Acute stroke and diabetes.

Diabetes and hyperglycaemia are each over-represented amongst patients with acute stroke. Hyperglycaemia is associated with poor stroke outcome. Symptomatic intracranial haemorrhagic transformation is commoner in diabetes and hyperglycaemia but the treatment effect of thrombolysis appears not to be influenced by blood sugar level. Evidence from general patients treated in intensive care units suggests that intensive control of hyperglycaemia may improve early outcome; this evidence cannot be directly extrapolated to patients with acute stroke since supportive randomized controlled trial evidence describing benefits and risks of insulin administration for hyperglycaemia in stroke is scant. Nevertheless, at present the European guidelines suggest that glucose control may be advisable and place a threshold of 10 mmol/l for definite intervention; American guidelines are weaker. Glucose-potassium-insulin infusion or adjusted insulin infusions each have their proponents: both are effective but both carry a small risk of hypoglycaemia. Use of a suitable locally approved regimen seems advisable.