• Change in infarct volume at Week 1 from baseline as measured on diffusion - perfusion magnetic resonance imaging
  
• Analyses of group mean infarct volume and the mean percent change from baseline to Week 1
  

• Blood sugar: at hour 0.25, 0.5, 1, 2,4,6,8,12,16,20,24, 36, 48
  
• Coagulation Studies at hour: 0, 6,12,24,48
  
• Neurological Assessment hr 0, 48, week 1 and week 12: NIHSS, Barthel Index, Modified Rankin Score
  
• Mortality rates
  

Insulin, by lowering blood glucose levels, has been shown to rescue ischemically threatened but potentially viable tissue of the penumbra surrounding the core of dead tissue. Insulin appears to act directly on the neuron and indirectly by lowering peripheral blood glucose. It has proven effective in animal models of stroke, and has a favorable toxicologic and cardiovascular profile. Dosing in this study will be individualized. The initial dose and subsequent doses will be modulated to maintain serum glucose levels between 80 and 110 mg/dL.

The first objective of this study is to determine the safety and efficacy of intravenous insulin versus Standard Treatment in patients with suspected cerebral infarction. The primary outcome parameter will be infarct volume at Week 1 as measured on diffusion - perfusion magnetic resonance imaging.

Secondary analyses of efficacy will be the effect of insulin on neurologic function as measured by the Modified Rankin Scale, the National Institutes of Health Stroke Scale, and the Barthel Index. Analysis of safety will include analyses of physical exam, adverse events, vital signs, laboratory data, hemorrhage and reinfarction rates and mortality rates.