Strict glucose control after acute stroke can be provided in the prehospital setting.

Objectives: The objective was to assess the feasibility of insulin infusion and subcutaneous insulin administered in the prehospital setting and their relative effect on hyperglycemia, a predictor of unfavorable outcome, in acute stroke patients.

Methods: Hyperglycemic patients (plasma glucose >6.0 mmol/L) with stroke symptoms were randomized prior to or during transport to the hospital to receive either 1) a single subcutaneous dose of short-acting insulin (n = 11) or 2) a continuous intravenous (IV) insulin infusion (n = 12) at a rate adjusted by glucose levels measured every 10 minutes and targeted to plasma glucose 4.5-6.0 mmol/L. The changes in plasma glucose concentration were compared with a nonrandomized control group (n = 38) receiving standard care.

Results: The baseline characteristics did not differ between the study groups. Plasma glucose concentration was significantly decreased during the prehospital phase in the IV-treated group in comparison to the control group (difference between groups -1.9 mmol/L, 95% confidence interval [CI] = -3.5 to -0.27) with no serious adverse events. In contrast, subcutaneous insulin did not achieve significant lowering of plasma glucose (-0.9 mmol/L, 95% CI = -2.4 to 0.6).

Conclusions: This small sample suggests that adjusted insulin infusion efficiently lowers blood glucose in the ultra-acute phase of stroke and is feasible in the prehospital setting.