title: Is management of hyperglycaemia in acute phase stroke still a dilemma?
abstract: BACKGROUND
  Close monitoring of blood glucose levels during the immediate post-acute stroke phase is of great clinical value, as there is evidence that the risk of neurological deterioration is associated with both hyper- and hypoglycaemia. The aim of this review paper is to summarise the evidence on post-stroke blood glucose management and its impact on clinical outcomes, during the early post-acute stage.
  
  
  RESULTS
  Post-stroke hyperglycaemia has been associated with increased cerebral oedema, haemorrhagic transformation, lower likelihood of recanalisation and deteriorating neurological state. Thus, hyperglycaemia during an acute stroke may result in poorer clinical outcomes, infarct progression, poor functional recovery and increased mortality rates. Although hypoglycaemia may also lead to poorer outcomes via further brain injury, it can be readily reversed by glucose administration. In most patients, the goal of regular treatment is euglycaemia and for acute-stroke patients, a reasonable approach is to target control of glucose level at 100-150 mg/dL.
  
  
  CONCLUSIONS
  Both hypoglycaemia and hyperglycaemia may lead to further brain injury and clinical deterioration; that is the reason these conditions should be avoided after stroke. Yet, when correcting hyperglycaemia, great care should be taken not to switch the patient into hypoglycaemia, and subsequently aggressive insulin administration treatment should be avoided. Early identification and prompt management of hyperglycaemia, especially in acute ischaemic stroke, is recommended. Although the appropriate level of blood glucose during acute stroke is still debated, a reasonable approach is to keep the patient in a mildly hyperglycaemic state, rather than risking hypoglycaemia, using continuous glucose monitoring.
authors.affiliation: 1st Propedeutic Department of Internal Medicine, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece. chrisavop@hotmail.com.
authors.forename: C
authors.initials: C
authors.lastname: Savopoulos
authors.affiliation: 1st Propedeutic Department of Internal Medicine, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece.
authors.forename: G
authors.initials: G
authors.lastname: Kaiafa
authors.affiliation: 1st Propedeutic Department of Internal Medicine, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece.
authors.forename: I
authors.initials: I
authors.lastname: Kanellos
authors.affiliation: Blood Donation Department, St Paul Hospital, Thessaloníki, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Fountouki
authors.affiliation: Nursing Department, ATEI, Thessaloníki, Greece.
authors.forename: D
authors.initials: D
authors.lastname: Theofanidis
authors.affiliation: 1st Propedeutic Department of Internal Medicine, Medical School, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloníki, Greece.
authors.forename: A I
authors.initials: AI
authors.lastname: Hatzitolios
mesh_terms: D000208:Acute Disease; D001786:Blood Glucose / Q000378:metabolism*; D019468:Disease Management; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy* / Q000209:etiology / Q000378:metabolism; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D020521:Stroke / Q000150:complications*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents
keywords: Continuous glucose monitors; Diabetes mellitus; Hyperglycaemia; Hypoglycaemia; Post-stroke glucose management