I am diabetic

What does diabetes have to do with heart disease and blood vessel disease?

If you have diabetes, you’re much more likely to have

· heart disease, also called coronary artery disease

· blood vessel disease, such as atherosclerosis (hardening of the arteries) or peripheral arterial disease (PAD)

· a heart attack

· a stroke

You can cut your chances of having these problems by taking special care of your heart and blood vessels. In addition to regular checkups, your health care team can do special tests to check the condition of your heart and blood vessels. If you already have heart or blood vessel problems, your health care team can use special procedures to open up or bypass narrowed or blocked blood vessels. Choosing foods wisely, being physically active, and taking medications can also help you stay healthy.

Below are some of the medical tests and procedures used for finding and treating heart and blood vessel disease. Terms are listed in alphabetical order.

Angiogram or arteriogram

In an angiogram or arteriogram, dye is injected into the blood vessels using a catheter (small tube) and X rays are taken. This test shows whether arteries are narrowed or blocked. A coronary angiogram checks for narrowing or blockages in the blood vessels that go to the heart. A cerebral arteriogram checks the blood vessels that go to the brain.

Angioplasty

Angioplasty, also called balloon angioplasty, is a procedure used to remove a blockage in a blood vessel to the heart (coronary angioplasty) or the brain. A small tube with a balloon attached is threaded into the narrowed or blocked blood vessel. Then the balloon is inflated, opening the narrowed artery. A wire tube, called a stent, may be left in place to help keep the artery open.

Ankle brachial index

A test called an ankle brachial index (ABI) is used to diagnose PAD. The health care provider compares the blood pressure in the ankle to that in the arm. Lower blood pressure in the lower part of the leg compared to the pressure in the arm may indicate PAD.

Coronary artery bypass graft

During a coronary artery bypass graft, also called a bypass or CABG (pronounced “cabbage”), a blood vessel taken from the leg, wrist, or chest is attached to the coronary artery to bypass a blockage and restore blood flow to the heart. A bypass graft can also be used for blood vessels leading to the brain.

Carotid artery surgery

Carotid artery surgery, also called carotid endarterectomy, is used to remove buildups of fat inside the artery and to restore blood flow to the brain.

CT scan

A CT (computed tomography), also called a CAT scan, uses special scanning techniques to provide images.

Cardiac catheterization

Cardiac catheterization is used in conjunction with other tests. A small tube is inserted into an artery and guided into a blood vessel.

Chest X-ray

This test shows the size and shape of the heart and can also show congestion in the lungs.

Echocardiogram

An echocardiogram uses very-high-frequency sound waves (ultrasound) to produce images of the heart and blood vessels on a screen. Results indicate whether the heart is pumping blood correctly. A stress echocardiogram uses either exercise or medication and ultrasound to provide images of the heart and blood vessels.

Electrocardiogram

An electrocardiogram, also called an ECG or EKG, provides information on heart rate and rhythm and shows whether there has been damage or injury to the heart muscle.

Exercise perfusion test

An exercise perfusion test, also called a stress nuclear perfusion test, uses small amounts of radioactive material to produce images of blood flow to the heart as you exercise.

Exercise stress test

Exercise stress tests are used to find heart disease that is evident only during physical activity. These tests can also be used to help a patient choose the most appropriate physical activity program. Also called a treadmill test, a stress test uses an ECG to measure how the heart performs during activity, such as walking on a moving treadmill. A medication stress test uses medication instead of exercise to increase the heart rate.

Holter monitoring

A holter monitor is a small, portable machine that records the heart’s electrical activity. The person wearing the monitor keeps track of symptoms and activities for the evaluation period. Readings on the machine are compared to the symptoms.

MRI

MRI (magnetic resonance imaging) uses special scanning techniques to provide images of body tissues. MRA (magnetic resonance angiography) uses MRI to examine blood vessels.

Nuclear ventriculography

Nuclear ventriculography, also called radionuclide ventriculography, uses small amounts of radioactive material to check heart function either while the body is at rest or during exercise. This test can also be used to check the blood vessels that go to the brain.

PET scan

A PET (positron emission tomography) scan uses special scanning techniques to provide images of body tissues.

Keeping your cholesterol and other blood fats, also called lipids, under control can help you prevent diabetes problems. Diabetic dyslipidemia, a condition in which your blood lipids are off target, can lead to heart attack and stroke. For most people, treatment for off-target blood lipids includes both lifestyle changes, such as choosing foods wisely, and medication. You can take steps to keep your blood lipids on target.

What are the different kinds of blood lipids and what do they do?

There are several kinds of lipids in your blood and each type affects your health differently.

· LDL cholesterol is sometimes called bad cholesterol. This lipid can narrow or block your blood vessels. Blocked vessels can lead to a heart attack or a stroke. Reaching your LDL target is the most effective way to protect your heart and blood vessels.

· HDL cholesterol is sometimes called good cholesterol or “helpful” cholesterol. This lipid helps remove deposits from the insides of your blood vessels and keeps them from getting blocked.

· Triglycerides are another kind of lipid. High triglyceride levels increase your risk of a heart attack or stroke.

How does diabetes affect my blood lipids?

Many people with diabetes have problems with their blood lipid levels—HDL (good cholesterol) levels that are too low and triglyceride levels that are too high. Also, LDL (bad cholesterol) particles are unusually small and dense in people with diabetes, which can be especially harmful to blood vessels. This combination of factors means an increased risk of heart attack and stroke. But the good news is that taking steps to keep your lipids within the target range will lower your risk for these problems.

How will I know if my blood lipid levels are off target?

You won’t know that your lipids are at dangerous levels unless you have a blood test to check your blood lipid levels. The American Diabetes Association (ADA) recommends that you have your levels checked at least once a year. Some people may need to be checked more often.

What are the recommended targets for blood lipids?

See the chart below for targets suggested by the ADA.

What treatments are recommended?

Both lifestyle changes and medication help control blood lipids. Treatment differs from one person to the next. Work with your health care provider to find a treatment that’s right for you.

Lifestyle Changes

Lifestyle changes can help control your blood lipids as well as your blood glucose and blood pressure levels. If your blood lipid levels are off target, you’ll want to consider making lifestyle changes right away. From the list below, decide whice steps you would be willing to try. If you need more information about how to make these changes, talk with your health care team.

Make Wise Food Choices

· I’ll eat less fat, especially saturated fat (found in fatty meats, poultry skin, butter, 2% or whole milk, ice cream, cheese, palm oil, coconut oil, trans fats, hydrogenated oils, lard, and shortening).

· I’ll choose lean meats and meat substitutes (such as chicken without the skin, lean beef such as flank steak or chuck roast, boiled ham, or pork tenderloin).

· I’ll switch to low-fat or fat-free dairy products (such as low-fat cheese and skim milk).

· I’ll cut back on foods that are high in cholesterol (such as egg yolks, high-fat meat and poultry, liver and other organ meats, and high-fat dairy products like whole milk).

· I’ll choose the kinds of fat that can help lower my cholesterol, such as olive oil or canola oil. Nuts also have a healthy type of fat. Other kinds of oils that protect my heart are corn oil, sunflower oil, and safflower oil.

· I’ll eat fish two or three times a week, choosing those high in heart-protective fat (such as albacore tuna, herring, mackerel, rainbow trout, sardines, and salmon).

· I’ll cook using low-fat methods (such as baking, roasting, or grilling foods or by using nonstick pans and cooking sprays).

· I’ll eat more foods that are high in fiber, such as oatmeal, oat bran, dried beans and peas (such as kidney beans, pinto beans, and black-eyed peas), fruits, and vegetables.

Lose Weight or Take Steps to Prevent Weight Gain

· I’ll cut down on calories and fat.

· I’ll try to be more physically active than I am now.

Be Physically Active

· Before I start a new routine, I’ll check with my doctor to find out which activities will be safe for me.

· I’ll try to do a total of about 30 minutes of aerobic exercise, such as brisk walking, most days of the week. If I’m just starting out, I’ll start off with 5 minutes a day and gradually add more time.

Be Careful With Alcohol

· I’ll talk with my health care team about whether it’s wise for me to have alcoholic beverages.

· If and when I drink alcoholic beverages, I’ll limit myself to no more than one serving (for women) or two servings (for men) daily.

Quit Smoking

I’ll talk with my health care team about methods that can help.

Stay on Target With Your Blood Glucose

I’ll help lower my LDL cholesterol and triglycerides by keeping my blood glucose under control with meal planning, physical activity, and medication (if needed).

Medications

Several types of medication are available. Not everyone takes the same blood lipid medication, and many people take more than one kind. The medications you take will depend on your blood lipid levels and other factors such as cost. Lifestyle changes along with medications can help you reach your targets. Some medications can help prevent heart attacks and strokes.

· Statins—These medications lower LDL cholesterol, boost HDL levels, and lower triglyceride levels. Studies have shown that they are the most effective medication for lowering LDL cholesterol.

· Fibric acid derivatives, also called fibrates—These medications lower triglycerides and raise HDL levels. They may either lower, raise, or not change LDL cholesterol.

· Nicotinic acid, also called niacin—This medication lowers triglycerides, raises HDL levels, and lowers LDL cholesterol.

· Cholesterol absorption inhibitors—This type of medication lowers LDL cholesterol and triglycerides and raises HDL levels.

Bile acid sequestrants—These medications lower LDL cholesterol and can raise HDL levels. They either have no effect on triglycerides or, in some cases, they can raise triglyceride levels.