The Diabetes and Heart Relationship

How does diabetes increase my risk for heart problems?

Both type 1 and 2 diabetes accelerate the progression of artherosclerosis – hardening of the arteries.  Having type 1 diabetes increases the risk for heart disease 10 fold. Heart attacks account for 60% of deaths in patients with diabetes while strokes account for 25% of deaths. Nearly all patients with type 2 diabetes have developed resistance to their own insulin, their pancreases churns out insulin which is a critical hormone in an effort to move glucose into cells, but it is more than the cells can utilize. High levels of insulin in the blood causes damage to the lining of blood vessels that leads to atherosclerosis. Hardening  of the arteries occurs and  sets the stage for plaques  to build.   Evidence shows that patients with diabetes have an increased level of low-grade inflammation of their arterial lining, a process that initiates the blood vessel changes leading to heart disease. Some of the increased susceptibility to blood vessel damage that people with diabetes have  is due to the long-term effects of inadequate control of blood glucose levels on the tissues or as a result of other cell damage related to diabetes.  A chemical reaction between glucose and proteins  exists in the body  to produce compounds called advanced glycosylation endproducts, or AGEs.  Diabetes increases the amount of glucose in your blood that’s available to be glycosylated, people with the disease tend to have high concentrations of AGEs. These compounds  damage arteries, making them more likely to create blockages, in addition to increasing the risk for a long list of other common diabetes complications.

Know your numbers

In the last 10 years, large-scale research studies around the world have shown that optimal control of LDL cholesterol (the “bad” cholesterol) and blood pressure can prevent adverse cardiovascular outcomes by 30% to 50%. The American Diabetes Association and the American Heart Association recommend an LDL cholesterol goal in all adults with diabetes at less than 100 mg/dl. In people who already have heart disease, a more desirable LDL cholesterol goal should be less than 70 mg/dl, based on evidence from more recent studies.

At least half of patients with diabetes have hypertension – high blood pressure. Chronically elevated blood pressure forces your heart to work too hard, which may cause it to weaken over time. High blood pressure also increases wear and tear on the arteries. The blood pressure goal in all patients with diabetes is less than 130/80. In most patients with diabetes, reaching these targets for blood pressure could require two or more medications. With diabetes, high blood pressure  usually develops if the kidneys become damaged. Kidney disease (nephropathy) is a very serious complication of diabetes. With this condition, the tiny filters in the kidney (called glomeruli) become damaged and leak protein into the urine. Over time this can lead to kidney failure. Urine tests showing microalbuminuria (small amounts of protein in the urine) are important markers for kidney damage. Diabetic nephropathy is the leading cause of end-stage renal disease (ESRD), occurs in about 20 – 40% of patients with diabetes.

Hemoglobin A1C tests— measure of average blood glucose levels over the preceding two to three months—the goal is less than 7%. Intensive control of blood glucose and keeping glycosylated hemoglobin (HbA1c) levels below 7% can help to prevent complications due to vascular (blood vessel) abnormalities and nerve damage (neuropathy) that can cause major damage to organs, including the eyes, kidneys, and heart.

A healthy eating plan, exercise and medications are the cornerstones of managing diabetes.

Blood sugar regulation through monitoring the diet and exercise  and the relationship to blood sugars levels is what diabetics need to understand to decrease the risk of heart disease. Exercise should be viewed as a medication with the goal of getting the proper dose every day to get the sustained benefits. The more regular one is with exercise the better one can control their blood sugars. Exercise requires close monitoring of blood sugars. They should be measured before, occasionally during and after exercise.

When not to exercise

If your fasting blood glucose is more than 300 mg/dl, no matter what type of diabetes you have, it is in poor control. It may be best to bring your blood glucose level back down or to check with your health care provider before exercising. If you decide to exercise, use caution. Make sure you are negative for ketones and re-check your blood glucose to make sure it is dropping in 10-15 minutes. Drink plenty of water, this can’t be emphasized enough the water helps to “wash out” the ketones from the blood stream.

If you have type 1 diabetes and your blood glucose results are 250 mg/dl before exercise, stop and check for ketones. If you have moderate or large amounts of ketones, do not exercise. Ketones are a sign that your insulin level is too low. Exercise could cause the body to make more ketones.  Ketones add acid to the blood. When too many ketones are produced, they disrupt your body’s chemical balance. This can be  very dangerous. Wait until your tests show negative or trace ketone levels before beginning to exercise.

If your blood sugar is lower than 100 before exercising it is considered too low to safely exercise. Exercise uses the circulating blood sugars to provide sustainable energy for the muscles to function. When the blood sugar drops too low this can be extremely dangerous.  The recommendation is to eat a snack containing carbohydrates and protein 30 minutes before the exercise to sustain prevent the blood glucose levels from crashing. If the exercise is prolonged greater than 30 minutes or symptoms develop such as profuse sweating, shakiness, vision changes, nausea, angina it is best to  stop and check the glucose levels again. Some will require a small amount of carbohydrates during the exercise to sustain the blood sugars above 100. If blood sugars repeatedly drop with exercise a medication adjustment may be required and this should be discussed with your healthcare provider. This is a common issue especially as one becomes more fit. Again many pre-diabetics or type 2 diabetics are able to reduce or stop medication through exercise and diet.

Resources

• www.diabetes.org — American Diabetes Association
• www.niddk.nih.gov — National Institute of Diabetes and Digestive and Kidney Diseases
• http://www.nhlbi.nih.gov— National Heart Lung and Blood Institute
• www.jdrf.org — Juvenile Diabetes Research Foundation
• www.nei.nih.gov — National Eye Institute
• www.eatright.org — American Dietetic Association
• www.kidney.org — National Kidney Foundation
• www.diabetestrialnet.org — Type 1 Diabetes International Clinical Trial Net
• www.medicalert.org — Bracelets or neck chain emblems with personal medical information
• www.childrenwithdiabetes.com — Children with diabetes online community