Opinion statement
Current recommendations for the treatment of abnormal blood glucose levels for stroke rely on evidence-based guidelines. Ongoing advances in neuroimaging, tissue studies, animal studies, and case series and reports present findings that expose additional variables to be considered in the causal analysis of the role of diabetes and glucose control for stroke occurrence and outcome. The physician when treating the individual patient must fold this information into that provided by large clinical trials. Consideration of all information available without limitation to results from large, double-blind randomized trials allows the physician to expect and thus forecast the result of clinical action by understanding the complexity of the situation. Avoiding hypoglycemia and levels of hyperglycemia able to produce symptoms of stroke and cerebral damage by themselves would seem common sense. The plethora of evidence consistent with worse outcome and increased mortality in acutely ill and stroke patients with hyperglycemia also would call for treatment, with prudent avoidance of hypoglycemia. These rules appear to apply for hemorrhage as well as ischemia, and aggressive recommendations for lowing blood glucose caution against hypoglycemia.
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References and Recommended Reading
Helgason CM. Blood glucose and stroke. Stroke. 1988;19:1049–53.
Helgason CM. The significance of glycosylated hemoglobin for stroke outcome (abstract). Stroke. 1987;18:296.
Quinn TJ, Dawson J, Witters MR. Sugar and stroke: cerebrovascular disease and blood glucose control. Cerebrovasc Ther. 2011;29:e31–2.
Grant PS. A prospective, observational study of the management of hyperglycemia in acute stroke. What is the optimum level of blood glucose at which to intervene? Br J Diabetes Vasc Dis. 2010;10:287–91.
Fitzsimmons B-FM, Lazzaro M. Cerebrovascular disease: ischemic stroke. In: Current diagnosis and treatment, neurology, Second Edition. John CM Brust, Lange Series, Mc Graw Hill; 2012. p. 102–127.
Bernstein RA. Cerebrovascular disease; hemorrhagic stroke. Ibid: 128–148.
Woo E, Ma JT, Robinson JD, Yu YL. Hyperglycemia is a stress response in acute stroke. Stroke. 1988;19:1359–64.
Mc Cormick MT, Muir KW, Gray CS, Walters MR. Emerging therapies; management of hyperglycemia in acute stroke. Stroke. 2008;39:2177–85.
Asadollahi K, Beeching N, Gill G. Hyperglycemia and mortality. JR Soc Med. 2007;100:503–7.
Van Cauter E, Polonsky KS, Scheen AJ. Roles of circadian rhymicity and sleep in human glucose regulation. Endocr Rev. 1997;18:716–38.
Kalsbeek A, La Fleur S, Van Heijningen C, Buijs RM. Suprachiasmatic gabaergic inputs to the paraventricular nucleus control plasma glucose concentrations in the rat via sympathetic innervation of the liver. J Neurosci. 2004;24:7604–13.
Kreier F, Kap YS, Mettenleiter TC, Van Heijningen C, Van der Vliet J, Kalsbeek A, Sauerwein HP, Fliers E, Romijn JA, Buijs RM. Tracing from fat tissue, liver, and pancreas: a neuroanatomical framework for the role of the brain in type 2- diabetes. Endocrinology. 2006;147:1140–7.
Zochodne DW, Kline G, Smith EE, Hill MD, editors. Diabetic neurology. London: Informa Healthcare; 2010.
Mandava P. Hyperglycemia, hypoglycemia.
Ahmed N, Davalos A, Eriksoon N, Ford GA, Glahn J, Hennerici M, Mikulik M, Kaste M, Lees KR, Lindsberg RJ, Toni D, for the SITS Investigators. Association of admission blood glucose and outcome in patients treated with intravenous thrombolysis. Arch Neurol. 2010;67:1123–30.
Leigh R, Saidat OO, Suri MF, Lynch G, Sundararajan S, Sunshine JL, Tarr R, Selman W, Landis D, Suarez J. Predictors of hyperacute clinical worsening in ischemic stroke patients receiving thrombolytic therapy. Stroke. 2004;35:1903–7.
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Helgason, C.M. Blood Glucose and Stroke. Curr Treat Options Cardio Med 14, 284–287 (2012). https://doi.org/10.1007/s11936-012-0178-5
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DOI: https://doi.org/10.1007/s11936-012-0178-5