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Avoiding Complications
Nurturing Your “Health Bank”

by Amy Tenderich, MA

Keep in mind that while the target ranges shown here have been associated with a lowered risk of complications for the general population with diabetes, your personal goals should be individualized with the help of your health-care providers.

HbA1c. According to the American Association of Clinical Endocrinologists, if your test result is at or under 6.5%, you’re right on target, so there’s no need for you to take immediate action to lower it. In other words, you’ve got lots of HbA1c dollars in the bank. If your HbA1c is between 6.5% and 7.0%, you still have a pretty good balance in your health account. But if your HbA1c is in the 8.0% to 9.0% range, this is an area of concern that should be addressed as soon as you’ve taken care of any matters that are even more pressing. If your HbA1c is 9.0% or over, this signifies a serious health risk that you’ll want to address immediately.

Blood pressure. Blood pressure is reported as two numbers, such as 120/80 mm Hg. The top number is called the systolic pressure, and the bottom number the diastolic pressure. Both are vital in assessing your risk of heart disease. For example, for every 10 points you reduce your systolic pressure (the top number in your blood pressure result), you reduce your chance of heart attack and stroke by 15% to 20%. And while the current recommendation for people with diabetes is to maintain a blood pressure lower than 140/80 mm Hg, studies show that there is additional benefit to lowering the systolic blood pressure to 120 mm Hg or lower. Anything over 140 mm Hg systolic is considered high blood pressure.

According to Dr. Jackson, high blood pressure is an underappreciated diabetes risk factor. Most people realize that it’s somehow important to their health, but often neither they nor their health-care providers recognize its fundamental role in predicting cardiovascular risk for people with diabetes.

Blood lipids. The current recommendations of the National Cholesterol Education Program are to aim for an LDL cholesterol level below 100 mg/dl for people at high risk of heart disease. For people who already have heart disease or who are at very high risk, the goal is an LDL cholesterol below 70 mg/dl. However, a growing body of research suggests that lower levels may be better for more people. For this reason, Know Your Numbers, Outlive Your Diabetes sets a target of 80 mg/dl for people with Type 2 diabetes, as well as a goal of an HDL cholesterol level of more than 45 mg/dl (in the case of HDL, higher is better), and triglycerides below 150 mg/dl.

Microalbumin. A number of tests can be used to measure albumin in urine, but the preferred test measures the albumin-to-creatinine ratio. This test is preferred not least because it requires a small urine sample; in contrast, another test for microalbumin requires collecting all urine excreted over 24 hours.

A normal albumin-to-creatinine ratio is less than 30 milligrams of albumin per gram of creatinine (mg/g). A diagnosis of microalbuminuria is given when the test result is between 30 mg/g and 300 mg/g, and a diagnosis of macroalbuminuria requires a level over 300 mg/g.

Because albumin excretion is variable and may be affected by factors such as strenuous physical activity, a urinary tract or other infection, high blood glucose, or high blood pressure on the day of the urine test, the test result should be confirmed in two or preferably three separate tests done over a 3- to 6-month period before a diagnosis is made.

Eye exam. Terms that doctors commonly use to describe the presence or absence of retinopathy include the following:

  • No evidence of diabetic retinopathy
  • Mild, minimal, or moderate background retinopathy
  • Nonproliferative retinopathy
  • Preproliferative retinopathy
  • Proliferative retinopathy

Obviously, the desired result of an eye exam is “no evidence of retinopathy” or any other eye disease. If you have proliferative retinopathy, laser therapy can be effective at slowing or stopping the progression of retinopathy. At the stages in between, no immediate treatment may be necessary, but you will want to know if you have progressed from one stage to the next so that you can reevaluate your overall diabetes regimen to determine whether your blood glucose and blood pressure control are at the levels recommended for preventing diabetes complications.

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Your Diabetes Health Account



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