by Ann S. Williams, MSN RN CDE
This column focuses on providing information to help people make their diabetes
care fit their needs and their lives.
This month's column will be shorter than usual. I need to make an emergency
trip out of town to see a relative who has just had a stroke. He, like myself,
and like many other members of my family, has type 2 diabetes. So I want to
take this opportunity to write about the link between diabetes and cardiovascular
disease -- in other words, heart attacks and stroke.
Many people do not realize there is a very strong link between diabetes and
cardiovascular disease. If you have diabetes, you have two to four times the
risk of having a heart attack or stroke than you would if you did not have diabetes.
You have two to four times the risk of having a heart attack or stroke than
you would if you did not have diabetes. You are much more likely to die of heart
attack or stroke than of diabetes itself.
In fact, your risk of heart attack or stroke is as high as someone who has already
had a heart attack or stroke. However, there is a lot you can do to reduce your
risk and protect your health.
What can you do to avoid heart attack and stroke?
You need to reduce all the risks you can control. These include:
1. Keep your blood sugar as close to normal as you can without having too much
hypoglycemia. It's good to aim for:
a. A1C: below 6.5.
b. Blood glucose readings before meals: under 110.
c. Blood glucose readings two hours after meals: under 140.
But if you get too much hypoglycemia at these levels, aim for as close as you
can reasonably get.
2. Do not smoke. If you do, quit.
3. Keep your blood pressure normal.
a. Blood pressure: under 130/80.
The goals for people with diabetes are lower than the goals for everyone else,
because of the increased risk. If your blood pressure regularly runs higher
than this, ask your diabetes educator or doctor to help you learn how to control
your blood pressure through lifestyle changes or through a prescription medication.
4. Keep your cholesterol and triglycerides (blood fats) normal.
This is a complicated subject, which I will not discuss in detail here. The
goals are:
a. LDL cholesterol: less than 100.
b. HDL cholesterol: greater than 40 for men, and greater than 50 for women.
c. Triglycerides: under 150
If your cholesterol or triglycerides regularly run higher than this, ask your
diabetes educator or doctor to help you learn how to control your cholesterol
or triglycerides through lifestyle changes or through a prescription medication.
5. Take a baby aspirin every day, unless you are allergic to it or have had
other bad effects from aspirin.
6. Move around! Be as active as you can. Make physical activity an everyday
part of your life.
7. Eat less fat in general, and especially less saturated fat (fat that is hard
at room temperature).
8. Eat more vegetables, especially low_calorie vegetables, and fruit. The vegetables
and fruits that are deeply colored are especially good for you. For example,
dark green, leafy vegetables, deep orange winter squash, blueberries, raspberries,
and strawberries, and red watermelon all contain many vitamins and minerals
and other substances that help to protect against heart attack and stroke.
9. Strive to reach and maintain a healthy weight.
I hope you all take the risk of heart attack and stroke very seriously. As I
think of my own aunts and uncles who had diabetes (there were seven of them),
I remember which ones worked at controlling their heart risk factors, and which
ones didn't. I also remember which of them died when they were in their 40s
and 50s, compared to the ones who lived well into their 80s. Now, as I face
another stroke in my family, thinking about my aunts and uncles with diabetes
who lived long and healthy lives provides me with the motivation I need to keep
up my efforts to control my risk factors.