Aggressive Glucose Control for Acute Ischemic Stroke Patients by Insulin Infusion |
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Authors: | Nayoung Kim Yunsook Jhang Jong-Moo Park Byung-Kun Kim Ohyun Kwon JungJu Lee Ji-Sung Lee and Ja-Seong Koo |
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Institution: | aDepartment of Neurology, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea.;bDepartment of Neurology, Dong-Eui Medical Center, Busan, Korea.;cDepartment of Biostatistics, Korea University College of Medicine, Seoul, Korea. |
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Abstract: | Background and PurposeHyperglycemia after acute ischemic stroke (AIS) is associated with poor outcomes. However, there is no consensus as to the optimal method for glycemic control. We designed an insulin infusion protocol for aggressive glucose control and investigated its efficacy and safety.MethodsWe applied our protocol to patients within 48 hours after AIS or transient ischemic attack (TIA) with an initial capillary glucose level of between 100 and 399 mg/dL (5.6-22.2 mmol/L). An insulin solution comprising 40 or 50 U of human regular insulin in 500 mL of 5% dextrose was administered for 24 hours. Capillary glucose was measured every 2 hours and the infusion rate was adjusted according to a nomogram with a target range of 80-129 mg/dL (4.4-7.2 mmol/L). Changes in glucose and overall glucose levels during insulin infusion were analyzed according to the presence of diabetes or admission hyperglycemia (admission glucose >139 mg/dL or 7.7 mmol/L) by the generalized estimating equation method.ResultsThe study cohort comprised 115 consecutive patients. Glucose was significantly lowered from 160±57 mg/dL (8.9±3.2 mmol/L) at admission to 93±28 mg/dL (5.2±1.6 mmol/L) during insulin infusion (p<0.05). Laboratory hypoglycemia (capillary glucose <80 mg/dL or 4.4 mmol/L) occurred in 91 (71%) patients, 11 (10%) of whom had symptomatic hypoglycemia. Although glucose levels were significantly lowered and maintained within the target range in all patients, overall glucose levels were significantly higher in patients with diabetes or hyperglycemia (p<0.05).ConclusionsOur insulin-infusion protocol was effective in glycemic control for patients with AIS or TIA. Further modification is needed to improve the efficacy and safety of this procedure, and tailored intervention should be considered according to glycemic status. |
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Keywords: | ischemic stroke hyperglycemia insulin |
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