Stroke and Diabetes

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Stroke and Diabetes
Reviewed by physicians in the Department of Endocrinology at The Cleveland Clinic
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If you have diabetes, it’s important to understand your increased risk of stroke. Multiple studies have shown that people with diabetes are at greater risk for stroke compared to people without diabetes regardless of the number of health risk factors they have. Overall, the health risk of cardiovascular disease (including stroke) is two-and-a-half times higher in men and women with diabetes compared to people without diabetes.

What Is a Stroke?

Brain tissue needs a constant supply of oxygen and nutrients to keep nerve cells and other parts of the tissue alive and functioning. The brain relies on a network of blood vessels to provide it with blood that is rich in oxygen. A stroke occurs when one of these blood vessels becomes damaged or blocked, preventing blood from reaching an area of the brain. When that part of the brain is cut off from its supply of oxygen for more than three to four minutes, it begins to die.

There are two types of strokes: those that are caused by a rupture in an artery, also known as hemorrhagic stroke, and strokes which are caused by blockage of an artery, also known as ischemic stroke.

Risk Factors of Stroke

High blood pressure is the number one risk factor for stroke. Other risks include smoking cigarettes and high levels of LDL "bad" cholesterol.

When people with diabetes have a stroke, they often fare worse than individuals without diabetes. When the oxygen supply is cut off, other arteries can usually deliver oxygen by bypassing the blockage. In people with diabetes, however, many of the bypass arteries are also affected by atherosclerosis, impairing blood flow to the brain. Other risk factors may be responsible for poorer outcomes in people with diabetes following stroke, as well.

While death rates from strokes have decreased, it is unclear whether death rates from strokes have decreased in people with diabetes.
What Are the Symptoms of Stroke?

A stroke is an emergency whether you have diabetes or not. If you experience any of these symptoms, call 911 immediately. You must get to the hospital as soon as possible.

* Sudden numbness or weakness in the face, arm, or leg (especially on one side of the body).
* Difficulty speaking or understanding words or simple sentences.
* Sudden blurred vision or decreased vision in one or both eyes.
* Sudden difficulty swallowing.
* Dizziness, loss of balance or becoming uncoordinated.
* Brief loss of consciousness.
* Sudden inability to move part of the body (paralysis).
* Sudden, unexplainable, and intense headache.

What Is the Treatment for Stroke?

One FDA-approved treatment for ischemic stroke is a clot buster drug called tPA. This drug must be given within the first three hours after stroke symptoms begin for it to work. This drug dissolves the clot that has clogged an artery and can reestablish blood flow to brain tissue. Also, there are several new and experimental drugs that may stop -- and even reverse -- the brain damage if administered immediately after a stroke.

What Is the Treatment for Stroke?

Another option is carotid endarterectomy, or surgical removal of the plaque from inside the carotid artery (the artery that supplies much of the blood to the brain).

A less invasive treatment is a carotid angioplasty and stenting procedure, which may be appropriate for some patients who have blockages within the carotid arteries. This involves inserting a deflated balloon into the artery, inflating it to expand the artery walls and then inserting a mesh structure (stent) to hold the artery open.

Angioplasty of the cerebral arteries can also be performed.

The FDA has approved another technology, the Merci Retrieval System, which can remove the blood clot up to 8 hours after the stroke.
How Can Stroke Be Prevented in Diabetes?

If you have diabetes and your doctor suspects that you have atherosclerosis (hardening of the arteries), he or she may suggest changes in diet and lifestyle, as well as certain medicines that may help to prevent the blockages that cause stroke. Other ways to reduce your risk of stroke include:

* Don't smoke.
* Have your cholesterol checked (especially your "bad" LDL-cholesterol) and if necessary, lower your levels by limiting the amount of fat and cholesterol you eat. The target should be an LDL level of less than100 mg/dl (milligrams per deciliter). Some experts recommend even lower levels (less than 70 mg/dl) for those considered very high risk.
* Limit the amount of alcohol you drink.
* Have your blood pressure checked and control your blood pressure, if necessary.
* Follow your health care provider's instructions for changing your diet.
* Follow your health care provider's instructions for taking preventive medicines.
* Take daily aspirin therapy* as prescribed by your doctor

*Low-doses of aspirin (81- 325 mg of aspirin a day) is recommended for men and women with diabetes who are over age 30 and are at high risk for heart disease, peripheral vascular disease, and stroke. Talk to your doctor to determine if aspirin therapy is right for you. If you have certain medical conditions, aspirin therapy may not be recommended.

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