Complications of Diabetes

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Complications of Diabetes

Heart and Blood Vessel Problems

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People with diabetes are 2 to 4 times more likely to get heart disease than those without diabetes. They are 5 times more likely to have a stroke. More people with diabetes die from heart disease than any other diabetes related complication.


How Does Diabetes Affect the Heart and Blood Vessels?


People with diabetes are more likely to have “hardening of the arteries” (atherosclerosis). This happens when fat builds up and sticks to the inside of the artery, causing them to become hard and narrow. Over time, this makes it harder for the blood to flow through.


Body parts with the highest risk of damage:


Heart: If the blood supply is reduced or cut off to the heart, a heart attack may occur.


Brain: The brain, like the other parts of the body, needs oxygen and nutrients from the blood. If not enough blood is making it to the brain a stroke or “brain attack” may occur.


Legs and Feet: When the blood vessels to the legs and feet are affected, there is less blood flow, less oxygen and fewer nutrients carried to the legs and feet. Cuts and sores heal more slowly. If you notice pain and/or cramps to the legs and calves when walking, it’s possible that the blood flow may have been reduced. Muscles use oxygen more quickly during activity/exercise.


What Causes Heart and Blood Disease?

The American Heart Association has identified several “risk factors” that put an individual at risk for developing heart and blood disease. The more risk factors you have, the greater your chance of developing this disease.


Diabetes itself is a risk factor for heart and blood disease. Other risk factors include:


High blood pressure (Hypertension)
High cholesterol
Smoking (nicotine narrows blood vessels)
Family history of heart disease (such as heart attacks or stroke)
Male Gender: after menopause women have a higher incidence of heart disease, but men still have an overall higher rate.
Increasing Age
Being Overweight
Can Heart and Blood Vessel Disease be Prevented?


Heart and blood vessel disease may be reduced by decreasing the number of risk factors or lessening the degree of impact of the risk factors. For example, cutting back on the amount one smokes vs. quitting altogether. Some risk factors can’t be changed, like gender, family history, and age.


A helpful way to remember how to improve heart heath and reduce risk is to know your “Diabetes ABC’s”.


What are the Diabetes ABC’s?


A is for A-1-C (or HGB A-1-C). A-1-C is a blood test performed by a doctor’s office/laboratory that tells what the blood sugar has averaged over the past 2-3 months. The American Diabetes Association (ADA) recommends that people with diabetes aim for an A-1-C of less than 7%. As with the blood glucose personal target range, people with diabetes should talk with their doctor about what is an appropriate goal for them. A-1-C should be checked at least twice a year, often 3-4 times in order to provide information that can help guide treatment.


B is for Blood Pressure. The blood pressure reading has two numbers, the top (systolic) reading and the bottom (diastolic) reading. When the blood pressure is high, the heart has to work harder to pump blood. The ADA recommends that people with diabetes keep their blood pressure below 130/80 (said as “130 over 80”). In some cases, as with kidney disease, the recommendations are lower. People with diabetes should check with their doctor to confirm their blood pressure target goals. Blood pressure should be monitored/checked at every health care visit and more often outside of clinic appointments as directed by your doctor.


C is for Cholesterol. The fasting cholesterol/lipid blood test tells you the amount of different fats in your blood. The total cholesterol goal is less than 200. The “good cholesterol” or HDL should be 40 mg/dl or higher. The higher, the better. The “bad cholesterol” or LDL should be less than 100 mg/dl. Triglycerides are another type of blood fat that can increase the risk of heart disease. They should be less than 150 mg/dl. Cholesterol/fat levels should be checked yearly. Cholesterol levels can be impacted through diet, exercise and medications. Many people with diabetes are also on cholesterol lowering medicines.


Keeping the blood sugar (and A-1-C) at target levels by making good food choices, engaging in regular physical exercise and taking medications as prescribed is a good way to help prevent or limit potential heart and blood vessel complications associated with diabetes.




Other risk factors can be modified by:


Quitting smoking
Maintaining a healthy weight
Reducing stress or developing stress reduction techniques (muscle relaxation, deep breathing, etc.)
Limiting alcohol to occasional and always in moderation (too much alcohol can increase triglycerides and affect blood sugar levels).

In addition to managing heart disease risk factors, it is important to know the warning signs of a heart attack and brain attack (stroke) so you can recognize them and act quickly. Often people affected aren’t sure what’s wrong and wait too long before getting help.


Heart Attack Warning Signs


The American Heart Association notes the following signs of a heart attack:

Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
Shortness of breath. This feeling often comes along with chest discomfort. But it can occur before the chest discomfort or even alone.

Other signs may include: breaking out into a cold sweat, nausea, and feeling lightheaded or dizzy.


Stroke (Brain Attack) Warning Signs


The American Stroke Association says these are common warning signs of a stroke:

Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden severe headache with no known cause

If you or someone with you has one or more of these heart attack or stroke signs, don’t hesitate to call 9-1-1, or the emergency medical services (EMS) number, so an ambulance (ideally with advanced life support) can be sent to assist you. Also, check the time so you’ll know when the first symptoms appeared. It’s very important to take immediate action. If given within three hours of the start of stroke symptoms, a clot-busting drug can reduce long-term disability for the most common type of stroke.


PATIENT OUTCOMES/GOALS



By the end of the educational session, the diabetic client will be able to:


Name one risk factor for developing atherosclerosis (hardening of the arteries).
State one action they can take that is beneficial in preventing heart/blood vessel complications.
Name one warning sign of a heart attack and brain attack (stroke).


KEY MESSAGES



People with diabetes are at a higher risk for developing heart and blood vessel disease, including heart attacks and stroke.
Risk can be lowered by eating a heart healthy diet, exercising, keeping blood sugar at or near target levels, quitting smoking, losing even a little weight (if you are overweight), and seeing your doctor regularly.




Assessment Questions Content Tips and Teaching Aids
Do you know how diabetes affects your heart and blood vessels? People with diabetes are more likely to have “hardening of the arteries” (atherosclerosis). This happens when fat builds up and sticks to the inside of the artery, causing them to become hard and narrow. Over time, this makes it harder for the blood to flow through.

Blood vessels of the heart, brain, and legs can be affected, resulting in heart attacks, strokes and poor leg circulation. This may also cause wounds to heal more slowly.
Aides:

Blood Vessel Disease

Which risk factors or causes of heart disease (heart attack or stroke) can you name? Just having diabetes is a risk factor for heart disease, stroke and blood vessel disease. Other risk factors are:
High blood pressure (hypertension)
High cholesterol
Cigarette smoking
Family history of heart attack, stroke, or hardening of the arteries
Male gender
Age
Being overweight
Handouts:

“Taking Care of Your Heart.” American Diabetes Association, Toolkit No. 18. “All About Strokes.” American Diabetes

The following are important steps you can take to reduce your risk for heart and blood vessel disease:
Be more physically active
If you are overweight, losing even a few pounds can help to improve blood fats and blood pressure levels
If you smoke, try to quit. Ask your doctor for help
Eat less saturated fat and less trans fat, eat more whole grains, fruits and vegetables
Have your lipid levels tested yearly (Goal LDL is less than 100, many people require cholesterol medication to achieve a lipid goal)
Keep blood sugar in the target range
Limit alcohol to occasional and always drink in moderation
Keep stress in check or develop stress reduction techniques that work for you
Adults should take an aspirin each day, unless they can’t tolerate it. Check with your doctor to make sure it won’t affect your other medications or health conditions

Taken in part from “The Joslin Guide to Diabetes: A Program for Managing Your Treatment” by Richard Beaser, MD & Amy Campbell, RD, 2005. Fireside/Joslin Diabetes Center.

An easy way to remember how to be heart smart is to know your diabetes ABC’s.

What are the Diabetes ABC’s?


A is for A-1-C (or HGB A-1-C). A-1-C is a blood test performed by a doctor’s office/laboratory that tells what the blood sugar has averaged over the last 2-3 months. The American Diabetes Association (ADA) recommends that people with diabetes aim for an A-1-C of less than 7%. As with the blood glucose personal target range, people with diabetes should talk with their doctor about what is an appropriate goal for them. A-1-C should be checked at least twice a year, often 3-4 times in order to provide information that can help guide treatment.


B is for Blood Pressure. The blood pressure reading has two numbers, the top (systolic) reading and the bottom (diastolic) reading. When the blood pressure is high, the heart has to work harder to pump blood. The ADA recommends that people with diabetes keep their blood pressure below 130/80 (said as “130 over 80”). In some cases, as with kidney disease, the recommendations are lower. People with diabetes should check with their doctor to confirm their blood pressure target goals. Blood pressure should be monitored/checked at every health care visit and more often outside of clinic appointments as directed by your doctor.


C is for Cholesterol. The fasting cholesterol/lipid blood tests tell you the amount of different fats in your blood. The total cholesterol goal is less than 200. The “good cholesterol,” known as HDL, should be 40 mg/dl or higher. The higher, the better. The “bad cholesterol,” known as LDL, should be less than 100 mg/dl. Triglycerides are another type of blood fat that can increase the risk of heart disease. They should be less than 150 mg/dl. Cholesterol/fat levels should be checked annually. Cholesterol levels can be impacted through diet, exercise and medications. Many people with diabetes are also on cholesterol lowering medicines.
















Do you know the signs of a heart attack or stroke and what to do? A-1-C, Blood pressure and Cholesterol can be impacted by:

Making good food choices
Engaging in regular physical exercise taking medications as prescribed


Other risk factors can be improved by:


Quitting smoking
Maintaining a healthy weight
Reducing stress or by using stress-reduction techniques (muscle relaxation, deep breathing, etc.)
Limiting alcohol to occasional and always in moderation (too much alcohol can increase triglycerides and affect blood sugar levels).


In addition to managing heart disease risk factors, it is important to know the warning signs of a heart attack and brain attack (stroke) so you can recognize them and act quickly. Often people affected aren’t sure what’s wrong and wait too long before getting help.
Heart Attack Warning Signs The American Heart Association notes the following signs of a heart attack:

Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness, or pain.
Discomfort in other areas of the upper body. Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
Shortness of breath. This feeling often comes along with chest discomfort, but it can occur before the chest discomfort or even alone


Other signs may include:


Breaking out in a cold sweat
Nausea
Lightheadedness
Dizziness


Brain Attack/Stroke Warning Signs


The American Stroke Association says these are the warning signs of stroke:

Sudden numbness or weakness of the face, arm or leg, especially on one side of the body
Sudden confusion, trouble speaking or understanding
Sudden trouble seeing in one or both eyes
Sudden trouble walking, dizziness, loss of balance or coordination
Sudden, severe headache with no known cause

If you or someone with you has one or more of these heart attack or stroke signs, don’t delay! Immediately call 9-1-1 or the emergency services (EMS) number in your area, so an ambulance (ideally with advanced life support) can be sent for you. Also, check the time so you’ll know when the first symptoms appeared. It’s very important to take immediate action. If given within three hours of the start of stroke symptoms, a clot-busting drug can reduce long-term disability for the most common type of stroke.


Let your doctor know immediately if you have some of these symptoms off and on as it may be a warning sign of heart/blood vessel disease.

ACTIVITY
Do you know what your personal risk factors are for heart and blood vessel disease? Review client’s known risk factors, focusing on the risks that they may be able to do something about:

A-1-C level (know it and try to reach target)
Blood pressure
Cholesterol levels
Physical activity
Heart healthy diet/foods
Smoking (including second-hand exposure)
Make regular doctor appointments
Limit alcohol use
Stress reduction
Take an aspirin daily if recommended by your doctor
Teaching Tips:

Write down notes on a handout or separate piece of paper. Ask client if they can bring this in the next time they meet with their provider, to trigger a conversation on reducing risks of heart and blood vessel disease.


Use this information to guide the self-management goal setting section (see next page)






SELF-MANAGEMENT GOAL



Educator may wish to paraphrase the following:


It’s helpful to consider setting a goal or an aim along with a behavior specific plan that you want to work toward over the next few weeks
It should be something you want to do in order to improve your health
It may be specifically related to diabetes or may be just something in general that you want to do to improve your health
Would you be willing to take a few minutes to think about a goal you would like to achieve and work through an action plan to achieve your goal?


Try to get client to write down their goal and action plan (Self-Management Goal/Action Plan Form). Remember to let them work through the process as much as possible.


Examples of Goals pertaining to this Module/Section Include:


Have blood lipids and/or blood pressure checked
Keep a log or wallet card of values/results of lipid tests, blood pressure, A-1-C
Start an exercise program
Focus on a heart healthy diet by reducing intake of salt, saturated/trans fats, and/or by increasing intake of fiber, fruits and vegetables


TOOLS/TEACHING AIDES, REFERENCES



Type 2 Diabetes: A Curriculum for Patients and Health Professionals,” American Diabetes Association, 2002.
The Joslin Guide to Diabetes: A Program for Managing Your Treatment, Beaser, R.S. Fireside ed./Joslin Diabetes Center, 2005.
The American Heart Association Website:
www.americanheart.org/presenter.jhtml?identifier=3053

American Diabetes Association, Cardiovascular Disease Toolkit:
http://diabetes.org/for-health-professionals-and-scientists/CVD.jsp






These materials were adapted from Type 2 Diabetes: A Curriculum for Patients and Health Professionals, American Diabetes Association, 2002.