Some studies indicate that diabetes may be connected to atrial fibrillation (afib).
In the past, there was disagreement as to whether diabetes and atrial fibrillation were linked.
A study from the Journal of General Internal Medicine published in 2010 indicated that there is a connection, noting that people with diabetes seem to have an almost 40 percent greater risk of developing afib than people without diabetes.
The study also found that the risk increases the longer a person has diabetes (with an estimate of afib increasing by 3 percent for each year the person has diabetes) and if the person has uncontrolled blood glucose levels (or if the HbA1c is more than 9 percent).
But there is one thing no study has yet found: Which comes first, diabetes or afib?
DIABETES, ARTERIES, AND VEINS
What are the main types of vessels in the body that transport blood?
The following are the three types of vessels that transport blood throughout the body:
Arteries and arterioles , The arteries and arterioles always transport blood away from the heart (via rhythmic contractions known as the pulse) to the various organs in the body. These vessels are under enormous pressure. Thus, their walls are made of thick and elastic smooth muscles.
Veins and venules , Veins return blood to the heart after it circulates through the body. They are relatively thin-walled vessels that lack muscular tissues but are located within skeletal muscle, which means the blood is propelled upward and back to the heart as the body moves. They also contain one-way “valves” that prevent the backflow of blood within the vein.
Capillaries , The smallest vessels are the capillaries, mostly microscopic vessels that form an elaborate network conveying blood between arteries and veins (the walls are only one cell in thickness). They branch from the ends of small arteries and carry oxygen-rich blood to all tissues of the body, along with allowing for the diffusion of nutrients and wastes between cells and the blood.
What is transcatheter aortic valve replacement?
Transcatheter aortic valve replacement (TAVR) is a surgical procedure for aortic valve stenosis. This is the narrowing of the heart’s aortic valve (one of the main arteries at the top of the heart) that makes the heart muscle work harder, and that can eventually lead to heart failure. People with diabetes are at higher risk of aortic-valve stenosis and have an even higher risk of other cardiovascular complications than others without diabetes.
There are two procedures.
One is the aortic valve replacement (AVR), which is usually performed during open-heart surgery (the aortic valve is physically replaced with a mechanical or tissue valve).
The other method is the transcatheter aortic valve replacement (TAVR), in which a catheter is inserted with a balloon at the tip.
As in a catherization, the catheter is inserted into an artery in the leg, or it can be inserted in a small incision in the chest.
The instrument works its way to the damaged aortic valve, and the balloon, which carries a folded tissue or mechanical valve around it, is inflated, pushing the artificial valve into the body’s own valve to fix the problem.
TAVR is often used if the patient is at a high risk of complications with AVR as TAVR is a less-invasive procedure than AVR.
In more recent studies, it has been shown that the TAVR procedure has a much higher survival rate than the AVR treatment.
What is peripheral artery disease?
Peripheral artery disease, or PAD, is a condition in which the peripheral arteries narrow.
The arteries that narrow can include those to the legs (the most common), stomach, arms, and head (brain).
It is often caused by atherosclerosis, a disease in which fats, cholesterol, and other substances create plaque that builds up in the peripheral arteries, or the outer regions away from the heart.
This buildup causes the arteries to become narrow, reducing or completely blocking the blood flow.
The most common symptoms are cramping, pain, or tiredness in the leg or hip muscles during walking (called claudication) or climbing stairs.
In many cases, the pain dissipates after resting and returns when the person walks or climbs stairs again.
Those most at risk for developing PAD include smokers, people with high blood pressure or high cholesterol, older people, and those who have diabetes.
Is there a connection between peripheral artery disease and diabetes?
Yes, there can be a connection between peripheral artery disease (PAD) and people with diabetes.
In fact, if a person has diabetes (either type 1 and type 2), he or she is at a higher risk of developing atherosclerosis, the most common cause of PAD.
In addition, PAD most commonly affects the legs and feet, places that may also be affected by diabetic peripheral neuropathy (for more about diabetic peripheral neuropathy, see the chapter “How Diabetes Affects the Nervous System”).
PAD (along with diabetic peripheral neuropathy) may lead to pain in the legs (especially during walking), slow-to-heal foot wounds, one foot’s being colder than the other, and, in severe cases, gangrene (in which there is a total loss of circulation), a condition that can increase the risk of foot or leg amputation.
What is the risk that a person with diabetes will develop peripheral artery disease?
It is estimated that a person with type 2 diabetes has a three-times-higher risk of developing PAD than a person without blood glucose problems. If a person has a higher blood glucose level, it means an even higher risk. According to a 2010 study, it is estimated that every one-point increase in a diabetic’s A1c level can increase the risk of having a PAD-related amputation by up to 44 percent for people with type 2 diabetes and 18 percent for people with type 1 diabetes.
How can a person with diabetes lower the risk of peripheral artery disease?
There are several ways a person with diabetes can lower the risk of developing PAD, or peripheral artery disease. The most important, of course, is to monitor blood glucose levels and keep them as balanced as possible, as diabetes promotes the buildup of plaque in the arteries. In addition, exercise can help, as can medications such as statins (especially medicines that help keep the arteries free of plaque).
What are varicose veins?
Varicose veins are enlarged or distended veins, usually occurring in the surface veins of the inside of the thighs and calves of legs. They are caused by the valves inside the veins becoming stretched so they no longer close completely. The affected veins then become filled with blood, often pushing on the skin and appearing as usually bluish or dark purple-colored veins that protrude or bulge through the skin.
Are there any health concerns if a person who has diabetes also has varicose veins?
While varicose veins can be mildly uncomfortable for some, a proliferation of such veins can be accompanied by aching pain, swelling, itching, numbness, or a rash in the legs.
In addition, if the veins gradually grow later, they may cause health problems that can require medical treatment.
For example, if the pooling of the blood in the vein is significant, it can slow the return of the blood to the heart, possibly causing blood clots and severe infections.
And if a varicose vein causes a rash or sore, it could eventually lead to an infection, which is why a person with diabetes and varicose veins should monitor his or her condition closely.
When valves in the veins no longer function properly, the veins get enlarged and distended. Diabetes can compound the problem because of the increased risk of infection it causes.
Can varicose veins occur if a person frequently crosses his or her legs?
C ontrary to popular belief, and according to Harvard Medical School, people are not at a higher risk of developing varicose veins if they frequently cross their legs. In fact, heredity is mostly to blame, and it is estimated that more than 80 percent of people are at risk for varicose veins if a parent has the same condition. There are other lesser factors, including high blood pressure, inactivity, smoking, hormonal changes that occur with puberty, pregnancy, and menopause, having a job that requires standing for prolonged periods, and obesity, the last of which often means a person who has type 2 diabetes (for more about obesity, see the chapter “Diabetes and Obesity”).
Are people with diabetes prone to varicose veins?
No, people with diabetes are not prone to varicose veins any more than the general population.
But certain conditions may mean a higher risk for people with diabetes.
For example, many overweight or obese people with type 2 diabetes have varicose veins, as both are associated with obesity.
In addition, because it is estimated that roughly half of people age 50 and up have some degree of varicose veins, and type 2 diabetes is often considered age related, older people may suffer from both conditions.
DIABETES AND BLOOD PRESSURE
What is blood pressure?
Blood pressure, as the term implies, is the pressure of the blood in the bloodstream (circulatory system).
This pressure rises with each heartbeat and falls when your heart rests between beats and can change from minute to minute, depending, for example, on whether a person is active, sleeping, resting, or under stress.
Blood pressure is the lowest in veins and the highest in the arteries when the ventricles of the heart contract.
This pumping of blood around the body gives it energy and the oxygen needed to survive.
Blood pressure is most often used for diagnosis of certain heart- and blood-related problems in a patient.
This is because it is closely related to the force and rate of a person’s heartbeat and the elasticity and diameter of the arterial walls (depending, for example, on whether there is a buildup of plaque in a person’s arteries that would narrow the vessels).
What are the two numbers associated with blood pressure measurements?
Two numbers are associated with blood pressure: the systolic (top number) and diastolic (bottom number).
For example, for a reading of 140/90, the top number is the systolic number (the measurement of the pressure when the heart’s ventricles contract as blood pushes through the heart), or 140.
The diastolic number (the measurement when the heart relaxes or the pressure maintained by the arteries between heartbeats) is 90.
This is often stated as 140/90 mm Hg, or “140 over 90 millimeters mercury,” or how blood pressure is measured by a blood pressure machine.
Currently, a much debated topic, the blood pressure for normal resting adults (over age 20) is most often 140/90.
These numbers have changed on the basis of new research.
In fact, less than a half decade ago, most physicians suggested that a reading of 120/80 was considered healthy (see below about changing blood pressure reading guidelines).
A blood pressure measurement of 120/80 is considered good for healthy adults in their twenties, but older adults may be fine with a reading of 15/90.
What new blood pressure guidelines were recently suggested?
According to the American Heart Association, a blood pressure reading below 120/80 for an adult over age 20 is recommended. But these numbers are currently being debated, and in 2014, the National Institutes of Health changed its blood pressure guidelines for the first time in 11 years. This was based on 2013 research presented in the Journal of the American Medical Association that suggested new guidelines for blood pressure readings depending on age and/or health conditions.