When you have diabetes it is essential that you monitor and manage all the factors that increase your risk of artery disease, as disease of the heart and circulatory system can be very serious.
As we get older, we all become more at risk of diseases occurring in our arteries. The walls of these arteries may become thickened by the build up of cholesterol and stiffened by the formation of scar tissue. This process is called ‘atherosclerosis’. Atherosclerosis tends to occur in localised patches. It may occur anywhere in the circulatory system, but certain arteries are more vulnerable. It is a problem because it restricts the flow of blood through the vessel, and because it increases the risk of blood clots in that vessel.
People with diabetes are at an increased risk of atherosclerosis if they do not maintain good blood sugar control. Risk is further increased by smoking, high blood pressure and high cholesterol levels. Unfortunately, diabetes often occurs together with high blood pressure and high cholesterol. Therefore, when you have diabetes it is essential that you monitor and manage all the factors that increase your risk of artery disease, as disease of the heart and circulatory system can be very serious.
Your blood needs to be kept under pressure in order for it to flow through your vessels, but if the pressure is abnormally high this increases the risk of artery disease developing. Therefore, the higher your blood pressure, the greater your risk of heart disease, peripheral vascular disease and stroke, as well as of kidney damage. Blood pressure naturally increases with age. Unfortunately, people with diabetes have a greater likelihood of an increased blood pressure or ‘hypertension’.
Most people with hypertension do not have any symptoms. The only way to know if your blood pressure is high is to have it measured by your doctor. Since blood pressure varies from minute to minute, several readings need to be taken over a few weeks to establish whether you really have hypertension.
You may be able to keep your blood pressure down by staying fit and by losing weight if you need to. Too much salt or alcohol can increase blood pressure so cutting down on these is a good idea. If you smoke, try to stop; smoking not only raises blood pressure, it also directly increases your risk of heart and circulatory disease. Many people with diabetes find they need to take regular medication to bring their blood pressure down to normal levels. There are many different kinds of medicines for blood pressure; these drugs are known as ‘antihypertensives’. If one kind doesn’t suit you, alternatives can usually be found.
It is likely that you will have heard the term ‘cholesterol’ in relation to heart disease. Cholesterol is a fat that is transported in the blood in small particles called ‘lipoproteins’. It has many important functions in the body. However, if the level of cholesterol in your blood is too high, excess cholesterol can become deposited in the artery walls directly contributing to the process of atherosclerosis. There are different types of lipoproteins, however, and while some contribute to artery disease others are actually beneficial. Your doctor will measure your total cholesterol level as well as the different types of lipoprotein to assess whether you are at risk of artery disease. Unfortunately, diabetes is often associated with high cholesterol. Your dietitian will advise you on diets that are low in cholesterol, but you may also need special medicines – ‘lipid-lowering drugs’ – to bring your cholesterol level down to normal.
One group of arteries that are vulnerable to atherosclerosis are the ‘coronary’ arteries. These supply the heart with blood, and hence oxygen. If blood flow is restricted through these arteries, the heart muscle is starved of oxygen. This causes chest pain, referred to by doctors as ‘angina’. Angina is most likely to be suffered during exercise when the heart’s requirement for oxygen is high. Rest usually eases the pain. Persistent angina can be treated with drugs or surgical procedures. People with diabetes are at increased risk of coronary artery disease if their blood sugar, blood pressure and cholesterol are not well controlled, and many will eventually need to take treatments for heart disease. Some patients who develop angina or other forms of heart disease may be referred to a cardiologist – a specialist in heart disease.
Sometimes, a clot can form in a diseased coronary artery completely blocking the vessel. Doctors call this situation a ‘myocardial infarction’ or ‘MI’, but it is popularly known as a ‘heart attack’. Symptoms include prolonged, crushing chest pain, sweating, nausea, breathlessness and loss of consciousness. It is vitally important for people who are suspected of having a heart attack to be taken to hospital. With modern intensive medical care, most people experiencing a heart attack are expected to survive if they reach hospital soon enough. Afterwards, they may need to take medications to support their damaged heart.
Atherosclerosis may affect other arteries besides the coronary arteries. If arteries supplying the brain are affected, areas of the brain can be starved of oxygen resulting in black-outs or permanent damage – a stroke. Stroke is common in people with high blood pressure. The effects of a stroke are very variable, and depend on the areas of brain damage. Many different bodily functions can be affected and the severity of symptoms varies greatly. With rehabilitation, many people recover the functions that they lost with their stroke. Sadly, some people are permanently disabled, and some strokes are fatal.
Atherosclerosis can also affect the large arteries supplying the lower limb muscles. If insufficient blood reaches the calf muscle, walking long distances can become painful, and the affected person must keep stopping to recover before they can continue. Doctors call this situation ‘intermittent claudication’. Sometimes drugs or a planned exercise program can help. Sadly, in some situations the limb receives insufficient blood to keep it alive and amputation becomes necessary. Keeping tight control of your blood sugar can decrease your risk of this dramatically.
The complications described above relate to disease of the large arteries. However, if you have diabetes, the smaller blood vessels can also become damaged. This in turn can result in damage to the kidneys, nerves, eyes and teeth/gums
APP/KOL/AC 22/02/07