Ischemic stroke is a heterogeneous disease with numerous underlying pathologies contributing to its pathogenesis. The association between diabetes mellitus and ischemic stroke is well established. Population-based studies suggest that diabetes is one of the most important modifiable risk factors for stroke. Having type 2 diabetes mellitus (T2DM) alone increases the risk of stroke 1.5- to 4-fold and is associated with unfavorable clinical outcomes.1 On the other hand, individuals presenting with ischemic stroke are more likely to have diabetes, with a prevalence reaching nearly 30%.2 The relative contribution of diabetes to the risk of different ischemic stroke subtypes is, however, less well known. Furthermore, there is conflicting evidence on the association of hyperglycemia in the prediabetic range with an elevated stroke risk.3,4 Whether other metabolic markers of pathogenic states such as insulin resistance or β-cell dysfunction alone can be considered risk factors for ischemic stroke is still a matter of debate.