Save your heart from diabetic chronic complication

So in the previous post I explained exactly how the chronic complication of diabetes leads to Congestive Cardiac Failure. But there are stages of heart disease in its progression that you must be aware of to trap it at an early stage to save your heart from collapsing due to severe pressure. Here goes the list of stages of heart disease.....

Hyperlipidemia - Its simply means high lipid (fatty acids) levels in the blood. Hyperlipidemia is a sheer result of extremely high fat intake in the diet, lack of exercise, lack of adequate rest, inadequate fat metabolism in the body as a result of the earlier reasons. Lipids like triglycerides (TG), choline and lipoproteins whose levels rise in the blood due to improper fat metabolism of the adipose tissue that stores fat in the body and excessive fat intake in the diet. These lipids go on to form what we commonly term as cholesterol like LDL (bad), HDL (good), VLDL (extremely bad). A rise in blood lipids should be a warning sign at the first instance to cut down on fat and excessive simple sugars in your diet and regulate insulin levels in the blood. It would also indicate in patients suffering from diabetes of the unbalanced blood sugar levels.

Hypercholesterolemia (> 240 mg/dl) - The next step forward to attaining the good 'ol heart disease in diabetes is hypercholesterolaemia. As mentioned above the fatty acids like TG combine with lipoproteins, choline to form a very low density lipoproteins or VLDL. A rise in either TGs or VLDLs is a strong indicator of a possible hypercholesterolaemia in the next 48 hours or more as these go on to form low density lipoproteins or LDL. If the TGs and VLDLs are well within levels they will form high density lipoproteins or HDL (we all have known it is the good cholesterol). Whether the body has more HDL to LDL ratio or less will determine if it goes into hypercholesterolaemia. The standard acceptable ratio of Total cholesterol : HDL is less than 5:1.

Hypertension - With the progression of high cholesterol in the blood hypertension or high blood pressure is not far behind. Hypertension would be influenced by many factors like high blood viscosity due to high blood sugar & high cholesterol levels. But majorly the high blood pressure is the outcome of the hardened and constricted arteries due to cholesterol plaques near the heart. This hypertension in turn puts even more pressure on the already burdened heart for blood circulation. Higher the blood pressure more the chances of chronic complications in diabetes percolating to other organs like brain, kidneys, eyes and lungs. The haemorrhage that can possibly occur in any of these organs can prove to be as fatal as a stroke or failure of the organ.

Arteriosclerosis - When smaller arterial walls have cholesterol plaques as mentioned in the previous post the condition is called arteriosclerosis. Sclerosis literally means hardening of soft tissue. This condition when occurs near vital organs can cause damage and thereby death due to lack of oxygen.

Atherosclerosis - When arteriosclerosis occurs in the coronary arteries supplying blood to the heart and larger arteries with atheromatus plaque (lumped, calcified and large) it is termed as atherosclerosis.

Cholesterol Embolism - Sometimes the cholesterol that forms plaques on the wall of arteries can get dislocated and be carried by blood to other organ. This proves to be clogging of the blood vessel of the other organ and causes purpling and marbled effect of the tissues due to lack of blood circulation in the area thereby lack of oxygen. If the organ to receive the embolic cholesterol is lungs or brain or kidney it could mean damage to their function.

Myocardial Infarction ( Heart Attack) - Well we're almost there to reach a cardiac failure but MI or heart attack as commonly known is more of a symptomatic incidence than a condition. All the above factors accumulate for a heart attack to occur. It is the alarming red alert given by the heart to the body of its inefficiency to circulate oxygenated blood. The blood supply to the heart is clogged, mostly deoxygenated, lactic acidosis driven and the muscles are nearing wastage due to all these reasons. The heart attack is when the left ventricular muscles undergo tremendous pressure while contracting and collapse giving out excruciating pain (angina) through the upper left side of the body. If not first aided well it could also instantly lead to stroke.

Cardiac Arrest - Final curtain call of the heart's life. Once all is said and done by your heart to alarm you as much as it can about its suffering condition through the months it gives up, leaving no time and death assumes.

Although this progression need not be experienced by anybody who suffers from diabetes or doesn't. Since a diabetic patient is suppose to be well informed about its lifestyle changes at time of diagnosis itself. However we still continue to see more medical deaths in the world due to heart disease even though controlling it is the easiest as it can be.

Wish you wellness.

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Diabetes and the chronic complications - Heart Disease

Previously I had written about the acute complications of diabetes mellitus and today I will start a series of blog posts throwing light from my experiences about the chronic or long term complications of the disorder. Chronic complications and its therapy is very close to my life as a wellness coach it has been my subject even when I was doing my post graduate research work on the diabetes. So I will begin with a long term complication thats close to every one's heart - Heart Disease.

While we all know the cause & effects of heart disease and also why and how it occurs, you need some clarity over how it all starts in a diabetic condition of the body. Well diabetes as I mentioned in earlier posts too isn't the killer its an open invitation to all the diseases that can occur in the body. So what does diabetes aid in to call upon its dear friend heart disease to come and visit for a longish holiday ? We're about to find out. You remember I had written about stress in diabetes previously, well that is the biggest crack in the pandora box. During the progression of diabetes over the years the metabolic stress causes oxidation of the biomolecules by means of free radicals. Free radicals or molecules with extra electron or oxygen molecule with extra electron act as stress producing agents in the blood and in the tissues. How do they do that? Well for starters lets take a peek into our blood stream where along with the usual molecules that constitute the blood (proteins, cells, platelets, gases, fatty acids, cholesterol, antibodies etc) there are molecules that are desperate to react freely with the other constituents of blood. The reason they are so desperate to react or as we chemically put it are highly reactive agents, is because they carry that extra electron which is not necessary for them. In order to rid them of the burden of carrying that electron they seek molecules to accept this electron so as to be oxidized. This reactivity is then passed on to whoever gets that electron leading to a series of reactions amongst molecules either of the same biochemical function or different. This reactivity passing on the electron like playing passing the parcel leads to high reactivity of the all those molecules in the way and accumulates sheer chaos in the blood stream of that part of the body. Chaotic situation leads to stress, stress leads to fatigue after a prolonged time and fatigue leads to collapsing of the body part.

Same is true for development of heart disease in diabetes. After a prolonged uncontrolled hyperglycemia or blood sugar levels there is enough stress accumulation due to the oxidation reactions in the blood stream. This stress leads to the highly reactive oxidated - LDL (bad cholesterol) from the LDL in the blood to create plaques on the walls of the coronary arteries. How does it do that ? It simply damages the wall by reacting to it since its only purpose in life is cause severe reactivity with anything in its way thanks to that oxidized electron it has received. So the sooner the plaque is formed there comes a boat load of other constituents like serum protein, antibodies, platelets, more fatty acids like triglycerols, VLDLs, etc to an extent where these all begin depositing themselves into the dented artery wall. Now the deposited debri of the blood on the wall hardens over a period of time casing the lumen of the artery (passage for blood to flow) to contrict. Remember we are talking about the Coronary Artery here (the one that supplies oxygenated blood to the heart). Which only means that if the heart which pumps oxygenated blood into the body is itself falling short of the same supply how will it carry out its primary function? Its like your fuel provider hasn't had its share of fuel so that its efficient to provide fuel to others. When the arterial wall hardens the supply of oxygenated blood suffers slowly and steadily to an almost trickle. As this condition progresses the high sugar levels in the blood do not help the situation as the body is perennially exhausted and needs oxygen and fuel constantly to combat the burden of burning subsidiary fuel for energy. In addition to that the heart is exhausted to an extent where at one point it starts regurgitating blood in the opposite direction causing fluid accumulation in the body, lack of enough oxygen, no glucose for fuel, and only toxin filled blood to live by. This gives birth to another common chronic complication of diabetes - Chronic Kidney Failure, but that is another post. When the heart has given up the condition is called Congestive Cardiac Failure (CCF). It is so named as the heart is congested with blood and is not physically any blood from its left ventricle into the body. The entire blood circulation is congested with no fresh blood coming in and water accumulation taking place.

There are however many stages of heart disease where you can stop this final stage to occur and sometimes the heart gives up due to excessive sugar levels and stress and succumbs to cardiac arrest instantly. But if you trap the condition at stages of Hypertension, Hypercholestroleamia, or even the first heart attack you can still save the heart from arrest. I will enlist and explain the stages of heart disease upto CCF in my next post, till then if you have any memories or questions regarding the topic please comment or write to me may be we can find a solution for you or your loved one.

Wish you wellness.

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Acute Complications in Diabetes Mellitus

Previously I explained how is the metabolic stress in our body caused in Diabetes. Today we see the acute stage complications in Diabetes caused due to this metabolic stress. When I say acute stage complications it is immediate reaction of the body to high blood sugar or lack or increase of insulin/ drugs. In this case scenario the body gives no time and can sometimes go straight into coma. There have been cases where coma is bypassed into sudden death as well. The acute complications of diabetes mellitus are Hyperglycemic Hyperosmolar Non- Ketotic Syndrome , Hypoglycemia, and Diabetic Ketoacidosis. Let us go through the pathophysiology of each separately.

1. Diabetic Ketoacidosis - This is seen mainly in diabetes type I (complete lack of insulin secretion) or sometimes even type II (insulin resistance induced or inadequate insulin secretion). It is a fatal complication and can directly lead to death if undiagnosed or untreated. As I had previously mentioned ketoacidosis is a stage when the body breaks down fatty acids in the absence of glucose. Since the breakdown of fats is an anaerobic activity it is incomplete which leaves behind ketone bodies in the blood. Ketonic accumulation in the system leads to high acidity of the blood. Ketoacidosis leads to vomiting, dehydration due to the excessive urination and water accumulation in the blood vessels, ketone bodies also have an effect of disorientation of the brain leading to a state of confusion. There exist abdominal pain and a palpable abdomen, excessive thirst and deep labored breathing. The other symptoms are fruity odored breath and urine (ketone bodies smell fruity). Therapy requires immediate intravenous hydration and insulin dosage to prevent more ketone formation.

2. Hyperglycemic Hyperosmolar Non-Ketotic Syndrome - Although the name is too long it simply means dehydration of the body tissue without any ketone formation. Like the Ketoacidosis the high blood glucose level reaches a point (> 600mg/dl) where osmosis leads to the water in the cells (tissue) to come out into the blood vessels just so that the solute : solvent ratio is maintained on both ends. However due to extremely high glucose levels in the blood the water shift from the cells to the blood is quite high leading to extreme dehydration, polyuria. This leads to disordered mental functioning, confusion, tremors, and could also go into coma or death. Ketone formation is inhibited due to some insulin presence.

3. Hypoglycemia - One of the most dreaded conditions in diabetes is low blood glucose levels. Due to inaccurate insulin therapy or over dose of diabetic drugs the blood glucose level may hit an all time low. This leaves no glucose in the blood to be metabolized for energy. Due to lowered levels in the blood of glucose the body is depleted of any energy source. The brain takes the first hit where a state of dizziness sets in and leads to coma or unconsciousness.

Treating acute complications of diabetes is extremely important especially with the paucity of time given by the body. When the nutritional and pharmacological therapy of diabetes mellitus are balanced with each other this stage will not be experienced. Next post would be on the chronic complications of diabetes. Let me know through comments of your experiences with the disorder or contact me to know more about it.

Wish you wellness.
Neha Wasnik, R.D

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