When you hear “diabetes” what comes to mind?
When you hear “diabetes” what comes to mind? Most people think high blood sugar along with images of obesity, cookies, and desserts. Elevated blood sugar is indeed a prominent and obvious part of diabetes. Patients see it for themselves as they check their blood sugar; they also experience first hand symptoms of out- of- control blood sugar like excessive urination, unquenchable thirst and even coma that sends them to the intensive care unit.
However, diabetes is more than just high blood sugar, it’s a disease of the arteries. Seven out of ten diabetic deaths are due to heart attacks and strokes, not elevated blood sugar. Diabetes makes all our arteries, large and small, much more sensitive to normal wear and tear. Artery damage due to smoking, high blood pressure, and high cholesterol is more susceptible as well. Merely controlling blood sugar level and keeping A1c at no more than 7%, although necessary, is hardly enough to protect diabetics from the most feared complications of their disease.
So, what can diabetic patients do to get maximum protection of their arteries? Consistently practice a healthy lifestyle (NO smoking cigarettes, keep a healthy diet, and near-daily exercise) AND keep blood pressure low AND take statins AND, possibly, a low-dose (81 mg) aspirin (provided that there are no stomach or serious bleeding problems). Medications like lisinopril or losartan are also important in protecting the kidneys which can commonly fail in diabetes. Additionally, some new non-statin cholesterol-lowering medications (Praluent and Repatha) are available but at a cost of approximately ten thousand dollars (US) per year of treatment.
Artery testing, especially testing of the heart arteries, is another element of good diabetic care. Within diabetes the nerves that signal heart pain do not work properly, so it’s not unusual for a diabetic patient to have significant clogging of the heart arteries without experiencing any chest pain. Due to this, the doctor may recommend a stress test from time to time. Diabetic patients need to create a partnership with their physicians in order to reap the full benefits of diabetes education and disease prevention.
Anthony Pothoulakis, MD, FACC
Taking something as “harmless” as…
Motrin (ibuprofen) Aleve (naproxen) Celebrex (celecoxib) or Voltaren (diclofenac) could actually be HARMFUL to you…These all are powerful medications known as “NSAIDs”.
These medications are some of the most commonly used medicines in adults and have been used for a long time, over half a century, and are used for many reasons. They help reduce swelling and inflammation caused by injury or arthritis and relieve fever. For women they help ease cramping, and control heavy menstrual bleeding. They are easy to obtain since you can buy them without a doctor’s prescription. However, these very effective medications can also cause serious, even life threatening, side effects.
Beyond simple skin rashes or mild stomach aches, all NSAIDs have been known to cause heart attacks, stroke, heart or kidney failure, high blood pressure, elevated potassium, stomach ulcers and stomach or intestinal bleeding. This is even more of a risk if they are taken at high doses and on a daily basis for prolonged periods of time.
If you suffer from diabetes, kidney or liver disease, high blood pressure, or have a history of heart attacks, stroke or heart failure you are most at risk of these side effects. Those taking diuretics, certain blood pressure medications (“ACE-inhibitors” or “ARBs”), smokers over the age of 45, and anyone over the age of 65 are especially vulnerable. Also in a higher risk category are pregnant women, those with Crohn’s disease, ulcerative colitis, stomach ulcer or history of intestinal bleeding, those who easily bruise, and those taking aspirin or other blood thinners.
Ask your doctor whether NSAIDs are right for you. If your doctor approves of the use of NSAIDs, ask how long you should take them and at what doses should they be taken. You may want to consider alternatives, such as acetaminophen (Tylenol) or other pain medicines.
Although aspirin is technically a NSAID, in low doses it helps prevent heart attacks and stroke and it is an unlikely cause of kidney or heart failure. It can, however, cause stomach problems such as ulcers or (intestinal) bleeding. Aspirin could also cause allergies and even asthma in susceptible individuals. As with all medication, best to check with your doctor first.