What's Worse Than A Low? A Heart Attack. Here's What Mine Was Like.

When I was first told about the complications that often come with Type 1 Diabetes, blindness, amputation and dialysis (what my doctor called "The BAD Ones) were those I feared most. They also said something about cardiovascular ones like heart attack and stroke, but since those happen to millions of people, I didn't worry about them much. I should have.

Stone cold fact: 3 out of 4 people with diabetes will die of a heart attack. Two weeks ago, I almost did.

Warning Signs I Ignored

On a Tuesday, I started to notice some pressure in my chest. No big deal - I've had it before, and my cardiologist told me not to worry about it unless I had other symptoms of a heart attack. Some of those either mimic Type 1 complications (sweating-hypoglycemia; indigestion or nausea-gastroparesis) or are hidden by another complication I have: autonomic neuropathy). But when shortness of breath and pain between my shoulder blades and in the left arm started, I began thinking something was going on. Or not.

Why not? Well, at most the symptoms were subtle - what I thought of as niggling. But they were persistent. After a lot of internal debate, on Thursday I decided to make the trip to the Durham Veterans Affairs Medical Center.

At the time, their ER was the subject of some negative press and intense scrutiny over alleged mistreatment. My experiences there (more than I can count) had been the opposite. Like any ER, if you aren't in extremis, you are going to wait. They'll get to you, but be prepared to be patient. This time, that wasn't necessary.

During My Heart Attack

I walked in at 3:50. I checked in and said I was having chest pain. A triage nurse heard my symptoms, took my vitals and gave me a baby aspirin. He hooked me up to an EKG, printed it out and disappeared. Within a minute they took me to a treatment room and drew some blood. In just a couple of minutes, the blood test result was back: my Troponin was at 6.56 (normal range is 0.0-0.49). One doctor explained it this way: Troponin is a heart enzyme test that shows if you are having a heart attack - it is the heart's way of say it is pissed off. Mine was.

By a quarter after four, doctors and nurses came out of the woodwork. Between the EKG and the Troponin I was clearly in the middle of a heart attack. One doctor said that they were going to do a cardiac catheterization on me - the only issue was whether it would be upstairs in the Durham VAMC or across the street at Duke Hospital. In as long as it takes to make a phone call, they took me upstairs. Happily, the cardiologist doing the procedure admitted that he liked the VAMC setup better - it was newer and better equipped.

They rolled my bed to the elevator and up we went. When we were in the hallway, I learned that the bed was motorized - suddenly we were flying down the halls. Once again, I was not disappointed.

The procedure was no big deal from my perspective. The only moment of worry was as the medical team was going down their checklist, one of the nurses asked me if I was an organ donor and if I had an advance directive on file. I told her yes to both, but chided her in a good natured way that those questions were not the best for inspiring confidence. We all had a good laugh over that.

First, my wrist was injected with a medication to make it numb. A catheter was placed in a vein in my wrist and snaked up to my heart. A dye was injected and filled the arteries of my heart. The doctor could see it on an x-ray screen. (The last time I had a 'cath' I was able to watch, but this time some of the equipment blocked my view.) I heard him describe the percentage and length of the blockages he found on my right coronary artery. Both were 99% blocked, one section was 23mm long, the other just 12. A balloon was used to clear both of them and a wire mesh called a stent was used to prop both of them open. Operation over.

From start to finish, the procedure took maybe 30 minutes, and it was barely an hour after I'd walked in the ER. Next stop: the Cardiac Intensive Care Unit. After the usual questions (how to you feel, are you in any pain, etc.) the next item on the agenda: dinner.

What I Learned

Part of my heart died. Starved of blood, a portion of the heart muscle died - getting stiff like a leftover hunk of porterhouse in the fridge and not nice and supple as it was before. In future tests, my cardiologist will look at this closer and will see what we will need to do to compensate for that.

Like other people with diabetes, I have long feared episodes of hypoglycemia - 'going low.' It is distressing, often painful and the hallmarks are discomfort, sweating, panic and helplessness. We often hear of people going so low that they die, and that tends to scare many of us to death. In my mind, that is the worst part of diabetes. As I found out, there are worse things, much worse.

Closer to home, about 18 years ago my mom had a massive heart attack and died. Her symptoms were almost identical to mine. Also like me, she didn't seem to think they were a big deal. One critical difference was that she was on a car trip in the middle of rural Illinois. In my case, I was an hour or two ahead of her when I walked into the ER. Had I not, according to the doctors I spoke with, I'd have had the same fate.

What continues to trouble me is that my symptoms were minor - barely niggling. On a scale of ten, my pain barely made it to a 4 at the most. Usually it was in the 1 to 2 range. My endocrinologist opined that with years of autonomic neuropathy, those signals weren't working right and that I'd have to use my brain to compensate for what my body wasn't telling me.

Another oddity is that I'd had a cath done 11 years ago. No stents, and at worst my left coronary artery was 50% blocked. Nothing on the right side. After this cath, the left hadn't changed an iota and the right was almost completely blocked.

What You Should Learn

Don't ignore the symptoms of a heart attack. Ultimately, this or other cardiovascular disease will eventually kill 75% of us who toil with diabetes. It is doubly threatening if you've had diabetes for a long time as your body might not warn you as easily as our more pancreatically advantaged friends.