Understanding your blood pressure for diabetes

Myth “You know if you have high blood pressure because it gives you headaches”

Truth High blood pressure does not always give you symptoms, and it is often found by chance during routine health checkups. Having your blood pressure checked at your annual diabetes reviews, and more frequently if your health professional suggest it, will be a more reliable indicator of whether your blood pressure is high.

My doctor tested me for Type 2 diabetes because I am having treatment for high blood pressure. Why is that?

Type 2 diabetes and high blood pressure are both linked to insulin resistance, so if you have one of these conditions it is common to have the other, too. If you keep both your blood pressure and your blood glucose level under control, your chances of developing long-term complications, especially heart disease, are greatly reduced.

What is high blood pressure?

If your larger blood vessels become more rigid and your smaller blood vessels start to constrict, your blood has to flow through a narrower space than before. The result is greater pressure on your blood vessel walls, which is known as high blood pressure or, medically, as hypertension. Having high blood pressure is common when you have Type 2 diabetes.

I have high blood pressure but I don’t feel sick. Why does it need to be treated?

Having high blood pressure makes you much more prone to cardiovascular disease (CVD) – a serious condition that develops over many years as your blood vessels gradually become narrower and less flexible. You may have high blood pressure without knowing it and, if it remains untreated, you may develop angina (severe chest pain) or have a heart attack or a stroke. Taking your blood pressure treatment as prescribed and having regular checkups can help prevent these serious conditions.

What should my blood pressure be?

If you have Type 2 diabetes your blood pressure should be below 130/80 millimeters of mercury (mmHg). In some situations, for example if you have already developed kidney damage (nephropathy), you may need to keep your blood pressure lower, for example, 125/75 millimeters of mercury (mmHg) to prevent further damage. Discussing your ideal blood pressure level, and ways to achieve it, with your health professional will give you the level that is right for you.

Why are there two figures in my blood pressure measurement?

The top figure refers to the level of pressure in your blood vessels as your heart contracts and pumps blood around your body. This is known as the systolic blood pressure. The second figure is the lowest pressure as your heart relaxes between beats. This is known as the diastolic blood pressure.

What can I do to lower my blood pressure?

Stop smoking and lose weight if you need to, eating more fresh fruit and vegetables and less saturated fat and salt (for example, less processed or commercially prepared meals) to help reduce your blood pressure. Physical activity will also lower your blood pressure. Take any blood pressure pills that you have been prescribed, even if they do not affect the way you feel, to help keep your blood pressure in the recommended range.

How low can my blood pressure go?

It would be unusual for your blood pressure to be under 100/60 mmHg if you are otherwise healthy. For every 10 mmHg drop in your systolic blood pressure (the first figure) toward this level, you benefit by reducing your risk of heart attack or stroke.

Who is at risk for Alzheimer’s?

We’re all at risk now by virtue of the fact that we are part of an aging population. It’s clear that the biggest risk for Alzheimer’s disease is aging. That’s why we know so much about it now. In this century the population is aging more successfully than ever before.

Alzheimer’s wasn’t as prevalent because we weren’t living as long?

Yes. At the turn of the century the average age life expectancy for males in some European cities was only 40 or 50-years-old. Now it’s 20 or 30 years more than that. So we didn’t see the population coming into the age that put them at risk for developing the disease.

Talk about the vascular connection

The connection has been known for a long time, ever since Alzheimer described the disease. There’s a small protein called amyloid that gets deposited in the brains of those that suffer from Alzheimer’s disease. There’s always been a question of how it causes the disease and if it has any normal functions. We started to look into that problem several years ago. One of the things we found was that when amyloid comes anywhere near blood vessels, it causes them to constrict and stay constricted. That was a novel finding, and there are several implications. This might be part and parcel of the Alzheimer process, that there may be a tendency of the vessels in the brain to close down and stay closed down. Of course that would have implications for delivering oxygen and nutrients to the nerve cells in the brain.

So this connection happens years before the amyloid?

Yes. One of the interesting aspects of this is that in full-blown Alzheimer’s disease you have aggregations of amyloid that precipitate out. They come out of solution and form plaques in the brain. Our findings occur with much lower concentrations. So the implication is some of the affects that we’re looking at occur many years early on before the disease really becomes full-blown and recognized in the way that we see it clinically.

Would you be able to see the vessels closed on an MRI or something?

I wish we could, but it’s very difficult to do that in humans. We have done animal studies that show that. The animals that produce too much amyloid do close their vessels, and they stay closed. That gives them significant problems.

Is this the same as somebody who has cardiovascular disease? If they have cardiovascular problems, would they be at a higher risk for Alzheimer’s?

If you have a little bit of Alzheimer’s and you have a little bit of cerebral vascular disease or even cardiovascular disease, those things can combine in a way that makes them both work. You can see individuals that have a slight amount of Alzheimer’s disease pathology and normally wouldn’t have any symptoms. If they have cerebral vascular problems on top of that, then they start to display symptoms.

People might see that and say, “If I had a heart attack, then I might be an Alzheimer’s patient later on.” Is that true?

If you have a heart attack then you usually have some form of atherosclerosis or some form of vascular disease. Quite often it extends to elsewhere in the body. Yes, that does put you at risk for increasing the expression of Alzheimer’s disease. In other words, it does put you at risk for having Alzheimer’s symptoms before you normally would if you just had Alzheimer’s alone.

Now that you understand this connection, where do you go from here?

What we’ve been working on for the last couple of years is finding out exactly why the vessels close down. To start with, we thought that it was mediated by free radicals. These substances increase with age and are generally thought to be bad news in a number of conditions. However, what we actually found out is the vessels close down because they began an inflammatory response. It’s the same as when you first scratch yourself the skin blotch is white because there’s an immediate inflammatory response. In fact, the blood vessels in the brain are doing something very similar when they come into contact with amyloid.

How would you treat this?

If we block the actual molecular mechanisms, the chemicals that are switched on inside cells, we can stop the effect. We’ve already demonstrated that in the experimental situation. Now what we have to do is demonstrate that in the clinic. That’s the next step.

Could drugs used for cardiovascular disease be used?

Yes. One of the first drugs we’ve investigated that blocks this effect in the experimental situation has been used for other conditions. It’s never been used for Alzheimer’s disease, but it has been used for cardiovascular disease. It’s that kind of drug that we want to test in a clinical situation.

What are those drugs?

We don’t have the full FDA approval to say.

Do antioxidants help?

As far as the vessel discovery is concerned, antioxidants mop up free radicals, and free radicals seem to make the situation much worse. That was one of the first things we found. So we’re not pursuing that in the clinic.

Using the cardiovascular connection as an identifier, it could be years before we see Alzheimer’s. How do you treat current Alzheimer’s patients if it’s already beyond that?

One of the other groups of patients that we look at are people that don’t have Alzheimer’s disease but are before that stage. They are memory-impaired but don’t have full-blown Alzheimer’s disease. If we follow a group like that, then we know that a certain percentage, quite a high percentage convert to Alzheimer’s disease every year. They would be an ideal population for us to give this medication to. That would be a much better intervention than waiting until folks have full-blown disease. That group is a target population for us.

So people who already have it might not benefit from this?

It’s generally recognized that once you’ve had the disease for five or six years then there’s very little that medical intervention can do now. The real target populations are those folks that are in the very early stages of Alzheimer’s disease or who would develop Alzheimer’s disease in the next several years. Right now those are the groups that we are actively recruiting into our study.

How do you identify those people?

We have sophisticated memory screens that give evaluations. These evaluations look at every aspect of memory and distinguish those effects that are truly pathological from those that are simple forgetfulness, which we all suffer from in one form or another.

Will you identify whether or not the amyloid is present?

We can’t detect amyloid in the brain. There’s no known way for us to do that at this stage. What we have to do is identify individuals who have memory impairment but don’t have full-blown Alzheimer’s disease and recruit those into our studies knowing that the largest majority of those will in fact develop the disease over a four- or five-year-period.

If I know somebody in my family who has it, what are my chances of developing Alzheimer’s?

One’s risk for the disease is definitely increased if you have a family history. However, the reality of that statement is it’s such a prevalent disorder, if most of us look far enough into our family histories we’ll find a case of Alzheimer’s disease. That’s just another way of saying that as we get to be 80 or 90 we’re all at risk for the disease. However, if you have a strong family history in addition to age, your risk is increased still further.

Are men or women more at risk?

Men and women are equally at risk for the disease. Men tend to die from other things before they get Alzheimer’s disease. So there’s an imbalance in the absolute numbers in the population. If you just take 100 women and 100 men, they’re equally at risk for the disease as they age.

News Source: Ivanhoe Newswire – 1999

Physical Activities for Diabetes

Myth “You have to spend a lot of time being active to get any benefit”

Truth The recommended amount of activity is 30 minutes five times a week. But you don’t’ necessarily have to dedicate specific times to this – you can feel the benefits just by being more active in your day-to-day life. Everyday things such as climbing stairs, going shopping, gardening, and housework all count as activity.

Will I still need to take my diabetes medication if I become more active?

Yes, but you may need a lower dose to achieve the same effect. If you are on insulin-stimulating pills, you may be more at risk of a hypoglycemic attack when you become more active, so you may need a reduction in the dose of your pills or a change to a different type of pill. Also, if you are more active, you may find that you lose weight. If you lose more than a few pounds you are likely to need a lower dose of pills or insulin.

I’ve been told I have impaired glucose tolerance. Will being more physically active help me?

Yes, people who have impaired glucose tolerance are more likely to go on to develop Type 2 diabetes. Becoming more active, especially if you also lose weight, will help your natural insulin work as effectively as possible to regulate your blood glucose level. You will always be at risk of developing diabetes, but the more active you are, the longer it may take to develop.

How does being more active help prevent the long-term complications of diabetes?

Regular physical activity helps the insulin you have produced or injected work more efficiently, which in turn contributes toward keeping your blood glucose and your blood pressure in the recommended ranges. These two benefits make the long-term complications of diabetes less likely.

How will being active help my heart?

Regular activity helps lower your blood pressure and your blood cholesterol levels, and consequently, you have less chance of having a heart attack or a stroke. It also makes your heart stronger and more efficient so that it can pump more blood with every heartbeat, and it reduces your risk of having a heart attack from clots forming in your coronary arteries. The more active you are, the less likely you are to have a heart attack, and the greater your chance of surviving a heart attack if you have one.

I’m prone to depression. Will being active help me?

Yes, activity raises your levels of endorphins and serotonin. These brain chemicals influence your mood and sense of well-being and have a strong antidepressant effect. Some types of activity, for example, playing golf or tennis, also entail spending time with other people, and this can help lift your spirits, too.

I don’t’ take pills or insulin yet. Will staying active allow me to continue without medication?

Because of the progressive nature of diabetes, you will probably need pills or insulin eventually, but with an active lifestyle, you may delay the need for medication because regular activity reduces your insulin resistance. Activity can help at any stage. If you already take tablets, increasing your activity levels may help delay the need to start injecting insulin and reduce the dose you need.

Long-term Complications of Diabetes

I’ve just been diagnosed with Type 2 diabetes. What sort of health problems might I develop in the long term?

You are at increased risk of two main sets of complications: those affecting your heart and circulation (macrovascular problems) and those affecting your eyes, feet, kidneys, and nerves (microvascular problems). Although serious, these problems are not inevitable. You can do a lot to reduce the risk of developing them by leading a healthy lifestyle and working with your health professionals to make sure that you have routine medical checks when you need them.

How long after diagnosis do the complications of Type 2 diabetes usually occur?

Complications take at least 5-10 years to develop but this can be misleading because you can have signs of them when you are first diagnosed. This is because you may have been developing Type 2 diabetes for years before your diagnosis. Once you know you have diabetes, you can show the rate at which complications progress, or increase the time before they develop.

What heart problems might I experience?

Type 2 diabetes is strongly linked to high blood pressure and high blood cholesterol. These two factors increase your risk of cardiovascular disease (CVD) and heart attack.

Why is diabetes linked with kidney problems?

High blood glucose levels over a period of years can damage the delicate filtering system in your kidneys. If left untreated, this damage can eventually progress so that your kidneys no longer function efficiently. Urine tests will be done once or twice a year to look for any early signs of damage.

Is it true that diabetes can affect my eyesight?

When you are first diagnosed with diabetes, you may have blurred vision. This is linked to high blood glucose levels and is usually temporary. Once your blood glucose levels reduce, your eyesight will return to normal. In the longer term, one of the complications of diabetes is retinopathy – damage to the small blood vessels at the back of your eye. Retinopathy can be successfully treated if diagnosed at an early stage, but if it is left untreated, your eyesight will be affected. Having your eyes checked at least once a year will reveal whether you have retinopathy.

Why are people with diabetes prone to foot problems?

Over a long period of time, high blood glucose levels can cause poor circulation and nerve damage, resulting in reduced sensation in your feet. This makes you more prone to problems such as ulcers on your feet or legs, or damage to the bones of your feet.

How will having diabetes affect my sex life?

If you are a man, over time you may find it more difficult to get an erection because of damage to your nerves or circulation. There are a variety of treatments for erectile dysfunction.

What can I do to prevent myself from getting the long-term complications of diabetes?

Controlling your blood glucose level and blood pressure as well as possible reduces your risk of complications. Eating healthily, being physically active, losing weight if you need to, stopping smoking, and taking prescribed pills or insulin all help. Other important measures include an annual checkup and keeping your knowledge of diabetes up to date. To minimize foot problems, check your feet daily, and seek help if you notice any injuries or abnormalities.

Type 2 diabetes and heart disease

What is the link between Type 2 diabetes and heart disease?

Type 2 diabetes is more than simply a raised blood glucose level. You are also likely to develop various problems related to your heart and blood vessels – for example, high blood pressure and high cholesterol levels. Although the link between high blood pressure and diabetes is not yet fully understood, it is thought that it may result from high levels of insulin circulation in your blood as a result of insulin resistance (which is usual in Type 2 diabetes). As a result, your blood vessels become scarred and hard plaques form – this causes narrowing of your blood vessels, which makes it more difficult for your blood to flow. The risk of blockages in your blood vessels also increases; these can cause angina (severe chest pain) or a heart attack.

What is cardiovascular disease?

“Cardio” means heart and “vascular” means blood vessels. If you have Type 2 diabetes, you are prone to a range of cardiovascular problems including high blood pressure, hyperlipidemia (a high level of fat in your blood), angina (severe chest pain), heart attack, stroke, peripheral vascular disease (pain in yoru legs when walking or resting due to reduced circulation), and heat failure. You are also two to four times more likely to develop cardiovascular disease (CVD) than someone without diabetes. CVD is one of the major problems associated with Type 2 diabetes.

How would I know if I have CVD?

CVD does not necessarily cause any symptoms and may only become apparent when you have a heart attack or a stroke. But it is possible for your health professional to look for signs of CVD, such as high blood pressure and high levels of cholesterol in your blood. If tests are positive, you can have treatment for these conditions even though they do not make you feel ill. This is why you need to have your blood pressure and blood cholesterol levels checked regularly.

Can I take drugs to prevent CVD?

Taking regular low doses of aspirin (or other blood-thinning tablets if you can’t take aspirin) can help reduce your risk. You may also be prescribed pills to reduce your cholesterol level if you need them. Even if you need pills, eating healthily and becoming or staying active will play an important role in lowering your risk of CVD.

What exactly are “raised blood lipids”?

When you have Type 2 diabetes, your levels of cholesterol and triglycerides – two types of lipids (fats) in the blood – are likely to be raised, a condition known as hyperlipidemia. Both of these fats are essential in small amounts, but when their levels are raised they can damage your arteries. There are two types of cholesterol in your blood: high-density lipoprotein (HDL) and low-density lipoprotein (LDL). In a healthy person, the proportion of HDL to LDL is higher than it is in a person with Type 2 diabetes. Elevated levels of lipids in the blood are treated in order to lower your blood fats and to correct the ratio of HDL to LDL. This in turn prevents your arteries from narrowing.

How can losing weight prevent CVD?

If you are overweight, losing even a few pounds is one of the most important things you can do if you have Type 2 diabetes. Losing weight and becoming more active will help to lower your blood cholesterol levels and blood pressure. Your body will also become more responsive to the insulin you produce, and your heart will be under less strain.

Will physical activity help me prevent CVD?

Yes, just 30 minutes of moderate activity five times a week will help you control your blood pressure and reduce your cholesterol level, which in turn reduces your risk of CVD. Physical activity helps you lose weight because you not only burn more calories while you are active but you also speed up your metabolic rate so that your body uses up more calories even when you are less active.

How important is it to stop smoking now I have Type 2 diabetes?

Very important; if you smoke, you have a far higher risk of CVD, heart attack, and stroke. Having Type 2 diabetes further increases the risk. Going to smoking cessation clinics and using nicotine replacement therapy such as patches or chewing gum can help you give up.

My Type 2 diabetes was diagnosed after a heart attack. How can I prevent another?

Taking any medication you have been prescribed to reduce your blood pressure and cholesterol level, increase your blood flow, and control your blood glucose level will make a big difference. Relaxation therapy and attending your cardiac rehabilitation meetings will help to reduce your risk. Stopping smoking and being active – for example, walking every day – are also important.

Omega-3 Fatty Acid Supplements

A new study shows daily supplements of the fatty acid found in fish oil may reduce the risk of sudden death in patients who have recently suffered a heart attack.

Patients who took omega-3 fatty acid supplements had a 42 percent reduction in sudden cardiac deaths three months after suffering a heart attack. The risk of sudden death is highest in the first months after a heart attack, which is caused most often by irregular heartbeats, called arrhythmias.

Researchers in Italy believe fatty acids play an important role in regulating the electrical activity of heart muscle cells, stabilizing them so they are resistant to arrhythmias. They analyzed data from more than 11,000 patients who suffered a recent heart attack. After three months, patients who took the fish oil supplements had significantly lower mortality rates than those who received standard medical treatment. They also fared better than those who received lifestyle counseling, vitamin E, or a placebo.

Study authors say further research is needed to confirm the results of using fish oil supplements alone. However, the American Heart Association already recommends that all individuals consume two servings of fish twice a week to promote heart health.

SOURCE: Circulation