From the Guidelines
For patients with hemorrhagic stroke, the target blood glucose level is generally between 140-180 mg/dL (7.8-10 mmol/L). This moderate glycemic control approach aims to prevent both hyperglycemia and hypoglycemia, as both conditions can worsen neurological outcomes after a stroke. Hyperglycemia is common after stroke and is associated with increased cerebral edema, inflammation, and secondary brain injury, while hypoglycemia can cause energy failure in already vulnerable brain tissue. Management typically involves regular blood glucose monitoring every 1-4 hours and insulin therapy (often with IV insulin infusion in the acute phase, followed by subcutaneous insulin as the patient stabilizes) 1.
Key Considerations
- Avoid aggressive glucose lowering, as rapid correction and hypoglycemic episodes can be particularly harmful in patients with brain injury.
- Nutritional support should be initiated early, usually within 24-48 hours of admission, to maintain metabolic needs while supporting glucose management.
- The benefits of glycemic control on morbidity reduction through implementation of intravenous insulin protocols administered using evidence-based practice algorithms are well described in the literature 1.
- A meta-analysis of >26 studies, including the NICE-SUGAR study, revealed increased rates of severe hypoglycemia and mortality in tightly versus moderately controlled cohorts 1.
Evidence-Based Recommendations
- Maintenance of glucose levels of 140 to 180 mg/dL (7.8–10 mmol/L) is recommended 1.
- Hyperglycemic management is important not just for diabetic patients, as patients with hyperglycemic stroke not known to have diabetes mellitus have a higher risk of poor outcomes 1.
- The approach to treating elevated blood glucose levels among patients with stroke is influenced by the approach to treating elevated blood glucose levels among patients with other critical illnesses 1.
Clinical Implications
- Target blood glucose level between 140-180 mg/dL to prevent both hyperglycemia and hypoglycemia, and to optimize recovery and reduce complications in hemorrhagic stroke patients.
- Regular blood glucose monitoring and insulin therapy are crucial in managing hyperglycemia in patients with hemorrhagic stroke 1.
From the Research
Target Blood Glucose Level for Hemorrhagic Stroke Patients
- The target blood glucose level for patients with hemorrhagic stroke is not explicitly stated in the provided studies, as most of the studies focus on ischemic stroke.
- However, study 2 mentions that for patients with ischemic stroke who are candidates for thrombolytic therapy, it may be best to rapidly lower severe hyperglycemia, with a target glucose level below 180 or 140 mg/dL.
- Study 3 recommends treating patients with acute ischemic stroke according to the American Diabetes Association inpatient glycemic control guidelines, initiating therapy to achieve glucose targets of 140 to 180 mg/dL.
- Study 4 suggests that current guidelines recommend maintaining blood glucose levels in a range of 140-180 mg/dL for patients with acute ischemic stroke.
- Study 5 mentions a target blood glucose range of 80-179 mg/dL for standard sliding scale subcutaneous insulin and 80-130 mg/dL for continuous intravenous insulin in hyperglycemic acute ischemic stroke patients.
- Study 6 discusses the use of glucose potassium insulin infusions in the treatment of acute stroke patients with mild to moderate hyperglycemia, but does not provide a specific target blood glucose level for hemorrhagic stroke patients.
Blood Glucose Management in Acute Stroke
- The studies suggest that hyperglycemia in acute stroke patients is associated with worse outcomes, and that maintaining blood glucose levels within a target range may improve prognosis 2, 3, 4, 5, 6.
- However, the optimal target blood glucose level for hemorrhagic stroke patients is not clearly established, and more research is needed to determine the best approach to blood glucose management in this population.