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Related Concept Videos

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Diabetes mellitus is a chronic metabolic disorder characterized by hyperglycemia. The four categories of diabetes are type 1 diabetes, type 2 diabetes, other specific types of diabetes, and gestational diabetes.
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Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
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Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to inadequate insulin production, insulin resistance, or both. The condition affects millions worldwide and can significantly impact their health and quality of life.
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Without prolonged fasting, healthy individuals maintain blood glucose levels above 3.5 mM due to a well-adapted neuroendocrine counterregulatory system that effectively prevents acute hypoglycemia, a potentially life-threatening condition. The primary clinical scenarios for hypoglycemia encompass diabetes treatment, inappropriate production of endogenous insulin or insulin-like substances by tumors, and the use of glucose-lowering agents in non-diabetic individuals. Notably, hypoglycemia in the...
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A Mouse Model of Hemorrhagic Transformation Induced by Acute Hyperglycemia Combined with Transient Focal Ischemia
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The peripheral immune response in hyperglycemic stroke.

K Bettermann1, K Sinha1, R Kumari2

  • 1Department of Neurology, Penn State College of Medicine, Hershey, PA, USA.

Clinical Neurology and Neurosurgery
|July 19, 2020
PubMed
Summary
This summary is machine-generated.

Hyperglycemia in stroke patients alters immune cells, increasing neutrophils and decreasing lymphocytes. The neutrophil-to-lymphocyte ratio (NLR) predicts poor outcomes, suggesting immune modulation as a therapeutic target.

Keywords:
DiabetesImmune responseIschemic strokeNL ratioNeutrophils

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Area of Science:

  • Neuroscience
  • Immunology
  • Endocrinology

Background:

  • Hyperglycemia is prevalent in acute ischemic stroke patients, correlating with adverse clinical outcomes.
  • Previous attempts to aggressively lower blood glucose post-stroke have not improved outcomes, indicating other detrimental mechanisms.
  • The acute immune response following stroke may be dysregulated in hyperglycemic states, contributing to increased mortality and morbidity.

Purpose of the Study:

  • To investigate temporal changes in circulating immune cells after stroke.
  • To compare immune cell profiles in hyperglycemic versus euglycemic stroke patients.
  • To determine the association between immune cell dynamics and clinical outcomes in these patient groups.

Main Methods:

  • Retrospective analysis of 97 acute ischemic stroke patients (within 12 hours of onset).
  • Sequential measurement of blood neutrophil, monocyte, and lymphocyte counts for 96 hours post-stroke.
  • Assessment of clinical outcomes including NIH Stroke Scale, discharge disposition, and modified Rankin Scale (mRS) at 90 days.

Main Results:

  • Hyperglycemic patients exhibited significantly higher neutrophil counts and trending lower lymphocyte counts within 48 hours post-stroke compared to euglycemic patients.
  • Hyperglycemic patients experienced higher mortality rates, less favorable discharge dispositions, and worse 90-day neurological function.
  • The neutrophil-to-lymphocyte ratio (NLR) strongly correlated with neurological function at discharge in both groups, remaining significant up to 48 hours in hyperglycemic patients.
  • Multivariate regression confirmed NLR as a significant predictor of neurological outcomes in hyperglycemic stroke patients, independent of other factors.

Conclusions:

  • Circulating immune cells significantly contribute to poor clinical outcomes in hyperglycemic stroke patients.
  • The neutrophil-to-lymphocyte ratio (NLR) serves as a potent predictor of neurological outcomes specifically in hyperglycemic stroke patients.
  • Targeting and modulating the immune cell response presents a potential therapeutic strategy to enhance outcomes for this high-risk patient population.