Diabetes and Cardiovascular Disease

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Diabetes and Cardiovascular Disease

• Jeanne Jacoby, ARNP
• Dartmouth Hitchcock Medical Center
• Section of Endocrinology
• Get Heart Smart!
• February 7, 2009

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What is Diabetes?

• Diabetes is a disease in which the body does not
  produce or properly use insulin.
• The cause of diabetes continues to be a
  mysterylikely multi-factorial
• Genetics
• And
• Environmental factors such as obesity and lack of
  exercise appear to play roles.

From http// www.diabetes.org
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Major Types of Diabetes

• Type 1 diabetes
• Results from the body's failure to produce
  insulin, the hormone that "unlocks" the cells of
  the body, allowing glucose to enter and fuel
  them.
• It is estimated that 5-10 of Americans who are
  diagnosed with diabetes have type 1 diabetes.
• Type 2 diabetes
• Results from insulin resistance (a condition in
  which the body fails to properly use insulin),
  combined with relative insulin deficiency.
• Most Americans who are diagnosed with diabetes
  have type 2 diabetes.

From http// www.diabetes.org
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Other Glucose intolerance

• Gestational diabetes
• Diabetes during pregnancy
• Immediately after pregnancy, 5 to 10 of women
  with gestational diabetes are found to have
  diabetes, usually, type 2.
• Pre-diabetes
• Pre-diabetes is a condition that occurs when a
  person's blood glucose levels are higher than
  normal but not high enough for a diagnosis of
  type 2 diabetes.
• There are 57 million Americans who have
  pre-diabetes, in addition to the 23.6 million
  with diabetes.

From http// www.diabetes.org
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Diagnosing Diabetes

• Fasting Blood Glucose (FBG)
• Blood Glucose Level is measured after a fast
• Oral Glucose Tolerance Test (OGTT)
• Blood glucose level is measured fasting and two
  hours after drinking a glucose-rich beverage

From http// www.diabetes.org
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Prevalence of Diabetes

• 23.6 million children and adults in the United
  States (7.8 of the population) have diabetes
• 17.9 million have been diagnosed with diabetes
• 5.7 million people are unaware that they have the
  disease
• Another 57 million people have pre-diabetes

From http// www.diabetes.org
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Whats the Link?

• Cardiovascular Disease (CVD)
• And
• Diabetes

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(No Transcript)
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Meet Jack

• 40 year old man presents to his PCP for a
  physical after 5 years away
• No prior medical history
• Overweight
• He does not exercisetoo busy at work
• New Diagnoses
• Type II diabetes
• High Blood Pressure
• High Cholesterol
• Family History of Heart Disease and Diabetes

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Diabetes-CVD Facts

• More than 65 of all deaths in people with
  diabetes are caused by cardiovascular disease.
• Heart attacks occur at an earlier age in people
  with diabetes and often result in premature
  death.

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Diabetes-CVD Facts

• Up to 60 of adults with diabetes have high blood
  pressure.
• Nearly all adults with diabetes have one or more
  cholesterol problems, such as
• high triglycerides
• low HDL (good) cholesterol
• high LDL (bad) cholesterol

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The Good News

• By managing the ABCs of diabetes, people with
  diabetes can reduce their risk for heart disease
  and stroke.
• A stands for A1C
• B stands for Blood pressure
• C stands for Cholesterol
• PLUS More Bs
• BMI
• Blood Sugars

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Jacks ABCs

• A1c - 9.1
• Blood Pressure 150/90
• Cholesterol
• LDL 120
• HDL 30
• Total Cholestrol 230
• Body Mass Index (BMI) 30
• Height 61
• Weight 225 lbs
• Fasting Blood Sugar (on diagnosis) 200

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Ask About Your A1C

• A1C measures average blood glucose over the last
  three months.
• Get your A1C checked at least twice a year.

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A1C Goal less than
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Getting Jack to GoalHemoglobin A1c

• Eat the right foods.
• Get daily physical activity.
• Test blood glucose regularly.
• Take medications as prescribed.

9.1 ? 7.0
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Beware of Your Blood Pressure

• High blood pressure raises your risk for heart
  attack, stroke, eye problems and kidney disease.
• Get your blood pressure checked at every visit.
• Target BP less than

130/80
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Getting Jack to GoalBlood Pressure

• Eat more fruits and vegetables.
• Reduce the amount of salt in diet.
• Lose weight.
• Lower alcohol intake.
• Quit smoking.
• Take blood pressure pills.

150/90 ? 130/80
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Check Your Cholesterol

• Several kinds of blood fats
• LDL (bad) cholesterol - can narrow or block
  blood vessels
• HDL (good) cholesterol - helps remove
  cholesterol deposits
• Triglycerides - can raise your risk for heart
  attacks/stroke

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ADA Goals for Cholesterol
100

• Target LDL less than
• Target HDL above (men) above (women)
• Target triglycerides less than

40
50
150
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Getting Jack to GoalCholesterol

• Eat less saturated fat
• Foods high in saturated fat fatty meats,
  high-fat dairy products, tropical oils
• Eat foods high in fiber
• Examples oatmeal, beans, peas, citrus fruits
• Take cholesterol-lowering medication
• Exercise regularly

LDL 120 ? 95
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Body Mass Index

• Being overweight or obese is a leading risk
  factor for type 2 diabetes.
• A healthy weight is measured by your body mass
  index (BMI).

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BMI Goal less than
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Getting Jack to GoalBody Mass Index

• Diet
• Choose foods low in Saturated Fat
• Eat Moderate Amounts of Carbohydrates
• Exercise
• Be more active throughout the day.
• Examples work in the garden, play with the kids,
  take the stairs
• Walk - work up to at least 30 minutes of walking
  on most days

30 ? 25
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Other Strategies

• Get help to quit smoking.
• Talk to your health care provider about taking
  aspirin and other medications to reduce your risk
  for heart disease and stroke.

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Check out your profile

• https//www.diabetes.org/diabetesphd

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Key Points Review

• People with diabetes are at a very high risk for
  heart attack and stroke.
• More than 2 out of 3 of people with diabetes die
  of heart disease or stroke.
• Diabetes is more than managing blood glucose.
  Its managing blood glucose and blood pressure
  and cholesterol.
• Know the ABCs of Diabetes.
• A1c, Blood Pressure, Cholesterol
• More treatments are available than ever before.
  Talk to your healthcare provider and learn what
  you can do to manage your ABCs.

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General Tips

• Take steps to lower your risk of D-CVD
  complications
• A1C lt 7.
• Blood pressure lt 130/80.
• Cholesterol (LDL) lt 100.
• Cholesterol (HDL) gt 40 (men) and gt 50 (women).
• Triglycerides lt 150.
• Get help to quit smoking.
• Be active.
• Make healthy food choices.
• Talk to your doctor about medication.

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For More Information

• Call 1-800-DIABETES
• Visit www.diabetes.org/MakeTheLink
• Email MakeTheLink_at_diabetes.org
• Contact me
• jeanne.m.jacoby_at_hitchcock.org

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One Away
As seen on The Price is Right
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A New Jeep!
3
7
1
2
4
,
2
6
0
1
5





,
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Hemoglobin A1c
Target!
8
1
7
0


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Blood Pressure
Target!
2
2
1
7
9
1
3
0
8
0





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LDL Cholesterol
Target!
2
9
1
1
0
0



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Triglycerides
Target!
2
1
4
0

5
1
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BMI
Target!
4
3
5

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