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Diabetes and Heart Health

by Paula S. Yutzy, RN, BSPA, CDE

Heart graphicTwo out of three diabetics will die from a heart attack or stroke, which means cardiovascular disease is more likely to kill you than any other complication of diabetes. I was dismayed to learn that in a recent survey of people with diabetes, many did not even identify cardiovascular disease as a complication of diabetes. Yet your risk, just by having diabetes, is very high. You need to know how to stay on top of this threat to your health. Understanding your test results for what I call the “Three Musketeers” of cardiovascular disease is a must for all diabetics and their caregivers. I encourage you to find a way to be physically active and watch your diet as well. These steps will help you reduce your risks from cardiovascular

The Three Musketeers

I call these three factors the “Three Musketeers” because where you find one, you often find the others. You need to know them by their descriptions and their numbers.

High Blood Sugar

You know that you need to pay attention to the amount of glucose in your blood. The A1c test indicates your average blood sugar level over the preceding two or three months. The name comes from the fact that the component of blood to which sugar sticks, and can therefore be measured, is called hemoglobin A1c. High blood sugar is generally regarded as an A1c of over 6.5 percent. The American Diabetes Association states the A1c goal for most diabetics is under 7 percent and under 6 percent, if possible, without significant hypoglycemia. Consult your health care provider for an individual goal.

High Blood Pressure

High blood pressure causes stress on blood vessels and contributes to damage that also leads to kidney failure and retinopathy. People with diabetes should be treated to achieve a systolic blood pressure under 130 mmHg and a diastolic blood pressure under 80 mmHg. Many people are on blood pressure medicine, but are not reaching these targets. They should check their own blood pressure with a sphygmomanometer (blood pressure machine) at different times of the day. Automatic and talking sphygmomanometers are available. If you get one of your own, take it to the doctor’s visit with you and have its accuracy verified by comparing the reading to what the doctor gets. Some people have what we refer to as “white coat syndrome” meaning they have an increase in their blood pressure when it is checked at the doctor’s office, but not at home. Keep a record of what you get at home and show it to the doctor when you go to your visit.

High Cholesterol

The cholesterol test measures three types of fats, or lipids, in your blood. You get high cholesterol in two ways: inherit it in your genes if it’s in your family health history, and from the fat in meats, egg yolks and dairy products that you eat.

The most dangerous type of blood fat is the low-density-lipoprotein (LDL). This is often called “bad” cholesterol, because it accumulates in blood vessels and clogs them. High-density-lipoprotein (HDL) is the “good” kind of cholesterol that actually works to remove LDL from the blood. Triglycerides are storage and energy fats, and are the most common fat cells in your body. I frequently see diabetics who have high LDL and triglycerides, and low HDL. This combination increases the risk of cardiovascular disease, and is one you should strive to avoid.

Medications and Diet

There are several medications that can be used to lower the LDL. Statins (e.g. Lipitor, Zocor) are frequently perscribed. Some people have bad reactions to these and get muscle pain or cramping; if this happens to you, notify your doctor immediately. You may need to change to another type of cholesterol medication.

I am amazed by the many people with diabetes who take expensive medication to lower their blood fats and at the same time eat lots of fatty food which raise their blood fats! Every day in my practice I seem to run into someone on cholesterol medicine who eats eggs, sausage and biscuits with butter for breakfast and a burger and fries for lunch or dinner. If you do this you are defeating the efforts of the medication to lower blood fats by choosing to eat these foods.

I am also surprised that many people (frequently men) do not recognize fatty food for what it is. I have devised a simple solution: Put the food on a napkin and walk away. After five minutes, if you see a grease spot on the napkin that food has too much fat and you should choose something else to eat.


You should discuss your exercise plans with your doctor before you begin. If you have not had a stress test, ask if your doctor thinks you should. The stress test allows the doctor to see how your heart is working during exercise and can identify problems before they become serious.

Once exercise is considered safe, you now have to decide what kind of exercise you can
do. You will begin slowly and gradually increase your activity. You might go to a gym or get a recumbent bike or stepper for use at home. Chair dancing is good for those who have mobility problems. Put on your favorite music (can’t be a waltz!), sit in a chair without arms and dance with your arms to the music. Move your legs to the beat if you like. You will be surprised how much exercise this can be.

I remember a patient I had years ago. She was a tiny lady of about 70. I described chair dancing to her and encouraged her to try it. When she came back, she told me that she and her 93-year-old mother would sit in the kitchen each morning and “chair dance to the oldies”! They laughed and had a great time. I can just see them in the kitchen dancing and giggling together. She reported that they had not had such fun for a long time.

When you exercise you should warm up for five minutes by stretching and easing into your activity. Bike, walk, swim (or whatever you have chosen) slowly at first. Then increase your speed. An easy way of judging your pace is this: If you can talk while you exercise you are going the right speed. If you can sing “Happy Birthday” you are not going fast enough, and if you can’t get words out, slow down! Some people like to count their pulse, but I think this is easier.

Start exercise sessions with five minutes warm up. Then do five minutes going faster. As you get in the exercise habit, increase the middle exercise time slowly by two to three minutes every few days, until your complete exercise period is at least 30 minutes. This should include cooling down for five minutes by going slower to give your heart time to slow down too.

The Three Musketeers are also known as the ABC’s. Do you know your ABC’s? A is for A1c, B is for Blood Pressure and C is for Cholesterol (see inside heart). The ABC’s are manageable, but I see many who are not managing them as well as they could. A recent report said that only 37 percent of people with diabetes had an A1c under 7 percent, only 36 percent had blood pressure under 130/80 and only 48 percent had total cholesterol under 200 mg/dL. Only 7.3 percent had all three in the control range!

You can improve this situation and decrease the effects of cardiovascular disease. Until we do, two of every three people with diabetes will die of a cardiovascular event. Although heart disease and stroke are the leading causes of death in people with diabetes, they are preventable if you have your ABC’s in control. Keep the Three Musketeers away!

Diabetes ABC’s

A1c under 6.5% or 7%
Blood Pressure under 130/80 mmHg.
Cholesterol, Total under 200 mg/dL
HDL over 40 mg/dL for men and 50 mg/dL for women
LDL under 100 mg/dL, under 70 mg/dL is preferred
Triglycerides under 150 mg/dl