Diabetes and stroke: part two--treating diabetes and stress hyperglycemia in hospitalized stroke patients.

It is well established that strict glycemic control for the hospitalized stroke patient is associated with improved outcome compared with poor control. This is particularly true for the stroke patients because hyperglycemia can adversely affect ischemic damage. A blood sugar level of less than 110 mg/dL is recommended for critically ill patients and should be achieved by intravenous insulin administration in an intensive care unit setting. Many stroke patients are unable to swallow, and insulin requirement must be readjusted carefully to conform to the nutritional state of the patient. The transition from intravenous insulin to subcutaneous insulin or oral antihyperglycemic agents must be carefully monitored. Careful discharge planning of diabetic care for the stroke patient is necessary to prevent long-term sequelae of inadequate control.