June 23, 2008 -- A bit more bad news for diabetics that you may not have known: having a diagnosis of type 2 diabetes makes your risk of having a heart attack just the same as someone who already had a heart attack. This means it is automatically assumed that with diabetes, there may be hidden heart disease as well.
In addition, a worldwide study of over 21,000 patients with diabetes found that vigorously controlling your blood sugar to get your blood sugar levels into near normal range did not lower the risk of heart attack or heart disease. For some patients, tight control of blood sugar led to more episodes of dangerously low blood sugar too.
So what is a patient with diabetes to do to lower the risk of heart attack?
It turns out that controlling your blood pressure is perhaps the single most important thing you can do to reduce many of the complications from diabetes. The dangers of high blood pressure — even a few points above normal — are much greater for diabetics.
The risks of heart attack, stroke, kidney disease and progressive blood vessel disease of the eyes that, if left untreated, can lead to blindness are all made greater when the blood pressure is high. Other conditions more common in diabetics, such as impotence and poor circulation to the legs, are also much worse with poorly controlled high blood pressure.
So why is it that, according to a number of studies, less then half the time doctors see a diabetic patient do the doctors make suggestions to change blood pressure medication or ask patients to come back for a blood pressure follow up — even when so much is on the line? And why do patients with diabetes all too often not know their blood pressure goals, fail to act on their own home blood pressure readings, or do not know exactly what their medications may do?
Studies note that doctors often fail to ask patients about monitoring their blood pressure at home. Home readings may give a better picture of how well your blood pressure is being controlled. Some patients don't even check or monitor their blood pressure at home.
Regardless of why your doctor may not always suggest changes to better control your blood pressure, it is YOUR JOB to see that your blood pressure is as close to target range for you as possible. In the end, it is your health that is on the line and you need to be in charge of it!
Taking Charge of Your Blood Pressure
So what are some things you can do?
1. Know your blood pressure treatment goal. For diabetics, a blood pressure under 130/80 is the usual goal. The lower the blood pressure, the better. A blood pressure of 140/90 or more is simply too high and places you at more risk of problems.
2. Buy a home blood pressure cuff to monitor your blood pressure. Bring the cuff to your next visit and have your doctor confirm that the cuff fits your arm size and matches the readings of your doctor. Keep track of all home blood pressure results and bring them to each doctor visit and show your doctor your readings. This test results at-a-glance form for women or for men will help.
3. Be sure you are doing your part with a blood-pressure-lowering diet and exercise routine to help lower your blood pressure. Lifestyle changes are critical to long term control of your high blood pressure in addition to your medications.
4. Take all of your medication as directed by your practitioner. Many patients with high blood pressure will need at least two — and often three — different medications. Are you on a mild diuretic such as hydrodiuril and/or an ACE inhibitor or ARB blocker? Make sure you know your cholesterol target goals. Ideally, with diabetes your LDL cholesterol (the "bad" cholesterol) should be under 100. Save an original copy of all your blood test results. Give your doctor a self-addressed stamped envelope to remind her to send you the information each time you have blood taken.
5. Talk to your doctor about your blood sugar and what goal your doctor is trying to achieve for you. Make sure you do all that you can to monitor your blood pressure. Even if extremely tight control may not always be best, good control is still very important.
For all patients with diabetes: Do you measure your blood pressure at home? Is your blood pressure in the target range of 130/80 or lower? If not, what have you done about it? What problems have you had monitoring your blood pressure or taking your medications?
As always, I welcome your comments and questions.
Dr. Marie Savard is an ABC News medical contributor.