DIABETES is a disorder of the body which affects our body’s ability to process carbohydrates, and the end product glucose. It is commonly known in Jamaica as “sugar”. There are two main types of diabetes – Type I and Type II.

Type I diabetes

Type I diabetes is less common and occurs in younger people. It occurs when the pancreas, (the organ that makes insulin), is not functioning well. In this case, the body lacks insulin.

The key marker of type I diabetes is that the patients are dependent on insulin. Without external insulin, which is administered either via daily injections or a pump, type I diabetics become very ill – the worst case scenario being a type of coma.

Type II diabetes

Type II diabetes is more common, and is considered a lifestyle illness. This means that poor dietary choices and minimal physical activity lead to a build-up of fat, mainly in the belly, and eventually to insulin resistance.

In this type of diabetes, the problem is not a lack of insulin. The body makes enough insulin but for multiple reasons does not respond well to the insulin. Over the course of the illness, however, the function of the pancreas declines, and there may be a relative insulin lack. Type II diabetics are not considered to be insulin dependent, though some patients may require insulin as the illness advances, in order to achieve good control of the diabetes.

How do we diagnose diabetes?

The diagnosis of diabetes is based on a combination of symptoms and blood tests. Some patients may not experience any symptoms of diabetes and may be diagnosed coincidentally, when routine screening is done.

The common symptoms of diabetes are related to the effects of high blood sugar levels and include increased thirst, feeling hungry all the time, and passing large volumes of urine. There may be other symptoms as well, depending on the duration of the illness without treatment.

The blood tests done to diagnose diabetes is mainly the blood glucose level, we check it in the fasting state and commonly two hours after a meal. We also check the Hba1C, which tells us about your blood glucose level average over the past three months.

* Normal fasting 4-6 mmol/L

* Normal two-hour post meal 8-10mmol/L

* Normal Hba1c less than 7%

How does diabetes affect the heart?

Over the long term, poor diabetes control leads to injury of the lining of the blood vessels and can lead to damage to the blood vessels of the eyes, kidneys and nerves, (called microvascular changes), as well as the blood vessels of the heart, brain and legs (macrovascular changes). These changes in the heart may lead to the rapid build-up of plaque inside the coronary arteries, especially if other illnesses are present, such as hypertension and high cholesterol, along with poor choices like cigarette smoking.

So the most common effect of diabetes on the heart is coronary artery disease. The symptoms of coronary artery disease range from none to chest pain during activity (angina), to heart attack.

In addition to coronary artery disease, diabetes may lead to “diabetic cardiomyopathy”, which is where there is obvious blockage of the coronary arteries, but the heart is weak and in some cases enlarged. The factors that lead to this heart weakness are not clear, and are the subject of intense ongoing research.

So, what can you do to protect your heart if you have been diagnosed with diabetes?

The diagnosis of diabetes is not a life sentence, and patients with diabetes can live a long life of good quality if they take care of themselves. This involves regular check-ups with your physician, taking the medications as prescribed, and sticking to the goals that you and your physician set for you.

For type II diabetes, the most important thing they can do is adjust their lifestyle by incorporating healthy meal choices, as well as a regular exercise routine or high level of physical activity.

Dr Claudine Lewis is an adult cardiologist and medical director at Heart Smart Centre in Montego Bay. She is also a cardiologist at the Cornwall Regional Hospital and an associate lecturer with the University of the West Indies. Questions may be sent to questions@heartsmartcentre.com and for additional information call 684-9989 or visit the website www.heartsmartcentre.com