Diabetes - The Medical Perspective
Diabetes and Heart Disease: What You Need to Know
Heart disease continues to be the leading cause of death in the United States for both men and women. The good news is that it is often preventable. The link between diabetes and heart disease
is well established. Diabetes is recognized as a major risk factor for heart disease. Having diabetes increases your risk of heart disease two to four times. So, why is this? What about having
diabetes makes heart disease more likely? Heart disease risk factors such as high cholesterol, high blood pressure, and smoking damage blood vessels. Blood vessels of people with diabetes
appear to be even more susceptible to damage from these factors. It may be that poorly controlled blood glucose over time contributes to the increased risk of damage to blood vessels.
Your best defense against heart disease is well-controlled diabetes and establishing targets of care for heart disease and diabetes.
Blood Glucose (Sugar) Levels
A target range for fasting, after meals and hemoglobin A1C levels (3-month average blood sugar) should be established with your health care provider. When blood glucose is high, it can
increase cholesterol and make controlling blood pressure harder. Low blood sugar levels can also damage the heart, especially if you already have heart disease. Your body responds to low blood
glucose by increasing heart rate.
You should always determine your personal blood sugar target levels with your health care provider. The following are general recommendations from the American Diabetes Association:
Fasting Blood Glucose checked 8 hours without food: 80-130 mg/dl
After Meal Blood Glucose checked 2 hours after eating: less than 180 mg/dl
A1C checked every 3 months if uncontrolled, or every 6 months if at goal: less than 7%
Uncontrolled blood pressure damages blood vessels. This increases the risk of having a stroke, heart failure, or a heart attack. Blood pressure should be checked at every office visit. Your
health-care provider may recommend a type of medication called an ACE-inhibitor or ARB to help control blood pressure. Along with controlling blood sugar, these drugs also protect your
A blood pressure goal for most people with diabetes and no additional risk factors: less than 140/90.
Goal for people with diabetes plus at least one of the following risk factors: high cholesterol, smoking, history of premature heart disease in your family, obesity, and having protein in the
urine: less than 130/80 mmHg.
Risk of heart disease increases in people who are overweight or obese. Your health-care provider assesses your weight status using body mass index (BMI). BMI compares your weight with your
height. Losing and maintaining a 7% weight loss can decrease risk of heart disease, especially for those with diabetes. Your registered dietitian can help with an individualized meal plan to
help you meet and maintain your weight loss goals.
Cholesterol build-up in your arteries can lead to a heart attack or stroke. We hear a lot about “good” and “bad” cholesterol levels. High- density lipoprotein (HDL) is
known as “good” cholesterol and low -density lipoprotein (LDL) is known as “bad” cholesterol. An easy way to remember the difference is L for “lousy”
cholesterol or H for “healthy” cholesterol. Eating less animal fat and more plant based fats will lower LDL. Regular physical activity increases HDL. To decrease risk of heart
disease the goal is LDL below 100 mg/dl and HDL above 40 mg/dl for men and 50 mg/dl for women.
Regular physical activity is beneficial in managing blood sugar, weight, and decreasing heart disease risk. Both physical activity and resistance training are important. Aim for 150 minutes a
week. For some, additional monitoring and medication adjustment may be necessary to maintain safe blood glucose levels. Always discuss your exercise plan with your health-care provider.
Diabetes and Food
Eating well to manage diabetes goes hand-in-hand with eating to decrease risk of heart disease. Both the American Diabetes Association and the American Heart Association make similar
recommendations for a healthy meal plan. Both consist of lean protein, fruits, and vegetables, whole grains, low fat dairy and healthy fats.
By choosing lean sources of protein such as lean meat, poultry with skin removed, and seafood you will be cutting down on unhealthy saturated fats. Beans, legumes and nuts are also healthy
Fruits and vegetables provide disease fighting antioxidants and dietary fiber. The most familiar antioxidants are vitamin C, E and beta- carotene. Eating a diet with a variety of colorful
fruits and vegetables provide disease-fighting antioxidants. Soluble fiber aids in maintaining healthy cholesterol levels. Oats, barley, peas, beans, carrots, apples, pears, and citrus fruits
are good sources of soluble fiber. Whole-grains are healthier choices than processed grains because whole-grains are rich in nutrients and dietary fiber. Instead of white bread, rice or pasta
try whole wheat bread, brown rice and whole-grain pasta. Choose whole grain cereals rather than processed cereals.
Whole milk dairy products contain unhealthy saturated fat. Low fat milk, yogurt and cheeses supply all the nutrients of full-fat dairy products except for the extra fat. The lower carbohydrate,
higher protein content of non-fat Greek yogurt make it a good choice.
Olive, canola and peanut oil, avocados and nuts are all heart healthy fats. Replacing animal fats with these fats or other plant-based oils will help reduce heart disease risk. Using soft tub
margarine spreads instead of butter is a heart-healthy change. Trans-fats are produced when a liquid oil is processed into a solid fat. Trans-fats are such a risk for heart disease that the
Food and Drug Administration has ruled that food companies have to stop adding trans-fats to food products by 2018. The American Heart Association recommends eating no more than 2 grams of
trans-fats per day.
An easy way to cut back on sodium intake is to buy fresh, frozen, or low sodium canned vegetables. Draining and rinsing canned vegetables decreases sodium content by 30-40%. Most sodium comes
from processed foods. Fast-food and restaurant foods tend to be high in sodium. Meals prepared at home generally have a lower sodium content. Plan your meals around lean protein, fruits,
vegetables, low-fat dairy, and heart-healthy fats without added sodium.