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Vol. 27, No. 2, 2009
Issue release date: February 2009
Section title: Original Paper
Cerebrovasc Dis 2009;27:167–175
(DOI:10.1159/000185608)

Pragmatic Management of Hyperglycaemia in Acute Ischaemic Stroke: Safety and Feasibility of Intensive Intravenous Insulin Treatment

Kreisel S.H. · Berschin U.M. · Hammes H.-P. · Leweling H. · Bertsch T. · Hennerici M.G. · Schwarz S.
aDepartment of Neurology, bVth Medical Department and cIVth Medical Department, Universitätsklinikum Mannheim, University of Heidelberg, and dCentral Institute of Mental Health, University of Heidelberg, Mannheim, and eInstitute of Clinical Chemistry, Klinikum Nürnberg, Nürnberg, Germany

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 5/30/2008
Accepted: 9/11/2008
Published online: 12/18/2008

Number of Print Pages: 9
Number of Figures: 3
Number of Tables: 3

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED

Abstract

Background: In patients with acute ischaemic stroke, hyperglycaemia has been retrospectively associated with negative outcome. There is an ongoing discussion as to which treatment algorithm, if any, provides the most effective prospective intervention. Here we test the safety and feasibility of an intravenous insulin-only infusion protocol designed for pragmatic routine clinical use. Methods: 40 ischaemic stroke patients with onset <24 h ago, admitted to our stroke unit, were randomized either to the study regimen (50 IU insulin in 50 ml 0.9% saline solution applied intravenously via a perfusor pump), with the aim of reaching and maintaining blood glucose levels between 4.44 mmol/l (80 mg/dl) and 6.11 mmol/l (110 mg/dl), or were treated with insulin subcutaneously if concentrations were above 11.10 mmol/l (200 mg/dl). Treatment was continued for 5 days. Primary outcome was the number of hypoglycaemic (<3.33 mmol/l; <60 mg/dl) and severe hyperglycaemic (>16.65 mmol/l; >300 mg/dl) events. Results: Hypoglycaemic events were significantly more common in patients treated intensively (total n = 25; incidence rate ratio, IRR = 5.3; 95% CI = 1.2–22.4; p < 0.05). Symptomatic events were rare (total n = 5). Severe hyperglycaemia was associated with conventional treatment (IRR = 4.9; 95% CI = 1.5–15.9; p < 0.05). Though those treated intensively attained near-normoglycaemic levels quicker and had significantly lower blood glucose levels over the study period (6.49 ± 2.19 mmol/l vs. 8.01 ± 3.06 mmol/l; 95% CI = –1.78 to –1.28, p < 0.0005), treatment imposes considerable strain on both patients and caregivers. Conclusions: The intensive intravenous insulin infusion protocol effectively lowers blood glucose levels with an increased risk of manageable hypoglycaemic events. However, a highly motivated and trained staff seems essential, limiting feasibility outside of specialty care settings.


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 5/30/2008
Accepted: 9/11/2008
Published online: 12/18/2008

Number of Print Pages: 9
Number of Figures: 3
Number of Tables: 3

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED


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Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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