I am diabetic

If you have diabetes, you are at high risk for having a heart attack or stroke. Take action now to prevent heart attacks and stroke. The information in the following sections will teach you how to take care of your heart and blood vessels and reduce your risks for serious health problems

Taking Care of Your Heart
Find out how you can take steps to prevent heart disease or reduce your chances of having another heart attack.

Treating High Blood Pressure in People With Diabetes
An important part of taking care of yourself is keeping your blood pressure under control.

Treating High Cholesterol in People with Diabetes
Keeping your cholesterol and other blood fats, also called lipids, under control can help you prevent diabetes problems.

Know the Warning Signs of a Heart Attack
If you have diabetes, you’re at risk for a heart attack.

Taking Aspirin to Protect Your Heart
Studies have shown that taking a low-dose aspirin every day significantly lowers the risk of heart attacks.

All About Stroke
If you have diabetes, you’re much more likely to have a stroke, heart disease, or a heart attack. But you can cut your chances of having these problems by taking special care of your heart and blood vessels.

All About Peripheral Arterial Disease
Learn how PAD is linked to diabetes and how you can treat it.

Medical Tests and Procedures for Finding and Treating Heart and Blood Vessel Disease
Find out what diabetes has to do with heart disease and blood vessel disease.

Make Wise Food Choices
Learn how food choices help keep your heart and blood vessels healthy.

Choose Fats Wisely
Diabetes increases your chances of having a heart attack or a stroke. Learn how making the right choices can help reduce the risk of haing a heart attack or storke.

Cook with Heart Healthy Foods
You can protect your heart and blood vessels by eating less saturated fat and by choosing the types of fats that help your cholesterol levels.

Why should I choose fats wisely?

Diabetes increases your chances of having a heart attack or a stroke. But you can protect your heart and blood vessels by choosing fats wisely. Some kinds of fat, such as butter and shortening, can increase your cholesterol and your chances of heart disease. Other kinds, such as olive oil and canola oil, protect your heart by lowering your cholesterol levels. All fats are high in calories. If you’re trying to lose weight, you’ll still want to limit the amount of fat you eat. The types and amounts of fat appear in the Nutrition Facts area of food labels.

How can I choose fats wisely?

Try these steps to protect your heart and blood vessels:

• Eat less total fat, especially less saturated fat and trans fat.
• Cut back on foods that are high in cholesterol.
• Choose the kinds of fat that can help lower your cholesterol levels.

Fats That Increase Your Chances of Heart Disease and Stroke

Saturated fat, trans fat, and cholesterol increase your blood cholesterol and can cause a buildup of materials that can clog your blood vessels. The blood supply to your heart can be blocked, leading to a heart attack. A blockage in the blood vessels going to your brain can result in a stroke.

Saturated Fat

Saturated fat can raise your cholesterol level.

Sources of saturated fat:

• bacon and bacon grease
• butter
• chocolate
• coconut and coconut oil
• cream sauce
• high-fat dairy products, such as cheese, cream, ice cream, whole milk, 2% milk, and sour cream
• fatback and salt pork
• gravy made with meat drippings
• lard and shortening
• high-fat meats like regular ground beef, bologna, hot dogs, sausage, and spareribs
• palm oil and palm kernel oil
• poultry skin

Trans -unsaturated Fatty Acids (trans fats)

Trans fats can also raise your cholesterol level.

Sources of trans fats:

• processed foods like snacks and baked goods with hydrogenated oil or partially hydrogenated oil
• stick margarines
• shortening
• some fast food items such as french fries

Cholesterol

Your body makes some of the cholesterol in your blood. The rest comes from the foods you eat. Foods from animals are the main sources of dietary cholesterol.

Sources of Cholesterol:

• high-fat dairy products
• egg yolks
• liver and other organ meats
• high-fat meat and poultry

Fats That Can Protect Your Heart

Monounsaturated fats, polyunsaturated fats, and special cholesterol-lowering margarines can actually protect your heart by lowering your blood cholesterol. That’s why it’s better to use them instead of saturated fat. Another kind of protective fat, called omega-3 fatty acids, is found in some types of fish.

Monounsaturated Fat

Monounsaturated fat, one type of unsaturated fat, can lower your blood cholesterol.

Sources of monounsaturated fat:

• avocado
• canola oil
• nuts like almonds, cashews, pecans, and peanuts
• olive oil and olives
• peanut butter and peanut oil
• sesame seeds

Polyunsaturated Fat

Polyunsaturated fat, another type of unsaturated fat, protects your heart.

Sources of polyunsaturated fat:

• corn oil
• cottonseed oil
• safflower oil
• soybean oil
• sunflower oil
• walnuts
• pumpkin or sunflower seeds
• soft (tub) margarine
• mayonnaise
• salad dressings

Omega-3 fatty acids

This type of fat helps prevent clogging of the arteries. Some types of fish are high in omega-3 fatty acids. Eat fish, prepared a low-fat way, 2 or 3 times a week. Choose broiling, baking, grilling, or steaming. You can also buy tuna packed in water and make tuna fish salad with low-fat or fat-free mayonnaise.

Sources of omega-3 fatty acids:

• albacore tuna
• herring
• mackerel
• rainbow trout
• sardines
• salmon

Special Colesterol-Lowering Mrgarine

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.

An important part of taking care of yourself is keeping your blood pressure under control. High blood pressure — also called hypertension — raises your risk for heart attack, stroke, eye problems, and kidney disease. As many as two out of three adults with diabetes have high blood pressure. Having your blood pressure checked regularly and taking action to reach your blood pressure target can prevent or delay diabetes problems.

What is high blood pressure?

Blood pressure is the force of blood flow inside your blood vessels. When your health care team checks your blood pressure, they record two numbers, such as 130/80 mmHg. You’ll hear them say this as “one-thirty over eighty.” Both numbers are important:

· The first number is the pressure as your heart beats and pushes blood through the blood vessels. Health care providers call this the “systolic” pressure.

· The second number is the pressure when the vessels relax between heartbeats. It’s called the “diastolic” pressure.

When your blood moves through your vessels with too much force, you have high blood pressure. Your heart has to work harder when blood pressure is high, and your risk for diabetes problems goes up. High blood pressure is a problem that won’t go away without treatment.

What is the recommended target for blood pressure?

Both diabetes and high blood pressure increases your risk of heart attack, stroke, and eye and kidney disease. Because of this, people with diabetes have a lower blood pressure target than the general public. The American Diabetes Association (ADA) and the National Institutes of Health recommend a target blood pressure of less than 130/80 mmHg for people with diabetes. When you keep your blood pressure below 130/80 mmHg, you’ll be lowering your risk for diabetes problems.

How will I know if I have high blood pressure?

High blood pressure is a silent problem — you won’t know you have it unless your health care provider checks your blood pressure. We that you have your blood pressure checked at every office visit, or at least two to four times a year.

What treatments are recommended?

Both lifestyle changes and medication help control blood pressure. 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 pressure as well as your blood glucose and blood lipids (cholesterol) levels. From the steps below, decide which 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 a serving of fruit at each meal.

· I’ll eat one or two servings of vegetables at lunch and at dinner.

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

· I’ll eat whole-grain breads (such as whole-wheat bread) and cereals.

· I’ll eat nuts or peanut butter sometimes.

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

· I’ll cook using low-fat methods such as baking, roasting, broiling, or grilling.

· I’ll add little or no salt to my food at the table and during cooking.

· I’ll try herbs and spices instead of salt

· I’ll check food labels and choose foods with less than 400 mg of sodium per serving.

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 one serving a day (for women) or two servings a day (for men).

Quit Smoking

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

Medications

Several types of medication are available. Not everyone takes the same blood pressure medication, and many people take more than one kind. Which ones you take will depend on your blood pressure readings and other factors such as cost.

ACE inhibitors — These medications lower blood pressure by keeping your blood vessels relaxed. ACE inhibitors prevent a hormone called angiotensin from forming in your body and narrowing your blood vessels. These medications also help protect your kidneys and reduce your risk of heart attack and stroke.

ARBs — These medications keep the blood vessels open and relaxed to help lower blood pressure. Like ACE inhibitors, ARBs protect your kidneys.

Beta blockers — These medications help lower blood pressure and relax your heart by allowing it to beat slower and less forcefully. Beta blockers help prevent heart attack and stroke.

Calcium channel blockers — These medications help the blood vessels relax by keeping calcium out of your blood vessels and heart.

Diuretics — These medications, sometimes called “water pills,” help rid your body of extra water and sodium through urine.

Am I likely to have side effects from my medications?

Some blood pressure medications produce side effects. Always talk to your health care team if you think your medication is causing a problem. Your health care team may be able to substitute another medication.

What is a stroke?

A stroke, sometimes called a “brain attack”, occurs when blood supply to part of your brain is interrupted and brain tissue is damaged. The most common cause is a blocked blood vessel. Stroke can cause physical problems such as paralysis, problems with thinking or speaking, and emotional problems.

What does diabetes have to do with strokes?

If you have diabetes, you’re much more likely to have a stroke, heart disease, or a heart attack. In fact, two out of three people with diabetes die from stroke or heart disease. But you can cut your chances of having these problems by taking special care of your heart and blood vessels.

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

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

· you have high blood pressure

· you have abnormal blood cholesterol levels

· you smoke

· you’ve already had a stroke or a transient ischemic attack (TIA), also called a mini-stroke

· you have a family history of stroke or TIAs

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

How can I lower my risk of having a stroke?

You can lower your risk by keeping your blood glucose (sugar), blood pressure, and cholesterol on target with meal planning, physical activity, and medication. Quitting smoking is important too. Every step you take will help. The closer your numbers are to your targets, the better your chances of preventing a stroke.

What are the warning signs of a stroke?

Typical warning signs of a stroke develop suddenly and can include:

· weakness or numbness on one side of your body

· sudden confusion or trouble understanding

· trouble talking

· dizziness, loss of balance, or trouble walking

· trouble seeing out of one or both eyes

· double vision

· severe headache

Sometimes one or more of these warning signs occur but then disappear. That condition, called a TIA, occurs when blood flow is temporarily blocked. It means you may be at risk for a future stroke.

If you have warning signs of a stroke, call 911 right away. Getting treatment can help prevent permanent damage to your brain. It’s wise to review the symptoms of a stroke with family and friends and to tell them about the importance of calling 911.

How is a stroke diagnosed?

A number of tests may be done if a stroke is suspected:

· Your doctor will examine you to check for any changes in body function. For example, the doctor can check your ability to move your arms and legs. The doctor also will check brain functions such as your ability to read or to describe a picture.

· A CT or MRI (magnetic resonance imaging) uses special scanning techniques to provide images of the brain.
An ultrasound examination can show problems in the carotid (ca-RAH-tid) arteries, which carry blood from the heart to the brain.

· A cerebral (seh-REEB-rahl) arteriogram is a test in which a catheter is inserted into an artery and positioned in the neck. Dye is injected and X rays show whether arteries are narrowed or blocked.

What are the treatments for stroke?

Treatment you need right away

“Clot-busting” drugs must be given within hours after a stroke to minimize damage. That’s why it’s important to call 911 if you’re having symptoms.

Surgical treatments you may need

Several options for surgical treatment of blocked blood vessels are available. These include

· Carotid artery surgery, also called carotid endarterectomy (en-dar-teh-REK-teh-mee) is used to remove buildups of fat inside the artery and to restore blood flow to the brain.

· Carotid stenting is a procedure used to remove a blockage in a blood vessel to the brain. A small tube with a balloon attached is threaded into the narrowed or blocked blood vessel. Then the balloon is inflated, opening the narrowed artery. A wire tube, or stent, may be left in place to help keep the artery open

Other treatments

Treatment following a stroke includes rehabilitation therapies to restore function or help people relearn skills. Physical, occupational, and speech therapy may be included, as well as psychological counseling. Steps to prevent future problems should include smoking cessation, meal planning, physical activity, and medications to manage blood glucose, blood pressure, and cholesterol levels.

You can protect your heart and blood vessels by eating less saturated fat and by choosing the types of fats that help your cholesterol levels. The ingredients you use and the way you cook can make a big difference. Try these tips:

• Cook with less fat
• Choose lean meats, poultry, and pork
• Choose low-fat dairy foods
• Substitute lower-fat ingredients in recipes

Cook with Less Fat

Use a low-fat or fat-free way to cook. You can cut down on total fat by broiling, microwaving, baking, roasting, steaming, or grilling foods. Nonstick pans and cooking sprays also work well.

Boost the flavor with seasonings and sauces instead of fats. Look for recipes that use herbs and spices for flavor instead of fat. Try these ways to season food:

• Squeeze fresh lemon juice on steamed vegetables, broiled fish, rice, or pasta
• Try lemon pepper or mesquite seasoning on chicken
• Use onion and garlic to liven up meats and vegetables
• Try baking chicken or pork with barbecue sauce or low-fat Italian dressing

Trim the fat when possible. Cut away visible fat from meat and poultry. Roast food on a rack to let the fat drip off. Make soups a day ahead so you can chill them and then remove the fat that has risen to the top.

Choose Lean Cuts of Beef, Poultry, and Pork

To help keep your cholesterol on target, choose lean cuts of meat and poultry. Try some of your favorite recipes with these lean choices:

• When selecting beef, choose lean cuts such as round, sirloin, and flank steak; tenderloin; rib, chuck, or rump roast; T-bone, porterhouse, or cubed steak
• Choose poultry such as chicken, turkey, or Cornish hen without the skin (The white breast meat is lower in fat than the darker meat in the thigh and leg pieces.)
• Lean types of pork include ham, Canadian bacon, pork loin, and center loin chops

Choose Low-fat Dairy Products

Dairy products can be part of your meal plan. To cut back on saturated fat, choose items made with non-fat or low-fat milk. Some low-fat choices are listed below.

• Milk: Fat-free (skim), 1/2%, and 1% milk and low-fat buttermilk
• Yogurt: low-fat or fat-free yogurt
• Cheese: cottage cheese, grated Parmesan, and any cheese with 3 grams of fat or less per ounce
• For a frozen treat, try low-fat ice cream or frozen yogurt instead of ice cream. You can also freeze regular yogurt for a treat.

Substitute Lower-fat Ingredients In Your Favorite Recipes

Try extra-lean ground beef or ground turkey instead of ground beef. Use low-fat mayonnaise and salad dressings instead of the regular types. Try plain yogurt in place of sour cream or mayonnaise. You can substitute up to half the margarine or butter in some recipes with applesauce.

Wise Food Choices: What to Try and Why