By Gelyka Dumaraos
People living with diabetes are mostly aware that they have an increased risk of cardiovascular disease in the long run if preventive measures are not taken.
The American Diabetes Association’s (ADA) data reveal that nearly two-thirds of people with diabetes have high blood pressure; and people with diabetes are two to four times more likely to die of heart disease or have a stroke than people who don’t have the condition.
The connection between diabetes and heart disease starts with insulin resistance leading to high blood sugar levels. The resulting hyperinsulinemia and hyperglycemia can damage the arteries, causing endothelial dysfunction and progressive atherosclerosis, leading to cardio-, and cerebrovascular diseases.
Heart-healthy tips for diabetics
There is a silver lining amidst this threat. The key is to learn more about the link between heart disease and diabetes which can help you take steps to help protect your heart and manage diabetes.
“Having diabetes is almost synonymous to having heart disease and addressing diabetes is integral to the prevention of heart disease,” emphasizes Dr. Dionisio Foronda, cardiology consultant at Asian Hospital and Medical Center.
Here are his tips to keep a healthy heart while dealing with diabetes:
- Observe a healthy diet
Most people think that dieting is an all-or-none phenomenon—either eating like there is no tomorrow or eating nothing at all. There is what we call a balanced diet. Food is not poison but should be consumed in the right amounts. Eat just the right amount of carbohydrates fruits, meats, and fats. Yes, eating rice is permitted but limit it to a cup per meal and don’t overeat fruits, too! Moderation is the key. - Exercise regularly
Physical activity is always beneficial. It helps regulate the blood pressure and helps the body consume excess blood glucose. Exercise need not be too strenuous. Do engage in some brisk walking exercise. Keep in mind, some exercise is better than no exercise at all. - Treat hypertension
Hypertension should always be addressed in all persons with diabetes. A blood pressure of 130/80 mmHg and above is already considered elevated based on the latest American Heart Association guidelines and may warrant taking blood pressure medication already in moderate to high risk patients, if lifestyle intervention is not able to control it. Hypertension is a stealthy killer since majority of hypertensive individuals may remain asymptomatic for quite sometime.
Treatment includes avoiding processed products, and salty foods and condiments like toyo (soy sauce), patis (fish sauce), and bagoong (salty relish made of small fish or shrimps). Remember that complications set in within 15 to 20 years and may be irreversible already. Always have your blood pressure checked regularly. Home blood pressure monitoring is now strongly recommended by all treatment guidelines.
- Treat high cholesterol
Dyslipidemia is a condition that’s closely related to diabetes. It causes the gradual build up of plaques in the arteries that will cause clogging, which in turn leads to the stroke (brain attack) or myocardial infarction (heart attack). Avoid food with saturated fat (fat that melts with heat but solidifies at room temperature). This includes butter and cheese. Most often, statins and other lipid-lowering agents are needed to keep cholesterol levels within optimal range. This may depend on the cardiovascular risk of the diabetic. But diabetics are generally classified as at least moderate risk, and many are high or extremely high risk. - Have a regular check up
If people can baby their cars and take it for periodic maintenance, we should also have regular check ups with your favorite doctor. Body weight, blood pressure, and blood tests may be done at regular intervals to make sure everything is alright. - Screen for complications
Diabetes makes the arteries age faster (early vascular aging) and its complications come out after sometime. It could be between 15 to 20 years after the onset of insulin resistance.
Complications can take the form of diabetic retinopathy (poor eyesight, cataracts), macrovascular disease (heart attacks and stroke, clogging of the arteries of the legs or peripheral arterial disease), and diabetic nephropathy (kidney failure) requiring dialysis and renal transplant.
To screen for complications, your doctor can request for an ECG, chest x-ray, 2D echocardiogram (heart ultrasound) and a treadmill stress test. Urine test for detection of proteinuria or microalbuminuria should be done periodically, too. Foot examination for signs of PAD are done every visit, and eye examination preferably by an eye specialist should be done at least once a year. When indicated, carotid doppler examination or a brain CT scan are requested, especially if there’s a history of stroke or transient ischemic attack.
- Treat complications
If you already have complications, having them treated would be the best way to go. The most serious cardiac complications of diabetes is coronary artery disease (CAD) and cardiomyopathy (CM). CAD can lead to heart attack and CM weakens the heart muscles and cause heart failure. Optimal medical management (OMT) is always a good therapeutic strategy in all patients, but some with more unstable CAD or severe coronary lesions may require percutaneous coronary intervention (PCI) or coronary bypass surgery.
Always keep in mind that even if you’ve had these procedures, you just have a re-conditioned heart, not a brand-new one. You will still need life time medications or OMT and a healthy lifestyle.
- Be a good patient
At the end of the day, it will still be up to you to observe a proper diet, do regular exercise, and religiously take your medications. Be adherent to treatment, follow your doctor’s recommendations, and maintain a healthy lifestyle.
