Hyperglycemia in acute stroke.

Elevated blood glucose is common in the early phase of stroke. The prevalence of hyperglycemia, defined as blood glucose level 6.0 mmol/L (108 mg/dL), has been observed in two thirds of all ischemic stroke subtypes on admission and in at least 50% in each subtype including lacunar strokes.1 Extensive experimental evidence in stroke models supports that hyperglycemia has adverse effects on tissue outcome, and an association between blood glucose and functional outcome has been found in an increasing number of clinical studies. Although no interventional stroke studies have addressed the acute reversal of hyperglycemia, active lowering of elevated blood glucose by rapidly acting insulin is recommended in most published guidelines, even in nondiabetic patients (European Stroke Initiative [EUSI] guidelines 10 mmol/L, American Stroke Association [ASA] guidelines 300 mg/dL).2