Your Heart is in Your Hands
Taking a closer look at a leading diabetes complication
By Wil Dubois
A mildly macabre hobby of the senior set is thumbing through the obits to pass their time. Oh dear… That was an awful pun, wasn't it? But it's a true fact. I suppose the older you get, the more people you know who have died, and its probably satisfying to see that you outlasted people you never really cared for in the first place (while no doubt saddening to learn someone you kept meaning to get together with has left the scene before you could meet at Starbucks for that seasonal latte).
But obituaries are vague when it comes to telling us the one thing we really want to know: What the Sam Heck did the person die of? People pass-on, pass surrounded by loved ones, go to their reward, go to heaven, are delivered into the arms of God, or sometimes expire suddenly. On rare occasions, in obits, people actually die. But rarely do we get a clue as to how they died. On occasion we might be told that So-and-so passed away after a lengthy illness. Sometimes we get even more details. For instance, we might be told that So-and-so (died/expired/passed/was delivered) following a battle with cancer.
What on heaven or earth does this have to do with diabetes? Well, have you ever seen an obit that says Joe Smith died of diabetes?
No? Me neither.
That might be because, as noted, we Americans seem to shy away from printing the one piece of news the readers really want to know. So by all means, when I die, please publish the facts. Frankly I'm hoping my obit will read something like this: "Multiple-Pulitzer-prize-winning author Wil Dubois, age 101, died of a fatal gunshot wound inflicted by a jealous husband following the discovery of the author's tryst with the shooter's 23-year-old wife," or words to that effect. No lengthy illnesses for me, thank you very much. But the real reason we don't read diabetes obits has little to do with the norms of our society. No, the real reason we don't see diabetes in obits is because diabetes doesn't actually kill people.
So if diabetes doesn't kill people with diabetes, what does kill people with diabetes?
Ticker failure. Overwhelmingly. Take a look at diabetes and heart disease statistics. When it comes to those of us with diabetes, heart disease will take out fully 60% of us. For what it's worth, your bad-heart-stuff risk is at least double that of the non-diabetes population (and some experts say the rate is four-fold). That six-out-of-ten number encompasses obituary-inspiring death from heart attacks, heart failure, atherosclerosis, and peripheral arterial disease. Strokes, related to heart crap, claim another 16% of us at the morgue. So that's more than three-quarters of us dying from broken hearts.
For those of you with morbid curiosity, the rest of the diabetes mortality breakdown looks something like this: 8% liver cirrhosis; 6% kidney disease; 5% cancer; 2% infectious diseases; 2% injury and poisoning; and1% shot and killed by jealous husbands, or stabbed to death by jealous wives.
I confess, those last numbers are pretty fuzzy. It depends on whose statistics you use, but regardless of that, what's clear is that some sort of heart disease will take most of us to the great beyond. Why? What's the connection between diabetes and heart disease? Can diabetes cause heart problems?
No. Yes. Maybe. OK, it' complicated. Let's see what I can do to simplify it.
Can Diabetes Cause Heart Problems?
The data is quite clear when it comes to causes of death for those of us with diabetes, and how we compare to those who don't have diabetes. So we know there is an association between heart disease and diabetes. But is diabetes the cause? Well, when we look at diabetes complications in general, we see that it's elevated blood sugar that wears the black hat, not diabetes itself. So shouldn't controlling blood sugar be enough to prevent heart problems? After all, well-controlled diabetes is the leading cause of absolutely nothing, right?
Ummm….. Well, yes, but…
Sorry, there's always a but in diabetes. More than once I've suggested that we should change its name to Buttabetes. Anyway, the short answer is control your diabetes, and complications—including heart crap—shouldn't happen. But stats from American Heart Association indicate that even people with well-controlled blood sugars still have a higher risk of heart disease. What's up with that?
The long answer might be that controlling diabetes, especially type 2, is a bit more complicated than just controlling blood sugar. Type 2 comes with quite a bit more baggage, and a lot of that baggage has been labeled as a smoking gun when it comes to the driving forces behind heart disease.
American Heart says that people with diabetes commonly have these additional risk factors for heart disease: high cholesterol, high blood pressure, and obesity. They also claim that type 2s tend to be less active and smoke more than others. Hey, don't shoot the messenger, at least not until I'm 101 and doing something deserving of being shot for. I'm just reporting what they say.
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As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...