Heart of the matter

Revathi couldn’t believe her fate when her husband Karthik suffered a major heart attack at just 41. She couldn’t understand how this could happen at such a young age. Although Karthik had diabetes, both Revathi and Karthik thought nothing of it until I explained to them that diabetes is not just about elevated blood sugar levels. Like Karthik, many patients do not take their diabetes seriously and suffer unexpected consequences. Diabetes is an important risk factor for heart disease and managing it is the only way to prevent unpleasant surprises like the one Karthik suffered.

Diabetes and other lifestyle diseases

Type-2 diabetes is commonly associated with being overweight. It also often brings with it other high-risk conditions such as hypertension and abnormal lipid levels. This is mostly due to changing lifestyles, minimum physical activity and easy availability of high calorie food. About 70 per cent of people with diabetes have high blood pressure or have one or more lipid abnormalities.

What does diabetes have to do with heart disease?

In comparison with people who don’t have diabetes, people who have diabetes:

• Are 2 – 4 times more at risk for heart disease
• May develop heart disease at a younger age
• May have silent heart diseases [where the person doesn’t feel chest pain], which can lead to delayed help in case of heart attacks

Further, type-2 diabetes is as bad as a heart attack. In fact, in the case of women, diabetes increases the risk of heart disease as it cancels out the protective factors that women are naturally endowed with.

Although these facts seem gloomy, there are millions of people who live normal and active lives, despite having diabetes. The disorder needs to be taken care of, but having it doesn’t mean that your normal life is over.

How can a diabetic prevent heart disease?

To prevent heart diseases and other complications of diabetes, a person with diabetes requires optimal management of HbA1c [a measure of average blood glucose of last 3 months], blood pressure, and cholesterol.

Along with maintaining these three targets, it is necessary to:

• Maintain a healthy weight. Type-2 diabetes, excess weight and heart disease often work on you as a team. Losing weight helps control the other two. Even a loss of 5 – 10 per cent weight can make a big difference. Weight loss becomes all the more important if the extra weight is in the abdominal area.
• Stop smoking. Smoking exacerbates all the three.

How can a person with diabetes achieve these goals?

Appropriate treatment, right diet, regular exercise and timely monitoring are important tools for diabetes management.

Treatment: Taking appropriate medicines for keeping blood sugar levels in control is crucial. Self-medicating or altering your doses without consulting a physician will do more harm than good. It is equally important to actively seek treatment for blood pressure, obesity and lipid values if they are above target range. If your parameters are out of range, you need to take several medicines.

Thanks to the advances in pharmacology, you now get treatment options that effectively reduce blood glucose while also addressing these issues and other risk factors. GLP-1 based treatment is one such treatment. GLP-1 appears to be impaired in those with type-2 diabetes. GLP-1 based treatment helps by lowering blood glucose levels, but not in excess. It also leads to weight loss. GLP-1 also maintains systolic blood pressure and improves lipid profile and heart function.

However, irrespective of the type of treatment, it is important to take regular medicines as directed by the physician. One also needs to get the medicines reviewed periodically as type-2 diabetes is a progressive disorder, which requires changing medicines from time to time.

Diet: The diet should be rich in whole grains, vegetables, fruits. Simple carbohydrates like sugar, jaggery, honey and excessive salt and oil should be avoided. Milk products should be fat-free or low-fat. It is essential to keep the trans fat to minimum. However, there is no need to eat bland or boiled food.

Exercise: Daily physical activity of at least 30 – 60 minutes is an important aspect of diabetes management. If you have not been active, you should consult your physician for activities that will work best for you.

Monitoring: Along with regular blood glucose and HbA1c monitoring, you need to also check your blood pressure and lipid levels. Periodic ECG and treadmill tests too are essential to reduce the risk factors for heart attack.

What if a person with diabetes cannot achieve all goals optimally?

It is essential to keep working towards management goals as research has shown that small changes make a big difference. Every 1 per cent reduction in HbA1c reduces complications related to blood vessels by around 37 per cent and heart attack by around 14 per cent.

For each 10 mmhg decrease in systolic blood pressure, the relative risk for complications related to the heart decreases by around 13 per cent, and heart attack by around 11 per cent. Improved control of cholesterol or blood lipids [for example, HDL, LDL, and triglycerides] can reduce heart related complications by 20 to 50 per cent.

Today, Karthik has resumed working and has a good understanding of management of diabetes. He is determined to protect his heart from diabetes. With healthy life style, positive attitude and appropriate medication, it is possible to control diabetes and its complications.

This was first published in the July 2012 issue of Complete Wellbeing.