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Understanding Brain Attack among Diabetics

Vanessa is distressed about her father who recently experienced a mini stroke attack, his second in a span of three years.  Her family didn’t make a big fuss at first since it was just a minor stroke.  After seeing a physician a couple times after the attack, his father returned to his old unhealthy lifestyle despite having been diagnosed with Type 2 diabetes the year before.  The succeeding mild stroke, however, alarmed Vanessa’s father and the whole family.

The doctor told them diabetes could have triggered the onset of stroke in the case of his father.  Though eager to learn more about their father’s health condition, the family found the diabetes-stroke link a little unrealistic to believe.

The Nation Institute of Health tells us it is not at all unlikely for diabetics to have stroke.  In fact, according to the NIH, people with diabetes have a two to four-fold chance of developing stroke and heart disease. In those without diabetes, stroke often happens among older people. In those with diabetes however, stroke attacks even the young.

Stroke, one of the prevalent neurological disorders in diabetes mellitus, takes place when blocked blood vessels deprive nerve cells of nutrients and oxygen. Damaged blood vessels have a hard time passing through an area of the brain and thus results to cessation or decrease in blood fIow. If not immediately fed, the involved brain cells deliberately stop working and eventually die. This kind of stroke, referred to as ischemic stroke, is what diabetics commonly encounter. Hemorrhagic stroke, the other type, occurs when blood vessels are completely shattered causing bleeding inside the brain.

“In diabetes, small blood vessels are involved,” says Dr. Ester Bitanga, president of the Stroke Society of the Philippines (SSP). “Therefore, the blood flow or supply to the brain may be involved and lead to. stroke because there’s a narrowing of blood vessels in the brain.”

According to the 2001 data of the World Health Organization, there were more than 20.5 million stroke cases worldwide. About 12.7 million stroke cases in the world are attributed to high blood pressure. Of the total number of stroke mortality worldwide, seven percent are caused by diabetes. Stroke or brain attack was ranked third among the main causes of health mortality in the country.

High blood pressure is named the top cause of stroke, diabetes closely follows. In people with diabetes, arteries are hardened (atherosclerosis) and this serves as an apt stage for blood vessel blockage. According to Dr. Rosa Allyn Sy, incumbent president of the Philippine Society of Endocrinology and Metal3olism (PSEM), “diabetics are four to five times more prone to develop neurological disorders (such as stroke) because majority of type 2 diabetics have clustering of metabolic problems that hasten atherosclerosis.”

In the country, local data revealing the risk factors for stroke are yet to come out but SSP, through
their website, named the possible culprits. The society gathered data from other countries and views of Filipino medical experts regarding the main risk factors for stroke. The physicians named hypertension, certain heart diseases like coronary artery disease and atrial fibrillation, transient ischemic attacks (TIA or mini-stroke), diabetes mellitus, and asymptomatic carotid disease as the main causes of stroke. The society also mentioned risk factors which have strong association with the disease but still need further research. These include too much alcohol, sedentary lifestyle, high blood cholesterol levels, and high fat diet.

Most people only realize they have stroke after having a TIA but diabetics should not wait for a mini-stroke to happen. SSP says stroke can be detected through a thorough medical history and physical examination. Specific tests such as blood count, cholesterol, electrocardiogram, and fasting blood sugar are also essential in screening for stroke.

According to Dr. Bitanga, who is also a past president of the Philippine Neurological Association, tell-tale signs of stroke or brain attack are sudden focal weakness, numbness on lower half of the body, slurring of speech, sudden loss of vision on one eye, and sudden loss of balance.

More serious symptoms include momentary loss of consciousness, extreme headache and even inability to move some body parts or paralysis. The latter is among the most common effects of stroke.

Of the two types of diabetes, type 2 is said to make one more inclined to develop stroke but at present, there are inadequate studies and data to back this assumption. What is known is that stroke strikes both men and women. When it comes to treatment, Dr. Sy said “neurological disorders (like stroke) are equally difficult to treat in both diabetic and non-diabetic patients.”

In terms of mortality, a study revealed those strokes occurring among diabetics are more fatal. In 1994, the Copenhagen Stroke Study showed mortality rate to be 24 percent among diabetics who suffered from stroke compared to 17 percent for those without the disease.  The researchers concluded that “diabetes influences stroke in several aspects: in age, in subtype, in speed of recovery, and in mortality.”

Hyperglycemia or high blood sugar among diabetics has been associated with aggravation of stroke. Normally, blood vessels can still convey oxygen through bypassing blocked areas but this is not possible for diabetics with atherosclerosis. Treatment depends on the kind and severity of stroke. There are medications which should be given no more than three hours after signs of stroke have been observed. The medications work by dissolving the blood clot which blocks the arteries to enable smooth flow of blood. Patients who already have plaque in the arteries may be required to undergo a surgery called carotid endarterectomy.

For both doctors interviewed, nothing could be more essential than keeping sugar levels in check among diabetics who are prone to have stroke. “As we always say, the best way to prevent different complications of diabetes mellitus is to keep blood glucose under optimal control at all times,” Dr. Sy reiterated.
According to Dr. Bitanga, who is also a diabetic, “Stroke can be prevented. Even if a diabetic person didri t have a stroke before, he should aspire to control sugar and fats.” She stresses that control of blood sugar, cholesterol and blood pressure are needed from the start because “in° treating diabetes, you are preventing stroke and other neurological disorders.”

True to its advocacy of stroke awareness and prevention, SSP has come up with guidelines in avoiding stroke for both diabetic and non-diabetic Filipinos. Established in 1995, SSP also organizes the Brain Attack Congress which tackles the latest studies on stroke. Through its website, the society imparts concise pointers in treating patients who have had mild, moderate or severe stroke. SSP also actively supports legislations and national campaigns such as Yosi Kadiri which aims to promote a smoke-free country. Smoking is linked to heart diseases and complications, including stroke.

Families like that of Vanessa’s can get in touch with concerned groups such as SSP to enrich their knowledge regarding what their family member has gone through. Why wait for a second and a third mini stroke to occur if it can be treated right after the first attack? Better yet, why let the first mini stroke happen if something can be done to prevent it? In line-with what Dr. Bitanga advised, “the best way to treat stroke is not to have one.”

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