title: Methods for the control of diabetes after acute myocardial infarction.
abstract: Blood glucose control in patients with diabetes after myocardial infarction is often poor, and this may contribute to increased mortality in the diabetic patient. A retrospective review of the records of 71 diabetic patients admitted with suspected myocardial infarction, and managed using a variety of methods, showed that adequate control (mean blood glucose less than 234 mg/dl; 13 mmol/L) was achieved in only 60%. Continuation of oral hypoglycemic agents and the use of irregular intermittent insulin in response to hyperglycemia were particularly associated with poor control. In a prospective study 68 consecutive patients were managed using regular subcutaneous insulin injections three times daily or a glucose-insulin-potassium intravenous infusion (in those with cardiogenic shock, severe hyperglycemia, or unable to eat). Control was adequate in 87% (P less than 0.001 versus retrospective group) and mean blood glucose concentration on days 1 and 2 were significantly lower than in the retrospective group (167 versus 232; 165 versus 236 mg/dl; both P less than 0.001). Simple protocols using three-times-daily subcutaneous insulin or glucose-insulin-potassium infusion provide a practical method for achieving good glycemic control in the diabetic patient with suspected acute myocardial infarction.
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000097:blood / Q000628:therapy; D004032:Diet; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin