Stroke and Diabetes: Causes, Symptoms, and Prevention
Key takeaways:
- People with type 1 and type 2 diabetes face an increased risk of stroke, but managing blood glucose, cholesterol, and blood pressure can help prevent it.
- Recognizing early stroke symptoms and getting medical help quickly can dramatically improve health outcomes.
- New treatments like GLP-1 medications and SGLT2 inhibitors offer promise for stroke prevention in those with diabetes.
Stroke remains one of the leading causes of death and long-term disability worldwide, accounting for nearly 18% of cardiovascular disease-related deaths in the U.S. Diabetes is one of the leading causes of stroke, along with high blood pressure, high cholesterol, smoking, and obesity.
In fact, one in three American adults has at least one of these major risk factors, which explains why almost 800,000 people in the U.S. experience a stroke each year, according to the Centers for Disease Control and Prevention.
The good news is, there are things you can do to help prevent a stroke from happening. Knowing the causes, recognizing the warning signs, and understanding the connection between stroke and diabetes are all meaningful steps you can take to protect your health.
Causes and types of stroke
A stroke occurs when blood flow to part of the brain is blocked or reduced, preventing it from getting the oxygen and nutrients needed to function properly. There are several types of stroke, each with its own causes and risk factors. Understanding the different types of stroke and what causes them is key to recognizing the warning signs and knowing when to seek medical attention.
Ischemic stroke
An ischemic stroke occurs when a blood clot or other obstruction blocks an artery supplying blood to the brain, reducing the amount of oxygen that can reach brain tissue. This type is the most common, accounting for 87% of all strokes.
Common risk factors include high blood pressure, high cholesterol, smoking, and diabetes. Ischemic strokes can also be caused by a blood clot that forms elsewhere in the body and travels to the brain (embolic stroke). Risk factors include blood clots that form in the heart from atrial fibrillation or other heart problems.
Transient ischemic attack
A transient ischemic attack (TIA) is often referred to as a “mini-stroke” and is caused by a temporary blockage in a blood vessel leading to the brain. While TIAs don’t usually cause permanent damage, they produce stroke-like symptoms and serve as a warning sign that a more serious stroke may occur soon or in the future.
Nearly one in five people who experience a TIA go on to have a full stroke within 90 days, making it critical for people to seek out medical attention so they can prevent further complications.
Hemorrhagic stroke
A hemorrhagic stroke occurs when a blood vessel in the brain ruptures, leading to bleeding that compresses surrounding brain tissue. This type of stroke is less common, but can be more severe. The most common cause of hemorrhagic stroke is high blood pressure.
An aneurysm, which is a weak area in a blood vessel that can “balloon” and rupture over time, is a type of vascular disease that can also lead to a hemorrhagic stroke. Another cause of hemorrhagic stroke is something called an arteriovenous malformation, which is a tangle of abnormal blood vessels that can rupture without warning.
Cryptogenic stroke
In some cases, doctors are unable to determine the exact cause of a stroke even after thorough testing. These are referred to as cryptogenic strokes. In a study of young adults aged 18-49 years who experienced a stroke, over a quarter were classified as cryptogenic.
Of the study participants who had a stroke with no clear cause, certain risk factors often showed up together. For example, migraines, smoking, and taking oral birth control pills may increase the risk of stroke in women.
Stroke symptoms
Recognizing the warning signs of a stroke and getting medical help right away can make a significant difference in one’s recovery, as stroke treatments are most effective when given within the first few hours.
To help remember the most common symptoms of a stroke, the National Institute of Neurological Disorders and Stroke recommends the acronym FAST:
Facial drooping can occur when there is sudden weakness or numbness on one side of the face, but this can also be experienced in the arms or legs. Other signs that you may be experiencing a stroke include:
- Trouble speaking or understanding speech
- Vision problems
- Difficulty swallowing
- Dizziness
- Loss of balance
- Confusion
- Sudden severe headache
Dr. Anastasios Mavridis, a stroke researcher at the Institute of Neuroscience and Physiology at the University of Gothenburg, explained these symptoms in more depth.
“Another helpful acronym is BEFAST: Balance, eyes, face, arm, speech, time,” he said. “It’s crucial to BEFAST and seek emergency medical attention if any of these symptoms occur.”
Studies have found that there may be differences in stroke symptoms between men and women. For example, a review found that while men experience more common symptoms like facial drooping and slurred speech, women are more likely to experience non-traditional symptoms like headache and confusion. Symptoms can also vary depending on stroke severity.
If you or anyone you know is experiencing symptoms that may indicate a stroke, time is of the essence – getting to a hospital quickly can significantly improve the chances of recovery.
Are people with diabetes more prone to strokes?
A recent paper authored by Mavridis and colleagues found that people with type 1 diabetes had more than double the risk of ischemic stroke and an 88% higher risk of hemorrhagic stroke compared to those without diabetes.
Type 2 diabetes was associated with a 37% higher risk for ischemic stroke, and significantly associated with a risk for hemorrhagic stroke when A1C levels are higher than 8.7%.
Over time, high blood glucose levels can cause inflammation, damage blood vessel walls, and promote fatty deposits and the formation of clots, Mavridis explained. When combined with high blood pressure or high cholesterol levels, the risk and severity of developing a stroke increase.
Other studies have also shown that post-stroke outcomes are worse in people with diabetes, with higher mortality rates, longer hospital stays, more significant cognitive impairment, and higher rates of stroke recurrence.
While the risks are higher, the good news is that strokes can be prevented through lifestyle interventions, regular medical care, and managing blood glucose, blood pressure, and cholesterol levels. There are also diabetes medications that help lower blood sugar as well as reduce heart disease and stroke risk, including GLP-1 drugs like semaglutide and tirzepatide, and SGLT2 medications like empagliflozin and dapagliflozin.
Tips for stroke prevention
Decreasing acute or recurrent stroke risk in people with diabetes involves managing risk factors. Since diabetes itself raises the risk of stroke, key steps for prevention include lifestyle changes, as well as managing blood glucose, blood pressure, and cholesterol levels.
“Regular physical activity, smoking cessation, a healthy diet, and weight management are all very important steps in reducing stroke risk. Take prescribed medications as instructed and keep up with routine checkups to help manage your health effectively,” Mavridis said.
The American Stroke Association provides secondary stroke prevention guidelines, which includes questions about modifiable risk factors such as physical activity, diet, and alcohol use, as well as other vascular risk factors.
Because strokes can occur without warning signs, regular checkups are essential – even if you’re feeling fine. Staying in close contact with your healthcare team helps catch potential problems early and keeps you on track with your prevention plan.
Stroke treatment
Current treatment for acute ischemic stroke is often an emergency IV medication. Ischemic strokes can sometimes be treated directly inside the blocked blood vessel with an emergency interventional procedure. Such treatment has been shown to improve outcomes and reduce long-term disability after ischemic stroke. However, it must be performed as soon as possible without delay. Both the IV injection and interventional procedure are strongly recommended.
The bottom line
Stroke is a significant risk for individuals with diabetes, but proactive management of blood glucose, blood pressure, and cholesterol – along with lifestyle changes – can help with both stroke prevention and overall cardiovascular disease prevention.
Recognizing early symptoms and acting quickly is essential. Access to modern treatment and the right support can greatly reduce risk, save lives, and improve recovery.
Learn more about ways to prevent stroke and support heart health here: