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Objective This study aimed to investigate the short- and long-term prognostic effects of glycemic management on stroke recurrence and mortality in patients with acute first-ever ischemic stroke (FIS) without previous diabetes. Methods In total, 484,952 patients aged ≥20 years with FIS and nonprevious diabetes were retrieved from the 2000 to 2015 Taiwan’s National Health Insurance Research Database. Patients were categorized into the following cohorts: FIS without hyperglycemia (FISw/oHG), FIS with hyperglycemia without glycemic treatment (FISHGw/oGT), and FIS with hyperglycemia with glycemic treatment (FISHGw/GT). The short-term (within 1 year) and long-term (at the endpoint of 9.3 ± 8.6 years) prognostic effects of glycemic treatment and blood glucose monitoring on stroke recurrence and mortality among the cohorts were tested through Cox regression analysis.Results The mortality risk was lower in the FISHGw/GT cohort than in the FISHGw/oGT cohort at 3 months, 6 months, and 1 year (adjusted hazard ratio = 0.68, 0.62, 0.69, respectively, p < 0.001) as well as at the study endpoint, but no difference was observed in stroke recurrence at any time point (p > 0.05). Furthermore, compared with FISHGw/oGT without blood glucose monitoring, FISHGw/GT combined with blood glucose monitoring led to decreased risks of stroke recurrence within 1 year (p < 0.001) and mortality within 1 year and at the study endpoint (p < 0.001). Conclusion For optimal glycemic management in the acute phase and improved prognoses for patients with FIS and nonprevious diabetes with hyperglycemia, intensive blood glucose monitoring combined with glycemic treatment is needed.