Diabetes and Heart Disease
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Diabetes mellitus is a very complex problem, but generally, it is a disorder
of carbohydrate metabolism due to an insufficiency or deficiency of insulin
produced by the pancreas. carbohydrate metabolism produces sugar, and insulin
helps keep the level of sugar in our blood stream at a normal level. It
is characterized by a unique form of small vessel (capillaries) disease.
Approximately 6% of the population have some form of diabetes.
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There are two types of diabetes mellitus. Type I usually starts
before the age of 30 in non-obese individuals. This type of diabetes almost
always requires treatment with daily insulin injection. Type II usually
occurs after the age of 40 in obese individuals and can most often be managed
by diet and/or medication in pill form. Both types do tend to run in families,
and both tend to increase the risk of CAD.
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How would someone know if they have diabetes? Many times
the first indication may be an elevated fasting blood sugar found on a routine
examination. An individual may also experience the classic symptoms of diabetes:
Excessive thirst, frequent urination, and weight loss.
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To diagnose diabetes a physician may order any of the following:
Fasting blood sugar and a blood sugar test following a meal, and a blood
test called glucose tolerance test or a urine test to check for sugar. A
normal fasting blood sugar ranges from 80-120 mg/dl.
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The relationship of diabetes and heart disease reveals some
very sobering facts regarding the
incidence of cardiovascular disease.
CAD is the most common cause of death in Type II diabetics. CAD also
increases dramatically in diabetics with any of the other risk factors
described earlier. Diabetics with CAD have more blood vessels with blockages
than those without diabetes, and those blockages are more complicated,
calcified and hard.
Heart attacks occur more frequently in diabetics and the size of the
heart attack tends to be larger. Because diabetes effects the nerves,
it is possible a diabetic would not feel the discomfort of angina (a warning
sign of decreased blood flow to the heart) as intensely. In fact, the
incidence of silent heart attacks (a heart attack without pain) is higher.
Additionally, a type of fat in the blood stream, triglycerides, tend
to run high. High triglycerides are suspected in the role of plaque build
up in the arteries. Diabetes also influence blockages of the arteries
of the legs (peripheral vascular disease) and neck (carotid artery) which
increases risk of stroke.
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Diabetics are at increased risk of a small vessel disease.
This, in particular, affects the eyes (diabetes is the leading cause of
blindness), and kidneys. The nerves are also commonly affected by diabetes
by unknown means, probably circulation.
The information may sound like the outlook for diabetics is quite bleak
-- but there is good news! The good news is it has been shown that Type
II diabetics under very strict control of their blood sugar levels have
less of a substance circulating in their system which is known to cause
the formation of clots. These clots when lodges in a narrowed blood vessel
can cause heart attacks and stroke. Data also shows that diabetics who
keep their blood sugars under control in general have less severe complications
of diabetes.
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In order to keep diabetes under tight control, it is essential
the patient follow their physician and dietitians guidelines without fail.
The treatment of diabetes focuses on three areas: Diet exercise, and medication.
Diet therapy centers on weight reduction in overweight individuals, a low-fat
diet (less than 20% of total calories) and a diet consistent with timing
and caloric intake. Many physicians will recommend a diet low in sugar,
starch, and alcohol as a first step. Beneficial effects of exercise for
diabetics includes wight control, increased HDL (good) cholesterol, and
lower blood sugar levels. Medication therapy is started with anti-diabetic
agents in pill form. If necessary, insulin will be prescribed and is injected
into the fatty layer of tissue on a daily basis. Diabetics are usually instructed
on how to take periodic test of blood and urine at home.
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Although these studies suggest a connection between insulin
resistance and heart disease, it's too soon to recommend that everyone have
their insulin levels measured. But if you know you have insulin problems,
discuss with your doctor strategies for preventing diabetes, including weight
loss, exercise, and improved diet. And everyone over age 45 should be tested
for diabetes every three years.
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