I Decide to Be More Active
Story by Catherine O'Neill Grace, Photos by Walter P. Calahan
Taking control of diabetes and cardiovascular risk factors can mean getting your life back
When Donna Thompson and her husband, Frank, stepped out on New Year’s Eve, they had a lot to celebrate.
“We went out and danced the whole night away — and I felt fi ne,” says Thompson, of Fullerton, Md. Not only that, they were the last couple up and dancing when the party wound down at 2 a.m. on January 1, 2008.
But that’s not the way the Thompsons’ New Year’s Eves had been going in recent years. Donna, who has type 2 diabetes, had been feeling more and more fatigued as she grew older — something she thought was inevitable.
“I developed gestational diabetes with my second daughter,” Thompson says. “I was told that it might come back later in life, and it did. My mother also has type 2 diabetes.”
Even so, she did not connect her fatigue with diabetes — and she didn’t think about cardiovascular disease at all.
“I was walking up the driveway to work one morning and I was so tired that I had to stop and put my stuff down,” says Thompson, who is an event coordinator for Good Samaritan Hospital in Baltimore. “I rested and then I picked up my stuff, went in to my offi ce and just went on working. I thought I was just stressed out.”
It turned out she was in atrial fi brillation, a potentially serious irregular heart rhythm. A cardiologist put her on medication, and although the heart rhythm was back under control, her tiredness persisted.
“I wasn’t feeling so good one day, and I was talking to the diabetes educator here. She suggested I see Dr. Shomali. He really straightened my life out,” Thompson says.
Mansur E. Shomali, MD, an endocrinologist and researcher, is medical director of the Good Health Center at Good Samaritan Hospital. He says he has seen a revolution in diabetes care during his career. “Before we had any treatment for diabetes — and the fi rst treatment was insulin in the 1920s — people used to die of high blood sugar. But that doesn’t happen anymore,” Shomali says. “I can’t imagine practicing endocrinology even 10 or 20 years ago, when we only had two medicines. It’s amazing that in the past five years so many new medicines have come on the market. Nowadays, with medicine and the new monitoring technologies, it’s possible not just to keep high blood sugar from making patients feel bad, but also to prevent complications such as blindness, nerve damage and kidney damage.We really have been able to minimize those.”
More complicated, Shomali says, is the connection between diabetes and heart problems.
Endocrinologist Mansur Shomali, MD, works with diabetes patient Donna Thompson to keep her heart healthy.
“When diabetes affects us, it tends to increase the risk of heart attacks and strokes. It’s an unfortunate coincidence of nature that these problems go together,” he says. “The next challenge — one that is already being met both in treatment and in the research arena — is fi nding out how to minimize the effects of diabetes on the heart and the blood vessels.”
Type 2 diabetes, the most common form of the disease, and cardiovascular disease are closely linked. Some 21 million Americans live with diabetes; nearly 95 percent of them have type 2 diabetes.
According to the American Diabetes Association, the most life-threatening consequences of diabetes are heart disease and stroke. These affect people with diabetes more than twice as often as they do others. Most of the cardiovascular complications related to diabetes have to do with the way the heart pumps blood through the body. Diabetes can change the chemical makeup of some of the substances found in the blood, which can cause blood vessels to narrow or clog up completely.
The ADA reports that a diagnosis of diabetes as an adult presents the same risk as already having had one heart attack. More than 65 percent of deaths in diabetes patients are attributed to heart and vascular disease.
Those are alarming numbers, but the good news, as Donna Thompson has discovered, is that diabetes and cardiovascular illness can be managed. It takes discipline and commitment to make the lifestyle changes involved, which include quitting smoking, maintaining a healthy weight and seeking effective medical options for your particular situation.
The good news is that diabetes and cardiovascular illness can be managed, but it takes commitment to make the lifestyle changes involved.
Shomali agrees that while you can’t fi ght genetics, you can manage your risk factors. So when he meets with patients, he tells them about the “ABCs” developed at the National Diabetes Education Program at the National Institutes of Health.
“A is for the A1C blood test that tells you how well your blood sugars are controlled over the previous three months. It should be in the 6-to-7 range; below 6 is normal,” he says.
The next letter, B, is for blood pressure. The goal for most people is 130/80. High blood pressure makes the heart work too hard, which can lead to heart attack and stroke.
C is for cholesterol. The LDL goal for most people should be less than 100. The HDL goal for most people should be above 40. LDL or “bad” cholesterol can build up and clog your blood vessels, which can cause a heart attack or a stroke. HDL or “good” cholesterol helps remove cholesterol from your blood vessels.
“Some people argue that if you have diabetes your LDL should even be under 70,” Shomali says. “That’s the really aggressive recommendation we use if patients are at high risk for having heart disease or have heart disease already.”
“It's a treatable condition — and that’s the most optimistic message you can give as a physician.”
When he sees patients, Shomali says, he reports on their ABC. “‘This is your report card,’ I say. ‘You’ll get one at every visit. Your A1C is this, your blood pressure is that, and your cholesterol is that. Now, here’s where you are doing well, and here’s where you could use some work.’ That work could be improved diet, lifestyle changes, adjusting the dose of a medicine, or all three. Those factors all play into each other.”
Donna Thompson (here with personal trainer Theresa Ryan) has lost 35 pounds since beginning an exercise program.
As people live longer, they stick around long enough to get heart disease. “We can’t change the aging process, but we want to change the behaviors that increase the risk of bad things happening,” Shomali says.
“Everybody’s diabetes is controllable,” he continues. “Everybody has heart disease risk factors that are controllable. It’s not like having a lethal cancer. It’s a treatable condition — and that’s the most optimistic message you can give as a physician.”
It was a message Donna Thompson was delighted to hear.
“When I went to Dr. Shomali I was in really bad shape,” she says. “I wasn’t using my glucometer or checking my blood every day. He did an A1C test, and it was 10.9.”
But now Thompson knows her ABCs. In her efforts to get her blood sugar, blood pressure and cholesterol in line, she has lost 35 pounds and works out regularly both at the Good Samaritan health center and in an aerobics class — not to mention dancing with her husband. Moreover, her heart rhythm is well under control.
“My life is wonderful now,” she says. “I feel like a different person. I feel like I did when I was in my 20s. I appreciate life. And you only have one life, so do it right ." HM
Knowledge is Power
February is American Heart Month, and this year the American Heart Association has launched a nationwide effort to raise awareness about the connection between diabetes and heart disease. Through its “Heart of Diabetes” campaign, the AHA provides these tips people should KNOW to help manage the two conditions.
Keep active and maintain a healthy body weight. Even 30 minutes of moderate physical activity fi ve days a week can help prevent diabetes, reduce blood pressure and cholesterol, maintain a healthy body weight and minimize the risk of cardiovascular disease.
Normalize your numbers. It has been shown that you can reduce cardiovascular disease by improving your blood sugar control. Learn to keep track of your critical health numbers, including blood pressure, cholesterol, body weight and blood sugar.
Opt for a healthy lifestyle. Eat a healthy, balanced diet. If you smoke, quit. Smoking increases the risk of cardiovascular disease.
Work with your doctor. People living with diabetes often need multiple approaches to treatment.
It is important to talk to your health care professional, describe your symptoms, and be persistent until you find treatment options and lifestyle changes that work for you.
For more information about the Heart of Diabetes campaign, go to http://www.IKnowDiabetes.org.