Initial Serum Glucose Levels Research Articles

PSAT277 Glucocorticoid Therapy for Management of Hypoglycemia in the context of Non-Islet Cell Tumor-Induced Hypoglycemia

Abstract Background Non-islet cell tumor-induced hypoglycemia (NICTH) is a rare paraneoplastic syndrome which can cause recurrent hypoglycemia. There is no clear standard of care for management of hypoglycemia. Often, these patients have high morbidity and therefore surgical tumor resection is not always possible. Clinical case: This is the case of a 69 year-old male presenting with altered mental status in the context of hypoglycemia without clear etiology with an initial serum glucose level of 32 mg/dL (normal range 60-100 mg/dL) which quickly corrected after administration of intravenous glucose. He was found to have a large bowel obstruction with CT abdomen revealing an underlying neoplasm. Biopsy of suspected lesion on colonoscopy revealed colorectal adenocarcinoma. Repeated episodes of hypoglycemia complicated by seizures required inpatient management. Workup included serum insulin level which resulted in suppressed level (<1. 0 uU/mL, normal range 1.9-23. 0 uU/mL), low c-peptide level (0.1 ng/mL, normal range 1.1-4.4 ng/mL), low beta hydroxybutyrate level (0. 07 mmol/L, normal level <0.3 mmol/L), cortisol level of 43.7 mcg/dL, undetectable insulin like growth factor-1 (IGF-1) level (<10 ng/mL, normal range 59-230 ng/mL) and low insulin like growth factor-2 (IGF-2) level (66 ng/mL, normal range 333 - 967 ng/mL). IGF2: IGF1 ratio was 66 (ratio >10 is indicative for diagnosis of non-islet cell tumor hypoglycemia). Due to extremely poor oral intake and recurrent episodes of hypoglycemia despite continuous dextrose infusion, the patient was started on 20 mg prednisone daily. Eventually, 40 mg of intravenous methylprednisolone in addition to dextrose infusion was needed as maintenance therapy effectively preventing hypoglycemia. Given his poor functional status, the surgical and oncology team decided he was no longer a surgical or chemotherapy candidate. Eventually, palliative medicine was consulted and the patient was transitioned to comfort care with a plan for outpatient hospice. Conclusion NICTH should be suspected in any patient with hypoglycemia without clear etiology, especially if there are suggestions to NICTH such as known malignancy or newly diagnosed mass. Once NICTH is identified and a primary tumor is found, complete tumor resection represents ideal management, however, not always attainable. In such cases, dextrose infusion might be insufficient to prevent hypoglycemia and is not always the preferred option given the required long-term venous access. In these circumstances, early high dose glucocorticoids are safe and appear to successfully prevent hypoglycemic events. Presentation: Saturday, June 11, 2022 1:00 p.m. - 3:00 p.m.

Early neurological deterioration in acute ischemic stroke patients after intravenous thrombolysis with alteplase predicts poor 3-month functional prognosis - data from the Thrombolysis Implementation and Monitor of Acute Ischemic Stroke in China (TIMS-China)

BackgroundWe aimed to investigate the risk factors of early neurological deterioration (END) after intravenous thrombolysis with recombinant tissue-type plasminogen activator (rt-PA) and the relationship between END and poor 3-month functional outcomes.MethodsPatients who accepted intravenous recombinant rt-PA were enrolled continuously. END was defined as an increase in National Institute of Health Stroke (NIHSS) score ≥ 4 points or death within 24 hours after intravenous thrombolysis. The modified Rankin Scale (mRS) score was recorded to evaluate the functional outcome of stroke, and the poor 3-month prognosis was defined as an mRS score ≥ of 3. Univariate and multivariate analyses were used to analyze the risk factors of END. The relation between END and 3-month functional outcome was analyzed by multivariate logistic regression analysis.ResultsA total of 1107 patients (mean age, 63.42 ± 11.33 years; 673 males) were included in the final analysis, and 81(7.32%) patients had END. In multivariate analysis, the serum glucose level was significantly associated with END; the odds ratio was 1.10 (95% CI 1.03 to 1.18, p = 0.004). The multivariate logistic analysis showed END has a notable association with the poor 3-month functional recovery even after adjusting for confounding factors; the adjusted OR was 8.25 (95% CI 3.77 to 18.03, p < 0.0001).ConclusionsThe initial serum glucose level might be an independent risk factor of END, and END might predict a poor 3-month prognosis.

Hyperosmolar hyperglycemic state in children: case report and review of the literature

Hyperosmolar hyperglycemic state (HHS) is a rare complication in children and a life-threatening emergency that presents with a significant increase in blood sugar and hyperosmolarity with or without low ketosis. This study reports the case of a 9-year-old boy with severe HHS due to type 1 diabetes. The patient’s initial serum glucose level was 1600; however, he was discharged in a stable condition. The patient presented many of the known complications of HHS, including decreased level of consciousness, hypovolemic shock, acute kidney injury, and very high serum glucose levels. The patient responded well to invasive fluid resuscitation and insulin administration, was discharged in good general condition without HHS-related complications, and was followed up with insulin therapy. As the prevalence of HHS in children is increasing, it is necessary for physicians to be aware of the unusual manifestations in children, especially children with type 1 diabetes, and to have the ability to diagnose and manage HHS and differentiate it from diabetic ketoacidosis.

Abstract 256: Length of Stay, Type of Stroke and NIHSS Score in Persons With Self-reported Diabetes

In the U.S., diabetes is the 7th leading cause of death and 65% of these deaths are attributable to cardiovascular disease or stroke or to both. Among patients admitted for acute stroke, diabetes was associated with a higher risk of death, functional dependency and stroke recurrence. The purpose of this investigation was to examine the relationship between length of stay (LOS), type of stroke [ischemic stroke (IS), Transient Ischemic Attack (TIA), Subarachnoid Hemorrhage (SAH), Intracerebral Hemorrhage (ICH)] and the NIH Stroke Scale (NIHSS) in patients admitted to the hospital with an initial diagnosis of stroke or TIA and self-reported diabetes. There were N=5105 subjects (2448 males and 2657 females) in our center’s Get With The Guidelines-Stroke (GWTG-S) database from April 2014 to March 2019. Age, race, sex, insurance type, lipids and lipoproteins, initial serum glucose on admission, blood pressure, stroke type, and initial stroke severity (NIHSS) were the variables analyzed in a multiple regression analysis, with p &lt;0.05 considered statistically significant. Mean LOS was 7.4 days (d) (range 0-119 d). LOS was negatively associated with age (as age (years) increased, the length of stay decreased by 0.05 d). We found that LOS to be positively associated with NIHSS score. Compared to those with mild NIHSS (0-5), those with severe NIHSS (&gt;10) had LOS increased by 4.3 d, whereas moderate NIHSS (6-10) had LOS increased by 1.9 d. When compared with IS, we found that TIA was associated with a 2.6 d decrease in LOS whereas SAH and ICH were associated with a 6.7 and 3 d increase, respectively. Insurance type also was associated with LOS. Those on Medicaid had a 2.7 d increase in LOS compared to those who had Medicare. No statistically significant difference was found between Medicare and private insurance. There was no difference between ethnicities and LOS among our subjects. As expected, higher initial serum glucose level was positively associated with increased LOS. Specifically, for every 1 unit increase in initial serum glucose level was an associated 0.01 d increase in LOS. Thus, in the current study, we demonstrated that diabetes and initial serum glucose level continue to be important criteria in estimating the LOS in person admitted with a stroke. We recommend that these variables be considered for discharge planning and length of stay benchmarks in persons with history of diabetes.

Clinical significance of serum amylase and glucose level in organophosphorus poisoning

Background: Organophosphorous (OP) poisoning is a common problem in country like Nepal where agriculture is the backbone of the economy. The primary mechanism of action is inhibition of acetylcholinesterase (ACHE). Organophosphorus poisoning is a possible cause of acute pancreatitis along with alternation of glucose metabolism.&#x0D; Materials and Method: This was a hospital based cross-sectional comparative study. The level of serum amylase and glucose were measured in thirty-eight OP poisoned patients at the time of admission, before discharge and were compared.&#x0D; Results: Amongst 38 patients, Majority had mild OP poisoning 27(71.1%) as per Peradeniya Organophosphorus Poisoning (POP) score whereas 9(23.7%) had moderate and 2(5.2%) had severe poisoning. The mean initial serum amylase level in patients with mild poisoning was 152±73.92 (IU/L)(p=0.000), in moderate poisoning was 213.38±69.39 (IU/L) (p=0.223) and in severe poisoning was 171.33±107.22(IU/L) (p=0.259). There was increase in serum amylase level in all patients with poisoning but level did not increase in proportion to increase with severity of POP score. The mean initial serum glucose level in mild poisoning was 132.48±37.73 (Mg/dl) (p=0.024), in moderate poisoning was 139±44.59 (Mg/dl) (p=0.033) and in severe poisoning was 174±23.38 (Mg/dl) (p=0.22). The serum glucose level increased as the severity of POP score increased. The serum amylase and glucose levels in recovering patients showed a tendency to decrease to their normal values. No patient had developed acute symptomatic pancreatitis.&#x0D; Conclusion: Serum amylase and glucose level were increased in all patients with OP poisoning but didn’t correlate with the clinical severity. Routine measurement of serum amylase in patients of OP poisoning has little value in the absence of clinical acute pancreatitis.

Case 3: Recurrent Symptom of Sleepiness in an Adolescent Girl

1. Jocelyn K. Lambuth, MSc, MD* 2. Hector F. Lantigua, MD† 3. Monaliza S. Evangelista, MD‡ 4. Amanda Tchakarov, MD§ 5. Avni Shah, MD† 1. *McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX 2. †Division of Endocrinology, Department of Pediatrics, 3. ‡Division of Community and General Pediatrics, Department of Pediatrics, and 4. §Department of Pathology and Laboratory Medicine, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, TX A 17-year-old girl presents with recurrent episodes of sleepiness. Her mother brought her to the emergency department after she was difficult to awaken from sleep. She has had recurrent symptoms of fatigue, difficult arousability, tremulousness, and diaphoresis for 5 months and experiences mild symptoms daily, which are alleviated by eating. In addition, she has had recent weight loss of 4 lb (1.8 kg), headache, and irregular menstruation. The remainder of her medical and family history is normal. On hospital admission her vital signs are normal. Growth parameters include weight of 103.4 lb (46.9 kg), height of 60 in (152 cm), and BMI of 20.3 (BMI Z -score, –0.3); physical examination findings are normal, and no unusual skin findings are seen. Her initial serum glucose level is 24 mg/dL (1.33 mmol/L), and dextrose-containing intravenous fluids are started. Pediatric endocrinology is consulted to aid in investigation and management. On further questioning, she reports a previous evaluation in another hospital for these episodes. During her admission she is found to have a fingerstick glucose level of 21 mg/dL (1.17 mmol/L) and receives 2 ampules of dextrose 50% due to recurrent hypoglycemia. She is admitted to the PICU for further monitoring. During a hypoglycemic event, her serum glucose level was 41 mg/dL (2.28 mmol/L), β-hydroxybutyrate level, 2.1 mg/dL; C-peptide level, 3.6 ng/mL; and serum insulin level, 16.6 …

Hyperglycemia Is Associated With Intracranial Injury in Children Younger Than 3 Years of Age

The objective was to see if hyperglycemia in the emergency department predicted traumatic intracranial hemorrhage (ICH) for infants and young children. A 6-year retrospective chart review was performed on patients younger than 3 years. Patients identified from the pediatric intensive care unit (PICU) database with ICH on computer tomography were compared with those with a history of trauma without ICH identified from a radiology database. Subgroup analysis was performed on the ICH group comparing abusive head trauma (AHT) and accidental. Primary outcomes measured were initial serum glucose level, length of stay, length of ventilation, mortality, and disability on discharge. Fifty-three patients were admitted to the PICU with traumatic ICH with an overall mortality of 7.5%. The average initial glucose in the emergency department was significantly higher for the patients with ICH than those without (164 vs. 99 mg/dL, P < 0.0001). Combining elevated serum glucose with any abnormality in Glasgow Coma Scale score yielded sensitivity and specificity of 100%. The average presenting glucose was higher for AHT compared with accidental injury (190 vs. 133 mg/dL, P < 0.001). Patients with AHT had greater PICU and hospital length of stay and more severe disabilities on discharge (P < 0.001). Elevated serum glucose is a good marker of ICH in children younger than 3 years. When correlated with an abnormal neurological examination, it is highly sensitive and specific. Patients with AHT have further elevation of serum glucose at presentation. Emergency department physicians should consider measuring the serum glucose in children younger than 3 years with abnormal neurological examinations and obtaining a head computer tomography if it is elevated.

Usefulness of initial glucose level to improve acute coronary syndrome diagnosis in the emergency department

IntroductionThe aim of the study was to analyse the incremental usefulness of high blood glucose level for non-ST elevation acute coronary syndrome (ACS) diagnosis in patients admitted to the emergency...

Initial serum glucose level and white blood cell predict ventricular arrhythmia after first acute myocardial infarction

Objective The aims of this study are to analyze the factors that predispose the occurrence of ventricular arrhythmia (VA) in young patients with a first acute myocardial infarction (AMI) in the emergency department (ED) and to establish predictive implications. Methods This is a 10-year retrospective cohort study. Patients who were older than 18 years and younger than 45 years with a first attack of AMI were recruited from the ED of 3 university teaching hospitals from January 1, 1998, to December 31, 2007. Results Five hundred young patients (472 men and 28 women) who met the inclusion criteria were enrolled. Within these patients, the incidence of life-threatening VA with first attack of AMI was 8% (n = 40). They were categorized into 2 groups: VA attack (n = 40) and non-VA attack (n = 460). In univariable analyses, acute anterolateral ST-segment elevation myocardial infarction (65% vs 47.8%; P = .04), elevate white blood cell (WBC) count (16.4 ± 3.4 vs 11.5 ± 3.1 × 10 3/mm 3; P < .01), and initial serum glucose level (202.6 ± 90.9 vs 151.9 ± 64.7 mg/dL; P < .01) were significantly increased in the VA group. Multiple logistic regression model identified WBC count and initial serum glucose level as the significant independent variables in the prediction of VA attack for young patients with first attack of AMI. The receiver operating characteristic area for WBC count and serum glucose level in predicting the risk of VA occurring after AMI was 0.869 and 0.756, respectively. Conclusion Initial serum glucose level and WBC may be used as valuable predictors for VA attack in young patients with first AMI.

Use of therapeutic responses to glucose replacement to predict glucose patterns in diabetic patients presenting with severe hypoglycaemia

The purpose of this study was to determine whether initial serum glucose levels, therapeutic responses to intravenous glucose replacement and changes in serum glucose levels over time could predict serum glucose patterns. The patients enrolled in this retrospective chart review had been previously diagnosed with diabetes mellitus and were later hospitalised for severe hypoglycaemia (SH). They were all admitted to the emergency department (ED) during a 4-year period between January 2003 and December 2006. Comparison of the therapeutic responses to glucose replacement according to the serum glucose patterns [categorised into recurrent hypoglycaemia (RH), overshoot hyperglycaemia (OH) and favourable groups] during the first 48 h was performed. Compared with the favourable group, therapeutic responses to glucose replacement were significantly lower in the RH group and higher in the OH group; the changes in serum glucose levels over time were also significantly lower in the RH group and higher in the OH group. Therapeutic responses to glucose replacement and changes in serum glucose levels over time can differentiate diabetic patients with RH and OH from those with favourable glucose patterns during the first 48 h after presentation in the ED with SH. We believe that a 'response-to-treatment' based strategy is useful in determining the ED disposition of diabetic patients presenting with SH.

Initial Serum Glucose Level as a Prognostic Factor in the First Acute Myocardial Infarction

We assess the prognostic role of initial glucose levels in patients with a first acute myocardial infarction in the emergency department (ED). We conducted a 3-year retrospective cohort study. Patients with a first acute myocardial infarction were recruited from the ED of a tertiary hospital from January 1, 2001, to December 31, 2003. Initial glucose levels in the ED were stratified into 3 levels (normal < 140 mg/dL; intermediate 140 to 200 mg/dL; and high > or = 200 mg/dL). Logistic and Cox regression models were applied to estimate the 1-month short-term and 1-year long-term adverse prognoses, respectively. A total of 198 eligible subjects (159 men and 39 women; mean age 63.1+/-14.2 years) were recruited. The estimated survival curves among the 3 initial glucose levels were significantly different (P=.0002). After adjustment for sex, age, diabetic status, reperfusion therapy, and infarct subtype, the adjusted odds ratio for short-term prognosis progressed with higher levels when compared with the normal level (intermediate level: odds ratio 3.87; 95% confidence interval [CI] 1.71 to 8.78; high level: odds ratio 5.16; 95% CI 1.97 to 13.51). High initial glucose level was an important risk factor for long-term adverse prognosis (hazard ratio 3.08; 95% CI 1.59 to 5.98). A high initial glucose level in the ED is an important and independent predictor of short- and long-term adverse prognoses in patients with first acute myocardial infarction.

Hyperglycemia After SAH

Hyperglycemia is common after subarachnoid hemorrhage (SAH). The extent to which prolonged hyperglycemia contributes to in-hospital complications and poor outcome after SAH is unknown. We studied an inception cohort of 281 SAH patients with an initial serum glucose level obtained within 3 days of SAH onset and who had at least 7 daily glucose measurements between SAH days 0 and 10. We defined mean glucose burden (GB) as the average peak daily glucose level >5.8 mmol/L (105 mg/dL). Hospital complications were recorded prospectively, and 3-month outcome was assessed with the modified Rankin scale. The median GB was 1.8 mmol/L (33 mg/dL). Predictors of high-GB included age > or =54 years, Hunt and Hess grade III-V, poor Acute Physiology and Chronic Health Evaluation (APACHE)-2 physiological subscores, and a history of diabetes mellitus (all P< or =0.001). In a multivariate analysis, GB was associated with increased intensive care unit length of stay (P=0.003) and the following complications: congestive heart failure, respiratory failure, pneumonia, and brain stem compression from herniation (all P<0.05). After adjusting for Hunt-Hess grade, aneurysm size, and age, GB was an independent predictor of death (odds ratio, 1.10 per mmol/L; 95% CI, 1.01 to 1.21; P=0.027) and death or severe disability (modified Rankin scale score of 4 to 6; odds ratio, 1.17 per mmol/L; 95% CI 1.07 to 1.28, P<0.001). Hyperglycemia after SAH is associated with serious hospital complications, increased intensive care unit length of stay, and an increased risk of death or severe disability.

Healing of diabetic foot ulcers in l-arginine-treated patients

Experimentally, we demonstrated the beneficial effects of l-arginine on regulation of hyperglycemia and dyslipidemia in experimental diabetes, in addition to a positive anti-aggregating effect in platelets in animals and humans. Here, the effect of l-arginine on foot ulcers from diabetic patients was studied. Three groups of diabetic patients were included: 11 patients without ulcer received neither treatment and served as controls. Eleven patients with diabetic ulcer received the standard treatment, this group served as diabetic control with diabetic ulcer. Eleven remain patients with diabetic ulcer received 10 mM l-arginine subcutaneously on the site of the wound. Biopsy with punch number 5 on wound site comprising both ulcerative and contiguous undamaged skin were performed in all patients with ulcerative lesions before any treatment. Patients with intact skin had biopsy performed with punch number 5 on external malleolar region of right lower limb. Biopsies were examined by light and confocal microscopy utilizing histochemical and immunohistochemical methods. Initial and final blood samples were collected to determine glucose, triglycerides, total cholesterol, glycated hemoglobin (HbA 1c), low (LDL), and high density lipoproteins (HDL). Significant differences ( P < 0.05) were observed between initial and final serum glucose levels for treated patients, and initial serum glucose levels between treated and control patients without diabetic ulcer. Glycated hemoglobin, triglycerides, cholesterol, and lipoprotein levels showed no significant changes. Eight patients treated with l-arginine reached total wound healing and the remaining three who abandoned the study because of change of residence showed relevant improvement. Histochemistry and immunohistochemistry methods have shown vascular impairment in both patients with diabetic ulcer (prior to treatment) and control patients without diabetic ulcer. Our observations strongly support efficacy of l-arginine for successful wound healing of diabetic ulcers.

Relationship between serum glucose and injury severity score in childhood trauma

Purpose: The aim of this study was to examine the relationship between initial serum glucose and injury severity score (ISS) in children with multiple trauma. Methods: Charts from all patients 0 to 19 years of age admitted to a children's hospital in 1995 with acute multiple trauma were reviewed. Data collected included initial serum glucose level, heart rate (HR), systolic blood pressure (SBP), Injury Severity Score (ISS), age, gender, location of trauma, and need for intravenous fluids or epinephrine. Data were analyzed using multiple linear regression. Results: A total of 185 charts were reviewed. The mean ISS was 11.3; the mean glucose was 162.8 mg/dL. After adjusting for age, gender, HR, SBP, and administration of epinephrine or fluid bolus, a significant direct relationship between serum glucose and ISS was found ( r = 0.52, P < .01). A stronger relationship was found in children less than 2 years old ( r = 0.60, P = .04). Conclusions: A significant direct relationship exists between glucose and ISS in children with multiple trauma. High glucose values may indicate more severe injury, especially in children less than 2 years old.

Impact of race and ethnicity on ischemic stroke. The University of California at San Diego Stroke Data Bank.

As the US minority population continues to grow, increasing numbers of nonwhite citizens are at risk for stroke. A better understanding of how ischemic stroke differs in the minority populations may lead to more effective clinical management. We prospectively evaluated 542 consecutive patients (416 whites, 71 Mexican Americans, 55 blacks) presenting to the University of California at San Diego Medical Center or the San Diego Veterans Affairs Hospital with presumed acute ischemic stroke or transient ischemic attack. Whites had a higher proportion of transient ischemic attacks (32% versus 18% and 17% for blacks and Mexican Americans, respectively) and had the lowest prevalence of diabetes mellitus (17% versus 29% and 40% for blacks and Mexican Americans, respectively). Mexican Americans had higher initial serum glucose levels (178 versus 133 and 131 mg/dL for whites and blacks, respectively). Blacks were youngest (average age, 56 years). There were no differences among the groups in the prevalence of prior stroke, hypertension, myocardial infarction, or smoking; initial systolic blood pressure, serum cholesterol levels, and functional deficit also were similar. Although it did not reach statistical significance, there was a trend toward relatively late presentation in the black stroke subpopulation: only 53% of blacks (compared with 73% of both Mexican Americans and whites) reached medical attention within 24 hours of stroke onset. All groups had similar diagnostic evaluations and functional outcome at 1 week. With the exception of a higher frequency of stroke of unknown cause in Hispanics, the distributions of stroke etiologies did not differ significantly among the groups. These data suggest that there are significant clinical differences in populations with ischemic stroke and transient ischemic attack that are related to race and ethnic origin, but in our population these differences did not include the extent of diagnostic evaluation undertaken or stroke severity.

Relation of hyperglycemia early in ischemic brain infarction to cerebral anatomy, metabolism, and clinical outcome

We studied the relation of serum glucose level measured in the first 12 hours of symptoms to the clinical findings, results of computed tomography (CT), and patterns of cerebral metabolism in 39 patients who had acute ischemic cerebral infarction. Structural damage was assessed by CT. Metabolic disruption was assessed using 18F-fluorodeoxyglucose and positron emission tomography (PET). Median initial serum glucose concentration was 155 mg/dl (6.7 mM). Clinical recovery was significantly poorer in patients with initial serum glucose levels higher than the median (p less than 0.05, chi square). PET tended to show normal results or minor abnormalities in patients with initial glucose levels less than the median, as opposed to lobar or multilobe abnormalities in patients with levels that were higher than the median (p less than 0.05, Kendall's Tau b). The severity of hypometabolism in the ischemic region, expressed as the percent asymmetry of local cerebral glucose metabolism between homologous brain regions, was greater in patients with initial glycemia concentrations higher than the median (p less than 0.001, t test). Relationships of serum glucose level with metabolic derangement and structural damage, but not outcome, held true in patients without a history of diabetes mellitus.

Reactive hyperglycaemia in patients with acute stroke

Initial and follow-up fasting serum glucose levels following acute stroke were evaluated retrospectively in 392 selected hospitalized patients. Transitory reactive hyperglycaemia was observed in a large number of patients (28% of the total series) without a history of diabetes prior to the acute cerebrovascular event. The data from this group suggest a possible relationship between the impairment of carbohydrate metabolism and the type and location of stroke since both the frequency and severity of the hyperglycaemic response were higher in patients with haemorrhagic stroke and brainstem infarction as compared with cerebral infarction. The incidence and degree of the reactive hyperglycaemia were also related to the severity of the acute stroke. There were more comatose patients in the group showing this phenomenon. Initial serum glucose levels in the latter group were higher in unconscious patients than in alert ones. In addition, hospital mortality was significantly higher in these patients. Transitory reactive increases of serum glucose levels were also observed in the majority of patients with a history of overt diabetes prior to the acute stroke. The hyperglycaemic reaction following acute stroke may be attributed to several underlying mechanisms. These include: a non-specific reaction to acute stress and tissue injury with the associated autonomic, hormonal and metabolic alterations; uncovering of underlying latent diabetes by the acute stroke; increased secretion of growth hormone due to stroke-induced hypothalamic dysfunction; and irritation of the glucose regulatory centres in the hypothalamus and brain stem by blood-laden cerebrospinal fluid or local ischaemia.