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Diabetes and heart
Dr Indu Waidyatilaka
Lecturer
Faculty of Medicine
People who have diabetes are more likely to get heart disease. When you have diabetes, your blood sugar level is much higher than normal and too much sugar in the blood can cause damage to many parts of the body, including blood vessels. Obesity which is a major risk factor for heart disease is strongly associated with diabetes. Majority of people with diabetes have disorders of lipid (fat) metabolism. In diabetics usually the good cholesterol (HDL ) levels are too low and triglyceride levels are too high. LDL (bad cholesterol) particles, which are unusually small and dense in people with diabetes, can especially be harmful to blood vessels. There is also a positive association between high blood pressure (hypertension) and diabetes. This means that diabetics are more prone for high blood pressure and vice versa. Hypertension is a major risk factor of heart disease. Lack of physical activity is very common among people with uncontrolled diabetes. This physical inactivity is another modifiable risk factor for heart and blood vessel disease. Combination of these conditions makes heart disease a major cause of death in people with diabetes.
We all should know the warning signs of a heart attack .They are, typically left sided chest pain, which radiates to the left arm or jaw, sweating, shortness of breath and nausea,. But not all cases of heart attack present with all these symptoms. Unfortunately if you have diabetes you may not have any of the typical symptoms due to nerve damage. One must be aware of this and at the slightest suspicion should go to a hospital where ECG facilities are available for confirmation. Early recognition and treatment can reduce the damage to the heart muscle. Even if you are not sure if your symptoms are that of a heart attack, you should still be evaluated.
But the good news is that you can take steps to lower your risk factors for heart disease. This will minimize your chance of getting a heart attack. Few suggestions
• Keep your blood glucose under control.-- Apart from routine Fasting Blood Sugar (FBS) testing you can have an idea about your blood glucose control by having an HbA1C test at least once in three months. The HbA1C test tells you your average blood glucose for the past 2 to 3 months. The target for most people with diabetes is below 7.
• Keep your blood pressure under control. -- Have it checked regularly. If you have diabetes the target should be to keep it below 130/80.
• Keep your cholesterol under control. -- Have it checked at least twice a year. The targets for most people with diabetes are
• LDL (bad) cholesterol – below 100
• HDL (good) cholesterol – above 40
• Triglycerides (another type of fat) – below 150
• Increase your physical activity. -- Aim for at least 30 minutes of exercise five days a week. Talk to your doctor regarding the activities that are best for you. Try brisk walking for half an hour every day. Or walk for 10 minutes after each meal. Swimming and cycling are other alternatives. What ever you do, choose an activity you like.
• Make healthy food choices.-- Include foods high in fiber, such as fruits, and vegetables and green leaves. Try to eat less fat, especially saturated fat (found in butter, cheese, sausages etc) and foods with trans fat which are found in junk foods such as pastries. Instead, switch to low fat products such as low fat cheese, skimmed milk, skinless chicken. Eat fish, especially small fish two or three times a week.
• Lose weight or prevent weight gain. -- Weight loss is important if you are overweight. If you carry extra weight around the waist you are at more risk for heart attack than people who have extra weight in the hips and thighs. Dietary modification and exercise play a major role in weight reduction. Just loosing few pounds of weight can make a huge difference to your risk of heart disease.
• If you smoke, quit. -- Your doctor can tell you about ways to help you quit smoking.
• Ask your doctor whether you should take an aspirin every day. -- If you are at high risk of getting a heart attack your doctor may prescribe a low dose of aspirin.
• Take your medicines as directed.
Finally one must realize that diabetes, high blood pressure, cholesterol disorders and obesity are all related. Lifestyle modification is the corner stone in the management. One can do a lot through one’s own efforts to stay healthy. When diet and exercise don't help enough, medicines can help control blood sugar levels, lower cholesterol levels and control blood pressure. Remember you can do a lot to prevent a heart attack.
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ail – induwaidyatilaka@hotmail.com
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