A Checklist Beyond Glucose Control

You've probably heard a lot about diabetes and how devastating it can be. You probably know a friend or relative who has diabetes and have witnessed the effects which diabetes has on each person. But did you know that more people with Type 2 diabetes die from cardiovascular disease and stroke than from any other illness? Furthermore, were you aware that much of the suffering is from peripheral arterial disease (PAD)? Diabetes greatly increases the risks for a heart attack and stroke. There are ways to help reduce that risk. There is more to diabetes management than glucose control.

The factors that increase the risk for heart attack and stroke can be divided into two categories— those that you can change and those you cannot change. Risk factors that cannot be changed are age, gender, ethnic group, and family history of arterial disease. Because there is nothing that can be done about these factors, it is more important to focus on what can be changed and try to improve the things that make arterial disease worse. The major factors that can be changed are listed in Table 1 (below) and include blood pressure, smoking, cholesterol, and weight.

Diabetes increases the risk of cardiovascular disease or PAD when compared to someone without diabetes at any given cholesterol or triglyceride level. So, if you have diabetes, what can you do to reduce your cardiovascular risk? First, consult your physician regarding exercise. Once he/she has cleared you, begin walking, gradually increasing the distance. This helps improve glucose and cholesterol control and will help you to lose weight. It is very important to walk even if you have intermittent claudication (pain in the buttocks, thighs, or calves after walking a certain distance that quickly goes away when you stop and rest, and does not improve by changing the leg's position.) You should walk until it hurts, stop and rest, then continue on until your distance increases. Make sure you wear comfortable shoes and check the insides for tears or objects before putting them on. If they hurt your feet, do not wear them. See a dietitian to determine a plan to decrease cholesterol in your diet, and learn how to read labels to ensure good nutrition. Talk to your health care provider about medication to control cholesterol.

Persons with diabetes often have hardening of the arteries, starting from the tiny vessels in the foot and progressing up the body. Such arteries are difficult to connect with bypass grafts. Keeping the arteries as healthy as possible is an important reason to be under the care of a vascular specialist. Amputation is a real problem when you have diabetes. Remember, it took years to clog your arteries and it will take walking more than a few days or weeks to begin to restore good blood flow.

High blood pressure must be carefully controlled because of the higher risk of stroke and other cerebrovascular and cardiac problems. African- Americans have a much higher risk of high blood pressure than Caucasians. Blood pressure tends to rise in developed societies, so you cannot blame higher blood pressure solely on age. Still, it is even more important to keep blood pressure low as we become older. Additional things you can do are to decrease salt or sodium in your diet and to keep close tabs on your blood pressure readings. Take your pressure regularly and, if it tends to run above 120/80, discuss it with your health care provider. Microalbuminuria and full albumin excretion in the urine are tests performed by your doctor. They are indicators of increased arterial risk factors. This may also indicate a need for better control of one's blood sugar levels.

Clotting in the blood can be worse in persons with metabolic syndrome (high cholesterol and triglycerides, high blood pressure, an apple-shaped body or belly fat, and insulin resistance). Clotting can cause the strokes or heart attacks we worry about. This is why it is important to get your weight and blood pressure down. All of the actions mentioned above can also help make this syndrome less of a risk. This is also why aspirin is prescribed for diabetes patients and those who are overweight or have high blood pressure.

Diabetes increases your chances of heart attack, stroke, and PAD without any other factors. If you stop smoking and keep your other risk factors under control, you can reduce your risk. Follow closely your health care provider's advice specific to you. It is a lot to manage along with your daily glucose control, but your improved health will be worth it.