Many have seen how the neurologic effects of low serum glucose (dextrose) levels can mimic the symptoms of acute stroke. A finger-stick glucose test should be done early to rule out hypoglycemia. In fact, if the glucose level was done pre-hospital and results were marginal, a repeat finger-stick test might be in order. Recall that the brain without sugar does not function! If the stroke patient is hypoglycemic, an ampule of D50W (25 g of sugar) is in order. Many sugar-starved brains respond when given intravenous glucose. Yet one does not want to “just give” dextrose prophylactically.
In the acute stroke patient, hyperglycemia is a predictor of poor outcome. Stress of a stroke has been seen to increase blood sugar even in the nondiabetic. Hyperglycemia is associated with longer hospital stays (7.2 days vs. 6 days), increased risk of bleeding into the penumbra, and an increased risk for death at 30 days.[28] The stroke patients who have their blood sugar tightly controlled early on with hourly blood glucose checks and intravenous insulin, seem to have less bleeding into the penumbra, and better outcomes.
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