Delayed Versus Early Antihyperglycemic Treatment for Severe Stroke

Inclusion Criteria: 1. Age ≥ 18 years; 2. Severe stroke within 24 hours of onset, meeting one of the following criteria: 1）Severe ischemic stroke: Glasgow Coma Scale (GCS) score ≤ 12 or National Institutes of Health Stroke Scale (NIHSS) score ≥ 15 or CT hypodensity \> 1/3 of middle cerebral artery (MCA) territory; 2）Severe intracerebral hemorrhage: Supratentorial hematoma volume ≥ 30 mL (thalamic hemorrhage ≥ 10 mL) or infratentorial hematoma volume ≥ 10 mL (brainstem hemorrhage ≥ 5 mL); 3）Aneurysmal subarachnoid hemorrhage; 3. Blood glucose level \> 10 mmol/L at randomization; 4. Signed informed consent. Exclusion Criteria: 1. Known history of type 1 diabetes mellitus; 2. Known allergy to insulin or diagnosis of insulinoma; 3. Pre-stroke modified Rankin Scale (mRS) score \> 1; 4. Hemodynamic instability refractory to medical treatment (systolic blood pressure \< 90 mmHg or diastolic blood pressure \< 60 mmHg); 5. Decompensated heart failure (New York Heart Association \[NYHA\] class III or IV); 6. Estimated glomerular filtration rate (eGFR) \< 30 mL/min; 7. Expected survival \< 90 days due to malignancy; 8. Participation in another drug or device clinical trial within the past 30 days; 9. Women of childbearing potential who refuse to use effective contraception despite negative pregnancy test, pregnant women, or breastfeeding women.