Many neurosurgery patients may have unrecognized diabetes or may develop stress-related hyperglycemia in the perioperative\r\nperiod. Diabetes patients have a higher perioperative risk of complications and have longer hospital stays than individuals without\r\ndiabetes. Maintenance of euglycemia using intensive insulin therapy (IIT) continues to be investigated as a therapeutic tool to\r\ndecrease morbidity and mortality associated with derangements in glucose metabolism due to surgery. Suboptimal perioperative\r\nglucose control may contribute to increased morbidity, mortality, and aggravate concomitant illnesses. The challenge is to\r\nminimize the effects of metabolic derangements on surgical outcomes, reduce blood glucose excursions, and prevent hypoglycemia.\r\nDifferences in cerebral versus systemic glucose metabolism, time course of cerebral response to injury, and heterogeneity of\r\npathophysiology in the neurosurgical patient populations are important to consider in evaluating the risks and benefits of IIT.\r\nWhile extremes of glucose levels are to be avoided, there are little data to support an optimal blood glucose level or recommend\r\na specific use of IIT for euglycemia maintenance in the perioperative management of neurosurgical patients. Individualized\r\ntreatment should be based on the local level of blood glucose control, outpatient treatment regimen, presence of complications,\r\nnature of the surgical procedure, and type of anesthesia administered.
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