Management of DM in Stroke

Dr. Orchid BaruaDepartment of NeurologyCMCHManagement of DM in Stroke

DM as a risk factor:

i.e. 4 fold increase risk of ischaemic cerebrovascular event in DM pt than non dm pt

High insulin level on the other hand increases the risk of atherosclerosis therefore cerebral small vessel disease

Mechanism of Stroke in DM:

Impaired mitochondrial funcion

Effect of Hyperglycemia on stroke pt:Accumulation of lactate & intracellular acidosis in ischaemic brain

Lipid peroxidation & free radical formation allowing accumulation of intracellular free Ca2+

Figure Link between hyperglycemia and poor hospital outcomes. Hyperglycemia and relative insulin deficiency caused by metabolic stress triggers immune dysfunction, release of fuel substrates, and other mediators such as ROS. Tissue and organ injury occur via the combined insults of infection, direct fuel-mediated injury, and oxidative stress and other downstream mediators.

Observational studies suggest a correlation between blood glucose level, mortality, morbidity, and health outcomes in patients with stroke.Capes et al.s meta-analysis identified an admission blood glucose 110 mg/dl (6.1 mmol/l) for increased mortality for acute stroke.Williams et al. reported a threshold admission blood glucose 130 mg/dl (7.2 mmol/l) for increased mortality, length of stay, and charges in acute stroke.Scott et al. demonstrated acceptable hypoglycemia risk and no excess 4-week mortality with glucose-insulin infusion treatment targeted to blood glucose range of 72126 mg/dl (47 mmol/l) in acute stroke.Target Blood Glucose Level?

The Glucose Insulin in Stroke Trial (GIST) examined the safety of GIK infusion in treating to a target glucose of 72126 mg/dl (47 mmol/l). Lowering plasma glucose levels was found to be without significant risk of hypoglycemia or excess mortality in patients with acute stroke and mild-to moderate hyperglycemia.

For working purpose we should control the blood glucose level :