Heart disease is the leading complication affecting people with diabetes. An alarming two out of three will die from heart attack or stroke. Heart disease takes a huge toll on people with diabetes. Yet many of them are unaware of it.
How do you reduce your chance of developing heart disease? First, remember that good diabetes management involves more than lowering blood glucose. Research shows that even small reductions in blood glucose, blood pressure and cholesterol allows people with diabetes to live longer with fewer complications. It is becoming more obvious that controlling blood pressure and cholesterol is just as important as managing blood glucose. The ABCs of diabetes self-management can help you protect your overall health, as well as your heart.
A A1C - This test measures average blood glucose over the past three months. Your doctor will give you a requisition to get this test done at a lab. An A1C of less than or equal to 7.0 per cent indicates good blood glucose control.
Over time, high blood glucose levels can damage many organs, especially the kidneys, eyes, nerves, heart and blood vessels. Diabetes treatment focuses on lowering blood glucose to as close to normal as is practical. In general, those with diabetes should aim for an A1C of less than 7.0 per cent. However, each person’s goal must be individual.
A1C measures the average blood glucose level over the past three months. It reflects both fasting blood glucose (FBG) and postprandial glucose (PPG), the glucose levels two hours after you eat. 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 (5.0-8.0 mmol/L if A1C targets are not being met).
Why is an A1C of less than or equal to 7.0 per cent important? Several randomized clinical trials (RCTs) showed the effects of lowering A1C on the incidence of diabetes-related complications.
In each study, lowering A1C by one to two percent significantly reduced kidney, eye and nerve damage as well as a reduction in heart complications.
B Blood Pressure - this should be below 130/80 mm Hg and measured at every visit with your physician.
The incidence of high blood pressure in people with diabetes is 1.5 to three times higher than in those without the disease. Studies show us that people with both diabetes and high blood pressure have approximately twice the risk of heart disease. This is why aggressive blood pressure control is so necessary.
Most people with high blood pressure do not have any symptoms. Lifestyle changes to lower blood pressure include reaching and maintaining a healthy weight and limiting sodium and alcohol intake. One of the most important things you can do is quit smoking, since that habit also increases blood pressure.
If lifestyle changes are not enough to reach the goal blood pressure (usually less than 130/80), medication will be prescribed. Various combinations of one or more medications can help.
C Cholesterol - (LDL-bad cholesterol) should be less than 2.0 mmol/L and the ratio of TC: HDL (TC = total cholesterol; HDL = good cholesterol) should be less than 4.
Benefits of Tighter Control
|Condition||Reduction in occurrence|
|Stroke||44 per cent|
|Heart attack||21 per cent|
|Retinopathy (eye disease) progression||34 per cent|
|Deterioration in vision||47 per cent|
|Microvascular disease||37 per cent|
|* United Kingdom Prospective Diabetes Study|
Cholesterol is a fat-like substance in the body that performs many useful functions. We get cholesterol from the food we eat. The liver makes some as well. 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.
People with diabetes often have less HDL than usual. While their LDL levels are often normal in quantity, the LDL has a tendency to stick to arteries and damage blood vessels more easily. Trigylceride (another kind of blood fat) levels may also be higher. The combination of lower HDL, higher triglycerides and ‘stickier’ LDL can form plaques in the blood vessels and harden arteries. This heightens the chance of having a heart attack or stroke.
Lifestyle changes such as lowering weight, eating a well-balanced diet and getting regular aerobic activity will also help to bring the blood fat levels down. If these changes do not bring the hoped-for results, your doctor will prescribe medication to lower the levels.
Low dose ASA therapy at a dose of 81- 325 mg/day may be considered in people with stable heart disease. Your doctor must decide if low dose ASA therapy is appropriate for you.
You can manage the ABCs of diabetes by making the following wise choices:
Following these recommendations can improve control of blood glucose, blood pressure and cholesterol. Studies show that knowing your ABCs and keeping them in your goal ranges can help you to live a longer, healthier life with fewer complications.