Diabetes Self-Management Blog

With diabetes, controlling blood pressure is as important as controlling blood sugar. You can self-manage blood pressure, but most doctors don’t tell you how. Here are some clues.

First, why is blood pressure so important when you have diabetes? It’s because high blood sugar levels damage and narrow blood vessels. Circulation gets squeezed, so cells don’t get as much blood, and they suffer. High blood pressure is also associated with the tightening of blood vessels, so cells are really starved. This is what causes complications.

In many cases, what is called “insulin resistance” may mainly be caused by poor circulation. It’s not always that cells are resisting the insulin. Rather, it may be that insulin can’t get to the cells in the first place because blood flow is too bad. This has been demonstrated in mouse studies I heard about at the ADA Scientific Sessions in June. There’s an interesting (but hard to understand) article about it here from the journal Circulation.

So the real goal of diabetes treatment and self-management is to open up blood vessels. Then complications will improve and insulin resistance will ease up. Lowering glucose and lowering blood pressure both relax blood vessels. Both can be done through self-management, although medicines often help.

A recent study in The Journal of the American Medical Association shows that people who check their blood pressure regularly have lower blood pressure levels. But it works best if they have made a plan with their doctor to regulate their medication dose by what their readings show.

In the study, about 450 people checked their blood pressure twice a morning for the first week of each month. They had made a plan with their doctors to take more or less medication, depending on the results. The average blood pressure in the self-monitoring group was ten points lower after a year compared to the results of the control group. The researchers said that would translate into a 30% lower risk of stroke and lower risks of kidney failure and heart attack.

It’s a lot like self-monitoring your glucose to find out what makes it go up and down. Then you can do the things that keep it down. The difference is that self-monitoring blood pressure doesn’t hurt, and it doesn’t cost money after you buy the home monitor. No needles, no test strips!

Maybe you’ll find that your pressure is lower when you meditate or listen to music. Maybe it gets higher when you’re talking or eating. This often happens because we change our breathing patterns when we talk or eat.

You might find that certain medicines raise your pressure and others lower it. You can see how effective your blood pressure medication is, and you may notice other meds that make a difference. (The mice in the study I heard about got Viagra to lower their pressure.) If you take vinegar to help control your blood sugar levels, you might monitor after that.

Food also make a difference. A Mediterranean or DASH diet is best for many people. Refined grains and sugars may raise your blood pressure over time, but you can check for yourself. Self-monitoring for a month should tell you a lot.

Unlike glucose monitoring, the effects of specific foods on blood pressure may not show up quickly enough to be caught by self-monitoring. Some foods, such as coffee or chocolate, might have a noticeable effect, though.

Exercise is usually good for blood pressure, but some exercises seem to raise it, at least while you’re doing them. That’s OK if the overall effect is to lower blood pressure, but not if it gets too high or stays high for too long.

Types of monitors
I’ve had a couple of different blood pressure monitors. Some seem to work more consistently than others. You can see how Consumer Reports rated of a variety of monitors here (subscription required).

Nearly all monitors give reliable readings, but some are easier to use, some are more durable, and some offer features others don’t have. Consumer Reports stresses fit. Get one that has the right size cuff for your arm. Many monitors save your readings and can give you an average of your recent numbers. Some will store data for two different users if asked.

Ease of use is also important. The Consumer Reports report advises, “Make sure that the display on the monitor is easy to read and understand and that the buttons are big enough. The directions for applying the cuff and operating the monitor should be clear.”

Prices range from roughly $30 to $130. Some health insurance will pay for a monitor if you have a prescription. Some stores give discounts, and big stores like Costco and Walmart usually have lower prices.

I encourage anyone with blood pressure over 120/80 to do some serious blood pressure monitoring for a few weeks. Look at everything — sitting position, watching TV, breathing patterns, exercise, thoughts, whatever — and see if you can match what’s happening to what your blood pressure is. Then you may be able to help yourself by modifying the behaviors that raise your pressure. I suggest meditation, prayer, laughter, and exercise as good places to start.

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