Physician Referral Online

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Physician Referral Online
Using your own criteria, you can request information from a database of 900 area physicians who have registered to participate.

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Manage your risk of heart disease

Although the link between diabetes and heart disease has been more widely communicated in the last five years, this survey indicates there is still a lack of understanding of the connection between the two diseases.

Almost everyone with diabetes is very aware of some of the more prominent complications of diabetes such as blindness, kidney disease and peripheral vascular problems that may result in amputations. These complications are generally restricted to patients with diabetes—unlike heart disease, which afflicts many Americans without diabetes. This may be one reason this misconception continues to exist in patients.

The fact is cardiovascular disease is the chief cause of death in between 70 and 80 percent of patients with type 2 diabetes, which is by far the more prevalent form of the disease. Diabetic patients have high levels of blood sugar in their bodies, which can damage vascular tissue and promote the atherosclerotic process. And perhaps even more important than the blood sugar level itself is a condition we call “insulin resistance syndrome” or “metabolic syndrome” that is present in the vast majority of patients with diabetes.

Metabolic syndrome
This condition is relatively common. Approximately 20 to 25 percent of Americans have a cluster of characteristics—obesity, particularly disproportionate amounts of abdominal fat; elevated blood pressure, blood sugar and triglycerides and low levels of HDL, the “good” cholesterol. Resistance to the action of the hormone insulin may be the root cause of this syndrome.

The metabolic syndrome greatly increases the risk of diabetes, heart attacks and stroke. This syndrome has led some scientists to refer to the “common soil hypothesis,” that is both diabetes and heart disease grow in the same “soil” of metabolic syndrome; hence, the strong link between the two diseases.

The syndrome stimulates the diabetic process by taxing the pancreas to make more and more insulin. Once this process takes hold, it can be difficult to reverse, so preventive measures, including low-fat diet, weight loss and exercise are very important. Though experts say the syndrome may be caused by a combination of genes and lifestyle factors, lifestyle—including overeating and a lack of exercise—may be the most important factor.

What is diabetes?
Diabetes is a disease in which your body is unable to properly use and store glucose, a form of sugar. There are two major types of diabetes:

• In type 1 (also called juvenile-onset or insulin-dependent) diabetes, your body completely stops producing insulin, a hormone that enables your body to use the glucose in foods for energy. People with type 1 diabetes must take daily insulin injections.
• In type 2 (also called adult-onset or non insulin-dependent) diabetes, the body produces insulin, but not enough to overcome an underlying resistance to its action.

Diabetes is defined as having a fasting blood sugar level of 126 mg/dl or greater on two separate occasions. If diabetes symptoms exist and you have a random blood sugar taken at any time that is equal to or greater than 200 mg/dl, and a second test shows the same high blood sugar level, then you have diabetes.

Prediabetic state
In general, people who have a fasting blood sugar in the 110-125 mg/dl range are defined as having “impaired fasting glucose,” which can be considered a prediabetic state. A similar condition is referred to as “impaired glucose tolerance.” People with such borderline blood sugar readings can reduce their risk of type 2 diabetes by 58 percent by losing just 7 percent of their body weight and by exercising moderately for 30 minutes per day.

What can you do to reduce your risk of heart disease?
If you've been diagnosed with diabetes, there are several things you can do to reduce your risk of heart disease.

1. Control your glucose levels. Follow your doctor's advice about diet and exercise and be aware that there are some new medications that, when used in combination with other drugs, may help you get better control of your blood sugar.
2. Control your blood pressure and ask your physician if you should be taking an ACE inhibitor. New evidence indicates even patients with diabetes who do not have high blood pressure may reduce their risk of heart disease by taking ACE inhibitors.
3. Seek aggressive treatment for high cholesterol. New evidence indicates even patients with diabetes who do not have high cholesterol may reduce their risk of heart disease by taking certain lipid-lowering drugs, known as “statins.”
4. Stop smoking.
5. Maintain a healthy weight.
6. Exercise regularly.
7. Talk to your doctor about taking aspirin every day.

The incidence of diabetes is approaching epidemic proportions. Both obesity and inactivity are becoming more common at younger ages, and for the first time, we are seeing type 2 diabetes in children in addition to the more highly publicized worldwide increase among people of all ages. Healthy eating habits and regular exercise can help prevent diabetes, but if you are diagnosed, learn all you can about how to minimize your risks for serious health consequences.

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Dr. Inzucchi is an attending physician at Yale-New Haven Hospital, as well as the director of the Yale Diabetes Center and associate professor of medicine at the Yale University School of Medicine.