Diabetes and Stroke

A stroke is a medical condition that can affect diabetics and non diabetics alike.  Yet, for diabetics, the chance of having one is 2 to 3 times greater.[1] Moreover, those with diabetes who suffer a stroke are at greater risk of both disability and death.[2]

What is a Stroke?

A stroke is the popular term for a cerebro-vascular accident or CVA. It is a life changing and life threatening disease or medical event that can sometimes be preventable.

There are several types stroke or a stroke warning sign. These are:

  • Ischemic stroke – This is the most common type caused by a blocked brain artery and leading to tissue damage due to lack of nutrients and oxygen. Symptoms depend on which artery was blocked and what part of the brain is deprived of oxygen.
  • Transient ischemic attack (TIA) – The TIA is a brief and temporary blockage of blood flow to the brain. It is not technically a stroke but has similar symptoms. It is considered to be an early warning sign the person may eventually experience a stroke.
  • Hemorrhagic stroke – This is a severe stroke in which a blood vessel in the brain leaks or breaks. The most common causes of this kind condition are high blood pressure and ruptured aneurysm.

What are the Risk Factors for Stroke?

Risk factors for stroke are the same as risk factors for other vascular conditions. A stroke is after all the result of a blocked blood vessel that happens in or near the brain and is not primarily a condition of the brain itself.

Your risk factors for a CVA fall into two categories: those that you can change and those you cannot.

The risks that you cannot control include:

  • Age – 75% of all CVA’s occur after age 65. The risk doubles for each decade thereafter
  • A history of congestive heart failure (CHF)
  • A family history of stroke – increases risk of you having a stroke
  • Ethnicity or race – African-Americans are at double the risk of having a stroke compared to other races, while Hispanics have higher rates of high blood pressure which can lead to strokes

There are also risk factors that do fall under your control. These consist of

  • Smoking – stopping smoking to prevent damage to blood vessels
  • Diet – eating low fat and low sugar foods with high nutrient content
  • Blood pressure – ensuring you have normal blood pressure reduces your risk
  • Blood lipids – lowering fat in the blood to lower risk of artery blockages
  • Blood glucose – the better your control of your diabetes, the less your risk of a CVA
  • Medication – using medications (such as aspirn or plavix) only when directed by your doctor

What are the Causes of Stroke

The basic cause of a stroke is the interruption of the blood supply to the brain. The root cause may be atherosclerosis accelerated by conditions like diabetes and high blood pressure (hypertension).[3] Other causes include blood clots from a distant organ such as the heart – either from infected valves or larger clots within the heart. Individuals with irregular heart rhythms are more prone to clots while those with thick or viscous blood are more susceptible to stroke.

Another potential cause for cerebral vascular insufficiency is partial blockage of the major arteries in the neck. Called the carotid arteries, they carry oxygen filled blood to most of the brain. Stenosis, or narrowing of the carotids, can affect the brain. They could also be the starting place of an embolus in which a piece of tissue or other element like fat or plaque comes loose and blocks an artery leading to the brain.

Symptoms of Stroke

The CVA may occur without warning. Yet, it is probable that there have been small warnings that have gone ignored. The most common of these are called transient ischemic attacks (TIA).They are called “mini strokes” though technically they are not strokes because brain tissue is not destroyed. They are indicated by:

  • A sudden numbness or weakness to the arms, face or leg
  • Vision becoming blurry, dim or is lost all together
  • Speech becoming awkward
  • Failing to understand what anyone is saying
  • Suddenly developing a headache unlike any you have had before
  • Feeling dizzy or unsteady increasing the chances you could fall

If you develop any of the above symptoms, you should seek medical attention urgently, potentially calling 911.

Test for Stroke

There are several tests that can be used to test whether a stroke has occurred or if you are at risk of a stroke. The brain is examined using computed tomography (CT scan). You may also need to undergo Doppler studies of the arteries in your neck to ensure function and blood flows are satisfactory. The blood tests may reveal an increase in the thickness of blood or a tendency to clotting.[4] Sometimes, it is necessary to get an MRI to determine if any damage to the brain has occured.

Treatment of Stroke

The type of treatment will depend upon the origin and stage of the stroke. It is imperative the doctor determine whether the stroke is the result of a blood stoppage or a blood leak.

If it’s attributable to a stoppage in the artery and the doctor manages to locate it after only a very short period of time (typically less than 3 hours), the blockage might respond to “clot buster” treatments. Afterwards, the patient will usually be placed on blood thinning medications and cholesterol lowering agents. If, however, the CVA is the result of bleeding, the very last thing the patient requires is a blood thinner or anticoagulant. In certain circumstances, a surgeon will perform a carotid endarterectomy. This procedure eliminates a blockage located in the carotid artery of your neck.[5]

No matter which treatment you ultimately need, time is of the essence and it is vital that you get to medical care as soon as possible.

Preventive Measures – Treatment of Hypertension

One of the most significant comorbidities associated with diabetes is hypertension (raised blood pressure). When you have diabetes and hypertension, you have metabolic syndrome meaning more than one condition exists that is related to metabolic processes. If the individual has type 2 diabetes and vascular disease, it is essential he or she correct their blood pressure imbalance. In other words, you have to address blood pressure as a part of an overall regimen to avoid such things as cardiovascular problems and stroke or CVA. [6]

Stroke prevention may be accomplished with the help of your doctor and certain medications. It is necessary to reduce your blood pressure level to a norm of 130/80. This goal is lower than other patients who do not have diabetes because the combination of high blood pressure and diabetes can be so dangerous. This goal can be achieved by employing various medications. Yet, medication is not the complete answer. Keeping your blood pressure consistently at a normal level requires you take a multi-prong approach. This includes:

  • Weight reduction
  • Exercise (at least 150 minutes of moderate exercise per week)
  • Stopping tobacco use
  • Reducing alcohol intake
  • Cutting down on your salt intake

It’s important to use caution when implementing some measures, like weight reduction, for elderly patients. The reduction of their blood pressure should be achieved gradually. A combination of drugs often is utilized to achieve this result.

In addition to controlling your blood pressure, it is also important to closely control your diabetes and your cholesterol.

Stroke is a serious problem whether or not you have diabetes. Controlling your blood pressure is one of the most important steps you can take to prevent stroke.

References

[1] Meltzer, SJ; and Belton, AB (2009). Diabetes in Adults. Toronto: Key Porter Books.

[2] Tuomilehto J; and Salomaa, V. (2005). “Diabetes Worsens the Outcome Of Acute Ischemic Stroke.” Diabetes Research Clinical Practice, 69 (3):293-298.

[3] Marcovitch, H (2006). Black’s Medical Dictionary 41st edition. Lantham, Maryland: Scarecrow Press.

[4] Burant, C.F. editor (2008) Medical Management of Type 2 Diabetes 6th ed. Alexandria, VA: ADA.

[5] American Diabetes Association (2009). Type 2 Diabetes. Your Healthy Living Guide. Alexandria, VA: ADA.

[6] Levin, ME; and Pfeiffer, MA (editors) (2009). The Uncomplicated Guide to Diabetes Complications, 3rd ed. Alexandria, VA: ADA.

[7] This article was originally published July 12, 2012 and last revision and update of it was 9/10/2015.