With every 5th diabetic in the world being an Indian, India has the highest number of diabetics in the world. On the eve of worlds diabetes day it’s a painful yet an undeniable fact to know that our country has 6.2 crore diabetic individuals and the numbers are adding up quickly (the number will increase to 7.94 crores by 2030!).
Whereas India is named as the world diabetic capital, with 16.6% Hyderabadi’s having diabetes (12.4% Bangalore, 13.5 % Chennai, 11.6% New Delhi, 11.7 % Kolkatta, 6.1% in Kashmir), our city is notoriously deemed as the diabetic capital of India.
The reasons for such high magnitude are many including urbanization, faulty diet, less physical activity, obesity, rising living standards, genetic factors and stress.
With the average age of onset of diabetes in India being 42.5 years and with an estimated ten lakh deaths because of diabetes every year, the burden on the nation is gigantic.
Diabetics have 2 to 3 times more risk of developing heart attack and brain stroke, 4 times more risk of developing kidney disease, 8 times more risk of blindness, another 32 times more risk of losing a limb due to leg amputation when compared with general population.
Despite huge knowledge through scientific research from all over the world, a few myths persist in our society regarding this pervasive common disease. The following article is to dispel few myths related to diabetes and heart disease and to state some, possibly unpalatable, facts.
10 MYTHS ABOUT DIABETES AND HEART DISEASE
Myth #1: If you control the diabetes well, you will never get heart disease
A lot of people think that controlling diabetes will prevent the heart disease totally. That’s why cardiologists often face incredulous well-controlled-diabetic patients when they are told that they have heart disease, looking at them with disbelief and denial. Unfortunately, even if you totally control your diabetes, your chance of having a heart disease doesn’t become zero. There are two kinds of organ damage with diabetes. One associated with small blood vessel disease and another associated with bigger blood vessel disease. Heart disease is classified as the macro-vascular (bigger vessel disease) complication of diabetes. In general, macro-vascular complications cannot be controlled adequately by controlling blood sugar levels.
The other reason why heart disease in diabetes cannot be prevented by controlling diabetes is because diabetes mellitus is associated with a lot of other cardiac risk factors like hypertension, hyper-lipidemia and obesity. To control the heart disease risk in Diabetics, one needs to control all these other risk factors optimally as well.
Myth #2: Though I am a diabetic I am still in my early 40s and I don’t have to worry about heart disease.
Not true. Diabetes not only increases the risk of having a heart attack, but it also brings the heart disease early. Usually heart disease occurs in the sixties, but in diabetics, it is seen around ten years earlier i.e., in the fifties and sometimes even in the forties. So, diabetics are supposed to work hard to reduce their chance of having heart disease. They have to reduce the risk factors more thoroughly. For example, while a LDL cholesterol level of 100mg% is desirable in non-diabetics, a more stringent level of less than 70mg% has to be achieved in diabetics. A similar anomaly happens with gender. Though normally young women are protected from the heart disease because of their hormones, diabetes will nullify any advantage they may have over men.
Myth #3: If I am a diabetic I would have symptoms
Wrong. A lot of diabetics suffer from the disease silently. They may not have any symptoms. Though excessive thirst and hunger are described as the symptoms of diabetes, they don’t occur in all the patients. So even if one doesn’t have any symptoms suggestive of diabetes, one is supposed to get tested for diabetes at regular intervals. And even if the diabetes is not symptomatic, the damage it does to the body goes on un-relented.
Myth #4: I cannot withstand CABG or PCI because I have diabetes
Not entirely true. Though a higher risk for angioplasty and Bypass surgery occurs in diabetics, a lot of diabetics undergo these procedures quite safely. Usually, diabetics have early heart disease, they have extensive heart disease, they may also have multi-vessel disease and they have diffuse disease of the heart blood vessels, at times rendering the therapeutic procedures difficult. But diabetics are the people who will require these procedures quite commonly. The increased risk because of diabetes is not prohibitively high to avoid these procedures. For example, most people think that the wound related infections post op would be unmanageable. But mostly, the sternal wounds heal well even in diabetics.
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Myth #5: I am a diabetic and I never had chest pain, so I don’t have heart disease.
Diabetes affects the nerves. Some of the nerves carry pain sensation to the brain from various organs. Because diabetes affects these nerves, diabetics do not perceive pain like the rest of the people. The same thing applies to the heart related pain as well. A lot of times, diabetics can have heart attack without ever having any chest pain. In fact, some diabetic patients may have repeated heart muscle damage without any symptoms and may present to the clinician as advanced heart failure instead of as a heart attack. So it is important to note that just as diabetes itself can be asymptomatic, the heart disease in diabetes may be asymptomatic as well and both diabetes and heart disease in diabetics have to be regularly sought for and treated, despite lack of obvious symptoms. ECG or Echo may show evidence of heart disease. But to detect heart disease in diabetics, Electocardiogram (ECG) alone is not sufficient because a normal ECG can be associated with fairly advanced heart disease. Similarly even an echocardiogram could be normal despite heart disease and a treadmill usually picks up the heart disease in silent affection of blood vessels in diabetics.
Myth #6: Heart failure means stopping of the heart.
Heart failure is different from heart attack. A heart attack means that the blood supply for a portion of the heart has suddenly stopped. This results in the damage of that portion of the heart. A damaged heart with less pumping capacity, being unable to supply adequate blood to the organs of the body is called Heart failure. A big heart attack may result in heat failure and so do multiple heart attacks. Cardiac arrest means that the heart has stopped completely and this may happen in patients suffering either from the heart failure or from the heart attack.
Myth #7: As long as my sugars are in control, I can eat anything.
Even common sense tells us that this concept is wrong. A lot of times diabetic patients control their blood sugars with medications and then tend to eat sweets and other proscribed foods. However, this may result in surges in glucose and free fatty acids in the blood which may precipitate sudden heart problems. Even cholesterol levels go up with indiscriminate food intake despite normal sugar values. So, what has to be understood is that the blood sugar is just one of the many values that have to be controlled when one has diabetes. Unless this concept is grasped, unnecessary and excessive obsession about the blood sugars alone could be quite inadequate and detrimental to the diabetic care.
Myth #8: Vitamins, if regularly taken, will prevent heart disease
No vitamin has been shown to decrease the heart disease. Almost all the vitamins have been investigated to find their association with heart disease. vitamin C and vitamin E were early in the race, but the current strongest contender for this role is the vitamin D. However, the best that was found out about any vitamin is that while a deficiency may increase the risk of heart disease, but it was never shown that the supplementation of vitamins by way of expensive tablets or injections would be helpful in prevention or treatment of heart disease. Similarly, it is often presumed that the anti-hypertensive or anti-diabetic medications need to be ‘supported’ with vitamin tablets or else the body may become weak. There is no evidence to support this claim as well. If the vitamins are in normal levels, they don’t need to be supplemented.
Myth #9: If you undergo a Bypass surgery successfully, your heart is as good as new.
Unfortunately, this is a false assumption. Neither bypass surgery, nor angioplasty can reverse heart disease. They may improve the blood supply to the heart and to certain extent, may improve the pumping capacity of the heart. But they cannot make the heart normal.
The problem with this myth is that a lot of patients tend to stop medication after successful interventions in the form of bypass surgery or angioplasty. Nothing would be more detrimental. Once heart disease is diagnosed, with or without diabetes, the medication has to be taken life-long. That’s why the aft repeated phrase: ‘if you want a Long Life, use medication Life-Long’.
Myth #10: One shouldn’t exercise after having a heart disease
Occasionally, after the acute phase of heart disease is treated, the cardiologist may ask the patients to take some rest. But this is only for a limited period. It has conclusively been proven that the physical exercise after heart disease will improve outcomes. The exercise not only will help to open new blood vessels for the supply of the heart muscle, but it will help control of blood pressure and blood sugar. It will also give a sense of well being and improve the confidence of the patient to lead a comfortable life after having a heart disease.
This year, the theme of the world diabetes day is ‘Healthy living starts at breakfast’. And like every year, world diabetes day gives us a great opportunity to understand the disease better and to approach it more rationally. Happy diabetes control!!