Diabetes-CVD FactsDiabetes-CVD Facts

More than 65% of all deaths in people with diabetes are caused by cardiovascular disease.

Heart attacks occur at an earlier age

in people with diabetes and often result in premature death.

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Diabetes-CVD FactsDiabetes-CVD Facts

Up to 60% of adults with diabetes have high blood pressure.

Nearly all adults with diabetes have one or more cholesterol problems, such as:– high triglycerides– low HDL (“good”) cholesterol– high LDL (“bad”) cholesterol

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What is Diabetes ?What is Diabetes ?

Diabetes is a disorder of metabolism

After digestion, glucose enters the blood stream

Then Glucose goes to cell through out the body where it Is used for energy

However, a hormone called insulin must be present to allow glucose to entre the cells

Insulin is produced by the pancreas, a large gland behind the stomach

Continue… Continue…

In people who do not have diabetes, the pancreas automatically produces the right amount of insulin to move glucose from blood into the cells

However, diabetes develops when the pancreas does not make enough insulin , or the cells in muscle,liver,and fats do not use insulin properly, or both.

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As a result, the amount of glucose in the blood increases while the cells are starved of energy…………..

ComplicationsComplications

ComplicationsComplications

Over time, high blood glucose levels damage nerves and blood vessels, leading to complications such as heart disease and stroke, the leading causes of death among people with diabetes

Uncontrolled diabetes can eventually lead to other health problems as well, such as vision loss, kidney failure

What is pre-diabetes ?What is pre-diabetes ?

Pre-diabetes is a condition in which blood glucose level are higher than normal but not high enough for a diagnosis of diabetes.

Also called impaired fasting glucose or impaired glucose tolerance

Many people with pre-diabetes develop type 2 diabetes within 10 years

With modest weight loss and moderate physical activity, people with pre-diabetes can delay or prevent type 2 diabetes and CHD

What is the connection

between

diabetes, heart disease and stroke ?

Connection b/n diabetes and CHDConnection b/n diabetes and CHD

If you have a diabetes, you are at least twice as likely as someone who does not have diabetes to have heart disease or a stroke

People with diabetes also tend to develop heart disease or stroke at an earlier age than other people

If you are middle aged and have type 2 diabetes, some studies suggest that your chance of having a heart attack is as high as someone without diabetes who has already had one heart attack

Connection continue…Connection continue…

Women who have not gone through menopause usually have less risk of heart disease than men of the same age.

But women of all ages with diabetes have an increase risk of heart disease because diabetes cancels out the protective effects of being a women in her child-bearing years.

Connection continue...Connection continue...

People with diabetes who have already had one heart attack run an even greater risk of having a second one

Heart attacks in people with diabetes are more serious and more likely to result in death.

Connection continue…Connection continue…

High blood glucose levels over time can lead to increase deposits of fatty materials on the insides of the blood vessel walls.

These deposits may affect blood flow, increasing the chance of clogging and hardening of blood vessels(atherosclerosis).

Connection continue…Connection continue…

Heart disease and strokeHeart disease and stroke

What are the risk factors For Heart disease and Stroke in people with diabetes ?

Risk factors in diabetesRisk factors in diabetes

Diabetes itself is a risk factor for heart disease and stroke

Many people with diabetes have other conditions that increase their chances of developing heart disease and stroke

This conditions are called ‘’Risk factors’’.

Risk Factors in diabetes patients Risk Factors in diabetes patients

Having a family history of heart disease

Having central obesity

Having abnormal blood fat (cholesterol) levels

Having high blood pressure

Smoking

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Family History

1. Having Family history1. Having Family history

If one or more members of your family had a heart attack at an early age (before age 55 for men or 65 for women), you may be at increased risk

You can’t change whether heart disease runs in your family, but you can take steps to control the other risk factors

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Central obesity

2. Having central obesity2. Having central obesity

Central obesity means carrying extra weight around the waist, as opposed to the hips

A waist measurement of more than 40 inches for Gentle men and more than 35 inches for women means you have central obesity

Central obesity continue…Central obesity continue…

Risk of heart disease is higher because abdominal fat increase the production of LDL (bad) cholesterol, the type of blood fat that can be deposited on the inside of blood vessel walls

Causes of central obesityCauses of central obesity

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Abnormal blood fat (cholesterol) levels

3. Abnormal blood fat levels3. Abnormal blood fat levels

LDL cholesterol can build up inside your blood vessels, leading to narrowing and hardening of your arteries

Triglycerides are another type of blood fat that can raise your risk of heart disease when the level are high

HDL (good) cholesterol removes deposits from inside your blood vessels and takes them to the liver for removal

Low level of HDL increase your risk factors of heart disease

Plasma cholesterol levelsPlasma cholesterol levels

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Having high blood pressure

4. Having high blood pressure4. Having high blood pressure

If you have high blood pressure, also called hypertension, your heart must work harder to pump blood

High blood pressure can strain the heart, damage blood vessels, and increase your risk of heart attack,stroke,eye problems and kidney problems

Complications of hypertension Complications of hypertension

Treatment of HPNTreatment of HPN

Anti hypertensive drugs

And…………….. On the following slide

5 Smoking

5. Smoking 5. Smoking

Smoking doubles your risk of getting heart disease

Stopping smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels

Smoking also increase the risk of other long-term complications, such as eye problems

What is Metabolic syndrome and How is it linked to Heart disease ?

Metabolic syndromeMetabolic syndrome

Metabolic syndrome is a grouping of traits and medical conditions that puts people at risk for both heart disease and type 2 diabetes

It is defined by the National Cholesterol Education Program as having any three of the following five traits and medical conditions :

Conditions are on following slide

What can you do to prevent or delay Heart disease and stroke ?

1. Heart healthy diet1. Heart healthy diet

1. Make sure that your diet is ‘’heart healthy’’ - Include at least 14 grams of fibers daily for every 1,000

calories consumed - Cut down on saturated fat - Keep your cholesterol in your diet to less than 300 mg a day - Keep the amount of Trans fat in your diet minimum

2. Physical activity2. Physical activity

2. Make physical activity part of your routine - Aim for at least 30 min of exercise most days of the week - Think of ways to increase physical activity, such as taking

the stairs instead of elevator.

3. Reach and maintain a healthy body weight - If you are over weight, try to be physically active for at least

1 hour a day - Aim for a loss of no more than 1 to 2 pounds a week

4. If you smoke, quit

5. Ask your Doctor(if you are not) whether you should take aspirin

6. Get prompt treatment for transient ischemic attacks (TIAs) - Early treatment for TIAs may help prevent or delay a future stroke - Signs of a TIAs are , - Sudden weakness - Confusion - Blindness in one or both eyes - Double vision - Difficulty speaking - Severe headache

How will you know whether your diabetes treatment is working ?

The Good News… The Good News…

By knowing the ABCs in diabetes, people with diabetes can reduce their risk for heart disease and stroke.

A stands for A1CB stands for Blood pressureC stands for Cholesterol

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Ask About Your A1CAsk About Your A1C

A1C measures average blood glucose over the last three months.

Get your A1C checked at least twice a year.

A1C Goal = less than 7%

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Key Steps for Lowering A1CKey Steps for Lowering A1C

Eat the right foods.

Get daily physical activity.

Test blood glucose regularly.

Take medications as prescribed.

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Blood glucose targetsBlood glucose targets

Before meals 90 to 130 mg/dL

1 to 2 hour after the Less than 180 mg/dL start of the meal

Beware of Your Blood PressureBeware of Your Blood Pressure

High blood pressure raises your risk for heart attack, stroke, eye problems and kidney disease.

Get your blood pressure checked at every visit.

Target BP = less than 130/80

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Key Steps for Lowering Blood PressureKey Steps for Lowering Blood Pressure

Eat more fruits and vegetables! Reduce the amount of salt in diet. Lose weight. Lower alcohol intake. Quit smoking. Take blood pressure pills.

– many people require more than one pill

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Check Your CholesterolCheck Your Cholesterol

Several kinds of blood fats:– LDL (“bad”) cholesterol - can

narrow or block blood vessels– HDL (“good”) cholesterol - helps

remove cholesterol deposits– Triglycerides - can raise your risk

for heart attacks/stroke

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ADA Goals for CholesterolADA Goals for Cholesterol

Target LDL = less than 100

Target HDL = above 40 (men) above 50 (women)

Target triglycerides = less than 150

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Key Steps for Controlling Your CholesterolKey Steps for Controlling Your Cholesterol

Eat less saturated fatFoods high in saturated fat: fatty meats, high-fat dairy products, tropical oils

Eat foods high in fiberExamples: oatmeal, beans, peas, citrus fruits

Take cholesterol-lowering medication Exercise regularly

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What type of heart and blood vessel

Disease occur in

The people with diabetes ?

Heart & blood vessel disease in diabetes Heart & blood vessel disease in diabetes

Two major type of cardiovascular disease are common in people with diabetes

Coronary artery disease (CAD) Cerebral vascular disease

People with diabetes are also at risk for heart failure

Narrowing or blockage of the blood vessels in the legs, a condition called (PAD) also occurs in people with diabetes

Coronary Artery Disease

Coronary Artery DiseaseCoronary Artery Disease

CAD also called ischemic heart disease, is caused by hardening or thickening of the walls of blood vessels that go to the heart

If the blood vessels to the heart become narrowed or blocked by fatty deposits, the blood supply is reduced or cut off, resulting in the heart attack

Cerebral Vascular Disease

Cerebral Vascular DiseaseCerebral Vascular Disease

Cerebral vascular disease affects blood flow to the brain, leading to strokes and TIAs.

It is caused by narrowing, blocking, or hardening of the blood vessels that go to the brain or by high blood pressure

Stroke

StrokeStroke

A stroke result when the blood supply to the brain is suddenly cut off, which can occur when a blood vessel in the brain or neck is blocked or bursts

Brain cells are then deprived of oxygen and die A stroke can result in problem with speech or vision or can

cause weakness or paralysis and coma.

Stroke continue…Stroke continue…

People with diabetes are at increase risk for strokes caused by blood clots

A stroke may also be caused by bleeding blood vessel in the brain Called an aneurysm, a break in a vessel can occur as a result of high blood pressure

Transient ischemic attacks

Transient ischemic attacks(TIAs)Transient ischemic attacks(TIAs)

TIAs are caused by a temporary blockage of a blood vessel to the brain

This blockage lead to a brief, sudden change in brain function, such as temporary numbness or weakness on one side of the body

However, most symptoms disappear quickly and permanent damage is unlikely

If symptoms do not resolve in a few minutes, rather than a TIAs, the event could be a stroke

TIAs means that a person is at risk for a stroke sometimes in future.

Heart failure

Heart failureHeart failure

Heart failure is a chronic condition in which the heart can not pump blood properly – it does not mean that heart suddenly stop working

Heart failure develops over a period of years, and symptoms can get worse over time

People with diabetes have at least twice the risk of heart failure as other people

Heart failure continue…Heart failure continue…

One type of heart failure is congestive heart failure, in which fluid builds up inside body tissue

If the buildup is in the lungs, breathing becomes difficult

Blockage of the blood vessels and high blood glucose levels also can damage heart muscle and cause irregular heart beats

Heart failure continue…Heart failure continue…

People with damage to heart muscle, a condition called cardiomyopathy, may have no symptoms in the early stages, but later they may experience

- Weakness - Fatigue - Shortness of breath - Swelling of the legs and feet - Severe cough

diabetes also interfere with pain signals normally carried by the nerves

That is why a person with diabetes may not experience the typical warning signs of a heart attack. (Silent killer)

Peripheral Arterial Disease

Peripheral Arterial DiseasePeripheral Arterial Disease

Common in people with diabetes

With this condition, the blood vessel in the legs are narrowed or blocked by fatty deposits, decreasing blood flow to the legs and feet

PAD increase the chances of a heart attack or stroke occurring

Some times people with PAD develop pain in the calf or other parts of the legs when walking, which is relieved by resting for few minutes

How will I know whether I have heart disease ?

Signs & symptoms of heart attackSigns & symptoms of heart attack

Chest pain or discomfort (angina)

Pain or discomfort in your arms, back, jaw, neck, or stomach

Shortness of breathing

Sweating

Nausea

Light-headedness

Symptoms continue…Symptoms continue…

Symptoms may come and go

However, in some people, particularly those with diabetes, symptoms may be mild or absent due to nerve damage caused by diabetes

Women may not have chest pain but more likely to have SOB, nausea, or back and jaw pain

If you have symptoms like that call 911 right away

Because treatment is most effective if given within an hour of heart attack, if delay lead permanent damage of heart

What are the treatment options For

Heart disease

Treatment for heart diseaseTreatment for heart disease

Treatment for heart disease includes meal planning to ensure a heart-healthy diet and physical activity

In addition, you may need medications to treat heart damage or to lower your blood glucose, BP, and cholesterol

You also may need surgery or some other medical procedure

How will I know

Whether I have had a stroke ?

Signs & symptoms of strokeSigns & symptoms of stroke

Sudden weakness or numbness of your face, arm, or leg on one side of your body

Sudden confusion, trouble talking, or trouble walking

Sudden trouble seeing out of one or both eyes or sudden double vision

Sudden severe headache

If you have any of these symptoms call 911 right away

What are the treatment options

For

Stroke

Treatment for strokeTreatment for stroke

At the first sign of a stroke, you should get medical care right away

If blood vessels to your brain are blocked by blood clots, ‘’clot-busting’’ drugs is useful

The drug must be given soon after a stroke to be effective

Subsequent treatment for stroke includes medications and physical therapy, as well as surgery to repair the damage

Meal planning and physical activity may be part of your ongoing care

In addition, you may need medications to lower your blood glucose, blood pressure, and cholesterol and to prevent blood clots

Key Points ReviewKey Points Review

People with diabetes are at a very high risk for heart attack and stroke.

More than 2 out of 3 of people with diabetes die of heart disease or stroke.

Diabetes is more than managing blood glucose. It’s managing blood glucose and blood pressure and cholesterol.

Know the ABCs of Diabetes.

More treatments are available than ever before. Talk to your healthcare provider and learn what you can do to manage your ABCs.

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General TipsGeneral Tips

Take steps to lower your risk of D-CVD complications:– A1C < 7.

– Blood pressure < 130/80.

– Cholesterol (LDL) < 100.

– Cholesterol (HDL) > 40 (men) and > 50 (women).

– Triglycerides < 150.

– Get help to quit smoking.

– Be active.

– Make healthy food choices.

– Talk to your doctor about medication.18

For More InformationFor More Information

Call: 1-800-DIABETES

Visit: www.diabetes.org/MakeTheLink

Email: MakeTheLink@diabetes.org

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