Showing posts with label Diabetes. Show all posts

May 10, 2025

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Jan 9, 2012

Diabetes Animation...Maintaining Blood Glucose Homeostasis.....

Dec 23, 2011

Glucose Testing....

Glucose

Also known as: Blood sugar; Fasting blood sugar; FBS; Fasting blood glucose; FBG; Fasting plasma glucose; FPG; Blood glucose; Oral Glucose Tolerance Test; OGTT; GTT; Urine glucose

Formal name: Blood Glucose; Urine Glucose

Related tests: Urinalysis; Insulin; C-Peptide; A1c; Microalbumin; CMP; BMP

At a Glance

Why Get Tested?

To determine if your blood glucose level is within a healthy range; to screen for, diagnose, and monitor high blood glucose () or low blood glucose (), diabetes, and pre-diabetes; to check for glucose in your urine

When to Get Tested?

Blood glucose: as part of a regular physical, when you have symptoms suggesting hyperglycemia or hypoglycemia, and during pregnancy; if you are diabetic, self-checks up to several times a day to monitor blood glucose levels
Urine glucose: usually as part of a urinalysis

Sample Required?

A blood sample drawn from a vein in your arm or a drop of blood from a skin prick; sometimes a is used. Some diabetic patients may use a continuous glucose monitor, which is a small sensor wire inserted beneath the skin of the abdomen that measures blood glucose every five minutes.

Test Preparation Needed?

In general, it is recommended that you fast - nothing to eat or drink except water - 8 hours before having a blood glucose test. In persons with diabetes, glucose levels are often checked both while fasting and after meals to provide the best control of diabetes. For random, timed, and post-meal glucose tests, follow your doctor's instructions.

The Test Sample

What is being tested?

This test measures the amount of glucose in the blood or urine. Glucose is the primary energy source for the body’s cells and the only energy source for the brain and nervous system. A steady supply must be available for use, and a relatively constant level of glucose must be maintained in the blood.
During digestion, fruits, vegetables, breads and other carbohydrates are broken down into glucose (and other nutrients); they are absorbed by the small intestine and circulated throughout the body. Using glucose for energy production depends on insulin, a produced by the pancreas. Insulin facilitates transport of glucose into the body's cells and directs the liver to store excess energy as for short-term storage and/or as triglycerides in adipose (fat) cells.
Normally, blood glucose rises slightly after a meal and insulin is released by the pancreas into the blood in response, with the amount corresponding to the size and content of the meal. As glucose moves into the cells and is metabolized, the level in the blood drops and the pancreas responds by slowing, then stopping the release of insulin.
If the blood glucose level drops too low, such as might occur in between meals or after a strenuous workout, glucagon (another pancreatic hormone) is secreted to induce the liver to turn some glycogen back into glucose, raising the blood glucose level. If the glucose/insulin is working properly, the amount of glucose in the blood remains fairly stable. If the balance is disrupted and the glucose level in the blood rises, then the body tries to restore the balance, both by increasing insulin production and by eliminating excess glucose in the urine.

There are a few different conditions that may disrupt the balance between glucose and the pancreatic hormones, resulting in high or low blood glucose. The most common cause is diabetes. Diabetes is a group of disorders associated with insufficient insulin production and/or a resistance to insulin. People with untreated diabetes are not able to process and use glucose normally. Those who are not able to produce enough insulin to process glucose are diagnosed as having type1 diabetes while people who are resistant to insulin have type 2. Either type of diabetic may have and/or increased blood glucose levels.
Severe, acute high blood glucose () or low blood glucose () can be life-threatening, causing organ failure, brain damage, coma, and, in extreme cases, death. Chronically high blood glucose levels can cause progressive damage to body organs such as the kidneys, eyes, heart and blood vessels, and nerves. Chronic hypoglycemia can lead to brain and nerve damage.
Some women may develop hyperglycemia during pregnancy, which is termed gestational diabetes. If untreated, this can cause these mothers to give birth to large babies who may have low glucose levels. Women who have had gestational diabetes may or may not go on to develop diabetes.

How is the sample collected for testing?

A blood sample is obtained by inserting a needle into a vein in the arm or a drop of blood is taken by pricking the skin, typically on a finger, with a small, pointed lancet (fingerstick). Sometimes, a is collected. Some diabetics may use a continuous glucose monitor, which is a small sensor wire inserted beneath the skin of the abdomen and held in place with an adhesive patch. The sensor measures blood glucose levels every five minutes and sends the results to a device that is attached to the person's clothing. A digital readout on the device lets the person know the blood glucose level in real time.

Is any test preparation needed to ensure the quality of the sample?

For screening purposes, fasting is generally recommended - nothing to eat or drink except water - at least 8 hours before a blood glucose test. Those who have been diagnosed with diabetes and are monitoring glucose levels are often tested both while fasting and after meals. For random and timed tests, follow the doctor's instructions. A glucose tolerance test requires that you fast for the first blood sample and then drink a liquid containing a specified amount of glucose. Subsequent blood samples are drawn at specified times.

The Test

How is it used?

The blood glucose test may be used to:

Screen for both high blood glucose (hyperglycemia) and low blood glucose (hypoglycemia)
Help diagnose diabetes
Monitor glucose levels in persons with diabetes

Depending on the purpose of testing, glucose may be measured on a fasting basis (collected after an 8- to 10-hour fast), randomly (anytime), post prandial (after a meal), and/or as part of an oral glucose challenge or tolerance test (OGTT / GTT).
Screening
Blood glucose is often measured as part of a group of tests, such as a CMP (Comprehensive Metabolic Panel), during routine physicals. This is done to screen for diabetes, which often causes no symptoms early in its course, and for pre-diabetes – moderately increased blood glucose levels that indicate an increased risk of developing type 2 diabetes. For screening purposes, a CMP or blood glucose test is performed on a fasting basis (fasting blood glucose, FBG).
Many pregnant women are screened for gestational diabetes, a temporary form of hyperglycemia, between their 24th and 28th week of pregnancy using a version of the OGTT, a 1-hour glucose challenge (GCT). For this test, a woman is given a standard amount of a glucose solution to drink. After one hour, her glucose level is measured and if the level is higher than a defined value, then a longer OGTT (usually 2 or 3 hours) is performed to clarify the woman's status. This is the recommendation of the American Congress of Obstetricians and Gynecologists.
In 2011, the American Diabetes Association adopted guidelines that recommend changes in the way women are tested for gestational diabetes. Instead of the GCT described above, a 2-hour OGTT, using a 75-gram glucose drink, is performed. If one or more of her glucose levels at fasting, 1 hour, or 2 hours are above a certain level, then she is diagnosed as having gestational diabetes.
The ADA’s new recommendations follow those proposed in 2010 by the International Association of Diabetes and Pregnancy Study Group (IADPSG). This group based their recommendations on results of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) trial. This large study found that risk to babies increases with the gradual increase of maternal glucose levels; it determined that there is an increased risk of adverse outcomes for a baby even when only one of the mother’s glucose levels is below the cutpoints used to diagnose gestational diabetes, and slightly lowered some of the cutpoints from those used in older guidelines. (For more on this, read the article Panel Suggests New Criteria for Gestational Diabetes.)
Diagnosis
The American Diabetes Association recommends a fasting glucose or a different test, the hemoglobin A1c (A1c), to diagnose diabetes but says that testing should be done twice, at different times, preferably with the same test in order to confirm a diagnosis of diabetes. Another way to diagnose diabetes, especially if the screening test is not diagnostic, is the OGTT test. This test is a series of blood glucose tests. A fasting glucose is collected; then the person being tested drinks a standard amount of a glucose solution to "challenge" their system. This is followed by one or more additional glucose tests performed at specific intervals to track glucose levels over time.
In those with suspected hypoglycemia in which an initial FBG result is low, the glucose test is used as part of the "Whipple triad" to confirm a diagnosis. (See Common Questions #5).
Monitoring
Diabetics must monitor their own blood glucose levels, often several times a day, to determine how far above or below normal their glucose is and to determine what oral medications or insulin(s) they may need. This is usually done by placing a drop of blood from a skin prick onto a glucose strip and then inserting the strip into a glucose meter, a small machine that provides a digital readout of the blood glucose level.
Urine
Urine glucose is one of the substances tested when a urinalysis is performed. A urinalysis may be done routinely as part of a physical or prenatal checkup, when a doctor suspects that a person may have a urinary tract infection or for a variety of other reasons. The doctor may follow up an elevated urine glucose test with blood glucose testing.

When is it ordered?

Blood glucose testing can be used to screen healthy, individuals for diabetes and pre-diabetes because diabetes is a common disease that begins with few symptoms. Screening with a glucose test may occur during public health fairs or as part of workplace health programs. It may also be ordered when someone has a routine physical exam. Screening is especially important for people at high risk of developing diabetes, such as those with a family history of diabetes, those who are overweight, and those who are more than 40 to 45 years old.
The glucose test may also be ordered to help diagnose diabetes when someone has symptoms of high blood glucose (), such as:

Increased thirst, usually with frequent urination
Fatigue
Blurred vision
Slow-healing infections

or symptoms of low blood glucose (), such as:

Sweating
Hunger
Trembling
Anxiety
Confusion
Blurred Vision

Blood glucose testing is also done in emergency settings to determine if low or high glucose is contributing to symptoms such as fainting and unconsciousness.
Pre-diabetes is characterized by fasting or OGTT levels that are higher than normal but lower than those defined as diabetic. The doctor may order a glucose test at regular intervals to monitor the person's status.
With known diabetics, doctors will order glucose levels periodically in conjunction with other tests such as A1c to monitor glucose control over time. Occasionally, a blood glucose level may be ordered along with insulin and C-peptide to evaluate insulin production.
Diabetics are often required to self-check their glucose, up to several times a day, to monitor glucose levels and to determine treatment options as prescribed by their doctor.
Pregnant women are usually screened for gestational diabetes late in their pregnancies, unless they have early symptoms or have had gestational diabetes with a previous pregnancy. When a woman has gestational diabetes, her doctor will usually order glucose levels throughout the rest of her pregnancy and after delivery to monitor her condition.

What does the test result mean?

Blood Glucose
High levels of glucose most frequently indicate diabetes, but many other diseases and conditions can also cause an elevated blood glucose. The following information summarizes the meaning of the test results. These are based on the clinical practice recommendations of the American Diabetes Association.

Fasting Blood Glucose

Glucose Level	Indication
From 70 to 99 mg/dL (3.9 to 5.5 mmol/L)	Normal fasting glucose
From 100 to 125 mg/dL (5.6 to 6.9 mmol/L)	Impaired fasting glucose (pre-diabetes)
126 mg/dL (7.0 mmol/L) and above on more than one testing occasion	Diabetes

Oral Glucose Tolerance Test (OGTT)

Levels applicable except during pregnancy. Sample drawn 2 hours after a 75-gram glucose drink.
Glucose Level	Indication
Less than 140 mg/dL (7.8 mmol/L)	Normal glucose tolerance
From 140 to 200 mg/dL (7.8 to 11.1 mmol/L)	Impaired glucose tolerance (pre-diabetes)
Over 200 mg/dL (11.1 mmol/L) on more than one testing occasion	Diabetes

Gestational Diabetes Screening: Glucose Challenge Test (as currently recommended by the American Congress of Obstetricians and Gynecologists)

Sample drawn 1 hour after a 50-gram glucose drink.
Glucose Level	Indication
Less than 140* mg/dL (7.8 mmol/L)	Normal screen
140* mg/dL (7.8 mmol/L) and over	Abnormal, needs OGTT (see below)
* Some use a cutoff of 130 mg/dL (7.2 mmol/L) because that identifies 90% of women with gestational diabetes, compared to 80% identified using the threshold of 140 mg/dL (7.8 mmol/L).

Gestational Diabetes Diagnostic: OGTT

In 2011, the American Diabetes Association adopted new guidelines that recommend a 2-hour glucose tolerance test rather than a 3-hour OGTT as still recommended by the American Congress of Obstetricians and Gynecologists. Details from both are included below.
Time of Sample Collection	Current ACOG Target LEVEL	ADA Target Level
	Glucose load: Samples drawn after 100-gram glucose drink	Glucose load: Samples drawn after 75-gram glucose drink
Fasting (prior to glucose load)	95 mg/dL (5.3 mmol/L)	92 mg/dL (5.1 mmol/L)
1 hour after glucose load	180 mg/dL (10.0 mmol/L)	180 mg/dL (10.0 mmol/L)
2 hours after glucose load	155 mg/dL (8.6 mmol/L)	153 mg/dL (8.5 mmol/L)
3 hours after glucose load	140 mg/dL (7.8 mmol/L)	Not applicable
Results interpretation	If TWO or more values meet or exceed the target level, gestational diabetes is diagnosed.	If ONE or more values meet or exceed the target level, gestational diabetes is diagnosed.

Moderately increased blood glucose levels may be seen in those with pre-diabetes. Left un-addressed, pre-diabetes increases the risk of developing type 2 diabetes.
Some other diseases and conditions that can result in an elevated blood glucose level include:

Acromegaly
Acute stress (response to trauma, heart attack, and stroke for instance)
Chronic kidney failure
Cushing syndrome
Excessive food intake
Hyperthyroidism
Pancreatic cancer
Pancreatitis

A low level of glucose may indicate hypoglycemia, a condition characterized by a drop in blood glucose to a level where first it causes nervous system symptoms (sweating, palpitations, hunger, trembling, and anxiety), then begins to affect the brain (causing confusion, hallucinations, blurred vision, and sometimes even coma and death). A diagnosis of hypoglycemia uses three criteria known as the Whipple triad. (See the common questions section.).
A low blood glucose level (hypoglycemia) may be seen with:

Adrenal insufficiency
Drinking excessive alcohol
Severe liver disease
Hypopituitarism
Hypothyroidism
Insulin overdose
Insulinomas
Starvation

Urine Glucose
Low to undetectable urine glucose results are considered normal. Any condition that raises blood glucose such as diabetes or the other conditions listed above also has the potential to elevate the concentration of glucose in the urine.
Increased urine glucose may be seen with medications, such as estrogens and chloral hydrate, and with some forms of kidney disease.

Is there anything else I should know?

Extreme stress can cause a temporary rise in blood glucose. This can be a result of trauma, surgery, heart attack or stroke, for example.
Drugs, including corticosteroids, tricyclic antidepressants, , epinephrine, estrogens (birth control pills and hormone replacement), lithium, phenytoin, and salicylates, can increase glucose levels, while drugs such as acetaminophen and anabolic steroids can decrease levels.

Common Questions

1. Can I test myself at home for blood glucose levels?

If you are not diabetic or pre-diabetic, there is usually no reason to test glucose levels at home. Screening done as part of your regular physical should be sufficient.

If you have been diagnosed with diabetes, however, your doctor or diabetes educator will recommend a home glucose monitor (glucometer, or one of the newer methods that use very tiny amounts of blood or tests the interstitial fluid -- the fluid between your cells -- for glucose). You will be given guidelines for how high or low your blood sugar should be at different times of the day. By checking your glucose regularly, you can see if the diet and medication schedule you are following is working properly for you.

2. Can I test my urine glucose instead of my blood?

Not in most cases. Glucose will usually only show up in the urine if it is at sufficiently high levels in the blood so that the body is "dumping" the excess into the urine, or if there is some degree of kidney damage and the glucose is leaking out into the urine. Urine glucose, however, is sometimes used as a rough indicator of high glucose levels and the urine indicator strip (dipstick) that measures the glucose is occasionally useful for tracking the presence of protein and in the urine.

3. What are the usual treatments for diabetes?

For type 2 diabetes, which is the most common type of diabetes, losing excess weight, eating a healthy diet that is high in fiber and restricted in carbohydrates, and getting regular amounts of exercise may be enough to lower your blood glucose levels. In many cases, however, oral medications that increase the body's secretion of and sensitivity to insulin are necessary to achieve the desired glucose level. With type 1 diabetes (and with type 2 diabetes that does not respond well enough to oral medications), insulin injections several times a day are necessary.

4. How can a diabetic educator help me?

If you are diabetic, a diabetic educator (often a nurse with specialized training) can make sure that you know how to:

Recognize and know how to treat both high and low blood sugar.
Test and record your self-check glucose values.
Adjust your medications.
Administer insulin (which types in which combinations to meet your needs).
Handle medications when you get ill.
Monitor your feet, skin, and eyes to catch problems early.
Buy diabetic supplies and store them properly.
Plan meals. Diet is extremely important in minimizing swings in blood glucose levels. A registered dietician can help you learn how to plan meals and a diabetic educator can help with this as well.

5. How is hypoglycemia diagnosed?

An actual diagnosis of hypoglycemia requires satisfying the "Whipple triad." These three criteria include:

• Documented low glucose levels (less than 40 mg/dL (2.2 mmol/L), often tested along with insulin levels and sometimes with C-peptide levels)

• Symptoms of hypoglycemia when the blood glucose level is abnormally low

• Reversal of the symptoms when blood glucose levels are returned to normal

Primary hypoglycemia is rare and often diagnosed in infancy. People may have symptoms of hypoglycemia without really having low blood sugar. In such cases, dietary changes such as eating frequent small meals and several snacks a day and choosing complex carbohydrates over simple sugars may be enough to ease symptoms

6. How is glucose different from table sugar?

Table sugar (sucrose) is a combination of two simple sugars, glucose and fructose, that are both released when table sugar is digested. Because glucose is the body's primary energy source, the blood glucose test is often informally referred to as a "blood sugar" test.

Article Sources

(Revised 2011 February). Know your Blood Sugar Numbers. National Diabetes Education Program [On-line information]. PDF available for download at http://ndep.nih.gov/media/knownumbers_eng.pdf through http://ndep.nih.gov. Accessed May 2011.
Olatunbosun, S. (Updated 2011 April 19). Glucose Intolerance. Medscape Reference [On-line information]. Available online at http://emedicine.medscape.com/article/119020-overview through http://emedicine.medscape.com. Accessed May 2011.
Dugdale, D. (Updated 2010 May 23). Glucose test – blood. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003482.htm. Accessed May 2011.

Sep 11, 2011

Diabetes and Diet and Excercise

A healthy diet, not a "diabetes diet"

Diets for people with diabetes, weight, heart disease or other health problems are all very similar. That is because a healthy diet is the same for almost everyone. That means:

Eat less fat and less sugar
Eat smaller portions of meats and dairy products
Eat more vegetables, fruits and whole-grain or unprocessed starches

It is true you will have to reduce sweets because they usually have high fat and high sugar. Cake, cookies and ice cream can all be part of your diet if you control the size of your servings.

Plan healthy meals

It is important to plan so you are balancing the different foods you need each day. Every meal should include something from each of the basic food groups:

Vegetables and starches (carbohydrates)
Low-fat meats, dairy products or certain types of beans (proteins)
Margarine, oils or fats present in the foods you eat or prepare

Here is an easy way to think of what a balanced meal might look like on your plate: three-quarters of the plate surface should be covered with vegetables, fruit or grains. The other quarter should have meat or dairy products.

Done correctly, good meal planning can reduce the need for insulin or other medicines. The best way to find a way that will work for you and your family is to talk to a dietician. Either your doctor or Priority Health can suggest a dietitian available to help in your local area.

Watch portions

For example, a healthy portion of protein - chicken breast, or steak, or a hamburger - is 3 oz., which is about the size of a pack of cards. Some people weigh their food to make sure they are eating the right amounts. There are other ways that your doctor or a dietitian can show you.

Eating smaller meals more often during the day is a good way to keep your blood sugar at the best levels for you.

Eat about the same amount of sugars and starches at each of your meals and snacks to keep your blood sugar consistent.
Don't skip meals so you can avoid having blood sugar levels from going up and down like a yo-yo.

Avoid fried foods.
Eat smaller servings of foods with cheese or creamy sauces.
Choose low-fat offerings.
Restaurants serve very large portions. Split your entrees with others or ask for half-orders. Ask for a doggie bag before you eat and put half your plateful into it to limit the food in front of you.
Choose broiled, grilled or baked meat or fish. These cooking methods reduce fat and usually do not have fats added.
Ask for steamed vegetables and ask your waiter or host not to put any other butter or sauces on them

Exercising is essential when you have diabetes, pass this information on to your clients....

Whether you have Type 1 or Type 2 diabetes, exercise can help you live a longer and better life.

Exercise can help to strengthen your heart, control your weight, and increase how much you enjoy life. If you have Type 2 diabetes, exercise could eliminate your need to take insulin or other drugs.

If you haven't been exercising up until now, you have plenty of good reasons to start. And if you have been exercising, congratulations.

Set goals

Start without goals and it is too easy to stop. Most people start a fitness program for personal reasons. Some common reasons are:

"My clothes are a little tight around the waist."
"It's getting a little harder to keep up with the kids or grandkids."
"I miss going out with my friends."

Take out a sheet of paper and at the top, write, "Why Exercise?" Then start writing why you think exercise would help you. Those reasons become your goals.

No excuses

You are not alone in thinking you have good reasons not to get started. But those are probably just excuses. The American Diabetes Association dedicates an entire page on their website (www.diabetes.org) just to the excuses people have for not getting exercising. Here are a few we hear all the time:

"I don't have time."
You can get positive benefits just by starting with a few minutes a day. Work up to 30 min. a day.
"I'm too tired."
Try walking at lunchtime, in the morning or whenever you're rested and ready.
"It hurts."
If exercise leaves you with sore muscles, go easy at first. Build up over time and there is no reason to be sore or uncomfortable. If your knees or joints hurt when you walk, consider pain-free alternatives like swimming or lifting light weights.
"I can't afford a gym."
The sidewalk in front of your house is free. The bike in your garage can be dusted off. Some people do more housework for exercise.
"It's boring."
It's a simple truth: if you don't enjoy it, you won't do it. So bring a friend along. Read a magazine on a treadmill. Walk in a mall and window-shop along the way. Ride your bike in a new direction. If one exercise is getting boring, add others.

Get professional advice

Talk with your doctor. Everybody can add or enjoy some form of exercise, but diabetics have good reason to make certain they choose an activity that fits their current health.

If you have experienced numbness in your feet, you should not do an impact sport like running or step aerobics without your doctor's approval.
If your eyes have been impacted by diabetes, you probably should not be doing an activity that either causes impact or raises your blood pressure (like weight lifting).
For people who are already active in sports, there are a lot of sources of online information dedicated to athletes with diabetes. For example, a group called the Diabetes Exercise and Sports Association has information and many links to help anybody from weekend warriors to professional sportspeople continue enjoying their fitness routines and activities.

Get geared up

Don't start by investing a lot of money in equipment. Start with a good pair of shoes and absorbent, seamless socks, some comfortable clothes and you're ready. Get a medical ID bracelet in case you are exercising and experience any difficulties.

Plan your blood tests

Until you know for certain how an exercise is going to affect you, test your blood glucose levels before and after an activity. Your doctor can provide good advice on what to look for and what any changes mean.

Get moving!

Write a plan, be realistic
Just the act of writing what you intend to do and patting yourself on the back when you do it is a big boost to building fitness. Write down what you will do on a calendar and watch how it all adds up.
Don't rush it
Improving fitness takes time. It takes time during your day and it takes days or even weeks to reach your goals. If you push too hard, you'll feel uncomfortable. Take your time, enjoy the trip and you will enjoy the goal when you reach it.
Make it a team sport
To have a plan and stick to it is a lot easier if you have the encouragement and support of friends and family members. Invite someone to join you.
Everything counts
When all is said and done, fitness is what you get for moving a little more than you did the day before. Every move you make during your day adds to your fitness. If it's raining outside, get out your vacuum cleaner. If your day is going to be too busy, park at the far end of the parking lot and walk a little further.

-source page here....

Diabetes, Heart Disease, and Stroke....

Diabetes and heart health

Diabetes raises the chances of developing heart problems... eating well and getting or staying active. Even if you have had a heart attack already, you can do a lot more than just take medicines your doctor prescribes.

What causes heart disease?

Atherosclerosis is when, over time, fat deposits from cholesterol build up on the walls of your arteries. As the fat builds up, less blood is flows through. If the blood to your heart is blocked enough, you have a heart attack. If these fat deposits break loose, the result is a stroke. This is why doctors focus on reducing cholesterol.
Diabetes is also more likely to cause heart problems due to damage from high glucose levels and high blood pressure.

Managing A1c levels

A1c is a measure of your blood sugar control over a period of time....daily testing for glucose levels will help manage how well you feel. Regular A1c tests help you know what steps you have to take to keep your blood sugar under control to protect your heart.

Managing blood pressure

High blood pressure can cause heart and kidney disease. Some people can reduce it with changes in diet or physical activity. Others require medicines. Your doctor or doctors will help you make the best decision for your specific situation.

Managing cholesterol

This chart shows you what most doctors agree are good measures of the scores you get.

Normal	less than 150 mg/dL
Borderline High	150-199 mg/dL
High	200-499 mg/dL
Very High	500 mg/dL

What are the risk factors for heart disease and stroke in people with diabetes?

Diabetes itself is a risk factor for heart disease and stroke. Also, many people with diabetes have other conditions that increase their chance of developing heart disease and stroke. These conditions are called risk factors. One risk factor for heart disease and stroke is having a family history of heart disease. If one or more members of your family had a heart attack at an early age (before age 55 for men or 65 for women), you may be at increased risk.
You can't change whether heart disease runs in your family, but you can take steps to control the other risk factors for heart disease listed here:

Having central obesity. Central obesity means carrying extra weight around the waist, as opposed to the hips. A waist measurement of more than 40 inches for men and more than 35 inches for women means you have central obesity. Your risk of heart disease is higher because abdominal fat can increase the production of LDL (bad) cholesterol, the type of blood fat that can be deposited on the inside of blood vessel walls.

Having abnormal blood fat (cholesterol) levels.
- LDL cholesterol can build up inside your blood vessels, leading to narrowing and hardening of your arteries-the blood vessels that carry blood from the heart to the rest of the body. Arteries can then become blocked. Therefore, high levels of LDL cholesterol raise your risk of getting heart disease.

- Triglycerides are another type of blood fat that can raise your risk of heart disease when the levels are high.

- HDL (good) cholesterol removes deposits from inside your blood vessels and takes them to the liver for removal. Low levels of HDL cholesterol increase your risk for heart disease.

Having high blood pressure. If you have high blood pressure, also called hypertension, your heart must work harder to pump blood. High blood pressure can strain the heart, damage blood vessels, and increase your risk of heart attack, stroke, eye problems, and kidney problems.

Smoking. Smoking doubles your risk of getting heart disease. Stopping smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels. Smoking also increases the risk of other long-term complications, such as eye problems. In addition, smoking can damage the blood vessels in your legs and increase the risk of amputation.

What is metabolic syndrome and how is it linked to heart disease?

Metabolic syndrome is a grouping of traits and medical conditions that puts people at risk for both heart disease and type 2 diabetes. It is defined by the National Cholesterol Education Program as having any three of the following five traits and medical conditions:

Traits and Medical Conditions	Definition
Elevated waist circumference	Waist measurement of 40 inches or more in men 35 inches or more in women
Elevated levels of triglycerides	150 mg/dL or higher or Taking medication for elevated triglyceride levels
Low levels of HDL (good) cholesterol	Below 40 mg/dL in men Below 50 mg/dL in women or Taking medication for low HDL cholesterol levels
Elevated blood pressure levels	130 mm Hg or higher for systolic blood pressure or 85 mm Hg or higher for diastolic blood pressure or Taking medication for elevated blood pressure levels
Elevated fasting blood glucose levels	100 mg/dL or higher or Taking medication for elevated blood glucose levels

Source: Grundy SM, et al. Diagnosis and Management of the Metabolic Syndrome: An American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005;112:2735-2752.
Note: Other definitions of similar conditions have been developed by the American Association of Clinical Endocrinologists, the International Diabetes Federation, and the World Health Organization.
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What can I do to prevent or delay heart disease and stroke?

Even if you are at high risk for heart disease and stroke, you can help keep your heart and blood vessels healthy. You can do so by taking the following steps:

Make sure that your diet is "heart-healthy." Meet with a registered dietitian to plan a diet that meets these goals:
- Include at least 14 grams of fiber daily for every 1,000 calories consumed. Foods high in fiber may help lower blood cholesterol. Oat bran, oatmeal, whole-grain breads and cereals, dried beans and peas (such as kidney beans, pinto beans, and black-eyed peas), fruits, and vegetables are all good sources of fiber. Increase the amount of fiber in your diet gradually to avoid digestive problems.
- Cut down on saturated fat. It raises your blood cholesterol level. Saturated fat is found in meats, poultry skin, butter, dairy products with fat, shortening, lard, and tropical oils such as palm and coconut oil. Your dietitian can figure out how many grams of saturated fat should be your daily maximum amount.
- Keep the cholesterol in your diet to less than 300 milligrams a day. Cholesterol is found in meat, dairy products, and eggs.
- Keep the amount of trans fat in your diet to a minimum. It's a type of fat in foods that raises blood cholesterol. Limit your intake of crackers, cookies, snack foods, commercially prepared baked goods, cake mixes, microwave popcorn, fried foods, salad dressings, and other foods made with partially hydrogenated oil. In addition, some kinds of vegetable shortening and margarines have trans fat. Check for trans fat in the Nutrition Facts section on the food package.
Make physical activity part of your routine. Aim for at least 30 minutes of exercise most days of the week. Think of ways to increase physical activity, such as taking the stairs instead of the elevator. If you haven't been physically active recently, see your doctor for a checkup before you start an exercise program.
Reach and maintain a healthy body weight. If you are overweight, try to be physically active for at least 30 minutes a day, most days of the week. Consult a registered dietitian for help in planning meals and lowering the fat and calorie content of your diet to reach and maintain a healthy weight. Aim for a loss of no more than 1 to 2 pounds a week.
If you smoke, quit. Your doctor can help you find ways to quit smoking.

Ask your doctor whether you should take aspirin. Studies have shown that taking a low dose of aspirin every day can help reduce the risk of heart disease and stroke. However, aspirin is not safe for everyone. Your doctor can tell you whether taking aspirin is right for you and exactly how much to take.
Get prompt treatment for transient ischemic attacks (TIAs). Early treatment for TIAs, sometimes called mini-strokes, may help prevent or delay a future stroke. Signs of a TIA are sudden weakness, loss of balance, numbness, confusion, blindness in one or both eyes, double vision, difficulty speaking, or a severe headache.

How will I know whether my diabetes treatment is working?

You can keep track of the ABCs of diabetes to make sure your treatment is working. Talk with your health care provider about the best targets for you.
A stands for A1C (a test that measures blood glucose control). Have an A1C test at least twice a year. It shows your average blood glucose level over the past 3 months. Talk with your doctor about whether you should check your blood glucose at home and how to do it.

A1C target
Below 7 percent

Blood glucose targets
Before meals	90 to 130 mg/dL
1 to 2 hours after the start of a meal	Less than 180 mg/dL

B is for blood pressure. Have it checked at every office visit.

Blood pressure target
Below 130/80 mm Hg

C is for cholesterol. Have it checked at least once a year.

Blood fat (cholesterol) targets
LDL (bad) cholesterol	Under 100 mg/dL
Triglycerides	Under 150 mg/dL
HDL (good) cholesterol	For men: above 40 mg/dL For women: above 50 mg/dL

Control of the ABCs of diabetes can reduce your risk for heart disease and stroke. changes in diet, activity, and medications can help reach goals.

What types of heart and blood vessel disease occur in people with diabetes?

Two major types of heart and blood vessel disease, also called cardiovascular disease, are common in people with diabetes: coronary artery disease (CAD) and cerebral vascular disease. People with diabetes are also at risk for heart failure. Narrowing or blockage of the blood vessels in the legs, a condition called peripheral arterial disease, can also occur in people with diabetes.

Coronary Artery Disease

Coronary artery disease, also called ischemic heart disease, is caused by a hardening or thickening of the walls of the blood vessels that go to your heart. Your blood supplies oxygen and other materials your heart needs for normal functioning. If the blood vessels to your heart become narrowed or blocked by fatty deposits, the blood supply is reduced or cut off, resulting in a heart attack.

Cerebral Vascular Disease

Cerebral vascular disease affects blood flow to the brain, leading to strokes and TIAs. It is caused by narrowing, blocking, or hardening of the blood vessels that go to the brain or by high blood pressure.

Stroke

A stroke results when the blood supply to the brain is suddenly cut off, which can occur when a blood vessel in the brain or neck is blocked or bursts. Brain cells are then deprived of oxygen and die. A stroke can result in problems with speech or vision or can cause weakness or paralysis. Most strokes are caused by fatty deposits or blood clots-jelly-like clumps of blood cells-that narrow or block one of the blood vessels in the brain or neck. A blood clot may stay where it formed or can travel within the body. People with diabetes are at increased risk for strokes caused by blood clots.
A stroke may also be caused by a bleeding blood vessel in the brain. Called an aneurysm, a break in a blood vessel can occur as a result of high blood pressure or a weak spot in a blood vessel wall.

TIAs

TIAs are caused by a temporary blockage of a blood vessel to the brain. This blockage leads to a brief, sudden change in brain function, such as temporary numbness or weakness on one side of the body. Sudden changes in brain function also can lead to loss of balance, confusion, blindness in one or both eyes, double vision, difficulty speaking, or a severe headache. However, most symptoms disappear quickly and permanent damage is unlikely. If symptoms do not resolve in a few minutes, rather than a TIA, the event could be a stroke. The occurrence of a TIA means that a person is at risk for a stroke sometime in the future.

Heart Failure

Heart failure is a chronic condition in which the heart cannot pump blood properly-it does not mean that the heart suddenly stops working. Heart failure develops over a period of years, and symptoms can get worse over time. People with diabetes have at least twice the risk of heart failure as other people. One type of heart failure is congestive heart failure, in which fluid builds up inside body tissues. If the buildup is in the lungs, breathing becomes difficult.

Blockage of the blood vessels and high blood glucose levels also can damage heart muscle and cause irregular heart beats. People with damage to heart muscle, a condition called cardiomyopathy, may have no symptoms in the early stages, but later they may experience weakness, shortness of breath, a severe cough, fatigue, and swelling of the legs and feet. Diabetes can also interfere with pain signals normally carried by the nerves, explaining why a person with diabetes may not experience the typical warning signs of a heart attack.

Peripheral Arterial Disease

Another condition related to heart disease and common in people with diabetes is peripheral arterial disease (PAD). With this condition, the blood vessels in the legs are narrowed or blocked by fatty deposits, decreasing blood flow to the legs and feet. PAD increases the chances of a heart attack or stroke occurring. Poor circulation in the legs and feet also raises the risk of amputation. Sometimes people with PAD develop pain in the calf or other parts of the leg when walking, which is relieved by resting for a few minutes.

How will I know whether I have heart disease?

One sign of heart disease is angina, the pain that occurs when a blood vessel to the heart is narrowed and the blood supply is reduced. You may feel pain or discomfort in your chest, shoulders, arms, jaw, or back, especially when you exercise. The pain may go away when you rest or take angina medicine. Angina does not cause permanent damage to the heart muscle, but if you have angina, your chance of having a heart attack increases.
A heart attack occurs when a blood vessel to the heart becomes blocked. With blockage, not enough blood can reach that part of the heart muscle and permanent damage results. During a heart attack, you may have

chest pain or discomfort
pain or discomfort in your arms, back, jaw, neck, or stomach
shortness of breath
sweating
nausea
light-headedness

Symptoms may come and go. However, in some people, particularly those with diabetes, symptoms may be mild or absent due to a condition in which the heart rate stays at the same level during exercise, inactivity, stress, or sleep. Also, nerve damage caused by diabetes may result in lack of pain during a heart attack.
Women may not have chest pain but may be more likely to have shortness of breath, nausea, or back and jaw pain. If you have symptoms of a heart attack, call 911 right away. Treatment is most effective if given within an hour of a heart attack. Early treatment can prevent permanent damage to the heart.
Your doctor should check your risk for heart disease and stroke at least once a year by checking your cholesterol and blood pressure levels and asking whether you smoke or have a family history of premature heart disease. The doctor can also check your urine for protein, another risk factor for heart disease. If you are at high risk or have symptoms of heart disease, you may need to undergo further testing.

What are the treatment options for heart disease?

Treatment for heart disease includes meal planning to ensure a heart-healthy diet and physical activity. In addition, you may need medications to treat heart damage or to lower your blood glucose, blood pressure, and cholesterol. If you are not already taking a low dose of aspirin every day, your doctor may suggest it. You also may need surgery or some other medical procedure.

For additional information about heart and blood vessel disease, high blood pressure, and high cholesterol, call the National Heart, Lung, and Blood Institute Health Information Center at 301-592-8573 or see www.nhlbi.nih.gov on the Internet.

How will I know whether I have had a stroke?

The following signs may mean that you have had a stroke:

sudden weakness or numbness of your face, arm, or leg on one side of your body
sudden confusion, trouble talking, or trouble understanding
sudden dizziness, loss of balance, or trouble walking
sudden trouble seeing out of one or both eyes or sudden double vision
sudden severe headache

If you have any of these symptoms, call 911 right away. You can help prevent permanent damage by getting to a hospital within an hour of a stroke. If your doctor thinks you have had a stroke, you may have tests such as a neurological examination to check your nervous system, special scans, blood tests, ultrasound examinations, or x rays. You also may be given medication that dissolves blood clots.

What are the treatment options for stroke?

At the first sign of a stroke, you should get medical care right away. If blood vessels to your brain are blocked by blood clots, the doctor can give you a "clot-busting" drug. The drug must be given soon after a stroke to be effective. Subsequent treatment for stroke includes medications and physical therapy, as well as surgery to repair the damage. Meal planning and physical activity may be part of your ongoing care. In addition, you may need medications to lower your blood glucose, blood pressure, and cholesterol and to prevent blood clots.

For additional information about strokes, call the National Institute of Neurological Disorders and Stroke at 1-800-352-9424 or see www.ninds.nih.gov on the Internet.

If you have diabetes, you are at least twice as likely as other people to have heart disease or a stroke.
Controlling the ABCs of diabetes-A1C (blood glucose), blood pressure, and cholesterol-can cut your risk of heart disease and stroke.
Choosing foods wisely, being physically active, losing weight, quitting smoking, and taking medications (if needed) can all help lower your risk of heart disease and stroke.
If you have any warning signs of a heart attack or a stroke, get medical care immediately-don't delay. Early treatment of heart attack and stroke in a hospital emergency room can reduce damage to the heart and the brain.

Hope through Research

The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) is one of the National Institutes of Health (NIH) under the U.S. Department of Health and Human Services. The NIDDK conducts and supports research in diabetes, glucose metabolism, and related conditions. Several studies related to diabetes, heart disease, and stroke are under way.

The Look AHEAD (Action for Health in Diabetes) trial is studying whether strategies for weight loss in obese people with type 2 diabetes can improve health. This trial is also sponsored by other NIH Institutes and by the Centers for Disease Control and Prevention. For more information on the Look AHEAD trial, visit the website at www.niddk.nih.gov/patient/SHOW/lookahead.htm.
The EDIC (Epidemiology of Diabetes Interventions and Complications) study is examining the long-term effects of prior intensive versus conventional blood glucose control. It is a follow-up study of patients who took part more than a decade ago in the Diabetes Control and Complications Trial (DCCT), a major clinical study funded by the National Institutes of Health.
The BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial, sponsored by the National Heart, Lung, and Blood Institute, in partnership with NIDDK, is studying approaches to the medical care of people with type 2 diabetes who also have coronary artery disease. For more information on the BARI 2D trial, visit the website at www.bari2d.org or call the nearest research center (listed on the website).
The ACCORD (Action to Control Cardiovascular Risk in Diabetes) trial is studying three approaches to preventing major cardiovascular events in individuals with type 2 diabetes. For more information on the ACCORD trial, visit the website at www.accordtrial.org or call 1-888-342-2380.
The NIDDK and other components of the NIH will continue to fund research on the best ways to enhance health promotion, self-management, and risk reduction in people with diabetes.