caa a22 4500 445298936 CHVBK 20180317142551.0 cr unu---uuuuu 170323e20101101xx s 000 0 eng 10.1007/s11940-010-0093-6 doi (NATIONALLICENCE)springer-10.1007/s11940-010-0093-6 Diabetes Mellitus, Acute Hyperglycemia, and Ischemic Stroke [Elektronische Daten] [Askiel Bruno, David Liebeskind, Qing Hao, Radoslav Raychev] Opinion statement: Acute brain ischemia is a dynamic process susceptible to multiple modulating factors, such as blood glucose level. During acute ischemic brain injury, hyperglycemia exacerbates multiple deleterious derangements. Timely and sufficient correction of hyperglycemia during acute brain ischemia may limit the brain injury and improve clinical outcomes. The clinical efficacy of such intervention remains to be proven. Although results from animal and clinical observational studies suggest that hyperglycemia during acute brain ischemia may exacerbate the brain injury, there is no evidence from randomized treatment trials that rapid correction of the hyperglycemia improves outcomes. Given the excess effort, cost, and risk involved in rapid and safe correction of hyperglycemia during acute stroke, less aggressive treatments with subcutaneous insulin seem appropriate at this time. Subcutaneous insulin protocols can maintain blood glucose levels below 200mg/dL a majority of the time in most patients, especially if basal insulin is added. When available, an endocrinology consultant can optimize the acute treatment and help the transition to long-term care. Given the multiple reports linking admission hyperglycemia with symptomatic hemorrhagic conversion of ischemic stroke treated with thrombolytic drugs, it may be best to rapidly lower severe hyperglycemia in such patients. For example, if the admission blood glucose is approximately 300mg/dL and the patient is a candidate for thrombolytic therapy, consider giving an intravenous bolus of regular insulin 8 units. Somewhat lower or higher insulin doses may be best for lesser or greater hyperglycemia. Such a bolus will start lowering the blood glucose in about 5min. A temporary continuous intravenous insulin infusion may then be used in most patients to maintain the glucose closer to normal levels (eg, below 180 or 140mg/dL). The Author(s), 2010 Bruno Askiel Department of Neurology, Medical College of Georgia, 1120 15th Street, BI3076, 30912, Augusta, GA, USA aut Liebeskind David Department of Neurology, University of California Los Angeles School of Medicine, Los Angeles, CA, USA aut Hao Qing Department of Neurology, University of California Los Angeles School of Medicine, Los Angeles, CA, USA aut Raychev Radoslav Department of Neurology, University of California Los Angeles School of Medicine, Los Angeles, CA, USA aut Current Treatment Options in Neurology Current Science Inc. 12/6(2010-11-01), 492-503 1092-8480 12:6<492 2010 12 11940 https://doi.org/10.1007/s11940-010-0093-6 text/html Onlinezugriff via DOI 1 review-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s11940-010-0093-6 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Bruno Askiel Department of Neurology, Medical College of Georgia, 1120 15th Street, BI3076, 30912, Augusta, GA, USA aut NATIONALLICENCE 700 1- Liebeskind David Department of Neurology, University of California Los Angeles School of Medicine, Los Angeles, CA, USA aut NATIONALLICENCE 700 1- Hao Qing Department of Neurology, University of California Los Angeles School of Medicine, Los Angeles, CA, USA aut NATIONALLICENCE 700 1- Raychev Radoslav Department of Neurology, University of California Los Angeles School of Medicine, Los Angeles, CA, USA aut NATIONALLICENCE 773 0- Current Treatment Options in Neurology Current Science Inc 12/6(2010-11-01), 492-503 1092-8480 12:6<492 2010 12 11940 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer