Stroke and Diabetes

Stroke and Diabetes

Summary

Stroke is a life-threatening event in which a part of the brain is deprived of sufficient oxygen. Also called a cerebrovascular accident (CVA), stroke affects about 700,000 Americans each year. Individuals with diabetes are two to four times more likely to have a stroke than nondiabetics, according to the U.S. Centers for Disease Control and Prevention (CDC).

There are two kinds of stroke:

  • Ischemic strokes typically occur when a blood clot blocks an artery leading to the brain. The clot can either form inside the artery (a thrombus) due to atherosclerosis(when excess plaque forms on the inner arterial walls), or it can become lodged inside the artery as it travels through the bloodstream (an embolus). These types of stroke are called thrombotic stroke and embolic stroke, respectively.
  • Hemorrhagic strokes usually occur when blood from the arteries leaks into the brain after a rupture.

People with diabetes are at increased risk for stroke because excess glucose (blood sugar) or insulin (a hormone that regulates glucose) in the bloodstream can damage the arteries that deliver oxygen to the brain. Individuals with diabetes are also more likely to have high blood pressure, obesity, coronary artery disease and many other risk factors for stroke.

Symptoms can vary depending on which type of stroke occurs. Common symptoms of both ischemic stroke and hemorrhagic stroke include confusion, severe headache, nausea or vomiting. Stroke is an emergency that requires immediate medical treatment. Diagnosis typically begins with a prompt review of the patient’s medical history, followed by a CAT scan (computed axial tomography), which helps determine which type of stroke has occurred.

Immediate treatment of stroke involves tasks such as re-establishing blood flow to the brain, maintaining breathing in individuals who are losing consciousness and administering fever-reducing medications. Once the patient is stabilized, the physician will typically order additional tests. Patients often require rehabilitation to minimize neurological damage and maximize function in areas such as movement, speech, swallowing and memory.

Individuals can greatly reduce their risk for stroke by making lifestyle modifications similar to those recommended for preventing and controlling diabetes, such as controlling levels of weight, glucose, cholesterol and blood pressure. Researchers are exploring new methods for treating and preventing strokes.

About stroke and diabetes

Stroke, also known as a cerebrovascular accident (CVA), occurs when the blood supply to part of the brain is interrupted, causing the cells to die within minutes. Brain damage from stroke can continue for several days after the event. 

Stroke is the third-leading cause of death in the United States, affecting about 700,000 individuals each year. Individuals with diabetes are two to four times more likely to have a stroke than nondiabetics, according to the U.S. Centers for Disease Control and Prevention (CDC).

Stroke is a life-threatening condition that requires immediate medical treatment. Delaying treatment can result in neurological and tissue damage (e.g., permanent speech loss or paralysis) or even death.

There are two types of stroke:

  • Ischemic stroke. About 88 percent of strokes are caused by a severe episode of cerebral ischemia (a reduction in the blood supply to the brain). Ischemic strokes typically occur when a blood clot blocks an artery leading to the brain. The blood clot can either form inside the artery (a thrombus) because of atherosclerosis(a condition characterized by excess plaque on the inner arterial walls), or it can travel through the bloodstream from another part of the body and become lodged inside the artery (an embolus). These conditions are called thrombotic stroke and embolic stroke, respectively.
  • Hemorrhagic stroke. This type of stroke occurs when blood from the arteries leaks into the brain after a rupture. In addition to starving some parts of the brain of essential blood and oxygen, the accumulated blood (hemorrhage) may cause further damage by exerting pressure on the surrounding tissue. Bleeding within the brain (cerebral hemorrhaging) accounts for about 9 percent of strokes, whereas bleeding around the brain (subarachnoid hemorrhaging) only accounts for about 3 percent of strokes. Cerebral hemorrhaging is often caused by high blood pressure which, according to the National Diabetes Education Program, affects 70 percent of people with diabetes. Subarachnoid hemorrhaging may be caused by a ruptured cerebral aneurysm (a bulging formation on the arterial wall), a head injury or other factors. Hemorrhagic strokes generally affect younger patients.

People with type 1 diabetes have an increased risk of stroke because high quantities of glucose (blood sugar) can damage blood vessels over time, making arterial walls thicker and less flexible and hindering the passage of blood. Hyperglycemia also puts individuals with type 2 diabetes at risk, and in addition they may experience vascular damage from persistently high levels of the glucose-regulating hormone insulin (hyperinsulinemia).  Diabetic individuals also tend to have higher levels of fats (lipids) in their blood, which can clog and narrow blood vessels, resulting in atherosclerosis. Additionally, people with diabetes are more prone to blood clots than nondiabetics.

Individuals with diabetes are also more likely to have high blood pressure, coronary artery disease, obesity and many other risk factors for stroke. However, numerous studies indicate that people with diabetes have a greater stroke risk than nondiabetics regardless of how many risk factors they exhibit.

For the general population, old age is a leading risk factor for stroke. However, recent research shows that young and middle-age diabetic adults and people recently diagnosed with type 2 diabetes have an especially high risk of stroke. People can help guard against this condition by having regular medical care and managing risk factors such as blood pressure, glucose, cholesterol and weight.

Risk factors and causes of stroke

Diabetes is a major risk factor for stroke. Excessive levels of glucose (blood sugar) or insulin (a hormone that helps regulate glucose) in the bloodstream can damage the arteries that deliver oxygen to the brain. Hyperglycemia and hyperinsulinemia may also increase the risk of stroke in people with prediabetes or high-normal glucose.

In addition, diabetic individuals are also more liable to exhibit the following risk factors for stroke:

  • High blood pressure. Studies indicate that individuals with high blood pressure (hypertension) are four to six times more likely to have a stroke than those with normal blood pressure. The National Diabetes Education Program estimates that 70 percent of people with diabetes have high blood pressure. New research indicates that low blood pressure (hypotension) may also increase the risk of stroke in people with chronic kidney disease, such as diabetic nephropathy or end-stage renal disease.
  • Vascular diseases. People with diabetes are more likely than nondiabetics to have diseases of the blood vessels such as atherosclerosis, peripheral arterial disease, cerebrovascular disease, carotid artery disease or coronary artery disease.
  • Heart conditions. Heart disease is the leading cause of death in people with diabetes. Conditions that are more common with diabetes and that raise the risk of stroke include: heart attack, heart failure and atrial fibrillation, a condition in which the two upper chambers of the heart quiver rather than beat effectively.
  • Unhealthy levels of cholesterol and triglycerides. Hyperlipidemia, which is common among diabetic individuals, is a chief contributor to atherosclerosis(a condition characterized by excess plaque on the inner arterial walls) and stroke. Cholesterol
  • Obesity. Being severely overweight is a major risk factor for type 2 diabetes and stroke.
  • Inadequate exercise. Although regular exercise is one of the cornerstones of diabetes management, many patients do not engage in sufficient physical activity.
  • Hypoglycemia (low blood sugar). Hypoglycemia increases the risk of stroke in older diabetic individuals. Consequently, a physician may advise older adults to treat for hypoglycemia at a higher glucose level than younger patients.
  • Preeclampsia. Diabetes increases a woman’s risk of preeclampsia (high blood pressure and proteinuria during pregnancy). Recent research from the U.S. Centers for Disease Control and Prevention (CDC) shows that preeclampsia raises the risk of stroke in the future as well as during the pregnancy.
  • Gum disease. Recent research associates periodontitis with higher risk for stroke, in addition to its previously established link to heart disease.
  • Diabetic retinopathy. This eye disease appears to be an independent risk factor for stroke, according to new research.

Other risk factors associated with stroke include:

  • Medical history. A personal history of mini-stroke (transient ischemic attack) or family history of stroke raises an individual’s risk. Genetics can also be a factor. For example, a gene variant LTC4S has been linked to stroke risk in women.
  • Smoking cigarettes. Smokers are three times more likely to have a stroke than non-smokers. Smokers who use certain birth control pills are at even greater risk, according to the American Heart Association.
  • Age. Rates of stroke nearly double in men and women in the general population who are over age 74. Diabetes, including type 1 diabetes and type 2 diabetes, boosts the risk of stroke in early and middle adulthood, recent research indicates.
  • Race. In addition to their higher risk of type 2 diabetes, black Americans are about twice as likely as white Americans to have a stroke. Reasons may include obesity, stress, habits such as diet and smoking, Genetics and the increased risk of sickle cell anemia, an inherited blood disease that can cause a stroke.
  • Sex. Strokes are more common in men but more deadly in women. Stress and the higher rate of diabetes may help explain the greater incidence of stroke in men. Pregnancy, preeclampsia, gestational diabetes, childbirth and menopause are risk factors for stroke in women. Hormonal and other biological reasons and genetics may contribute to women’s poorer outcomes after a stroke.
  • Excessive consumption of alcohol.
  • Drug abuse. This includes cocaine, intravenous drugs and, according to some research, marijuana.
  • Injuries to the head and neck.
  • Sleep apnea. A condition in which an individual’s breathing stops and starts many times during sleep.
  • Carotid artery dissection. A tear in a carotid artery’s inner lining which creates a space between the inner and outer layers. Stroke may occur if blood leaks into this region.
  • Atrial flutter (atrial fibrillation). A type of tachycardia, which is an unusually fast heart rhythm, that originates in the heart’s upper chambers (atria)).
  • Certain surgical or catheter-based procedures.
  • Depression.
  • Air pollution. Previous studies have linked air pollution to risk of heart attack, and recent research suggests a possible connection to stroke risk.

Children can also suffer strokes, but many of these causes and risk factors are much different.

Signs and symptoms of stroke

Symptoms of stroke can vary depending on which type of stroke is present. For instance, the symptoms of a thrombotic stroke tend to develop gradually, whereas the symptoms of an embolic stroke may appear suddenly. Patients experiencing either of these types of ischemic stroke may exhibit the following symptoms:

  • Sudden weakness or numbness of one or more limbs, particularly on one side of the body (the opposite side from where the stroke has occurred)
  • Difficulty speaking or understanding speech
  • Drooling caused by weakness on one side of the face
  • Confusion
  • Loss of vision in one or both eyes
  • Dizziness or loss of coordination/balance
  • Severe  headache (resembling a migraine)
  • Nausea or vomiting
  • Seizure
  • Hearing problems, particularly in one ear

Other possible signs of stroke that are more common in women include chest pain, facial pain, shortness of breath and hiccups.

Sometimes, symptoms of ischemic stroke are only temporary. This is called a transient ischemic attack (TIA) or “mini-stroke.” A mini-stroke occurs when the flow of blood to the brain is briefly interrupted.

Mini-strokes were originally considered harmless. However, recent research indicates they may result in long-term brain damage. Additionally, the National Stroke Association estimates that 40 percent of individuals who have had a mini-stroke will probably experience a major stroke at some point in their lives.

Much like embolic strokes, cerebral hemorrhagic strokes tend to occur suddenly. Individuals experiencing this type of stroke, which typically worsens over time, may experience the following symptoms:

  • Confusion
  • Severe headache
  • Nausea or vomiting

Subarachnoid hemorrhagic strokes typically produce symptoms similar to cerebral hemorrhagic strokes, as well as:

  • Pain or stiffness of the neck
  • Pain upon staring at or into a light

Another type of stroke, called a silent stroke, causes brain damage but does not produce any obvious symptoms. Having diabetes and high blood pressure dramatically raises an individual’s risk of experiencing a silent stroke, according to the American Heart Association (AHA). Silent stroke also affects about one-third of elderly individuals. Studies have shown that experiencing a silent stroke doubles an individual’s risk of developing dementia.

Strokes that continue to progress can result in coma or death. Individuals exhibiting symptoms of a stroke or mini-stroke should seek immediate medical treatment. It is important to note that individuals exhibiting stroke symptoms should not take aspirin. Aspirin can aggravate a stroke.

Individuals presenting symptoms of a stroke should not attempt to drive themselves to the hospital. If no driver is available, emergency treatment should be requested by calling for emergency medical services (phoning 911 in the United States and some other countries).

Many people ignore symptoms of a stroke, but early diagnosis and treatment are crucial for recovery.

Diagnosis methods for stroke

Diagnosis of a stroke begins with a prompt review of the patient’s medical history, followed by tests such as CAT scan (computed axial tomography).

The CAT scan helps the physician determine whether the patient is experiencing a cerebral ischemia (a stroke caused by the blockage of an artery) or a cerebral hemorrhage (a stroke caused by the rupture of an artery), and assists in identifying the exact position of the damage. This information enables the physician to select a course of emergency treatment.

After the patient is stabilized the physician will perform a complete medical evaluation. Evaluation of a stroke patient may take several days and can include:

  • Physical examination. The physician uses a stethoscope to examine the carotid artery in the neck. If the physician hears an abnormal sound (a carotid bruit) during examination, there is a greater chance of finding atherosclerosis(a condition characterized by excess plaque on the inner arterial walls) or cerebrovascular disease. Diabetic patients have an increased risk of developing both of these contributors to stroke.
  • Carotid ultrasound, or duplex scanning. This test uses high-frequency sound waves to assess the presence of plaque in the carotid artery. Plaque accumulation can result in atherosclerosis, a diabetic complication and major stroke risk factor.
  • Magnetic resonance angiography(MRA). An MRA is another noninvasive diagnostic test used to help determine the degree of blockage in the carotid arteries. This test is a variation of magnetic resonance imaging (MRI). An MRI can also be useful in diagnosing a stroke, particularly a variation known as functional MRI, which produces real-time images of blood flow to parts of the brain.
  • Electrocardiogram (EKG or ECG). This test is used to identify any underlying cardiac problems that may have contributed to the stroke, such as a prior heart attack. Cardiovascular disease is the most serious and common complication of diabetes. In addition, diabetic patients are more likely to suffer cardiovascular complications than non-diabetics.
  • Blood tests. These tests may include a complete blood count (CBC) and a cholesterol test (lipid profile).

The physician may also recommend tests that use electrical activity to assess overall brain functioning. These tests can reveal how much neurological damage resulted from the stroke. The most common of these tests include:

  • Electroencephalogram (EEG). During this painless procedure, small metal devices (electrodes) are attached to the scalp. The electrodes are connected by wires (leads) to an electroencephalograph machine that charts the brain’s electrical activity.
  • Evoked-potential study. This test measures the brain’s response to sight, hearing and touch.

Treatment options for stroke

Individuals experiencing symptoms of a stroke, or another person present, should immediately summon emergency medical assistance (phoning 911 in the United States and some other countries).

When the patient arrives at the hospital, staff will order an emergency CAT scan (computed axial tomography) to help determine whether the patient is experiencing cerebral ischemia (a stroke caused by the blockage of an artery) or a cerebral hemorrhage (a stroke caused by the rupture of an artery).

Staff will then attempt to stabilize the patient by using the following common strategies:

  • Maintaining breathing in individuals who are losing consciousness. Breathing can often be maintained through the use of supplemental oxygen or special breathing equipment.
  • Administering clot-busting drugs (thrombolytics) intravenously to dissolve obstructing blood clots in patients with ischemic stroke.
  • Administering fever-reducing medications (if applicable).
  • Taking special measures to prevent pneumonia, a complication that often occurs after a stroke.

The U.S. Food and Drug Administration (FDA) has approved the clot-dissolving drug tissue plasminogen activator (tPA). This intravenous medication is used only to treat strokes caused by blood clots, within three hours of the stroke. It works by dissolving the clot and allowing blood to flow normally to the brain. Though tPA does carry a risk of bleeding in the brain, its benefits outweigh the risks when properly used by an experienced physician. Patients who have suffered a hemorrhagic stroke should not be treated with tPA. Men appear to benefit more than women from tPA, according to recent research.

In an experimental procedure, tPA is delivered directly into the blood clot using microcatheters. Early results are promising, but more research is needed before the FDA could approve this treatment.

In cases where the stroke was caused by a partial blockage of a carotid artery in the neck, a surgery called carotid endarterectomy might be used to remove the plaque. This procedure involves the removal of accumulated fat along the walls of the carotid arteries, which supply blood to the brain. While the patient is under general anesthesia, the plaque and the inner lining of the artery are removed.

In other cases, cerebral angioplasty may be used to treat problems with the brain’s blood vessels. This procedure commonly uses balloons, stents and coils to widen arteries, prevent closure or to remove blood clots.

Surgery may also be recommended for hemorrhagic stroke, such as clipping (in which an aneurysm is snipped off) to prevent additional bleeding from an aneurysm, or coiling to close an aneurysm by inserting a small coil through a catheter.

Imaging tests of the carotid arteries and other structures can indicate who is at risk of a second stroke. These include ultrasound, magnetic resonance imaging (MRI) and cerebral angiogram, in which a dye (contrast medium) that highlights vessels of the brain is injected through a catheter that has been threaded through an artery. Several studies show that such tests are underused, especially in women.

Stroke survivors often require rehabilitation to minimize neurological damage and maximize function. According to the American Heart Association(AHA), between 50 percent to 70 percent of stroke survivors are able to maintain their independence after recovery. However, strokes leave 15 percent to 30 percent of patients permanently disabled.

Individuals who experience severe strokes generally require more post-stroke rehabilitation than those who experience minor strokes. Patients should begin treatment soon after experiencing a stroke to increase the likelihood of regaining functions. Changes in functioning that are often addressed in rehabilitation include:

  • Paralysis (hemiplegia) or weakness (hemiparesis) on one side of the body
  • Lack of coordination (ataxia) or balance
  • Immobilization of a joint
  • Spasms or stiffness in muscles
  • Impaired awareness of one side of the body
  • Impaired sensation
  • Difficulty speaking (dysarthria) or communicating in general (aphasia)
  • Difficulty swallowing (dysphagia) or eating
  • Drooping on one side of the mouth or face
  • Difficulty planning and carrying out a task (apraxia)
  • Confusion or dementia
  • Visual or auditory difficulties
  • Emotional disturbances
  • Incontinence (difficulty controlling the bladder or bowels)

Rehabilitation may include physical therapy to address walking and strengthening, occupational therapy to work on fine-motor coordination and activities of daily living (ADLs) such as dressing and driving, and speech therapy to improve swallowing, communication and cognition.

About 10 percent of stroke survivors experience pain in the areas that lost sensation after their stroke. The cause of this central post-stroke pain is unknown and often difficult to treat. However, treatment methods for this condition are being tested.

Temporary or permanent loss of basic functions may cause depression in some patients. These individuals are strongly encouraged to seek assistance from a mental health counselor.

Prevention methods for stroke

People can take many actions to reduce their risk of suffering a stroke. Many of these lifestyle modifications are similar to those recommended for preventing and controlling diabetes, diabetic angiopathy and heart conditions. Control of risk factors can reduce the incidence of stroke by 50 percent and the mortality by 30 percent, according to the American Association of Diabetes Educators. These steps include:

  • Controlling glucose (blood sugar). Elevated glucose (hyperglycemia) can damage the arteries and promote atherosclerosis(a condition characterized by excess plaque on the inner arterial walls). Diabetic individuals can reduce their risk of stroke through regular glucose monitoring and glycohemoglobin tests.
  • Controlling high blood pressure. Blood pressure abnormalities are a chief contributor to strokes and should be continually monitored and controlled. This is especially important for individuals with diabetes. Diabetic patients are generally advised to keep blood pressure below 130/80 mmHg. Blood pressure that cannot be controlled through exercise and diet may require antihypertensive medication.
  • Controlling cholesterol and triglycerides. Unhealthy levels of blood lipids, such as high LDL “bad” cholesterol or low HDL “good” cholesterol, can lead to atherosclerosis and stroke. People with hyperlipidemia should have a cholesterol test annually or as recommended by their physician. Certain patients may require cholesterol-reducing drugs, which lower levels of harmful cholesterol in the body.
  • Achieving and maintaining an ideal weight.
  • Exercising regularly. Experts recommend that all individuals – especially those with type 2 diabetes – get regular exercise. A general recommendation is a minimum of 30 minutes a day on most days of the week. Patients should consult their physician before starting an exercise program.
  • Eating a heart-healthy diet. Findings from numerous studies illustrate that a heart-healthy diet can decrease the risk of stroke. For instance, women who ate fish – which is rich in omega-3 fatty acids – in excess of five times a week demonstrated a significantly lower risk of stroke than those who consumed fish less than once a month.
  • Quitting smoking or not starting to smoke. Smoking contributes to atherosclerosis, high blood pressure, stroke and heart conditions. Recent research even shows that women who smoke during pregnancy raise their children’s risk of atherosclerosis and cardiovascular diseases in adulthood.
  • Managing stress. Stress and anger have been linked to stroke as well as heart disease.
  • Limiting consumption of alcohol to about one glass of wine or beer a day, if approved by a physician. Some evidence suggests that modest consumption of alcohol can reduce the risk of stroke and heart disease, but heavy use can impair control of diabetes and can cause or worsen many other health problems.
  • Getting regular dental care and performing good dental hygiene. Increasing numbers of studies are linking periodontal disease to vascular diseases.

Patients are also advised to seek treatment for sleep apnea (a condition in which an individual’s breathing stops and starts many times during sleep), depression, drug abuse or any other risk factors.

The physician may recommend taking aspirin or other antiplatelets or anticoagulants to help prevent the formation of blood clots. Diabetes patients may be underusing aspirin therapy to guard against stroke and heart disease, according to the American College of Preventive Medicine. However, people are advised not to begin aspirin therapy without their physician’s approval. Aspirin may increase the risk of hemorrhagic stroke, especially in women, and it can be dangerous to some individuals, such as those with diabetic nephropathy, other kidney diseases, liver disease or gastrointestinal problems.

Other antiplatelets and anticoagulants also increase the risk of hemorrhagic stroke, especially in people over age 80. Patients taking anticoagulants may be monitored with a blood test called INR (international normalized ratio).

Some blood tests can help predict the risk of stroke in certain patients. The U.S. Food and Drug Administration (FDA) has approved the PLAC test for this purpose. Another test that detects inflammation and may suggest who is at risk of stroke is the c-reactive protein test. However, this is not recommended for routine use.

Some high-risk patients, such as those who have already had a stroke, may benefit from carotid artery stenting. The FDA has approved carotid artery stents for use in certain patients. These tiny mesh tubes have proven to be as effective as surgery in preventing stroke for certain individuals. Carotid artery stents crush plaque against the arterial wall and hold it in place, thereby preventing pieces of plaque from breaking off and traveling in the bloodstream, resulting in stroke.

Alternatively, carotid endarterectomy surgery has proven to be an effective means of stroke prevention for many patients who have already had a stroke or transient ischemic attack (mini-stroke) as well as those with significant carotid artery blockages (80 percent blockage or greater). This procedure involves the removal of accumulated fat along the walls of the carotid arteries, which supply blood to the brain. While the patient is under general anesthesia, the plaque and the inner lining of the artery are removed.

A cerebral aneurysm (a bulging formation on the arterial wall) that has yet to rupture may be diagnosed early, especially if it produces warning signs that prompt the patient to seek treatment. Surgery may be recommended to repair the aneurysm and prevent a hemorrhagic stroke. This surgery, which involves snipping off the aneurysm before it can rupture, is sometimes called “clipping.”

Another practice that is gaining attention is called the detachable coil technique. This minimally invasive procedure involves implanting a small coil into the bulge in the arterial wall. The coil provokes an immune response from the body, which, in turn, produces a blood clot inside the aneurysm that strengthens the walls or the artery and reduces the risk of a rupture.

Ongoing research for stroke

Researchers are continuously exploring new methods for treating and preventing strokes. Research is being conducted in several areas, including:

  • Antibiotics. Studies indicate that bacteria can inhabit atherosclerotic plaque (plaque that accumulates in the blood vessels and causes atherosclerosis), potentially increasing the tendency for plaque rupture. Researchers are investigating whether antibiotics can exert any effects over such bacteria, thereby increasing the stability of the plaque and reducing the risk that it will break off and cause a stroke.
  • Cholesterol drugs. Recent studies indicate that statinsmay decrease an individual’s risk of stroke.
  • Mechanical thrombolysis. These devices break up or remove blood clots using catheter-delivered tools. Currently, clot-busting drugs are the only available method of dissolving a blood clot in the brain. However, these medications can take up to an hour to be effective. Researchers are testing sound waves, lasers, suction, spinning blades and snares to determine which of these methods, if any, will prove useful in disbanding blood clots.
  • Neuroprotective agents. These agents attempt to rescue brain cells from injury resulting from an ischemic stroke. For instance, some agents attempt to increase blood flow to the region of the brain affected by the stroke. Others seek to limit damage caused by the dying brain cells.
  • Stem cell transplants. Stem cells are basic cells that are able to develop into many types of cells. Although they start out very similar to one another, stem cells become highly individualized after they adopt their specialized functions. Researchers are investigating various methods in which stem cell transplants could be used to treat stroke and other conditions involving damaged brain cells.
  • Hypothermia. Researchers are studying whether reducing a patient’s body temperature, and consequently the brain’s demand for oxygen, can decrease the amount of cell damage caused by a severe stroke.
  • Internet consultations. Rural hospitals are trying computer networks and video feeds as a way of getting help from stroke experts in cities and universities.

Additional research is needed to determine the effectiveness and safety of these potential treatments, and to determine the most effective method of administering these treatments to stroke survivors.

Questions for your doctor about stroke

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about stroke and diabetes:

  1. Am I at increased risk of stroke?
  2. Would I be more likely to have an ischemic stroke or a hemorrhagic stroke?
  3. How can my diabetes affect my risk of or recovery from a stroke?
  4. Do mild or moderate swings in my blood sugar affect my risk of stroke?
  5. My father was diabetic and suffered a stroke, but I do not have diabetes – am I at increased risk for stroke as well?
  6. What signs and symptoms of stroke or transient ischemic attack (TIA) should I watch for?
  7. What should I do if I may be experiencing a stroke or TIA?
  8. Does having a TIA or cerebrovascular disease mean I will likely experience a major stroke?
  9. What are my treatment options, and which do you recommend?
  10. What will my stroke rehabilitation involve? How much therapy will I get? What can I do to benefit most from my therapy?
  11. How much function am I likely to recover?
  12. Will I receive tests that show my risk of a second stroke?
  13. Can I prevent a stroke or second stroke by improving diet, exercise and other habits?
  14. Should I take preventive medicine such as aspirin, or would that have more risks than benefits for me?
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