Diabetes Research and Wellness Foundation
Heart and blood vessel disease
I have read that poor circulation in the feet is a problem for people with diabetes. Is there any way I can improve my circulation to avoid developing this?
Narrowing (‘hardening’) of the arteries is a normal part of growing older – and the arteries to the feet can be affected by this process, leading to poor circulation in the feet and legs. This occurs in people with diabetes as well as those without, but it is more common in those who have. The causes of arterial disease are not very well understood, but we know that smoking and poor diabetes control makes it worse. So if you have diabetes and smoke cigarettes, the risk of bad circulation increases greatly.
Stop smoking, control your blood glucose, and keep active – these are the only known recipes for helping the circulation.
I am in my seventies and am worried that I might develop heart problems. I am already being treated for high blood pressure. Is heart disease likely?
Heart disease is two to five times more common in people with diabetes and it goes hand in hand with high blood pressure, excess body weight and raised cholesterol. There is increasing realization that this grouping of risk factors is an important cause of premature death in diabetes. Knowing this, it is important that your blood pressure and cholesterol levels are controlled well.
My husband died recently from a heart attack. He had had diabetes for 12 years and was controlled on tablets, and at about the same time that he developed diabetes he started having angina attacks. I wondered whether these were related and whether poor control had anything to do with his fatal heart attack?
There is certainly a connection between heart disease and diabetes. It has been shown that control of high blood pressure, cholesterol, and blood glucose are effective in preventing heart disease.
I am in my early twenties, but haven’t had good diabetes control for a couple of years. Will this affect my arteries in later life?
It is unlikely to have much effect but any period of poor control is not going to do any good either. Our arteries get more rigid and more clogged up as we get older and this process can be aggravated by periods of poor diabetes control and smoking.
My left leg has been amputated because I developed diabetic gangrene. I now get a lot of pain in my right foot and calf. Could too much insulin be the cause of this pain?
No. It sounds very much as if the blood supply to your leg is insufficient and that the pain in your right foot and calf is a reflection of this poor blood supply, which was the reason why you developed gangrene in your left leg. You must be very worried, particularly about the survival of your right leg. There are a number of different ways of protecting your remaining leg and these include:
• stopping smoking (if you smoke)
• keeping diabetes, blood pressure and cholesterol under very good control, and
• maintaining close contact with a podiatrist who has a special interest in diabetes.
If you do notice any sign of increased pain or change in colour, you should seek medical advice immediately.
My husband had a heart attack last year. Nine months later he had part of his leg amputated. We have been told that he could have further problems but have been given no advice. Please give us some information on what we should do to try and avoid this.
It sounds as though your husband has generalized arterial disease (arteriosclerosis) affecting his blood vessels to the heart and to the leg. There are a number of things which you and he can do that may be of help in preventing further trouble. Firstly, if he smokes, he should stop straight away; secondly, he should keep his diabetes and blood pressure as well controlled as possible; thirdly, he should keep his remaining foot and leg warm and make sure that he has expert foot care, either by a chiropodist or by you, under the supervision of a chiropodist or district nurse. If you see any signs of damage to his foot or any discolouration then seek medical advice immediately.
Blood pressure problems
Now I have been diagnosed with diabetes, will I be more prone to high blood pressure and strokes?
Yes, there seems to be a very strong link between Type 2 diabetes and high blood pressure. Unfortunately these both increase the risk of strokes. The good news is that strict control of both diabetes and blood pressure keeps down this risk. Since publication of the UKPDS findings, we realize that the blood pressure should be kept as low as 130 mmHg in diabetes.
I have been told that my blood pressure is raised as a result of diabetic kidney problems and, because of this, it is very important that I take tablets to lower it – why is this?
There is good evidence to show that lowering the blood pressure to normal in people such as yourself protects the kidneys from further damage and helps delay any further kidney problems. We also know that controlling blood pressure reduces the risk of heart disease and stroke. There have been some studies done in Germany and the UK showing that self-monitoring of blood pressure and the active participation of people in their own treatment can significantly reduce blood pressure. In the studies, people were provided with a blood pressure monitor, and were given information about high blood pressure, and non-drug remedies, such as reducing salt and increasing fruit and vegetable intake, and exercising, and were taught how to use an individual flow chart for medication. The British Hypertension Society provides advice on how to select a reliable monitor, and if you think that you may benefit from self-monitoring of blood pressure, you should discuss this with your health professional.
The mind
My 68-year-old mother has had diabetes for 44 years. In the past few years her mental state has deteriorated considerably and she is now difficult to manage. Is this common for someone who has been on insulin for so long?
Memory loss (most commonly Alzheimer’s disease) is mainly a problem of the elderly. People are also more likely to develop diabetes as they get older, so it is likely that both these problems may sometimes affect the same person. There is some disturbing evidence that memory loss may be more common in old people with diabetes than those without. However, the extra risk in diabetes is only small, and we do not know the relevant importance of other factors such as smoking and high blood pressure. So it is possible, but not certain, that your mother’s memory problem is related to diabetes.
I had a brain haemorrhage 18 months ago and I have had diabetes since childhood. Am I more likely to get complications from diabetes?
Brain haemorrhages and strokes are more common in people with diabetes than in those without, particularly if blood pressure levels are high. Your treatment is no different than from anyone else with your condition. Your doctor will be on the lookout for chest infections and pneumonia, particularly if you have any problems with swallowing.
I have been very depressed since my diagnosis. Are peo- ple with diabetes more prone to depression or suicide, or other psychiatric illnesses?
There is some evidence to suggest that people with diabetes are prone to depression, and the suicide rate is higher than in the general population. This is probably due to the demands of a long-term condition that has an impact on daily living rather than a result of the diabetes itself. Recent studies have found that the tendency to depression can be helped by letting people become more involved in the management of their diabetes. You have obviously taken a first step in recognizing that you have depression. Visit your doctor to discuss how you feel.
There is help out there! I have read that hypos can cause brain damage – is this true?
The strict answer is yes, but only very occasionally. Only a severe hypo causing a long period of unconsciousness can lead to brain damage and this is extremely unusual. There is no evidence to suggest that the repeated hypos, which may be common in people taking insulin, cause any permanent brain damage.
