If you have been diagnosed with either Type 1 or Type 2 diabetes, there is something you should know. Managing your diabetes is not just about managing your blood sugar. It is also about managing other health goals such as your blood pressure, your lipid panel, and fat intake. You see, research has shown that cardiovascular disease is the most common complication of diabetes. It is also perhaps the most serious. Unfortunately, about 65% of people with diabetes will die from cardiovascular disease. In fact, middle-aged people with diabetes have about the same risk for heart attack as people without diabetes who have already had a heart attack. By managing certain other health goals (which we will review below), you greatly decrease your risk for developing cardiovascular disease.  

Let’s take a moment to familiarize ourselves with the treatment goals you should strive for when you have diabetes. The closer you can get to these goals, the more you will decrease your risk of heart attack and stroke.

Table 1: Diabetes Treatment Goals 

The recommendations above have been put together by the American College of Endocrinology (ACE), the American Association of Clinical Endocrinologists ( AACE ) and the American Diabetes Association (ADA).  Please note that the recommendations put forth by the ADA and the ACE/AACE guidelines differ slightly. For the sake of this article, we have gone with the more stringent recommendations.

 Blood Pressure

If you have diabetes and also have high blood pressure, you are not alone. About 70% of people with diabetes also have high blood pressure. Controlling your blood pressure not only greatly decreases your risk of cardiovascular disease, it also greatly decreases your risk for eye, kidney and nerve damage when you have diabetes.  Maintaining a blood pressure of 130/80 is very important when you have diabetes. Note that this goal (130/80) is lower than the recommended blood pressure goal for people who don’t have diabetes (140/90). This is because, as mentioned above, research has shown that people with diabetes are much more likely to suffer from cardiovascular disease.   

 Managing Your Blood Lipids

Ninety-seven percent of adults with type 2 diabetes have one or more lipid abnormalities. Examples of lipid abnormalities could be increased LDL (AKA ‘bad cholesterol’), increased triglycerides or decreased HDL (AKA ‘good cholesterol’). We have known for some time now that abnormal blood lipids can lead to a heart attack or stroke. It is thought that extra LDL or triglycerides in the body can ‘stick’ to the walls of blood vessels, eventually leading to the clogging of blood vessels. This is a rather simplified view of how these lipids contribute to heart disease and stroke, but it illustrates the point. For this reason, the guidelines recommend people with diabetes keep LDL less than 100mg/dL and triglycerides less than 150mg/dL. They also recommend women keep their HDL greater than 50mg/dL and men keep their HDL greater than 40mg/dL.

 Diet and Exercise

It is now a well known fact that being overweight or obese can greatly increase your risk of developing diabetes. Even if you don’t develop diabetes, being overweight or obese greatly increases your risk of cardiovascular disease. Since most people who are diagnosed with type 2 diabetes are overweight or obese, the guidelines recommend that overweight people with diabetes people lose 5-10% of their total body weight. In addition, they also recommend a diet containing no more than 30% total fat and 10% saturated fat. Trans fats should be avoided altogether. Increasing fiber to 15 grams for every 1000 calories consumed is also recognized to decrease the risk of cardiovascular disease.

Since diet and exercise go hand in hand in maintaining cardiovascular health, the guidelines recommend at least 150 minutes of moderate physical activity per week. Moderate physical activity is defined as activity that gets you working at 50-70% of you maximum heart rate. To figure out your maximum heart rate, subtract your age in years from 220. For example, a 50 year old person would have a maximum heart rate of 170 beats per minute (or 220 minus 50). 

If 150 minutes a week is too much, the guidelines recommend an alternative of at least 90 minutes per week of vigorous aerobic exercise (more than 70% of your maximum heart rate). Finally, the guidelines recommend people with type 2 diabetes perform resistance exercise three times a week that targets all major muscle groups, progressing to three sets of 8-10 repetitions at a weight that can not be lifted more than 8-10 times. Examples of resistance exercise would be those performed using free weights or resistance machines.

 Managing Your Blood Sugar

Carefully controlling your blood sugar is an important part of treating your diabetes. High blood sugar levels after meals have been linked to the development of blood vessel damage.  It is this blood vessel damage that increases the risk for heart disease, stroke and organ damage. It can also contribute to damage of the blood vessels and nerves in the legs.  Studies have shown that people with diabetes who tightly control their blood sugar lower their risk of heart disease and stroke by 50%. Further, they have found that the better the control, the lower the risk.  For these reasons, the guidelines recommend a fasting blood sugar of less than 110mg/dL and a  2-hour post-meal blood sugar of less than 140mg/dL. They also recommend that your Hemoglobin A1C levels (HgA1C) be less than 6.5%. The HgA1C is an indicator of how well your blood sugar has been controlled over the last 3 months.

The Bottom Line  

Managing your diabetes involves a lot more than just managing your blood sugar; it involves managing all of the factors mentioned above. The problem with diabetes is usually not the diabetes itself, but the complications that come with it. Complications such as heart disease and stroke can rob you of precious years and decrease your quality of life. By managing the factors that contribute to these complications, you will decrease your risk for developing these complications.