JDF Juvenile Diabetes Foundation International
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Diabetes and Your Heart

Taking care of the heart is a vital health concern for all adults. Cardiovascular disease is the leading cause of death among adults in the United States. The two most common types of cardiovascular disease are: hypertension, or high blood pressure, and coronary artery disease, when arteries feeding the heard become blocked with fatty deposits (like cholesterol) in a process called atherosclerosis.

Diabetes is one of the four major risk factors for developing heart disease. The other factors are high blood pressure (hypertension), cigarette smoking, and high levels of blood fats (cholesterol). Other risk factors include: a family history or heart disease, obesity, a sedentary lifestyle, and stress. Two of the four risk factors--high blood pressure and high cholesterol--are frequently found in people with diabetes.

Like diabetes itself, hypertension and heart disease are controllable. Every person with diabetes can effectively improve their cardiovascular risk factor. You will find that the same guidelines that promote a healthy heart help in overall diabetes self-care.

Hypertension

Blood pressure is the force exerted by blood against the blood vessel walls. Each time your heart beats, it causes a surge of pressure, which is called systolic pressure. When the heart rests between beats, the blood pressure is lower, and this is called diastolic blood pressure. Blood pressure is usually represented by two number, which measure the systolic pressure against the diastolic pressure. The ideal blood pressure is considered 120/80 (systolic is the higher number). If blood pressure readings are consistently higher than 140/90, it usually indicates hypertension. Blood pressure varies frequently during the day so it is important to take readings over a period of time.

Symptoms
Headaches, dizziness, fatigue and spontaneous nosebleeds are sometimes symptoms of hypertension. More often, people with hypertension show no real signs of trouble--so it is important to have frequent check-ups. If hypertension is allowed to continue unattended, the first sign could be a major problem, such as a heart attack or stroke.

Causes
In people with diabetes several conditions contribute to hypertension:

Coronary Heart Disease

Coronary heart disease occurs when arteries that supply the heart muscle become narrowed by fatty deposits (atherosclerosis).

Symptoms
Reduced blood flow to the heart can cause a kind of chest pain called angina. Angina is usually experienced during emotional stress, physical exertion, heavy meals or even very high or low temperatures.

Other symptoms include shortness of breath and swollen ankles--a sign that blood is not being pumped efficiently throughout the body.

If atherosclerosis is allowed to go on undetected, the heart may lose strength and fail to pump enough blood (congestive heart failure). Eventually, an artery may become completely blocked, causing permanent damage to a part of the heart. This happens during a heart attack (myocardial infarction). There are several reasons coronary heart disease is more prevalent among people with diabetes:

Take Heart--And Take Control

Diabetes, hypertension and heart disease can be controlled effectively. And the best news is, what's good for the care of your heart is good for the care of your diabetes.

Regular Checkups
Like other disorders, heart disease is easier to treat when it is spotted early. Your physician will check your blood pressure to make sure that you are within a normal range. Your doctor will also take a blood test to monitor fat and cholesterol levels.

If any heart problems are suspected, your physician will probably refer you to a heart specialist (cardiologist), who is likely to give you the following tests:

The following measures can help prevent heart problems and enhance your diabetes control:

Weight Loss
Maintaining your ideal body weight is part of good diabetes control and good heart care. If you are overweight, you should begin a supervised weight reduction plan. Weight loss will decrease stress on the heart and lower unhealthy blood cholesterol.

Exercise
Make exercise (walking, jogging, cycling, swimming, etc.) A part of your life. Not only does exercise expend energy and make losing weight easier, it also improves control of blood glucose and overall cardiovascular fitness. Equally important, exercise lowers blood cholesterol and triglycerides and raises the level of good cholesterol.

Be sure and talk to your physician before starting any exercise program.

Diet
The following should be avoided or used minimally:

Treatments and Medications

If diet and exercise don t succeed in significantly lowering blood pressure, medication is the next step in treatment. A wide range of antihypertensive (blood pressuring-lowering) drugs are available. But it may take some trial and error before your doctor finds the best medication and dosage for you.

Medication fall into several main categories. Often these drugs are used in combination.

Diuretics (Water Pills) These drugs help the body get rid of excess water, lowering the amount of pressure on blood vessel walls.

Vasodilators A vasodilator dilates, or relaxes, the blood vessels, thereby reducing blood pressure. Some common vasodilators are: Hydralazine and Apresoline.

Beta Blockers These drugs lower blood pressure by interfering with the action of hormones like adrenalin, which speed up the heart. By lowering the heart rate and decreasing blood pressure, beta blockers make the heart's job easier.

Cholesterol Lowering Agents A variety of new drugs have been developed which can lower cholesterol levels. Typically these drugs are not prescribed until dietary modification has been tried. As these drugs have a number of side effects, you should consult your physician to determine if they are appropriate.

Taking Care of Your Heart--For Life!

Like diabetes control, taking care of your heart is a lifelong project. Sticking to the proper diet and exercise program, taking our medication--all are within your control and are your responsibility. And even though it takes commitment, the rewards are great--reduced chances of complications from either diabetes or heart disease and a stronger, healthier life.

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