Diabetes, heart disease and stroke

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Dr. J. C. Mangwiro
Consultant Specialist Physician, ZDA President MMED (UZ) MSC Diabetes (CARDIFF UNIVERSITY,UK) FCP (ECSA)
Having diabetes means that one is more likely to develop heart disease and have a greater chance of a heart attack or a stroke. People with diabetes are also more likely to have certain conditions, or risk factors, that increase the chances of having heart disease or stroke, such as high blood pressure or high cholesterol. If one has diabetes, they can protect heart and health by managing their blood glucose, also called blood sugar, as well as blood pressure and cholesterol.
What is the link between diabetes, heart disease and stroke?
Over time, high blood glucose from diabetes can damage blood vessels and the nerves that control heart and blood vessels. The longer one has diabetes, the higher the chances of developing heart disease.1
People with diabetes tend to develop heart disease at a younger age than people without diabetes. In adults with diabetes, the most common causes of death are heart disease and stroke.
Adults with diabetes are nearly twice as likely to die from heart disease or stroke as people without diabetes. The good news is that proper managing of diabetes also helps to lower chances of having heart disease or stroke.
What else increases chances of heart disease or stroke in diabetics?
If one has diabetes, other factors add to chances of developing heart disease or having a stroke.
Smoking
Smoking raises the risk of developing heart disease. If one is diabetic, it is important to stop smoking because both smoking and diabetes narrow blood vessels. Smoking also increases chances of developing other long-term problems such as lung disease. Smoking also can damage the blood vessels in legs and increase the risk of lower leg infections which can lead to amputation.
High blood pressure
When one has high blood pressure, the heart must work harder to pump blood. High blood pressure can strain the heart, damage blood vessels, and increase the risk of heart attack, stroke, eye problems, and kidney problems.
Abnormal cholesterol levels
Cholesterol is a type of fat produced by the liver and found in the blood. There are two kinds of cholesterol in the blood: LDL and HDL.
LDL, often called “bad” cholesterol, can build up and clog blood vessels. High levels of LDL cholesterol raise the risk of developing heart disease.
Another type of blood fat, triglycerides, also raises the risk of heart disease when the levels are higher than recommended .
Obesity and belly fat
Being overweight or obese can affect the ability to manage diabetes and increase the risk of many health problems, including heart disease and high blood pressure.
A healthy eating plan with reduced calories often will lower glucose levels and reduce the need for medications. Excess belly fat around the waist, even in slim people, can raise the chances of developing heart disease.
Excess belly fat is indicated in waist measures:
More than 40 inches in men;
More than 35 inches in women.
Family history of heart disease
A family history of heart disease may also add to the chances of developing heart disease. If one or more family members had a heart attack before age 50, there is a higher chance of one developing heart disease.
Although one cannot change their genetical predisposition to heart disease, steps to protect against heart disease and decrease chances of having a stroke can be taken. Taking care of diabetes is important to help take care of the heart. Chances of having a heart attack or stroke can be alleviated by taking the following steps to manage diabetes to keep the heart and blood vessels healthy.
1. Manage diabetes ABCs
Knowing one’s diabetes ABCs will help manage blood glucose, blood pressure, and cholesterol
A is for the A1C test. The A1C test shows the average blood glucose level over the past 3 months. This is different from the blood glucose checks that are done every day. The higher the A1C number, the higher the blood glucose levels have been during the past 3 months. High levels of blood glucose can harm the heart, blood vessels, kidneys, feet, and eyes. The A1C goal for many people with diabetes is below 7 percent. Some people may do better with a slightly higher A1C goal.
B is for blood pressure. Blood pressure is the force of the blood against the wall of the blood vessels. If the blood pressure gets too high, it makes the heart work too hard. High blood pressure can cause a heart attack or stroke and damage kidneys and eyes. The blood pressure goal for most people with diabetes is below 140/90 mm Hg.
C is for cholesterol. There are two kinds of cholesterol in the blood: LDL and HDL. LDL or “bad” cholesterol can build up and clog blood vessels. Too much bad cholesterol can cause a heart attack or stroke. HDL or “good” cholesterol helps remove the “bad” cholesterol from blood vessels.
Most people over 40 years of age, may need to take medicine such as a statins to lower cholesterol and protect the heart. Some people with very high LDL (“bad”) cholesterol may need to take medicine at a much younger age.
S is for stop smoking. Not smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels, the heart has to work harder.
Quitting smoking:
Lowers the risk for heart attack, stroke, nerve disease, kidney disease, eye disease, and amputation.
Improves blood glucose, blood pressure, and cholesterol levels.
Improves blood circulation.
2. Develop or maintain healthy lifestyle habits
Developing or maintaining healthy lifestyle habits can help in managing diabetes and prevent heart disease:
Follow a healthy eating plan.
Make physical activity a life style routine.
Stay at or get to a healthy weight.Get enough sleep.
3. Learn to manage stress
Managing diabetes is not always easy. Feeling stressed, sad, or angry is common when one is living with diabetes. One may know what to do to stay healthy but may have trouble sticking with the plan over time.
Long-term stress can raise blood glucose and blood pressure, so it is important to learn ways to lower stress. Deep breathing, gardening, taking a walk, doing yoga, meditating, doing a hobby, or listening to music are all stress coping mechanisms.
4. Take medicine to protect the heart
Medicines may be an important part of the treatment plan. The doctor will prescribe medicine based on specific needs. Medicine may help one to:
Meet A1C (blood glucose), blood pressure, and cholesterol goals.
Reduce the risk of blood clots, heart attack, or stroke.
Treat angina, or chest pain that is often a symptom of heart disease. (Angina can also be an early symptom of a heart attack.)
Statins can reduce the risk of having a heart attack or stroke in some people with diabetes. Statins are a type of medicine often used to help people meet their cholesterol goals. Talk with your doctor if you have questions about your medicines and always take them as prescribed. Don’t stop taking your medicines without checking with your doctor first.
Warning signs of heart attack and stroke:
Pain or pressure in the chest that lasts longer than a few minutes or goes away and comes back.
Pain or discomfort in one or both arms or shoulders; or back, neck, or jaw.
Shortness of breath.
Sweating or light-headedness./Indigestion or nausea.
Feeling very tired.
Treatment works best when it is given right away. Warning signs can be different in different people. One may not have all of these symptoms but still have a heart attack. People with diabetes-related nerve damage may not notice any chest pain. The following may also indicate a stroke or heart attack:
Weakness or numbness of the face, arm, or leg on one side of the body.
Confusion, or trouble talking or understanding.
dizziness, loss of balance, or trouble walking.
Trouble seeing out of one or both eyes.
Sudden severe headache.
If you have any one of these warning signs, call emergency services. Permanent damage can be alleviated by getting to a hospital within an hour of a stroke.

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