A randomised, controlled pilot study to investigate the potential benefit of intervention with insulin in hyperglycaemic acute ischaemic stroke patients

Background: Hyperglycaemia on presentation with acute ischaemic stroke ( AIS) is associated with poor outcome, but intervention is unproven. We investigated the safety and tolerability of one method of glycaemic control. Methods: Patients within 24 h of AIS and plasma glucose 8 - 20 mmol/ l were randomised to receive either rigorous glycaemic control ( RC) or standard management ( SM) for 48 h. RC comprised i. v. insulin at a variable rate adjusted for target glucose concentration of 5 - 8 mmol/ l, and intravenous crystalloid. The SM group received intravenous crystalloid alone in an open-label design. Results: Thirteen patients were randomised to RC and 12 to SM ( age 75 +/- 6.2 years; 40% male; 20% lacunar stroke; time to treatment 8 +/- 6.1 h; plasma glucose 10.6 +/- 0.9 mmol/ l; known diabetes 52%; NIHSS 8, range 2 - 28). The glucose concentration- time curve was reduced in the RC group ( AUC 324 +/- 15 versus 385 8 28 h (.) mmol/ l, p = 0.04). By 48 h, plasma glucose in both groups was 6.8 +/- 1.1 and 7.5 +/- 1.3 mmol/ l respectively, but mean hourly insulin requirements in the RC group had dropped from 3.25 +/- 0.32 units to 1.25 +/- 0.5 units ( p < 0.01). One transient episode of hypoglycaemic symptoms occurred in the RC group. Conclusion: Glycaemic control with sliding scale insulin for 48 h is feasible and well- tolerated after AIS. Treatment after 48 h may be unnecessary. Copyright (c) 2006 S. Karger AG, Basel