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March 19, 2002

Complications

Question from Sydney, New South Wales, Australia:

My 70 year old father, who had type�1 diabetes for 40 years and was insulin twice daily, also had a 60% blockage of the right carotid artery to the brain, and about three months ago, he had some discomfort in chest and nasal breathing so a general practitioner in India suggested doing an electrocardiogram (ECG) and angiogram which revealed three vessel disease in his heart and a 90% blockage of his carotid artery. His doctors advised a right carotid angioplasty and coronary bypass as soon as possible to solve these problems respectively. He had the right carotid angioplasty a couple of weeks later, but developed several complications and passed away after spending 18 days in intensive care unit due to cardiac failure before being operated for coronary bypass. Why didn't the diabetes specialist with whom my father consulted regularly even suggested a routine ECG well before as a precautionary measure? The doctor knew that my father had diabetes and blocks in the artery to his brain.

Answer:

I am sorry to hear about your father. I am not familiar with the data comparing carotid angioplasty (where a balloon dilates the blood vessel) versus carotid endarterectomy (where the narrowing is surgically removed with an operation). I do know that it is a controversial area.

I am not sure why your father’s physician did not recommend more cardiac tests. It is known that heart disease is the most common killer of patients with type�2 diabetes. It is also frequent in patients with type�1 diabetes who have kidney involvement.

JTL