The connection between Diabetes and the heart.

Diabetes is a health condition that runs on my mother’s side of the family.  I remember learning in my early teens how demanding and unrelenting this chronic condition can be.  A great aunt who was diabetic visited us after we moved to the Washington, D.C. area.  We were out touring the mall, where the Washington Monument, Lincoln Memorial and Jefferson Memorial can be found.  This was in the 1970s so the medications for diabetes were much more limited.  I recall clearly that my great aunt was not disciplined in monitoring her condition to make sure she did not have a diabetic reaction. 

We were walking along the mall and she informed us that she did not have a snack with her, and she had to eat something right away.  She did not look well.  This was long before food vendors and food trucks filled the mall area and we were concerned about finding her something to eat.  We finally found a place that at least sold snacks and she avoided having a serious diabetic reaction.  It was not a pleasant experience, and the episode may explain why I am so careful with my diet, because I realize my healthy diet (or lack thereof) can facilitate or torpedo my chronic health condition. 
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Happily, as of today I have no signs that I have diabetes.  I do know people who have this chronic condition, so I realize it is a threat to health and long life, just like heart disease.  As a chronic condition, and similar to my heart condition, diabetes often requires taking daily meds and continually monitoring things like diet and exercise.  But imagine my surprise when I learned that there is a link between heart disease (especially heart failure) and diabetes.  It struck me that this is a double whammy, so I wanted to provide some facts to anyone who has diabetes to help them remain especially watchful in order to avoid the additional threat and burden of a heart condition.

So there are a number of medical authorities who report that individuals who have been diagnosed with diabetes need to be vigilant in guarding against diseases of the heart.  An article on the Cleveland Clinic website from March 9, 2017 entitled “Diabetic Cardiomyopathy, 5 Tips For Cutting Your Risk” says that “although doctors can detect and treat it, cardiovascular disease remains a major cause of mortality for people with diabetes. In fact, heart disease or stroke claim the lives of two out of three people with diabetes.”  So for those I know who suffer from diabetes, please know that you are at risk. 

An apparently lesser known fact according to the article is that “research links diabetes to a higher risk of cardiomyopathy:  thickening, stiffening and other changes in the heart muscle that limit the heart’s ability to pump blood throughout the body.”  Hmmm - I have been diagnosed with dilated cardiomyopathy for 5 years, so why is it only now that I have learned about the link between diabetes and my condition?  I guess we need to stay vigilant not just in battling our own challenges, but to understand unidentified health invaders that may be lurking on the fringes.

So what can one do to prevent a diabetic condition from fostering cardiomyopathy as well?  The Cleveland Clinic says that the damage cardiomyopathy inflicts relates directly to blood glucose levels.  Here are the tips that the article provides to help you avoid an adverse result to your blood glucose level, as well as avoiding cardiomyopathy:

• Get 30 minutes of moderate physical activity at least five days a week
• Monitor your blood sugar levels
• Eat a healthy diet and limit carbohydrate intake
• Take all medications/insulin prescribed by your doctor
• See your doctor regularly.

I found an interesting website called diaTribe.org.  This intrigued me as the definition of the word diatribe according to the English Oxford Living dictionaries website is:  a forceful and bitter verbal attack against someone or something.  So I figured that the website had to provide information and resources to help those with diabetes, but I couldn’t figure out how the diatribe part fit.  Maybe the information is so forceful that it compels the patient to take positive action?  

Actually, it isn’t just a website.  diaTribe is a foundation, and according to its website, it was founded with a mission to improve the lives of people with diabetes, prediabetes and obesity, and to advocate for action.  Their patient-focused on line publication is part of The diaTribe Foundation’s mission to improve the lives of people with diabetes.  Their online publication, also known as diaTribe seeks to empower readers with useful, actionable information that gives them hope for a better future, and helps them live happier and healthier lives. Their tag line is “Making Sense of Diabetes.”

The diaTribe on-line publication has an article from June 2018 entitled “Heart Failure – the Overlooked Diabetes  Complication, Part 1:  What and Why?”  The article begins with the statement that “Healthcare providers often discuss diabetes complications such as vision loss (retinopathy) and kidney disease (nephropathy), but a less-talked-about complication is heart failure. “ So the intent of this article appears to be to inform readers of this very real and serious complication.  

Why am I saying it is a real complication?   Because according to the section of the article called “What Does Heart Failure Have To Do With Diabetes”, it is noted that people with type 2 diabetes are 2.5 times as likely to develop congestive heart failure than people without diabetes. This is partly because many of the key risk factors for heart failure are common in people with type 2 diabetes, such as a body mass index over 25, high blood pressure, coronary artery disease, or a history of a heart attack. (Other risk factors for heart failure include heart valve problems, sleep apnea, lung disease including from smoking.)
But the shared risk factors alone don’t explain everything – diabetes itself is an independent risk factor for congestive heart failure. In major diabetes heart health trials, heart failure was just as common a reason for hospitalization as the more commonly considered heart complications, like heart attacks, strokes, or coronary bypass surgeries. Why then, does heart failure tend to get overlooked?  While no one can say for sure, one possible explanation is that heart attacks and strokes are more sudden and defined “events,” rather than a slower progressive process like heart failure.
 
Growing up, I learned that if you were a diabetic, you needed to exercise caution when it came to food with sugar.  But imagine my surprise when I learned that diabetics and heart failure patients have a common bond in sharing concern over sodium.  That’s right.  The American Diet Association advises: 
Decreasing the amount of sodium in the diet can help many people lower their blood pressure. Lowering blood pressure also means you are decreasing your risk for heart attack of stroke, both of which are common diabetes complications. The American Diabetes Association recommends that people with diabetes aim to have 2300 mg or less per day. If you have high blood pressure, your health care provider may recommend even less.

Of course, the recommended daily allowance of sodium is 2300  mg.  I guess what the ADA is saying is that if you are diabetic, you really really need to make sure you comply with this guidelines, and not do like a lot of folks and eat 3400 mg or even more per day.

​So as I continue to write about heart failure, I come across references to, and information about other chronic illnesses such as diabetes and many others.  All the patients with these conditions share a bond forged through managing similar unpleasant symptoms and rigid health regimens.  Sure – it’s a bummer.  But I consider us brothers and sisters finding strength in each other as we unite to overcome our very daunting challenges.  How can we lose if we stand together in the most important chapters of our lives?