| An intravenous insulin protocol for strict glycemic control in acute ischaemic stroke. | |
| | |
MedLine Citation:
|
PMID: 22008406 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
|
Background and purpose: There is a J-shaped association between admission glycemia and outcome. We designed an intravenous insulin protocol aiming at rapid and strict glucose control in hyperglycemic ischaemic stroke patients. Here, we describe the initial experience, safety, and efficacy of this protocol to achieve and maintain euglycemia in the first 48 h. Methods: The protocol is based on parallel scales for adjustment of insulin infusion rate according to current glycemia and the rate of change of glycemia, which was recommended in our stroke unit in 4/2007 in acute ischaemic stroke patients with glycemia > 6 mM. Data were registered in the Acute Stroke Registry and Analysis of Lausanne (ASTRAL). Capillary blood glycemia was measured hourly with fingerprick test at onset of treatment and after each scale change. Target glycemia was 4.0-6.0 mM pre-prandially (5.5-8.0 mM post-prandially). Hypokalemia was defined as serum potassium < 3.5 mM and measured every 12 h. Specific algorithms were employed during meals and for patients leaving temporarily the stroke unit for diagnostic or therapeutic workup. Results: In the 90 protocol patients, the first normoglycemia was achieved within 8 h of treatment in 91.1% of patients (median interval 4 h (interquartile range (IQR): 3-6). During the median treatment duration of 25.5 h (IQR: 19.7-37.7), median glucose reduction was 2.5 mM (IQR: 1.3-4.3 mM). The overall rate of hypoglycemias was 4.5% and hypokalemias 18.5%. There was a significant increase in the proportion of hypokalemias on the first on-treatment measurement compared to admission (24.4% vs. 8.9%, P = 0.002). Conclusions: The proposed intravenous insulin protocol controls acute post-stroke hyperglycemia but frequently leads to hypokalemia. This issue needs to be addressed for the protocol to be suitable for use in larger, randomized controlled trial to explore its clinical effect. |
| | |
Authors:
|
G Ntaios; M Egli; A Arsovska; D Joye; Y Bettex; E Lauber; A Eskandari; S D Ambrogio; B Richoz; J Ruiz; P Michel |
Related Documents
:
|
15758846 - Full suspension mountain bike improves off-road cycling performance. 1468186 - Metabolic effects of aldose reductase inhibition in diabetic man. 12200756 - Autoregulation of endogenous glucose production during hyperglucagonemia. 8447726 - Glucose effects on oxygen consumption by the arterial wall. 7649316 - Control of gestational diabetes. 8694076 - Ketoacids attenuate glucose uptake in human trophoblasts isolated from first-trimester ... |
Publication Detail:
|
Type: JOURNAL ARTICLE Date: 2011-10-18 |
Journal Detail:
|
Title: European journal of neurology : the official journal of the European Federation of Neurological Societies Volume: - ISSN: 1468-1331 ISO Abbreviation: - Publication Date: 2011 Oct |
Date Detail:
|
Created Date: 2011-10-19 Completed Date: - Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 9506311 Medline TA: Eur J Neurol Country: - |
Other Details:
|
Languages: ENG Pagination: - Citation Subset: - |
Copyright Information:
|
© 2011 The Author(s). European Journal of Neurology © 2011 EFNS. |
Affiliation:
|
Neurology Service Service of Endocrinology, Diabetes and Metabolism, Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Incentive spirometry: 2011.
Next Document: Phylogenetic relationships, character evolution, and taxonomic implications within the slipper lobst...