Stroke and Diabetes: What Is the Relationship?

Diabetes (also called diabetes mellitus) is a group of conditions that cause the body to be less efficient in managing levels of blood glucose (sugar). People with diabetes are at risk of having high blood glucose.

Having high blood glucose levels can harm blood vessels over time. A damaged blood vessel in the brain may become blocked or break, which causes a stroke. A stroke is an emergency condition that can lead to brain damage and death. 

This article will discuss the connection between diabetes and stroke, including causes, risks, and prevention.

Connection Between Diabetes and Stroke

Diabetes is a group of chronic conditions that affect the metabolic system. A metabolic disease affects how the body uses the nutrients from food to fuel the cells of the body.

When you eat, the body breaks food down and releases glucose (sugar) into the bloodstream. This causes an organ in the digestive system, the pancreas, to release a hormone called insulin.

In diabetes, the pancreas either doesn’t make insulin or doesn’t make enough insulin to help the body convert all the glucose from food into energy. One of the results is a rise in the glucose level in the bloodstream.

The symptoms of diabetes can include:

• Blurred vision
• Dry skin
• Unexpected weight loss
• Extreme hunger
• Extreme thirst
• Fatigue
• Infections
• Numbness or tingling in the hands or feet
• Slow healing of sores or bruises
• Urinating often
  

An increased blood glucose level can damage blood vessels over time. Blood vessels may become blocked or burst, leaving a part of the body without a blood supply.

When this happens in the brain, a stroke can occur. The cells of the brain may die, which can impact the body in various ways, depending on which blood vessels are affected. Altered vision, memory loss, paralysis, and other signs and symptoms may result.

Risks

People who live with diabetes are twice as likely to have a stroke as people who don’t have the disease. After having a stroke, people with diabetes are also less likely to fully recover and they also have a higher risk of dying from a stroke.

People with diabetes are more likely to have hypertension (high blood pressure), hyperlipidemia (high levels of fat in the blood), coronary disease (reduced blood flow to the heart muscle), or peripheral vascular disease (reduced blood flow in vessels other than the heart). These conditions are also risk factors for a stroke.

Metabolic syndrome is another condition connected to diabetes. It is characterized by increased blood pressure, high blood glucose levels, excess body fat around the waist, and high cholesterol or triglycerides (dyslipidemia). Having metabolic syndrome may increase the risk of stroke by as much as 20% to 40%.

Microalbuminuria, which is having too much of a protein called albumin in the urine, is also connected to diabetes. Having diabetes and microalbuminuria is associated with an 80% increased risk of stroke.

Historically marginalized populations, including Black, Hispanic, and American Indian populations, have a higher prevalence of acquiring both diabetes and stroke than other groups.

Treatment and Management of Stroke With Diabetes

A stroke is a medical emergency, and it’s important to get care immediately when the symptoms of a stroke are recognized. Unfortunately, people with diabetes tend to do worse after having a stroke than people who don’t have diabetes. There are recommendations for the care of stroke in people who have diabetes.

A stroke is both physically and mentally stressful. Stress can affect blood glucose levels. When you have a stroke and are admitted to a medical facility, blood glucose levels must be managed and kept to normal levels. 

Blood glucose levels are often too high in people with diabetes who are hospitalized for a stroke. It is recommended to normalize the blood glucose level to 140 to 180 milligrams per deciliter (mg/dL) in the first 24 hours and maintain it for the first 48 hours after a stroke.

Normalizing blood glucose levels might also improve your outcome and lower your risk of death. Insulin is usually given to manage blood glucose levels.

Other treatments and supportive care will be given according to the type of stroke. Tissue plasminogen activator (TPA) may be given, but it must be administered within the first few hours after a stroke. TPA dissolves blood clots that cause some types of strokes.

Other blood thinners such as heparin or aspirin may be needed when a blockage causes a stroke. Additionally, medications can help manage blood pressure.

Fluids with a balance of electrolytes (sodium, potassium, and calcium) may be given through an intravenous (IV) line in a slow drip to prevent swelling in the brain.

Various surgical procedures can also alleviate any brain swelling or bleeding in the brain. This can include removing a small portion of the skull bone for a time until the swelling in the brain goes down, or draining or removing a brain bleed.

Poststroke rehabilitation may include physical therapy, occupational therapy, and speech therapy.

Rehabilitation may take place at a recovery facility if there’s a need for long-term skilled nursing care or on an outpatient basis. Many factors will be considered to decide the level of care needed, including the type of family and community support available to the person.

Prevention

Prevention of stroke in people with diabetes is important and can take many forms. Healthcare providers may use a risk assessment tool to estimate the risk of stroke in a person with diabetes. 

Stroke prevention measures may include making adjustments to your lifestyle. This includes changing eating habits, stopping smoking, keeping to moderate alcohol use, and getting regular exercise. These types of changes may be suggested to help control the effects of diabetes.

The two types of drugs that prevent a stroke in people with diabetes are:

• Sodium-glucose cotransporter inhibitor (SGLTi): An SGLTi such as Farxiga (dapagliflozin), Invokana (canagliflozin), Jardiance (empagliflozin), or Steglatro (ertugliflozin) might be used by people with type 2 diabetes. These medications work by preventing glucose in the blood from being absorbed by the kidneys. Instead, some of the excess glucose leaves the body in urine, which can lower your risk of a stroke.
  
• Glucagon-like peptide hormone-1 receptor agonists (GLP1RA). A GLP1RA may help with appetite control, releasing the right amount of glucose from the pancreas, and slowing the transit of food through the digestive tract. GLP1RA medications include the short-acting types Adlyxin (lixisenatide), Byetta (exenatide), and Victoza and Saxenda (liraglutide); and long-acting types Bydureon (exenatide); Ozempic (semaglutide); Rybelsus (semaglutide); Trulicity (dulaglutide); Wegovy (semaglutide). These drugs may help lower the risk of a stroke and may be preferred in some cases over an SGLTi.
  

High blood pressure (hypertension) is a risk factor for stroke in people who have diabetes. American Diabetes Association (ADA) guidelines recommend that people with diabetes maintain a blood pressure of less than 140/90 mmHg.

High blood pressure can be treated with medications, such as angiotensin-converting enzyme inhibitors (ACEI) or an angiotensin receptor blocker (ARB).

Dyslipidemia (high cholesterol and triglyceride levels) is another condition that can increase the risk of stroke when left untreated. For those who have dyslipidemia, medications called statins might be recommended to reduce cholesterol levels. Lowering cholesterol may reduce the risk of stroke by more than 20%.

Other methods of preventing stroke include the use of aspirin and/or fibrate medications. Fibrates such as Lopid (gemfibrozil) lower triglyceride levels and increase HDL cholesterol. So far, aspirin or fibrates haven’t been shown to help prevent strokes in people with diabetes.

Even though it’s important to have good blood glucose levels in diabetes, strict control hasn’t been proven to reduce the risk of stroke.

More prevention methods may be used to lower the risk of having another stroke in those who have already had a stroke.

Summary

People who live with diabetes should be aware of their risk of getting a stroke. Well-controlled blood glucose levels may not lower the risk of a stroke. Lifestyle changes such as quitting smoking, eating a healthful diet, treating high blood pressure, and getting exercise are important in reducing the risks.

A Word From Verywell

People who have diabetes and those who care for them will want to familiarize themselves with the signs and symptoms of a stroke and to talk with healthcare providers about the risk of a stroke. Prevention strategies will be key.