DIABETES AND STROKE

Diabetes and Stroke

Stroke occurred when blood stream to the brain is insufficient. It is considered as an emergency case that should seek for immediate help. There are two types of stroke. The first one is ischemic stroke due to a clot or blockage of blood and oxygen supply to the brain. The second one is hemorraghic stroke or bleeding stroke caused by a rupture of a brain aneurysm or leak of tiny weakened or inflamed blood vessel in the brain.

About 75% of stroke cases are clot stroke. The blockage is caused by either a thrombus or an embolus. A thrombus is a static clot in the blood vessel, while if it is loosing itself and moves following blood stream it is called an embolus. An embolus may fix in another smaller vessel causing the obstruction.

Clot stroke may be preceded by a condition called by transient ischemic attacks or TIA. This a kind of mild stroke indicated by sudden physical weakness, inability to talk, double vision and dizziness. In TIA the recovery of blood circulation is quite fast so that serious neurological damage can be avoided. The survival rate of clot stroke is generally high.

In the bleeding type, as blood flows into the brain it increases the pressure in the brain that may directly kill brain cells. The increased tension may also block blood circulation and destroy brain cells. This condition is reflected as severe headache which is sometimes followed by unconsciousness. Unlike the clot stroke, mortality of massive bleeding is around 80% of the cases.

Cause

The cause of a clot stroke is related to cardiovascular diseases, e.g. atherosclerosis or heart attack. Atherosclerosis is responsible in the formation of a thrombus or embolus that causes the obstruction. After a heart attack the blood flow becomes slower. This creates the possibility to form blood clots.

A bleeding stroke may result from a brain aneurysm rupture. It can also caused by a weakening blood vessel due to consistent strain of high blood pressure. A rare condition is the leaking of arteriovenous malformation, a congenital disease in the brain.

Signs and Symptoms

Stroke symptoms are; sudden loss of vision, strength, sensation and coordination, ability to speak or to understand speech. Impairment may occur to one side of the body, like lack of sensation at one side of the face or one-eye blindness. The patient may also experience a sudden loss of balance followed by nausea and vomiting, hiccup or trouble when swallowing. If the patient shows sudden and severe headache followed by unconsciousness it is the symptoms of bleeding stroke.

Risk factors

Factors that are considered as condition or illness that can lead to stroke are; age over 60’s, gender, high blood pressure, high cholesterol especially Low Density Lipoproteins, diabetes, obesity, smoking, drug abuse, use of birth control pills and stress.

Diagnosis and Treatment

A neurologist should confirm all the stroke symptoms that appear. In addition, the neurologist should conduct a thorough and quick exam to identify the type of stroke, the location of the lesion and the extent of the affected brain area to be able to provide the right treatment. A standard exam like to assist the diagnosis like the examination of blood vessels in the eye, looking for possible unusual noise in the heart and carotid artery of the neck, measuring blood pressure and pulse rate, and test to assess sensation and neurological reflexes. A critical test for stroke includes a CT scan and MRI scan.

Stroke patients are best treated in a hospital to provide the necessary treatment to avoid further brain damage. In clot stroke the conventional medicine is an anti-coagulant like heparin. While in bleeding stroke a surgical operation may be necessary to drain the accumulating blood and clip the ruptured vessel.

After passing the critical condition, the patient should stay in the hospital until the condition is stable. When released from the hospital the patient should be guided by a recovery program to prevent future strokes. The program may include diet and lifestyle changes, drug treatment, and paralysis rehabilitation. A neurologist may also consider a surgical operation there is an indication of critical brain artery narrowing.

Prevention of future stroke

Patients with bleeding stroke should keep their blood pressure at a low level. In clot stroke, anti coagulant like aspirin should be taken. Aspirin is strongly prohibited for patient with bleeding stroke. Be sure to see your doctor regularly and follow his instruction and guidance. Try to run a healthy lifestyle which includes low fat, salt and cholesterol food, exercise regularly, control weight, monitor blood pressure and cholesterol levels.

On the Alert

You should call you doctor if you or someone else is experiencing the following symptoms:

• Sudden loss of vision, strength, sensation and coordination, ability to speak or understand speech.
• Impairment may occur to one side of the body, like lack of sensation at one side of the face or one-eye blindness.
• Sudden loss of balance followed by nausea and vomiting, hiccup or trouble when swallowing.
• Sudden and severe headache followed by unconsciousness which is the symptoms of bleeding stroke

If the symptoms passed quickly, you may experience TIA or transient ischemic attack in the brain. Do not neglect it, report to your doctor to seek immediate medical intervention.

DIABETES AND HEART ATTACK

Diabetes and Heart Attack

Heart attack is another emergency condition that needs immediate medical care. This condition is triggered by insufficient blood and oxygen supply to heart muscle or myocardium. To be able to pumping blood to our entire body, the heart should have enough supply of blood and oxygen through two major arteries called the coronary artery.

Cause

Heart attack is the result of a long process starting with the accumulation of lipoproteins in the vessels lining. The process continues to become atherosclerosis, the hardening and narrowing of blood vessels and the formation of plaques and thrombus.

A thrombus may release itself to become an embolus that is carried by the blood stream to park and cause obstruction somewhere else. If this happened to the coronary artery, the main vessel that supplies blood and oxygen to heart muscles, it will cause myocard infarct or damage of the heart muscle.

Myocard infarct may cause a sudden break of the heart pumping function, known as cardiac arrest, which can be deadly. One third of people suffering heart attack died during mobilization to the hospital without any symptoms shown prior to the attack.

Heart attack is strongly related to diabetes. Diabetes is considered as one of the major predisposition factors of suffering from a heart attack if not treated well. Heart attack in diabetic people is more complicated to handle and usually ends up with death.

Sign and Symptoms

There are 3 conditions that may reflect the severity of myocard infarct, those are: angina pectoris, acute heart attack and cardiac arrest

Angina pectoris 

A stubbing pain may be felt yanking in short intervals. It is usually felt after some exercise and disappear after resting for a while. Overeating, cold weather and stress may trigger angina pectoris. In normal conditions or resting period, blood stream – which means oxygen – will be sufficient. As soon as an activity that needs oxygen and energy is exerted, the pain of angina pectoris will appear.

Acute Heart Attack 

The specific pain in an acute heart attack is a persistent pain felt in the chest, reflected to the left upper arm, down to the lower arm and could be felt till the tip of the little finger. It can be felt minutes to hours before a pain relief is taken. The patient may feel being helpless and is in terrible pain. The first several hours may be very critical, since decrease of blood flow to the muscle will cause heart arrythmia (irregular heart beats) and the diminishing of the heart’s pumping power. The heart may last 20 – 25 minutes in this low oxygen situation, but beyond that, muscle damages will be irreversible.

Cardiac Arrest 

This is a sudden break of the heart. This is the most severe condition of myocard infarct where the damaged of heart muscles is too severe and covers a large area. The heart is already helpless. The severe blood or oxygen insufficiency will cause the trembling of the heart chamber (= atrial fibrillation). The patient may feel a sudden stubbing pain in the chest and will loose consciousness in minutes. Dead will come in minutes if no action is taken.

Risk factors

Studies of risk factors for acquiring a cardiovascular disease have been established. Risk factors are genetic factors, age, high blood pressure, high cholesterol, smoking, obesity, diabetes and stress. To minimize the possibility of getting a heart disease, all risk factors should be taken into consideration when trying to set a corrective treatment.

Diagnosis and Treatment

Series of tests and scans will be required to thoroughly detect heart defects. An electrocardiogram or ECG recording plus some blood tests can be used for primary assessment of the heart and patient’s condition. An x-ray photo of the heart may indicate enlargement of the heart, while angiograms and radio-isotope scan may specifically locate damaged and blocked area.

Since heart attack is a medical emergency, it should be quickly attended by the administration of conventional medicines and or surgical therapy. This can best be done in the hospital’s intensive coronary care unit (ICCU). The patient is connected to an ECG machine and automatic drug feeder for constant monitoring and drug administration.

The initial conventional medicines prescribed by a cardiologist may consist of morphine (a strong analgesic or pain killer), beta-adrenergic blockers (to relax the heart) and aspirin (an anticoagulant to dilute blood and prevents blood clotting). If the critical situation passed successfully, treatment may be continued. Drug combination is a beta-adrenergic blocker, nitrates to increase blood flow and an anticoagulant

A patient recovering from a heart attack should be forced to mobilize themselves to avoid the formation of blood clots in leg veins. If this happen, a clot may travel with the blood stream and can cause an obstruction in the lungs. After hospitalization, the patient may as well continue drug treatment in combination with the therapeutic lifestyle changes as suggested by the cardiologist.

Prevention

Seek for social support by getting along with your relatives and friends. This may lower the risk of a heart attack. It is proven through research that people with poor social support have greater risk to acquire a heart attack.

Try to control emotion such as anger and hostility. Emotion may stimulate secretion of adrenalin that increases heart beats and tension of the blood vessels

Acquire a heart attack risk assessment as a basis in setting your lifestyle changes

If you are at high risk for heart attack you should schedule a regular test to detect silent ischemia of the heart muscle.

Consult your doctor whether it is necessary for you to take an aspirin daily, since aspirin significantly reduce the risk for heart attack.

On the Alert

Contact your doctor immediately without any delay if: 

You or someone else experience symptoms of heart attack, like prolonged crushing, squeezing, stubbing or burning pain in the chest. Pain that is projected to the neck, left shoulder and arms, also shortness of breath, dizziness, nausea, chills, sweating and weak pulse. Gray pallor face, cold and clammy skin. Fainting and loss of consciousness

You suffer from angina pectoris and start to feel the same pain that does not respond to your medication. This is a sign that a heart attack is on its way

Your angina attacks become more frequent, prolonged and severe. This is the sign that your angina becomes worst and need quick action to prevent heart attack.

DIABETIC NEPHROPATHY

Understanding Diabetic Nephropathy

Diabetic nephropathy - kidney disease that results from diabetes - is the number one cause of kidney failure. Almost a third of people with diabetes develop diabetic nephropathy.

People with diabetes and kidney disease do worse overall than people with kidney disease, alone. This is because people with diabetes tend to have other long-standing medical conditions, like high blood pressure, high cholesterol and blood vessel disease (atherosclerosis). People with diabetes also tend to have other kidney-related problems, such as bladder infections, and nerve damage to the bladder.

Kidney disease in type 1 diabetes is slightly different than in type 2 diabetes. In type 1 disease, kidney disease begins acutely and may start at an early or young age. Overt disease, when present, is obvious after about 15 years of having type 1 diabetes.

In type 2 diabetes, many patients have kidney disease at the onset, when they are diagnosed with diabetes. Because type 2 diabetes is frequently found in the middle or older aged person with other chronic medical conditions, kidney disease may have been caused by other conditions.

Symptoms of Diabetic Nephropathy

Although there are often no symptoms with early kidney damage, they may include:

• Swelling of the hands, feet and face.
• Weight gain.
• Itching (end-stage kidney disease) and extremely dry skin.
• Drowsiness (end-stage kidney disease).
• Blood in the urine (rare).
• Abnormalities in the hearts' regular rhythm, because of increased potassium in the blood.
• Muscle twitching.

As kidney damage progresses, your kidneys cannot remove the waste from your blood. The waste then builds up in your body and can reach poisonous levels, a condition known as uremia. People with uremia are often confused or comatose. Uremia is worsened by high blood pressure.

Diagnosis

Diabetic nephropathy is detected by finding protein in the urine. That's why you should have your urine tested every year.

Treatment

Lowering blood pressure and maintaining blood glucose control are absolutely necessary to slow the progression of diabetic nephropathy. Some medicines called angiotensin converting enzyme (ACE) inhibitors can help slow down the progression of kidney damage. Although ACE inhibitors - including Altace, Lotensin and Capoten - are usually used to treat high blood pressure and other medical problems, they are often given to people with diabetes to prevent complications, even if their blood pressure is normal. If a person has side effects from taking ACE inhibitors, another class of drugs called angiotensin receptor blockers can be given instead.

If not treated, the kidneys will continue to fail and larger amounts of proteins can be detected in the urine. Advanced kidney failure requires treatment with dialysis or a kidney transplant.