Diabetes and heart disease

Diabetes is a metabolic disorder, where the body is unable to produce insulin or cells become resistant to the amount of insulin in the body. This results in derangement of sugar metabolism. There can be acute and chronic complications due to uncontrolled diabetes in the body. If high blood sugar levels persist in the body for a long time, various organs of the body are damaged, like the heart, kidneys, eyes, e.t.c. Of all these complications of diabetes, its effect on the heart, is what causes heart disease in young people and affects their capacity to work. Unchecked it can be fatal. It can be prevented by good control of diabetes. Diabetes is part of and one of the manifestations of the metabolic syndrome. In this case, one develops resistance to the insulin being produced in the body; hence blood glucose levels go up. It is associated with obesity and hypertension and is also a high risk factor for coronary artery disease. High levels of glucose in the blood promote atherosclerosis, i.e. deposition of fat in the inner layers of blood vessels. This leads to development of hypertension. This also is the reason for development of coronary artery disease. In this, the lumen of the coronary arteries (vessels supplying blood to the heart) is blocked, thus impeding the blood supply and essential nutrients to the heart. Thus one suffers from pain in the chest while walking or doing some work. If the block is severe or prolonged, the affected part of the heart becomes necrotic or dead, the condition is called myocardial infarction. Diabetic patients have a higher prevalence of coronary artery disease as compared to other people. The age at which one can have a coronary artery disease is much lower for diabetic individuals. Moreover, one usually has silent coronary artery disease due to diabetes. Myocardial infarction can occur without any chest pain due to blunting of sensations caused by diabetic neuropathy. The dead myocardium is detected during post mortem examinations. Heart failure is yet another complication of uncontrolled diabetes. The heart muscle gets affected, a condition known as diabetic cardiomyopathy. This affects the functioning of the heart. Gradually it becomes sluggish resulting in heart failure. Outwardly this is manifested as breathlessness on exertion and swelling of the feet. As the disease progresses, there is swelling all over the body and breathlessness even on rest. Once these conditions develop regular medicines are needed for life to keep the person symptom free. Over a time, adverse effects of these drugs are produced invariably, like low blood pressure, dry cough, gastric disturbances, e.t.c., necessitating more medicines. Interventions like coronary artery bypass surgery or stent implantation can be done in patients who are physically fit for these interventions. These procedures are not hazard free and have associated risks. Moreover they are very expensive, hence out of reach of many people. The best solution for prevention of these cardiac problems lies in keeping diabetes well controlled. A suitable diabetic diet is important for keeping the blood glucose levels low. Sugar and saturated fats like cheese, margarine, e.t.c., are best avoided. Total calorie intake should be as per the gender and level of physical activity of the individual. Food should include plenty of fresh vegetables, fruits with fewer carbohydrates like apples and citrus fruits, lean meat like fish and whole grains and cereals.Alcohol is forbidden if one desires to keep diabetes well controlled. Regular physical activity is also important to control of diabetes. One should exercise daily. But if that is difficult due to time constraints, one should exercise at least three times a week. Regular check up of blood glucose is essential to know the levels of glucose. Treatment is modified accordingly. Simple hand held glucometers are available for those who can afford them for self monitoring of blood glucose. It is important to go for cardiac evaluation at least once a year. In this way any problem can be detected at its earliest and suitably treated. A person with diabetes can avoid cardiac problems and maintain good quality of life. Pande is a specialist; Internal medicine -Ruhengeri Hospitalrachna212002@yahoo.co.uk