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Treating High Cholesterol in People with Diabetes

Sunday, October 14th, 2007

Keeping your cholesterol and other blood fats, also called lipids, under control can help you prevent diabetes problems. Diabetic dyslipidemia, a condition in which your blood lipids are off target, can lead to heart attack and stroke. For most people, treatment for off-target blood lipids includes both lifestyle changes, such as choosing foods wisely, and medication. You can take steps to keep your blood lipids on target.

What are the different kinds of blood lipids and what do they do?

There are several kinds of lipids in your blood and each type affects your health differently.

· LDL cholesterol is sometimes called bad cholesterol. This lipid can narrow or block your blood vessels. Blocked vessels can lead to a heart attack or a stroke. Reaching your LDL target is the most effective way to protect your heart and blood vessels.

· HDL cholesterol is sometimes called good cholesterol or “helpful” cholesterol. This lipid helps remove deposits from the insides of your blood vessels and keeps them from getting blocked.

· Triglycerides are another kind of lipid. High triglyceride levels increase your risk of a heart attack or stroke.

How does diabetes affect my blood lipids?

Many people with diabetes have problems with their blood lipid levels—HDL (good cholesterol) levels that are too low and triglyceride levels that are too high. Also, LDL (bad cholesterol) particles are unusually small and dense in people with diabetes, which can be especially harmful to blood vessels. This combination of factors means an increased risk of heart attack and stroke. But the good news is that taking steps to keep your lipids within the target range will lower your risk for these problems.

How will I know if my blood lipid levels are off target?

You won’t know that your lipids are at dangerous levels unless you have a blood test to check your blood lipid levels. The American Diabetes Association (ADA) recommends that you have your levels checked at least once a year. Some people may need to be checked more often.

What are the recommended targets for blood lipids?

See the chart below for targets suggested by the ADA.

Type of Blood Lipid	ADA Targets
LDL cholesterol	below 100 mg/dl
HDL cholesterol	above 40 mg/dl (for men) above 50 mg/dl (for women)
Triglycerides	below 150 mg/dl

What treatments are recommended?

Both lifestyle changes and medication help control blood lipids. Treatment differs from one person to the next. Work with your health care provider to find a treatment that’s right for you.

Lifestyle Changes

Lifestyle changes can help control your blood lipids as well as your blood glucose and blood pressure levels. If your blood lipid levels are off target, you’ll want to consider making lifestyle changes right away. From the list below, decide whice steps you would be willing to try. If you need more information about how to make these changes, talk with your health care team.

Make Wise Food Choices

· I’ll eat less fat, especially saturated fat (found in fatty meats, poultry skin, butter, 2% or whole milk, ice cream, cheese, palm oil, coconut oil, trans fats, hydrogenated oils, lard, and shortening).

· I’ll choose lean meats and meat substitutes (such as chicken without the skin, lean beef such as flank steak or chuck roast, boiled ham, or pork tenderloin).

· I’ll switch to low-fat or fat-free dairy products (such as low-fat cheese and skim milk).

· I’ll cut back on foods that are high in cholesterol (such as egg yolks, high-fat meat and poultry, liver and other organ meats, and high-fat dairy products like whole milk).

· I’ll choose the kinds of fat that can help lower my cholesterol, such as olive oil or canola oil. Nuts also have a healthy type of fat. Other kinds of oils that protect my heart are corn oil, sunflower oil, and safflower oil.

· I’ll eat fish two or three times a week, choosing those high in heart-protective fat (such as albacore tuna, herring, mackerel, rainbow trout, sardines, and salmon).

· I’ll cook using low-fat methods (such as baking, roasting, or grilling foods or by using nonstick pans and cooking sprays).

· I’ll eat more foods that are high in fiber, such as oatmeal, oat bran, dried beans and peas (such as kidney beans, pinto beans, and black-eyed peas), fruits, and vegetables.

Lose Weight or Take Steps to Prevent Weight Gain

· I’ll cut down on calories and fat.

· I’ll try to be more physically active than I am now.

Be Physically Active

· Before I start a new routine, I’ll check with my doctor to find out which activities will be safe for me.

· I’ll try to do a total of about 30 minutes of aerobic exercise, such as brisk walking, most days of the week. If I’m just starting out, I’ll start off with 5 minutes a day and gradually add more time.

Be Careful With Alcohol

· I’ll talk with my health care team about whether it’s wise for me to have alcoholic beverages.

· If and when I drink alcoholic beverages, I’ll limit myself to no more than one serving (for women) or two servings (for men) daily.

Quit Smoking

I’ll talk with my health care team about methods that can help.

Stay on Target With Your Blood Glucose

I’ll help lower my LDL cholesterol and triglycerides by keeping my blood glucose under control with meal planning, physical activity, and medication (if needed).

Medications

Several types of medication are available. Not everyone takes the same blood lipid medication, and many people take more than one kind. The medications you take will depend on your blood lipid levels and other factors such as cost. Lifestyle changes along with medications can help you reach your targets. Some medications can help prevent heart attacks and strokes.

· Statins—These medications lower LDL cholesterol, boost HDL levels, and lower triglyceride levels. Studies have shown that they are the most effective medication for lowering LDL cholesterol.

· Fibric acid derivatives, also called fibrates—These medications lower triglycerides and raise HDL levels. They may either lower, raise, or not change LDL cholesterol.

· Nicotinic acid, also called niacin—This medication lowers triglycerides, raises HDL levels, and lowers LDL cholesterol.

· Cholesterol absorption inhibitors—This type of medication lowers LDL cholesterol and triglycerides and raises HDL levels.

Bile acid sequestrants—These medications lower LDL cholesterol and can raise HDL levels. They either have no effect on triglycerides or, in some cases, they can raise triglyceride levels.

Tags: Complications, Heart Disease, Type 1 diabetes
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Make Wise Food Choices

Friday, October 5th, 2007

How can food choices help keep my heart and blood vessels healthy?

Diabetes increases your chances of having a heart attack or a stroke. But you can protect your heart and blood vessels by

eating less of the foods that raise your blood cholesterol and your chances of heart disease
eating more of the foods that lower your cholesterol and your chances of heart disease

Choosing foods wisely can also help you lose weight and keep your blood glucose (sugar) levels on target.

How can I make wise food choices?

Try these steps to help protect your heart and blood vessels:

Eat less fat, especially saturated fat and trans fats, and fewer high-cholesterol foods. Saturated fat is found in meat, poultry skin, butter, 2% or whole milk, ice cream, cheese, lard, and shortening. You’ll also want to cut back on foods that contain palm oil or coconut oil.

Trans fats are produced when liquid oils are turned into solids. This process is called hydrogenation. Cut back on foods that list hydrogenated or partially hydrogenated oils on the labels. This type of fat is found in crackers and snack foods, baked goods like cookies and donuts, french fries, and stick margarine. Use a soft margarine in place of butter or stick margarine. Look for soft margarine in a tub that lists a liquid oil such as corn, safflower, soybean, or canola oil as the first ingredient.

Egg yolks and organ meats such as liver are high in cholesterol. Check the Nutrition Facts and the list of ingredients on food labels.

Choose the kinds of fat that can help lower your cholesterol. If you use cooking oil, choose olive oil or canola oil. Nuts have a healthy type of fat as well. Corn oil, sunflower oil, and safflower oil also protect your heart. However, all oils, nuts, and fats are high in calories. If you’re trying to lose weight, you’ll want to keep servings small.

Have fish 2 or 3 times a week. Albacore tuna, herring, mackerel, rainbow trout, sardines, and salmon are high in omega-3 fatty acids, a type of fat that may help lower blood fat levels and prevent clogging of the arteries.

Use special cholesterol-lowering margarine. Having 2 to 3 tablespoons of a cholesterol-lowering margarine every day can lower your cholesterol. These margarines contain plant stanols or plant sterols, ingredients that keep cholesterol from being absorbed. You’ll find several types at the grocery store in the margarine section.

Cook with less fat. You can cut down on total fat by broiling, microwaving, baking, roasting, steaming, or grilling foods. Using nonstick pans and cooking sprays instead of cooking with fat also helps.

Eat more foods that are high in fiber. Foods high in fiber may help lower blood cholesterol. Fiber also can prevent problems with the digestive system such as constipation. Oatmeal, oat bran, dried beans and peas (such as kidney beans, pinto beans, and black-eyed peas), fruits, and vegetables are good sources of fiber.

Include more soy protein in your meals and snacks. Replacing foods high in saturated fat with soy-containing foods may help lower your cholesterol. Foods with soy protein include soybeans, tofu, miso, tempeh, soy nuts, soy milk, textured soy protein, soy protein powder, and items that are made from soybeans, such as burgers.

Limit your alcoholic beverage consumption. Drinking light to moderate amounts of alcohol is associated with a low risk of heart disease, perhaps by raising HDL (good) cholesterol levels. There isn’t enough information to recommend that people who don’t drink should start drinking alcohol to reduce heart risk. But, for those who do drink alcohol, 1 serving daily for women and up to 2 servings daily for men have been associated with good health. Drinking more than 1 to 2 drinks per day isn’t helpful; it contributes unnecessary calories and may actually raise your blood pressure and triglycerides. In addition, it can cause other health problems. It’s best to discuss drinking alcohol with your health care provider to find out whether it may be helpful for you.

A Day of Heart-Healthy Meals

Breakfast

Fresh orange sections
Oatmeal with 1% milk and raisins
Toast with cholesterol-lowering margarine
Coffee with 1% milk

Lunch

Sliced turkey on whole wheat bread with lettuce and mustard
Carrot sticks
Cherry tomatoes
Fresh apple

Dinner

Baked chicken
Baked potato with cholesterol-lowering margarine and low-fat sour cream
Steamed green beans
Tossed salad with low-fat salad dressing
Low-fat frozen yogurt

Between-meal Snacks

Dried fruit air-popped popcorn rice cakes with peanut butter

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Depression

Thursday, October 4th, 2007

Feeling down once in a while is normal. But some people feel a sadness that just won’t go away. Life seems hopeless. Feeling this way most of the day for two weeks or more is a sign of serious depression.

At any given time, most people with diabetes do not have depression. But studies show that people with diabetes have a greater risk of depression than people without diabetes. There are no easy answers about why this is true.

The stress of daily diabetes management can build. You may feel alone or set apart from your friends and family because of all this extra work.

If you face diabetes complications such as nerve damage, or if you are having trouble keeping your blood sugar levels where you’d like, you may feel like you’re losing control of your diabetes. Even tension between you and your doctor may make you feel frustrated and sad.

Just like denial, depression can get you into a vicious cycle. It can block good diabetes self-care. If you are depressed and have no energy, chances are you will find such tasks as regular blood sugar testing too much. If you feel so anxious that you can’t think straight, it will be hard to keep up with a good diet. You may not feel like eating at all. Of course, this will affect your blood sugar levels.

What to do?

Spotting depression is the first step. Getting help is the second. If you have been feeling really sad, blue, or down in the dumps, check for these symptoms:

Loss of pleasure You no longer take interest in doing things you used to enjoy.
Change in sleep patterns You have trouble falling asleep, you wake often during the night, or you want to sleep more than usual, including during the day.
Early to rise You wake up earlier than usual and cannot to get back to sleep.
Change in appetite You eat more or less than you used to, resulting in a quick weight gain or weight loss.
Trouble concentrating You can’t watch a TV program or read an article because other thoughts or feelings get in the way.
Loss of energy You feel tired all the time.
Nervousness You always feel so anxious you can’t sit still.
Guilt You feel you “never do anything right” and worry that you are a burden to others.
Morning sadness You feel worse in the morning than you do the rest of the day.
Suicidal thoughts You feel you want to die or are thinking about ways to hurt yourself.

If you have three or more of these symptoms, or if you have just one or two but have been feeling bad for two weeks or more, it’s time to get help.

Getting Help

If you are feeling symptoms of depression, don’t keep them to yourself. First, talk them over with your doctor. There may a physical cause for your depression.

Diabetes that is in poor control can cause symptoms that look like depression. During the day, high or low blood sugar may make you feel tired or anxious. Low blood sugar levels can also lead to hunger and eating too much. If you have low blood sugar at night, it could disturb your sleep. If you have high blood sugar at night, you may get up often to urinate and then feel tired during the day.

Other physical causes of depression can include

alcohol or drug abuse
thyroid problems
side effects from some medications

Do not stop taking a medication without telling your doctor. Your doctor will be able to help you discover if a physical problem is at the root of your sad feelings.

If you and your doctor rule out physical causes, your doctor will most likely refer you to a specialist. You might talk with a psychiatrist, psychologist, psychiatric nurse, licensed clinical social worker, or professional counselor. In fact, your doctor may already work with mental health professionals on a diabetes treatment team.

All of these mental health professionals can guide you through the rough waters of depression. In general, there are two types of treatment. One is psychotherapy, or counseling. The other is antidepressant medication.

Psychotherapy with a well-trained therapist can help you look at the problems that bring on depression. It can also help you find ways to relieve the problem. Therapy can be short term or long term. You should be sure you feel at ease with the therapist you choose.

If medication is advised, you will need to consult with a psychiatrist (a medical doctor with special training in diagnosing and treating mental or emotional disorders). Psychiatrists are the only mental health professionals who can prescribe medication and treat physical causes of depression.

If you opt for trying an antidepressant drug, talk to the psychiatrist and your primary care provider about side effects, including how it might affect your blood sugar levels. Make sure that the doctors will consult about your care when needed. Many people do well with a combination of medication and psychotherapy.

If you have symptoms of depression, don’t wait too long to get help. If your health care provider cannot refer you to a mental health professional, contact your local psychiatric society or psychiatry department of a medical school, or the local branch of organizations for psychiatric social workers, psychologists, or mental health counselors.

Tags: Complications, Depression, Type 1 diabetes
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Diabetic Neuropathy and Nerve Damage

Thursday, October 4th, 2007

Nerves send messages to and from your brain about pain, temperature and touch. They tell your muscles when and how to move. They also control body systems that digest food and pass urine. About half of all people with diabetes have some form of nerve damage. It is more common in those who have had the disease for a number of years. Nerve damage from diabetes is called diabetic neuropathy (new-ROP-uh-thee). It can lead to many kinds of problems.

But if you keep your blood glucose levels on target, you may help prevent or delay nerve damage. There are treatments that can help as well.

What types of nerve damage can occur?

There are two common types of nerve damage. The first is sensorimotor (sen-so-re-MO-tor) neuropathy, also known as peripheral (puh-RIF-uh-rul) neuropathy. This can cause tingling, pain, numbness, or weakness in your feet and hands.

The second is called autonomic (aw-toh-NOM-ik) neuropathy. This type can lead to:

digestive problems such as feeling full, nausea,
vomiting, diarrhea, or constipation
problems with how well your bladder works
problems having sex
dizziness or faintness
loss of the typical warning signs of a heart attack
loss of the warning signs of low blood glucose
increased or decreased sweating
changes in how your eyes react to light and dark

People with diabetes can also have what is called focal (FOH-kal) neuropathy. In this kind of nerve damage, a nerve or a group of nerves is affected, causing sudden weakness or pain. It can lead to double vision, a paralysis on one side of the face called Bell’s palsy, or pain in the front of the thigh or other parts of the body.

People with diabetes also are at risk for compressed nerves. Something in the body presses against a nerve preventing it from sending a signal. Carpal tunnel syndrome is a common cause of numbness and tingling in the fingers and can lead to muscle pain and weakness as well. Nerve damage can be hard to diagnose because its symptoms can be caused by other conditions. Symptoms can be very mild. Knowing the symptoms to look for and reporting them to your health care team can help. Make a list of your symptoms or use the checklists in this brochure. Your doctor will give you an exam and a number of tests to check for nerve damage.

What You Can Do If You Have Diabetic Neuropathy (Nerve Damage)

There’s a lot you can do to prevent or delay nerve damage. And, if you already have diabetic neuropathy (nerve damage), these steps can prevent or delay further damage and may lessen your symptoms.

Keep your blood glucose levels in your target range.

Meal planning, physical activity and medications, if needed, all can help you reach your target range. There are two ways to keep track of your blood glucose levels:

Use a blood glucose meter to help you make decisions about day-to-day care
Get an A1C test (a lab test) at least twice a year to find out your average blood glucose for the past 2 to 3 months

Checking your blood glucose levels will tell you whether your diabetes care plan is working or whether changes are needed.

Report all possible signs of diabetic neuropathy.
If you have problems, get treatment right away. Early treatment can help prevent more problems later on. For example, if you take care of a foot infection early, it can help prevent amputation.
Take good care of your feet. Check your feet every day. If you no longer can feel pain in your feet, you might not notice a foot injury. Instead, use your eyes to look for problems. Use a mirror to see the bottoms of your feet. Use your hands to feel for hot or cold spots, bumps or dry skin. Look for sores, cuts or breaks in the skin. Also check for corns, calluses, blisters, red areas, swelling, ingrown toenails and toenail infections. If it’s hard for you to see or reach your feet, get help from a family member or foot doctor.
Protect your feet. If your feet are dry, use a lotion on your skin but not between your toes. Wear shoes and socks that fit well and wear them all the time. Use warm water to wash your feet, and dry them carefully afterward.
Get special shoes if needed. If you have foot problems, Medicare may pay for shoes. Ask your health care team about it.
Be careful with exercising. Some physical activities are not safe for people with neuropathy. Talk with a diabetes clinical exercise expert who can guide you.

Tags: Complications, Diabetic Neuropathy and Nerve Damage, Type 1 diabetes
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All About Peripheral Arterial Disease

Friday, September 28th, 2007

What is peripheral arterial disease?

Peripheral arterial disease, also called PAD, occurs when blood vessels in the legs are narrowed or blocked by fatty deposits. Blood flow to your feet and legs decreases. If you have PAD, you have an increased risk for heart attack and stroke. An estimated one out of every three people with diabetes over the age of 50 have this condition. However, many of those with warning signs don’t realize that they have PAD and therefore don’t get treatment.

What does diabetes have to do with PAD?

If you have diabetes, you’re much more likely to have PAD, a heart attack, or a stroke. But you can cut your chances of having those problems by taking special care of your blood vessels.

How do I know whether I’m at high risk for PAD?

Just having diabetes puts you at risk, but your risk is even greater if

· you smoke

· you have high blood pressure

· you have abnormal blood cholesterol levels

· you already have heart disease, or have had a heart attack or a stroke

· you’re overweight

· you’re not physically active

· you’re over age 50

· you have a family history of heart disease, heart attacks, or strokes

You can’t change your age or your family history, but taking care of your diabetes and the conditions that come with it can lower your chances of having PAD. It’s up to you.

What are the warning signs of PAD?

Many people with diabetes and PAD do not have any symptoms. Some people may experience mild leg pain or trouble walking and believe that it’s just a sign of getting older. Others may have the following symptoms:

· leg pain, particularly when walking or exercising, which disappears after a few minutes of rest

· numbness, tingling, or coldness in the lower legs or feet

· sores or infections on your feet or legs that heal slowly

How is PAD diagnosed?

The ankle brachial index (ABI) is one test used to diagnose PAD. This test compares the blood pressure in your ankle to the blood pressure in your arm. If the blood pressure in the lower part of your leg is lower than the pressure in your arm, you may have PAD. An expert panel brought together by the American Diabetes Association recommends that people with diabetes over the age of 50 have an ABI to test for PAD. People with diabetes younger than 50 may benefit from testing if they have other PAD risk factors.

These other tests can also be used to diagnosis PAD:

· Angiogram (AN-gee-oh-gram): a test in which dye is injected into the blood vessels using a catheter and X rays are taken to show whether arteries are narrowed or blocked

· Ultrasound: a test using sound waves to produce images of the blood vessels on a viewing screen

· MRI (magnetic resonance imaging): a test using special scanning techniques to detect blockages within blood vessels

How is PAD treated?

People with PAD are at very high risk for heart attacks and stroke; therefore, it is very important that cardiovascular risk factors are managed. Follow these steps:

· Get help to quit smoking. Your health care provider can help you.

· Aim for an A1C below 7%. The A1C test measures your average blood glucose (sugar) over the past 2 to 3 months.

· Lower your blood pressure to less than 130/80 mmHg.

· Get your LDL cholesterol below 100 mg/dl.

· Talk to your health care provider about taking aspirin or other antiplatelet medicines. These medicines have been shown to reduce heart attacks and strokes in people with PAD.

Studies have found that exercise, such as walking, can be used both to treat PAD and to prevent it. Medications may help relieve symptoms.

In some cases, surgical procedures are used to treat PAD:

· Angioplasty, also called balloon angioplasty: a procedure in which a small tube with a balloon attached is inserted and threaded into an artery; then the balloon is inflated, opening the narrowed artery. A wire tube, called a stent, may be left in place to help keep the artery open.

· Artery bypass graft: a procedure in which a blood vessel is taken from another part of the body and is attached to bypass a blocked artery