I am 33 years old, have had type 1 diabetes for 20 years now, and have been on an insulin pump for almost 11 years. My hemoglobin A1c level right now is in the high 7% range, but for the past three years, it has been steadily rising. For a long time, I kept it at 6% with no problem.

I have been experiencing some mild chest pains (in the middle) with heart palpitations. My blood pressure always runs around 90/60, and today it was 117/80. I know that is not high but it is higher than my BP normally is. With diabetes for this number of years what can I expect in the way of complications, especially heart trouble?

There are no specific recommendations I can give you. The best insurance is good blood sugar control. The DCCT. indicated that the risk of microvascular complications (retinopathy, nephropathy, and neuropathy) is related to overall level of control.

Heart disease is not included in the microvascular classification of complications. However, nephropathy, or kidney involvement, is the greatest predictor of cardiovascular disease in patients with type 1 diabetes. Your blood pressure also looks good.

I would suggest you work with your physician to determine why you have chest pains. This may include doing a stress test, which can be performed as a stress echocardiogram or an exercise stress test.

JTL