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Diabetes and Cardiovascular Disease

Diabetes and Cardiovascular Disease. Jeanne Jacoby, ARNP Dartmouth Hitchcock Medical Center Section of Endocrinology Get Heart Smart! February 7, 2009. What is Diabetes?. Diabetes is a disease in which the body does not produce or properly use insulin.

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Diabetes and Cardiovascular Disease

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  1. Diabetes and Cardiovascular Disease Jeanne Jacoby, ARNP Dartmouth Hitchcock Medical Center Section of Endocrinology Get Heart Smart! February 7, 2009

  2. 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 mystery…likely multi-factorial: • Genetics And • Environmental factors such as obesity and lack of exercise appear to play roles. From http:// www.diabetes.org

  3. 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

  4. 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

  5. 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

  6. 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

  7. What’s the Link? Cardiovascular Disease (CVD) And Diabetes

  8. 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 exercise…too busy at work • New Diagnoses: • Type II diabetes • High Blood Pressure • High Cholesterol • Family History of Heart Disease and Diabetes

  9. 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.

  10. 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

  11. 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 B’s… • BMI • Blood Sugars

  12. Jack’s ABC’s • A1c - 9.1% • Blood Pressure – 150/90 • Cholesterol: • LDL: 120 • HDL: 30 • Total Cholestrol: 230 • Body Mass Index (BMI): 30 • Height: 6’1” • Weight: 225 lbs • Fasting Blood Sugar (on diagnosis): 200

  13. Ask About Your A1C • A1C measures average blood glucose over the last three months. • Get your A1C checked at least twice a year. 7% A1C Goal = less than

  14. Getting Jack to Goal:Hemoglobin A1c • Eat the right foods. • Get daily physical activity. • Test blood glucose regularly. • Take medications as prescribed. 9.1 %  7.0 %

  15. 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

  16. Getting Jack to Goal:Blood 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

  17. 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

  18. ADA Goals for Cholesterol 100 • Target LDL = less than • Target HDL = above (men) above (women) • Target triglycerides = less than 40 50 150

  19. Getting Jack to Goal:Cholesterol • 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

  20. 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). 25 BMI Goal = less than

  21. Getting Jack to Goal:Body 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

  22. 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.

  23. Check out your profile… https://www.diabetes.org/diabetesphd

  24. 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. It’s 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.

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

  26. For More Information Call: 1-800-DIABETES Visit: www.diabetes.org/MakeTheLink Email: MakeTheLink@diabetes.org Contact me: jeanne.m.jacoby@hitchcock.org

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