping glucose roughly in the 140–180 mg/dL band. This approach minimizes the risks associated with both high glucose and low glucose and aligns with evidence that overly aggressive insulin therapy can worsen outcomes.

So, the recommended glycemic target in the acute phase of traumatic brain injury is to maintain glucose around 140–180 mg/dL, avoiding levels that are clearly hyperglycemic or hypoglycemic.