Sugar Control and Vascular Disease

Happy New Year! This is the second part of our series focusing on lifestyle management for the prevention of vascular disease. In the December edition, we addressed smoking cessation. Now we will discuss the importance of sugar control.


Diabetes and Vascular Disease

Diabetes mellitus is a disease that affects the body’s ability to absorb glucose, which is a form of sugar and a major source of energy.  There are two types of diabetes, type 1 and type 2.  Both cause high levels of glucose in the bloodstream. High blood sugar causes many of the long-term effects of diabetes. Too much sugar in the blood damages the lining of the arteries of all sizes, and that can cause atherosclerosis, in which arteries get lined with plaque.  


Atherosclerosis in diabetic patients can lead to:

  • Kidney damage: Kidneys have tiny blood vessels that remove waste from the blood, but diabetes blocks these blood vessels. As the disease progresses, the kidneys lose function and eventually fail leading to the patient being dependent on dialysis.
  • Retinopathy: High blood sugar can cause tiny blood vessels in your eyes to become blocked. When your eyes try to grow new blood vessels, the growth is abnormal, eventually leading to blindness.
  • Peripheral arterial disease: Glucose damages arteries that feed oxygen and nutrients to the legs and feet. This can lead to pain in the legs, foot sores that do not heal, chronic pain from ambulation and in some cases, amputation.
  • Neuropathy: In this condition, the patient loses feeling in the foot and toes.  Decreased blood flow caused by clogged arteries can cause damage to nerves and blood vessels in the extremities. Patients with diabetes are more likely to get vascular disease. Patients with both diabetes and vascular disease are at risk of amputation, blindness, kidney failure and other serious illnesses.


Treatment of Diabetes: Know Your A1c

Because of the effects, it is very important to aggressively treat both types of diabetes to minimize long-term damage. Careful maintenance of the blood glucose level is the primary goal of this treatment. The HbA1c is a test that estimates the average glucose level over 3 months. Maintaining HbA1c at less than 7% is known to lower the risk of amputation, heart attacks, stroke and onset of peripheral arterial disease. Avoiding foods high in sugar can help maintain healthy glucose control. This includes seemingly innocuous items such as white bread and pasta. In addition, exercise helps to burn energy and improve your body’s ability to keep your glucose at a healthy level.

Activity medication is often required to maintain this control. For type 2 diabetes, it has been shown that use of an insulin-sensitizing medication and oral agent dramatically decreases cardiovascular complications compared to using only insulin. Consultation with an endocrinologist can help you manage your diabetes optimally. There are many new ways to check your glucose at home, including phone apps, and this knowledge and feedback can be very helpful.


Preventive Care 

Preventive care is a critical component of limiting lifetime complications for diabetes.  Diabetes predisposes you to heart attacks, strokes, kidney failure and peripheral arterial disease. Knowing the signs and symptoms of these can facilitate you seeking help before a tragic event occurs. However, diabetes can also blunt the usual nerve response to pain. This loss of sensation results in an increased risk of pressure ulcers on the feet. Patients with diabetes should perform a routine inspection of the feet to evaluate for any breaks in the skin and notify the foot doctor immediately.


Nail care can be complicated in diabetic patients.  If you have been told you have peripheral neuropathy, ask for a referral to a podiatry doctor to assist you with nail care to avoid potentially dangerous injuries and nail care

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