I recently sustained several TIA’s [Transient Ischemic Attacks, or mini-strokes]. I am age 49, male, have had diabetes for 31 years and am maintained on an insulin pump. I have three questions:

Can a hypoglycemic reaction cause or contribute to a stroke?
Can sustained hyperglycemia cause or contribute to strokes?
What is the relationship between strokes and tight blood glucose control?

The brain requires a consistent supply of glucose for fuel. Without it, it will dysfunction. Your blood sugar should be taken into consideration when trying to determine what happened when you had TIA-like symptoms. If they are low, it may have had something to do with your symptoms. Your doctor needs to be involved in this evaluation since it is key in making the correct diagnosis. However, if low sugars were not present, you need to discuss with your doctor the evaluation you will need to diagnose the cause of the TIAs because several causes for TIAs can be corrected before a more severe stroke occurs.

There are several keys to getting the story correct. Were the symptoms associated with localized neurological deficits or more general problems? Hypoglycemia is more likely to cause global problems and less likely to cause localizing neurologic symptoms but, this distinction is not always easy to make. In general, if you have this problem with neurologic problems, and you are having frequent hypoglycemia, you need to check with your doctor following your diabetes about trying to prevent the hypoglycemia.

JTL