Diabetes mellitus is a metabolic disease in which a person has high levels of blood sugar. Ahead of World Diabetes Day 2017, Dr Yadava tells us how to keep the heart safe.
- Diabetes doubles the risk of heart diseases.
- Diabetes can lead to kidney damage and blindness.
- Generic symptoms like weight loss can also be a reason for diabetes.
Diabetes mellitus is a metabolic disease in which a person has high levels of blood sugar. This may be due to:
- Decreased production of insulin from the pancreas (Type I Diabetes Mellitus) or
- Because the cells do not respond to the insulin – Insulin Resistance (Type II Diabetes Mellitus). Sometimes the two may exist together. It is a life-style disorder and is a risk factor for blockages in the arteries of the heart and heart attacks.
We in South-East Asia are genetically predisposed to development of diabetes and specifically India has been labelled as the Diabetes Capital of the world. We abound in the risk factors for Diabetes like central obesity, high blood pressure, high bad cholesterol (LDL and Triglycerides) in the blood, low good cholesterol levels (HDL) and Insulin Resistance. Infact this conglomeration of risk factors goes by the name of ‘Metabolic Syndrome’ and is ubiquitous in our country. Therefore it is all the more important for us to:
- Prevent development of diabetes in first place
- To detect Diabetes at an early stage, should it develop and
- To treat it adequately to prevent complications.
How does diabetes harm us?
Diabetes affects virtually all organs of the body and doubles the risk of heart diseases. There are essentially two major kinds of complications that it produces:
1. Macro vascular – in which relatively larger blood vessels, seen by naked eye, are affected. They harden with deposition of cholesterol and Calcium and get blocked. This may lead to heart attack (blockage in the arteries of the heart), stroke (blockage in the arteries of the brain) and leg pain on walking/gangrene (peripheral vascular disease – blockage in arteries of the limbs).
2. Microvascular – It may involve the small or microscopic blood vessels called Capillaries (micro-angiopathy) leading to eye problems including blindness (retinal blood vessel involvement), kidney damage (Nephropathy – involvement of the small blood vessels of kidneys) or even the small blood vessels of the legs producing pain in the leg on walking, tingling and numbness (neuropathy).
In the heart, these blockages in the arteries, both the major blood vessels and the smaller blood vessels, can lead to heart attacks, heart failure and weakening of the muscle of the heart producing cardiomyopathy. It also leads to premature heart disease in not only men, but also in women, who are generally protected in the pre-menopausal period from heart diseases. But if women are suffering from diabetes, then they may get heart attacks, even in this relatively safe period.
How do I know, I have diabetes ?
The classical symptoms of untreated diabetes are:
- Polyuria (frequent urination),
- Polydypsia (increased thirst) and
- Polyphagia (increased hunger)
Sometimes generic symptoms like fatigue, weight loss and frequent infections of skin, gums, urinary bladder or vagina in women may be the main presenting complaints. However most patients remain symptom free for long period of time and develop symptoms very late and when complications have set in and that is why, the prime importance of preventive check up of blood sugar levels to detect diabetes at an early stage.
Symptoms of heart disease like angina too may either be absent, or may be so modified that they may not be classical and may confuse both the doctor and the patient leading to a wrong or a delayed diagnosis. Therefore patients should not take the liberty of ignoring or underplaying the symptoms and must always report them to the doctor, who would be in a better position to interpret them. Further, because of the involvement of small blood vessels, the results of various forms of treatment like angioplasty and bypass surgery are suboptimum and not as good as in a non diabetic patient.
How can I control my diabetes?
Diabetes has no known permanent cure and would require medicines, as well as life-style modification and dietary restrictions for life. Impact of diabetes increases manifold if it is present along with other risk factors like family history of heart disease, obesity, abnormal cholesterol levels, high blood pressure, tobacco intake, physical inactivity and sedentary life. It is therefore important that pari passu with lowering of blood sugar levels, all other concomitant risk factors must also be adequately addressed. There need not be any drastic changes, but one must keep the weight under control by prudent changes in the diet and by maintaining adequate level of exercise. By exercise, one maintains the muscle strength and increases the utilisation of glucose in the tissues, besides improving Insulin sensitivity, and by the dietary control, one reduces the intake of simple carbohydrates and sugars and by this judicious combination, control the blood sugar level. Medications can be in form of oral tablets or various forms of insulins for which, your doctor would give clear cut instructions. One must remember that the anti diabetic medications should never be stopped without proper medical guidance and any and every symptom should be reported to the doctor.
The good news
Overt diabetes is generally preceeded by almost five years of pre-diabetes phase in which a person’s blood glucose levels are higher than normal, but not high enough for a diagnosis of diabetes. If adequate precautions are taken and life-style modification introduced, development of full blown diabetes can be averted during this phase. Even in early stages of established Type II Diabetes Mellitus, which is predominantly due to reduced insulin sensitivity, the diabetic status can be reversed with aggressive life-style modification.
Glycosylated Haemoglobin (Hb A1C) – This indicates the average blood sugar level of previous 3 months and is an important test, for not only diagnosing, but also for checking the level of control of Diabetes. We should aim to keep Hb A1C levels below 7.0%.
Hb A1 C Levels Interpretation
- 4.0 – 5.5% Non Diabetic
- 5.7 – 6.4% Pre-Diabetes
- >6.5% Diabetic
- <7.0% Good control
- >8.0% Poor control