Bill Klaproth (Host): This is Columbus Community Hospital Healthcasts. I'm Bill Klaproth. With me today is Dr. Kurt Kapels, hospitalist and physician at Columbus Community Hospital, here to discuss stroke and diabetes. Dr. Kapels, thank you for being here.

Kurt Kapels, MD: Sure, Bill. Thank you for having me. Glad to be here.

Host: Absolutely. This is such an important topic, so let's jump in. What are some of the most common signs of stroke that people should look out for? And if someone notices them, how fast should they get help?

Kurt Kapels, MD: Yeah. So, strokes, unfortunately, are very common. And so, it's very important to know some of the more common effects and symptoms that you might see, because time is important when it comes to stroke evaluation and management. And so, a simple mnemonic that we use that anybody can use is FAST. So, some of them are common things you're looking for is facial drooping. So if you notice someone's face doesn't appear like it typically does, you notice some droop unilaterally, that can be a sign of a stroke; arm weakness for A is another common symptom, and speech abnormalities. So, slurring of your speech, confusion, repeating yourself, difficulty finding words. All these things can be signs or symptoms of a stroke. And so, time becomes very important if you notice these symptoms, especially from the last time that we know that someone's well, if you can get them to the appropriate medical center to be evaluated and treated as soon as possible, it's very important for management and outcomes when it comes to stroke.

Host: So, we should always remember the acronym fast. So, that's a good way to remember it. So, we hear that high blood sugar can do long-term damage. How exactly does it affect the body, especially the brain and the heart when we're talking about risk factors?

Kurt Kapels, MD: Yeah. So, we're learning more as time goes on about the effects both acutely and chronically of having high blood sugars. And so, obviously, medicine's an ever-evolving area. And so, we're constantly learning and not all the mechanisms are that well understood. But we know that having high blood sugars does increase your risk of having a stroke, particularly in women. And it is associated with potential for larger strokes or poor prognosis or longer recovery time. And so, the mechanisms of how that works is, again, pretty complex and not fully understood, but likely to do with a combination of several things, including inflammation of the vessels and of neurologic tissue, oxidative stress, vascular damage. Particularly, endothelial dysfunction, so the lining inside of your blood vessels can cause dysfunction to platelets or your coagulation or clotting pathways. So, lots of different things that can be associated with high blood sugars, especially over time; and therefore, increase your risk of vascular dysfunction.

Host: So, that's really important to remember. Pay attention to inflammation, stress, vascular damage, those types of things. So when it comes to stroke risk then, if we could boil this down, what are the biggest factors people should know about? And which ones are the most important that they really need to stay on top of?

Kurt Kapels, MD: Sure. So, a simple way that we kind of look at risk factors for strokes is you can kind of divide them into modifiable risk factors and things that are not modifiable. So, things you can't change. So, there's things about each of us that we can't change. We can't change our age, we can't change genetic predispositions. There's certain other underlying medical conditions that may not be amenable to quick changes. So, some things are beyond your control. But modifiable risk factors become very important because those are the things that we can aggressively try to manage to reduce the risk of strokes and to improve outcomes after strokes.

And so, that would include things like diabetes is an important one, uncontrolled high blood pressure, weight, including particularly central obesity, physical inactivity, obstructive sleep apnea that's not well-controlled. So, there's lots of modifiable risk factors, including some of our habits. Physical activity, we talked about, but also smoking, alcohol or other substance intake. Diet is another thing that there's some evidence may be helpful. And so, some of the things that we can control become very important, again for both management and outcomes.

Host: Yeah. That's a really good list, and people really should take that to heart, what you just said, Dr. Kapels. So, diabetes, blood pressure, weight, physical inactivity, sleep apnea, smoking, alcohol intake, those are all modifiable things that you should pay attention to. And if you're having trouble in any one of those areas, you should certainly address that. So when we talk about diabetes, we hear type 1 diabetes and type 2 diabetes. When it comes to long-term health problems, what's the difference between type 1 and type 2 diabetes?

Kurt Kapels, MD: So, again, a pretty complex topic and something that, again, we're still learning about. But long-term complications between the two are pretty similar in a lot of respects. However, there's significant differences a lot of times when it comes to, for instance, age of presentation of complications; the time of onset of complications from the time of your diagnosis, maybe shorter or longer depending on your diabetic diagnosis. Your prognosis long-term recovering from complications may be different. And so, the complications themselves can be similar, but the rate of progression, the risk of those can be different. For instance, like diabetic retinopathy. So, damage to your eyes is probably more common in type 1 diabetics and may progress faster in type 1 diabetics. Prevalence of things like diabetic nephropathy, so kidney problems. Prevalence is higher in type 2 diabetics, but again, may progress faster in type 1 diabetics, especially if they're not well-controlled.

Other complications like infections, cardiovascular disease, diabetic cardiomyopathy, diabetic neuropathy can present in both type 1 and type 2, but again, maybe at different ages or may progress at different rates.

Host: So, let me ask you this then. Are people with diabetes more likely to have a worse stroke or a longer recovery time. And if so, why is that?

Kurt Kapels, MD: It appears based on, again, what we know that that's probably the case, that people with underlying diabetes probably are at higher risk of having larger strokes. We know they're at higher risk of having a stroke in the first place, and also high risk of having recurrent strokes. Also, probably more likely to have conversion of an ischemic stroke to a bleeding type stroke; so, a blockage stroke, converting to more of a bleeding type stroke. And long-term, the prognosis may not be as favorable in diabetics as compared to non-diabetics. So, recovery time and recovery of neurologic function, again, very complex, not that well understood. It probably has a lot to do with cumulative effect of high blood sugar over time. In particular, like we talked about, those oxidative elements that are created inside of the body causing inflammation, vascular dysfunction and inflammation; damage to the repair functions, neurodegenerative repair functions of the brain and tissue. All those things are affected by poorly controlled blood sugars and therefore may affect the recovery that you have after a stroke.

Host: Always a good advice. So, talking about modifiable risk factors, and you were just talking about weight and eating habits and those things. So people, then the question is, "Okay, what should I be eating to protect myself against stroke and also, at the same time, help keep my diabetes under control? Can you tell us what should we be eating?"

Kurt Kapels, MD: Sure. So, again, I think as a general rule, a lot of us know the things we probably shouldn't be eating. That's always an easy place to start. But I think your diet plan for each individual person should be individualized with your healthcare providers. And so, leaning on them based on your other underlying diagnoses, other medications, and various other elements is important when you're trying to put together a nutritional plan. But a more broad approach, trying to be consistent with carbohydrates, trying to limit carbohydrates is important. There's some evidence diets similar to like a Mediterranean type diet are helpful, especially people who have underlying cardiovascular disease that's known. So, that would be things like diet high in fruits and vegetables, legumes, healthy whole grains, again, limiting carbs. Nuts and seeds and olive oil, those types of things. Some fish, some poultry, trying to limit red meats and limit alcohol and smoking, those types of things. And so, we are learning more and more about processed foods and ultraprocessed foods and some of the dangers that those present to our health. And so, trying to avoid those is important when you're trying to reduce your risk for both diabetic complications and stroke.

Host: Yeah. That's things we've heard before, but you just have to take these things to heart. Like you said, you have to be consistent and have a nutritional plan. Limit your carbs and be consistent with carb intake. Pay attention to fruits and vegetables, right?

Kurt Kapels, MD: When it comes to your medications and your treatment too being consistent with what you're eating and your carb intake and those kinds of things can help you to avoid big swings in your diabetic control and to help regulate your blood glucose a lot more effectively.

Host: Yeah. Both of those things together obviously make a big difference. So, really paying attention to what you eat and learn about the Mediterranean diet, as Dr. Kapels says, could be good things in there for you. So then, let's continue on with the modifiable things. Let's talk about regular exercise. How important is exercise in all of this, both for preventing strokes and managing diabetes?

Kurt Kapels, MD: So, very important as you'd expect, and we know that physical inactivity increases your risk of cardiovascular complications, strokes, those sorts of things. And so, maintaining regular physical activity is very important for a lot of reasons. It helps you to build and maintain lean muscle mass to reduce central obesity, which is really a problem in a lot of health conditions, including diabetes and stroke risk. Maintaining healthy blood pressure, helping with treatment of things like obstructive sleep apnea and healthy sleep habits. So, regular exercise also helps do a lot of other things, regulates your mood, you're more likely to have other healthy habits and avoid other unhealthy habits if you're a regular participant in daily exercise. And so, being physical, even if it's starting with a little and working your way up is very beneficial when it comes to management of both stroke risk and diabetes.

Host: So, pay attention, diet and exercise, they go together. So, I know this is variable. But if someone does have a stroke, what does recovery look like? And is a full recovery possible?

Kurt Kapels, MD: Yeah. Like you said, it's really individualized to each person for a lot of reasons. The short answer is, yes, strokes can be fully recoverable. But a lot of that depends on, again, time of presentation from when you first arrive for medical care, from when your stroke symptoms develop; what area of the brain is affected, how much of the area of the brain is affected, how many other risk factors you carry, other comorbid conditions. Those are all important when you're talking about prognosis and long-term recovery. But yes, recovery is something that can be variable from patient to patient all the way up until fully recovered, that may look different from each individual case. It may involve a wide array of specialists, including physical therapists, occupational therapists, rehab doctors, speech therapists, a whole team of folks, depending on what your needs and your deficits are to help aggressively and thoroughly try to manage your recovery process.

Host: Well, that's really good to know. And that's, again, where that FAST acronym comes in. Again, the quicker you get in, right, and if a stroke is diagnosed and treated, probably the better the recovery. Would that be correct?

Kurt Kapels, MD: It appears that way. It certainly improves the odds of better prognosis as you move forward. And the more you can control those risk factors, it appears better your long-term prognosis is.

Host: So, let's talk about some advances in medicine. Are there any new treatments or technologies out there that are helping people recover better from strokes or manage diabetes more effectively?

Kurt Kapels, MD: Yeah. So, it's an ever-evolving, ever-changing two major areas of medicine when you're talking diabetes management and you're talking strokes. And so, again, a very broad topic and a very quickly evolving topic. But there's a lot of both evaluation and treatment options that are either new or becoming more of a commonplace how we manage these patients.

And so, for strokes, lots of different types of treatment in the acute setting, such as IV thrombolytic medications to help with obstructed vessels. There's also what's called, mechanical thrombectomies for certain patients who present at the right moment in time and have large blood vessel occlusions that can be actually mechanically removed by doing a procedure.

There's definitely lots of new medications that have been on the market or coming on the market that are helpful for treatment of those modifiable risk factors and treatment of diabetes in particular. And when it comes to diabetes, things like continuous glucose monitors to better monitor your blood sugars more effectively and more consistently. Things like insulin pumps are becoming more common and more easily managed by a patient. Again, all kinds of different medications and we're learning more about diets and exercise plans and those kinds of things that can be helpful as well. So, very comprehensive approach is what's needed when you're talking about both strokes and diabetes.

Host: Absolutely. Well, this has really been interesting and informative, Dr. Kapels. I want to thank you for your time. Last question, is there anything you want to add or anything that we missed that you want to cover?

Kurt Kapels, MD: Not particularly. I think just it's important to, if you carry some of these modifiable risk factors to be in touch with your medical team, with your physician, individualize your plan of what you can do to try to help both maintain a healthy lifestyle and reduce your risk factors as you move forward.

So, again, reducing your risk of any of these, things like strokes or cardiovascular disease and complications that move forward, it really becomes a team effort. And so. finding physicians a care team that fits you and putting together an individualized plan and sticking with that plan. It's incredibly important when it comes to your long-term health.

Host: Thank you Kurt Kapels MDso much for your time. I really appreciate it.

Kurt Kapels, MD: Yes. Thanks, Bill. Thanks Kurt Kapels MDfor having me. I enjoyed chatting with you.

Host: Absolutely. Thank you again. And for more information and resources, please visit columbushosp.org. That's columbushosp.org. And if you found this podcast helpful, please share it on your social channels and check out the entire podcast library for topics of interest to you. This is Columbus Community Healthcasts. I'm Bill Klaproth. Thanks for listening.