What goes up must come down: glucose variability and glucose control in diabetes and critical illness

The central question of this thesis is whether it is necessary to curb all glucose peaks. From the studies presented in this thesis we conclude that this is not always the case. In diabetes it is important to lower mean glucose while avoiding hypoglycaemia, but we found that lowering of glucose to normoglycaemia in critically ill patients seems actually harmful, in patients with and without diabetes. In addition, our studies show that glucose variability does not need separate treatment in diabetes, while it is associated with mortality in critically ill patients without diabetes. Thus, not all what goes up must come down.