aAfter spending nearly two decades trying Type 2 diabetes managementIn 2015, Agnes Kochlevsky landed in the emergency room, with news of a heart attack. I also learned that she has metabolic syndrome, a group of conditions that include diabetes but also increase the risk of heart disease and stroke.
“Because I needed to lose a significant amount of weight when I was first diagnosed, I would focus on the number I saw on the scale, and then on my blood sugar numbers,” recalls Kochlevsky, 68, who lives in New York City. . “I didn’t realize other numbers were at play, like blood pressure and cholesterol. It came as a shock. It made me realize there were more things I needed to control than I thought.”
According to the American Heart Association (AHA), people with diabetes have twice as much Stroke risk Compared to those without diabetes. They also tend to develop heart disease or have a stroke at a young age, and the American Heart Association estimates that an American adult with diabetes is hospitalized for a stroke every two minutes.
This connection has to do with how the body handles blood glucose to generate energy, says Dr. Deepak Gulati, MD, a neurologist at The Ohio State University’s Comprehensive Stroke Center Wexner Medical Center. When food breaks down into glucose, it uses the hormone insulin to enter cells, but people with type 1 diabetes lack the insulin needed for this process. With type 2 diabetes, very little insulin is produced. Either way, this can cause too much glucose to remain in the blood, which can lead to increased fatty deposits in the blood vessels.
“These blood vessels are found in the brain, heart, and other organs,” says Gulati. “The plaque can weaken blood vessel walls and also cause blockages, which greatly increases the risk of heart attacks and strokes.”
This does not mean that cardiovascular problems are inevitable for diabetics. Although there are some factors you can’t change, like your family history or your age — stroke risk increases as you get older — the good news is that there are ways to make stroke prevention more robust when you have diabetes.
Be aware of your own risk level
The first step to prevention is simply to be aware of the link. As Kochlevsky discovered, managing diabetes is critical to health, but without knowing your stroke risk, you might ignore other key variables like blood pressure and cholesterol.
Dr. Carolyn Messer, MD, an endocrinologist and medical director of the Center for Neuroendocrinology at Lenox Hill Hospital in New York says.
She adds that awareness should go both ways. Not only does this mean that people with diabetes should understand the risks of stroke, but those with cardiovascular problems may want to investigate their potential for diabetes. Sometimes, says Messer, someone is in the emergency department has a stroke Or they will be told in a heart attack that they also have diabetes, and that can be concerning.
You don’t need to wait for a tragic health event to happen. If you have other risk factors for heart disease such as high blood pressure, sedentary habits, poor diet, and high cholesterol, Messer suggests it’s a good idea to get a full screening — one that looks at your likelihood of having diabetes as well as heart problems, since they go hand in hand. side by side.
“A risk for one can increase the risk for another,” she says. “So, if you already know you have heart health challenges, it’s a good idea to get screened for diabetes as well. It will help you manage everything that might happen.”
Know your numbers
For diabetes, the numbers that get the most attention are daily blood sugar levels as well as the A1C – a test that measures blood sugar levels over a three-month period as a way to determine trends. But it’s also important to understand where you stand in terms of cholesterol and blood pressure.
“Hypertension, or high blood pressure, by itself has no symptoms, so people may not know it’s a problem for them until they have an event like stroke or heart attack,” Gulati says. “As a person with diabetes, you should be fully aware of your blood pressure reading, due to the higher risk of stroke.”
According to the US Centers for Disease Control and Prevention (CDC), a normal blood pressure is 120/80 mm Hg. Gulati says you’re considered to have high blood pressure with a reading of 140/90 or higher. High blood pressure damages arteries throughout the body, which can cause them to burst or clog more easily. If this happens, it can limit or stop the delivery of oxygen to the brain, resulting in a stroke.
It’s also helpful to know how to decipher your cholesterol numbers. A high amount of low-density lipoprotein (LDL) cholesterol can refer to fatty deposits in the blood vessels, while high-density lipoprotein (HDL) cholesterol is often called the good kind. Cholesterol absorbs, and high HDL levels can reduce the risk of heart disease and stroke.
Gulati says that like blood pressure, there are usually no symptoms of high cholesterol, so you can have high levels of LDL without even realizing it. Additionally, high blood pressure and high cholesterol are linked when it comes to stroke risk. Plaque deposits from cholesterol can narrow the arteries, causing the heart to pump more blood to pump blood through the body. It can raise blood pressure.
Gulati says checking your numbers and understanding what they mean — as well as having a conversation with your doctor or diabetes educator about how to treat them — is a vital step toward preventing stroke.
Expand your care team
Because people with diabetes have a higher risk of stroke, your facilitator suggests adding a cardiologist to your care team, in addition to an endocrinologist.
“Every person with diabetes should see a cardiologist at least once a year, especially if you have additional risk factors such as high blood pressure or a family history of stroke,” she says.
You may also want to consider other health professionals who have the knowledge and insight to address both heart health and diabetes. For example, this list might include a diabetes educator, registered dietitian, physical therapist, and smoking cessation counselor.
The latter can play a major role if you are struggling to quit tobacco. 2018 study in the journal BMJ is open It found that people with diabetes who smoke are 3.5 times more likely to have a stroke than those who don’t smoke. Another study, in the 2009 edition of Diabetes careSmoking increases the risk of cardiovascular disease in people with diabetes, in part because it raises blood pressure. It can also damage blood vessels and increase insulin resistance.
Read more: The truth about fasting and type 2 diabetes
Consider medication if recommended
If you have high cholesterol or high blood pressure, your doctor may suggest taking medications that treat these issues, such as calcium channel blockers or statins, says Gulati. Although the medication regimen will depend on your specific situation, he adds that such options are not only safe to take with diabetes medications, but are common to pair together.
Even if your numbers are in a good range, another option that you and your doctor might consider, Messier adds, is a class of diabetes medications called GLP-1 agonists. This class of medication has been shown to help control blood sugar and Possible weight lossResearch suggests that it is promising to reduce the risk of stroke in people with diabetes.
Whatever medication you and your doctor decide to try, another basic strategy is to stick to your medication schedule. This may seem obvious, but a 2014 study in gamma It found that medication non-adherence — when people do not take their medication as recommended — is a common problem, and as many as half of US adults who take prescription drugs may suffer from it. Another study, on diabetes medications specifically, found that non-adherence is associated with poorer glycemic control and an increased risk of diabetes complications.
Focus on heart-healthy lifestyle changes
If you have diabetes, you are probably already careful about what you eat in terms of carbohydrate and fat content as a way to control your blood sugar. It’s also helpful to take a look at heart-healthy diets for inspiration, suggests Dr. Jason Tarpley, MD, a stroke neurologist and director of the Stroke and Vascular Neurology Center for the Pacific Neuroscience Institute at Providence Saint John’s Health Center in Santa Monica, California.
“When it comes to the best way to prevent stroke, food is very good as a starting point,” he says. “An approach like the Mediterranean diet can help treat your diabetes and cardiovascular health, particularly with its focus on seafood, beans, and nuts.”
Other heart-enhancing lifestyle habits are also key. For example, it has been shown that getting regular physical activity, focusing on sleep quality, reducing stress, quitting smoking, and maintaining meaningful social connections may help with factors such as blood pressure regulation, Tarpley says.
The Mayo Clinic notes that over time, getting less than six hours of sleep each night can contribute to high blood pressure due to negative changes in the regulation of hormones such as cortisol and melatonin. People with diabetes already face hormonal challenges, and these can be exacerbated with sleep problems. According to the Centers for Disease Control and Prevention, lack of sleep can increase insulin resistance, for example.
Physical activity is another boon for stroke prevention and Diabetes management. The American Diabetes Association noted in the magazine Diabetes care In 2016, exercise improves glycemic control, reduces cardiovascular risk factors, contributes to weight loss, and even helps improve emotional state.
“There are many factors you can’t change when it comes to your stroke risk as someone with diabetes,” Tarpley adds. You can’t change your genes or your age, in particular. But there are modifiable factors that can make a big difference. It is really exciting to see how much better you can feel with habits like this, and you will reduce your risk of stroke at the same time.” •
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