Farquhar: Diabetes a ‘silent killer’
The statistics are grim—up to 80 per cent of people with diabetes will die prematurely from heart disease, on average 10 to 15 years younger than those without diabetes.
Although high blood pressure has been referred to as “the silent killer,” I believe that title more aptly belongs to type 2 diabetes, in which blood vessels are damaged for years before the diagnosis of diabetes.
Complications, which may have taken years to develop, are often the presenting feature of diabetes.
“The clock is ticking” long before disaster actually strikes.
Often diabetes is identified only when an individual presents to the hospital with a heart attack.
I have seen many patients who believed that their heart attack caused diabetes. How wrong that is, for diabetes causes heart attacks!
Diabetes is a complex disease which causes extensive damage to both large and small blood vessels.
Protecting blood vessels is what diabetes management is all about.
This involves a much more comprehensive approach than focussing only on blood glucose which, though important, is certainly not the most important in terms of avoiding a heart attack.
Trials involving tens of thousands of people with diabetes show very clearly that in terms of “bang for the buck” lowering LDL cholesterol level has most impact on reducing risk of a heart attack.
The good news is that statin drugs do this very effectively and, for the vast majority of people, very safely.
Blood pressure control comes a close second, but is much more difficult to achieve and requires significantly more drugs.
Controversy continues to rage over the role of blood glucose control in preventing heart attacks and strokes.
Glucose is important, but near normal levels are notoriously difficult to achieve without running the risk of hypoglycemia (too low a glucose level), which at best is inconvenient, at worst may be lethal.
Several drugs and/or insulin are usually required to manage glucose levels, often at a prohibitive cost. The complexity and severity of vascular damage in diabetes demands an informed and aggressive approach from both physicians and patients alike.
This complicated disease demands complicated treatment. Multiple drugs are essential.
The more insight you have into why you may require so many drugs, the more likely it is that you will actually take them and derive benefit.
For various reasons some people are reluctant to take prescription drugs.
One individual I saw was very suspicious of my encouraging her to take a statin for her cholesterol.
She thought I had a vested interest in that I derived some kind of a financial incentive from the company who made the drug.
I was shocked at her completely misguided comment, stressed there was absolutely no monetary gain for me and explained that my only vested interest was in helping her avoid becoming one of the sad statistics of diabetes.
Drugs are vital for preventing/managing heart disease in diabetes.
But equally important is a firm commitment to a healthy lifestyle—namely not smoking, being a healthy weight, eating a healthy diet , and prioritizing at least 30 minutes a day to some form of physical activity.
Your diabetes is your responsibility. You make all the critical decisions.
The American Heart Association recently noted that falling death rates from heart attack and stroke seen over the past 30 years may be starting to slow down. Indeed, a worrying increase has been noted among young adults ages 35 to 44.
The exploding epidemic of diabetes seems destined to be the forerunner of a new tidal wave of cardiovascular disease.
Our children may be the first generation of Canadians who will not outlive their parents.