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Article by Dr. Sheri Colberg, Phd, FACSM

 

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TYPE 2 DIABETES, CIRCULATION AND CORONARY ARTERY DISEASE (HARDENING OF ARTERIES/ATHEROSCLEROSIS)


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Many people with type 2 diabetes suffer from heart disease caused by circulation problems.

The American Heart Association estimates that heart disease and stroke are responsible for two-thirds to three-quarters of all deaths among persons with diabetes.

But there is good news. Steps can be taken to greatly reduce the degree of circulation-related heart disease in persons with diabetes. This process involves a careful combination of diet and regular exercise to lose weight and maximize effective diabetes management by reversing Insulin Resistance to increase insulin sensitivity.

Persons with diabetes run a greater risk of developing cardiovascular problems, with the most common heart condition being coronary artery disease - also called hardening of the arteries or atherosclerosis. This condition consists of a build-up of plaque in the blood vessels that supply oxygen and nutrition to the heart and then on to other parts of the body like the brain. Plaque, which is made up of cholesterol and other fatty substances as well as fibrin and calcium, can block these vital blood vessels, causing them to rupture and prevent blood flow.

Doctor and woman chatting.The build-up usually begins before the blood sugar level increases that occur in type 2 diabetes. In other words, heart disease has often established itself prior to a diagnosis of diabetes.

Studies have shown that hyperinsulinemia (high blood insulin levels) and hyperglycemia (high blood glucose levels) can lead to atherosclerosis. High levels of glucose cause proteins to become sticky and not function properly. This can occur in several areas, including the inner lining of the blood vessels where proteins travel in the blood.

These proteins with glucose stuck to them are called AGEs, or advanced glycosylation end products, which accumulate in the blood and become incorporated in the walls of the arteries to form atherotic plaques. Macrophages, or immune cells, play a big role in forming plaques. They absorb glycosylated proteins and LDL "bad" cholesterol particles, swell up to become foam cells and enter into the now-sticky arterial wall. This process causes the blood vessel to narrow and restrict blood flow.

Recent studies have shown that, in persons with type 2 diabetes, inflammation is also linked to the development of artery damage known as atherosclerosis. (1,2)

Inflammation is the body's defensive response to harmful stimuli. The latter can range from an external example like a splinter in your finger, causing reddened, inflamed skin, to a complex internal process in response to a harmful condition like high blood pressure.

In the case of diabetes, the harmful stimuli are thought to elevated levels of insulin - a classic symptom of Insulin Resistance.

If neglected over the years, a cause of inflammation like high blood pressure can lead to serious damage to the body. The medical profession is still studying and evaluating the role of inflammation in a wide variety of disorders than can be inter-connected like diabetes, the cluster of increased risks for cardiovascular disease called Metabolic Syndrome (Syndrome X) and Polycystic Ovarian Syndrome (PCOS), a leading cause of menstrual irregularity and infertility as well as skin conditions, excess facial and body hair and female baldness.

To learn more, please click on Inflammation, Insulin Resistance and Diabetes.

People with diabetes are prone to the development of plaque in their arteries. The plaque can break apart, causing blood clots which can block the blood vessel and cause a stroke.

High blood sugar levels increase the chance of plaque breaking loose. Normally plaque is protected by the smooth muscle in the middle layer of the vessel wall. But when the smooth muscle layer dies and becomes calcified, it can no longer prevent plaque from breaking loose.

Artistic imagery of a muscular man.The smooth muscle layer may die due to Diabetic autonomic neuropathy, or nerve damage, resulting from high blood sugar levels which cause the nerve supplying the smooth muscle to die. The same process can happen in all of the arteries in the body, resulting in lack of blood to the brain, causing a stroke, or to the heart, resulting in a heart attack. It can also cause a lack of blood to the feet, hands or arms, creating peripheral vascular disease which may lead to the need for amputation.

People with high blood sugar levels also tend to form clots easier in the blood, due to higher levels of certain clotting factors like fibrinogen, lipoprotein and platelets that become even more sticky with elevated glucose levels. All of these factors can be normalized by keeping the blood sugar levels controlled by reversing Insulin Resistance.

Persons with diabetes are also at higher risk for heart failure, a condition in which the heart is not able to pump blood adequately. This can lead to fluid build-up in the lungs that causes difficulty breathing or fluid retention in other parts of the body (especially the legs) that causes swelling.

Young lady standing, wearing a t-shirt and jeans.The best way to prevent circulation problems causing heart and blood vessel disease is to manage your diabetes as efficiently as possible by reversing Insulin Resistance. The resulting increase in insulin sensitivity will lead to more effective control of blood sugar and insulin.

You can help this process by adopting a healthy lifestyle that includes a balanced, nutritious diet and regular exercise to lose weight.

It's also advisable to work out a regime that's right for your individual needs by consulting your doctor and a nutritionist. Insulin-dependent persons with diabetes have a particular need to closely monitor their insulin levels, especially during exercise.

Some general guidelines for avoiding circulation problems associated with diabetes include:

  • Keeping blood glucose in the optimal range: 80-100 mg/dl fasting; 140 mg/dl 2 hours after eating; 100-140 mg at bedtime.
  • Controlling your blood pressure, with medication if necessary. The target for people with type 2 diabetes is under 130/80, with an optimal goal of below 128/80.
  • Get your cholesterol numbers under control. This can be achieved by diet and exercise, as well as controlling your blood sugar and reversing Insulin Resistance - the imbalance in blood glucose and insulin levels, which often underlies excess weight and obesity. Reducing your dietary carbohydrate intake can also help achieve these goals.
  • Lose weight if you are overweight or obese.
  • Exercise regularly.
  • Eat a heart-healthy diet, which contains good fats, such as omega-3 fatty acids from salmon, walnuts, seeds and flax oil.
  • Quit smoking.

(1) G. Wehrwein et al. Lipopolysaccharide regulated protein expression is only partly impaired in monocytes from patients with type 1 diabetes.
Cardiovasc Diabetol. 2006 Mar 27;5:5.

(2) Pavel N. Shaskin et al. Insulin and Glucose play a role in foam cell formation and function.
Cardiovasc Diabetol. 2006 Jun 20; 5:13.

 

 

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