I have had diabetes for 30 years. What is the effect of diabetes on heart disease?

People with diabetes do have more heart disease than those without. Whilst very good and strict sugar control may reduce some of the risk, this is undone by an increased number of hypoglycemic attacks. Although you can't help having diabetes and, unfortunately, it cannot yet be cured, you can help the other factors that cause heart disease. Do not smoke, keep as fit as you can and avoid getting overweight; keep your cholesterol in check and aim for a normal blood pressure.

Many doctors routinely put people with diabetes on statins to reduce the risk no matter what their cholesterol level is.

I have diabetes and have now been told that I have insulin resistance and am at risk of heart disease - what is insulin resistance?

Formally, when you eat food, your blood sugar (glucose) levels go up; your body produces insulin as a response; insulin helps glucose to be taken up by the tissues, the glucose in your blood falls, and then your insulin level falls. It is called a negative feedback mechanism. If you are insulin-resistant the action of insulin in the tissues is less effective than it should be and glucose (sugar) is not used properly, so the sugar and insulin levels remain raised because the feedback is interrupted. Insulin in high levels can raise the blood pressure, cause salt and water retention and raise LDL ('bad') cholesterol and lower HDL ('good') cholesterol. Therefore, yes, insulin resistance can increase your risks of developing heart disease.

Being overweight, particularly abdominal obesity (a fat belly), is associated with or causes insulin resistance and Type 2 diabetes. By reducing weight, both diabetes and insulin resistance can be controlled or even overcome. It is more common among Indo-Asian people. Besides reducing your weight, you can also take medications to lower insulin resistance such as metformin or other anti-diabetic drugs.

Illegal drugs

I worry that my teenage daughter might have access to drugs. Do illegal drugs affect young people's chances of heart problems?

Cannabis (or 'pot' or marijuana) increases the heart rate and blood pressure as well as body temperature. It also contains carbon monoxide in the smoke. Although it can help some medical problems, for example, the nausea of cancer therapy, severe pain and multiple sclerosis, heart problems is not one of them and it is therefore not recommended.

Cocaine ('crack') is a powerful addictive drug which can cause blood vessels to shut down (go into spasm; see Figure 2.7). It can raise blood pressure, cause strokes and lead to severe heart disease, provoking irregular heartbeats, inflaming heart muscle and causing heart attacks. Just one 'fix' can do it - my advice is don't try it.

You may have heard that morphine helps the heart. It is not that simple. Children may begin with the idea of taking heroin (related to morphine) in small amounts and keeping it under control, but the addiction takes over, infection risks rise (from dirty needles or impure products), the heart valves can become severely damaged and the heart, overwhelmed by disease, gives up functioning properly. This leads to heart failure, resulting in a rapid and inevitable premature death.

If you think your child may be addicted, seek help. Help is available for recovery but an addict needs to admit to addiction, want to end it and accept help from professionals.

Ecstasy has been very much in the news. Taking even one ecstasy tablet is akin to committing suicide. It may cause a very high fever, irreversible brain damage and heart failure.

Lengthways section of (a) a normal artery and (b) an artery in spasm, which narrows the opening available for blood flow.

Figure 2.7 Lengthways section of (a) a normal artery and (b) an artery in spasm, which narrows the opening available for blood flow.

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