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. 2009 Dec;5(4):167-72.
doi: 10.3988/jcn.2009.5.4.167. Epub 2009 Dec 31.

Aggressive glucose control for acute ischemic stroke patients by insulin infusion

Nayoung Kim  1 , Yunsook Jhang, Jong-Moo Park, Byung-Kun Kim, Ohyun Kwon, Jungju Lee, Ji-Sung Lee, Ja-Seong Koo
Affiliations

Aggressive glucose control for acute ischemic stroke patients by insulin infusion

Nayoung Kim et al. J Clin Neurol. 2009 Dec.

Abstract

Background and purpose: Hyperglycemia 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.

Methods: We 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.

Results: The 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).

Conclusions: Our 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.

Keywords: hyperglycemia; insulin; ischemic stroke.

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Figures

Fig. 1
Fig. 1
The distribution of capillary glucose at 2 hours after insulin infusion with regard to target range (TR).
Fig. 2
Fig. 2
Change of mean capillary glucose during insulin infusion according to the presence of diabetes.
Fig. 3
Fig. 3
Change of mean capillary glucose during insulin infusion according to the presence of admission hyperglycemia.
See this image and copyright information in PMC

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