High Blood Pressure is a common Problem among Diabetics, conversely those diagnosed with High Blood Pressure are more likely to become Diabetic and should routinely Check their Blood Glucose levels. Metabolic syndrome is a characterized by High Blood Pressure, weight, abnormal Cholesterol levels and High Blood Sugar levels; the root cause of all this is Insulin Resistance- as a result of which ,ore insulin is produced to keep Blood Glucose undercontrol, till some extent the body is able to maintain Normal Glucose levels but high levels of Insulin lead to increased storage of Fats in the Body reservoirs and all the complicating problems.
High Blood Pressure in Diabetics is often difficult to treat, most of the Diabetics may require three or more medicines to control their Blood Pressure. If Blood Pressure in not controlled by three agents in their maximum doses , it is called Resistant Hypertension.
High Blood pressure coupled with High Blood Glucose and Cholesterol levels predispose Diabetics to deadly complications like Heart Attack and Stroke.
Total Control of Diabetes- Blood Sugar, Weight and Blood Pressure with Lipids goes a long way in preventing complications of Diabetes
Heart is also an organ and requires blood for its own functioning, Coronary arteries supply blood to different portions of heart. Cardiac muscles rythmically contract and relax causing the pumping action. When arteries supplying blood to heart itself get clogged due to atherosclerosis, heart muscles do not recieve adequate blood and together with it oxygen, thus causing undue fatigue of the muscles- this condition is termed as Coronary Artery Disease, when this happens for a long time the muscles may get permanently damage and may not work efficiently leading to 'Heart failure'.
Causes and Symptoms
While walking, lifting weight, climbing, upstairs, while thinking, under any emotional stress or even after eating the requirement of oxygenated blood increases and heart has to pump more, in order to do this 'extra' work heart muscles themselves require 'extra' blood, when they do not get that - pain or heaviness in chest is felt, initially it may be relieved with rest but as blockages increase it may require medication for relief. Such pain or discomfort is called 'Angina' . Important thing is that in diabetics with autonomic neuropathy this pain may not be percieved (silent Angina)and the person would continue to overburden the fatigued heart.
If any such symptoms are noted 2 tabs of Sorbitrate ( Isosorbide dinitrate ) should immediately be kept under the tongue as they dilate the blood vessels of heart and allow more blood to flow to heart.
Poorly controlled Diabetes with persistently high blood glucose levels cause damage to the muscles of heart. They slowly loose their functional capability and are not able to pump the required amount of Blood leading to a condition called heart failure.
Causes and Symptoms
As the muscles of heart contract they push out the blood from the respective chamber, when they relax that chamber again gets filled with blood. In diabetics the characterstic failure is that of the relaxing muscles,the chambers of heart do not get filled up sufficiently and hence do not pump sufficient blood. Damage to the muscles may be compounded by coronary artery disease which may further decrease their fuctioning.
Symptoms of Heart failure may be breathlesness after exertion or swelling in feet, initially breathlesness may occur after a sufficiently long period of exertion, like walking, climbing stairs , lifting weight etc. But as disease progresses breathlesness begins earlier, a stage may be reached when patients find it difficult to breath even while sitting or standing.
The functioning capacity of heart is assessed by Echocardiography, a non invasive technique similar to ultrasound.
Heart Attack ( Myocardial Infarction) & Angina in Diabetes
The Human heart, beating around 80-100,000 times a day is also a living organ. While pumping approx 2000 gallons per day of blood the heart also requires blood for its own consumption and energy needs. Two major blood vessels -the coronary arteries, supply the ceaselessly working muscles of heart with oxygen and nutrients continously. These blood vessels branch like a tree and supply blood to all parts of the heart. These vessels are not jsut solid tubes but sort of elastic- there diameter can increase or decrease depending on the requirements of the heart or emotional conditions. Atherosclerosis or blockage of these arteries may result in decreased blood supply to a particular region of heart. Due to deposition of calcium in the walls of these blood vessels they may loose their ability to expand.
Whenever we do more physical work the working mucsles require more oxygen and nutrients as a result heart has to pump more blood, which causes both- an increase in the number of times and the volume of blood pumped by the heart. Obviously, due to the increased workload the heart muscles ( myocardium) also require more blood for themselves. If the lumen of the blood vessels supplying blood to heart is itself constricted by blockages or they cannot sufficiently expand to allow more blood to flow through, the heart starts feeling the pinch and cannot pump sufficient blood. These result in symptoms of Angina pain like:
Pain and Heaviness in chest
Pain radiating to the left hand in a line til the tip of the little finger
Pain in the back
Cold Sweats on the face
These symptoms are relieved with rest in the classic angina. During unction or stable Angina the symptoms mat be present even without exertion and wax and wane.
If a brach of the coronary artery supplying blood to heart is completely blocked - the part of heart which recieves blood from it does not get any oxygen and nutrients and starts dying- this is called Myocardial Infarction or Heart Attack. Strange it may seem at the first glance- the heart muscles are pumping blood, they are surronded by it, but they die because of lack of it- yes, its like dying in the middle of an Ocean due to thirst. The nerves connecting heart to brain send the signal of immense pain.
Unbearable pain in chest, radiating to left arm back or jaw.
Sweating of face
Loss of consciousness
Any person with such symptoms should be immedialtely taken to a Hospital for appropriate treatment.
As First aid tablets of Nitroglycerine should be put under the toungue and 1/2 tablet of Aspirin should be given to the patient.
If the blockage is not removed withing 3-6 hrs the heart muscles may permanently die and that part of heart would never work.
Unfortunately such overt signs of Heart attack may even be absent in Diabtics of long standing, due to autonomic neuropathy which affects the nerves carrying signal of pian from heart to the brain.
Just Controlling Blood Sugar levels is not enough to prevent Heart Attack in Diabetes patients, It is also important to control, Blood Cholesterol levels, Keep normal weight and Stop smoking if there is any such habit.
Cardiovascular Complications- as the name implies are caused by the changes in major organs related to circulation of blood in the body, These are major blood vessels - Arteries; and the pumping station of the body- the Heart.
As a result of changes in the constitution of blood caused by uncontrolled Diabetes or even the prediabetic state, like high levels of harmful Cholesterols, low levels of protective cholesterols, high levels of blood glucose leading to inflammation in the walls of the blood vessels and increased probabilty of formation of blood clots, some areas in the large and small blood vessels get thickened causing narrowing of the internal passage for blood flow these thickened areas are called Atherosclerotic plaques.
Further blockage of these already narrowed blood vessels may lead to complete disruption of blood supply to portions of heart or Brain supplied by these vessels, causing Heart Attack and stroke respectively.
The cause of the drastic complications start early in the life of diabetics, EVEN EARLIER THAN THE RISE IN BLOOD SUGAR. Hence these complications may occur early in the life of diabetics.
If such complications in diabetics inflict more damage than in non diabetic persons. Heart attacks are more severe and fatal in diabetics than in non diabetics. Stroke happen more often and cause more disability. Diabetics are more prone to repeat Attacks than non Diabetics.
Smoking perhaps is one of the most important factors in Diabetics- It causes great damage to the blood vessels by deranging cholesterol levels and increasing blood pressure.
Premenopausal women are more prone to Heart attacks than non Diabetic women.
Similar narrowing of arteries supplying blood to legs may lead to symptoms of intermitent claudication, Working muscles of legs Other than keeping blood glucose in control, maintaining adequate cholesterol levels and weight may decrease chances of these complications.
Diabetics are also prescribed Aspirin tablets to prevent formation of clots which may result in Heart attacks and stroke. But these should be taken only on prescription of a doctor, since Aspirin may be contraindicated in some people like those with a gastric ulcer, or asthma .