title: Hypoglycaemia risk among a hospitalised stroke patient cohort: a case for increased vigilance in glucose monitoring.
abstract: We conducted a retrospective cohort study involving a review of the records of 112 patients consecutively admitted with acute stroke or transient ischaemic attack (TIA) to all three district general hospitals in one Health and Social Care Trust in Northern Ireland from 1 January to 15 April 2008. Glucose results for each of the first 5 days of hospital admission were ascertained. We compared interventions and clinical outcome between patients who experienced hypoglycaemia (glucose<4.0 mmol/l) in the first 5 days, and patients with higher glucose results. Our results indicated that 11 (10%) patients experienced incidents of hypoglycaemia ranging from 1.8 to 3.9 mmol/l. None of the individuals affected had received intravenous or subcutaneous insulin. Only two of the hypoglycaemic episodes involved patients with a history of diabetes mellitus. Two patients experienced episodes of hypoglycaemia on 2 or more days. Six patients experienced hypoglycaemia at the lower threshold of glucose<3.5 mmol/l and this was not associated with a history of diabetes. A history of diabetes mellitus prompted near patient glucose testing, but among patients without diagnosed diabetes, glycaemia was under-monitored. The test that most frequently indicated hypoglycaemia was a routine electrolyte profile tested in the hospital laboratory. Patients in the first 5 days after stroke have a small risk of hypoglycaemia. There is a need for greater vigilance in the monitoring of glucose among patients admitted to hospital with stroke or TIA.
authors.affiliation: School of Nursing, University of Ulster, Northland Road, Londonderry BT48 7JL, UK. Electronic address: ea.laird@ulster.ac.uk.
authors.forename: E A
authors.initials: EA
authors.lastname: Laird
authors.affiliation: University of Ulster and Western Health and Social Care Trust, Institute of Nursing Research, University of Ulster, Coleraine, UK.
authors.forename: V E
authors.initials: VE
authors.lastname: Coates
authors.affiliation: Institute of Nursing Research, University of Ulster, Coleraine, UK.
authors.forename: A A
authors.initials: AA
authors.lastname: Ryan
authors.affiliation: Department of Neurology, Altnagelvin Area Hospital, Derry, UK.
authors.forename: M O
authors.initials: MO
authors.lastname: McCarron
authors.affiliation: School of Nursing, University of Ulster, Coleraine, UK.
authors.forename: D
authors.initials: D
authors.lastname: Lyttle
authors.affiliation: School of Health Sciences, University of Ulster, Newtownabbey, UK.
authors.forename: E
authors.initials: E
authors.lastname: McCrum-Gardner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001774:Blood Chemical Analysis; D001786:Blood Glucose / Q000032:analysis*; D002545:Brain Ischemia / Q000097:blood / Q000150:complications; D048909:Diabetes Complications / Q000097:blood; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood* / Q000150:complications* / Q000453:epidemiology; D007297:Inpatients; D020300:Intracranial Hemorrhages / Q000097:blood / Q000150:complications / Q000453:epidemiology; D002546:Ischemic Attack, Transient / Q000097:blood / Q000150:complications; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000150:complications*; D055815:Young Adult
chemical_list: D001786:Blood Glucose
keywords: Diabetes; Management; Prevention; Stroke