Act F.A.S.T. on stroke
People living with diabetes have an increased risk of stroke compared to the general population. While not all strokes can be prevented, many modifiable risk factors can be addressed through evidence-based diabetes care and ongoing support.
Understanding stroke
Stroke occurs when blood flow to part of the brain is interrupted, depriving brain tissue of oxygen and nutrients. Without prompt treatment, brain cells can begin to die within minutes. There are three main types of stroke:
- Ischaemic stroke is the most common and occurs when a blood clot blocks a cerebral artery.
- Haemorrhagic stroke results from the rupture of a blood vessel in the brain. High blood pressure is a common cause.
- Transient ischaemic attack (TIA) is a temporary interruption of blood flow to the brain. Although symptoms may resolve quickly, a TIA is a medical emergency and an important predictor of future stroke risk.
Why stroke risk is higher in diabetes
Diabetes contributes to vascular damage through multiple pathways. Prolonged hyperglycaemia can damage blood vessels and accelerate atherosclerosis, increasing the likelihood of plaque formation and subsequent thrombotic events. When plaque ruptures, a clot may form and obstruct blood flow to the brain.
Stroke risk is further increased in people with diabetes who also have:
- Hypertension
- Dyslipidaemia
- Chronic kidney disease
- Atrial fibrillation
- Smoking or vaping behaviours
- A family history of cardiovascular disease
- Excess weight affecting health outcomes
Addressing these risk factors should form part of diabetes care planning and review.
Recognising stroke symptoms
Rapid recognition and treatment of stroke symptoms can significantly improve outcomes. It’s a good idea to routinely educate people living with diabetes and their families about the F.A.S.T. message:
- Face – Has the person’s face drooped on one side?
- Arms – Can they raise both arms?
- Speech – Is speech slurred or difficult to understand?
- Time – Call 000 immediately if any of these signs are present
Additional symptoms may include:
- Sudden weakness or numbness, particularly on one side of the body
- Sudden loss of vision or visual disturbances
- Dizziness or loss of balance
- Trouble swallowing
- Confusion
- Sudden severe headache
People should be encouraged to seek emergency medical care immediately, even if symptoms appear mild or resolve quickly, as may occur with a TIA.
Reducing stroke risk
Stroke prevention strategies should be individualised and aligned with each person’s overall cardiovascular risk profile. Key areas where you can provide support include:
Optimising glucose management
Supporting people to achieve and maintain agreed glucose targets can help reduce long-term vascular complications. Regular review of treatment plans, self-management strategies and monitoring practices is important.
Managing blood pressure
Hypertension is a major contributor to stroke risk. Regular blood pressure monitoring, patient education and use of medication if necessary are essential components of preventive care.
Lipid management
Many people living with diabetes benefit from lipid-lowering therapy based on their overall cardiovascular risk.
Encouraging physical activity
Regular physical activity supports cardiovascular health, glucose management and weight management. Referral to an accredited exercise physiologist may help individuals develop safe and sustainable activity plans.
Supporting healthy eating
Dietary patterns that emphasise vegetables, fruit, wholegrains, legumes, nuts, seeds and healthy fats can contribute to cardiovascular risk reduction. Referral to an accredited practising dietitian may assist with personalised nutrition planning.
Facilitating smoking cessation
Smoking cessation remains one of the most effective interventions for reducing cardiovascular and stroke risk. Health professionals should routinely assess smoking status and offer appropriate support and referrals.
Discussing alcohol consumption
Conversations about alcohol intake should be incorporated into routine diabetes care, particularly where alcohol may affect glycaemic management, cardiovascular risk or medication effectiveness.
Supporting medication adherence
Glucose-lowering, antihypertensive, lipid-lowering and antithrombotic therapies can all contribute to reducing stroke risk when clinically indicated. If a client is hesitant about taking a medication, supporting informed decision-making can improve outcomes.
Promoting preventive health checks
Regular review through the annual cycle of care provides opportunities to identify emerging risk factors.
The health professional’s role
Every interaction presents an opportunity to discuss stroke prevention and improve health literacy. Supporting people living with diabetes to understand their personal risk factors, know the signs of stroke and engage in evidence-based risk-reduction strategies can significantly influence long-term outcomes.