This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Lindsberg, P. J. Articles by Roine, R. O. Search for Related Content PubMed PubMed Citation Articles by Lindsberg, P. J. Articles by Roine, R. O. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB GLUCOSE Medline Plus Health Information Stroke

(Stroke. 2004;35:363.)
© 2004 American Heart Association, Inc.

Advances in Stroke 2003

Hyperglycemia in Acute Stroke

Perttu J. Lindsberg, MD, PhD Risto O. Roine, MD, PhD

From the Department of Neurology (P.J.L., R.O.R), Helsinki University Central Hospital; and Neurosciences Programme (P.J.L.), Biomedicum Helsinki, Helsinki, Finland.

Correspondence to P.J. Lindsberg, Neurosciences Programme, Biomedicum Helsinki, PO Box 700, FIN 00029 HUS, Helsinki, Finland. E-mail perttu.lindsberg@hus.fi

Key Words: Advances in Stroke • hyperglycemia • stroke, acute

An extract of the first 250 words of the full text is provided, because this article has no abstract.

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

Causes of Acute Hyperglycemia

Although up to one third of acute stroke patients have either diagnosed or newly diagnosed diabetes, probably a major proportion of patients have stress hyperglycemia mediated partly by the release of cortisol and norepinephrine. It is also a manifestation of relative insulin deficiency, which is associated with increased lipolysis. Even in nondiabetic patients, stress hyperglycemia may be a marker of deficient glucose regulation in individuals with insulin resistance and developing diabetes mellitus.

How Elevated Glucose Injures the Ischemic Brain

By provoking anaerobic metabolism, lactic acidosis, and free radical production, hyperglycemia may exert direct membrane lipid peroxidation and cell lysis in metabolically challenged tissue. Moderately and severely increased blood glucose has been found to further the metabolic state and mitochondrial function in the area of ischemic penumbra.³ Insulin resistance is . . . [Full Text of this Article]

This article has been cited by other articles:

				D. Summers, A. Leonard, D. Wentworth, J. L. Saver, J. Simpson, J. A. Spilker, N. Hock, E. Miller, P. H. Mitchell, and on behalf of the American Heart Association Counci Comprehensive Overview of Nursing and Interdisciplinary Care of the Acute Ischemic Stroke Patient: A Scientific Statement From the American Heart Association Stroke, August 1, 2009; 40(8): 2911 - 2944. [Full Text] [PDF]

				B. Fuentes, J. Castillo, B. San Jose, R. Leira, J. Serena, J. Vivancos, A. Davalos, A. G. Nunez, J. Egido, E. Diez-Tejedor, et al. The Prognostic Value of Capillary Glucose Levels in Acute Stroke: The GLycemia in Acute Stroke (GLIAS) Study Stroke, February 1, 2009; 40(2): 562 - 568. [Abstract] [Full Text] [PDF]

				B Thanvi, S Treadwell, and T Robinson Early neurological deterioration in acute ischaemic stroke: predictors, mechanisms and management Postgrad. Med. J., August 1, 2008; 84(994): 412 - 417. [Abstract] [Full Text] [PDF]

				S. Lerche, B. Brock, J. Rungby, H. E. Botker, N. Moller, A. Rodell, B. M. Bibby, J. J. Holst, O. Schmitz, and A. Gjedde Glucagon-Like Peptide-1 Inhibits Blood-Brain Glucose Transfer in Humans Diabetes, February 1, 2008; 57(2): 325 - 331. [Abstract] [Full Text] [PDF]

				K Lipska, P N Sylaja, P S Sarma, K R Thankappan, V R Kutty, R S Vasan, and K Radhakrishnan Risk factors for acute ischaemic stroke in young adults in South India J. Neurol. Neurosurg. Psychiatry, September 1, 2007; 78(9): 959 - 963. [Abstract] [Full Text] [PDF]

				H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists. Circulation, May 22, 2007; 115(20): e478 - e534. [Abstract] [Full Text] [PDF]

				H. P. Adams Jr, G. del Zoppo, M. J. Alberts, D. L. Bhatt, L. Brass, A. Furlan, R. L. Grubb, R. T. Higashida, E. C. Jauch, C. Kidwell, et al. Guidelines for the Early Management of Adults With Ischemic Stroke: A Guideline From the American Heart Association/ American Stroke Association Stroke Council, Clinical Cardiology Council, Cardiovascular Radiology and Intervention Council, and the Atherosclerotic Peripheral Vascular Disease and Quality of Care Outcomes in Research Interdisciplinary Working Groups: The American Academy of Neurology affirms the value of this guideline as an educational tool for neurologists Stroke, May 1, 2007; 38(5): 1655 - 1711. [Abstract] [Full Text] [PDF]

				L. Allport, T. Baird, K. Butcher, L. MacGregor, J. Prosser, P. Colman, and S. Davis Frequency and Temporal Profile of Poststroke Hyperglycemia Using Continuous Glucose Monitoring Diabetes Care, August 1, 2006; 29(8): 1839 - 1844. [Abstract] [Full Text] [PDF]

				F. Vancheri, M. Curcio, A. Burgio, S. Salvaggio, G. Gruttadauria, M.C. Lunetta, R. Dovico, and M. Alletto Impaired glucose metabolism in patients with acute stroke and no previous diagnosis of diabetes mellitus QJM, December 1, 2005; 98(12): 871 - 878. [Abstract] [Full Text] [PDF]

				E. C. Nemergut, A. S. Dumont, U. T. Barry, and E. R. Laws Perioperative Management of Patients Undergoing Transsphenoidal Pituitary Surgery Anesth. Analg., October 1, 2005; 101(4): 1170 - 1181. [Abstract] [Full Text] [PDF]

				A. M. Kanaya, D. Herrington, E. Vittinghoff, F. Lin, V. Bittner, J. A. Cauley, S. Hulley, and E. Barrett-Connor Impaired Fasting Glucose and Cardiovascular Outcomes in Postmenopausal Women with Coronary Artery Disease Ann Intern Med, May 17, 2005; 142(10): 813 - 820. [Abstract] [Full Text] [PDF]

				C. L. Thompson, K. C. Dunn, M. C. Menon, L. E. Kearns, and S. S. Braithwaite Hyperglycemia in the Hospital Diabetes Spectr, January 1, 2005; 18(1): 20 - 27. [Abstract] [Full Text] [PDF]

				R. O. Roine and P. J. Lindsberg Editorial Comment--Prime Time for Proactive Blood Glucose Control? Stroke, November 1, 2004; 35(11): 2498 - 2499. [Full Text] [PDF]