All About Diabetes» heart attack

Wholly Good Whole-Grain Breakfast

admin — Fri, 09 Jul 2010 05:53:17 +0000

A new US study says eating whole-grain breakfast cereal reduces the risk of heart failure. “The significant health benefits of whole-grain cereal are not just for kids but also for adults. A whole-grain, high-fiber breakfast may lower blood pressure and bad cholesterol and prevent heart attacks,” said the study’s main author Dr. Luc Djousse of the Harvard Medical School in Boston .

Breakfast cereals were considered whole-grain if it contained “at least 25 percent oat or bran content, according to the study. In the study conducted from 1982 to 2006, nearly 10,500 doctors agreed that people who ate whole-grain breakfast cereal seven or more times a week lessened heart ailments by 28 percent since whole grains have a higher fiber content and are rich in vitamins, minerals and antioxidants.

Insulin and Diabetes

admin — Thu, 03 Jun 2010 06:49:42 +0000

“Does using insulin mean that your diabetes is at its worst?”

Not necessarily. This just means that your doctor feels that insulin is the better treatment for you at this time. If you are a type 1 diabetic, you will need insulin from the very start of your treatment to bring down the blood sugar. Because you don’t make your own natural insulin hormone, you will still need to continue injecting insulin even when the blood sugars are already in the normal range.

If you have type 2 diabetes, your pancreas produces its own insulin but other organs cannot properly use the insulin to bring down the blood sugar. Because you actually make insulin, treatment is proper nutrition, weight loss and physical exercise. Your doctor may also start you on tablets to make the body more sensitive to the insulin from the pancreas. When diet, exercise, and medications still do not achieve optimal blood sugar levels, then it may be time to shift to insulin therapy. The longer a person has had diabetes, the more likely they will have to start insulin treatment at some point.

There are certain circumstances when it may be necessary to give insulin temporarily to type 2 diabetes patients. This happens when there is a relative lack of insulin being produced by the pancreas, when you cannot take tablets or when there is a need to bring down the blood sugar immediately. Your insulin needs are increased temporarily when you have a severe infection or are acutely ill in the hospital.

Tablets take time to work and the severity of the illness contributes to the high sugar. Insulin given in small doses can stop this vicious cycle and control blood sugar fast. Giving insulin at the same time the infection is being treated can shorten the course of the disease and prevent repeated infections.

Heart attacks, strokes and other critical illnesses are more common in diabetics. Better blood sugar control can help with patient recovery and shorten hospital stay. When the infection or illness resolves, your doctor will let you know when you can safely resume oral medications.

You may also need insulin when you cannot take tablets as in pregnancy, or during surgery. Near normal blood sugars during surgery promote wound healing and prevent infections. Even if some diabetic medications have already been found to be safe for use in pregnancy, insulin is still the fastest and most effective means of controlling the blood sugar in the mother and preventing complications in the baby. After delivery, most mothers are advised to resume the tablets they were taking before the pregnancy.

When your diabetes is already complicated by eye, kidney or nerve damage, then bringing down the blood sugar to near normal levels is more effectively achieved by insulin. Further, hyperglycemia tends to worsen these complications. Most diabetes drugs pass through the liver or the kidney. If you have liver or kidney problems, your doctor may opt to stop medications that go through these organs and give small doses of insulin to prevent blood sugar fluctuations.

Then of course, there are cases when tablets just don’t work. Severe weight loss, excessive thirst, frequent urination and blurring of vision indicate that your current treatment is not controlling your blood sugar. Your pancreas has been bombarded by high blood sugars for some time, and your own insulin is vanishing. You’re out of insulin! Using tablets that work by trying to increase the body’s insulin production are useless at this time. Treatment with insulin will effectively bring down the blood glucose levels, relieve your symptoms and give your pancreas a break.

Short, intensive courses of insulin may slow down the progression of diabetes. Your doctor can help you adjust your insulin dose, giving more if the blood sugars remain high, and giving less if hypoglycemia (or low sugars) occurs. These low sugars may signify a return in the function of your pancreas. In such cases, patients can be slowly shifted back to tablets without a rebound increase in the blood sugar. With proper diet, exercise and maintenance of weight, the need for permanent replacement of your pancreas with insulin injections could take years to come.

Preventing Heart Attack in Diabetes

admin — Sat, 17 Jan 2009 13:06:28 +0000

It was the wee hours of the morning. I heard the door to my parents’ room open and heard my father coughing hard. He went to the kitchen hurriedly followed by my mother’s nervous queries of whether he’s alright. They went back to their room, with my father coughing even harder, as , if trying to spit out something that was obstructing his breathing. In a few more seconds, all I heard was my mother’s piercing screams. And before I even reached their room, he was gone. Heart attack took Papa from us, just like that.

The silent killer
Often likened to a thief in the night, a heart attack hits its victims without warning and does irreparable damage,and oftentimes, fatal results in the blink of an eye. My father who was a type 2 diabetic was undergoing weekly dialysis for his kidney disease when he succumbed to heart attack. It was not the high blood sugar, nor the kidney problem that got him. Rather, it was the heart complication that took his life.

Most patients with diabetes these days die not of diabetes but firstly because of heart attack, second by renal (kidney) failure, said Dr. Eduardo Vicente Caguioa, chairman of the Preventive Cardiology Council of the Philippine Heart Association and consultant cardiologist at the University of Santo Tomas Hospital and St. Luke’s Medical Center. “Cardiologists consider diabetes as a coronary equivalent. Once you are a diabetic, your life span is equivalent to somebody who already has had a heart attack,” he said.

This is because diabetics have a metabolic problem that makes them more prone to develop heart problems and complications, according to Dr. Caguioa. “The risk of cardiovascular events which include heart attack, heart failure, stroke, hypertension, even kidney disease is higher in diabetics primarily because atherosclerosis (clogging of heart arteries), which is all over the body, is accelerated,” he said.
Heart attack results from the sudden, complete blockage of a coronary artery (blood vessel supplying the heart muscle) by a blood clot. The blockage can cause significant damage to the heart muscle and may lead to death, heart failure and related complications.

Prevention and treatment
For Dr. Caguioa, the most important way to prevent heart problems in diabetes is education. “Diabetics should understand that diabetes is not a disease of sugar alone,” he said. According to him, 50 or 60 years ago, when insulin and oral hypoglycemics were still not available, diabetics die because of high blood sugar.

But now, with the availability of insulin and oral hypoglycemic agents, diabetics who are being treated do not generally die anymore of high blood sugar, rather they die of heart attack, coronary artery disease, kidney failure and stroke. Given the case, most diabetics should realize that they should not only see an endocrinologist or diabetologist, but also see a cardiologist because of the heartrelated complications associated with diabetes, explained Dr. Caguioa.

Another important measure in preventing heart attacks is good blood sugar control. Tight control of blood sugar, resulting from proper diet and use of insulin or oral hypoglycemics, helps prevent the other silent problems associated with diabetes like abnormalities in cholesterol metabolism. Proper management of the disease is also important to prevent a possible heart attack. According to Dr. Caguioa, treatment of diabetes is multi-factorial, where it is not only diabetes that is being treated, but also other risk factors like weight, cholesterol and blood pressure levels. He said that diabetics should reduce their weight as most of them are overweight or obese, lower their cholesterol to optimal levels, and control their blood pressure.

Dr. Caguioa also emphasized the need to screen diabetics for peripheral vascular disease (PVD) because the presence of PVD means that the patient already has coronary artery disease. However, he pointed out that as in all other diseases, no amount of treatment or medication would be effective without diet and lifestyle modification.

PHA efforts
The Philippine Heart Association (PHA), through its Council on Preventive Cardiology is currently implementing programs that help address the diabetic problem in the country, especially regarding cardiovascular complications like heart attack. Dr. Caguioa shared some of the Council’s plans on how to address the diabetes and heart disease problem in the country. As of the now, the Council already came out with guidelines that can be used by Filipino doctors in addressing marginalized patients. “These guidelines will give options to doctors on how to manage patients who are diabetics with atherosclerosis, or diabetics with cholesterol problems,” he said.The guideline, as of this writing, is currently being printed and will be ready for dissemination to physicians all over the country.

Another project that the Council is looking at is that of gathering data to be able to come up with PHA guidelines or statements on particular issues that concern diabetes and cardiovascular problems. “We have to come out with statements that help doctors and help the laymen understand better. We are also coming out with pamphlets for laymen to talk about diseases of the heart, like diabetes,” according to Dr. Caguioa.

Finally, the Council on -Preventive Cardiology is also planning to forge an agreement with the diabetic societies and collaborate on how to go about managing holistically the diabetic problems in the country.

Heart-friendly advice
To prevent heart attacks and other complications in diabetes, Dr. Caguioa offered some healthful advice:

Know your family history. Having a parent, a brother or sister who has diabetes makes you a very likely candidate for diabetes too. So it is important to have yourself checked by a doctor.
If you are a diagnosed diabetic, you have to see not only a diabetologist or endocrinologist, but also a cardiologist because diabetes is considered a coronary equivalent.
Do not be satisfied with just having your blood sugar controlled. You have to control everything that is associated with diabetes like blood pressure, cholesterol and weight.
Regular check-up and monitoring of your diabetes is important. Having diabetes means monitoring your self for the rest of your life. Go back to your doctor for regular checkups and follow your prescribed medications religiously.
Lastly, lifestyle modification is essential. Remember that no amount of medication will work without lifestyle modification.

Diabetes need not always end with a heart attack. As a diabetic, you can still live a longer, healthier life if you will only take good care of your self. With careful monitoring of your diabetes plus the other risk factors like cholesterol, blood pressure and weight, add to that diet and lifestyle modification, you can protect your heart and prevent a heart attack. Doing these preventive measures can save not only your life but the lives of those you love as well. Preventing heart attacks translates to husbands and wives growing old together, parents living to see their children’s children grow up, and children not having to be orphaned early.

Hypertenstion Management

admin — Thu, 01 Jan 2009 22:38:31 +0000

Clinical evidence has shown the necessity for the use of combination therapy, or the use of two or more antihypertensive agents, in the management of hypertension. Observations from major clinical trials in different kinds of patients, from elderly to stroke and diabetic patients, indicate that usually two agents are necessary to control the blood pressure in the majority of these patients.

The recent cardiovascular summit held in Prague last March 2007 focused on how the management of hypertension could be improved through combination therapy. The diuretic combinations are widely used for hypertension.”Diuretic combinations are widely practiced ‘or the reason that it is the fastest drug to decrease blood pressure,” said Dr. Josep Galceran of Manresa, Spain. Diuretics also help the kidneys eliminate salt and water, decreasing =iuid volume throughout the body and ;nus lowering blood pressure.

However, diuretics can-also increase ;7e level of blood sugar. This causes -oncern over the use of the drug ~,ecause increased ‘blood sugar evel is a marker for diabetes. The -~ntihypertensive and Lipid-lowering Treatment to Prevent Heart Attack ALLHAT) trial showed that compared other classes of anti-hypertensive ::rugs, the use of thiazide diuretics -~crease a patient’s risk of having -ew-onset diabetes as the therapy – rogresses. In addition, those hypertensive patients affected with new-onset diabetes (NOD) are most likely to have higher glucose levels, higher occurrence of impaired glucose tolerance,highersystolic and diastolic blood pressure and some extent of left ventricular hypertrophy.

Because of the mentioned sideeffects, researchers are studying other combinations . that would not only effectively manage blood pressure but are also safer. Dr. George S. Stergiou from the Hypertension Center of Sotiria Hospital in Athens, Greece, cited the importance of raising the standard of antihypertensive care. He emphasized paying attention to how effective both short-term and long-term effects of the therapies.

According to Stergiou, first consider how effective the antihypertensive agent is in lowering blood pressure. Secondly, limit the adverse effects associated with the treatment to prevent treatment non-compliance.

Among the combination therapies, the verapamil-trandolapril combination showed effective blood pressure lowering minus adverse effects, particularly the incidence of new-onset diabetes as seen in the Study of Trandolapril-Verapamil and Insulin Resistance (STAR) trial. STAR sought to find out if glycemic control could be maintained to a greater degree with a renin angiotensin (RAS) inhibitor/nondihydropyridine calcium channel blocker (verapamil SR/trandolapril) combination compared with a RAS inhibitor-thiazide diuretic (losartan/ hydrochlorothiazide) combination in hypertensive patients with metabolic syndrome.

Results of the trial showed that both combinations notably lowered patient’s blood pressure, losartan/ HCTZ caused an increase in glucose, insulin and HbA I c levels. In contrast, verapamil SR/trandolapril had a neutral effect on glucose tolerance. Furthermore,a six month extension of the STAR trial showed that switching to verapamil SR/ trandolapril combination therapy reversed the unfavorable side effect on glycemic control brought about by using losartan/HCTZ.

With the favorable results of STAR trial, the combination of verapamil SR/trandolapril can prove to be an ideal choice for hypertensive patients requiring combination therapy.The verapamil SR/trandolapril combination is marketed in the Philippines by Abbott Laboratories under the brand name Tarka.

Low Blood Sugars at Night?

admin — Thu, 01 Jan 2009 22:24:57 +0000

How can the elderly keep from having low blood sugars at night?

Hypoglycemia, defined variably as blood sugar <60 mg/dL, is one of the dreaded complications of diabetes management. It usually hinders the achievement of a satisfactory glucose control level because of the fear of developing symptoms of hypoglycemia – palpitations, excessive sweating, tremors, and disorientation. These “warning signs” are triggered by counter-regulatory hormones, like adrenalin, which are defense mechanisms of our body to increase sugar levels back to normal.

In the elderly, hypoglycemia may be associated with seizures, heart attack and stroke, which are dangerous especially at night. Although the possibility of persistent mental deficits have been raised, like coma and even death, permanent neurologic defects are actually rare. Despite the risks, it is warrranted to treat diabdtes to prevent acute and chronic complications of diabetes.

Several factors make the elderly more likely to develop hypoglycemia, among them are:

“Warning Signs” are impaired – they are unable to trigger adrenalin to counteract the low sugar.
Erratic food intake – because of loss of appetite, skipped meals or alcohol intake
Kidney, liver or other medical problems – kidney or liver malfunction can make the antidiabetic agents stay longer in the body
Decrease in body weight – after an illness or infection, in patients with cancer or even due to physiologic decline in muscle mass
Mistakes in the intake of medicines – due to lack of supervision, poor eyesight or concomitant medicines that can interact with diabetic medications

Some helpful tips in preventing hypoglycemia in the elderly:

Frequent self monitoring of blood glucose – this will give the doctor an idea of the trend of the patient’s blood glucose
Maximize diet, exercise and lifestyle change – especially in newly diagnosed cases of diabetes. For people already on drug treatment, avoid skipping meals especially at night, to avoid hypoglycemia in the early morning.
Ensure that there is fast and longer-acting carbohydrate at hand in case of hypoglycemia.
Check with your doctor regularly – tell him/her about your “warning signs” if any, ask about dose adjustments especially if on insulin treatment.
Make sure the medicines are correct. Inquire from your doctor the possibility of drug interactions, for example, with alcohol, beta. blockers or sulfa drugs. Your doctor may also consider giving smaller doses of medicines. Insulin can also be utilized in the elderly without causing severe hypoglycemia, as proven in studies.

In summary, treating elderly diabetics should be individualized. It must be aggressive enough to prevent the acute and chronic complications of diabetes while avoiding the dangerous effect of hypoglycemia.