The Effects of Diabetes Type II in Hypertensive Thalamic Hemorrhage: A Review

Over the years, epidemiological studies argue that type 2 diabetes and hypertension are much related, commonly having similar symptoms among populations [1]. Studies have shown that hypertensive thalamic hemorrhage affects about 40% of people with diabetes, which is also a significant risk factor of stroke [2]. It has always been a devastating situation, as 30% of individuals with the condition end up losing their life. The risk of death also reached 75% during the first 24 hours, primarily if hemorrhage occurs on the brainstem [3,4]. Individuals aged 55 to 70 years or above are also at high risks, with hemorrhages being destructive as they change the arteries leading to their rupture [5]. Studies have cited risk factors such as hypertension, arteriovenous malformation, vasculopathy, smoking, and hyperlipidemia as the significant causes of hemorrhage occurrences [6,7]. Current research has aimed at researching the link between the two, given their drastic effects on human health and populations [8]. Type 2 diabetes is associated with certain environmental factors, genetic predispositions, and lifestyle choices [9]. This condition involves the failure of insulin to produce pancreatic beta cells. It may also be a result of the resistance of insulin hormones in the body cells. It is a condition that begins with the body cells' resistance to the body [10]. The resistance interferes with the production of insulin by the beta cells [11]. The resilience and inability of the cells to produce the hormones inhibit their capability to absorb and use glucose in metabolic processes [12]. Thus sugar molecules remain in the bloodstream due to insulin failure in cellular uptake of glucose [13]. Hypertensive Thalamic Hemorrhage is caused by the rupturing of a weakened vessel, which then bleeds into the surrounding parts of the brain [14]. The blood compresses and accumulates in the brain tissue surrounding [15,16]. The two weakened vessels that cause this condition are arteriovenous and aneurysms malformations. These malformations are clusters of blood vessels formed abnormally [5]. The rupture of any of these vessels may cause bleeding into the brain [17].

DM patients with frequent exercise limit the complications of the disease. Exercise has proven to control blood glucose levels significantly and reduces the complications leading to brain hemorrhage. Uncontrolled diabetes may put the patients at a higher risk of both hemorrhagic and ischemic strokes. Individuals with diabetes are likely to display some signs of ischemic stroke [18]. 

Unfortunately, the mortality rates among patients were 52% in 30 days. Individuals with type 2 diabetes also recorded a higher risk of hypertensive thalamic hemorrhage. Diabetes mellitus occurrences among patients differ, with its prevalence increases with age [12]. Increased correlation between diabetes mellitus and brain hemorrhages has shown a strengthened relationship with Hypertensive Thalamic Hemorrhage. In contrast, some research studies also found completely different results, as they explained that DM reduced the risk of Hypertensive Thalamic Hemorrhage [8]. Again, cerebral vasodilator response among type 2 diabetes patients caused a significant increase in blood pressure, eventually leading to hypertension, including Hypertensive Thalamic Hemorrhage [19].

There are several possible mechanisms in which diabetes type 2 may lead to Hypertensive Thalamic Hemorrhage [5]. These mechanisms include systemic inflammation, vascular endothelial dysfunction, thickening of the capillary membrane, and increased early-age arterial stiffness [20]. Diabetes type II usually leads to abnormalities in the left ventricular diastolic filling [21]. Diabetes type II is responsible for mechanisms such as metabolic disorders, hypertension, interstitial fibrosis, and autonomic dysfunction resulting in congestive heart failure [10]. Vascular endothelial function is very vital in the maintenance of the functional and structural integrity of the blood vessels' walls and the vasomotor control. Nitric Oxide (NO) is responsible for vasodilation; thus, if its reduction may result in endothelial dysfunction. Individuals with diabetes type II have impaired NO-mediated vasodilation [22]. This is a result of increased inactivation of Nitric Oxide. Therefore, Individuals with diabetes type II may have decreased elasticity and stiffer arteries than those with average glucose levels [23]. Tight and stiff arteries are prone to rupturing and busting. Rupture of these arteries, thus, in turn, causes thalamic hemorrhage. 

Uncontrolled diabetes may put the subjects at a higher risk of both hemorrhagic and ischemic strokes. Individuals with diabetes are likely to display some signs of ischemic stroke [18]. For instance, they may have dysarthria and lamb weakness showing lacunar infarcts. Diabetes type II is associated with an increase in intracerebral hemorrhage. Intracerebral hemorrhage is fatal as there are no proven treatments to stop the bleeding [24]. An increase in the glucose levels in the blood causes hypertension, which is linked to the rise of hemorrhagic stroke. Researchers show that normalizing the glucose levels may block the plasma kallikrein effect and reduce the diabetic impacts to the brain hemorrhage [25]. Diabetes type II affects the ability of the beta cells to manufacture insulin that controls glucose levels in the blood. People with diabetes, therefore, are likely to record high blood sugar levels [26]. Excess sugars may contribute to the development of fat deposits and clots inside the blood vessel connecting the neck and the brain. This condition is referred to as atherosclerosis [27]. Diabetes type II, therefore, may make it hard for the body to react to hemorrhagic strokes. If the vessel supplying oxygen into the brain is blocked or ruptures, other arteries may play the role [1]. However, in individuals with diabetes, the vessels are hardened with a plaque. As a result, it becomes harder for the blood to reach the brain.

The unanswered questions 

The study used articles between 2000 and 2020 and assumed they are most effective with current information [13]. However, there are still unanswered questions based on the study populations, and participants used to make the deducted conclusions of the studies [28]. More analysis and data on the study populations are considered necessary to make exact conclusions on the role of diabetes mellitus in Hypertensive Thalamic Hemorrhage [29]. The results are also not fully comparable to the arguments made in the articles, as some have divergent opinions. Again, patients proved to have differing occurrences of diabetes mellitus in accordance with Hypertensive Thalamic Hemorrhage [30].

In conclusion, this study proves that diabetes mellitus occurs as frequent in patients suffering from Hypertensive Thalamic Hemorrhage. Luckily, the conditions are manageable when the DM is reported early. Scholars and medical practitioners believe that diabetes is usually an active modifiable risk for ischemic, among other types of strokes. Again, clinical research estimates that lower blood pressure causes a significant decrease in the risk of cardiovascular diseases, including Hypertensive Thalamic Hemorrhage among patients with type II diabetes. In addition, there is an increased risk of higher mortality rates caused by antihypertensive treatments, especially among patients with hemorrhagic and ischemic stroke. The admission rates proved higher mortality rates among patients hospitalized with diabetes and ischemic or hemorrhagic stroke. The study also recommends the reduction of obesity, given its high risks associated with both strokes and type II diabetes.