title: Aggressive glucose control for acute ischemic stroke patients by insulin infusion.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Neurology, Eulji General Hospital, Eulji University College of Medicine, Seoul, Korea.
authors.forename: Nayoung
authors.initials: N
authors.lastname: Kim
authors.forename: Yunsook
authors.initials: Y
authors.lastname: Jhang
authors.forename: Jong-Moo
authors.initials: JM
authors.lastname: Park
authors.forename: Byung-Kun
authors.initials: BK
authors.lastname: Kim
authors.forename: Ohyun
authors.initials: O
authors.lastname: Kwon
authors.forename: Jungju
authors.initials: J
authors.lastname: Lee
authors.forename: Ji-Sung
authors.initials: JS
authors.lastname: Lee
authors.forename: Ja-Seong
authors.initials: JS
authors.lastname: Koo