What You Should Know About Diabetes and Heart Disease

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What You Should Know About Diabetes and Heart Disease
Your Family's Health

How do you control a disease when a third of the people who have it, donÌt even know it? That is the case with diabetes in this country. Almost 800,000 people are diagnosed each year, who join the 15.7 million people who have the disease -- 10.3 million who know it, and another 5.4 million who donÌt. For most of us, unless there are family members or loved ones who have the disease, diabetes is something that happens Ïto someone else.Ó

Unfortunately, diabetes can be associated with serious complications and premature death. The statistics are dramatic.

* The death rates are twice as high among middle-aged people with diabetes as among the same population without the disease.
* diabetes is the seventh leading cause of death on U.S. death certificates in 1996 -- but is believed to be underreported as a cause of death.
* Eighteen percent of all people in the 65 years or older age group have diabetes -- thatÌs 6.3 million people.
* Heart disease is the leading cause of diabetes-related deaths because chronic high blood sugar is associated with narrowing of the arteries, increased blood levels of triglycerides, decreased levels of ÏgoodÓ HDL cholesterol, high blood pressure, and heart attack. Adults with diabetes have cardiovascular death rates about 2 to 4 times higher than those of adults without diabetes.
* The risk of stroke is 2 to 4 times higher, as well.
* Diabetes is the leading cause of new cases of blindness in adults 20 to 74 years old, and youÌre four times more likely to become blind than if you donÌt have diabetes.


What is Diabetes?

Diabetes is not a single disease, but is more accurately described as a group of diseases in which high levels of blood glucose result from defects in insulin secretion, insulin action, or both. Insulin regulates the bodyÌs use of sugar, and metabolizes it for immediate energy needs or stores it for future use in the form of glycogen. During the digestive process, enzymes in the intestine break down food into glucose, which is then absorbed into the bloodstream for transport to cells throughout the body. If undetected, the unused glucose builds up in the bloodstream, resulting in a condition called hyperglycemia. Most people have heard of childhood and adult forms of the disease, but actually there are four types: Type 1, Type 2, Gestational, and Ïother specificÓ types.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) of the National Institutes of Health, Type I diabetes (previously called insulin-dependent diabetes mellitus or juvenile-onset diabetes) accounts for between 5 and 10 percent of all diagnosed cases. The risk factors for this type are not as well defined as for Type 2, but probably include autoimmune, genetic and environmental factors contribute to its development. In this form of the disease, the pancreas stops producing insulin as a result of an attack launched by the bodyÌs own immune system. The symptoms -- which usually occur in children -- are sudden and severe. Because insulin is absent, nutrients from food do not enter the cells and are ÏwastedÓ in the urine -- leading to excessive urination day and night -- which results when blood sugar is too high and the kidneys canÌt absorb the excess glucose. In spite of the high blood sugar, the cells are in a perpetual state of starvation and dehydration which causes the person to relieve their constant hunger and thirst by eating and drinking excessively. Even with the increased intake, the person loses weight and soon becomes generally debilitated. Before insulin was discovered in the 1920Ìs, Type 1 diabetes was a fatal disease, as it is today if left untreated.

Type 2 diabetes (previously known as non-insulin-dependent diabetes mellitus or adult-onset diabetes) accounts for about 90 or 95 percent of the diagnosed cases. The risk factors for this type include advancing age, obesity, family history, physical inactivity, impaired glucose tolerance, and certain ethnic and racial groups. Those in the particularly high risk category for Type 2 are African Americans, Hispanic Americans, American Indians, as well as some Asian Americans and Pacific Islanders. There is an excessive glucose production by the liver in this type. The pancreas produces insulin but releases it abnormally and the bodyÌs cells are resistant to the insulin action, or ignore it altogether. Type 2 diabetics may not have any symptoms at all, or they may simply complain about not feeling ÏgoodÓ, say they feel tired all the time, or complain of tingling or loss of feeling in hands or feet. Some report having blurred vision. People with Type 2 diabetes may also experience excessive urination and constant thirst, but this is less intense than what characterizes Type 1.

Gestational diabetes is found in 2 to 5 percent of all pregnancies, but disappears after childbirth. This form of the disease can develop because hormones secreted during pregnancy can increase the bodyÌs resistance to insulin. Again, ethnicity is a factor; this form of the disease occurs more frequently among African Americans, American Indians, Hispanic Americans and people who have a family history for diabetes or who are obese. Women who have had this form of the disease also face a higher risk for developing Type 2 later in life.

The final category -- other specific types -- accounts for only 1 or 2 percent and includes diabetes that results from specific genetic syndromes, surgery, drugs, malnutrition, infections and other illnesses.

Diagnosing and Treating Diabetes

In 1997, the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus suggested some new criteria which makes a fasting plasma glucose test (rather than the previously recommended oral glucose tolerance test) the routine diagnostic test. After having nothing to eat or drink overnight, a blood sample is taken to measure the glucose level. The American Diabetes Association recommends that all adults have a fasting plasma test at age 45 and, if results are normal, repeated every three years. In some circumstances, however, physicians may still choose to perform the oral test. Except in certain circumstances, abnormal test results must be confirmed by repeating the testing on another day.

Each individual diagnosed with diabetes is different, but for most people, learning to live with a chronic disease will usually include significant lifestyle modifications. When it comes to living with diabetes, the cornerstone is a thorough understanding of how the body operates and what is necessary to keep the blood glucose level under control. The important thing is to get an early diagnosis rather than to wait until complications have set in.

Today, there are some relatively simple-to-use devices that enable those with diabetes to check glucose levels at home, at work or just about anywhere. This blood glucose monitoring is essential to managing the disease. It provides an excellent opportunity to see how different foods, activities, stress, illness and medications affect a personÌs blood glucose level, and helps aim at keeping blood glucose near normal levels at all times.

Not everyone with diabetes takes insulin. Treatment for Type 1 diabetes usually requires diet management, planned physical activity or exercise, glucose monitoring and maintenance, and often oral medications or insulin injections. For Type 2, treatment can include the same measures, but only about 40 percent of people with this form of the disease require insulin while virtually all Type 1 diabetics must rely on insulin.

Oral medications for the treatment of Type 2 diabetes have been around since the 1950Ìs. Recently, there has been a marked increase in the availability of new drugs in the arsenal for treating diabetes. They join sulfonylureas (oral hypoglycemic or glucose-lowering agents); biguanides (medications which enhance the ability of tissues to absorb glucose and to reduce the amount of glucose released by the liver); alphaglucosidase inhibitors (which blocks starch digestion and slows down the rise of glucose in the blood after eating); and thiazolidinediones (drugs that reduce resistance to insulin). In July of this year, two new oral drugs in this last category were approved for the treatment of Type 2 diabetes that help reduce or eliminate the use of insulin injections for some people. (Users of another thiazolidinediones drug, troglitazone (Rezunlin) developed some liver complications and now the FDA requires people taking the drug to undergo regular testing for evidence of liver damage.) An agency panel has recommended that the new drugs carry similar warnings about the risks of liver damage and suggest regular testing for this damage, as well.

Minimizing the Risk of Heart Disease...

People who have diabetes that goes undetected and untreated face an increased risk for heart disease because atherosclerosis may occur at earlier-than-expected ages and more sever in diabetics. People who have diabetes-related atherosclerosis in their coronary arteries sometimes suffer what is called Ïsilent ischemiaÓ or silent heart attack. Silent, in this case, means without typical pain because neuropathy, or nerve damage, is a result of uncontrolled diabetes.

These people will not feel many sensations of touch, vibration, heat, cold or pain, and this may also include the expected pain of a heart attack. The resulting vague -- instead of acute -- symptoms may be ignored, or passed off as indigestion or stomach upset. When there is damage to the autonomic nervous system, signals that should be sent to the brain to regulate heart rate and blood pressure are blocked.

Early diagnosis and learning how to monitor and control the disease are key to avoiding complications down the road. Some experts suggest that the course of this disease can be changed when patients: 1) adopt a good attitude, 2) are committed to doing what is necessary to learn about their condition and its treatment, and 3) make a conscious decision to control the disease instead of allowing the disease to control them.

Diabetics respond to almost the same health regimen that helps heart patients recover. A closely monitored and controlled diet that involves reducing the intake of sugar and fats, and increasing the amounts of complex carbohydrates and fiber; weight control and smoking cessation; and a regularly performed aerobic exercise routine can be critical to both groups.

A specially tailored exercise regimen can lower triglycerides and blood glucose, heighten sensitivity to insulin and lower blood pressure. When a person begins aerobic exercise, muscle glycogen is the primary fuel. After five to 10 minutes, glucose uptake from blood is seven to 20 times the resting rate, depending upon how strenuous the exercise is and diabetics can benefit from this uptake.

If you are over 40 and notice any vague symptoms -- fatigue, constant thirst, excessive urination, transient blurred vision, or even that minor skin injuries take a long time to heal -- make an appointment with you physician. If there are other diabetics in your immediate family or if you are more than 20 percent over your ideal body weight, schedule a physical examination as soon as possible.

There is no cure for diabetes, but with careful monitoring and commitment, diabetics can avoid complications and enjoy a long, productive life. Making an equally important commitment to reduce the risks of cardiovascular disease can help make this possible.