Certified Diabetes Educator Article

Prevention of Circulatory Problems

Circulatory problems, especially heart disease, are the major cause of premature death in people with diabetes, and prevention of these problems is a central goal in the treatment of diabetes. You can take a number of steps to reduce your risk of heart disease and circulatory problems:

Improve glucose control. The target levels are described in Chapter 5.

Lower blood pressure. I have already discussed in the “Diabetic Kidney Disease” section earlier in this chapter the importance of controlling blood pressure. The treatment goal is to get the systolic blood pressure (top number) below 130 mm Hg and the diastolic blood pressure (bottom number) below 80.

Take aspirin. Clinical studies show that aspirin reduces the risk of heart attacks and stroke. Aspirin works by making platelets (the cells in the blood that are responsible for blood clotting) less sticky. Recent studies indicate that lower doses are just as effective as higher doses, so low-dose aspirin therapy (a 75–81 mg dose once a day) is recommended if you already have heart disease or circulatory problems. If you cannot tolerate aspirin because of allergic reaction or another reason, your doctor may prescribe a medicine called clopidogrel (Plavix), which also makes the platelets less sticky. Individuals with type 1 and 2 diabetes without heart disease or circulatory problems should also take low-dose aspirin therapy if they have a strong family history of heart disease; if they have kidney damage, high blood pressure, or lipid problems; if they are smokers; or if they are older than forty years.

Stop smoking. Smoking increases the risk of both macrovascular and microvascular damage in people with diabetes.

Improve your lipid profi le. People with type 2 diabetes frequently have abnormalities of their lipid profi le—a collective term for cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol levels. Almost all people with type 2 diabetes and many with type 1 diabetes need to take medicines for the lipid abnormalities.