title: Strict glucose control after acute stroke can be provided in the prehospital setting.
abstract: OBJECTIVE
  The objective was to assess the feasibility of insulin infusion and subcutaneous insulin administered in the prehospital setting and their relative effect on hyperglycemia, a predictor of unfavorable outcome, in acute stroke patients.
  
  
  METHODS
  Hyperglycemic patients (plasma glucose >6.0 mmol/L) with stroke symptoms were randomized prior to or during transport to the hospital to receive either 1) a single subcutaneous dose of short-acting insulin (n = 11) or 2) a continuous intravenous (IV) insulin infusion (n = 12) at a rate adjusted by glucose levels measured every 10 minutes and targeted to plasma glucose 4.5-6.0 mmol/L. The changes in plasma glucose concentration were compared with a nonrandomized control group (n = 38) receiving standard care.
  
  
  RESULTS
  The baseline characteristics did not differ between the study groups. Plasma glucose concentration was significantly decreased during the prehospital phase in the IV-treated group in comparison to the control group (difference between groups -1.9 mmol/L, 95% confidence interval [CI] = -3.5 to -0.27) with no serious adverse events. In contrast, subcutaneous insulin did not achieve significant lowering of plasma glucose (-0.9 mmol/L, 95% CI = -2.4 to 0.6).
  
  
  CONCLUSIONS
  This small sample suggests that adjusted insulin infusion efficiently lowers blood glucose in the ultra-acute phase of stroke and is feasible in the prehospital setting.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Helsinki University Central Hospital, Finland. jouni.nurmi@helsinki.fi
authors.forename: Jouni
authors.initials: J
authors.lastname: Nurmi
authors.forename: Perttu J
authors.initials: PJ
authors.lastname: Lindsberg
authors.forename: Olli
authors.initials: O
authors.lastname: Häppölä
authors.forename: Erkko
authors.initials: E
authors.lastname: Klemetti
authors.forename: Jukka
authors.initials: J
authors.lastname: Westerbacka
authors.forename: Maaret
authors.initials: M
authors.lastname: Castrén
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis*; D004632:Emergency Medical Services / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000209:etiology; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007262:Infusions, Intravenous; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020521:Stroke / Q000097:blood / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin