By: Dileep Menon
Since diabetes is a condition that leads to narrowing of the blood vessels in every part of the body, people with diabetes often suffer from vascular complications like heart attacks, strokes , renal failure leading to dialysis , blindness , ulcers and non-traumatic amputations. They are considered to have “heart disease risk equivalent” status, meaning that they will have the same future risk of cardiac events as that of someone who has established heart disease. That’s why it’s important that people with diabetes need to be aware of their underlying risk and address this aggressively with a healthy lifestyle and risk factor modification.
The primary goal in treating and managing diabetes is to control the blood sugar, which is assessed through a blood test called Hemoglobin A1c (HgBA1c). A HgBA1c less than 7% has been shown to prevent heart attacks in people with diabetes. Blood sugar control can be achieved with diet, exercise and medications. Diet plays a pivotal role in the management of diabetes with special emphasis on calorie restriction and limiting carbohydrates, especially sugars. It’s also recommended to increase fruit and vegetable intake, avoiding saturated and trans-fats and increased fiber intake.
Regular exercise enables calorie expenditure ,facilitates weight management and lowers blood pressure. There has been tremendous progress in medications for diabetes that not only lower blood sugar but also reduce heart attacks, heart failure and death among those with diabetes. With these medications, there is less dependence on insulin, which effectively lowers blood sugar but is also associated with side effects such as low blood sugar episodes and weight gain. At the same time, insulin can potentially accelerate the narrowing of the blood vessels due to its pro-atherogenic properties.
Frequently, diabetes is also associated with co-morbidities like high blood pressure and high cholesterol. Control of blood pressure to less than 130/80 mm Hg is critical in preventing development of kidney disease, kidney failure and delaying need for dialysis. Blood pressure lowering medications such as Angiotensin Converting Enzyme Inhibitors (ACE- Inhibitors ) and Angiotensin Receptor Blockers (ARB) have shown to be beneficial in diabetics with protein in their urine to prevent kidney damage. Statin medications to lower cholesterol have also shown tremendous benefits in reducing heart attacks and death in diabetics. Aspirin in doses of 75-81 mg daily may be considered to prevent heart attacks and strokes in diabetics provided they are not at high risk for bleeding complications.
As the adage goes, “an ounce of prevention is worth a pound of cure”. This could not be more apt for people with diabetes to stay heart healthy. Preventing heart disease as it relates to diabetes starts with consistent monitoring of HgBA1c, blood pressure and total cholesterol / LDL cholesterol. Adapt healthy eating and exercise routines to keep these levels as low as possible. Be sure to take your medications as prescribed by your doctor and follow up with your doctor to ensure your risk factors are under optimal control. For this Heart Month, I remind you to Live Healthy Daily, Live Heart Healthy Daily and Live Long Heart Healthy.
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