Good diabetic control decreases the chance that the patient will develop hardening of the arteries or athlerosclerosis. It also decreases the chance that the patient will develop kidney damage with increased blood pressure. The combination of the diabetic state and high blood pressure puts people at a very high risk for stroke, a high risk for developing hardening of the arteries, and a high risk that even one of the blood vessels in the brain will burst and cause a brain hemorrhage, which also causes a stroke. So a diabetic state that’s not well controlled and high blood pressure are bad partners because they really markedly increase the risk of a stroke.
The warning signs of a stroke coming on consist of an unusual period where the person can’t speak for a few minutes, or notices that when they are eating food that one side of their mouth is drooping and maybe the food dribbles out, or their arm or their leg suddenly becomes week for a transient period of time (like a few minutes.) That’s usually sometimes called a mini-stroke or a transient ischemic attack – that is a brief period when the blood didn’t get to some of the parts of the brain. Usually it resolves quickly but it is a warning that a bigger stroke is coming on and just like the chest pain that people have when they exert themselves argues for “watch out for a heart attack” – those little symptoms like a sudden loss of some function is a warning signal for “hey, watch out for a bigger stroke coming.”
There are two ways to treat a stroke and it's similar whether you have diabetes or not. The first one consists of trying to open up the blood vessel that's been blocked. You can only do that in the first two to three hours after the stroke starts. So if the stroke is already well beyond that, then it consists of blood thinners to try and prevent the clot from extending, as well as controlling blood pressure to some degree. And then also just the overall improvement in the diabetic state. Better control of blood sugar, better control of blood pressure, taking care of that you're taking your medicines, that you're touching base with your doctor. In other words, all the things that we've talked about before, control the diabetes, control the blood pressure, control the cholesterol, and then we use blood thinners, usually. Sometimes milder blood thinners like aspirin or Clopidogrel and sometimes more powerful blood thinners such as Warfarin or Rivaroxaban or Apixaban.
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