Ruth Kam Heart & Arrhythmia Clinic
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Diabetes can lead to many other disease complications – and heart disease is one of the dangerous outcomes that may arise if the blood sugar is not well controlled.
Diabetes is more than having too much sugar in the blood or urine. It is a metabolic disease that causes a wide range of inflammatory conditions.
There are two forms of diabetes:
Type 1 diabetes, also called juvenile or insulin-dependent diabetes, occurs when the body does not produce insulin at all. This type of diabetes is usually diagnosed in children and young adults. Type 1 diabetics need to take insulin daily to regulate blood sugar levels.
Type 2 diabetes, also called adult onset diabetes, is a lifestyle-related disease and is closely correlated to obesity and physical inactivity. In Singapore, Type 2 diabetes affects about 8.9% of adult men and 7.6% of adult women – and the rate is increasing as more people become overweight. Unlike those with Type 1 diabetes, insulin production in Type 2 diabetics is normal, but the cells of the body become insensitive or resistant to insulin. This results in a high level of sugar in the blood. Persistent high sugar levels in the blood affect the blood vessels, particularly the delicate vessels in the eyes, nerves, kidneys and heart, causing life-threatening and debilitating conditions. In Singapore, the disease is the eighth biggest cause of death.
Diabetic heart disease
One of the potential targets of diabetes is the heart. Compared with people who don’t have diabetes, people with the condition are at higher risk for heart disease, and may develop it at a younger age. They may also have more severe degrees of heart disease. Forms of this disease include:
Coronary heart disease: This condition results when plaque builds up inside the coronary arteries that bring oxygen-rich blood to the heart muscle. When plaque (made up of substances such as fat, cholesterol and calcium) builds up in the arteries, it narrows them and reduces blood flow.
The build-up of plaque (a condition called atherosclerosis) also makes the arteries stiff and inflamed, and increases the risk of blood clots that can partially or completely block blood flow. This form of heart disease can cause chest discomfort (angina), and lead to irregular heartbeat (arrhythmia) or cause a heart attack.
Heart failure: Heart failure occurs when the heart cannot pump enough blood for the body’s needs. This can happen when coronary heart disease weakens the heart muscle over time.
Diabetic cardiomyopathy: This disease damages the structure and function of the heart, making it unable to effectively circulate blood. Diabetics have a much higher risk of this even when they do not have coronary heart disease.
It is important to note that not only are diabetics at higher risk of heart disease, but they also tend to have worse outcomes. Many diabetics delay medical attention because nerve damage due to diabetes means they are less sensitive to pain and may be unaware when they are having a heart attack.
There are other serious consequences of poorly controlled sugar levels, such as kidney disease, higher risk of blindness and amputations due to infections of the lower limbs.
Managing diabetes well
To prevent heart disease (and other complications) from arising, it is important for diabetics to manage their sugar levels well. A good diabetes management plan looks at controlling your blood sugar levels in three ways: diet, exercise and compliance with medication.
While it may seem difficult to diet and exercise, small steps are better than none. Start by cutting back on refined sugars and starches. It does not need to be an ‘all or nothing’ approach. After all, it is not too hard to take a few less teaspoons of sugar in your morning coffee or tea, or one less soft drink a day. You can also simply swop refined grains for wholegrain food to make an impact on your sugar levels. As your taste buds get accustomed to less sweetness, try cutting back even more.
Physical activity is an important part of managing diabetes well and exercise need not take up too much time or effort. You don’t have to start running marathons or lifting heavy weights. Take a short 30-minute walk everyday or climb the stairs instead of taking the escalator. Any activity is good because it uses up sugar (glucose) in the blood, which means lower blood sugar levels. Regular activity also improves the body’s sensitivity to insulin. Even daily activities – housework, gardening or walking – can lower blood sugar levels.
The key is to be consistent. Many patients benefit greatly from losing just a few kg. In fact, a 10% weight loss in the obese can already lower the risk of diabetes complications.
DR RUTH KAM
Cardiologist

MBBS (Singapore)
MRCP (Int Med) (UK)
M Med (Int Med) (Singapore),
FAMS (Cardiology), FRCP (Edin)
Ruth Kam Heart and Arrhythmia Clinic
3 Mount Elizabeth #08-06
Mount Elizabeth Medical Centre.
Tel: 6333 6866
www.arrhythmia.com.sg