INSULIN RESISTANCE AND ANEURYSMAL SUBARACHNOID HEMORRHAGE

After aneurysmal subarachnoid hemorrhage (SAH), hyperglycaemia is frequently
observed and persists throughout in-hospital stay, also in the absence of
diabetes mellitus (DM).
Recently, we found that after SAH, levels of fasting glucose are also frequent
and independently predict the occurrence of delayed cerebral ischemia (DCI) and
poor clinical outcome.
High levels of fasting glucose could represent a state of insulin resitance,
such as discribed for patients with critical illness, patients admitted for
trauma and after surgery. Insulin resistance has been linked to alterations in
endothelial function, a pro-inflammatory state, coagulation and fibrinolysis
that could predispose to secondary cardiovascular complications.

Several mechansims could explain a state of insulin resitance after SAH. First
patients could already be resistant to insulin prior to the SAH such as is
often seen after ischemic stroke. Second, a transient stress reaction induced
by the SAH with the activation of the sympathetic nervous system could induce
insulin resistance. Third, the stress reaction could induce an altered glucose
metabolism that persists throughout hospital stay or longer. Finally, tissue
damage due to the SAH could lead to a profound inflammatory reaction, reflected
by the release of pro-inflammatory cytokines such as tumor necrosis factor *
(TNF-*) which in turn has been associated with insulin resistance. In
conclusion, insulin resistance after SAH seems frequent and predicts DCI and
poor clinical outcome. This however has never been characterized and if indeed
such a state exists, it remains unclear whether this is was pre-existent to the
SAH, only on admission, throughout hopsital stay or persistent on the long run.
Furthermore it is unclear how this relates to systems involved in fibrynolysis,
coagulation, inflamation and endothelial function in this patient group.

The primary objective of the present study is to characterize the glucose
metabolism in patients with SAH in the acute- and, sub acute phase and during
follow-up.

The secondary objectives are to relate glucose metabolism to clinical condition
on admission and during follow up and to parameters of fibrinolysis,
coagulation, inflammation and endothelial function

Prospective cohort study

Patients will be asked to remain sober the first morning after inclusion, days
2-7 days after SAH, and days 10, 14 days and 17 after SAH. Finally also at
follow up assessment. During admittence and at follow up, blood sugar and
insulin levels have to be assessed 6 times extra, and patients will be asked to
drink sugar water for the oral glucose tolerance test.
Also, during admittence and at follow-up we will measure weight, length and the
hip and waist circumference.
Mentioned investigations do not carry significant risks.