Potential link between post-acute ischemic stroke exposure to hypoglycemia and hemorrhagic transformation

Kyle D. Klingbeil, Sebastian Koch, Kunjan R. Dave

Research output: Contribution to journalReview articlepeer-review

11 Scopus citations


Hemorrhagic transformation is a severe complication of acute ischemic stroke owing to its limited treatment options and poor prognosis. In the last decade, the rates of hemorrhagic transformation incidence have been associated with blood glucose levels. In particular, hyperglycemia at the time of admission has been associated with increased rates of hemorrhagic transformation in acute ischemic stroke patients. Recent pilot clinical trials have attempted to use intensive insulin therapy during stroke treatment to reduce the severity of cerebral infarction and possibly alleviate the risk of hemorrhagic transformation. However, the results of these studies have shown no clear clinical benefit. In addition, intensive insulin therapy has increased rates of hypoglycemia which may be associated with larger infarct growth. We hypothesize that hypoglycemia, similarly to hyperglycemia, is a risk factor for worse outcomes in acute ischemic stroke by promoting hemorrhagic transformation. This review serves to call attention to patterns present within intensive insulin therapy trials and shed light into the pathophysiological effects of hypoglycemia. It is critical that efforts be directed toward the prevention of hemorrhagic transformation by optimizing insulin therapy during the treatment of acute ischemic stroke.

Original languageEnglish (US)
Pages (from-to)477-483
Number of pages7
JournalInternational Journal of Stroke
Issue number5
StatePublished - Jul 1 2020


  • Intensive insulin therapy
  • acute ischemic stroke
  • cerebral hemorrhage
  • hemorrhagic transformation
  • hypoglycemic unawareness
  • iatrogenic hypoglycemia

ASJC Scopus subject areas

  • Neurology


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