IV insulin during acute cerebral infarction in diabetic patients

Although hyperglycemia can be a nonspecific response to stress, tight glycemic control during acute myocardial infarction1 and in postoperative ventilated patients2 has been shown to significantly reduce mortality. Animal3 and human4-6⇓⇓ studies suggest that hyperglycemia also augments acute cerebral ischemia, and clinical efficacy of tight glycemic control during acute cerebral infarction is being investigated.7 Good glycemic control during acute cerebral infarction in nondiabetic patients appears feasible and safe, but this has not been reported in patients with diabetes mellitus.7 Our Institutional Review Board approved this study, and all subjects signed a valid informed consent. We prospectively administered an IV insulin protocol initiated within 12 hours after onset of cerebral infarction to 24 consecutive patients with admission hyperglycemia (9.4 to 22.2 mmol/L or 170 to 400 mg/dL). Nurses supervised closely by the principal investigator administered the insulin protocol in an open-label fashion. We modified our insulin protocol after each three to seven treated subjects to improve glycemic control and minimize hypoglycemia while keeping the protocol practical. We adjusted the insulin …