Diabetes Mellitus is the medical name for what is commonly known as diabetes. It is classed as a metabolism disorder in which the body has high blood sugar, the reason being, either the body cells did not respond properly to the insulin or because the insulin production was insufficient or both. Common symptoms of the disease are polyuria (frequent urination), polydipsia (increasingly thirsty) and polyphagia (hungry).
People who have suffered heart diseases or a heart attack may have already gone through a lot of procedures to survive the attack and diagnose the condition. For example, many heart patients have to undergo Thrombolysis, a procedure that involves injecting a clot-dissolving agent to restore blood flow in a coronary artery. This procedure is supposed to be administered within a few hours of the heart attack. If this treatment isn’t done immediately after a heart attack, many patients may have to undergo coronary angioplasty or coronary artery bypass graft surgery (CABG) later to improve blood supply to the heart muscle.
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Dr Pradeep Nambiar
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The artery blockage can be treated with the help of medicines, stents or a heart bypass surgery. The treatment depends on the severity and the number of blockages. Surgery is suggested in case two or more arteries are blocked or if the left main stem is stenosed. During a heart bypass surgery commonly, surgeons all over the world use arteries from the leg called the saphenous veins to bypass the blocked arteries and supply blood beyond the blockage. These leg veins block off in 10 years’ time and the patient is required to go through a through a redo heart surgery with higher mortality risks. Besides, surgeons also follow the old school method of making big incisions in the middle of the chest with all its complications and the associated patient fear and apprehension. Robotic surgery because of its cost factor, availability and technical difficulty is still not increasingly followed in cardiac surgery even in the West.
Considering all these complications, the Nambiar Technique is the answer to the situation with a minimal access coronary bypass. This technique could be a great procedure to be used on diabetic patients as well bearing in mind that it is less invasive and minimises the threat of infection and wound healing issues. It encompasses using a two inch left mini (thoracotomy) surgical incision in the chest wall through which the bilateral internal thoracic arteries (BITAS) are harvested under direct vision without robotic/thoracoscopic assistance on a beating heart. Multivessel total arterial revascularisation is then done using the left internal thoracic artery (LITA) – right internal thoracic artery (RITA) Y composite conduit by the off pump methodology. In this surgery, instead of using the saphenous veins from the legs, the doctor uses the mammary arteries from inside the chest to bypass the blocked arteries. This minimal access or keyhole surgery has revolutionised the field of heart surgery. The technique has wonderful advantages like the mammary internal arteries lasting more than 30 years. It also keeps away the complications of splitting the chest open. This surgery enables the patients to be discharged from the hospital in three days and be back at work in 10 days from discharge whether one is an executive or a manual labourer.
There are three types of diabetes viz. Type I diabetes in which the body does not produce insulin. People with this type of diabetes need to take insulin injections throughout their life. The second type of diabetes is the Type II diabetes in which the body does not produce adequate insulin for the body to function properly or the cells in the body do not respond to insulin properly. This type of diabetes is however progressive and it worsens gradually. The patient has to take insulin may be in the form of a tablet. The third type of diabetes is called gestational diabetes which affects mostly females during pregnancy. High levels of glucose in a woman’s body render the body unable to produce enough insulin to transport all the glucose into her cells which results in gradually rising levels of glucose. If diabetes is not kept under control, it can unleash a blast of complications that affects almost every organ in the body which includes the heart and the blood vessels, the eyes, the kidneys, the nerves, the gums and teeth. People with uncontrolled diabetes mostly face heart and blood vessel diseases. In 2004, almost 68 per cent deaths pertaining to heart diseases because of diabetes were registered among people aged 65 years or older, with stroke being noted in 16 per cent of death certificates. Diabetes can also cause poor blood flow in the legs and feet (peripheral artery disease).
The sickness and the mortality rates during surgeries or any kind of required incisions are bigger in diabetic patients as compared to the non-diabetic patients of similar age group for various reasons. Macro vascular disease is extremely common in the patients with Type I and Type II diabetes. Over and above that, patients over the age of 50 years have impaired renal functions and are prone to fluid and electrolyte imbalance, dehydration and obtundation. During the post-operative period, diabetic patients have more incidences of infection at the site of operation and are also prone to urinary tract infection, pneumonia and various kinds of infections. A diabetic patient’s wound healing is mostly weakened in the setting of persistent hyperglycaemia as a result of modified fibroblast function. All these defects pooled with the infections may result in incision dehiscence, which frequently leads to a difficult and prolonged hospitalisation and frequent readmissions. Consequently, the diabetic patient spends 30 per cent to 50 per cent more time in the hospital than the non-diabetic following surgery, even if the surgery proceeds without incident.
Heart disease today is accelerating at an alarming pace in our country and is proliferating among the current generation because of stress, food habits and most importantly diabetes. India is the diabetic and heart attack centre all over the world and aggravating the situation, it has also been witnessing an upsurge in the coronary artery diseases. These are arteries which carry blood to the heart muscles. In heart disease cases, the coronary arteries get blocked leading to chest pain and heart attacks and damaging the heart muscles. It also reduces the functioning and pumping power of the heart.
The Nambiar Technique successfully demonstrates how even diabetic patients can elongate their life span and increase their chances of leading a normal life. It is advisable to keep diabetes in control by maintaining a disciplined lifestyle and regulating one’s diet and fitness with proper medication and your doctor’s supervision to avoid risking heart disease.
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