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Diabetes and Heart Disease

What is Diabetes?

Diabetes is a disease that occurs when body does not produce enough of insulin or can not use insulin properly. It is called type 1 when body’s pancreas does not produce any insulin. Type 2 diabetes occurs when the pancreas either does not produce enough insulin or body’s cell ignores the insulin. Over 35 million Indians are diabetic making India, the diabetes capital of the world. Type 2 diabetes is associated with a two or three fold higher risk of heart disease as compared to those having no diabetes.

Heart disease- Diabetes link

Excess blood sugar gets converted to fat, leading to increased fat levels in the blood, enhancing the risk of thickening of arteries. This gradual build up of fatty deposits on the walls of the arteries is called coronary artery disease. Over time, artery may become narrowed to give rise to angina-a pain or discomfort in the chest. A heart attack occurs when piece of the fatty deposit breaks away from the artery and causes blood clot to form. Heart muscle will be starved of blood and oxygen if this clot blocks the artery causing chest pain, pain in the arms, jaw, or neck, indigestion, shortness of breath, sweating, nausea. However, in diabetic persons, heart disease can present itself without any symptoms. Some patients show evidence of a recent heart attack only when they go for regular diabetic check-up and ECG. This is called ‘silent heart attack’. The lack of symptoms may give a false sense of good health until more serious complications arise. Diabetics may have other conditions that increase their chance of developing hear disease and stroke like sedentary life style, obesity, smoking, stress, increased cholesterol and high blood pressure. These are common preventable risk factors for both diabetes and heart disease, which if corrected, can not only help prevent heart attacks but can prevent diabetes itself.

Metabolic syndrome occurs when a group of metabolic risk factors are present in one person. People suffering from this condition are also at increased risk of coronary heart disease and type 2 diabetes. It clusters with abnormal abdominal fat tissue, blood fat disorders and plaque build-up in artery walls, insulin resistance or intolerance to glucose, high blood pressure, fibrinogen, plasminogen activator inhibitor, C-reactive protein in the blood. Metabolic syndrome is extremely common in USA, and is increasing rapidly in India.

Indian Scenario

Indians are more prone to heart attacks as compared with western people. Indians also tend to develop heart attacks two to three decades earlier compared to other population. In India approximately 2.78 million deaths are due to cardiovascular disease of which over 50% is due to heart attack making heart attack number one killer disease in our country. The rising trend of heart disease in diabetes will shortly make India, the leader in heart attack death rates also. Thus India faces the dangerous dual epidemic of diabetes and heart disease. Heart attack in diabetic patients tends to occur at young age, and is more malignant, extensive and recurrence is more common.

Prevention and Treatment

The first step to prevent heart disease is to detect diabetes early. Unfortunately, nearly half of these with diabetes in India are not even aware of it. To achieve the goal of preventing heart disease, it is important to avoid the occurrence of the major risk factors themselves. This is known as primordial prevention. Better social, economic and cultural statuses correlate inversely with lifestyle factors of smoking, abnormal food patterns and exercise. Primordial prevention begins in childhood when health risk behavior begins. In Indian urban adolescent school children there is a high prevalence of obesity, high blood pressure, increased cholesterol and high fat diet. Diabetic individuals can take steps to lower their risk of heart disease by emphasizing the “ABCs” where A stands for A1c or hemoglobin A1c test, which measures average blood glucose over past three months, B for blood pressure and C for cholesterol. The need to promote dietary discretion and physically active lifestyle in children is important. All adults should know their blood pressure and blood cholesterol levels, should not smoke, and should monitor their salt and fat intake, and engage in at least moderate exercise. A low saturated fat diet and maintenance of ideal body weight and waist circumference is also advocated. Medications are used when these therapy fail.

To assess the risk, it is necessary to take an electrocardiogram and tread-mill test. If these are abnormal, one should undergo coronary angiography that allows the doctor to look inside the arteries and find out where and how severe any narrowed areas (blocks) are. Patients with diabetes have small caliber coronary arteries, extensive and multiple blocks. Some of them could be managed with angioplasty that would widen the narrowed artery. A stent (metallic mesh) is placed in place to maintain the patency of the artery. Sometimes the stent becomes narrowed later on (restenosis) and gives rise to angina. These patients would need a heart bypass operation.

In nutshell, Indians seem to be more predisposed to both diabetes and heart disease. By adopting lifestyle changes, more of the risk factors can be modified and thereby both diabetes and heart disease are potentially preventable.

The devil has put a penalty on all things we enjoy in life. Either we suffer in health or we suffer in soul or we get fat. (Or get heart disease) Albert Einstein has got it so right. Now here is a list of things with no penalty. To help keep your heart healthy, make some lifestyle changes. Exercise and healthy eating are two ways to help keep your heart and body healthy.

Exercise Regularly

Like any muscle, your heart works best with routine exercise. Being active also reduces stress, lowers your cholesterol, and helps you lose weight. Talk with your health care provider before you start exercising.

Choose an Aerobic Activity

Exercise that works your lungs and heart can improve the way they use oxygen. Choose an activity you enjoy. Make it fun. You may even want to ask a friend to join you. Aerobic activity like Walking, Swimming, Climbing stairs, Bicycling, Dancing, Jogging.

Start Slowly and Keep at It

Begin exercising daily for 5 to 10 minutes.
Slowly build up to at least 30 minutes on all or most days of the week. You don't have to do all your exercise in one session. You can reach this goal by being active for 10 minutes 3 times a day.
Plan exercise sessions in advance. Write them down on your calendar.
If you have chest pain while exercising, stop and call your doctor right away.

Everyday tips

  • If you're not convinced about the need to develop an exercise program for your life, you can at least try following some of these tips in your everyday routine. Take advantage of any opportunity for exercise.
    • Take the stairs instead of an elevator or escalator. Just start with one flight. Soon, you'll be ready for two.
    • Park your car at the far end of the parking lot. The short walk to and from the store/office helps your heart.
    • If you ride a bus or subway, get off a stop before your destination. Walk the rest of the way.
    • If you can, spend a few minutes of your lunch break taking a stroll. It should help you stay awake after lunch.
    • Think of housework as an extra chance to exercise.
    • Mowing the lawn, pulling weeds, and raking leaves are chores that can be done yourself as a chance to exercise if you have a garden.
    • If you have a dog, think of the dog as an exercise machine with fur. A brisk walk with the dog is good for both of your hearts. Make it a part of your daily routine.
    • If you have a family, schedule an after-dinner walk. Make it quality time.

Eat Heart-Healthy Food

Changing the way you eat can lower your cholesterol, blood pressure, and weight. Food doesn't have to be bland and boring to be healthy. Start by working some healthy changes into your present diet. Try some of the tips below. Also, ask your health care provider for other tips. Better eating habits can help your whole body.

Less Fat

Total fat intake should be less than 30 percent of total calories daily and Cholesterol intake should be no more than 300 milligrams per day.
Eat fewer fatty cuts of meat and more fish. Use less butter, margarine, and lard.
Avoid foods containing palm and coconut oil or hydrogenated (check the label) oils.
Eat fewer high-fat dairy products like cheese, ice cream, and whole milk.
Get a heart-healthy cookbook and try some new, low-fat dishes.

Less Salt

Sodium intake should be no more than 3000 milligrams per day.
Don't add salt to food when cooking, and keep the salt shaker off the table.
Don't use sauces or cooking aids that are high in salt such as soy sauce, MSG, baking soda, and baking powder.
Instead of salt, season your food with herbs and flavorings such as lemon, garlic, or onion.

More Fiber

Eat more fresh fruits and vegetables. Eat at least 5 servings of fresh fruits and vegetables for a healthier heart.
Add oats, whole-grain rice, and bran to your diet.
Eat more beans and potatoes. They are great sources of fiber.
When you eat more fiber, be sure to drink more water to prevent constipation.

Food additives

Beware of chemicals in your food like caffeine, MSG, and other food additives.

Stop Smoking

If you smoke, quit. It's one of the best things you can do for your heart. If you smoke, your heart gets less oxygen. Plaque builds up faster in your vessels. And your risk for a heart attack is increased. Quitting reverses these risks. Even if you've tried to quit before and haven't, don't give up. Many smokers try quitting 4 or 5 times before they succeed.


If you must drink, ensure that it's no more than 2 drinks a day for men and a drink a day for women.

Reduce Stress

Spend time with your loved ones
Take up an activity that you love
Make time for yourself.
Learn stress reducing techniques like meditation.

Health checks

Get regular health checkups. Take your blood pressure and diabetes medications if advised.