Amanda Wilde (Host): Adults who have diabetes are twice as likely to have a stroke. We'll talk about how to manage the risks and steps you can take to stay healthy as we explore the connections between diabetes and stroke with Ardelia Morris, Registered Dietitian and Certified Diabetes Care and Education Specialist at University of Maryland Rehabilitation and Orthopedic Institute, part of the UM Rehab Network.

 Welcome to the Live Greater podcast series, information for a healthier you from the University of Maryland Medical System. I'm Amanda Wilde. Ardelia, great to have you here.

Ardelia Morris, MA, RDN, CDCES: Thank you. It's nice to be here.

Host: Can you further explain the connection between diabetes and stroke? How does having diabetes increase the risk of stroke?

Ardelia Morris, MA, RDN, CDCES: Well, when a person has diabetes, especially when their diabetes is not well controlled, it increases their risk of developing a stroke. It makes the blood vessels become stiff and can cause buildup of fatty deposits. This change can lead to a blood clot which travels to the brain, thereby causing a stroke.

As you mentioned also, Amanda, people with diabetes are twice as likely to have a stroke as people without diabetes. And that's according to the American Stroke Association. They're also more likely to have a stroke at an earlier age and it may be worse. And here's what's interesting too, I want to add, people that have pre diabetes have a higher risk of heart disease and stroke than people without diabetes.

Host: And there's 96 million more of those people out there as well. So are there any warning signs or symptoms that people with diabetes should be aware of regarding stroke risk?

Ardelia Morris, MA, RDN, CDCES: Well, as far as the warning signs, we can talk about what we call the BEFAST. B-E-F-A-S-T. We'll quickly kind of look at that acronym and it's a real handy technique to help people quickly recognize common signs of a stroke. B stands for balance. Is there a sudden loss of balance or coordination? E, that stands for eyes. Is there sudden blurred or double vision? F, ask the person to smile. Is one or both sides of their face drooping? A, arms. Ask the person to raise both arms. Does one side drift downward? Is there a weakness or numbness maybe on one side? S. Speech. Does the person have slurred or garbled speech? You know, can they repeat simple phrases? And the last letter is T, which is time. Okay, you know what, it's time to call 911. They need to seek immediate medical attention if any of these signs are noticed. And one other thing I want to add is very, very important. Knowing these symptoms and getting immediate medical attention are key to saving brain function.

About 2 million nerve cells are lost for every minute a stroke goes untreated.

Host: Wow, that is very sobering.

Ardelia Morris, MA, RDN, CDCES: Yes, most definitely. And you know what too, if a person seeks medical attention immediately, usually within three hours of symptoms, patient has a much better chance of a full recovery. They're giving a drug called TPA, it's called. The drug dissolves that clot and the blood flow to the affected part of the brain. But unfortunately, many people don't even make it to the hospital in time for that type of treatment.

Host: Well, in order to prevent getting to that point, are there risk factors that are commonly shared by diabetes and stroke, and how do they interact with each other?

Ardelia Morris, MA, RDN, CDCES: There's different risk factors for stroke and diabetes, but since you're asking about the actual common, the ones that are kind of related to stroke and diabetes; I would say they're probably more like things like obesity and being older, although a stroke can happen at any age. And you could also get diabetes at any age, but it tends to be when the person is a little bit older.

If there's a family history of a stroke and then there's also some lifestyle risk factors, poor nutrition, not getting enough physical activity; these are some really common risk factors that it goes for both stroke and diabetes. But the key is lifestyle change is just important for both stroke. And that's one of the big correlations between diabetes and stroke is that lifestyle change is needed to help to lessen the risk factors of developing either one.

Host: I hear this a lot. It's lifestyle modifications. But also, what role does medication play in reducing the risk of stroke inindividuals with diabetes? Are there specific medications that help?

Ardelia Morris, MA, RDN, CDCES: As far as prevention, and I got this confirmed with one of my doctors cause I was looking to think, well, are there other medications for stroke prevention? The only one is good old baby aspirin. That is the one, but there's some medications that are very good for patients with diabetes to have that are out there now.

They are called GLP-1 medications, like maybe Ozempic or the semaglutides, you know, is what they call them. But they've been shown to be very cardioprotective. Now, prevention of stroke, I can't say, but they have been studied and shown to be more cardioprotective and helping those patients with diabetes.

And that's why it should be, it's not always the case, first line of treatment for those that have diabetes, that have a lot of the risk factors that we talked about, ideally medically, they should be on one of these forms of medication, like a GLP-1. I'll say GLP-1s, and then also, too, there's other medications, SGLT-2s.

So these are kind of fancy names for some of these medications that are now being used to help to lessen that patient's risk. Really of cardiovascular disease.

Host: And is there a role for monitoring? In other words, are there any preventive measures or screenings that individuals with diabetes should undergo to detect and manage their stroke risk?

Ardelia Morris, MA, RDN, CDCES: We know the only thing to manage their stroke risk; I would say the ABCs of diabetes and that again, there goes that correlation again between the two, the ABCs. I encourage everybody to kind of keep those under control and that automatically helps to lessen their risk. A stands for the A1c, looking at the overall blood sugar over two to three month period. That's the A. The B is for blood pressure. Blood pressure's got to be controlled and many people that have diabetes, have blood pressure issues which also poses a higher risk of them developing a stroke. And the last letter is C, cholesterol. Want their cholesterol to be controlled. And that includes their good and their bad cholesterol.

Good being the HDL and the bad cholesterol being the LDL. So, I would say just as an overview to keep things simple, the ABCs of diabetes really should be managed the best that they can.

Host: Manage is a great word for it. What about the role of regular checkups and monitoring for people with diabetes, in terms of stroke?

Ardelia Morris, MA, RDN, CDCES: I think anyone listening would probably agree that it's very important to go and get medical care. And I cannot tell you how many people I see in the hospital that they admit that they stopped seeing their doctor, for various reasons that we won't get into because they felt fine. They thought that things were going fine.

So therefore they hadn't gone to see anybody as far as medically for probably two or more years. They stopped taking their medication, which is obviously very much of a concern when they don't take their medication, whether it is their medication for the cardiovascular health that often many of them are on, or their diabetes medication.

And then they come to us with a stroke. So, the health follow up going to your physician, very, very important, because they can help to monitor some of those things that we talked about earlier, which is the ABCs, that we mentioned earlier, but that you really, really want to be on top of that management.

If I were to add, I'd like to add other alphabet ABCs. We talked about that, but D is diet or dental. Cause some people that have diabetes certainly can have more issues with their gums because of the high blood sugars and the bacteria that forms. And then they can have the gingivitis and other dental issues.

And E, stands for. Guess what? Eyes or exercise. And then the F is the foot, foot care. So the list goes on and on, but that's a simplified way that I like to use to talk to my patients about what things do they need to keep their eye on? There's questions that they can ask for their doctor at their visits, when they go for their medical visits. Yes.

Host: Well, N is for November, which is Diabetes Awareness Month. As we look into the future, Ardelia, what do you see in terms of diabetes care?

Ardelia Morris, MA, RDN, CDCES: I like to start by saying that we use evidence based principle here, it's called the Seven Behaviors of Diabetes Care, and that's been established by the American Diabetes Care and Education Services. So there's an evidence based program that has seven behaviors, and that's incorporated within the teaching of the diabetes educator. And also during new employment orientation, there's a presentation that I do where I try to give new nurses and new techs and anyone that comes to orientation; tips on what can they do whenever they touch a patient with diabetes or care for a patient with diabetes. What can they do? First principle is healthy eating. Being active is the second one. Then monitoring. Taking medications. Problem solving. Healthy coping. Reducing risk. These seven behaviors really can make a difference.

And I tell everybody they're part of the team. It's like planting seeds. We all can plant seeds. Let's go ahead and plant some seeds with this patient. And today we're going to talk to them about the importance of activity. You know, maybe monitoring or whatever the topic may be. And I have it set up where they can do different topics at different days of the week and, they feel like they're more involved in helping their patient with diabetes. No, you're not a certified educator to do this, but there's some basic things you can do with these patients because you're seeing the patient way more often than I am.

What can you do? We have a diabetes fundraiser going on right now, which I'm really, really excited about because it's an opportunity during this Diabetes Awareness Month that you mentioned earlier, Amanda. We are trying to raise funds just to kind of help to provide the patients with continued education and give them some tools that they can take home with them. And I won't go over the items that we're going to try to have. I call it the toolbox or the toolkit, but we're raising funds to just kind of help to make everyone aware of diabetes and prediabetes; providing them some tools to go home so they can be more successful in their diabetes care and management. So hopefully they don't come back here with another stroke because we do get some re-admissions, which is not good. So education, education, education, can't stress that enough.

Host: Yeah, I was going to say you give amazing support and education and planting seeds is just how it works.

Ardelia Morris, MA, RDN, CDCES: exactly. And then other people come and do what, Amanda? They water. And next thing you know, wow, this patient is flourishing. They're learning more. They're managing their diabetes more. It's now become a beautiful tree.

Host: And those diabetes numbers are going down.

Ardelia Morris, MA, RDN, CDCES: Exactly, exactly. Oh my goodness. that excites me too, when just to know that they're taking better control of their diabetes, they're practicing some of the behaviors that we talk about. And we have a wonderful transitional care team that follows the patients at discharge. And sometimes I communicate with them to find out how some of the patients are doing. And what a wonderful thing to see A1Cs come down and to see that they are feeling better and they're practicing better lifestyle behaviors. And, that's what it's all about.

Host: Yeah, because diabetes increases the chance of the stroke, but you can truly minimize your own risks and it's great to know someone with your focus and resources is on the job, Ardelia. Thank you for this helpful conversation really outlining the relationship between diabetes and stroke and raising awareness of prevention and treatment.

Ardelia Morris, MA, RDN, CDCES: It's been a joy to be here. And I want to end with one more thing. I really, really want to say this. Diabetes can be managed and the risk of stroke can be lowered. Follow medication regimen given to you, okay? Work on lowering your risk of stroke. Manage your weight, exercise, follow a healthy eating plan. If you smoke, work on stop smoking. Alcohol needs to be limited or none at all. And also manage your stress. That would be a nice overview of what I'd like to leave everybody with today.

Host: Thank you, Ardelia.

Ardelia Morris, MA, RDN, CDCES: You're welcome. I have enjoyed it. you know, if it just makes an impact with just a handful of people, you know what, I am excited about that.

Host: That was Ardelia Morris, Registered Dietitian and Certified Diabetes Care and Education Specialist at University of Maryland Rehabilitation and Orthopedic Institute, part of the UM Rehab Network. Find more shows just like this one at umms.org/podcast and on YouTube.

Thanks for listening to Live Greater, a health and wellness podcast brought to you by the University of Maryland Medical System. We look forward to you joining us again, and please share this on your social media.