As the central control station for all bodily functions, the brain is of enormous importance. The brain cells require lots of energy and a plentiful supply of oxygen for their activities. Clear access through the many blood vessels that carry oxygen and nutrients to the brain is therefore a high priority.

When people with diabetes get arteriosclerosis, these cerebral vessels are frequently also affected. The walls of the arteries change – often over years, without being noticed – until finally the vessel narrows, with the result that the brain no longer receives enough blood. If such a shortage of blood supply occurs suddenly, it is known as a stroke.

How much damage such an event causes in the brain depends above all on how big the affected blood vessel is and which nerve cells it supplies. The symptoms may last for seconds or minutes or even several hours. This is called a transient ischaemic attack. It may occur in a cerebral blood vessel that is already partially blocked.

The most common cause is that a plaque that has developed on the internal wall of a blood vessel breaks off and passes along the circulation until it becomes trapped in a narrow vessel, preventing the flow of blood. A stroke does not always manifest itself as a transient ischaemic attack.

In order to start treatment at the right time, it is advisable for people with diabetes to have a regular examination of the major blood vessels feeding the brain. Nowadays, this can be done very easily and precisely using ultrasound. This shows not only the state of the blood flow but also whether the vessel walls already have plaques forming, indicative of the start of arteriosclerosis.

Once there is evidence that the blood vessels are becoming blocked, there are several options at our disposal. On the one hand, it is important to tackle the risk factors for arteriosclerosis. On the other hand, the ‘stickiness’ of the blood platelets can be reduced by drug treatment, which reduces the risk that a blood clot will form and block one of the narrow vessels.

The best known drugs for this are aspirin (acetyl salicylic acid) and clopidogrel. If the cerebral arteries that serve the brain are already dangerously affected, it may be necessary to widen the partially blocked vessel or even to bypass it by a surgical procedure.