Comprehensive Care To Prevent More Health Problems

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Comprehensive Care To Prevent More Health Problems

Diabetes Type 2
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Comprehensive Care To Prevent More Health Problems
Comprehensive Care To Prevent More Health Problems
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Your efforts to control your diabetes also can prevent or delay related health problems.
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InteliHealth
2010-07-30
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InteliHealth Medical Content
2013-07-30

Reviewed by the Faculty of Harvard Medical School

Comprehensive Care To Prevent More Health Problems
 
If you have diabetes, there are many ways to guard your health. Your efforts will help to control diabetes. They also can prevent or delay related health problems (complications).
 
Top-notch diabetes care uses every available strategy to lower your risk of complications:
 
Eat a Reduced-Calorie Diet
 
Watching your diet is one of the most important parts of diabetes care. A reduced-calorie diet lowers blood-sugar levels. This diet decreases insulin resistance. It also can improve blood pressure and cholesterol.
 
Exercise
 
Try to exercise for at least 30 minutes on most days of the week. This can improve:
  • Cholesterol
  • Blood-sugar levels
  • Insulin resistance
  • High blood pressure
Exercise is one of the mainstays of treatment for diabetes. Our exercise recommendations can help you to design a safe activity plan.
 
Use Medicines To Lower Blood Sugar
 
Diet and exercise usually are combined with medicines. They should help you to reach your blood-sugar goal safely.
 
Avoid Smoking
 
Smoking multiplies your risk of artery disease. Your risk of heart attack or early death may be as much as 40% higher if you smoke. Smoking also increases kidney damage in people with diabetes. If you smoke, keep trying to quit until you succeed.
 
If You Have Extra Risk, Take an Aspirin
 
Heart and artery disease risk is 2 to 4 times higher in people with diabetes. In fact, 68% of deaths in people with diabetes after age 65 are from heart attacks. About 16% are from strokes. Daily aspirin is an important way to prevent these events, for those who are at highest risk.
 
In 2010, three major groups agreed on updated advice about aspirin use for adults with diabetes. The groups were the American Diabetes Association, the American Heart Association and the American College of Cardiology Foundation.
 
People who have already had a heart attack or stroke have the highest risk of another one. Daily aspirin is recommended for this group.
 
But the benefits of using aspirin to prevent a first heart attack or stroke don't always outweigh the risk of side effects. The main concern is potential bleeding problems.
 
Adults who have diabetes do not all need to take daily aspirin. People with no history of heart or blood vessel disease should take aspirin only if they have a high risk of a heart attack or stroke in the next 10 years. Most men older than 50 and most women older than 60 are considered high-risk if they also have one or more of these major risk factors:
  • Smoking
  • High blood pressure
  • Cholesterol problems
  • Family history of heart disease at an early age
  • Protein in the urine from diabetic kidney disease
If you take aspirin, use a daily dose of either 75 to 81 milligrams (baby aspirin) or 162 milligrams (half of a regular-strength aspirin).
 

Do not take aspirin if you have any of the following:

    • An allergy to aspirin
    • A medical problem that causes bleeding
    • Recent bleeding in the intestines
    • Significant liver disease
    • A history of hemorrhagic stroke (a stroke caused by bleeding in the brain)

Control Blood Pressure and Cholesterol
 
Blood pressure and cholesterol problems are common. If you have diabetes, you should keep your blood pressure and cholesterol below specific number goals.
For people with diabetes, lowering blood pressure reduces:
  • Strokes
  • Early death
  • Heart disease
  • Eye disease
  • Kidney disease
Ideally, the blood-pressure goal for someone with diabetes is less than 130/80. The first number is called systolic pressure. The second number is called diastolic pressure.
 
Drugs that treat cholesterol reduce your heart attack risk. The best is a statin drug. If you already have coronary artery disease, you should take a statin even if your blood cholesterol is normal.
 
Everyone should:
  • Limit the amount of saturated fat in the diet.
  • Eat plenty of fruits and vegetables.
  • Exercise regularly.
  • Keep weight under control.
Consider these additional cholesterol goals and treatment recommendations for diabetics:
  • LDL is the "low density" or "bad" type of cholesterol. For most people with diabetes, the LDL goal is less than 100 milligrams per deciliter of blood (mg/dl).
  • Your LDL goal can be less than 70 mg/dl if you have coronary artery disease as well as diabetes. Reaching this goal would bring your LDL down to an optimal level.
  • Some people get protection by taking a statin even if their LDL cholesterol is perfect (below the goal) without medicine. This is true for people who have coronary artery disease plus diabetes. It is also true for people who are over 40 and have a high risk for coronary artery disease. For example, they may have high blood pressure or a family history of heart disease in addition to diabetes. If you have this medical history, you should consider taking a statin.
  • Some people should not take cholesterol medicine, even if cholesterol isn't at healthy levels. You should not take a statin if you are pregnant. Children under the age of 10 also should not take a statin.
  • HDL is the "high density" or "good" cholesterol. Your HDL goal is greater than 40 mg/dl in men or greater than 50 mg/dl in women. This cholesterol type is good for your arteries. It increases if you take cholesterol medicine.
  • Triglyceride goal is less than 150 mg/dl.
Your doctor should start cholesterol medicine or adjust the dose if you are not meeting the goals for LDL or total cholesterol. You may not need medicine for HDL or triglycerides that don't meet your goals. Certain conditions must apply:
  • HDL or triglycerides must be your only cholesterol problem.
  • Levels must be close to the goal.
Protect Your Kidneys
 
Certain medicines are recommended for diabetics who have evidence of early kidney disease or high blood pressure. These drugs are called ACE inhibitors and angiotensin-receptor blockers.
 
Medicines from these groups reduce kidney damage. ACE inhibitors also have been shown to reduce your risk of dying of heart disease if you have diabetes.
 
Keep Up Your Shots
 
Besides routine childhood vaccinations, diabetics should receive:
    • A flu vaccine every year
    • A pneumococcal pneumonia vaccine once. If you are over 65 and it has been more than five years since your vaccine, you should receive a second vaccination as a booster.
Have Regular Eye, Foot and Dental Examinations
 

Have your eyes examined by an ophthalmologist or optometrist once a year. It's best to diagnose eye damage from diabetes (retinopathy) before it causes symptoms. In this case, laser treatment can reduce your risk of severe vision loss in half.

Have your feet examined once a year by your primary-care doctor or by a podiatrist. The doctor will look for:

  • Foot pressure points (shown by redness or calluses)
  • Bony deformities
  • Areas of the foot with no feeling
  • Skin or nail infections

Any of these can put you at risk for serious problems if they are not quickly treated. If you have poor blood flow, minor foot problems can lead to ulcers or gangrene. Part of the foot or limb might eventually need to be amputated, if problems are not prevented. A yearly exam can promote early treatment. Proper foot care at home can help to prevent problems before they start.

Talk with your dentist about when you need cleanings and check-ups. Most people go to the dentist two times a year. Some people need to go more often. Having healthy teeth and gums can make it easier to control your blood sugar. Good control of blood sugar may lower your risk of periodontal disease. This is an infection that starts in the gums. It can lead to tooth loss. It also makes blood sugar control more difficult. Plus, some studies have shown that people with periodontal disease are more likely to have clogged arteries and heart disease.

Plan Before Pregnancy
 
Keep careful control of diabetes before and during pregnancy. This can reduce the risk of birth defects as well as your own dangers from pregnancy.
    • Use a reliable form of birth control if you are not prepared for pregnancy.
    • Discuss your medicines with your doctor before trying to become pregnant.
    • Have your eyes and kidneys carefully evaluated before making a decision to become pregnant. Eye and kidney disease can get worse faster in pregnant women with diabetes.
To make sure you are keeping up with your diabetes fully, print out our Diabetes Care Checklist. Review it with your doctor during appointments.

 

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cholesterol,diabetes,aspirin,heart,diet,exercise,ldl,blood pressure,heart attack,blood sugar,coronary artery disease,hdl,high blood pressure,smoking,diabetics,kidney disease,stroke,dentist,dose,insulin,kidney,periodontal disease,vaccine
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Last updated September 30, 2013


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