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Treating strokes quickly can mean difference between life and death or life unchanged and permanent impairment

New Pittsburgh Courier - 8/6/2019

Ischemic (in the brain) strokes happen when a blood clot or fatty deposits (called plaque) block a blood vessel carrying oxygen-rich blood to the brain, which means the brain cannot get the oxygen it needs. Within minutes of being starved of oxygen, tissue in affected areas of the brain starts dying. Therefore, strokes can lead to brain damage, disability or even death.

Treating strokes quickly can mean the difference between life and death or life unchanged and permanent impairment. Researchers continue to work on ways to quickly treat people who have had strokes to minimize brain damage. One particular area of research done recently at the University of Pittsburgh and other sites examined the common connection between high glucose (blood sugar) levels and worse outcomes for people who have had strokes. The Stroke Hyperglycemia Insulin Network Effort (SHINE) study, funded by the National Institute of Neurological Disorders and Stroke, looked at how closely doctors control blood sugar levels in people who have had strokes. The standard treatment in monitoring blood glucose levels after stroke is to check blood sugars every four to six hours to make sure the level is not above 180. If it is above 180, then patients are given insulin to lower to the number. Knowing that people with lower blood sugars fare better after strokes, researchers designed the SHINE study to use a more intensive treatment after strokes: Patients' blood sugar levels were inserted into a computer that would then calculate the amount of insulin needed to maintain a blood sugar level between 80-130. The Pitt portion of the study was managed by Lori Shutter, MD, professor and vice chair of education, Department of Critical Care Medicine, and professor of neurology and of neurosurgery, Pitt School of Medicine.

"The idea was to tightly control the patients' glucose levels for 72 hours after a stroke event with the hope that patients would have better outcomes," says Dr. Shutter. "When it finished, the SHINE study results showed that keeping tight control of patients' blood sugar levels did not improve their 90-day outcome and slightly increased their risk for low blood sugar. We found that keeping the glucose below 180, checking it four to six times a day and injecting insulin as needed is the preferred treatment, which is what we've been doing for years. The old-fashioned way works! We also know that that keeping blood sugar below 180 is the right number."

Now that researchers have answered the question of how aggressively to control blood sugar levels in people after ischemic strokes, Dr. Shutter emphasizes the importance of always keeping blood sugar levels below 180 to prevent strokes, especially in people with diabetes.

"High blood sugar can affect healthy blood vessels, which are very important to overall health, including healthy heart, brain, eye and kidney function," says Dr. Shutter. "It's like tree limbs - the arteries are like the big trunk, then the arterials and then to the tiny twigs on the tree, the capillaries. These are tiny little vessels delivering blood. If you have diabetes, the twigs become brittle and get narrower. Just as in a big storm, the little twigs can fall off or get too narrow to carry blood through; you won't get blood to your kidneys, brain, heart, eyes, etc. You'll start having kidney and heart problems, small strokes and eyesight changes."

The Centers for Disease Control and Prevention (CDC) report that strokes are the fifth leading cause of death in the United States but that the risk of having a stroke varies greatly between races and ethnicities. The risk of having a stroke is almost twice as high for African Americans as it is for whites. African Americans have the highest rate of death due to strokes. In the past few years, Latinx populations are experiencing higher rates of death from strokes. According to the CDC, one in three people in the United States has at least one stroke risk factor - being male, having high blood pressure, high cholesterol, diabetes, smoking and being obese.

Dr. Shutter says, "The overall message is that there's a lot people can do to change many of their risk factors for having a stroke - stop smoking, exercise regularly, make healthy eating choices as much as possible and be aware of their blood sugar levels."


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