Hyperglycemia – Part 2

I know some stubborn people with diabetes that will not contact their doctor and then often forget about what has happened for the period between appointments. You should make an appointment with your doctor if:

1. You experience ongoing diarrhea or vomiting, but you're able to take some foods or drinks
2. You have a fever that lasts more than 24 hours
3. Your blood glucose is more than 240 mg/dl (13.3 mmol/L) even though you've taken your diabetes medication
4. You have trouble keeping your blood glucose within the desired range

During digestion, your body breaks down carbohydrates from foods, such as bread, rice, and pasta, into various sugar molecules. One of these sugar molecules is glucose, which is the main energy source for your body. Glucose is absorbed directly into your bloodstream after you eat, but it can't enter the cells of most of your tissues without the help of insulin, a hormone secreted by your pancreas.

When the level of glucose in your blood rises, it signals your pancreas to release insulin. The insulin, in turn, unlocks your cells so that glucose can enter and provide the fuel your cells need to function properly. Any extra glucose is stored in your liver and muscles in the form of glycogen.

This process lowers the amount of glucose in your bloodstream and prevents it from reaching dangerously high levels. As your blood sugar level returns to normal, so does the secretion of insulin from your pancreas. Diabetes drastically diminishes the effects of insulin on your body, either because your pancreas doesn't produce enough insulin (type 1 diabetes) or because your body is resistant to the effects of insulin or doesn't produce enough insulin to maintain a normal glucose level (type 2 diabetes). As a result, glucose tends to build up in your bloodstream and may reach dangerously high levels (hyperglycemia) if not treated properly. Insulin or other drugs are used to lower blood sugar levels.

Many factors can contribute to hyperglycemia, including:

1. Not using enough insulin or oral diabetes medication
2. Not injecting insulin properly or using expired insulin
3. Not following your diabetes eating plan
4. Being inactive
5. Having an illness or infection
6. Using certain medications, such as steroids
7. Being injured or having surgery
8. Experiencing emotional stress, such as family conflict or workplace challenges

Illness or stress can trigger hyperglycemia because hormones produced to combat illness or stress can also cause your blood sugar to rise. Even people who don't have diabetes may develop hyperglycemia during severe illness. But people with diabetes may need to take extra diabetes medication to keep blood glucose near normal during illness or stress. Always make sure that you contact your doctor when blood glucose levels are above 200 mg/dl.

Untreated hyperglycemia can cause long-term complications. These include:

• Cardiovascular disease
• Nerve damage (neuropathy)
• Kidney damage (nephropathy) or kidney failure
• Damage to the blood vessels of the retina (diabetic retinopathy), potentially leading to blindness
• Clouding of the normally clear lens of your eye (cataract)
• Feet problems caused by damaged nerves or poor blood flow that can lead to serious infections
• Bone and joint problems, such as osteoporosis
• Skin problems, including bacterial infections, fungal infections and nonhealing wounds
• Teeth and gum infections

Concluded in next blog.

Hyperglycemia – Part 1

Hyperglycemia or high blood glucose levels are more common than even I realized. In talking with a doctor recently, he made mention of the number of patients he serves who don't worry about blood glucose readings consistently over 200 mg/dl (11.1 mmol/L). I asked why they are not concerned. He admitted he does not understand why as he has told them about the complications that can develop and losing their eyesight, kidney failure, heart problems, and that readings consistently over 150 mg/dl (8.3 mmol/L) would cause the complications. He said that they even see readings near 300 mg/dl (16.7 mmol/L). HbA1c readings were mostly between 8.0 and 11.9% on a regular basis.

He has tried to educate them, and teach them what testing can tell them, but nothing changes. Other patients are doing excellent and he had no concerns about their developing complications. He is not concerned about patients that have excursions into blood glucose levels above 150 mg/dl. Yes, he is concerned about hyperglycemia and how it affects people with diabetes.

Several factors can contribute to hyperglycemia,

1. Food
2. Physical activity choices
3. Illness
4. Nondiabetes medications
5. Too low a dose of glucose-lowering medication

It's important to treat hyperglycemia, because if left untreated, hyperglycemia can become severe and lead to serious complications requiring emergency care, such as diabetic coma. In the long term, persistent hyperglycemia, even if not severe can lead to complications affecting your eyes, kidneys, nerves, and heart. This is why you should be instructed about testing and why you need to contact your doctor if you have consistent elevated blood glucose readings.

Symptoms of hyperglycemia generally don't happen until blood glucose is elevated above 200 mg/dl (11.1 mmol/L). Then the symptoms can develop slowly over several days or weeks. The longer blood glucose levels remain elevated, the more serious the symptoms become.

Recognizing the early symptoms of hyperglycemia can help you treat the condition promptly. Watch for:

• Frequent urination
• Increased thirst
• Blurred vision
• Fatigue
• Headache

If hyperglycemia goes untreated, it can cause toxic acids (ketones) to build up in your blood and urine (ketoacidosis). Signs and symptoms include:

• Fruity-smelling breath
• Nausea and vomiting
• Shortness of breath
• Dry mouth
• Weakness
• Confusion
• Abdominal pain
• Coma

If you let hypoglycemia get to the level above, call 911 or emergency medical assistance if:

1. You're sick and can't keep any food or fluids down, and
2. Your blood glucose levels are persistently above 240 mg/dl (13.3 mmol/L) with ketones in your urine

Continued in the next blog.

Our Support Group's March Meeting

We had planned for a meeting on March 7, but had some conflicts and Tim postponed it to March 14. The main problem was that on Friday, March 6, Brenda was rushed to the Hospital and then transferred to another hospital. With that information, we didn't need to wonder as this meant it had to be a heart problem.

It has been more than a week now and she is still not home. Tim said that she had requested that we go ahead with the meeting and had passed this request through her daughter. Tim and her daughter have been in almost daily contact and Tim passes information to the rest of us in emails. Because of the distance and the fact that in the beginning, Brenda was in isolation, people were asked not to make the trip. Max and Allen did make the trip on Wednesday, but they could not visit her. Brenda was able to acknowledge them from her bed, but that was it.

We had a full explanation when we started the meeting and everyone understood that it was serious as she had a heart attack and was lucky to be alive. It was one of the grandchildren that had called 911, and then called her mother. Brenda's daughter arrived, as she was loaded into the ambulance and picked up the children and went to the hospital. The decision was made to transfer her mother to another hospital and she selected the one about two and a half hours away. Not that by helicopter, but it is still some distance by auto.

Tim stated that there was really no program now as Brenda and Jason were working on one and Jason said that all the work was at Brenda's house as she was putting a few things on slides. At that point, Rose asked if Tim could bring up a few of my blogs that I was posting on diabetes complications. Earl seconded this and said he was learning a lot and some things he didn't want to learn, but should.

Tim asked if that was okay and no one opposed this. Tim asked which to start with and I suggested with the eye disease I suggested that he pull up the January 21, 2014 blog or near that date. Tom raised his hand and said he had a question he wanted to ask. Tim told him to ask. Tom asked which complications I was going to cover. I said I have covered eye diseases which Tim will display shortly, I have covered depression, neuropathy which is nerve damage, hypoglycemia which is low blood glucose, nephropathy which is kidney disease, and I have atherosclerosis which is heart disease being posted. Next, I will have hyperglycemia, followed by diabetic ketoacidosis and then hyperglycemic hyperosmolar nonketotic syndrome.

Tom asked what was next. I said gastroparesis, foot care, and preventing amputations, infections, periodontal disease, fatty liver disease, diabetic skin problems, Alzheimer's disease, deafness, and gestational diabetes. Then I am planning on doing some blogs on related problems. This will include polypharmacy, sleep apnea, statins, and sleep. There may be a topic or two more, but this is my goal.

At that point, Tim had my first blog on eye disease on the screen and said he was ready to begin. He started with this:

Risk factors for cataracts include:

• Most cataracts are due to aging
• Diseases, like diabetes
• Eye injury or trauma
• Eye surgery for another problem
• Inheritance or pregnancy-related causes
• Overexposure of the eyes to the sun's damaging ultraviolet rays
• Smoking
• Certain medications

This generated some discussion and Tim asked me what stage my cataracts were considered. I said at the early stage and I was being checked every six months. My next appointment was in April.

Then we moved on to this:

The most common cataract symptoms include:

• Blurred or cloudy vision
• Faded colors
• Increased glare from headlights, lamps, or sunlight
• Poor night vision
• Multiple images in a single eye, or double vision
• Frequent prescription changes for your eyeglasses or contact lenses

For early cataracts, these steps may help:

• Obtaining a new prescription for eyeglasses or contact lenses
• Using brighter lighting
• Using magnifying lenses
• Wearing sunglasses

I said that as of yet I have not noticed any of symptoms except the glare of certain headlights, and my wife even has problems with them. I said this is one reason when you have diabetes to have a dilated eye exam once a year and have a good eye exam as you become older. I said they also check my vision and record the proposed prescription every year so that when I need surgery, they will have all the information needed.

More discussion followed with some on glaucoma. Tim said we can cover more of Bob's blogs in the future as it looks like there will be plenty to get our attention. Tim said the meeting is over and some started to leave. Tom stopped me and asked to follow me home. We left then.

Atherosclerosis – Part 5

Lifestyle changes can help you prevent or slow the progression of atherosclerosis.

• Stop smoking. Smoking damages your arteries. If you smoke or use tobacco in any form, quitting is the best way to halt the progression of atherosclerosis and reduce your risk of complications.
• Exercise most days of the week. Regular exercise can condition your muscles to use oxygen more efficiently. Physical activity can also improve circulation and promote development of new blood vessels that form a natural bypass around obstructions (collateral vessels). Exercise helps lower blood pressure and reduces your risk of diabetes. It is always suggested that your doctor approve any exercise regimen if you have not been a participant in regular exercise.

Ideally, you should exercise 30 to 60 minutes most days of the week. If you can't fit it all into one session, try breaking it up into 10-minute intervals. You can take the stairs instead of the elevator, walk around the block during your lunch hour, or do some situps or pushups while watching television.

• Eat healthy foods. A heart-healthy diet based on fruits, vegetables, and low in saturated fat, cholesterol and sodium, can help you control your weight, blood pressure, cholesterol and blood sugar. Try substituting whole-grain bread in place of white bread; grabbing an apple, a banana, or carrot sticks as a snack; and reading nutrition labels as a guide to controlling the amount of salt and fat you eat. I am not promoting whole grains like the source does and I do not believe cholesterol reduction improves atherosclerosis. Those of us with diabetes will need to limit or eliminate whole grains. We also need to be careful of carbohydrate-laden fruits, like bananas, and certain vegetables, as carrots are sources of carbohydrates.
• Lose extra pounds and maintain a healthy weight. If you're overweight, losing as few as 5 to 10 pounds (about 2.3 to 4.5 kilograms) can help reduce your risk of high blood pressure and high cholesterol, two of the major risk factors for developing atherosclerosis. Losing weight helps reduce your risk of diabetes or control your condition if you already have diabetes.
• Manage stress. Reduce stress as much as possible. Practice healthy techniques for managing stress, such as muscle relaxation and deep breathing.
• Tightly manage your diabetes. While this may not be a lifestyle change, it is necessary to prevent more damage to your arteries and minimize atherosclerosis.
  

If you have high cholesterol, high blood pressure, diabetes or another chronic disease, work with your heart doctor to manage the condition and promote overall health.

It's thought that some foods and herbal supplements can help reduce your high cholesterol level and high blood pressure, two major risk factors for developing atherosclerosis. With your doctor's OK, consider these supplements and products:

• Alpha-linolenic acid (ALA)
• Artichoke
• Barley
• Blond psyllium (found in seed husk and products such as Metamucil)
• Calcium
• Cocoa
• Cod liver oil
• Coenzyme Q10
• Garlic
• Oat bran (found in oatmeal and whole oats)
• Omega-3 fatty acids
• Sitostanol (found in oral supplements and some margarines, such as Benecol) and be sure that the margarines have no transfats.

Warning – Talk to your heart doctor before adding any of these supplements to your atherosclerosis treatment. Some supplements can interact with medications, causing harmful side effects.

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You can also practice relaxation techniques, such as yoga or deep breathing, to help you relax and reduce your stress level. These practices can temporarily reduce your blood pressure, reducing your risk of developing atherosclerosis.

The same healthy lifestyle changes recommended to treat atherosclerosis also help prevent it. These include:

• Quitting smoking
• Eating healthy foods
• Exercising regularly
• Maintaining a healthy weight
• Tightly managing diabetes

Just remember to make changes one step at a time, and keep in mind what lifestyle changes are manageable for you in the long run. While lifestyle changes does not include tightly managing diabetes, this is necessary to prevent atherosclerosis.

Atherosclerosis – Part 4

Lifestyle changes, such as eating a healthy diet and exercising, are often the best treatment for atherosclerosis. Properly managing diabetes is a must to assist in keeping atherosclerosis from happening or getting worse. Sometimes, medication or surgical procedures may be recommended.

Various drugs can slow, or even reverse, the effects of atherosclerosis. Here are some common choices:

• Cholesterol medications. Aggressively lowering your low-density lipoprotein (LDL) cholesterol, the "bad" cholesterol, can slow, stop, or even reverse the buildup of fatty deposits in your arteries. Boosting your high-density lipoprotein (HDL) cholesterol, the "good" cholesterol, may help, too. Your doctor can choose from a range of cholesterol medications, including drugs known as statins and fibrates. In addition to lowering cholesterol, statins have additional effects that help stabilize the lining of your heart arteries and prevent atherosclerosis.
• Anti-platelet medications. Your doctor may prescribe anti-platelet medications, such as aspirin, to reduce the likelihood that platelets will clump in narrowed arteries, form a blood clot, and cause further blockage.
• Beta-blocker medications. These medications are commonly used for coronary artery disease. They lower your heart rate and blood pressure, reducing the demand on your heart and often relieve symptoms of chest pain. Beta-blockers reduce the risk of heart attacks and some heart rhythm problems.
• Angiotensin-converting enzyme (ACE) inhibitors. These medications may help slow the progression of atherosclerosis by lowering blood pressure and producing other beneficial effects on the heart arteries. ACE inhibitors can also reduce the risk of recurrent heart attacks.
• Calcium channel blockers. These medications lower blood pressure and are sometimes used to treat angina.
• Water pills (diuretics). High blood pressure is a major risk factor for atherosclerosis. Diuretics lower blood pressure.
• Other medications. Your doctor may suggest certain medications to control specific risk factors for atherosclerosis, such as diabetes. Sometimes specific medications to treat symptoms of atherosclerosis, such as leg pain during exercise, are prescribed.

Sometimes more aggressive treatment is needed. If you have severe symptoms or a blockage that threatens muscle or skin tissue survival, you may be a candidate for one of the following surgical procedures:

• Angioplasty and stent placement. In this procedure, your heart surgeon inserts a long, thin tube (catheter) into the blocked or narrowed part of your artery. A second catheter with a deflated balloon on its tip is then passed through the catheter to the narrowed area. The balloon is then inflated, compressing the deposits against your artery walls. A mesh tube (stent) is usually left in the artery to help keep the artery open. Been there, had this done.
• Endarterectomy. In some cases, fatty deposits must be surgically removed from the walls of a narrowed artery. When the procedure is done on arteries in the neck (the carotid arteries), it's called a carotid endarterectomy.
• Thrombolytic therapy. If you have an artery that's blocked by a blood clot, your heart surgeon may use a clot-dissolving drug to break it apart.
• Bypass surgery. Your heart surgeon may create a graft bypass using a vessel from another part of your body or a tube made of synthetic fabric. This allows blood to flow around the blocked or narrowed artery.

Atherosclerosis – Part 3

Now that you have your questions and are ready for your appointment, here are some questions that you should expect your doctor to ask. Make sure you have the necessary information.

• Do you have a family history of high cholesterol, high blood pressure, or heart disease?
• What are your diet and exercise habits like?
• Do you or did you smoke or use tobacco in any form?
• Have you had a cholesterol test? If so, when was your last test? What were your cholesterol levels? Some doctors will have the test done before your appointment.
• Do you have discomfort in your chest or pain in your legs with walking or at rest?
• Have you had a stroke or unexplained numbness, tingling or weakness of one side of your body or difficulty speaking?
• What was your last HbA1c? Again your doctor may do the test before your appointment.

During a physical exam, your doctor may find signs of narrowed, enlarged, or hardened arteries, including:

• A weak or absent pulse below the narrowed area of your artery
• Decreased blood pressure in an affected limb
• Whooshing sounds (bruits) over your arteries, heard using a stethoscope
• Signs of a pulsating bulge (aneurysm) in your abdomen or behind your knee
• Evidence of poor wound healing in the area where your blood flow is restricted. This is dangerous for those of us with diabetes and can be the cause of amputations.

Depending on the results of the physical exam, your doctor may suggest one or more diagnostic tests, including:

• Blood tests. Lab tests can detect increased levels of cholesterol and blood sugar that may increase the risk of atherosclerosis. You'll need to go without eating or drinking anything but water for nine to 12 hours before your blood test. Your doctor should tell you ahead of time if this test will be performed during your visit.
• Doppler ultrasound. Your doctor may use a special ultrasound device (Doppler ultrasound) to measure your blood pressure at various points along your arm or leg. These measurements can help your doctor gauge the degree of any blockages, as well as the speed of blood flow in your arteries.
• Ankle-brachial index. This test can tell if you have atherosclerosis in the arteries in your legs and feet. Your doctor may compare the blood pressure in your ankle with the blood pressure in your arm. This is known as the ankle-brachial index. An abnormal difference may indicate peripheral vascular disease, which is usually caused by atherosclerosis.
• Electrocardiogram (ECG). An electrocardiogram records electrical signals as they travel through your heart. An ECG can often reveal evidence of a previous heart attack. If your signs and symptoms occur most often during exercise, your doctor may ask you to walk on a treadmill or ride a stationary bike during an ECG.
• Stress test. A stress test, also called an exercise stress test, is used to gather information about how well your heart works during physical activity. Because exercise makes your heart pump harder and faster than it does during most daily activities, an exercise stress test can reveal problems within your heart that might not be noticeable otherwise. An exercise stress test usually involves walking on a treadmill or riding a stationary bike while your heart rhythm and blood pressure and breathing are monitored. In some types of stress tests, pictures will be taken of your heart, such as during a stress echocardiogram (ultrasound) or nuclear stress test. If you're unable to exercise, you may receive a medication that mimics the effect of exercise on your heart.
• Cardiac catheterization and angiogram. This test can show if your coronary arteries are narrowed or blocked. A liquid dye is injected into the arteries of your heart through a long, thin tube (catheter) that's fed through an artery, usually in your leg, to the arteries in your heart. As the dye fills your arteries, the arteries become visible on X-ray, revealing areas of blockage.
• Other imaging tests. Your doctor may use ultrasound, a computerized tomography (CT) scan, or magnetic resonance angiography (MRA) to study your arteries. These tests can often show hardening and narrowing of large arteries, as well as aneurysms and calcium deposits in the artery walls.

Atherosclerosis – Part 2

The buildup of plaque occurs over time. Besides natural aging, factors that can increase the risk of atherosclerosis include:

1. High blood pressure
2. High cholesterol
3. Diabetes
4. Obesity
5. Smoking and other tobacco use
6. A family history of early heart disease
7. Lack of exercise

The complications of atherosclerosis depend on which arteries are blocked. For example:

• Coronary artery disease. When atherosclerosis narrows the arteries close to your heart, you may develop coronary artery disease, which can cause chest pain (angina), a heart attack or heart failure.
• Carotid artery disease. When atherosclerosis narrows the arteries close to your brain, you may develop carotid artery disease, which can cause a transient ischemic attack (TIA) or stroke.
• Peripheral artery disease. When atherosclerosis narrows the arteries in your arms or legs, you may develop circulation problems in your arms and legs called peripheral artery disease. This can make you less sensitive to heat and cold, increasing your risk of burns or frostbite. In rare cases, poor circulation in your arms or legs can cause tissue death (gangrene). PAD can also be the cause of amputations.
• Aneurysms. Atherosclerosis can also cause aneurysms, a serious complication that can occur anywhere in your body. An aneurysm is a bulge in the wall of your artery. Most people with aneurysms have no symptoms. Pain and throbbing in the area of an aneurysm may occur and is a medical emergency.

If an aneurysm bursts, you may face life-threatening internal bleeding. Although this is usually a sudden, catastrophic event, a slow leak is possible. If a blood clot within an aneurysm dislodges, it may block an artery at some distant point.

If you think you may have atherosclerosis or are worried about having atherosclerosis because of a strong family history of heart disease, make an appointment with your doctor to have your cholesterol level checked. Here's some information to help you get ready for your appointment and know what to expect from your doctor.

What you can do -

• Be aware of any pre-appointment restrictions. When you make the appointment, be sure to ask if there's anything you need to do in advance, such as restrict your diet. Many blood tests, including cholesterol and triglycerides, require that you fast beforehand.
• Write down any symptoms you're experiencing. Atherosclerosis seldom has symptoms, but it is a risk factor for heart disease. Knowing you have symptoms such as chest pains or shortness of breath can help your doctor decide how aggressively to treat your atherosclerosis. Do not forget to show the doctor any slow healing wounds or foot ulcers, or heal cracks.
• Write down key personal information, including a family history of high cholesterol, heart disease, stroke, high blood pressure or diabetes, and any major stresses or recent life changes.
• Make a list of all medications, vitamins, or supplements you're taking.
• Take a family member or friend along, if possible. Someone who accompanies you may remember something that you missed or forgot.
• Be prepared to discuss your diet and exercise habits. If you don't already eat a healthy diet or exercise, you can talk to your doctor about challenges you might face in getting started.
• Write down questions to ask your doctor.

Preparing a list of questions will help you make the most of your time with your doctor. For atherosclerosis, some basic questions to ask your doctor include:

1. What tests will I need?
2. What's the best treatment?
3. What foods should I eat or avoid?
4. What's an appropriate level of physical activity?
5. How often do I need a cholesterol test?
6. What are the alternatives to the primary approach you're suggesting?
7. I have other health conditions. How can I best manage them together?
8. Are there restrictions I need to follow?
9. Should I see a specialist?
   10. Is there a generic alternative to the medicine you're prescribing?
   11. Are there brochures or other printed material that I can take with me?
   12. What websites do you recommend?
   13. How can I best manage my diabetes to prevent heart problems?

Don't hesitate to ask any other questions you may have.

Atherosclerosis – Part 1

If I confused you in the last blog, hopefully I will clear things in this blog. Atherosclerosis is a specific type of arteriosclerosis. It is unfortunate that the terms are sometimes used interchangeably. In my research, I found many articles on atherosclerosis that were specifically about arteriosclerosis.

Arteriosclerosis happens when the blood vessels (arteries) that carry oxygen and nutrients from your heart to the rest of your body become thick and stiff. This in turn can restrict blood flow to your organs and tissues. Healthy arteries are flexible and elastic, but over time, the walls in your arteries can harden, a condition commonly called hardening of the arteries.

Atherosclerosis refers to the buildup of fats, cholesterol, and other substances in and on your artery walls (plaques), which can restrict blood flow. These plaques can burst, triggering a blood clot. Although atherosclerosis is often considered a heart problem, it can affect arteries anywhere in your body. Atherosclerosis usually is preventable and is treatable. This and the following blogs are on atherosclerosis.

Atherosclerosis develops gradually. Mild atherosclerosis usually doesn't have any symptoms. You usually won't have atherosclerosis symptoms until an artery is so narrowed or clogged that it can't supply adequate blood to your organs and tissues. Sometimes a blood clot completely blocks blood flow, or even breaks apart and can trigger a heart attack or stroke.

Symptoms of moderate to severe atherosclerosis depend on which arteries are affected. For example: If you have atherosclerosis

1. In your heart arteries, you may have symptoms, such as chest pain or pressure (angina). This is what sent me to the hospital for the ballooning of several arteries and placing a stent in another artery. This is also when diabetes was diagnosed.
2. In the arteries leading to your brain, you may have signs and symptoms such as sudden numbness or weakness in your arms or legs, difficulty speaking or slurred speech, or drooping muscles in your face. These signal a transient ischemic attack (TIA), which, if left untreated, may progress to a stroke.
3. In the arteries in your arms and legs, you may have symptoms of peripheral artery disease, such as leg pain when walking (intermittent claudication).
4. In the arteries leading to your kidneys, you develop high blood pressure or kidney failure.
5. In the arteries leading to your genitals, you may have difficulties having sex. Sometimes, atherosclerosis can cause erectile dysfunction in men. In women, high blood pressure can reduce blood flow to the vagina, making sex less pleasurable.
   

If you think you have atherosclerosis, talk to your doctor. Also, pay attention to early symptoms of inadequate blood flow, such as chest pain (angina), leg pain, or numbness. Early diagnosis and treatment can stop atherosclerosis from worsening and prevent a heart attack, stroke, or another medical emergency.

Atherosclerosis is a slow, progressive disease that may begin in childhood. The exact cause is yet unknown, but it may start with damage or injury to the inner layer of an artery. The damage may be caused by:

• High blood pressure
• High cholesterol, often from getting too much cholesterol or saturated fats in your diet
• High triglycerides, a type of fat (lipid) in your blood
• Smoking and other sources of tobacco
• Diabetes
• Inflammation from diseases, such as arthritis, lupus, diabetes, infections, or inflammation of unknown cause

Once the inner wall of an artery is damaged, blood cells and other substances often clump at the injury site and build up in the inner lining of the artery. Over time, fatty deposits (plaques) made of cholesterol and other cellular products also build up at the injury site and harden, narrowing your arteries. This causes the organs and tissues connected to the blocked arteries not to receive enough blood to function properly.

Eventually pieces of the fatty deposits may break off and enter your bloodstream. In addition, the smooth lining of a plaque may rupture, spilling cholesterol and other substances into your bloodstream. This may cause a blood clot, which can block the blood flow to a specific part of your body, such as occurs when blocked blood flow to your heart causes a heart attack. A blood clot can also travel to other parts of your body, blocking flow to another organ.