Diabetes and Heart Disease - Surviving the Double Whammy

Allen Richardson considers himself a lucky man. Diagnosed with type 2 diabetes in his mid 60s, Richardson was working to manage the disease with the assistance of a Greenwich Hospital endocrinologist. He was modifying his diet to include more healthy choices, knowing that weight could impact diabetes. Quitting smoking was tougher.

Then life took a dramatic turn, forcing Richardson to pay even closer attention to his health.

While preparing him for back surgery at Greenwich Hospital, the surgeon noticed Richardson had swollen ankles, a sign of edema, a condition caused by excess fluid. During a cardiac workup, the stress test and angiogram revealed substantially blocked arteries. After consulting with doctors in New York and Connecticut, Richard chose Yale New Haven Hospital, where he had quadruple bypass surgery.

“I got the lesson of a lifetime, without dying,” said Richardson of Old Greenwich. Today he is fully recovered from heart surgery and successfully manages his diabetes with a healthy diet, regular exercise and effective medications, thanks to his endocrinologist and the diabetes self-management team at Greenwich Hospital’s Center for Behavioral and Nutritional Health. He also quit smoking.

Richardson’s case illustrates the importance of having coordinated care when managing multiple chronic illnesses, such as diabetes and cardiovascular disease, which share many of the same risk factors. Six in 10 Americans live with at least one chronic disease.

Type 2 diabetes (the most common type of the disease) is characterized by the body’s insensitivity to insulin, which can lead to insulin resistance. Insulin is the hormone that converts blood sugars or glucose into energy. Type 2 diabetes occurs when the body fails to keep up with a high demand for insulin production to overcome the insulin resistance, leading to high blood glucose. High blood glucose can damage blood vessels and nerves that control the heart and blood vessels. People with diabetes are more likely to have certain conditions – such as high blood pressure and high cholesterol – that put them at greater risk for heart disease, heart attack and stroke.

“Diabetes is a cornerstone risk factor for cardiovascular illness,” said Christopher Howes, MD, chief of Cardiology at Greenwich Hospital. “It’s a perfect storm of risk.”

More than 30 million Americans have diabetes and another 84 million have prediabetes with glucose levels above normal, according to the Centers for Disease Control and Prevention. People with diabetes tend to develop heart disease at a younger age, and adults with the disease are nearly twice as likely to die from heart disease or stroke as people without diabetes, according to the National Institute of Diabetes and Digestive and Kidney Diseases.

Healthcare providers encourage people with diabetes to follow a self-management program to help reduce the chance of developing serious consequences, including cardiovascular-related complications such as heart disease, kidney failure, eye disease that can lead to blindness, and neuropathy of the feet, which can result in amputation.

“With specialized medical treatment and self-management, patients can minimize the risk of complications from this chronic disease,” said Yi-Hao Yu, MD, PhD, the endocrinologist who treats Richardson.

Greenwich Hospital’s Center for Behavioral and Nutritional Health has a dedicated team of diabetes specialists – certified diabetes educators, registered dietitians and psychologists – to help patients establish self-management programs. The team assesses patients to determine their unique needs before creating a personalized management plan, and encourages them to attend weekly group classes for diabetes education and support.

“Patient education is crucial because they need to understand the disease. It makes it easier for people to follow the recommended lifestyle changes,” said Richard Becker, a certified diabetes educator and registered clinical exercise physiologist who still works with Richardson.

“Diet and lifestyle choices are an integral part of managing this chronic disease,” said Dr. Yu. He typically prescribes one or more medications tailored to the individual’s needs to control glucose levels and advises most of his patients to regularly measure their glucose levels, using a blood glucose meter or a continuous glucose monitor. Most patients do well by taking medication consistently and by keeping a reasonably healthy lifestyle. “Allen did very well in blood glucose control,” said Dr. Yu.

People newly diagnosed with diabetes may need assistance to improve their diets, explained Erica Christ, a registered dietitian and certified diabetes educator. She meets with patients to explain the relationship between food and its effect on the body’s blood glucose. “My job is to teach them how to manage their blood sugar levels by eating healthy foods,” she said.

Christ recognizes people crave foods high in calories, carbohydrates and fats – cheeseburgers, pasta, white rice, pizza, ice cream and sugary drinks – that can raise glucose levels. She helps patients set individualized goals and create meal plans with lean, protein-rich meats, vegetables, fruits and whole grains designed to help them gradually lose weight and keep it off. She emphasizes portion control, sensible snacking and home-cooking. Christ tries to avoid sounding like the “food police,” reassuring people they can enjoy a piece of cake without guilt. “Together we find the right way to combine their lifestyle with prudent diabetes treatment,” she said.

Physical activity also plays a major role in managing diabetes. “Just as they learn about nutrition, patients should know how activity benefits the body,” Becker said. Benefits can include improved metabolism, weight maintenance and stabilized glucose levels. Increased activity also can improve sleep patterns and relieve stress. Becker admits the word “exercise” can deter some people who equate physical activity with joining a gym, jogging or cycling. He points to walking, dancing, gardening or doing household chores as simple, inexpensive ways to stay physically active.

In some cases, a diagnosis of diabetes can be overwhelming, leading new patients to experience psychological issues when suddenly faced with having to make lifestyle changes. “Some patients struggle with making lifestyle changes, so psychologists provide behavioral and emotional support,” said Mary Motwani, PhD. “I counsel patients individually on ways to overcome barriers such as stress, changing eating habits and losing weight. We’re big on collaborating with patients in finding ways to comply with their management program.”

Richardson’s self-management plan includes practicing yoga at home, plus supervised weight training and workouts at Greenwich Hospital’s Center for Healthy Living three days a week. “I golf once a week, too, weather permitting, and I end up walking two to three miles,” he said.

While Richardson’s heart surgery temporarily set him back, the episode “made me even more serious about my diet and exercise, as well as measuring my blood sugar levels in the morning and at night,” he said. He quit smoking and is ready to reschedule the back surgery. He injects himself daily with an insulin pen and takes an oral medication that lowers blood sugar and maintains heart health. “His diabetes is under control and I’m really pleased that he quit smoking,” said Dr. Yu, who sees Richardson every three to six months.

The moral of Richardson’s story? “If I could say anything to people with diabetes,” he mused, “it really is true that the value of the right diet, regular exercise, taking your medication and measuring your blood sugar is phenomenal.”