Dr Swapnil Mate Cardiologist

Types Of Diabetes

The types of Diabetes include :-

In Type 1 diabetes your immune system attacks and destroys those cells in your pancreas that make insulin. Type 1 diabetes is more common in young children and young adults but can occur at any age. If not diagnosed on time, it can form blood clots as well as high blood pressure and high cholesterol. Over time it can affect major organs of the body including the heart, blood vessels, nerves, eyes, and kidneys. This increases the force of blood through the arteries and can damage artery walls. This stops the supply of oxygen to the heart and can cause a heart attack.

In Type 2 Diabetes, your body does not make or use insulin well. There is no definite age for developing this condition. It can happen at any age, even in childhood. Type 2 Diabetes is the most common type of diabetes. High blood sugar levels, can cause damage to the blood vessels and nerves that control them. Also, if the person's low-density lipoprotein is too high, then it can build fatty deposits of plaque in the arteries, creating blockages and causing part of the heart muscles to die.

Diabetes that occurs when a woman is pregnant is called Gestational Diabetes. Most of the time, this condition can be cured after the baby is born. Women with a history of diabetes during pregnancy were as twice as likely in mid-life to develop calcium in heart arteries, a strong indicator of heart disease. Gestational diabetes can affect the fetus's heart health too, causing thickening of the fetus's heart muscles, a condition known as hypertrophic cardiomyopathy which causes rapid breathing and shortage of oxygen in the fetus's heart muscles.

How Does Diabetes Lead To Cardiovascular Disease?

The hormone insulin produced by the pancreas is responsible for the absorption of food in the intestine and storage of glucose in the muscle and liver(glucose breaks down into glycogen). If glucose is not absorbed by the body cells or stored properly in the liver and muscle, then this might result in an increase in glucose levels in the bloodstream. The high-density lipoprotein is good for the heart since it helps in removing cholesterol deposits from the coronary arteries and transports them to the liver, which then removes them from the body. The low-density lipoprotein transports cholesterol from the liver to other tissues and cells, which use this as energy. If low-density lipoprotein is higher than the high-density lipoprotein Low-density lipoprotein, along with triglycerides, gets deposited in the arterial wall. This causes a slight injury in the walls and to heal, platelets travel to that area which forms blood clots around the area(thrombosis).

Gradually others substances that flow along with the bloodstream like calcium, sodium, glucose, and other substances stick to the walls. All these substances combine with the fatty deposits to form 'plaque'. This substance hardens and if cracks, platelets reach the area, forming more blood clots, resulting in narrowing of the blood vessels. If the blood supply to a heart muscle is very low, it ruptures the entire pumping system of the heart, which includes blood vessels, arteries, capillaries, and veins. Symptoms of a heart attack include chest pain, shortness of breath. In some situations, the skin turns blue since the organs of the body are not getting enough blood.

Risk Factors

Risk factors in a diabetic patient that might lead to cardiac disorders are :

Smoking and alcohol consumption - actively smoking or consuming alcohol makes the blood sticky, and it is most likely to clot, which can obstruct the blood flow to the heart. It also lowers good cholesterol in the body.
High blood pressure - High blood pressure or hypertension makes the coronary arteries less elastic, which reduces blood flow to the heart. This makes the heart work harder, causing stiffening of the heart muscle and death of the cells present in the cardiac muscle.
Cholesterol - The total number of cholesterol in the blood also affects the heart. There are two types of cholesterol, High-density lipoprotein, and low-density lipoprotein. The high-density lipoprotein is good for the heart since it helps in removing cholesterol deposits from the coronary arteries and transports them to the liver, which then removes them from the body. The low-density lipoprotein transports cholesterol from the liver to other tissues and cells, which use this as energy. Low-density lipoprotein, along with triglycerides, gets deposited in the arterial wall, obstructing the blood flow to the heart. This can cause a heart attack. Cholesterol levels can be controlled by following a strict diet that does not contain saturated fats.
Obesity - Obese individuals require more blood so that they can carry oxygen and nutrients to the tissues to function efficiently. This puts pressure on the heart to work harder, which stiffens the heart muscle, reducing blood flow. (For type 2 diabetes)
Lack of physical exercise - Lack of physical activity increases blood cholesterol, blood pressure, and blood sugar levels.
Stress - A person can react to stress in ways that can contribute to heart disease, for example, smoking, alcohol consumption. Overeating, etc.
Sleep - Not getting the required amount of sleep can lead to a possible episode of a heart attack because while sleeping, your blood pressure reduces, maintaining its optimum level. If a person does not get enough sleep or does not sleep at all, it puts pressure on the heart to work harder. This stiffens the heart muscle, causing damage to the tissues of the muscle.

Signs And Symptoms

Signs and symptoms of a person diagnosed with diabetes are :

Weight loss( In type 1): Weight gain ( In type 2)
Abnormal production and passage of urine
Excessive thirst
Excessive desire to eat(Overeating)
Fatigue
The person might feel very lethargic
Blurry vision

Blurry vision
Headache
Wounds heal slowly
Itchy skin
Pain felt in the abdomen
Excessive sweating
Labored breathing pattern
Seizures; confusion

Further Complications

Diseases that can affect individuals if they do not take proper measures for curbing diabetes are: :

Heart Attack - Accumulation of glucose, calcium, protein, cholesterol, triglycerides in the walls of the coronary arteries results in the formation of plague, which blocks the passage of blood flow to the heart muscle. If the blood supply to a heart muscle is very low, it ruptures the entire pumping system of the heart.
Heart Failure - Congestive cardiac failure can take place when the heart has completely lost its ability to pump blood to other organs of the body. Heart failure results in developing excess fluid in and around the lungs, coughing blood, shortness of breath, swelling of the abdomen, legs, and ankles.
Cardiac Arrest -happens when there is a sudden loss of blood in the body due to failure of the heart to pump blood. It requires immediate action like performing CPR to restore the lack of oxygen in the body.
Diabetic Retinopathy - This is referred to damage to the retina of the eye and retinal circulation due to high blood sugar. The symptoms include blurred vision and headaches.
Peripheral artery disease - Peripheral arteries are a part of the circulatory system that are present in the legs, arms, feet, kidneys, and so on. The peripheral arteries supply oxygen-rich blood to the body and take deoxygenated blood to the heart for its oxygenation. Peripheral artery disease takes place when fatty deposits like triglycerides, 'bad cholesterol' (low-density lipoprotein) get accumulated in the walls of the peripheral arteries.
Coronary artery disease- This is a condition where the coronary arteries are narrowed and hardened due to a lack of oxygen-rich blood supply to the heart muscle by the cholesterol deposits in the walls of the coronary arteries. This results in the death of the heart muscle, leading to a heart attack or gradually progressing to heart failure. The coronary arteries supply oxygen-rich blood to the heart muscle. The functioning of the arteries is responsible for the continuous flow of oxygen and nutrients to the heart.
Congenital heart disease - is inherited, either genetically or through unhealthy habits practiced by pregnant women. This can lead to heart defects in infants, which might progress to a possible heart failure in the future

Prevention And Treatment

This includes :

Lifestyle changes - this involves adhering to a strict diet plan that does not include foods that are high in cholesterol and sugar. Quitting consumption of alcohol and smoking can lead to a speedy recovery. Engaging in physical activities regularly can improve cardiac health. It can also help lose weight since weight loss can keep cholesterol, blood sugar, and blood pressure at optimum levels. The individual also needs to manage stress, since stress can lead to engaging in such acts that can hamper cardiac health.
Low-Density Lipoprotein and High-Density Lipoprotein test to check the amount of good cholesterol and bad cholesterol in the blood
C-Reactive Protein test to check whether the immune system is performing its function of fighting illness. If not, CRP will be lower.
International Normalized Ratio - INR checks the tendency of the blood to clot.
Glucose tolerance test - done to see whether the individual's body can remove glucose from the bloodstream.
Blood pressure test
Triglyceride test to check the number of fatty acids in the body
Coronary calcium scan to check calcium deposits in the coronary arteries that cause narrowing of the arteries and cause a heart attack.
Electrocardiogram that checks the electrical activity of the heart. A Holter monitor is also used if the electrical activity of the heart has to be monitored for 24 hours.
Cardiac stress test to check the heart response to vigorous and strenuous activities like running, swimming.
Medications - include SGLT2 inhibitors or gliflozins which reduce blood glucose levels without activating the release of insulin from the pancreas. They also reduce blood pressure in diabetic patients. Medications like SGLT2 inhibitors and GLP-1 help reduce obesity, hypertension, and blood sugar levels since these three factors contribute to heart diseases. For those who already have had their first heart attack, PCSK9 inhibitors are given to reduce cholesterol levels or low-density lipoprotein in the patient's circulatory system.
Bariatric Surgery - Also known as weight loss surgery, this is done on type 2 diabetic patients who are going through obesity. This includes Sleeve Gastrectomy, where the stomach is freed from other organs and the maximum amount of the stomach is removed. The Roux-en-Y Gastric Bypass, where the stomach is divided into a smaller and larger portion in which the larger portion is bypassed and no longer stores or digests food. The intestine is divided and the smaller portion is attached to it for storing food. The small bowel segment is attached to it for bowel movement which resembles the shape of Y. Adjustable Gastric Band is a device that is attached to the top part of the stomach.

The faculty of Dr. Swapnil Mate's Cardiology clinic includes experienced cardiologists, cardiac surgeons, cardiac imaging specialists, a preventive cardiology team, experienced pediatric cardiac surgeons and assisting surgeons, physical therapists, nutritionists, geneticists, child-life specialists, and a group of pathologists who run by tests and give the proper cause of diseases. The cardiologists and surgeons recommend the ideal surgery to the patients. They mention the advantages and risks associated with the surgeries they plan to do on them. Together, they provide extensive care to mothers and children, providing services that cater to their needs. Consult Dr. Swapnil Mate for the best medical assistance.