Stroke and Diabetes

Stroke is a sudden impairment of brain function caused by either reduction of blood flow to the brain or bleeding into the brain. Also known as brain attack, strokes are categorised into two types – ischaemic and haemorrhagic stroke. 

Ischaemic stroke (clot), which makes up approximately 60 – 70% of all stroke cases, is when there is a lack of blood flow to the brain caused by a clot or rupture of a blood vessel. This clot is usually formed due to fat, cholesterol, and other substances that collect on the artery walls, forming a sticky substance called plaque.

Haemorrhagic stroke (bleed) happens when a blood vessel in part of the brain becomes weak and bursts open, causing blood to leak into the brain. This can cause compression of tissue in the brain, where the pressure may also lead to a loss of blood supply to affected tissue.

There’s also the mini stroke or Transient Ischaemic Attack (TIA), which is technically not a stroke, but a warning sign of a future stroke. Unfortunately, up to 40% of TIA patients will have a future stroke, says Dr Tan Swee Teng, Consultant Neurologist at the Sunway Medical Centre.


Generally, people with diabetes are 40% more likely to have an ischemic stroke than non-diabetics. Since type 2 diabetics are often obese or overweight, they often have high blood pressure, high cholesterol and circulation problems that put them at high risk of getting a stroke.

The symptoms of stroke typically develop suddenly and without warning. These symptoms depend on the area of the brain affected. The more extensive the area of brain affected, the more damage there is and the more functions that are likely to be lost.

Stroke symptoms include:

  • Sudden and severe headache
  • Trouble seeing in one or both eyes
  • Sudden dizziness / Trouble walking
  • Sudden confusion / Trouble speaking
  • Sudden numbness or weakness of face, arm or leg (especially on one side of the body). Sometimes weakness of the face may cause drooling.

These symptoms happen because the brain cells are suddenly deprived of oxygen, hence they cease to perform their usual tasks.


According to Dr Tan, up to 80% of all strokes are preventable through risk factor management.

As people with diabetes are more likely to have stroke, stroke prevention in diabetics is even more crucial.

“The most important thing is to ensure blood sugar is optimised by regularly controlling and monitoring blood glucose levels. Diabetes patients should also control their diet, exercise, achieve an ideal body weight if they are obese, and meticulously take their medication that doctors have prescribed,” advises Dr Tan.


Do not delay in calling an ambulance or going to the nearest hospital if a person exhibits any signs of a stroke. Stroke cuts off oxygen to the brain, hence the longer the delay, the more severe the brain damage.

Apart from taking the patient’s medical history, imaging tests are used to pinpoint the type and size of a stroke. Doctors need this information to give patients the best line of treatment.

The first line of treatment is usually computerised tomography (ct) scan, which are 3-d x-rays of the brain to look for bleeding or masses within the brain that indicate or mimic a stroke. This method, however, does not pick up small strokes or early strokes that have just happened within the first few hours.

Sometimes, the non-radiation magnetic resonance imaging (MRI) is used to create 3d pictures of the brain.  The examination may take longer than a ct scan, but mri images are more detailed.

A procedure known as MRA (magnetic resonance angiogram) can also be used to specifically look for narrowing or blockage of blood vessels non-invasively, i.e. without using tubes or injections/dyes, which some patients can be allergic to.

In order to diagnose stroke at its earliest onset, another MRI technique called DWI (diffusion weighted imaging) can detect the area of abnormality, minutes after the blood flow to a part of the brain has ceased.


Many people lose their quality of life after a stroke. Family members and friends may even have their lives altered as they find themselves in the new role as caregivers.

With more advanced diagnosis and treatment methods, the recovery outcome of stroke patients has now improved.

“the outcome of stroke for both diabetic and non-diabetics patients are similar. But the risk of recurrent stroke is higher in people with diabetes,” said dr tan.

Her take home message is to control and monitor diabetes for both primary (first) and secondary (recurrent) stroke prevention.

Early detection is the best way to find out about your health status. For more information on diabetes management and access to medical experts, please visit the diabetes care centre at sunway medical centre located on the 1st floor in the east wing or contact a diabetes nurse specialist at 03 7491 9191 (ext. 11139/11149). Sunway medical centre also has a stroke caregivers club. To register for a session, you can contact: Amira at +603 7491 9191, ext. 71152, or email

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