Managing Diabetes and Stent Complications: Key Concerns for Patients

Q: Managing Diabetes and Stent Complications: Key Concerns for Patients

Hello： Hearing your own heartbeat after a meal may be a temporary phenomenon of palpitations, and there is no need to worry too much. <br>For tinnitus, you may consult an otolaryngologist for an examination. <br>It is also beneficial for patients to sit and rest for half an hour

Issues in Diabetic Patients After Stent Placement

Hello Doctor: My father has had diabetes for over 20 years (with blood sugar levels around 200), and he has significant vision impairment.
Last year, he was diagnosed with vascular occlusion and had two drug-eluting stents placed.
Since then, he has been on anticoagulants, taking medication daily—antidiabetic medication before meals and anticoagulants after meals.
However, he needs to sit and rest for half an hour after taking his medication because he hears his heartbeat and experiences a constant ringing in his ears (tinnitus).
The cardiothoracic surgeon mentioned that placing the stents was not advisable, as it requires lifelong medication, and suggested that bypass surgery (using autologous veins) would have been a more definitive solution.
He also stated that in other countries, they typically perform bypass surgery directly without first placing stents, but in our country, the standard practice is to place stents first, which he considers the least favorable approach.
I would like to ask: 1.
What are some ways to improve my father's need to rest for half an hour after taking his medication to adjust his heart? 2.
If the cardiothoracic surgeon's advice is correct, would it be better not to place stents if my father has a recurrence in the future? 3.
Since he must take anticoagulants for life, if he misses a meal or a day without taking them, will that immediately cause heart problems? I appreciate your assistance in answering these questions.
Thank you.

Xiaozi, 20~29 year old female. Ask Date: 2008/10/20

Dr. Lin Jixiong reply Cardiology

Hello: Hearing your own heartbeat after a meal may be a temporary phenomenon of palpitations, and there is no need to worry too much.
For tinnitus, you may consult an otolaryngologist for an examination.
It is also beneficial for patients to sit and rest for half an hour after taking medication.
Diabetic patients with coronary heart disease can consider bypass surgery based on the clinical judgment of their physician.
However, due to the risks associated with surgery and anesthesia, many patients and their families tend to prefer percutaneous coronary intervention as the first-line treatment.
After the placement of a drug-eluting stent, previous studies have suggested long-term use of antiplatelet medication to prevent sudden stent thrombosis.
However, recent studies have found that stopping antiplatelet medication after one year of use results in rates of stent thrombosis and mortality similar to those seen with traditional stents.
Therefore, lifelong use of antiplatelet medication is not currently mandated, but aspirin should be taken for life.
Even if undergoing bypass surgery, aspirin should still be taken indefinitely.
As for whether to opt for bypass surgery in the event of recurrence, it is ideal to assess the condition of vascular occlusion at that time and discuss it with the clinical physician before making a decision.
Sincerely, Dr.
Lin Chi-Hsiung, Taoyuan General Hospital.

Reply Date: 2008/10/20

More Info

Managing diabetes, especially in patients who have undergone procedures like stenting, presents unique challenges and concerns. Your father's situation, with a long history of diabetes and recent stent placement, requires careful management to minimize complications and maintain his quality of life. Here are some key considerations and recommendations based on your questions:

1. Managing Post-Stenting Symptoms
It’s not uncommon for patients to experience symptoms such as palpitations or tinnitus (ringing in the ears) after stenting, especially when they are on anticoagulants. These symptoms can be exacerbated by anxiety or the body's adjustment to new medications. Here are some strategies that may help:
- Gradual Activity: Encourage your father to gradually increase his physical activity as tolerated. Light walking can improve circulation and may help alleviate some symptoms.

- Medication Review: It's essential to have a healthcare provider review all medications. Sometimes, side effects from other medications can contribute to symptoms. Adjusting dosages or switching medications may be beneficial.

- Stress Management: Techniques such as deep breathing exercises, meditation, or gentle yoga can help manage anxiety, which may reduce the perception of palpitations or tinnitus.

- Regular Follow-ups: Ensure that your father has regular follow-ups with his cardiologist to monitor his heart condition and medication effects.

2. Stenting vs. Bypass Surgery
The choice between stenting and bypass surgery often depends on the specific circumstances of the patient, including the location and severity of blockages, overall health, and the presence of other medical conditions. While some practitioners may prefer bypass surgery for long-term relief, stenting is often chosen for its less invasive nature and quicker recovery time.
If your father experiences recurrent blockages, it’s crucial to have a thorough discussion with his cardiologist about the best approach for future interventions. Factors to consider include:
- Severity of Blockages: If blockages are recurrent and significant, bypass surgery might be a more suitable option.

- Overall Health: Your father’s overall health and ability to tolerate surgery should be assessed.

- Expert Opinion: Seeking a second opinion from another cardiologist or a cardiovascular surgeon can provide additional insights into the best treatment options.

3. Importance of Anticoagulant Adherence
Anticoagulants are crucial for preventing blood clots, especially after stenting. Missing a dose can increase the risk of clot formation, which can lead to serious complications, including heart attacks. Here are some strategies to ensure adherence:
- Medication Reminders: Use pill organizers or set alarms on a phone to remind your father when to take his medications.

- Routine: Encourage him to take his medications at the same time as other daily activities (e.g., meals) to create a routine.

- Education: Educate your father about the importance of these medications and the risks associated with missing doses. Understanding the "why" can motivate adherence.

- Communication with Healthcare Providers: If he misses a dose, he should consult his healthcare provider for guidance on what to do next.

Conclusion
Managing diabetes and the complications associated with stenting requires a comprehensive approach that includes medication management, lifestyle modifications, and regular medical follow-ups. It’s essential to maintain open communication with healthcare providers to ensure that your father receives the best possible care tailored to his needs. Encourage him to engage in discussions about his treatment options and to express any concerns he may have. This proactive approach can significantly enhance his quality of life and health outcomes.

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