2023-04-28 15:05:30
[김경희 인천세종병원 심장이식센터장] Mr. Kim (57), who has been through menopause for several years, has a family history of diabetes and cardiovascular disease. She has been taking diabetes medication since 7 years ago. With her usual chubby physique, she had a lot of visceral fat in her belly. After menopause, I felt that I did not lose much weight even if I exercised, and that I might gain weight even if I ate a little more. After failing to control her exercise and diet, Mrs. Kim eventually gained more belly fat and her back pain became so severe that she even received a pain injection.
In this situation, from one day, even a little movement caused severe breathing difficulties. Kim Mo-nim, who visited the hospital outpatient clinic like that. His face didn’t look very serious. However, coronary artery disease, which feeds the heart, was strongly suspected, considering the sudden dyspnea from two weeks ago, underlying diseases such as diabetes, postmenopausal women, obesity, and family history of cardiovascular disease. Mrs. Kim
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After hospitalization for examination, coronary angiography and echocardiography were performed. No pulmonary edema was found on chest X-ray. However, on echocardiography, cardiac function was reduced by 2/3 compared to normal people, and overall cardiac muscle function was poor.
He was immediately prescribed medication for heart failure. The results of subsequent coronary angiography were more serious than expected. All three coronary arteries were generally narrowed and thinned. Even severe calcification was found around it. In particular, a situation where it is difficult to widen the blood vessel by inserting a stent in one part. For this reason, only heart failure drug treatment was carried out, and heart failure education and rehabilitation treatment were combined.
Of course, the patient was once more made aware of the need for diabetes control. In the meantime, the injections that were given due to back pain were mainly steroids, and the patient’s sugar control was not well controlled. I took a lot of anti-inflammatory painkillers, so my kidney function was also somewhat weak. I decided to refrain from taking anti-inflammatory painkillers as much as possible and rehabilitate my back while undergoing surgery if necessary rather than injections. Fortunately, the heart failure medication was effective, and the patient’s symptoms improved significantly. The problem is diabetes. Since the blood vessels were already narrowed due to diabetes not being well controlled, an acute myocardial infarction might occur if the blood vessels were further clogged, so a statin dose was increased to lower LDL, called bad cholesterol, as much as possible.
Mr. Kim is a case that clearly shows the correlation between diabetes and cardiovascular complications. Diabetes is the biggest enemy of cardiovascular risk. Especially if you have a family history of diabetes, you need more thorough management. Glycated hemoglobin is called hba1c (hemoglobin A1C), which indicates how well a patient’s blood sugar has been controlled for the past 3 months. Glycated hemoglobin is a combination of hemoglobin (hemoglobin) in red blood cells, which plays a role in carrying oxygen in the blood, and glucose in the blood.
Since the life span of red blood cells is regarding 120 days, the average level of blood sugar control over the past 2 to 3 months can be known through the HbA1c level. This is why diabetic patients usually have regular measurements every 2 to 3 months. Incidentally, the results of this test are not affected by diet. It has the advantage of being able to know the average blood sugar level in the past without affecting fasting blood glucose level, blood glucose level 2 hours following eating, or glycated hemoglobin. However, the extent of blood sugar fluctuation is unknown. Even if blood sugar is not controlled, even if it goes between hypoglycemia and hyperglycemia during the day, the change is unknown. If it is 6.5% or higher, it is called diabetes. I would like to advise you that the younger you are, the more you need to control yourself.
The American Heart Association and the Diabetes Association classify diabetes as a super-risk group for cardiovascular disease. Therefore, it is emphasized that people with diabetes should more actively prevent and manage cardiovascular diseases. Adults with diabetes are two to four times more likely to die from heart disease than adults without diabetes, and at least 68% of people with diabetes over the age of 65 die from heart disease, and 16% die from stroke. In addition, the rate of coronary artery blockage surgery is regarding 10 times higher than non-diabetic patients. Unfortunately, diabetes itself has no symptoms, so diabetic patients tend to neglect early diabetes management until complications arise.
Diabetes is often accompanied by other diseases that cause cardiovascular diseases, such as hypertension, dyslipidemia, and obesity. Patients with diabetes must take hyperlipidemia drugs, and if they already have cardiovascular disease or have other risk factors such as high blood pressure and old age, it is recommended that their LDL level be lowered to 50 or less. Controlling diabetes is important, but controlling hyperlipidemia is the key to lowering the complications of cardiovascular disease and slowing the progression of vascular disease. Most of the patients feel the burden of continuing to take medicine following being diagnosed with diabetes for the first time. Some people are reluctant to eat, saying that taking hyperlipidemia drugs will cause diabetes. However, it does not mean having the right lifestyle and controlling it well. 50 A person who has lived his whole life without any significant exercise and cannot control his diet does not suddenly change his life as a bodybuilder just because he is diagnosed with diabetes. Most of them end in three days. Rather, it is recommended to take diabetes medications and combine moderate and steady exercise and diet. If your body condition improves, then you can try reducing the medication a little.
The importance of diet for diabetic patients is nagging to say the least. Share common sense once more. In order to reduce the sudden increase in sugar, the point is to reduce refined sugar. This is because a rapid increase in sugar promotes insulin secretion and causes blood sugar to rise and fall, which adversely affects blood vessels. Food that raises sugar slowly is the answer. Mixed grains such as brown rice are better than rice, and whole wheat is better than wheat flour. Avoid sauces such as ketchup and mayonnaise. Sauce contains a lot of liquid fructose. Even if you eat a little, it’s high in calories and it’s easy to raise the sugar. Inadvertently drinking beverages containing a lot of fructose liquid should also be stopped immediately.
You should get into the habit of checking how much fructose is in your usual food. Vegetables of various colors, protein-rich but salt-free chicken breast, nuts, and foods containing unsaturated fats such as mackerel and salmon are recommended. It is good to exercise at least 3 times a week, aerobic exercise for at least 30 minutes a day and strength training at least twice a week. If your knees are not good, do not overdo it from the beginning and start with strength exercises such as leg lifts while lying down. If you still smoke, all of this effort is a joke.
In the case of diabetes caused by obesity, surgical treatment can be effective. In the case of patients who are difficult to control their weight on their own and are using insulin, they can choose obesity metabolism surgery. Metabolic surgery for obesity reduces the absorption of food by partially resecting the stomach and prevents the secretion of bad hormones. As a result, the dose of insulin can be reduced or stopped, and diabetes medications can also be reduced.
If you have diabetes, you may not feel pain very well. As a result, even if the blood vessels are gradually blocked, chest pain may not be felt at all, and in some cases, as in the case of Mr. Kim mentioned above, shortness of breath may occur in an overall narrowed state. Even if they seem to be fine, they suddenly die in their sleep. She recently heard from a celebrity that she had died from sap while on a mission in Cambodia. It is said that he ate well even on the day of his death, but in the photo, he has already suffered from diabetes for a long time and seems to be accompanied by cardiovascular disease. This is why we cannot agree that he died simply from being hit with sap. Rather, it is more persuasive that he died suddenly from ventricular fibrillation due to acute myocardial infarction due to clogged blood vessels without undergoing a heart examination in an underdeveloped environment.
It is emphasized once more that diabetes is a risk factor for all cardiovascular diseases. If there is a family history, it is recommended to manage sugar well, check for cardiovascular disease, and take hyperlipidemia drugs if there is a narrowed blood vessel when diagnosed. This is a part that many patients miss, but high sugar also invades micro blood vessels such as the retina of the eye, so annual eye examinations are required. It is important to keep in mind that underlying diseases such as high blood pressure are controlled, and exercise, diet, and smoking cessation are the basics.
time cannot be stopped What regarding a family history of diabetes? You won’t be too disappointed though. Medical science and technology, such as drugs and equipment, are developing. It is a thing of the past that people died before the age of 60 due to diabetes or cardiovascular disease. If you keep in mind that hope is still by your side and keep working hard, you can live a healthier life than anyone else.
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