Actually, a lot of it has to do with lifestyle changes. For example: people should keep their weight down into the ideal range and if they are obese, they should work on a diet to get their weight down. They should exercise regularly – that doesn’t mean going to the gym and lifting 250 pounds, it means just regular exercise like walking for 30-40 minutes a day or stationary bicycle or swimming or ice skating or whatever – one can mix it up. But it’s important to get some exercise every day – that also works against the diabetic state. Also – the diet: watch out for all of those simple Carbs. I always call them the four white substances: white sugar, white flour, white potatoes, white rice. Keep those to a minimum in the diet. Lots of fruits and vegetables, lots of lean meats and fish and poultry. And, of course, keep your weight down and exercise regularly. All of those three things can markedly diminish the chance of developing diabetes or can help make the diabetic state much more mild. And of course – follow your doctor’s instructions. Take your pills or the insulin, check your sugar, be sure as a diabetic that you’re getting your eyes checked regularly and your feet checked regularly because often little sores on the feet end up resulting in amputation. So follow through with your doctor and work on your lifestyle.
There is a major connection between diabetes and heart disease. In fact, diabetes is one of the most important risk factors for developing hardening of the arteries (we call it athlerosclerosis – that is the cholesterol deposits and scarring in the walls of the arteries) and that leads to heart attacks and strokes. One of the most feared complications of diabetes are those two things: heart attacks and strokes.
There are two distinct forms of heart disease that are related to diabetes: The commonest one is the hardening of the arteries (the atherosclerotic process) that leads to heart attacks and can also lead even to sudden death when people collapse and die at home or even out in town. The second diabetic heart disease is less common: it’s when the diabetes affects the ability of the heart to squeeze. In other words, it decreases the heart function so that patients develop heart failure. With heart failure, people are short of breath, they develop swollen ankles, they’re fatigued, and it is also a very lethal complication of diabetes.
Diabetics have a number of risk factors that go along with the diabetic state. They are: kidney damage, high blood pressure, and abnormal fats in the blood. Kidney damage is very common in diabetics and that complicates the situation when patients have a heart attack and also makes patients more likely to have a heart attack. The same thing is true about the fats in the blood. Diabetics have high triglyceride fats (which are bad) and low HDL fats (which are good.) So that increases the risk for arthrosclerosis and it increases the likelihood of a patient developing hardening of the arteries and a heart attack. Finally, when there is damage to the kidney, often that engenders high blood pressure. So the damaged kidney is bad in two ways: both because it makes the heart attack issue more complicated and also because it increases the likelihood of a heart attack and, by the way, also a stroke.
What happens in a heart attack is that the blood supply to a piece of the heart muscle is cut off and the heart muscle dies. This can, of course, damage the heart so much that the person dies from the heart attack (if it’s a very big one) or it can damage the heart to the degree that patients develop heart failure – shortness of breath, fatigue, and swelling of their legs. The diabetic who has a heart attack is at higher risk for complications in the healing period after the heart attack than a person who has a heart attack who hasn’t had diabetes. One of the reasons for that is that we’re treating not only the physical complication of the injury to the heart but we’re also treating the chemical reactions that occur to the diabetic state is often worsened immediately after something like a heart attack (just like after an infection) so you have a more complicated patient to take care of who is at higher risk for other complications (such as heart failure) or even from not surviving the heart attack.
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