Understanding the link between diabetes and stroke
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“The chance of having a stroke increases fourfold when you have diabetes,” says Dr. William Hills, a neurohospitalist at Eastern Idaho Regional Medical Center (EIRMC).
That’s a shocking statistic, but it’s accurate. According to the American Stroke Association, “every two minutes an American adult with diabetes is hospitalized for stroke. … People with diabetes are twice as likely to have a stroke as people without diabetes.”
At EIRMC, Dr. Hills has noted that 30% of stroke victims who come into the ER have diabetes. Interestingly, another 30% of their stroke patients are diagnosed with diabetes while being treated for the stroke. These numbers speak to the very strong link between diabetes and stroke risk.
Why are people with diabetes more at risk for stroke?
According to Dr. Hills, “the primary reason is endothelial dysfunction. Blood vessels are like a three-layer hose. There’s an outer layer, a middle layer and an inner layer. The inner layer is the endothelium, and it is very sensitive to high levels of glucose (sugar) in the blood. Over time, glucose irritates the endothelium, making the inside of the blood vessels thick and sticky. So as blood passes through, blood cells can adhere to the inside wall of the vessel and form a clot. The clot can break off and act like a snowball, rolling along and collecting more cells as it goes, and then it stops in the brain, causing a stroke.”
People with type 2 diabetes tend to have additional health issues that contribute to stroke risk, including include heart disease, high blood pressure, high cholesterol, and extra body weight.
Not only does diabetes raise the risk of having a stroke, it also increases the severity of a stroke. As Dr. Hills explains, “All measures of outcome are affected: longer hospital stays, higher readmission rates, higher mortality (death rate), lower rates of functional recovery. A stroke in a diabetic patient will likely cause more damage to the brain than it would in a person without diabetes.”
Whatever the cause, the symptoms of a stroke are all the same
Strokes caused by diabetes have the same symptoms as stroke caused by any condition:
- Weakness/numbness on one side of the body
- Double vision or trouble seeing
- Dizziness, trouble walking, balance problems
- Trouble speaking
- Severe, sudden headache
- Sudden confusion
Stroke or low blood sugar?
The above symptoms can also be caused by hypoglycemia (low blood sugar), which is common in people with diabetes who take insulin or certain medications.
“Low blood sugar can mimic almost anything neurologic,” explains Dr. Hills. “Glucose is the fuel for our brains to operate. The brain acts like it has had a stroke if it isn’t getting enough glucose. Hypoglycemia can even cause a seizure, which can cause one side of the body to be paralyzed.
“In the ER, before we give a thrombolytic to break up a possible clot, we check for low blood sugar and blood pressure. EMTs in the field will check both before physicians administer clot-busting medication.”
Because hypoglycemia and stokes can both be life threatening, Dr. Hills recommends that people experiencing any of the above symptoms should just call 911 rather than attempt to self-treat.
“Even if they suspect their blood sugar is low, they already know something is really wrong. If they try to treat themselves first and lose consciousness, then they can’t call for help,” he says.
Reducing stroke risk
Lifestyle changes that help improve overall health and wellbeing for people with diabetes also reduce risk of stroke. First and most important, says Dr. Hills, is “if you smoke, quit. Then, and this is just basic, control blood sugar levels. Watch dietary intake of carbs, get exercise, get good sleep. Regularly follow up with your primary care provider to manage glucose. And, super important, lose weight. I know these changes are hard, but they are very important.”
People with diabetes who have not yet had a stroke or heart attack should also have a conversation with their doctor about aspirin.
“The current recommendation regarding taking daily aspirin to prevent strokes is to only take it if you’ve already had a stroke or heart attack,” says Dr. Hills. He advises that “people with diabetes should talk to their provider about aspirin before self-medicating.”
The right care
EIRMC is a Primary Stroke Center certified by the Joint Commission and provides the most advanced stroke treatment in the area. Since “time is brain” when it comes to stroke care and the likelihood of surviving, EIRMC is the right place to receive care for stroke.