Managing the risks of heart disease when living with type 2 diabetes
Vivian Stokes says patient empowerment is important to her as she manages her type 2 diabetes. Supported by her physician, she believes she’s making the best decisions to keep her heart healthy. supplied
In her late fifties and early sixties, social worker Vivian Stokes began envisioning her ideal life when she retired. A resident of Calgary, Alberta, she loved being active and was looking forward to continuing that lifestyle in retirement, with regular walks and deep water aerobics classes three to four times a week.
Then, Stokes found herself facing health challenges that reduced her mobility. Due to back and knee issues, she had surgery and couldn’t be as active while she recovered. Shortly after her surgery, in early 2019, she received a diagnosis that she describes as “overwhelming.” Her doctor told her she had type 2 diabetes.
Already contending with knee and back problems, Stokes initially felt like it was all too much to cope with. She also says type 2 diabetes seemed to be yet another burden that could undermine her vision of health and activity in her retirement years.
“It was one more thing about my body not working as well anymore,” she explains. “At that time, I was not feeling as positive about my future or about the plans I had made for my life after retiring. This diagnosis was for me a challenge because I didn’t know how I was going to be successful in the plans that I had made for my senior years.”
Stokes has a family history of diabetes; her father had type 2 diabetes. She is very conscious about the link between type 2 diabetes and heart disease as she has relatives with both diabetes and heart issues.
“When I was diagnosed with type 2 diabetes, I was extremely worried about the complications that came with that diagnosis. And I was shocked as I understood that it’s a lifelong diagnosis. It’s not something where I can take a pill or have an operation and be cured.”
Stokes has now moved past her initial shock and feelings of being overwhelmed about living with diabetes. Working with her physician in what she calls a true partnership, she is today feeling positive about her ability to manage her overall health.
“I want to be empowered so that I can make the right decisions for my life. The decisions that I make now are going to determine what’s going to happen to me later. And I think that’s important because at the end of the day, I am responsible for my own health.”
Links between diabetes and cardiovascular disease
One of the most important health risks for people with type 2 diabetes to be aware of is heart disease, as those living with type 2 diabetes face an increased risk of dying from heart disease at an earlier age.
“When we talk about heart disease in diabetes, we are often referring to atherosclerotic disease, which means narrowing of the arteries that supply the heart,” says Dr. Sue Pedersen, a specialist in endocrinology and metabolism who treats patients at the C-ENDO Diabetes and Endocrinology Clinic in Calgary. “If those arteries get completely blocked, it causes a heart attack.”
Dr. Pedersen also says diabetes can increase the risk for micro-vascular disease in the heart, which can lead to a type of heart failure.
“Routine screening is highly important because it gives us the opportunity to find heart disease in earlier stages and to manage the person’s risks to prevent a heart attack. ”
“People with type 2 diabetes benefit from regular screening to detect signs of heart disease and from monitoring their status with respect to other cardiovascular risk factors, for example, do they have high blood pressure?” says Dr. Pedersen. “Routine screening is highly important because it gives us the opportunity to find heart disease in earlier stages and to manage the person’s risks to prevent a heart attack.”
Screening begins with asking patients questions to see if they have any symptoms that may suggest heart disease, she explains. “For example, are they having any chest discomfort or any shortness of breath when they exert themselves? The next part of screening is a physical exam.”
Dr. Pedersen says that people with type 2 diabetes should also have routine electrical tracing of the heart through an electrocardiogram (EKG), starting at age 40, or earlier, for example, if they have other cardiovascular risk factors. Managing blood pressure is particularly important for people with type 2 diabetes, she adds. Also important is for patients to have regular testing of their cholesterol.
Managing blood glucose levels and keeping those levels within a healthy range also helps reduce the risks of various complications from diabetes, including the cardiovascular risks, Dr. Pedersen says.
She says that lowering the risk of heart disease and preventing other diabetes-related complications often requires a combination of medications and lifestyle factors.
“Being active is something that I talk with my patients about because we know that physical activity, even if it doesn’t cause weight loss, improves cardiovascular health, and reduces risk of a heart attack and stroke,” she says. Additionally, maintaining a healthy weight is important in the management/prevention of diabetes and heart disease.
“What we define as being active needs to be individualized,” Dr. Pedersen says. Clinical practice guidelines often recommend a certain number of minutes of moderate to vigorous physical activity. For one person, it might mean running three kilometres, and for another person, it might be walking two blocks, so we want to have individualized physical activity prescriptions.
Another key piece of advice on lifestyle is to make healthy dietary choices. “So that’s important for many things; a healthy diet improves blood sugar levels and helps keep blood pressure and cholesterol within healthy ranges,” says Dr. Pedersen.
“My main goal is to optimize my patient’s health so that they live a long, healthy life with a good quality of life and with good health during that long life,” she says.
Empowered to control your health
Stokes continues to make the best decisions possible to manage her diabetes and keep her heart healthy. She’s feeling in control of her destiny and seeing a brighter future ahead.
“I think patient empowerment is so important,” she says. “I’m feeling quite positive about how my diabetes is being managed. I think I’m doing well in terms of healthy eating, and I’m able to exercise now that I’ve got some of my back and knee issues dealt with.
“I have my family and an amazing group of friends. I’m working part-time and doing activities. Life can be good.”
This content is sponsored by Boehringer Ingelheim Canada and Eli Lilly Canada.
Visit www.myheartmatters.ca to learn more.
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To view the full report as it appeared in The Globe's print edition Diabetes Awareness Month