Heart Disease and Diabetes: A Common Asssociation

Diabetes is a very frequently encountered problem in the valley. According to Prof A H Zargar, a very well known endocrinologist of the country, one third of Kashmiris either suffer from diabetes ...

Diabetes is a very frequently encountered problem in the valley. According to Prof A H Zargar, a very well known endocrinologist of the country, one third of Kashmiris either suffer from diabetes or have pre diabetes. This is a very concerning and alarming data. India is often termed the diabetes capital of the world with an annual increase of 104 per cent per year. The number of patients at a conservative estimate is at least 5 crores and if no preventive measures are taken the numbers will increase to at least 9 crores by 2015 as per the WHO projections.
Diabetes is a complex disease, it is actually more aptly described as a group of diseases in which high levels of blood glucose results from defects in insulin secretion, insulin action or both. If it remains undiagnosed it results in hyperglycemia (high blood sugar levels) and is associated with several associated complications. Involvement of the heart and a very high risk of heart attacks is an important association.  Its incidence is increasing throughout the world but the magnitudes of increase are different.

Diabetes and heart disease:
Patients with diabetes face a high risk of heart disease especially a heart attack. Ten years' risk of getting a heart attack in a patient with uncomplicated diabetes is 20 per cent. Other problems often seen in diabetics are high blood pressure, kidney failure and brain strokes.
"Silent heart attack" is another peculiarity seen in diabetics. This is because of involvement of pain transmitting nerves due to uncontrolled diabetes. These people will not feel many sensations of touch, vibration, heat, cold or pain, and this may also include the expected pain of a heart attack.
The resulting vague — instead of acute— symptoms may be ignored, or passed off as indigestion or stomach upset. Other reasons for diabetics being more prone for heart attacks are:
•High cholesterol and triglyceride levels
•High blood pressure
•Increased coagulablity of blood
Early diagnosis and learning how to monitor and control the disease are key to avoiding complications down the road. Some experts suggest that the course of this disease can be changed when patients:

Health Education is  the key:
•Patients should be committed to learning about their condition and its treatment
•Make a conscious decision to control the disease

Symptoms of heart disease
The following are the most common symptoms of heart disease. However, each individual may experience symptoms differently. Symptoms may include:
•Chest discomfort
•Shortness of breath
•Very slow or fast pulse rate
•Episodes of unexplained unconsciousness
•Swollen feet
The symptoms of heart disease may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

Tips to Prevent heart disease in diabetics

• Keep your blood sugar under control

Many diabetics check blood sugar level every day to make sure it is in the normal range. If not every day, a periodic assessment is necessary. By exercising often and eating a healthy diet, many people with Type 2 diabetes (the kind you're not born with) can keep their blood sugar level nearly normal. Some may have to take medicines. A very useful test which gives the average blood sugar of the previous 3 months is called Glycosylated hemoglobin or HbA1C. Levels more than 6.5% indicate a diabetic level. A well controlled diabetic has a Hb A1c of 6.5 t0 7%.

• Maintain proper weight

Diabetes, being overweight and heart disease often go together. Losing weight helps a lot of health problems — including high blood pressure and high blood sugar. Weight loss is important if you have a lot of extra weight around your waist and tummy. People who have fat around their waist are more at risk for heart disease than people who have extra weight around the hips or thighs. You don't have to lose a huge amount. Losing even 5 kgs can help.

Lower your cholesterol level

Cholesterol is present in fats and oils of animal origin, but it is not a fat. It is a part of many important body substances (like hormones) and body structures (including brain and nerves). But too much bad cholesterol (LDL) in your blood can clog your arteries.
•Eat a heart healthy diet (4 to 5 servings of fruits and leafy vegetables daily)
•Avoid high-fat diet (full cream milk products, excessive red meat etc)
•Regular intake of almonds and nuts (6 to 8 per day)
If diet alone doesn't help, there are medicines, for which you can consult a doctor. Statins are very effective medicines to keep bad cholesterol low and prevent heart attacks and strokes.

Regular exercise

If you have changed your diet to lose weight, exercising can help you lose faster. You don't need a gymnasium .Brisk walking is good too. Climbing stairs instead of taking an elevator is another smart thing to do.

• Control your blood pressure

Diabetics have high blood pressure, which is a major risk factor for stroke. It also increases your risk for heart disease and kidney disease. It is also important not to drink too much alcohol. You need to keep their BP below 130/80 mms Hg at all costs. If diet and exercise does not help, you might have to take medicines.

• Quit smoking

Smoking is really bad for diabetics because it damages the blood vessels. It doubles your risk of heart disease. Worse, if you keep smoking while you try to lose extra weight, you won't make any headway. Remember smoking 1 cigarette shortens your life by 11 minutes.

Measures to Prevent Heart Disease in Diabetics: 

Follow a healthy eating plan as advised by your doctor or the dietician
Exercise every day for at least 30 minutes at least 5 times a week
Regular intake of fresh and green vegetables in plenty
Reduce Intake of dairy products
Take your prescribed medicines regularly
Check your blood sugar levels frequently and make a chart for ready reference
Control your blood pressure and cholesterol very well
Check your feet every day for cuts, blisters, sore toe nails
Brush and clean your teeth and gums every day.
 Do not smoke

Dr Upendra Kaul is Executive Director and Dean FORTIS Hospitals, and Escorts Heart institute, New Delhi

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