February is a great time to think about your heart health, not just because of Valentine’s Day, but because February is American Heart Month. Since heart disease is a leading cause of death in the United States and because people with diabetes are more likely to have heart disease than people without diabetes, it’s a perfect time to give your heart (and blood vessels) some TLC.
This week, the focus is on knowing your “numbers,” or goals to help you see where you’re at with both your diabetes and your heart health. Your numbers serve as a plan or road map to help you better understand where you need to go. And by understanding your goals, you can be an active participant in making treatment decisions with your healthcare provider.
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One of the key markers of how your diabetes is doing is your blood glucose, or blood sugar. Blood sugars that are too high or too low can cause short-term and long-term health complications. In fact, high blood sugars have a direct impact on your heart health, as they can damage blood vessels and the nerves that control your heart and blood vessels. High blood sugars can also impact blood cholesterol levels and make blood pressure harder to manage. Low blood sugars can cause a rapid heartbeat and, in some people, heart palpitations.
Checking your blood sugar with a blood glucose meter or using CGM (continuous glucose monitoring) are tools to help you know and understand your blood sugars. Bring your meter, CGM or logbook to your appointments with your diabetes team; this helps them know if your treatment plan needs tweaking. Blood sugar goals for most people with diabetes are as follows:
• Fasting blood sugar: 80 to 130 mg/dl (after 8 or more hours without food)
• Post-meal blood sugar: Less than 180 mg/dl (2 hours after eating)
Talk with your healthcare team about your own blood sugar goals, as well as how, when and how often to check your blood sugars. You may be asked to check your blood sugars more often in some situations, such as when you are ill or if you are changing your diabetes medicine, for example.
Hemoglobin A1C (A1C for short) is a marker of average blood sugar over two to three months. A1C is measured with a blood test. It’s also one of the commonly used tests to diagnose prediabetes and diabetes, and is used to help you and your healthcare team manage your diabetes. High A1C levels are linked to diabetes complications, including heart, eye and kidney disease. For people with diabetes, the A1C should be checked at least twice a year, or every six months. If your A1C is not at goal, your provider may recommend that it be checked every 3 months. A1C goals are as follows:
• A1C for most adults: Less than 7%
• A1C (less strict): Less than 8%
People who might have a “less strict” A1C are those who are older, who have severe heart disease, or who have had diabetes for a long time.
Cholesterol and triglycerides
Cholesterol is a type of fat that’s made by the liver and found in your blood. If excess cholesterol builds up in arteries, it can lead to a heart attack or a stroke (called atherosclerotic cardiovascular disease, or ASCVD). LDL cholesterol is the “bad” cholesterol and HDL is the “good” cholesterol. Triglycerides, another type of fat found in the blood, are also linked with a buildup of fatty deposits in arteries, especially when LDL levels are high or HDL levels are low.
LDL targets can vary for people with diabetes, based on the presence of heart disease or multiple risk factors for heart disease. Your goal may be an LDL of less than 70 or 100 mg/dl, for example. Your provider will likely use a tool called the ASCVD Risk Estimator to determine what the course of treatment should be to help you lower your risk of heart disease. This tool takes various factors into consideration such as your cholesterol levels, as well as blood pressure, age, gender and whether you smoke.
Based on the ASCVD “score,” your healthcare provider may start you on a medicine called a statin, or possibly change the statin dose to help lower your LDL cholesterol.
If your LDL cholesterol is not at goal on a statin, you will need your cholesterol levels checked every four to 12 weeks. Otherwise, if you’re at goal, you only need testing every six to 12 months.
Triglycerides should be less than 150 mg/dl. Medicines called fibrates and prescription-strength omega-3 fatty acids may be prescribed to help lower them if they are above goal.
High blood pressure can damage blood vessels, raising the risk of stroke, heart attack and kidney problems. You usually don’t get symptoms if your blood pressure is high, so it’s important to get your blood pressure checked at every regular provider visit. Your healthcare provider may suggest that you check your blood pressure at home, as well; you can purchase a blood pressure monitor at your drugstore or online.
In addition to lifestyle measures, you might be prescribe blood pressure medicines such as an ACE inhibitor or an ARB (these medicines also help your kidney health, too).
Blood pressure goals can vary depending on if you have high blood pressure and your risk for heart disease.
• Diabetes & high blood pressure at higher risk of heart disease: Less than 130/80 mmHg
• Diabetes & high blood pressure at lower risk of heart disease: Less than 140/90 mmHg
• Diabetes & high blood pressure and are pregnant: 120/80 to 160/105 mmHg
Urine albumin-to-creatinine ratio
Having kidney disease can affect your chances of getting heart disease (and vice versa). That’s why it’s important to pay attention to your kidney health along with your heart health.
The urine albumin-to-creatinine ratio (UACR) is a way for your provider to check for early kidney disease. This is a spot check that measures how much albumin, or protein is in the urine. The test is done at the time of diabetes diagnosis, and then yearly after that.
• Goal for UACR: Less than 30 mg/g
A UACR higher than 30 mg/g could be a sign of kidney disease.
eGFR (estimated glomerular filtration rate) is based on a blood test for creatinine, which is a waste product in the blood. This test tells you how well your kidneys are working. The eGFR is calculated from the creatinine results, as well as your age, gender and race. If you have kidney disease, the eGFR number goes down.
• Goal for eGFR: 90 or higher
If you are overweight or obese, your risk for heart disease goes up. Body-mass index, or BMI, is a tool that can indicate if you’re at a healthy weight. A healthy BMI is between 18 and 24.9 kg/m2. Overweight is a BMI between 25 and 29.9 kg/m2, and obese is a BMI greater than 30 kg/m2. However, it’s important to know that BMI has some limitations. For example, it doesn’t take into account age, muscle mass, activity level, body shape and ethnicity.
BMI should be used in conjunction with other factors, such as waist size and waist-to-height ratio, as well as an overall look at blood pressure, A1C and cholesterol.
For many people, especially those with type 2 diabetes, losing even a small amount of weight (if overweight) can lead to big gains. Every amount of weight loss can improve blood sugar, blood pressure and cholesterol, and can help with improving sleep, mood and quality of life, as well.
• Goal for weight loss: Between 5% and 10% of total body weight
You might be wondering where to start if you are aiming to lose weight. A good first step is to meet with a dietitian or a diabetes educator for an individualized plan. There’s no one right plan for losing weight, so it’s helpful to have guidance from your team to ensure that your plan is healthy and sustainable.
Remember, too, to talk with your provider about your goals for all of the numbers mentioned above.
Want to learn more about protecting your heart? Read “Does Diabetes Hurt Your Heart?” “Fight Off Heart Disease With These Five Heart-Healthy Foods” and “Lower Your Risk of Heart Disease.”