Heart care

Q	What are macro-vascular complications?
A	Macro-vascular complications are complications caused by damage to large blood vessels particularly of the heart, brain and limbs because of uncontrolled diabetes. These occur because of diabetes over a long period of time. Fatty deposits and blood clots within the blood vessels block or reduce the flow of blood. If the blood supply to the heart muscle is reduced because of a block, a heart attack can occur. If the blood supply to the brain is cut off, a stroke can occur. And if the blood supply to the arms and legs is reduced, gangrene can result.	Top
Q	Why do heart problems occur more often in persons with diabetes?
A	Heart problems occur more often in persons with diabetes because of raised blood sugar level damages blood vessels, making them thick, hard and less elastic and thereby causing difficulties in blood flow. People with diabetes have higher levels of fat in the blood, due to lack of insulin action and associated high blood sugars. The fats or lipids in the blood vessels clog and restrict the flow of blood. Prolonged high blood sugar damages the heart muscle proteins, negatively influencing its ability to contract and loss in pumping action and heart failure.	Top
Q	What causes a heart attack?
A	Heart attacks occur when blood supply to a part of the heart muscle is stopped or reduced because of a block. The blockage is usually because of deposition of plaque (fat like substances). The plaque can tear or rupture, or a blood clot can form which further blocks the artery and stops blood flow. Because of loss of blood supply the affected portion does not get enough oxygen and the affected heart muscles die.	Top
Q	What are risk factors for heart attacks?
A	The major risk factors for heart attacks are increasing age, male sex (women after 40 and also women with diabetes do not have the same protection as they would have otherwise against heart attacks), heredity, tobacco use, raised blood fats (high blood cholesterol), high blood pressure, physical inactivity, obesity and overweight, Diabetes mellitus and psychological stress	Top
Q	What are warning signals of heart attack?
A	The common warning signals of heart attacks are pain, uncomfortable pressure, feeling of fullness or squeezing in the centre of the chest lasting more than a few minutes. Pain spreading to the shoulders, neck or arms, particularly on the left side is also a cause for concern. Feeling of discomfort in the chest, with light-headedness, fainting, sweating, nausea or shortness of breath is a clear warning signal. The less common signs of impeding heart attack are - atypical chest pain, stomach or abdominal pain, nausea or dizziness, shortness of breath and difficult breathing, unexplained anxiety, weakness or fatigue. Palpitations, cold sweat or paleness are also a cause for concern. People with long standing diabetes may not experience any chest pain. If any of the above symptoms is felt, it is important to seek medical attention immediately.	Top
Q	How does Atherosclerosis occur?
A	Atherosclerosis occurs because of fatty deposits (plaque) in the inner lining of the arteries. These fatty deposits build up in the large and medium- sized arteries and may partially or completely stop the flow of blood. People with diabetes, high blood pressure, lipid abnormalities and smokers are at high risk of atherosclerosis.	Top
Q	How can persons with diabetes prevent heart disease?
A	There are sure-fire ways of avoiding heart disease, but there are many ways by which the risks to heart disease can be reduced. They include, quitting smoking; regular exercising; regular checks and appropriate treatment to keep blood pressure normal; weight loss if overweight and maintenance of a healthy body weight; strict control of high blood sugar and keeping the blood fats and cholesterol under normal range. Regular use of small doses of aspirin is also beneficial, but check with your doctor whether aspirin use is appropriate for you.	Top
Q	How can I avoid my heart disease affecting my diabetes?
A	There are common factors that affect both heart disease and diabetes. These are smoking, high blood pressure, being overweight, high fat intake, lack of physical activity and the like. By controlling these factors you help both conditions. However, heart disease may prevent you from indulging in physical activity. Please check with your doctor.	Top
Q	What is Cholestrol?
A	Cholesterol a wax like substance and is one of the fats found in blood, muscle, liver, brain and other tissues along with other fats such as phospholipids, triglycerides, and fatty acids. The liver produces cholesterol in the body. Cholesterol can also be supplied to the body through the diet. Certain foods like, egg yolk, butter, ghee (rarefied butter), milk, and certain meats are rich in cholesterol. Cholesterol is needed in the body for building cell membranes, production of certain hormones and to form a protective lining for the nerves. Normally the body produces enough cholesterol for its need and we do not need to add any from the diet.	Top
Q	What are Triglycerides?
A	Triglycerides are a type of fat in the blood. In association with cholesterol they form the blood fats (plasma lipids). Triglycerides exist both in food as well as in the body. They are formed in the body from the fat and carbohydrate in the diet. Excess carbohydrates ingested in a meal that are neither used up immediately nor stored by tissues are converted to triglycerides by the liver. These are then transported to fat cells to be stored there. The body needs insulin to remove this type of fat from the blood. Overweight and persons with uncontrolled diabetes are at a higher risk of high blood Triglyceride levels.	Top
Q	My cholesterol is normal but my Triglyceride is raised. What should I do to bring down my Triglyceride level?
A	Weight loss and increased physical activity will help lower Triglyceride level and increasing the HDL levels in the blood. Cutting down fat intake particularly saturated fats and use of monounsaturated fats instead will also help. High triglycerides are also because of excess refined sugar in the diet. Cut out all sugar, sweets and foods rich in refined carbohydrates. Take foods, which are rich in fibre. A change in the diet plus increased activity will help to reduce Triglyceride levels. In some cases drugs may be needed if diet and the exercise regimen do not work. It is important to follow your doctor's advice. Even though the doctor may advice medicine, diet and an exercise program must continue.	Top
Q	How can I reduce my blood cholesterol level?
A	Eat healthy food, which is high in fibre, and low in fat and cholesterol as advised by the dietician, exercise regularly and try to lose weight if overweight. In some cases drugs are also advised to help reduce blood cholesterol levels. Even though your doctor may advice medicines to bring down he cholesterol level, diet and exercise program must continue. Consult your doctor on what is best for you and how to lower the blood cholesterol level.	Top
Q	What precautions should be taken if high blood pressure is present along with diabetes?
A	High blood pressure is often associated with diabetes. The precautions remain the same: Avoid overeating, shed excess weight, avoid smoking, visit your doctor regularly, get your blood pressure and blood glucose checked regularly, take the medicine/s as advised by your doctor, ensure that you meet the target blood glucose and blood pressure values, avoid stress of all types; avoid consumption of highly refined carbohydrates and saturated fats; get your kidney functions checked. Seeking proper medical advice is very important, but following the advice regularly is even more important	Top
Q	How do I control Hypertension?
A	Persons with diabetes have a higher risk of hypertension. Leading a healthy lifestyle can control high blood pressure - attaining and maintaining a healthy body weight; doing regular exercise; eating a low salt/sodium and low fat diet; stop smoking. If medicines are required -taking appropriate drugs/tablets for high blood pressure and good control of high blood sugar is very important.	Top
Q	How dangerous is high blood pressure and diabetes together?
A	High blood pressure adds fuel to the fire. It speeds up almost all complications of diabetes and increases the risk of strokes, heart attacks and heart failure, eye disease (Diabetic Retinopathy), and kidney failure (Diabetic Nephropathy). Controlling high blood pressure is therefore as important as controlling high blood sugar.	Top