Hyperglycaemia at time of stroke presentation is common, and has been shown to be associated with worse functional outcomes and increased mortality1. Our current hospital guidelines recommend maintaining glucose levels between 5 and 10mmol/L for first 48-72 hours of admission (in line with various recommendation bodies2,3).
A retrospective analysis of quality and effectiveness of hyperglycaemia management for patients admitted to the stroke unit of a tertiary hospital. A ‘standardised subcutaneous insulin chart’ (SSIC) was introduced at the stroke unit from November 2015, and patients were divided into two groups (for comparison), each including patients admitted three months prior (group 1) or three months after (group 2) the introduction of the standardised forms.
58 patients were included in group 1 (mean age: 72 years) and 56 patients in the group 2 (mean age: 70.5 years). The prevalence of type 2 Diabetes Mellitus in the cohort was 29%. Significant hyperglycaemia (blood glucose level > 10mmol/L) was observed on presentation in 11/58 and 10/56 patients in groups 1 and 2 respectively but intravenous insulin infusions were utilised in only 4 and 2 patients in group 1 and 2 respectively for management of hyperglycaemia. Although insulin infusions were effective, glycaemic control remained inadequate in these patients, with readings greater than 10mmol/L observed for an average of 10.5, 12 and 6 hours/day in the group 1 and 10.5, 8.5 and 6 hours/day in group 2 on day 1, 2 and 3 post stroke respectively. Hypoglycaemia was infrequent.
In-patient hyperglycaemia was frequently observed in our patients, especially in patients with Diabetes and initial significant hyperglycaemia (>10mmol/L). SSIC didn’t appear to make much difference and glycaemic control remained suboptimal. More frequent utilisation and possibly higher doses of insulin infusion, as well as early involvement of a specialised diabetes management team could be beneficial.