Diabetic Heart Disease

What is diabetes?

Diabetes is a disease in which your blood glucose, or blood sugar, levels are too high. Glucose comes from foods you eat. The cells of your body need glucose for energy. A hormone called insulin helps the glucose get into your cells.

With type 1 diabetes, your body doesn't make insulin. With type 2 diabetes, your body doesn't make or use insulin well. Without enough insulin, glucose builds up in your blood and causes high blood sugar levels.

What is diabetic heart disease?

Diabetic heart disease is a term for heart disease in people who have diabetes. If you have diabetes, you are much more likely to develop heart disease or have a stroke than people who don't have diabetes. And you may start having these problems at a younger age.

Over time, the effects of high blood sugar from diabetes can include damage to the blood vessels and nerves in your heart. This damage increases your chance of developing heart diseases, including:

• Coronary artery disease (CAD). It happens slowly as a sticky material called plaque builds up in the arteries that supply your heart muscle with blood.
• Heart failure. With this condition, your heart can't pump enough oxygen-rich blood to meet the needs of your body.
• Cardiomyopathy. This is a group of diseases in which the heart muscle may become thick or stiff.

Who is more likely to develop diabetic heart disease?

Diabetes puts you at serious risk for heart disease. It also makes you more likely to develop other conditions that raise your risk even more, including:

• High blood pressure
• High blood levels of LDL "bad" cholesterol
• High triglycerides (a type of fat in your blood) with low blood levels of HDL "good" cholesterol

Your risk for heart disease is also higher if you

• Are male
• Smoke
• Have obesity
• Have too much belly fat around your waist, even though you're at a healthy weight:
  • For men, that's a waist more than 40 inches
  • For women, that's a waist more than 35 inches
• Have a family history of heart disease
• Have chronic kidney disease

What are the symptoms of diabetic heart disease?

In the early stages, heart disease usually doesn't have any symptoms. But if your heart disease worsens, you can have symptoms. Your symptoms will depend on the type of heart disease you have. They might include:

• Shortness of breath
• Fatigue
• Dizziness or fainting
• Arrhythmia (problem with the rate or rhythm of your heartbeat)
• Swollen feet and ankles
• Chest pain

It's important to know that people with diabetes may not feel chest pain. That's because diabetes can damage the nerves in your heart. If you have any symptoms that could be heart disease, talk with your health care provider.

How is diabetic heart disease diagnosed?

To find out if you have diabetic heart disease, your provider will:

• Ask about your medical history, including your symptoms and other health conditions you may have
• Ask about your family history, to find out if you have relatives who have or had heart disease
• Do a physical exam
• Likely run some tests to help understand your personal risk for heart disease, including:
  • Blood tests to check your cholesterol, triglycerides, and blood sugar levels
  • A blood-pressure check
  • Heart tests, if needed

Depending on your risk level, your provider may send you to a cardiologist (a doctor who specializes in heart diseases) for care. If you do have heart disease, treatment will depend on the type of heart disease you have.

How can I prevent diabetic heart disease?

You may be able to prevent heart disease or keep it from getting worse by working with your provider to:

• Control your blood sugar levels
• Manage other conditions you may have that can raise your risk for heart disease
• Take any medicines your provider prescribed
• Make heart-healthy habits part of your daily life
• Follow a healthy eating plan for diabetes

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Diabetic Kidney Problems

If you have diabetes, your blood glucose, or blood sugar, levels are too high. Over time, this can damage your kidneys. Your kidneys clean your blood. If they are damaged, waste and fluids build up in your blood instead of leaving your body.

Kidney damage from diabetes is called diabetic nephropathy. It begins long before you have symptoms. People with diabetes should get regular screenings for kidney disease. Tests include a urine test to detect protein in your urine and a blood test to show how well your kidneys are working.

If the damage continues, your kidneys could fail. In fact, diabetes is the most common cause of kidney failure in the United States. People with kidney failure need either dialysis or a kidney transplant.

You can slow down kidney damage or keep it from getting worse. Controlling your blood sugar and blood pressure, taking your medicines and not eating too much protein can help.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Diabetic Nerve Problems

If you have diabetes, your blood glucose, or blood sugar, levels are too high. Over time, this can damage the covering on your nerves or the blood vessels that bring oxygen to your nerves. Damaged nerves may stop sending messages, or may send messages slowly or at the wrong times.

This damage is called diabetic neuropathy. Over half of people with diabetes get it. Symptoms may include:

• Numbness in your hands, legs, or feet
• Shooting pains, burning, or tingling
• Nausea, vomiting, constipation, or diarrhea
• Problems with sexual function
• Urinary problems
• Dizziness when you change positions quickly

Your doctor will diagnose diabetic neuropathy with a physical exam and nerve tests. Controlling your blood sugar can help prevent nerve problems, or keep them from getting worse. Treatment may include pain relief and other medicines.

NIH: National Institute of Diabetes and Digestive and Kidney Diseases

Medical Ethics

The field of ethics studies principles of right and wrong. There is hardly an area in medicine that doesn't have an ethical aspect. For example, there are ethical issues relating to :

• End of life care: Should a patient receive nutrition? What about advance directives and resuscitation orders?
• Abortion: When does life begin? Is it ethical to terminate a pregnancy with a birth defect?
• Genetic and prenatal testing: What happens if you are a carrier of a defect? What if testing shows that your unborn baby has a defect?
• Birth control: Should it be available to minors?
• Is it ethical to harvest embryonic stem cells to treat diseases?
• Organ donation: Must a relative donate an organ to a sick relative?
• Your personal health information: who has access to your records?
• Patient rights: Do you have the right to refuse treatment?
• When you talk with your doctor, is it ethical for her to withhold information from you or your family?

Patient Rights

What are patient rights?

As a patient, you have certain rights. Some are guaranteed by federal law, such as the right to get a copy of your medical records and the right to keep them private and secure. Many states have additional laws protecting patients. And some states, insurance plans, medical organizations, and health care facilities have their own patient bill of rights.

Some other examples of patient rights include:

• Being treated with respect
• Not being discriminated against in your medical care
• The right to refuse treatment
• The right of informed consent

What is informed consent?

Informed consent is an important patient right. It is a process in which your health care provider gives you the information you need to make decisions about your care. The types of care could be treatments, procedures, genetic testing, or clinical trials. The information should include the risks and benefits of the care, as well as details about your medical condition.

It's important that you understand everything before you give consent. Sometimes your provider will ask you to sign a form to give your consent. This is called written consent.

You have the right to change your mind about consent at any time.

Where can I get help with patient rights?

There are different resources that can help you if you have a problem with your patient rights:

• Many hospitals have patient advocates. These are people who can help guide you through the health care system and make sure that your rights are protected.
• Your state may have resources to help you, such as:
  • Your state may have an office (called an ombudsmen office) for problems with long term care.
  • Your state's department of health may be able to help.
  • States also have oversight agencies for insurance companies and various types of health care facilities and providers. These agencies make sure that these organizations and providers follow the rules so you can get quality care.
• The U.S. Department of Health and Human Services has an Office for Civil Rights (OCR). You can file a complaint with them if you feel you have been discriminated against in your medical care or if you think your health information privacy rights have been violated.