Diabetes and Stroke
A stroke occurs when the blood supply to the brain is cut off. This can happen when a blood vessel to the brain ruptures. This is called hemorrhagic stroke. Or it can occur when a blood vessel that supplies the brain is blocked. This is an ischemic stroke.
Eighty percent of all strokes are ischemic. A stroke deprives the brain of the oxygen and nutrients it needs to function. The severity of the stroke depends on how long the brain is deprived of oxygen and what part of the brain is affected. Sometimes a temporary interruption of blood flow, called a transient ischemic attack, can serve as a warning sign that a stroke is imminent or that there is a partial blockage of blood to the brain.
The arteries that supply blood to the brain can become blocked for many reasons, much like the arteries to the heart can clog up. Atherosclerosis, a condition in which the linings of the brain arteries become blocked with deposits of cholesterol and fat, is common. Atherosclerosis can occur in the large arteries that supply the brain or the smaller arteries within the brain.
Ischemic stroke can also be triggered by a blood clot that breaks loose from the heart and lodges within an artery in the brain. Stroke often occurs in people with hematologic or blood abnormalities. In such cases, blood is much more adhesive or stick and much more likely to form clots. This is especially true among people with diabetic kidney disease.
People with diabetes are at an increased risk of experiencing an ischemic stroke compared to those without diabetes and they tend to fare worse after the stroke. Compared to the general population, people with diabetes are more severely disabled by stroke, are more likely to have another stroke, and are more likely to die from stroke. This is true whether you have a type 1 or type 2 diabetes. However, the good news is that you can reduce your risk of stroke by taking steps to keep your blood glucose under control and by minimizing the effects of other risk factors that also contribute to stroke.
DIABETES STROKE SYMPTOMS
Sometimes, but not always, the first warning that a stroke is imminent is a transient ischemic attack. About 20% of all people who have a stroke first experience a transient ischemic attack. The symptoms of a transient ischemic attack and stroke are similar, but a transient ischemic attack usually lasts only 5 to 15 minutes. However, it is important to pay attention to the symptoms of a transient ischemic attack, because they can mean that a stroke is about to occur.
Symptoms and signs of a transient ischemic attack and stroke include a sudden weakness or numbness in the face, arm or leg on one side of the body. In rare instances, both sides of the body can be affected. You may feel this weakness as a sort of heaviness or clumsiness in the arm or leg. Or you could feel as though one side of your face is drooping. You might also experience a sudden sense of dimness or loss of vision, especially in one eye.
Some people describe this as a haze, fog or fuzziness over one eye. You may sense a loss of vision from the top to the bottom. If you are having a stroke or transient ischemic attack, you may also notice that your speech is slurred or that you have trouble articulating your words. Others may notice your speech difficulty. You may also have trouble understanding what others are saying to you or you may have trouble reading or writing.
You may also feel dizzy, unsteady or have trouble walking. If you are having a stroke, you may feel any combination of these symptoms or only an isolated symptom. Some people are overcome with sudden violent headache that seems to come out of nowhere. Headaches accompany ischemic stroke about 20% of the time.
DIABETES STROKE RISKS
Approximately over half a million people have stroke each year. People with diabetes are twice as likely to experience a stroke as someone without diabetes. Other factors that increase the risk are advancing age, a family history of stroke (especially if there is also a family history of high blood pressure), diabetes, high cholesterol or blood lips, sex and race. Men are more likely than women to have a stroke, but women with diabetes are at a higher risk than men with diabetes. African Americans are 60% more likely to experience stroke compared to Caucasians.
High blood pressure is the major risk factor for stroke. High blood pressure is defined as any reading greater than 130/85. Smoking can also increase the risk of stroke. Men who smoke are 40% more likely to have a stroke, and women who smoke are 60% more likely to have a stroke.
For women, taking birth control pills increases the risk of stroke, and women who smoke and take birth control pills are 22 times more likely to suffer from stroke. High cholesterol and blood lipids also increase the risk of stroke, although the effect on stroke is not as great a risk factor as it is for heart disease. Heart disease can also increase the likelihood of stroke. Certain drugs that are known to increase blood pressure, such as cocaine, LSD and amphetamines, can also trigger stroke. Heavy drinking, which also increases blood pressure, makes stroke more likely.
What You Should Do
If you experience any of the symptoms of stroke, call your doctor right away. If you cannot reach your doctor, call for emergency help at once. If your symptoms disappear, do not dismiss them. They may signal an impending acute stroke. Depending on the severity of your symptoms, you may be admitted immediately to a hospital or advised to see your doctor. It is extremely important to have your situation evaluated as soon as possible. Do not delay!
DIABETES STROKE TREATMENT
Whether you are experiencing a stroke or a transient ischemic attack, you will probably be admitted to a hospital. Your doctor can most likely diagnose your stroke based on your symptoms, history and physical examination. The treatment will depend on what caused the stroke. You may have a computed tomography (CT) scan performed. This provides an image of the brain and can reveal whether the stroke is caused by bleeding (hemorrhagic) or an arterial blockage (ischemic).
A magnetic resonance imaging (MRI) scan can help your doctor identify places in the brain affected by stroke that cannot be viewed by a CT scan. Your doctor may also perform a carotid artery duplex scan, which uses ultrasound to look for blockages in the carotid arteries of the neck.
If the stroke or transient ischemic attack is caused by a blood clot that becomes lodged in a narrowed artery, it is very likely that another stroke will follow. Your doctor will try to treat the problem that is causing the blood clots to form. If your heart is beating irregularly, for example, blood clots can form and find their way to the arteries that supply the brain.
Your doctor may perform an electrocardiogram to check your heart rhythm or an echocardiogram to see if clots are visible within the chambers of the heart. Your blood may also be tested to rule out the possibility that problems with blood coagulation could be contributing to the problem. Your blood glucose will also be tested to rule out the possibility that low blood glucose may be triggering the symptoms that mimic stroke.
If your stroke is in its early stages and your doctor determines it is due to a blood clot, and not a hemorrhage, you may be given certain drugs that prevent clot formation or dissolve existing clots. Anticoagulants such as heparin and warfarin may help patients who have had a transient ischemic attack or who are in the early stages of a stroke. For example, some strokes begin slowly and progress over several hours or even days. An anticoagulant may prevent further clot formation.
However, most strokes happen rapidly with the damage occurring within minutes. Anticoagulant therapy is of little use in this situation. Anticoagulants are also dangerous for people with high blood pressure and for people who have had a hemorrhagic stroke.
Recent studies have shown great promise with new drugs in preventing paralysis and some of the major disabilities of stroke. Drugs such as tissue plasminogen activator and streptokinase work by breaking up or dissolving clots that already exist. They must be given within 3 hours of the onset of symptoms of stroke and cannot be given to patients with hemorraghic stroke.
Your doctor may also suggest a surgical treatment. If your stroke or transient ischemic attack is caused by a blockage in the carotid artery, you may be a candidate for a carotid endarterectomy. In this procedure, the carotid artery in the neck is opened and a layer of cholesterol plaque in the artery is removed. This surgery is helpful to people who have had a narrowing of the artery.
If your arteries are less than 30% blocked or completely blocked, this surgery is beneficial. It is not yet known whether carotid endarterectomy can benefit those with a 30% to 70% narrowing of the carotid artery. This surgery is not recommended if you have poor heart or lung function, which puts you at risk for complications from surgery. People with diabetes who have retinopathy, nephropathy, congestive heart failure, heart valve disease, or peripheral vascular disease may be at high risk for complications of surgery.
Surgical and medical treatments for stroke can benefit those in the early stages of stroke and those with a transient ischemic attack, and they may help prevent another, more severe, stroke from occurring. But they will not help a stroke that has already occurred. Once the blood supply to the brain has been shut off, the damage to the brain cannot be reversed. However, rehabilitation can help patients regain function. The brain is a remarkable organ and other parts of the brain can be trained to take over for damaged parts.
Many people find that with rehabilitation they can resume normal day-to-day living for years to come. Others are never able to overcome the disabilities of stroke and may have problems eating, speaking or moving. About 20% of those who have a stroke die in the hospital. This is especially true among the elderly.
Rehabilitation can begin as soon as blood pressure, pulse and breathing are stable. Doctors, nurses and occupational and physical therapists may work with you in the hospital to keep your muscles strong and maintain flexibility. You may be given specific exercises to do on your own. Once discharged, you may continue with a program of physical therapy on an outpatient basis or you may be transferred to a rehabilitative center for more intensive therapy. Your therapist can help you make the transition from the hospital or rehab center to living at home
DIABETES STROKE PREVENTION
Many of the treatments for stroke are aimed at preventing a second stroke. If you have had a stroke, your doctor may suggest anticoagulant therapy or carotid artery surgery, as discussed above. You may also be treated for any heart problems that are causing clots to form.
Your doctor may also recommend long-term aspirin therapy. Aspirin is a platelet antiaggregant. It thins the blood by preventing blood platelets from sticking to each other. This reduces the likelihood of clot formation. A daily low dose of aspirin has been shown to reduce the risk of stroke by 30%. Talk to your doctor about whether this would be advisable for you.
Your doctor will recommend a specific dose that suits your need. Many people complain of upset stomach when using aspirin and some experience gastrointestinal bleeding. If this is the case, your doctor may suggest an alternative.
If you have been on aspirin therapy but continue to have transient ischemic attacks, or even a stroke, your doctor may recommend ticlopidine (Ticlid). Like aspirin, ticlopidine inhibits platelet aggregation, but it does not cause gastrointestinal problems. It is stronger than aspirin and is a potent inhibitor of platelet aggregation.
In people with diabetes, it also slows the progression of diabetic retinopathy. However, ticlopidine is more expensive than aspirin and has other side effects. It can cause diarrhea and skin rash. It can also reduce the number of neutrophils or infection-fighting white blood cells, in the body, a condition known as neutropenia. This is a potentially fatal side effect, but it is reversible if detected early enough. Blood tests should be performed every 2 weeks for at least the first 3 months of therapy.
In addition to surgery and blood-thinning medications, you can also prevent stroke by making lifestyle changes and minimizing the effects of other contributing risk factors. These include quitting smoking, controlling high blood pressure, lowering blood lipid and blood cholesterol levels and treating heart disease, such as coronary artery disease, congestive heart failure, atrial fibrillation and other heart-rhythm disturbance.
If you drink alcohol to excess, it can also increase blood pressure and increase the risk of stroke. Therefore, try to drink alcohol in moderation. Also, avoid the use of drugs such as cocaine and amphetamines that also increase the risk of stroke.
If you have diabetes, your risk of stroke is two to three times greater than that of someone without diabetes. It is not yet known whether controlling blood glucose levels actually reduces the risk of stroke, but it is a good idea to keep blood glucose under control.
Sources and References
The Diabetes Problem Solver—Quick Answers to Your Questions About Treatment and Self-Care by Nancy Touchette
Diabetes and Stroke: Epidemiology, Pathophysiology, Pharmaceuticals and Outcomes by Rong Chen, Bruce Ovbiagele and Wewei Feng
Management of Acute Ischemic Stroke by Franziska Herpich and Fred Rincon
Rich Health Editorial Team
Rich Health Editorial Team is made up of medical practitioners and experienced writers who provide information for dealing with health issues in a simple and easy-to-understand manner
Share This Article: