Diabetes and heart diseases: Common cause of death among Buddhist monks



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By Dr. Upali Illangasekera


Former Professor in Medicine,Peradeniya


Founder President, Diabetes Association of Sri Lanka (Kandy Branch)


Managing Director, Kandy Diabetes Centre


Two significant events took place in the Month of November. Sri Lanka lost one of her most erudite and respected Buddhist priests, Ven. Madulawae Sobitha Nayaka Thera at the beginning of the month. He passed away due to complications of diabetes. Then nearly a century ago in the month of November, Sir Fredrick Banting, the discoverer the life saving drug insulin used in the treatment of diabetes was born in Canada. November 14th is the birth day of Sir Banting and the authorities have named it the World Diabetes Day. All over the world including Sri Lanka, this day is used mainly to highlight and create awareness on all aspects of diabetes. Some of these activities include Diabetes Day Walks, exhibitions, lectures and screening programmes to identify those with diabetes and its complications.


Ven. Sobitha led a very active and a productive life which may have contributed to the complications he had culminating in a heart attack and death. He had once told one of a relative of mine who was very close to him that a Buddhist priest is not private but public property. In fact, priests are highly vulnerable to heart disease mainly because of adverse lifestyle factors such as diet and lack of exercise.


At most alms-givings several desserts consisting of a very high content of sugar is served which the priests whether they are diabetic or not are ‘forced’ to consume so as not to hurt the feelings of those who offer the alms. In fact, in a study conducted by the author in Kandy several years ago revealed that among the urban Buddhist priests in Kandy the prevalence of diabetes was as high as 30%.


The Kandy Branch of the Diabetes Association of Sri Lanka distributed a menu card among the laymen indicating as to how alms should be provided to the clergy. The Buddha Sasana ministry also has distributed a menu for them but it is not known how many priests as well as laymen adhere to it.


The two commonest cause of death in diabetes are heart disease and strokes. Heart disease is twice as common in those with diabetes compared to non-diabetics.


Causes of heart disease


in diabetes


Diabetes on its own does not contribute to heart disease. There are other associated conditions such as high blood pressure, high cholesterol, smoking, proteins in the urine and even infections of the gums (periodontitis) which play a role. High blood sugar, the basic lesion in diabetes is less important than associated high blood pressure and high cholesterol. This is the reason why some with very high blood sugar values do not suffer from heart attacks where as those with slightly elevated blood sugar may sustain an attack. Therefore, it is important to identify the risk of a person getting a heart attack by collating all these conditions. Such ‘Risk Calculation Charts’ are available to doctors for their use. However whatever the cause or causes the final lesion that brings about death and disability is atherosclerosis, which means deposition of cholesterol in the blood vessels that supply the heart (coronary arterie).


In the prevention of heart disease in diabetes it is crucial that these risk factors such as high blood pressure and high cholesterol are identified and treated.


Furthermore now it has been established that those with ‘prediabetes’ (stage before someone develops diabetes defined as a fasting blood sugar value of between 100 and 125mg/dl) too could develop heart disease. In the prevention of heart disease in diabetes it is important to identify those with prediabetes and treat accordingly. Recent research has also revealed that time tested drugs such as tolbutamide and glibenclamide could be detrimental to the heart.


Symptoms of heart disease in diabetes


It is not difficult to recognize the commonest symptom of a heart attack namely severe chest pain with its characteristic features. However, some patients with diabetic heart disease may not exhibit the typical chest pain and may not have chest pain at all. These are called ‘silent heart attacks" and may manifest as just a fainting attack. A high degree of suspicion is therefore needed to recognize such events. Other symptoms may consist of those of heart failure such as difficulty in breathing and swelling of legs and palpitations’


Screening for heart disease in diabetes


In more than a half patients with diabetes there may not be any symptoms suggestive of heart disease. Similarly, some patients are recognized to have diabetes only at presentation with a heart attack. The guidelines suggest that every patient with diabetes of more than five years or even less than five with one or more risk factors should be screened for heart disease. These screening tests consist of routine ECG, echocardiography, exercise testing and if positive are subjected to angiography, where a dye is injected to the coronary blood vessels and x-rays taken. Other more sophisticated tests include CT coronary angiography. Fortunately, these tests are available in both the state and private sector in our country.


Treatment of heart disease in diabetes


With the advent of new modes of treatment revolutionary changes have taken place in the treatment of heart disease in diabetes. These include angioplasty and stenting which could be carried out within a few hours of the onset of chest pain there by reducing further damage to the heart. In the case of diabetes most patients end up getting coronary artery bypass surgery since more than one blood vessel is affected and is more severe and extensive than in nondiabetics. In addition very effective drugs such as streptokinase (‘clot busters’), too, are freely available. As indicated above there should be simultaneous treatment of other risk factors such as high blood pressure and high cholesterol.


Prevention of heart disease in diabetes


Prevention consists of prevention of diabetes itself and if already diabetic attention paid to the risk factors such as high blood pressure and high cholesterol. In the case of prevention of diabetes it consists mainly of tackling the lifestyle factors such as diet, mental stress and lack of exercise. Drugs, too, have a place in the prevention of heart disease in diabetes. These consist of aspirin, anti-cholesterol drugs and drugs that reduce the blood sugar and blood pressure.


 
 
 
 
 
 
 
 
 
 
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