Many people with diabetes are unaware of the complications that develop when diabetes is not well controlled. These include retinopathy, or damage to the retinas of the eyes, that can lead to blindness; neuropathy, or nerve damage; kidney failure, which can lead to dialysis; and cardiovascular disease. The term cardiovascular disease generally refers to diseases that include the heart and blood vessels. The latest statistics from the Texas Department of Health Services places diabetes as the sixth leading cause of death in Texas. The first and third leading causes of death in Texas are from heart attacks and strokes (cardiovascular diseases). In the Rio Grande Valley the death rate from diabetes is higher than in many other parts of Texas. It is also estimated that death from diabetes is underreported.

Diabetes and its effects on the cardiovascular system is a slow and progressive process. If a diabetic person also has high blood pressure and abnormal lipids (high total cholesterol, high triglycerides, high LDL, and low HDL), which is a common finding in poorly controlled diabetics, the disease process is much more accelerated. The vessels that supply blood to the heart and the brain begin to stiffen, plaque develops inside them, and the blood supply to the heart and brain is greatly diminished. Decreased blood supply to the heart leads to symptoms of ischemia. A person may experience shortness of breath with activities, pressure–like chest pain, or feelings of fatigue. This can also lead to a heart attack and possible death. Sometimes signs of ischemia can be found on an–electrocardiogram (ECG or EKG) when the symptoms are more pronounced. A stress test almost always helps to determine if a patient has ischemia from narrowing heart vessels (coronaries). Adding smoking and family history of cardiovascular disease increases the risk of complications and premature death.

When ischemia develops in the brain, it is called a stroke. This can cause weakness or numbness on one–side of the body. Slurred speech also develops in those that are having a stroke. The narrowing of the carotid arteries (neck arteries), which supply blood to the brain, can be detected with an ultrasound exam (carotid Doppler) to determine the extent of the narrowing. High blood pressure is also a type of cardiovascular disease. Its constant high force can enlarge the heart, weaken it (heart failure), and cause hemorrhagic (bleeding) strokes. When the vessels in the lower legs are narrowed, it is termed peripheral arterial disease (PAD). In this condition, the blood supply to the lower legs and feet is severely diminished. A person with PAD often feels pain in the legs when walking or exercising (claudication). In severe cases, the toes or feet can change color from a lack of blood circulation and can become very painful. For diabetics, this can make it very difficult to treat wounds, like ulcers or infections, and may result in amputations.

It takes many years of poorly controlled diabetes to get to these stages. However, early intervention with diet, exercise, and medications, and keeping the Hemoglobin A1C less than 7.0% is essential to prevent or even slow down the progression of these complications. Risk factors for developing diabetes are: being of Hispanic origin, family history of diabetes, being overweight, and having a sedentary lifestyle. A simple blood test can help determine if you are diabetic or have “pre–diabetes”. Ask your doctor if you should undergo testing for diabetes.

by Fernando Valdez, MD