At least one lifetime pneumonia vaccine is also recommended for adults with diabetes. In some cases, the vaccine needs to be repeated. Check with your diabetes care team for specific recommendations regarding a pneumonia vaccine for you.
Preventing cardiovascular disease
Cardiovascular disease is the cause of death in at least 65% of adults with diabetes. Type 2 diabetes is an independent risk factor for macrovascular disease (disease of the large blood vessels, including the heart’s blood vessels), and cardiovascular complications may already be present when diabetes is diagnosed.
Risk factors for cardiovascular disease include dyslipidemia (abnormal levels of blood lipids such as cholesterol and triglycerides), high blood pressure, smoking, a family history of developing heart disease at an early age, and the presence of the protein albumin in the urine.
You can lower your risk of cardiovascular disease by controlling your cholesterol, triglyceride, and blood pressure levels with diet, exercise, and drug therapy if necessary; by stopping smoking if you smoke; and by taking aspirin if your physician recommends it.
Lipid management. Abnormal lipid, or blood fat, levels contribute to higher rates of cardiovascular disease, particularly in people who have Type 2 diabetes. You and your physician should discuss lifestyle measures you can take, such as following an eating plan that focuses on reduction of saturated fat, dietary cholesterol, and trans fat intake as well as weight loss (if necessary); increased physical activity; and, if you smoke, smoking cessation. These measures can help lower low-density lipoprotein (LDL, or “bad”) cholesterol, raise high-density lipoprotein (HDL, or “good”) cholesterol, and lower triglycerides (see “Target Lipid Levels for Adults With Diabetes”). Keeping blood glucose levels close to the normal range can also improve lipid levels, particularly high triglyceride levels.
If you do not meet your goals with lifestyle changes alone, your physician will likely recommend drug therapy. The first priority is to lower LDL cholesterol to a target level of less than 100 mg/dl, and a class of drugs called statins is the first choice for this job (except during pregnancy). If you already have cardiovascular disease, a reduction in LDL to a level of less than 70 mg/dl is an option that is widely recommended to stave off cardiovascular events. Lipid levels are usually measured once a year in people with diabetes, although they may be measured more or less often depending on a person’s cardiovascular risk.
Controlling high blood pressure. High blood pressure, defined as blood pressure greater than or equal to 140/90 mm Hg, affects the majority of people with diabetes. In people with Type 1 diabetes, it is often the result of underlying nephropathy (kidney disease). In people with Type 2 diabetes, high blood pressure contributes to high rates of cardiovascular disease.
Because high blood pressure is so common and can do a lot of damage to your internal organs, your blood pressure should be measured at every routine diabetes visit. If your systolic blood pressure (the top number) is greater than or equal to 130 mm Hg or your diastolic blood pressure (the bottom number) is greater than or equal to 80 mm Hg, you will need to take steps to lower these values. You should also have your blood pressure measured again on another day to confirm that it is elevated.