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Diabetes Matters: Keeping the Beat . . . Heart Health for People with Diabetes

January 25, 2011

Keeping the Beat… Heart Health for People with Diabetes

There’s no denying the connections between diabetes and cardiovascular disease. The National Institutes of Health (NIH) notes that if you have diabetes, you are at least twice as likely to have heart disease or a stroke as someone who does not have diabetes. People with diabetes also tend to develop cardiovascular disease at an earlier age than other people, and heart attacks in people with diabetes are more serious and more likely to result in death.

Why does diabetes so dramatically increase your risks for cardiovascular disease?

"Diabetes is a progressive disease that affects all the body’s blood vessels, both large and small," explains Washington Hospital cardiologist Dr. Ash Jain, Medical Director of the Cardiac Catheter Lab and Peripheral Vascular Services.

"Damage to the small blood vessels causes weakening of the heart muscle that can result in heart failure," he says. "Damage to the large arteries – including blockages – can cause heart attacks. In addition to heart problems, the effects of diabetes on blood vessels can result in high blood pressure and strokes in the brain. If arteries in the kidneys are affected, it could lead to kidney failure. Damage to arteries in the legs can lead to gangrene and amputation. And damaged blood vessels in the eyes can lead to vision problems and blindness."

To help people in the community learn more about the relationship between diabetes and cardiovascular disease, Washington Hospital is sponsoring a free "Diabetes Matters" class, featuring a lecture by Dr. Jain. The class is scheduled for Thursday, February 3 from 7 to 8 p.m. in the Conrad E. Anderson, M.D. Auditorium in the Washington West Building at 2500 Mowry Avenue in Fremont. A question-and-answer session and Diabetes Support Group moderated by registered nurse and certified diabetes educator Sandra Mertesdorf will follow the lecture from 8 to 9 p.m.

"Diabetes is generally slow in progressing, so patients may not sense any symptoms of heart disease for years, so the diagnosis of such problems may be delayed," Dr. Jain notes. "That’s why it is essential for people with diabetes to have thorough medical check-ups at regular intervals. An annual exam should include a stress test and an evaluation of the peripheral vascular system."

Preventing heart disease is important for everyone – whether you have diabetes or not. But it is imperative for people who do have diabetes, especially women. The American Diabetes Association reports that women with diabetes tend to have higher risks of cardiovascular disease and death following a heart attack than diabetic men of the same age.

"We are not sure of all the reasons for this difference between men and women, but one reason may be that women have smaller arteries that are more easily damaged," says Dr. Jain.

"Because diabetes causes damage to the body’s nerve endings and limits the sensation of pain, people with diabetes who have a heart attack may not have the typical symptom of a crushing pain in the chest," he adds. "Instead, it is more likely that they will have symptoms such as shortness of breath, weakness and extreme fatigue."Controlling Risk Factors

People with diabetes often have high blood pressure and cholesterol levels, which are additional risk factors for heart disease. Obesity, which is a risk factor for diabetes, also can contribute to cardiovascular disease. These risk factors are all interrelated.

"Controlling high blood pressure to the range of 120/80 to 130/90 is very important for people with diabetes," Dr. Jain says. "In terms of managing cholesterol, people with diabetes should maintain an overall cholesterol level of 150, with the LDL or ‘bad’ cholesterol level below 100 and the HDL or ‘good cholesterol’ level above 50. That compares to the general recommendations for people without diabetes of an overall cholesterol level below 200, with the LDL level below 160 and the HDL level above 40. People with diabetes also should keep their level of triglycerides below 150."

In addition to these guidelines, Dr. Jain offers several other recommendations for reducing your risk factors for heart disease:

  • Make sure your diet is "heart-healthy," with foods that are high in fiber and low in saturated fats and cholesterol. The registered dietitians at Washington Hospital can help you plan a diet to meet these goals.
  • If you are overweight or obese, try to achieve a healthier body weight. Weight loss can help control blood sugar, blood pressure and cholesterol levels.
  • Increase your level of physical activity to help your body function properly. Aim for at least 30 minutes of exercise most days of the week.
  • If you smoke, ask your doctor for help to stop smoking. Smoking damages the blood vessels, which are already at risk of damage from diabetes.
  • Keep your blood sugar level under control, monitoring it every day to make sure your diet, exercise and any prescribed medications are working.

Checking your blood glucose at home with a meter shows your blood sugar level at that particular moment. The A1C blood test, which usually is done at your doctor’s office, shows your average blood sugar level over the past two or three months. The A1C test is a good way to see how your diabetes treatment program is working to control your blood glucose levels. Your doctor may recommend an A1C test two to four times per year. The A1C test does not replace the need for daily self-testing of blood glucose.

"Control of diabetes is imperative, but you do not have to make life miserable in the process," Dr. Jain notes. "Studies have shown that adequate control, keeping A1C between six to seven percent, helps as much as very tight control that keeps A1C below six percent – especially in elderly patients."

Medications also can play an important role in managing diabetes. Several types of medications are available to treat diabetes, including insulin. Type 1 diabetes is caused by a lack of insulin production, so people with Type 1 diabetes must take insulin injections every day. Insulin injections also can be used for people with Type 2 diabetes when they don’t respond well to other medications.

"In many cases, insulin is the best way of treating diabetes since it is a natural body substance," says Dr. Jain. "Other medications can help the pancreas secrete more insulin or help the body use insulin more effectively. Because these medications may carry some risks of complications such as congestive heart failure, heart attacks and kidney failure, it is important to take the medications properly and consult your doctor about any potential side effects."

When lifestyle changes and medications still do not prevent diabetes-related heart disease, there are several interventions available to treat such problems, including balloon angioplasty, stents and bypass surgery.

"Unfortunately, the results of these interventions are not as good in people with diabetes," Dr. Jain cautions. "We’re not sure why that is the case, but it makes prevention of heart disease even more critical for people with diabetes."
Come to the Diabetes Support Group

Success in managing diabetes has a lot to do with receiving and giving social support. For people who suffer from diabetes, The Washington Outpatient Diabetes Center offers a support group that allows people to have in-depth conversations about what’s happening in their lives and share information about dealing with diabetes in a positive and caring environment.

The support group meetings are held at 8 p.m. every month immediately following the hour-long Diabetes Matters lecture which begins at 7 p.m. the first Thursday of each month. Family members and friends are also welcome. For more information about the support group or other classes and programs, call the Diabetes Services program at (510) 745-6556 or visit www.whhs.com/diabetes.