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Heart Disease and Diabetes

Coronary Artery Disease is caused by a build up of fatty substances like cholesterol. These fatty lumps collect in the blood vessels (arteries) which are the tubes that carry blood around the body. The fatty lumps cause thickening-of-the walls and narrowing of the vessels. This means that less blood and therefore less oxygen can get through. These fatty build ups are sometimes called plaque or lesions. The process is called atherosclerosis, commonly referred to as 'hardening' of the arteries. Prolonged high blood glucose levels and high blood pressure also contributes to narrowing of the blood vessels

Depending on the site of the plaque build up it can affect the following:

  • Heart - Angina/Heart Attacks
  • Feet / Circulation - Claudication (pain in the legs on walking)/ Peripheral vascular disease
  • Brain- stroke/cerebrovascular disease/Transient Ischaemic Attack (TIA)

UK guidelines recommend that all people >40 years have routine cardiovascular assessment. If you already have cardiovascular disease or diabetes then you are already in the high-risk group

Risk Factors

High Blood Pressure

BP should be 130/80 or 125/75mmHg (if you have kidney problems)

In Type 1 diabetes, high blood pressure is no more common than in people without diabetes, the exception being in patients with established kidney problems.

In Type 2 diabetes high blood pressure is more common that the general population and may even be present prior to diagnosis of diabetes.

You may not have any symptoms to indicate your blood pressure is high; this is why regular monitoring of blood pressure is important.

High Cholesterol

All individuals with diabetes over the age of 40 years should be considered for medication to lower blood cholesterol. Statins are the most widely used medication.

All patients with diabetes should be encouraged to reduce the amount of fat in the diet, especially if cholesterol is high. The dietician can give you advice about this. Below are some reasonable targets for cholesterol- the general principle is the lower the better!

  • Total cholesterol < 4 mmol/l
  • Triglycerides < 2.3mmol/l
  • High Density Lipoprotein > 1 mmol/l
  • Total Chol/HDLratio < 3.5 mmol/l
  • Low Density Lipoprotein < 2 mmol/l

High Blood Sugars

Elevated blood sugars over a prolonged period can damage the heart and increase the fatty deposits in the artery wall therefore increasing further risks of heart disease.

For most people, you should aim for HbA1c levels of 45 - 55 mmol/mol to reduce risk of all diabetes complications.

Your diabetes doctor may wish to agree a slightly different target with you dependent on your personal circumstances.

Smoking

Having diabetes increases your risk of developing angina, heart attack, stroke, and poor circulation. Adding smoking to diabetes more than doubles your risk of illness and death from these conditions. If you are pregnant, smoking can harm your baby.

Get support from professionals. You can discuss with your GP the value of using aids such as nicotine chewing gum, nicotine patches and smoking cessation classes.

Smokeline - Tel 0800 84 84 84

Alcohol

Many alcoholic drinks are high in calories. You should think about cutting back if you are trying to lose weight. Low sugar beers tend to be higher in alcohol content and are not recommended, especially if you are on insulin.

Drinking too much alcohol can raise the levels of some fats in the blood such as triglycerides. It can also lead to high blood pressure and obesity. Excessive alcohol intake can lead to stroke and other serious heart problems.

Men:

No more than 3 units/day (no more than 21 units in a week)

For Women:

No more than 2 units/day (no more than 14 units in a week)

Everyone should have at least one or two alcohol-free days a week.

Exercise

Physical inactivity roughly doubles the risk of coronary heart disease and is a major risk factor for stroke. Inactivity contributes to obesity, high blood pressure, poor circulation, high cholesterol and poor glucose intolerance. Lack of exercise therefore enhances the individuals' risk of physical and emotional stress.

Stress

Research indicates that people with significant levels of anxiety have higher levels of blood glucose than those who do not. This is probably partly because stress hormones cause the body to release glucose into the blood. When the body is under stress, the adrenal glands trigger the release of glucose stored in various organs, which often leads to elevated levels of glucose in the bloodstream. This makes controlling blood glucose even harder.

Anxiety is also associated with higher blood pressure: increased fat deposits in arteries, and reduced immune system.

There are various types of stress. Stress is not always an emotional problem, such as anxiety, worry, or depression. It may be a physical stress such as pain or illness or the stress experienced such as during an accident, bereavement or conflict with others. Stress can be considered as anything that tends to change the control that you have over our body and emotions.

Living with a life long condition like diabetes can be difficult. At times, people can feel overwhelmed by the demands of trying to look after themselves and the demand of life in general.

Below there are links to other resources that have more information on this subject:

Living Life To The Full

Glasgow Steps

Mood Gym

Preventative Measures

  • Achieve HbA1c target
  • Achieve and maintain a healthy weight
  • Maintain a healthy balanced diet
  • Reduce salt intake and saturated fats.
  • Drink below the recommended intake of alcohol
  • Exercise at least 30 minutes, 5 days/week
  • Stop Smoking
  • Attend Annual review appointments
  • Attend Nurse Specialist clinics
  • Attend dietetic education sessions
  • Ensure compliance with medications

Below there are links to other resources that have more information on this subject:

Lifestyle Section

British Heart Foundation

Or Call the British Heart Foundation on 0300 330 3311


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