Glycaemic therapy

Hyperglycaemia, or high blood glucose after stroke is found in one-third of patients, although the reported incidence varies between 8% and 83% depending on the cohort and definition. Previously undetected diabetes is found in 16–24% of patients admitted with stroke. Observational data indicate that hyperglycaemia fluctuates in the first 72 hours in both non-diabetic and diabetic patients, even with current best practice. Observational data also reveal poorer outcomes for non-diabetic patients with hyperglycaemia. Glucose intolerance after stroke is also common (approximately 25%) and linked to higher stroke recurrence.

There is now good evidence that hyperglycaemia needs management regardless of the patient's diabetic status. Implementation of effective glycaemic control requires education of nursing staff across all shifts, which can be challenging. Glucometers also need to be readily available. National Stroke Audits report that 91% of Australian stroke hospitals have locally agreed protocols for glucose control in place.

For current research and evidence-based recommendations see our Clinical Guidelines.