Dr Hassan Makki DO FACC
Phoenix Heart Center
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Diabetes mellitus (DM) is a group of diseases
characterized by high levels of blood glucose
resulting from defects in insulin production,
insulin action, or both.
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The term diabetes mellitus describes a metabolic
disorder of multiple causes characterized by
chronic hyperglycemia with disturbances of
carbohydrate, fat and protein metabolism
resulting from defects in insulin secretion,
insulin action, or both.
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At least 10.3 million Americans have
been diagnosed with diabetes mellitus,
and another 5.4 million are estimated to
have undiagnosed diabetes. Onset often
precedes diagnosis.
90% of diabetic patients have Type II
diabetes
Hispanics 11 %, African Americans 10%,
Native Americans, and Asians
Diabetes in women essentially cancels
out any hormonal protection (up to 13%).
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Makes cholesterol
particles smaller,
stickier and more
plaque forming
Sugar molecules
actually directly (and
indirectly) damages
artery walls
Sets up a ProInflammatory and ProClotting environment
Hormone activation of
immune cells
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~80% of all diabetic mortality
 75% from coronary atherosclerosis
 25% from cerebral or peripheral
vascular disease
>75% of all hospitalizations for diabetic
complications
>50% of patients with newly diagnosed
type 2 diabetes have heart or vascular dz
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#1 Cause of
amputation
Every 30 sec
someone looses a
limb to DM
1/5 require
amputation
1/4 diabetics will
develop an ulcer
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With DM
Often no symptoms
Neck, back, shoulder,
stomach pains
The longer someone is
diabetic, the more
subtle the symptoms
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Activity LEVEL
Weight (BMI >30), waist size (40/36 m/f)
BP
Family history
Sugars….Fasting (>100), Post meal (>200)
CHOL screening
STOP SMOKING
If known DM, more testing may be required;
stress test, ABI, Ultrasound, Calcium score.
Consult Cardiologist!
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Impaired Fasting
sugar (>100) or
Post meal (>200),
HGAIC less than
5.7
HGAIC >6.0
Full blown DM
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Diet exercise,
follow up
Start DM Meds
Start HEART
MEDS!
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ASA
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STATINS
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BP meds
ACE inhibitors
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17% reduction in
cardiac/vascular
events
52% reduction vs
32% in non DM
51% reduction
when diastolic
less than 80-85
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Diabetics are a delicate population with
serious medical problems.
Problem is an epidemic!
Early detection and appreciation is key
High index of suspicion is required when
diabetics have any symptoms….or not
having symptoms.
Aggressive risk modification upstream
prevents problems downstream
Very preventable disease!
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Thank you
Questions!?
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www.Phoenixheartcenter.com
DM
www.Yourdiabetesinfo.org
http://diabetes.niddk.nih.gov/
For Diabetes screening:
•http://ndep.nih.gov/am-i-atrisk/DiabetesRiskFactors.aspx
•http://ndep.nih.gov/am-i-at-risk/diabetesrisk-test.aspx