Marilyn Lawrence-Wright | Diabetes and its impact on heart health

This is one of Jamaica’s most burdensome and prevalent non-communicable diseases and which affects heart health – diabetes mellitus.

Diabetes mellitus, or ‘sugar’, as Jamaicans call it, is a condition that causes high glucose (sugar) levels in the blood. It affects approximately one in eight adult Jamaicans and occurs when there is a problem with a hormone called insulin. This hormone is produced by the pancreas and moves glucose from the bloodstream into the body’s cells, where it can be used for energy. In type 1 diabetes, one’s pancreas fails to produce insulin. This form of diabetes is diagnosed more among children. In type 2 diabetes, the more common form of diabetes, the pancreas produces insulin, but the body is resistant to its effect. Initially, insulin levels are high, but over time, the pancreas ‘burns out’ and insulin levels fall. Without enough insulin or its effect, glucose stays in the bloodstream and cannot move into your cells to give them energy to work properly.

Diabetes mellitus is diagnosed if you have, on two occasions, a fasting blood sugar level ≥ 7.0 mmol/L, or a random blood sugar level ≥ 11.1 mmol/L and diabetes symptoms such as frequent urination, excess thirst, unexplained weight loss, or glycated haemoglobin A1 C (HbA1C) level (a measure of the average blood sugar level over the previous three months) ≥ 6.5 per cent, or a sufficiently abnormal oral glucose tolerance test. Prediabetes, a precursor of diabetes, is also highly prevalent in Jamaica. In this condition, one’s blood sugar is higher than normal but is not high enough to meet the criteria for diabetes mellitus. Having prediabetes increases not only the risk of developing type 2 diabetes, but also the risk of stroke and heart disease.

HOW DOES DIABETES MELLITUS HARM THE HEART?

American Diabetes Association and British Heart Foundation statistics confirm that persons living with diabetes mellitus are two times more likely to have a heart attack and 1.5 times more likely to have a stroke than persons without diabetes.

Diabetes mellitus harms the human heart in a myriad of ways. Over time, a high blood sugar level can damage blood vessels and nerves throughout the body, including the ones that supply your heart. Aside from the surge in blood glucose levels, diabetes triggers chronic inflammation (an activation of the immune system). Both conditions injure the walls of the arteries, making them more susceptible to developing atherosclerosis. This build-up of fats, cholesterol and other substances on the blood vessel wall causes plaque formation which can restrict blood flow. This build-up of plaque within your coronary arteries (the arteries that supply oxygen-rich blood to your heart) leads to coronary heart disease and can cause a heart attack. Plaque formation in the arteries that carry blood to your brain increases your risk of having a stroke.

Elevated blood sugar levels can also cause the arteries to stiffen and therefore contribute to hypertension. They make blood platelets stickier and more likely to form blood clots, which can starve the heart of nutrients and oxygen. Diabetes can also cause scar tissue to form in the heart muscle, increasing the risk of abnormal heart rhythms and heart failure, where the heart loses its ability to pump blood properly. This can cause swelling in the legs and difficulty breathing due to fluid build-up in the lungs. Diabetes can also damage the nerves to the heart, which reduces one’s ability to detect when there is inadequate blood flow to the heart muscle. Persons with diabetes mellitus are therefore at risk of having silent heart attacks.

Persons living with diabetes mellitus, particularly those with type 2 diabetes, are more likely to have other conditions such as hypertension (high blood pressure), abnormal cholesterol levels and overweight or obesity that also raise the risk of heart disease. These associated conditions are often asymptomatic. Jamaicans are therefore implored to do regular testing to know their health numbers. Do your blood pressure checks and a simple blood test to see if your sugar, cholesterol or triglyceride level is high. Diabetes is treatable. However, even when glucose levels are controlled, many patients with diabetes remain at increased risk of heart disease and stroke. Therefore, the identification and aggressive management of all cardiovascular risk factors is key.

TAKE CARE OF YOUR HEART

Like most non-communicable diseases, diabetes mellitus continues to place a strain on our health system and can have devastating effects on households and families. According to The Jamaica Health and Lifestyle Survey 2016-17, the overall prevalence of diabetes mellitus, among Jamaicans aged 15 years and older, was approximately 12 per cent. This prevalence rose to 42 per cent among Jamaicans 75 years and older. The prevalence of both diabetes and prediabetes was higher among women than men. As we grapple with the COVID-19 pandemic, it is important to note that persons with diabetes are up to three times more likely to have severe illness, or die from COVID-19, than persons without diabetes.

If you have type 1 or type 2 diabetes, you should be particularly strident in your efforts to avoid the coronavirus which causes COVID-19 disease. Ensure that you follow all recommended public health protocols for mask-wearing, handwashing and physical distancing. The good news is that despite the host of complications of diabetes and its impact on heart health, you can reduce your risk of developing heart disease or of having a heart attack.

LIFESTYLE CHANGES

Here are lifestyle changes that can help you manage your diabetes and that can lower your risk for heart disease:

- Follow a healthy diet. Eat more fresh fruits and vegetables, lean protein, and whole grains. Eat fewer processed, pre-packaged foods (such as chips, sweets, fast food) and avoid foods high in salt, sugar and unhealthy fats such as saturated and trans-fat. Drink more water, fewer sugary drinks, and less alcohol. You may also consult a nutritionist to help with meal planning, which is important for persons living with diabetes.

- Aim for a healthy weight. If you are overweight, losing even a modest amount of weight can lower your triglycerides and blood sugar. According to the CDC, modest weight loss means five to seven per cent of body weight, just 10 to 14 pounds for a 200-pound person.

- Get regular screening for heart disease and manage your ABCs:

- Get a regular HbA1C test to measure your average blood sugar over the preceding 3 months; aim to stay in your target range as much as possible.

-Try to keep your blood pressure below 130/80 mm Hg (or the target your doctor sets).

- Manage your cholesterol levels.

- Stop smoking, or even better, do not start.

-Get active. Being physically active makes your body more sensitive to insulin which helps to manage your diabetes. Physical activity both controls blood sugar levels and lowers your risk of heart disease. Try to get at least 150 minutes per week of moderate-intensity physical activity, such as brisk walking.

- Manage stress. Stress can raise your blood pressure and can also lead to unhealthy behaviours, such as drinking too much alcohol or overeating. Try meditation or deep breathing, get some physical activity, get support from friends and family or visit a mental health counsellor.

-Maintain regular visits to your doctor/physician and take your medication as prescribed. Your doctor may prescribe medications to treat heart disease if you have diabetes. Some medicines help to protect your heart by reducing high blood pressure and you may benefit from these even if you do not have a blood pressure problem.

-Pay attention to your symptoms and report them promptly to your doctor. Symptoms of diabetes include increased thirst, frequent urination, blurred vision, slow-healing sores, and fatigue. If you have been diagnosed with diabetes and are experiencing heart disease symptoms such as pain or pressure in your chest, shortness of breath, or fatigue, you should see your doctor right away.

Call your doctor if you get coronavirus-like symptoms such as a dry cough, fever, or shortness of breath. Have your most recent blood sugar readings available to share with your doctor. With the COVID-19 pandemic continuing to rage across our land, it is now more important than ever to take care of your heart, especially if you have diabetes mellitus. You and your healthcare providers can manage your risk factors and improve your heart health through lifestyle changes and adherence to the other aspects of your medical management regime.

Check your heart, be COVID-19 smart!

- Dr Marilyn Lawrence-Wright is a consultant cardiologist at the Heart Foundation of Jamaica and head of cardiology at the University Hospital of the West Indies/The University of the West Indies. Send feedback to jctc@heartfoundationja.org