Diabetes and Diabetes and Cardiovascular Cardiovascular

DiseaseDiseaseJeanne Jacoby, ARNPJeanne Jacoby, ARNP

Dartmouth Hitchcock Medical CenterDartmouth Hitchcock Medical CenterSection of EndocrinologySection of Endocrinology

Get Heart Smart!Get Heart Smart!February 7, 2009February 7, 2009

What is Diabetes?What is Diabetes?►Diabetes is a disease in which the body Diabetes is a disease in which the body

does not produce or properly use does not produce or properly use insulin.insulin.

►The cause of diabetes continues to be a The cause of diabetes continues to be a mystery…likely multi-factorial:mystery…likely multi-factorial: Genetics Genetics

AndAnd

Environmental factors such as obesity and Environmental factors such as obesity and lack of exercise appear to play roles.lack of exercise appear to play roles.

From http:// www.diabetes.org

Major Types of DiabetesMajor Types of Diabetes

► Type 1 diabetesType 1 diabetes Results from the body's failure to produce Results from the body's failure to produce

insulin, the hormone that "unlocks" the cells of insulin, the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel the body, allowing glucose to enter and fuel them. them.

It is estimated that 5-10% of Americans who are It is estimated that 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes.diagnosed with diabetes have type 1 diabetes.

► Type 2 diabetesType 2 diabetes Results from insulin resistance (a condition in Results from insulin resistance (a condition in

which the body fails to properly use insulin), which the body fails to properly use insulin), combined with relative insulin deficiency. combined with relative insulin deficiency.

Most Americans who are diagnosed with diabetes Most Americans who are diagnosed with diabetes have type 2 diabetes.have type 2 diabetes.

From http:// www.diabetes.org

Other Glucose intoleranceOther Glucose intolerance►Gestational diabetesGestational diabetes

Diabetes during pregnancyDiabetes during pregnancy Immediately after pregnancy, 5% to 10% of women Immediately after pregnancy, 5% to 10% of women

with gestational diabetes are found to have diabetes, with gestational diabetes are found to have diabetes, usually, type 2. usually, type 2.

► Pre-diabetesPre-diabetes Pre-diabetes is a condition that occurs when a Pre-diabetes is a condition that occurs when a

person's blood glucose levels are higher than normal person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 but not high enough for a diagnosis of type 2 diabetes. diabetes.

There are 57 million Americans who have pre-There are 57 million Americans who have pre-diabetes, in addition to the 23.6 million with diabetes. diabetes, in addition to the 23.6 million with diabetes.

From http:// www.diabetes.org

Diagnosing DiabetesDiagnosing Diabetes

► Fasting Blood Glucose (FBG):Fasting Blood Glucose (FBG): Blood Glucose Level is measured after a fastBlood Glucose Level is measured after a fast

►Oral Glucose Tolerance Test (OGTT)Oral Glucose Tolerance Test (OGTT) Blood glucose level is measured fasting and two Blood glucose level is measured fasting and two

hours after drinking a glucose-rich beveragehours after drinking a glucose-rich beverage

From http:// www.diabetes.org

DiagnosisDiagnosis FBGFBG OGTTOGTT

Pre-Pre-DiabetesDiabetes

100-125100-125 140-199140-199

DiabetesDiabetes ≥ ≥ 126126 ≥ ≥ 200200

Prevalence of DiabetesPrevalence of Diabetes

► 23.6 million children and 23.6 million children and adults in the United adults in the United States (7.8% of the States (7.8% of the population) have diabetespopulation) have diabetes ~ 17.9 million have been ~ 17.9 million have been

diagnosed with diabetesdiagnosed with diabetes 5.7 million people are 5.7 million people are

unaware that they have the unaware that they have the diseasedisease

► Another 57 million people Another 57 million people have pre-diabeteshave pre-diabetes

Type II

Type IUndiagnosed

From http:// www.diabetes.org

What’s the Link?What’s the Link?

Cardiovascular Disease (CVD)Cardiovascular Disease (CVD)

AndAnd

DiabetesDiabetes

Meet JackMeet Jack► 40 year old man presents to his PCP for a 40 year old man presents to his PCP for a

physical after 5 years awayphysical after 5 years away No prior medical historyNo prior medical history OverweightOverweight He does not exercise…too busy at workHe does not exercise…too busy at work

►New Diagnoses:New Diagnoses: Type II diabetesType II diabetes High Blood PressureHigh Blood Pressure High CholesterolHigh Cholesterol

► Family History of Heart Disease and DiabetesFamily History of Heart Disease and Diabetes

Diabetes-CVD FactsDiabetes-CVD Facts

►More than 65% of all deaths in people More than 65% of all deaths in people with diabetes are caused by with diabetes are caused by cardiovascular disease. cardiovascular disease.

►Heart attacks occur at an earlier age in Heart attacks occur at an earlier age in

people with diabetes and often result people with diabetes and often result in premature death.in premature death.

Diabetes-CVD FactsDiabetes-CVD Facts

► Up to 60% of adults with diabetes have high Up to 60% of adults with diabetes have high blood pressure.blood pressure.

►Nearly all adults with diabetes have one or Nearly all adults with diabetes have one or more cholesterol problems, such as:more cholesterol problems, such as: high triglycerideshigh triglycerides low HDL (“good”) cholesterollow HDL (“good”) cholesterol high LDL (“bad”) cholesterolhigh LDL (“bad”) cholesterol

The Good News… The Good News… ► By managing the ABCs of diabetes, people By managing the ABCs of diabetes, people

with diabetes can reduce their risk for heart with diabetes can reduce their risk for heart disease and stroke.disease and stroke.

AA stands for stands for AA1C1C BB stands for stands for BBlood pressurelood pressure CC stands for stands for CCholesterolholesterol

PLUS More B’s…PLUS More B’s…►BMIBMI►Blood SugarsBlood Sugars

Jack’s ABC’sJack’s ABC’s►AA1c - 9.1%1c - 9.1%►BBlood Pressure – 150/90lood Pressure – 150/90► CCholesterol:holesterol:

LDL: 120LDL: 120 HDL: 30HDL: 30 Total Cholestrol: 230Total Cholestrol: 230

► Body Mass Index (BMI): 30Body Mass Index (BMI): 30 Height: 6’1”Height: 6’1” Weight: 225 lbsWeight: 225 lbs

► Fasting Blood Sugar (on diagnosis): Fasting Blood Sugar (on diagnosis): 200200

Ask About Your A1CAsk About Your A1C

►A1CA1C measures average blood glucose measures average blood glucose over the last three months.over the last three months.

►Get your A1C checked at least twice a Get your A1C checked at least twice a year.year.

A1C Goal = less thanA1C Goal = less than7%7%

Getting Jack to Goal:Getting Jack to Goal:Hemoglobin A1cHemoglobin A1c

► Eat the right foods.Eat the right foods.

►Get daily physical activity.Get daily physical activity.

► Test blood glucose regularly.Test blood glucose regularly.

► Take medications as prescribed.Take medications as prescribed.

9.1 % 9.1 % 7.0 %7.0 %

Beware of Your Blood PressureBeware of Your Blood Pressure

►High blood pressure raises your risk for High blood pressure raises your risk for heart attack, stroke, eye problems and heart attack, stroke, eye problems and kidney disease. kidney disease.

►Get your blood pressure checked at Get your blood pressure checked at every visit.every visit.

Target BP = less thanTarget BP = less than130/80130/80

Getting Jack to Goal:Getting Jack to Goal:Blood PressureBlood Pressure

►Eat more fruits and vegetables.Eat more fruits and vegetables.►Reduce the amount of salt in Reduce the amount of salt in

diet.diet.►Lose weight.Lose weight.►Lower alcohol intake.Lower alcohol intake.►Quit smoking.Quit smoking.►Take blood pressure pills.Take blood pressure pills.

150/90 150/90 130/80130/80

Check Your CholesterolCheck Your Cholesterol

►Several kinds of blood fats:Several kinds of blood fats: LDL (“bad”) cholesterolLDL (“bad”) cholesterol - can - can

narrow or block blood vesselsnarrow or block blood vessels HDL (“good”) cholesterolHDL (“good”) cholesterol - helps - helps

remove cholesterol depositsremove cholesterol deposits Triglycerides Triglycerides - can raise your risk for - can raise your risk for

heart attacks/strokeheart attacks/stroke

ADA Goals for CholesterolADA Goals for Cholesterol

►Target LDL = less thanTarget LDL = less than

►Target HDL = above Target HDL = above (men)(men)above above

(women)(women)

►Target triglycerides = less thanTarget triglycerides = less than

10010040405050

150150

Getting Jack to Goal:Getting Jack to Goal:CholesterolCholesterol

►Eat less saturated fatEat less saturated fat Foods high in saturated fat: fatty meats, Foods high in saturated fat: fatty meats,

high-fat dairy products, tropical oilshigh-fat dairy products, tropical oils

►Eat foods high in fiberEat foods high in fiber Examples: oatmeal, beans, peas, citrus Examples: oatmeal, beans, peas, citrus

fruitsfruits

►Take cholesterol-lowering medicationTake cholesterol-lowering medication►Exercise regularlyExercise regularly

LDL: 120 LDL: 120 9595

Body Mass IndexBody Mass Index► Being overweight or obese is a leading risk Being overweight or obese is a leading risk

factor for type 2 diabetes. factor for type 2 diabetes. ► A healthy weight is measured by your body A healthy weight is measured by your body

mass index (BMI). mass index (BMI).

BMIBMI CategoryCategory

Below 18.5Below 18.5 UnderweightUnderweight

18.5-24.918.5-24.9 HealthyHealthy

25-29.925-29.9 OverweightOverweight

Over 30Over 30 ObeseObese

BMI Goal = less thanBMI Goal = less than2255

Getting Jack to Goal:Getting Jack to Goal:Body Mass IndexBody Mass Index

►DietDiet Choose foods low in Saturated FatChoose foods low in Saturated Fat Eat Moderate Amounts of CarbohydratesEat Moderate Amounts of Carbohydrates

►ExerciseExercise Be more activeBe more active throughout the day. throughout the day.

►Examples: work in the garden, play with the kids, Examples: work in the garden, play with the kids, take the stairstake the stairs

WalkWalk - work up to at least 30 minutes of - work up to at least 30 minutes of walking on most dayswalking on most days

30 30 25 25

Other StrategiesOther Strategies

►Get help to quit smoking.Get help to quit smoking.

►Talk to your health care provider about Talk to your health care provider about taking aspirin and other medications taking aspirin and other medications to reduce your risk for heart disease to reduce your risk for heart disease and stroke.and stroke.

Check out your profile…Check out your profile…

https://www.diabetes.org/diabetesphdhttps://www.diabetes.org/diabetesphd

Key Points ReviewKey Points Review► People with diabetes are at a very high People with diabetes are at a very high

risk for heart attack and stroke.risk for heart attack and stroke.► More than 2 out of 3 of people with More than 2 out of 3 of people with

diabetes die of heart disease or stroke.diabetes die of heart disease or stroke.► Diabetes is more than managing blood Diabetes is more than managing blood

glucose. It’s managing blood glucose glucose. It’s managing blood glucose andand blood pressure blood pressure andand cholesterol. cholesterol.

► Know the ABCs of Diabetes. Know the ABCs of Diabetes. AA1c, 1c, BBlood Pressure, lood Pressure, CCholesterolholesterol

► More treatments are available than ever More treatments are available than ever before. Talk to your healthcare provider before. Talk to your healthcare provider and learn what you can do to manage and learn what you can do to manage your ABCs.your ABCs.

General TipsGeneral Tips

Take steps to lower your risk of D-CVD complications:Take steps to lower your risk of D-CVD complications: A1C < 7.A1C < 7. Blood pressure < 130/80.Blood pressure < 130/80. Cholesterol (LDL) < 100. Cholesterol (LDL) < 100. Cholesterol (HDL) > 40 (men) and > 50 Cholesterol (HDL) > 40 (men) and > 50

(women).(women). Triglycerides < 150.Triglycerides < 150. Get help to quit smoking.Get help to quit smoking. Be active.Be active. Make healthy food choices.Make healthy food choices. Talk to your doctor about medication.Talk to your doctor about medication.

For More InformationFor More Information

Call:Call: 1-800-DIABETES 1-800-DIABETES

Visit:Visit: www.diabetes.org/MakeTheLink www.diabetes.org/MakeTheLink

Email:Email: MakeTheLink@diabetes.org MakeTheLink@diabetes.org

Contact me:Contact me:jeanne.m.jacoby@hitchcock.orgjeanne.m.jacoby@hitchcock.org