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Stroke /Brain Attack Risk for Uncontrolled Diabetes

Stroke is a medical emergency. Prompt treatment of a stroke could mean the difference between life and death. Early treatment can also minimize damage to your brain and potential disability.

The term "brain attack" is starting to come into use in the United States for stroke, just as the term "heart attack" is used for myocardial infarction, where a cutoff of blood causes necrosis to the tissue of the heart. Many hospitals have "brain attack" teams within their neurology departments specifically for swift treatment of stroke.

A stroke can happen if something keeps the blood from flowing as it should. A person might have a clogged blood vessel, so the blood can't get through. Or a blood vessel may burst and a part of the brain is suddenly flooded with blood. Either way, with a stroke, brain cells die because they don't get the oxygen they need.

In the United States, stroke is a leading cause of adult disability and the third-leading cause of death; only heart disease and cancer cause more deaths annually.On average, a stroke occurs every 45 seconds and someone dies every 3 minutes. Of every 5 deaths from stroke, 2 occur in men and 3 in women.A stroke can happen when:

A blood vessel carrying blood to the brain is blocked by a blood clot. This is called an ischemic stroke .
A blood vessel breaks open, causing blood to leak into the brain. This is a hemmorhagic stroke .

They occur when a blood vessel leading to the brain becomes blocked or bursts. Brain cells in the area quickly begin to die because they aren't getting the oxygen and nutrients they need to function.Because of the serious and sudden nature of stroke, people need to be aware of their own personal risk and take steps to reduce it.Key risk factors for stroke include having high blood pressure, diabetes or heart disease, high cholesterol, and cigarette smoking. These treatable conditions have been strongly linked to stroke but often can be successfully controlled through diet, exercise and drug therapy.

Diabetes risk factors are still not well-controlled in patients, even though the disease increases their stroke risk, a new study finds.

Researchers at Massachusetts General Hospital, in Boston, analyzed data on nearly 50,000 stroke patients with diabetes.

Diabetes can cause many complications. Acute glucose level abnormalities may occur if insulin level is not well-controlled. Serious long-term complications include cardiovascular disease (doubled risk), chronic renal failure (the main cause of dialysis in developed world adults), retinal damage (which can lead to blindness and is the most significant cause of adult blindness in the non-elderly in the developed world), nerve damage (of several kinds), and microvascular damage, which may cause erectile dysfunction (impotence) and poor healing. Poor healing of wounds, particularly of the feet, can lead to gangrene .

They found that these patients had high rates of obesity, high blood pressure, cholesterol disorders, and poor control of blood sugar at the time of the stroke.

The data came from the American Stroke Association's Get With the Guidelines - Stroke program. The findings are expected to be presented Wednesday at the American Stroke Association's annual meeting, in San Francisco.

Patients with undiagnosed diabetes when their stroke occurred had poorer control of their diabetes risk factors than patients who'd been diagnosed with diabetes prior to their stroke, the researchers said.

Stroke patients with undiagnosed diabetes may be at greater risk of recurrent stroke and cardiovascular complications, the study authors warned.

"There are good evidence-based guidelines for diagnosing and treating risk factors for diabetes, but those guidelines have thus far not translated into better risk factor management," Dr. Lee Schwamm, MGH's vice chairman of neurology and director of acute stroke services, said in a prepared statement.

"These results show that more emphasis is needed on early diagnosis of diabetes and management of risk factors in people who have diabetes," Schwamm said.
Persons with diabetes must stay alert for symptoms that can lead to clinical complications. The best way to do this is:

get regular checkups -- finding problems early is the best way to keep complications from becoming serious.
keep appointments with your physician -- even when you are feeling well.
be aware of symptoms and warning signs of potential problems, including:
vision problems (blurriness, spots)
fatigue
pale skin color
obesity (more than 20 pounds overweight)
numbness or tingling feelings in hands or feet
repeated infections or slow healing of wounds
chest pain
vaginal itching
constant headaches
keep blood-sugar levels close to normal
control weight
eat a healthy, well-balanced diet
get regular exercise
check your feet every day for even minor cuts or blister
do not smoke