Nurse's Notes

Diabetes and Heart Disease

We know that heart disease is the leading cause of death in the United States, and stroke is the 4th leading cause. Diabetes is 7th. Having diabetes increases the risk that a person will develop heart disease or stroke.

Diabetes is a disorder in how our bodies make and use insulin to help digested food provide energy. Glucose is the body's main source of energy. Food we eat is digested and metabolized into glucose, the form of sugar in the blood. After digestion, glucose enters the bloodstream. A hormone called insulin must be present to allow glucose to then enter the cells throughout the body where it is used for energy.

In people who do not have diabetes, the pancreas automatically produces the right amount of insulin to move glucose from blood into the cells. Diabetes develops when the pancreas does not make enough insulin, or the cells in the muscles, liver, and fat do not use insulin properly, or both. As a result, the amount of glucose in the blood increases because the glucose cannot enter the cells, so the cells are starved of energy.

Over time, high blood glucose levels damage nerves and blood vessels, leading to complications such as heart disease and stroke, the leading causes of death among people with diabetes. Uncontrolled diabetes can eventually lead to other health problems as well, such as vision loss, kidney failure, neuropathies and vascular disease.

Diabetics are at least twice as likely as non-diabetics to have heart disease or a stroke, and tend to develop heart disease or have strokes at an earlier age than non-diabetics. Studies suggest that the chance of a middle aged person with type 2 diabetes having a heart attack is as high as someone without diabetes who has already had one heart attack. Pre-menopausal women usually have less risk of heart disease than men of the same age. But women of all ages with diabetes have an increased risk of heart disease because diabetes cancels out the protective effects of being a woman in her child-bearing years.

High blood glucose levels over time can lead to increased deposits of plaque in blood vessel walls. These deposits affect blood flow, increasing the chance of clots and hardening of blood vessels (atherosclerosis).People with diabetes who have already had one heart attack run an even greater risk of having a second one. In addition, heart attacks in people with diabetes are more serious and more likely to result in death.

Diabetes itself is a risk factor for heart disease and stroke. Also, many people with diabetes have other risk factors that increase their chance of developing heart disease and stroke. One risk factor is having a family history of heart disease. If one or more members of your family had a heart attack at an early age (before age 55 for men or 65 for women), you may be at increased risk. You can't change whether heart disease runs in your family, but you can take steps to control other risk factors for heart disease:

Central obesity-carrying extra weight around the waist, as opposed to the hips. A waist measurement of more than 40 inches for men and more than 35 inches for women means you have central obesity. Your risk of heart disease is higher because abdominal fat can increase the production of LDL (bad) cholesterol, the type that can be deposited on the inside of blood vessel walls.

Abnormal cholesterol levels

	LDL (bad) cholesterol can build up inside your blood vessels, leading to narrowing and hardening of your arteries, which can become blocked, raising your risk of getting heart disease.
	Triglycerides are another type of blood fat that can raise your risk of heart disease when the levels are high.
	HDL (good) cholesterol removes deposits from inside your blood vessels and takes them to the liver for removal. Low levels of HDL cholesterol increase your risk for heart disease.
	Trans fats, a form of fat manufactured to make processed foods more tasty, raises the 'bad' cholesterol level and lowers the 'good'.

High blood pressure-called hypertension makes your heart work harder to pump blood. Hypertension can strain the heart, damage blood vessels and increase your risk of heart attack, stroke, eye problems, and kidney problems.

Smoking-doubles your risk of getting heart disease. Stopping smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels. Smoking also increases the risk of other long-term complications, such as eye problems. In addition, smoking can damage the blood vessels in your legs and increase the risk of needing an amputation.

You can help reduce your risk for stroke and heart disease by taking the following steps:

	Make sure that your diet is "heart-healthy." Include at least 14 grams of fiber daily for every 1,000 calories you eat. Foods high in fiber may help lower blood cholesterol. Oat bran, oatmeal, whole-grain breads and cereals, dried beans and peas (such as kidney beans, pinto beans, and black-eyed peas), fruits, and vegetables are all good sources of fiber.
	Cut down on saturated fat. It raises your blood cholesterol level. Saturated fat is found in animal products, dairy products, and tropical oils such as palm and coconut oil.
	Keep the cholesterol in your diet to less than 300 milligrams a day. Cholesterol is found in meat, dairy products, and eggs.
	Keep the amount of trans fat in your diet to a minimum. Limit your intake of crackers, cookies, snack foods, commercially prepared baked goods, cake mixes, microwave popcorn, fried foods, salad dressings, and other foods made with partially hydrogenated oil. In addition, some kinds of vegetable shortening and margarines have trans fat. Check for trans fat values on the food label.
	Engage in at least 30 minutes of exercise most days of the week. Think of ways to increase physical activity, such as taking the stairs instead of the elevator. If you haven't been physically active recently, see your doctor for a checkup before you start an exercise program. (Watch for our upcoming Walk to Emmaus program that starts the day after Easter).
	Reach and maintain a healthy body weight. If you are overweight plan meals to lower fat and calorie content of your diet to reach and maintain a healthy weight. Aim for a loss of no more than 1 to 2 pounds a week.
	If you smoke, quit. Your doctor or your parish nurse can help you find ways to quit smoking.
	Ask your doctor whether you should take aspirin. Studies have shown that taking a low dose of aspirin every day can help reduce the risk of heart disease and stroke, but, aspirin is not safe for everyone.
	Get prompt treatment for transient ischemic attacks (TIAs) to help prevent or delay a future stroke. Signs of a TIA are sudden weakness, loss of balance, numbness, confusion, blindness in one or both eyes, double vision, difficulty speaking, or a severe headache.

Sr. Mary Michael McCulla, Tri-Parish Nurse



Sr. Mary Michael McCulla

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