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The "Heart" of Diabetes: More Than Just Blood Glucose

Jan Chait

August 22, 2007

I downloaded data from my continuous glucose monitor on Sunday and checked my average blood glucose level. Surely, I had told myself, with a reading every five minutes, my average would be lower than the one on my blood glucose meter, which I use…well, much less frequently. To my chagrin, it was higher. By about 25 points. Oops!

At least, I told myself on Monday after reading the New York Times’ package on diabetes, my cholesterol and blood pressure are under control. The main article, which can be found here, says that merely controlling blood glucose isn’t enough: Because we’re at high risk for cardiovascular disease, having good cholesterol and blood pressure levels is just as important. (You may need to be registered to read articles from the Times. However, registration is free.)

The problem, which I can personally vouch for, is that most doctors tend to focus on blood glucose levels and ignore the other things we need to be doing to lower our risk of heart disease, stroke, and many of those other not-so-nice things diabetes can contribute to.

“Largely because of a misunderstanding of the proper treatment,” the article says, “most patients are not doing even close to what they should to protect themselves. In fact, according to the federal Centers for Disease Control and Prevention, just 7 percent are getting the treatments they need.”

“That, to me, is mind-boggling,” Dr. Michael Brownlee is quoted as saying in the article. Brownlee is director of the JDRF International Center for Diabetic Complications Research at the Albert Einstein College of Medicine in New York. “It makes me ask, What is going on? I can only conclude that people are not aware of their risks and what could be done about them.”

“Patients” aren’t doing enough? “People” are unaware of their risks and what can be done? What about doctors? Aren’t they supposed to know what should be done? Aren’t they the ones who went to medical school? No wonder we’re in trouble!

I recall my former primary care physician who told me my blood pressure was “a little bit high, but OK.” And I told him that “a little bit high” wasn’t good enough when you have diabetes.

It reinforces the idea that we’re the ones who need to know what our health-care professionals should be doing. And if they’re not doing it and won’t do it, then fire ‘em. I do. (Insert mental picture of battered and bruised docs littering the path behind me.)

The American Heart Association (AHA) recommends a blood pressure level that’s no higher than 120/80 mm Hg. Interestingly enough, the American Diabetes Association only recommends that blood pressure be less than 130/80 mm Hg. High blood pressure contributes to more than heart disease; it also can lead to strokes and kidney failure—which we’re also at higher risk for. So I’ll go with the AHA’s recommendations, thanks.

Our targets for cholesterol are different from people who have no risk factors.

“People with diabetes,” says the AHA, “have the same risk for heart disease and stroke as people who already have cardiovascular disease.” On top of that, diabetes itself can lead to higher LDL and triglyceride levels and lower HDL levels. Lucky us.

LDL, or low-density lipoprotein, cholesterol is the “bad” one: the type of cholesterol that forms plaque on the walls of your arteries. If you have diabetes, keep that number below 100 mg/dl, the AHA says. If you have diabetes in conjunction with other risk factors for heart disease, that number can go down to 70 mg/dl, tops.

HDL (high-density lipoprotein) cholesterol is the “good” kind. It’s the one that removes cholesterol from the blood, so you want that number to be as high as possible. The AHA recommends not less than 50 mg/dl for women and 40 mg/dl for men.

Triglycerides, which are the main form of fat in the body, need to be less than 150 mg/dl.

Fortunately, regulating cholesterol and blood pressure levels are a lot easier than trying to wrest blood glucose levels into some semblance of order.

The Times article faults three things for “missed opportunities”: The medical system, with doctors who’ve had little instruction on diabetes and not enough time to spend with us; advertisements for diabetes drugs that emphasize blood glucose control; and “public health campaigns that give the impression that diabetes is a matter of an out-of-control diet and sedentary lifestyle and the most important way to deal with it is to lose weight.”

While there’s little we can do about those, we can first educate ourselves, then our doctors. It won’t just benefit us, but those who come after us as well.



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