Diabetes and Heart Disease: The deadly duo
Robert* entered the waiting room of his local diabetes education program with his daughter to attend a full day class about how to control his diabetes. He was given forms to fill out, but he handed them to his daughter to complete because his vision and reading abilities have been severely damaged by a recent stroke. He is only 37 years old, and he will always need assistance completing these everyday tasks.
It’s not uncommon for the staff at the Texas A&M Health Science Center Coastal Bend Health Education Center (CBHEC) to work with diabetes patients who have suffered from heart related complications. In fact, most of their patients are on cholesterol-lowering medications and blood pressure medications long before they enter the diabetes education program.
“Diabetes and heart disease just go hand in hand,” said Maggie Sheerer, RN, CDE with the Texas A&M CBHEC diabetes education program. “Because of the disease process of diabetes, blood vessels are already compromised, so people who have diabetes are at a much higher risk for stroke, heart disease or heart attack.”
The statistics are staggering. Adults with diabetes are two to four times more likely to have heart disease or a stroke than those without diabetes. Heart disease and stroke are the number one causes of death and disability among people with type 2 diabetes. And in the end, two out of three people with diabetes die from stroke or heart disease.
The facts are scary, but Hermelinda Basurto, RN, with the Texas A&M CBHEC diabetes education program says it’s necessary to educate patients about their increased risk.
“We wouldn’t be doing our job if we didn’t tell them what’s ahead if they don’t try to live healthier lifestyles,” Basurto said.
Luckily, diabetes is one of the seven major controllable risk factors for cardiovascular disease. The health educators at the diabetes education program recommend people with diabetes take the following steps to help lower their risk of heart attack or stroke.
1. Count your ABCs
You can lower your risk for heart disease by keeping your ABCs of diabetes on target. Visit your health care provider regularly to check your levels.
A is for A1c. A1c measures your average blood glucose for the past two to three months. The American Diabetes Association (ADA) recommends that people aim for an A1c below seven percent.
B is for blood pressure. Blood pressure indicates the level of force at which blood is flowing through your blood vessels. The higher your blood pressure, the harder your heart has to work. The ADA recommends keeping blood pressure below 130/90 mmHg (said as “130 over 90”), according to their newly revised 2015 Standards of Medical Care in Diabetes.
C is for cholesterol. Cholesterol levels indicate the amount of fat in your blood. HDL cholesterol can help protect your heart, but LDL cholesterol can clog blood vessels, which can lead to heart disease. Triglycerides also raise your risk for heart disease. The ADA recommends keeping triglycerides below 150 mg/dl and LDL cholesterol below 100 mg/dl. Men should keep their HDL cholesterol levels above 40 mg/dl and women above 50 mg/dl.
2. Eat less fat
While watching carbohydrates is most emphasized in meal planning for diabetes, it’s also important to limit fat intake. Eat less fat, especially saturated fat found in fatty meats, poultry skin, butter, two percent or whole milk, cheese, hydrogenated oils, lard and trans fats. Choose lean meats and meat substitutes (such as soy or tofu) and switch to low-fat or fat-free dairy products.
But it’s important to know that not all fats are created equal. Monosaturated fat found in nuts, avocados and olive oil, and polyunsaturated fat found in fish (such as salmon, tuna, mackerel, herring, trout, and sardines) actually help lower cholesterol levels. To incorporate these good fats into your diet, cook with olive oil, eat fresh avocados or guacamole, snack on nuts, and dress your own salad with olive oil, flaxseed oil or sesame oil. Keep total fat intake to 20 to 35 percent of calories.
3. Be active
Regular physical activity does wonders for blood sugar levels, cholesterol, triglycerides, and blood pressure. Before starting a new routine, check with your health care team to find out which activities are safe for you.
If you’re just starting out, health educators recommend beginning with just five minutes of physical activity a day and gradually adding more time. Work up to 30 minutes or more of aerobic exercise most days of the week. Going for brisk walks, riding a bike, or playing with your kids or dogs can be easily incorporated into your daily routine.
4. Take your medications
Certain types of blood pressure and cholesterol-lowering medications can help manage your ABCs. Aspirin can also lower your risk for heart disease, but always consult with a health care provider before taking any medications to determine the options most suitable for you. If you’ve already been prescribed a medication regimen, take your medications as directed and don’t skip dosages.
5. Quit smoking
Smoking can double your risk for heart disease, but it can also be difficult to quit. Even alternatives to traditional, tobacco smoking, such as e-cigarette use, are not approved to aide with smoking cessation. If you think you’re ready to quit, talk with your health care team. They can provide resources to help you quit. Joining a smoking-cessation program can also help. The Texas A&M CBHEC diabetes education program offers a smoking-cessation class for their patients every year.
Following the advice outlined above helps control your diabetes and can lead to weight loss, which in turn helps lower your risk for heart disease.
“People will share in our diabetes education class that ‘Yeah, I’ve had a stroke’ or ‘I’ve had a heart attack,’” Scheerer said. “They’ll say this happened to them because they didn’t keep their health under control. The class gets very quiet during these moments. It’s a tough reality check for most people.”
Robert will continue needing assistance to read and write, and he may never drive again. But if he puts into action the advice he received at the diabetes education class and continues to visit his health care team, he will live to see his daughter’s most important moments.
*name has been changed to ensure patient confidentiality