Preventing and Spotting Strokes
What people with diabetes need to know about "brain attacks"
The human brain has countless jobs, from triggering hunger pangs to composing symphonies. Its crazy workload requires a lot of power or, more precisely, circulating blood, to provide it with nutrients, oxygen, and chemical information about what's going on elsewhere in the body. A stroke can cut off that blood supply, putting the brain's health in jeopardy. Diabetes increases the risk of stroke by two to four times. This makes it critical for people with diabetes to take steps to prevent stroke, recognize its symptoms, and know how to react quickly if one occurs.
A stroke happens when blood flow to a part of the brain is interrupted. Without blood, the brain is damaged and vital functions may quickly be lost. There are two main types of stroke: ischemic and hemorrhagic. Ischemic strokes, the most common variety, occur when a blood clot blocks a blood vessel in the brain and cuts off the flow. Hemorrhagic strokes are caused by a blood vessel breaking and bleeding into the brain, often because of a structural weakness. There are also transient ischemic attacks, or TIAs, mini strokes caused by a brief interruption of blood flow to the brain.
The link between diabetes and stroke is probably atherosclerosis, the narrowing of blood vessels due to a buildup of fat, cholesterol, and other gunk. Diabetes increases the risk of atherosclerosis, for reasons that aren't entirely understood. The result can be a heart attack (caused by a blockage, somewhat like an ischemic stroke) or a stroke, which is, in effect, a brain attack.
Blood clots are more likely to form if blood has to maneuver through clogged arteries. A clot that forms in the brain, blocking blood flow, causes a thrombotic stroke. An embolic stroke is triggered by a clot that forms elsewhere in the body and travels to the brain.
Genes, race, gender, and age—all factors you can't control—can affect your susceptibility to stroke. Yet there are critical things you can do to protect your brain. First, don't smoke. Second, bring down high blood pressure (hypertension), the No. 1 risk factor for stroke. The American Diabetes Association recommends keeping blood pressure under 130/80 mmHg through a combination of healthy eating, exercise, and medication.
Keeping cholesterol and triglycerides (blood fats) at optimal levels can also reduce stroke risk. Taking cholesterol-lowering statins is believed to help stave off strokes in people with diabetes, especially in those with additional stroke risk factors.
Atrial fibrillation, a heart condition more common with age, may precipitate a stroke. The hearts of people with atrial fibrillation may quiver instead of beat, which can cause blood to clot in the heart. These clots can then travel to the brain. People with atrial fibrillation should talk to their doctors about taking anti-clotting medications to help guard against stroke.
If you suspect that you or someone else is having a stroke, it's critical to get immediate medical care, even if the symptoms dissipate. The sooner the treatment, the better the chance of survival and a full recovery. With a stroke, symptoms are likely to come on rapidly, though in some cases they occur intermittently for a couple of days and get progressively worse. Signs to watch for include:
- Numbness, weakness, or tingling on one side of the body
- Confusion and trouble speaking, swallowing, or understanding
- Problems with taste, smell, vision, or hearing
- Dizziness or trouble walking
A January 2011 study in the Journal of the American Medical Association found that the chances of surviving a stroke are better at hospitals with a certified stroke center.
At the hospital, a doctor may test vision, movement, blood pressure, and other body functions to determine what type of stroke, if any, has occurred and its location in the brain. A CT scan, MRI, or both may be done to get a better look. A CT scan would reveal any bleeding in the brain, allowing the doctor to determine the type of stroke.
A stroke caused by a blood clot may be treated with drugs that dissolve clots, such as tPA, or tissue plasminogen activator. This medication must typically be administered within three hours of the stroke, which is one reason it is critical to promptly seek medical attention. If bleeding caused the stroke, blood thinners such as aspirin may make it worse, so a CT scan is done to rule out hemorrhage first.
In some cases, the medical staff may evaluate a stroke with angiography, a technique that allows doctors to examine blood vessels, followed by restoring blood flow using stents or other devices if a clogged artery can be identified.
After the emergency measures to renew blood supply to the brain, treatment will focus on alleviating problems that may have resulted from stroke damage. This may involve speech therapy, physical therapy, swallowing therapy, or some combination.
Regaining functions lost during a stroke can take time, often weeks or months. Some people will continue to recover for years. One focus of long-term treatment is preventing a second stroke, which is most likely to occur relatively soon after the first one. Depending on a stroke's type and severity, there may be some permanent loss of function. But more than half of people who have a stroke can live independently afterward.
Medicine has come a long way in saving the lives of stroke victims, and the chances of fully recovering from a stroke are better now than ever. Retraining the brain after a stroke can be a frustrating and difficult endeavor, but the brain does show remarkable resilience and an ability to "rewire" itself. With an eye on prevention and a handle on stroke symptoms, people with diabetes can mount a good defense against an attack on the brain.