Having diabetes dramatically increases your risk of having heart disease or stroke.
Although there is no cure for diabetes, with careful monitoring and healthful lifestyle changes,
diabetics can avoid complications and enjoy a long, productive life. To reduce your risk of
cardiovascular disease, learn all you can about the condition.
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What is diabetes?
Diabetes occurs when the level of glucose (sugar) in your blood is too high – either because
your body doesn’t produce enough insulin or your body doesn't effectively use the insulin
that it does produce. Your body needs insulin to carry sugar from your bloodstream into your
body cells where it is used for energy. If there is too little insulin, your blood sugar levels will
continue to rise, as glucose is not removed from your bloodstream.
A screening (finger prick) blood test can be done at a clinic or pharmacy to give you a
snapshot of how high your blood sugar level is. A normal fasting blood glucose level is
between 4-6 mmol/l, while for non-fasting 4-10 mmol/l is acceptable. Levels above these
limits will require additional fasting blood glucose testing at your doctor, where levels greater
than 7 mmol/l would be used as a diagnosis for diabetes.
There are two main types of diabetes – type 1 (insulin dependent) and type 2 (also known as
maturity-onset or non-insulin-dependent diabetes). Type 1 usually affects younger people
while type 2 tends to develop gradually in adults and is much more common.
You are more likely to develop diabetes if you have one or more of the following risk factors:
being overweight or obese
physical inactivity
family history of diabetes
previous diabetes in pregnancy (gestational diabetes).
It has been estimated that there are about 1.5 million South Africans with diabetes, but there
are many adults who have diabetes and don’t know it, because it has not been diagnosed.
Symptoms and complications of diabetes
Some of the symptoms include: constant thirst, passing more urine than normal, tiredness,
unexplained weight loss, blurred vision or regular episodes of thrush. These symptoms are a
result of having too much glucose in the blood and not enough in the cells.
In uncontrolled diabetes, high levels of glucose over many years can damage many different parts of the
body:
in the heart and blood vessels it aggravates atherosclerosis (hardening and narrowing
of blood vessels by fatty deposits), causing coronary artery disease, stroke and blood-circulation problems
in the eyes, causing reduced vision which may lead to blindness
kidney disease and kidney failure
ulcers, infections, gangrene etc. in the feet
in the nerves, causing loss of sensation (especially in the feet and legs), pins and
needles, and impotence
How does diabetes affect your heart?
High glucose levels in the blood affect the walls of the arteries, making them more likely to
develop atherosclerosis. Diabetes also increases the damage done by smoking, high blood
pressure and high cholesterol. Type 2 diabetics often have higher triglycerides (a type of fat)
and lower levels of HDL (“good”) cholesterol.
People with diabetes are more likely to have high blood pressure. Diabetes can even affect
the heart muscle itself, making it a less efficient pump. As diabetes can affect the nerves to
the heart, symptoms of angina may not be felt in the usual way and may be passed off as
indigestion or a stomach upset. This leads to delays and difficulties in diagnosing angina and
heart attacks.
As you can see, diabetes increases the risk of stroke and heart disease, especially if other risk factors are already present. The risks multiply!
The good news is that there are things that you can do to control your diabetes, reduce your risks and stay healthy. If you are a diabetic, here's what you can do to reduce your risk of heart disease or stroke:
A healthy diet and medication (if necessary) is essential for control of blood sugar.
Monitor and check your blood-glucose levels regularly. Blood glucose levels should be
between 4-6mmol/l before meals and less than 10mmol/l two hours after meals.
Give up smoking.
Check your blood pressure regularly and keep it below 130/80mmHg.
Check and manage your cholesterol levels. Your goal should be to have: a total
cholesterol under 5mmol/l, an LDL cholesterol of less than 3mmol/l, an HDL cholesterol
of over 1.2mmol/l and a triglyceride level of less than 1.5 mmol/l.
Aim for a healthy weight with a BMI of less than 25, a waist measurement of less than
80cm for women and under 94cm for men.
Follow a healthy, varied diet with small, regular meals including fibre-rich starches, beans,
pulses and five portions of fruit and vegetables a day. Cut down on your total fat intake,
especially saturated fats from animal products. Sugar, salt and alcohol should only be
used by well-controlled diabetics and then only in limited quantities.
Be more physically active – aim for at least 30 minutes of moderate exercise five days a
week.
Learn to deal with stress where possible - get the support you need and learn
relaxation techniques.
Look after your feet - report any cuts or problems to your doctor or nurse as soon as
possible.
Have an annual review with your doctor to check your long-term glucose control, blood
pressure, cholesterol, weight, general circulation and that you're not developing any
of the complications of diabetes.
For dietary guidelines for diabetics, support, advice and more information on general
heart health, contact the Heart Mark Diet Line on 0860 223 222, e-mail
heart@heartfoundation.co.za or visit www.heartfoundation.co.za.
- (Erika Ketterer, Registered Dietician at the Heart and Stroke Foundation SA, May 2008)
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