The diabetes and stroke connection

Jaqui Jones, MD

Family Medicine

According to the American Diabetes Association, the risk for stroke is one-and-a-half times higher among people with diabetes. Jaqui Jones, MD, explained why and what you can do to prevent both conditions.

First, what is diabetes?

Diabetes is a chronic condition that affects how we use food for energy. Under normal circumstances, food is broken down into glucose, which stimulates the pancreas to release a hormone called insulin. Insulin then allows sugar to be taken up by your cells, which they use for energy.

There are two types of diabetes:

• Type one diabetes happens when the cells of the pancreas get destroyed through an autoimmune disease. In that case, you never release enough insulin to manage the glucose you need for energy.

• Type two diabetes, which is common, is also known as insulin resistance. The cells stop responding to insulin and cannot utilize the glucose to energize the cells.

What is a stroke?

A stroke occurs when blood flow to the brain is disrupted. There are two kinds of stroke:

• Ischemic stroke, the most common, happens when your vessels get clogged with a clot or cholesterol. This prevents blood from flowing to the brain.

• A hemorrhagic stroke occurs when a vessel bursts or ruptures, causing bleeding in the brain and physical defects.

A mini stroke, or a trans ischemic attack (TIA), happens when there is a temporary blockage of blood flow. “Most people recover and do fine, but it’s a warning sign for major strokes in the near future. So, when we see that happen, we get very serious and want to make sure we are doing all we can to prevent strokes from occurring,” Dr. Jones said.

Who is at risk for diabetes and stroke?

Some risk factors you can change and some you cannot. Risk factors you can’t change include:

• Age/elderly
• Family history
• Race
• Gender
• Prior stroke, TIA or heart attack

There are other things you can change to reduce your risk. These are called modifiable risk factors and they include:

• High blood pressure
• Cigarette smoking
• Type two diabetes
• Diet
• Cholesterol
• Alcohol consumption
• Lack of exercise
• Obesity
• Heart disease

How are diabetes and stroke connected?

If diabetes is not well controlled and your glucose is high, it causes damage to the vessels and arteries. Having too much sugar in your blood can lead to a buildup of cholesterol or blood vessels, which can eventually block off a vessel that supplies blood to your brain and cause a stroke.

“They’re connected because they’re both dependent on good blood flow,” Dr. Jones said. “One of them does damage to the vessels and the other is reliant on vessels to be clear. When they’re not clear, other diseases happen. So it’s important we decrease the risk as much as possible.

How can you prevent diabetes and stroke?

Dr. Jones said to follow your ABCs. For diabetes, it looks like this:

• A1C test. This blood test is looking at your average blood glucose levels over three months. The goal is to keep it less than 7%.

• Blood pressure. Guidelines recommend 140/80 mmHg or less. “If you do not have a blood pressure cuff at home, please feel free to get one,” Dr. Jones said. “Monitor those blood pressures at home and bring them in when you have an appointment so that we can make sure you’re staying on goal.”

• Cholesterol. Total cholesterol should be 150 mg/dL or less, and LDL (lousy cholesterol) should be less than 100 mg/dL.

• Smoking. Quitting smoking will improve your blood glucose, blood pressure and cholesterol levels.

The ABCs of stroke look like this:

• Aspirin. A baby aspirin once a day will help lower the risk of stroke. If you are not on an aspirin and would like to take one, see your primary care doctor first.

• Blood pressure. Again, 140/80 mmHg or less.

• Cholesterol. Again, total cholesterol should be 150 mg/dL or less, and LDL (lousy cholesterol) should be less than 100 mg/dL.

• Smoking. Smoking does a lot of damage to the vessels and bad vessels means bad blood flow. This can lead to heart attacks and stroke.

But there’s still more you can do:

• Eat a healthy diet. Eating 14 grams of fiber a day for every 1000 calories consumed helps keep cholesterol down. It helps move out some of the unhealthy fat.

• Don’t smoke or vape. Smoking or vaping increases your risk of stroke, whether or not you have diabetes.

• Maintain a healthy weight. Waist circumference for women of 35 inches or more puts you at increased risk of heart disease, stroke and diabetes. If you are a man, 40 inches or more puts you at risk.

• Limit alcohol consumption. No more than one drink a day for women or two drinks a day for men.

• Manage stress. “Mental health is physical health. If your mood is better, you’re more motivated to do things like get out and exercise, maintain a heart healthy diet, not smoke or vape, and not drink more than one or two drinks per day,” Dr. Jones said.