Diabetes and stroke: Know the risks

There is a strong link between diabetes and stroke. Diabetes is a condition that causes high blood sugar. This chronic disease occurs when your body does not make enough insulin or doesn't use insulin the way it should. As a result, blood sugar levels rise and can lead to serious health conditions such as heart disease, kidney disease, vision loss and stroke.

Diabetes and stroke risk

Eighty-seven percent of strokes are ischemic and occur when a clot in a blood vessel blocks blood flow to the brain. Hemorrhagic stroke is far less common and occurs when a blood vessel bursts or leaks. If you have diabetes, your stroke risk is about two times higher than that of a person who does not have diabetes. You are also at risk of developing heart disease and stroke at an earlier age.

Diabetes increases stroke risk because of the way your body manages blood glucose. After you eat, food is broken down into glucose to produce energy for the body. The pancreas, a pear-shaped organ behind the stomach, makes two hormones, insulin and glucagon, which help regulate blood sugar. When blood sugar levels in the blood rise from glucose, the pancreas releases insulin to bind the insulin receptors. Then, the cells open to take in the glucose. When the body doesn’t produce enough insulin or the cells can't use insulin properly, blood sugar levels remain high.

Over time, high blood sugar levels can damage your blood vessels and contribute to fatty deposits and blood clots. If blood vessels in the brain or neck become narrowed or blocked, blood flow and oxygen can be interrupted, causing a stroke.

If you have diabetes, smoking can further increase your risk of stroke. Other factors that increase the risk of stroke include:

• Extra belly fat (a waist of more than 40 inches for men and more than 35 inches for women)
• High blood pressure
• High cholesterol

Stroke signs and symptoms

When you have diabetes, the symptoms of stroke are the same as they are for people without diabetes. They include:

• Sudden numbness or weakness in the face, arm or leg — usually on one side of the body
• Sudden confusion, difficulty speaking or trouble understanding speech
• Sudden vision problems in one or both eyes
• Sudden trouble walking, dizziness, impaired coordination or loss of balance
• Sudden severe headache with no obvious cause

Diabetes and mini stroke (TIA)

A mini stroke, also called a transient ischemic attack (TIA), presents with the same symptoms as a stroke, but the symptoms are brief. While TIAs don't cause permanent damage, they are serious and should be treated as a warning sign of future stroke.

Transient ischemic attacks occur when blood flow to part of the brain is briefly blocked. When the blockage clears, the symptoms go away. Most TIA symptoms last less than five minutes.

Even if symptoms disappear, it is important to seek medical treatment immediately. One-third of people who have a TIA go on to have a severe stroke within a year.

Recognizing stroke symptoms

Recognizing stroke symptoms and seeking treatment as soon as possible can be lifesaving. The acronym F.A.S.T. can help you identify common warning signs.

• F — Face: Ask the person to smile. Look for facial drooping.
• A — Arms: Ask the person to raise both arms. If one arm drifts downward, it may be a sign of stroke.
• S — Speech: Listen for slurred or garbled speech when repeating a simple phrase.
• T — Time: If any of the above symptoms are present, call 9-1-1 immediately.

Because some treatments are more effective when given as quickly as possible, it’s important to note when symptoms first appear. Never wait to see if symptoms improve. Call for help immediately. Don't try to drive someone having a stroke to the hospital. Call 9-1-1 so treatment can begin as soon as possible.

Diabetes and stroke prevention

Having diabetes raises your risk of stroke, but there are ways to reduce your risk.

• Consume a healthy diet. Aim for 14 grams of fiber for every 1,000 calories and reduce cholesterol as low as possible.
• Avoid smoking or vaping. Tobacco use damages blood vessels, increases plaque buildup and raises the risk of blood clots.
• Maintain a healthy weight. Excess weight, especially around the abdomen, is linked to high blood pressure, atherosclerosis and other stroke risk factors.
• Stay physically active. Regular exercise can help manage blood sugar, lower blood pressure, improve cholesterol levels and support a healthy weight. Talk with your doctor before beginning a new exercise program.
• Drink alcohol in moderation. Excessive alcohol use can increase the risk of health conditions that contribute to stroke.
• Manage stress. While stress can’t always be avoided, healthy coping strategies may support overall heart and brain health.
• See your doctor regularly. Routine checkups, including monitoring A1C levels, blood pressure and cholesterol, can help identify problems early and support stroke prevention.

Stroke treatment

Prompt treatment can improve outcomes after a stroke. For some ischemic strokes, clot-busting medication may be used if treatment begins within the appropriate timeframe. Other treatments may be available depending on the type of stroke and individual circumstances.

Hemorrhagic stroke may require surgery or specialized procedures to stop bleeding and repair a weakened or burst blood vessel.

Stroke recovery after diabetes and stroke

Diabetes may be associated with more complicated recovery after an ischemic or hemorrhagic stroke. This can include higher mortality, worse outcomes, longer hospital stays, more readmissions and greater recurrence of stroke.

Inpatient rehabilitation is beneficial for almost all who are recovering from a stroke and should start soon after a stroke. Patients may receive a combination of physical, occupational and speech therapy, along with care from rehabilitation physicians and other specialists. A registered dietitian can also help patients manage diabetes during recovery.