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Managing Chronic Illnesses after a Stroke

Chronic Illness

Although you had a stroke, continue to care for your health and treat your other illnesses.

After a stroke you still need to look after your other health needs that required care and treatment before your stroke or that you have developed since your stroke. Two serious chronic illnesses, diabetes and high blood pressure are discussed here.

Managing Diabetes

If you have Type 1 or Type 2 diabetes, follow your eating plan, exercise, and continue to check your blood sugar one or more times every day and write down the results in your log book or on your calendar. If your blood sugar is continuously high (greater than 180 on your meter), share this information with your Health Care Provider. See below to find out what you should do for low blood sugar. Continue to take your diabetes medications as prescribed by your health care provider and refill the prescriptions when needed.

What Else Can You Do for Your Diabetes?

Control Your Eating

  • Eat a balanced diet, keeping the amount of carbohydrates you eat at about 250 grams daily, which is about half of your daily calories if you eat 2000 calories a day.
  • A balanced diet includes fresh fruits, vegetables, whole grains (such as those found in whole grain bread, cereals and brown rice), and proteins like lean meats, beans and low fat dairy products. If you eat about 2000 calories a day, you need around 3 servings of fruit and 4 servings of vegetables each day.
  • Avoid sugary desserts and high fat snack foods (for example, crackers, potato chips, pork rinds, and cheese curls).

Control Low Blood Sugar

Be alert to recognize signs of low blood sugar and make sure your family or caregiver knows what low blood sugar is and what to do for it. Missing a meal, extra activity, or too much medicine can cause low blood sugar. Low blood sugar is a reading of 70 or less when blood is tested on the meter.

The following are symptoms of low blood sugar:

  • Shakiness
  • Dizziness
  • Sweating
  • Hunger
  • Pale skin color
  • Confusion

To treat low blood sugar:

  • Eat 15-20 grams of fast acting carbohydrates, immediately
  • Eat 1 tablespoon of honey (15 grams of carbohydrates), or
  • Immediately take 3 BD glucose tablets, 15 grams of carbohydrates in 3 tablets (available at the drugstore to have on hand), or
  • Drink about a ½ cup of fruit juice (3 grams of carbohydrate/fluid ounce), or
  • Eat 3-4 pieces of hard candy (6 grams of carbohydrate/ piece).

*Recheck blood sugar 15 to 20 minutes after eating your carbohydrate choice, to ensure that you have returned to a safe blood sugar level.

Carry identification with you at all times on a card stating that you are diabetic, or wear a medical alert tag.

Participate in Daily Exercise:

  • Exercise is still important after a stroke. Be prepared to fully participate when you go to physical therapy and make an effort to exercise daily at home.
  • If you are not able to walk outside move around indoors to get some exercise. Exercises can be done from your chair or wheelchair by moving the joints in your shoulders, arms, legs and ankles. Remember to inspect your feet daily for blisters and open sores, especially if one foot is affected by the stroke inspect that one carefully.

Managing High Blood Pressure

High blood pressure needs to be controlled so it will not lead to another stroke.

  • Adopt a healthy eating plan that includes fresh fruit, fresh vegetables, ( for example, 3-5 servings per day),low fat foods, whole grains, nuts and small portions of lean red meat and poultry. Lower the amount of sodium (salt) you eat and try to keep your salt intake around 1,500 milligrams per day.
  • Click on the following website to get more information about salt in your diet:
    http://www.mayoclinic.com/health/sodium/NU00284

  • Start reading food labels so you can see how much sodium is in the foods you eat.
  • Make your dinner plate” full of color “by adding fruit and vegetables to your meal.
  • Exercise daily by walking, gardening, or doing yard work.
  • Have a family member or caregiver check your blood pressure every morning and write it down.
  • If you desire, click on the following website to buy an automatic blood pressure monitor:
    http://www.semedicalsupply.com/blood_pressure.htm

  • According to the National Heart Lung and Blood Institute, stage 1 high blood pressure is 140-159 (top number) over 90-99 (bottom number).
  • Watch for trends in your blood pressure numbers so you can notice if your blood pressure is too high or too low (low blood pressure is 90: top number, over 60:bottom number).
  • Low blood pressure can be caused by too much blood pressure medicine.
  • Share your blood pressure numbers with your health care provider.
  • Keep appointments with your health care provider and tell your health care provider about any concerns or questions you may have.
  • Continue your blood pressure medications as directed by your health care provider and get your prescriptions refilled as needed.
  • Follow through with blood tests that your health care provider orders and get any other tests your health care provider thinks you need.

General Suggestions

Notebook
  • Get a notebook and start a journal (diary) by writing about how you feel every day so you can see progress over time and the results of following your health care provider's plan for you.
  • Report new symptoms or problems to your health care provider. Do not let a new problem go until it gets worse and causes you a lot of pain. Good communication with the health care provider is the key to feeling better.
  • To help with remembering everything the health care provider tells you at a visit, take a trusted family member or friend with you to your appointment
  • According to researchers who focused on stroke survivors, additional chronic illnesses that should be controlled are: high cholesterol, sleep apnea, and heart disease
  • Habits that should be eliminated are smoking and alcohol use
  • Managing your health problems puts you in control of how you feel each day. Preventing another chronic illness can be a goal you can reach by making healthy living your top priority.
For more information about living with Type 2 diabetes and high blood pressure after stroke, click on the following websites: 

American Heart Association:
http://www.heart.org/HEARTORG/Conditions/HighBloodPressure/AboutHighBloodPressure/About-High-Blood-Pressure_UCM_002050_Article.jsp

American Diabetes Association: http://www.diabetes.org/type-2-diabetes.jsp

National Heart, Lung, and Blood Institute: http://www.nhlbi.nih.gov/


References:

American Stroke Association (2007). Let’s talk about living at home after stroke. Retrieved from http://www.strokeassociation.org

Burton, C.R. (2000). Re-thinking stroke rehabilitation: The Corbin and Strauss chronic illness trajectory. Journal of Advanced Nursing, 32(3), 595-602.

Hoeman, S.P. (2008). Rehabilitation nursing prevention, interventions, & outcomes (4th ed.). St. Louis, Missouri: Mosby Elsevier.

Jacelon, C. (2011). The specialty practice of rehabilitation nursing. Glenview, IL: Association of Rehabilitation Nurses.

National Heart Blood and Lung Institute (2008). High blood pressure. Retrieved from, http://www.nhlbi.nih.gov/health/dci/Diseases/Hbp/HBP_OtherNames.html

Ostwald, S.K., Davis, S., Hersch, G., Kelley, C., & Godwin, K.M. (2008). Evidence-based educational guidelines for stroke survivors after discharge home. Journal of Neuroscience Nursing, 40(3), 173-179.

Written in 2009 by Julie Jessop, MSN, RN at the University of Toledo for the Caring~Web©.
Revised 2012

Last Updated: 5/26/16