Optimization of blood glucose control in MI patients: state of the art and a proposed protocol for intensive insulin therapy.

Hyperglycemia in the acute phase of myocardial infarction (MI) is a marker of worse short- and long-term prognosis, in both diabetic and non-diabetic patients. Aggressive control of glycemia is recognized in the literature as an important therapeutic target, being associated with a better clinical outcome in this subset of patients. This means that a new approach should be adopted in patients admitted to coronary care units due to MI, control of glucose metabolism being pivotal in this context. Administering a continuous i.v. insulin infusion at a variable rate is acknowledged to be the best way to achieve rapid and sustained optimized metabolic control. The authors present an original protocol for intensive insulin therapy to be used in coronary care units, in both diabetic and nondiabetic patients admitted due to MI and with admission blood glucose of over 180 mg/dl