Heart disease is the leading complication associated with diabetes. An alar ming two out of three people with diabetes will die from heart attack or stroke. This complication is taking a huge toll on those with diabetes, though many are unaware of it.
How can you lower your chance of developing heart disease? First, remember good diabetes management involves more than lowering blood glucose. Research shows even small decreases in blood glucose, blood pressure and cholesterol can lead to a longer life with fewer diabetes-related complications. Control of blood pressure and cholesterol is as important as that of blood glucose levels. The ABCs of diabetes self-management can help.
A. The A1C test measures average blood glucose over the past three months. An A1C of less than or equal to 7.0 per cent indicates good blood glucose control. Your doctor will give you a form to get this test done at a lab. Over time, high blood glucose can damage many organs, particularly the kidneys, eyes, nerves, heart and blood vessels. Effective diabetes treatment involves lowering blood glucose levels to as close to normal as possible. In general, those with diabetes should aim for an A1C of less then 7.0 per cent. Remember that your target goal will be suited to your individual needs. A1C gives a measure of both fasting blood glucose (FBG) and postprandial glucose (PPG), the glucose level one to two hours after eating.
A1C = FBG + PPG
Although we do not know how much the FBG and PPG contribute to the total A1C, both are likely important to achieving glucose goals. It helps to check blood glucose levels using a meter at home both before meals and two hours afterwards. To achieve an A1C of less than or equal to 7.0 per cent, aim for a FBG of between 4.0 mmol to 7.0 mmol and a two-hour PPG target of 5.0 mmol to 10 mmol/L.
Why is an A1C of less than or equal to 7.0 per cent important? Several clinical trials have studied the effect of lowering A1C on the development of diabetes-related complications. In each study, lowering A1C by one to two percent significantly decreased kidney, eye and nerve damage.
B. Blood pressure should be measured at every visit with your doctor to make sure it is below 130/80 mm Hg.Those with diabetes are as much as three times more likely to develop high blood pressure than those without it. For people with both diabetes and high blood pressure, the risk of heart disease is doubled. Aggressive blood pressure control is necessary, as the results in Table 1 show.
Most people with high blood pressure do not have any symptoms. Lifestyle changes to lower blood pressure include maintaining a healthy weight while limiting sodium and alcohol and quitting smoking.
If lifestyle changes are not enough to reach the goal blood pressure (usually less than 130/80), blood pressure low ering medication may be suggested. Your physician can prescribe various combinations of one or more medications to help you reach your target goal.
C. Cholesterol (LDL-bad cholesterol) should be less than 2.5 mmol/L and the ratio of TC: HDL (TC = total cholesterol; HDL = good cholesterol) should be less than 4.
Cholesterol, a fat-like substance in the body, performs many useful functions. It comes from food and is also made by the liver. Cholesterol travels around in the body on particles called lipoproteins. Low-density lipoproteins (LDL) take cholesterol from the liver to the rest of the body. High density lipoproteins (HDL) bring excess cholesterol back to the liver. Those with diabetes often have less HDL than usual. As well, while LDL may be at a normal level, it can stick to arteries and damage blood ves sels more easily. People with dia betes also often have higher trigylceride (another kind of blood fat) levels. The combination of lower HDL, higher triglycerides and ‘stickier’ LDL can result in plaque forming in the blood vessels and hardening of the arteries. The chance of having a heart attack or stroke increases.
Lowering weight, eating a well-balanced diet and doing regular aerobic activity can also help reduce blood fat levels. If these lifestyle changes do not bring the desired results, your doctor will prescribe medication to lower cholesterol levels.
Since smoking can increase blood pressure, decrease the good cholesterol (HDL) and add other risks, quitting is essential for those with diabetes (as well as those without it).
Generally, a low dose (81 to 325 mg/day) of ASA (Aspirin™) is recommended for anyone with diabetes who has signs or risk factors for heart disease.
All of these recommendations can help control blood glucose, blood pressure and cholesterol. Knowing your ABCs can help you to live a longer, healthier life with fewer complications.