When you hear “diabetes” what comes to mind?

When you hear “diabetes” what comes to mind? Most people think high blood sugar along with images of obesity, cookies, and desserts. Elevated blood sugar is indeed a prominent and obvious part of diabetes.  Patients see it for themselves as they check their blood sugar; they also experience first hand symptoms of out- of- control blood sugar like excessive urination, unquenchable thirst and even coma that sends them to the intensive care unit.

However, diabetes is more than just high blood sugar, it’s a disease of the arteries. Seven out of ten diabetic deaths are due to heart attacks and strokes, not elevated blood sugar. Diabetes makes all our arteries, large and small, much more sensitive to normal wear and tear. Artery damage due to smoking, high blood pressure, and high cholesterol is more susceptible as well.  Merely controlling blood sugar level and keeping A1c at no more than 7%, although necessary, is hardly enough to protect diabetics from the most feared complications of their disease.

So, what can diabetic patients do to get maximum protection of their arteries? Consistently practice a healthy lifestyle (NO smoking cigarettes, keep a healthy diet, and near-daily exercise) AND keep blood pressure low AND take statins AND, possibly, a low-dose (81 mg) aspirin (provided that there are no stomach or serious bleeding problems). Medications like lisinopril or losartan are also important in protecting the kidneys which can commonly fail in diabetes.  Additionally, some new non-statin cholesterol-lowering medications (Praluent and Repatha) are available but at a cost of approximately ten thousand dollars (US) per year of treatment.

Artery testing, especially testing of the heart arteries, is another element of good diabetic care. Within diabetes the nerves that signal heart pain do not work properly, so it’s not unusual for a diabetic patient to have significant clogging of the heart arteries without experiencing any chest pain. Due to this, the doctor may recommend a stress test from time to time. Diabetic patients need to create a partnership with their physicians in order to reap the full benefits of diabetes education and disease prevention.

Anthony Pothoulakis, MD, FACC