Ways To Lower Blood Pressure

The evidence is in. Blood pressure control in people with both type 1 and type 2 diabetes is just as important as blood glucose control. High blood glucose (diabetes) and high blood pressure often go hand in hand. 60 to 65 percent of people who have diabetes also have high blood pressure. Blood pressure control, at a level at or below 130/80, can help prevent or slow down the progression of several common long-term diabetes problems—heart disease, stroke, kidney disease and loss of vision.

What steps can you take?

Get your blood pressure checked at every medical visit. Make sure is it below 130/80. If your blood pressure is higher than 130/80 on several occasions, talk with your health care provider about which of the following steps might help you lower your blood pressure:

• Get to or stay at a healthy weight
• Make changes in your eating plan if you don’t already eat: - at least six servings of whole grains a day - at least two servings of fat-free or low-fat dairy foods high in calcium (i.e. milk and yogurt) - five servings of fruits and vegetables a day
• Reduce the number of high sodium foods you eat and the amount of salt you use   If you drink alcohol, reduce the amount you drink
• Be as active as you can be — strive for at least 30 minutes of activity five times per week
• Do not start to smoke, or quit smoking if you smoke Put the steps that make sense for you into action. Then, if your blood pressure stays high after you have made some changes, ask your health care provider if you should begin to take a blood pressure medicine. The blood pressure medicine recommended for people with diabetes to start on is called an ACE inhibitor.

What’s the connection between type 2 diabetes and high blood pressure?

Today, experts believe that people with type 2 diabetes have a higher incidence of high blood pressure due to often relatively high amounts of insulin in their circulation, as well as insulin resistance. This is the inability to use the insulin that your body makes. This situation causes high blood pressure. It is well known that people with type 2 diabetes who are overweight, inactive and/or don’t eat healthy are more likely to have high blood pressure. It also is well known that if people with type 2 diabetes eat more vegetables, fish, whole grains, and low-fat dairy foods, become more active and lose a few pounds, they can lower their blood pressure.

Know your blood pressure. High blood pressure often has no signs or symptoms. The only way to find out if you have high blood pressure is to have it checked.

Tips for accurate blood pressure readings

• Do not drink coffee or smoke for 30 minutes before you get your blood pressure checked.
• Sit for five minutes with your back supported and your feet flat on the ground while resting your arm on a table at the level of your heart.
• Wear short sleeves or be able to pull up your clothes so your arm is exposed.
• Go to the bathroom to empty your bladder first. A full bladder can impact the reading.
• Ask the person taking your blood pressure to take two readings. These should be done at least two minutes apart. Take an average of the result.

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Diabetes - Checking Your Blood Glucose After You Eat

You may be surprised to learn that checking your blood sugar after you eat can be more important than checking before you eat a meal. If you are like most people, you just check your blood sugar in the morning when you get up. Although that reading is important, you may be missing a helpful source of information.

Why check after meals?

After-meal readings tell you about the impact of food on your blood sugar. The blood sugar reading taken two hours after you start to eat should be about 30 mg/dl higher than before you ate. So if your blood sugar was 117 mg/dl before you ate two cups of pasta with chicken and vegetables and 322 mg/dl two hours later, you’ve learned that two cups of pasta is too much for you. However, a reading of 157 mg/dl two hours after eating one cup of pasta helps you to learn the portion of pasta that your body can handle.

Many people are shocked by the elevated readings that they measure after meals. For example, you may decide to drink sweetened soda with your meals because your fasting blood sugar was always less than 120 mg/dl. But, finding measured readings over 400 mg/dl after drinking sweetened soda, you may decide to switch to sugar-free soda. Checking after-meals can also teach you about better food choices or products.

Eight ounces of orange juice with your breakfast may raise your blood sugar to 299 mg/dl two hours later, whereas 8 ounces of a fruit drink sweetened with Equal or Sweet ‘N Low may only raise your blood sugar to 150 mg/dl. Blood glucose rises after eating mainly from the carbohydrates you eat. Carbohydrates begin to raise blood glucose within 15 minutes of food intake and is changed to nearly 100% glucose within about two hours. Blood glucose levels should be back to your pre-meal target by about 3 to 4 hours after the start of meals.

In general, people spend about half of each day in a state where blood glucose is higher than pre-meal levels. If your blood glucose levels after meals are often high, it will be hard for you to achieve good control.

What can you learn?

• Learn if you are eating either too much, or uneven amounts of carbohydrates.

For example: after observing varying after breakfast blood glucose levels, you realize the bagel you eat raises your blood glucose higher than the oatmeal. Then you read the “Nutrition Facts” labels and learn that a bagel contains 60 grams of carbohydrate and oatmeal contains 30 grams.

•  Learn the effects of different foods on your blood glucose.

Perhaps you choose to eat a high fiber meal, or maybe a few slices of pizza, a glass of wine or a dessert? These choices can all affect your blood glucose differently.

• Learn the effect of activity on your blood glucose. Is your blood glucose lower if you take a walk after dinner?
• Learn if the diabetes medicine you take to lower after-meal blood glucose is working effectively or not.

Once people learn the importance of checking their blood sugar two hours after a meal, they are free to experiment with different foods. Portions of ethnic foods or combination foods such as casseroles are often hard to measure. Checking your blood sugar two hours after you eat is the only way to know the portion of ethnic foods or combination foods that your body can tolerate.

 This essential feedback puts you in the driver’s seat when making food choices. You may have intended to check your blood sugar after you ate but forgot because you were involved with something. Simply forgetting is the biggest barrier to measuring blood sugar after meals. Some people set a timer or a wrist watch alarm as a reminder. Don’t be discouraged if you forget, just try another time.

Do I have to check more often?

Blood sugar monitoring is meant to provide you (and your health care provider) with helpful feedback. Just writing numbers in a log book is meaningless. You may choose to check three times per week and alter the times based on your needs. So if you want to learn the impact of two slices of pizza on your blood sugar at lunchtime, check before and two hours after lunch that day.

Two days later you may decide to try a new breakfast cereal so that day you will check before and after breakfast. An elevated reading before a meal has nowhere to go but up. If your blood sugar is high before a meal, it will only be higher after a meal so you won’t learn anything about the impact of the food you ate on your blood sugar. Pre-meal readings help you and your health care provider evaluate your medications and overall eating patterns.

What else do the numbers mean?

The readings taken two hours after a meal also tell you about the amount of insulin that your body is making. If your pre-meal reading is within range and the reading two hours later is high but you didn’t overeat, the after-meal reading can give us a clue about the amount of insulin made by your pancreas. In type 2 diabetes, the body loses its ability to immediately release insulin after food is eaten.

 An elevated blood sugar reading two hours after a healthy meal may be telling us that your body needs a boost of insulin right after you eat. There are some new medications that provide a boost of insulin after a meal. Either Prandin (repaglinide) or Starlix (nateglinide) can lower your blood sugar after meals. Those who take rapid-acting or fast-acting insulin before a meal use the pre-meal reading to decide what dose of insulin to inject and they use the after-meal reading to evaluate if the dose was correct.

What do experts say?

A group of experts recently reviewed the role and importance of after-meal blood glucose levels in diabetes control. The experts did not set an after-meal target, nor did they conclude that everyone with diabetes should check it. However, by the time they got done listing who would benefit from after-meal checking, it included many people. They suggest checking if you:

• suspect you have high blood glucose levels after meals and/or
• take a diabetes medication intended to lower after-meal blood glucose levels and/or
• need to monitor for low blood glucose levels or
• have diabetes during pregnancy (gestational).

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Blood Glucose Monitoring

Why is it so important to test my blood?

Regular testing and recording of your blood glucose level can reinforce your healthy lifestyle choices as well as inform you of your response to other choices and influences.

Importantly, blood glucose level pattern changes can alert you and your health care team to a possible need for a change in how your diabetes is being managed.

Testing your blood glucose levels will help you to:

• Develop confidence in looking after your diabetes.
• Better understand the relationship between your blood glucose levels and the exercise you do, the food you eat and other lifestyle influences such as travel, stress and illness.
• Know how your lifestyle choices and medication, if used, are making a difference. 
• Find out immediately if your blood glucose levels are too high (hyperglycaemia) or too low (hypoglycaemia), helping you to make important decisions such as eating before exercise, treating a ‘hypo’ or seeking medical advice if sick.
• Know when to seek the advice of your diabetes health team about adjusting your insulin, tablets, meal or snack planning when blood glucose goals are not being met.

How do I test my blood?

You will need a blood glucose meter, a lancet device with lancets and test strips. The finger is pricked with the lancet to obtain a very small drop of blood which is then applied to a test strip placed in the meter. The results are displayed within seconds.

Blood glucose meters are usually sold as kits giving you all the equipment you need to start. There are many different types, offering different features and at different prices to meet individual needs. Most of these are available from your State or Territory Diabetes Organisation, pharmacies and some diabetes centres. 

What do I aim for?

Successful management of diabetes is all about aiming for a careful balance between the food you eat, how active you are and the medication you take for your diabetes. Because this is a delicate balance, it can be quite difficult to achieve ideal control all the time.

For some people, the ranges will vary depending on the individual and their circumstances. While it is important to keep your blood glucose levels as close to a normal or non-diabetic state as possible to prevent complications, it is equally important to check with your diabetes educator or doctor for the range of blood glucose levels that are right and safe for you. Therefore the following information should be treated only as a general guide. 

Targets for glycaemic control

Target ranges may differ depending on your age, duration of diabetes, the type of medication you are taking and if you have any other medical problems. Speak with your doctor about your individual target ranges.

Normal blood glucose levels are between 4.0–7.8mmol/L.

1 Targets are as recommended by the American Diabetes Association. NHMRC guidelines are currently under development.

2 Targets are as recommended by the NHMRC, Blood Glucose Control in Type 2 Diabetes, (2009).

 Who is at risk of LOW blood glucose (hypoglycaemia)?

• People who are using insulin or those taking diabetes tablets which increase their own insulin production are at risk as both medications have the effect of lowering blood glucose. They can therefore cause hypoglycaemia (low blood glucose) when blood glucose levels are less than 4mmol/L†. (Note: Hypoglycaemia can occur at higher blood glucose levels in children and people who have had elevated blood glucose levels for a long time).
• People whose diabetes is managed by lifestyle alone or with other types of diabetes tablets which do not increase their own insulin production, are not at risk of hypoglycaemia.

Are HIGH blood glucose levels dangerous?

Sometimes you may get a higher blood glucose reading than usual and you may not be able to figure out the reason. When you are sick with a virus or flu, your blood glucose levels will nearly always go up and you may need to contact your doctor, especially if ketones are present (more likely to develop in a person with type 1 diabetes). However, it is only when blood glucose levels are consistently higher than they ought to be over weeks or months that the damage-causing complications can occur. 

What causes glucose levels to go up and down?

There are a number of common causes for glucose levels to increase or decrease.  These include:

• Food – time eaten, type and amount of carbohydrate (eg: bread, pasta, cereals, vegetables, fruit and milk)
• Exercise or physical activity
• Illness and pain
• Diabetes medication
• Alcohol
• Emotional stress
• Other medications
• Testing techniques

When should I test?

Your doctor or diabetes educator will help you decide how many tests are needed and the levels to aim for.

You will also be advised to record all your tests. Even though your meter may have a memory, it is important to keep a record of your readings in a diary and to take this with you to all appointments with your diabetes health team. Most meters on the market have software which allow you to download your records in different formats such as graphs and charts. Even if you can do this, it is still helpful to keep a diary, not only for your tests but also details of your daily activities, the food you eat and other relevant information. This will provide both you and your diabetes health team with important information in deciding if and how your treatment may need to be adjusted.

Ask your doctor or diabetes educator how you can use a diary to help you to better manage your diabetes.

General guidelines

• Frequency of testing may vary depending on your treatment. Check with your doctor or diabetes educator as to when it is suggested you test.
     Possible times are: 
     > before breakfast (fasting) 
     > two hours after a meal 
     > before bed
• Testing four times a day is usually recommended for people with type 1 diabetes. However many people test more often, such as those using an insulin pump (CSII – continuous subcutaneous insulin infusion).

Test more often when you are:

• Being more physically active or less physically active.
• Sick or stressed.
• Experiencing changes in routine or eating habits eg: travelling.
• Changing or adjusting your insulin or medication.
• Experiencing symptoms of hypoglycaemia. 
• Experiencing symptoms of hyperglycaemia.
• Experiencing night sweats or morning headaches.

What if the test result doesn’t sound right? 

If you’re not convinced that a result is correct, here’s a suggested check list:

• Have the strips expired?
• Is the strip the right one for the meter?
• Is there enough blood on the strip?
• Has the strip been put into the meter the right way?
• Have the strips been affected by climate, heat or light?
• Did you wash and thoroughly dry your hands before doing the test?
• Is the meter clean?
• Is the meter too hot or too cold?
• Is the calibration code correct?
• Is the battery low or flat?

All meters will give a different result with a different drop of blood. As long as there is not a big difference (more than 2mmol/L) there is not usually cause for concern.

The accuracy of all meters can be checked with meter-specific liquid drops called control solutions. These are expensive, have a short shelf life and only last a few months once opened. However, your diabetes health professional or pharmacy may be able to do this for you at no charge. 

What is a glycosylated haemoglobin (HbA1c) test?

The HbA1c test shows an average of your blood glucose level over the past 10–12 weeks and should be arranged by your doctor every 3–6 months.  

Is the HbA1c the same as testing your own BGLs?

No. The HbA1c test doesn’t show the highs and lows that your home testing shows. Therefore it does not replace the tests you do yourself but is used as an added tool in giving the overall picture of your blood glucose management. 

How does it work? 

A glycosylated haemoglobin test is possible because red blood cells (RBC) are continuously being made by your long bones and released into your circulation. When these cells are released, they pick up  glucose in the blood stream at that time.

Each RBC lasts about 120 days. Therefore any blood sample will have a range of cells released over the previous 120 days with different amounts of glucose attached.  The HbA1c test gives a good guide to the average.

What HbA1c do I aim for?

The goal for most people with diabetes will be in the 6.5–7% (48–53mmol/mol) range however this may need to be higher for children and the old and frail. Your doctor will advise.

How is HbA1c reported?

The way that HbA1c is reported is changing. HbA1c has been expressed as a percentage (%). From 2011 it will be reported in IFCC HbA1c units as mmol/mol. The new method is more accurate and consistent between laboratories. For some time both mmol/mol and % will be reported by pathology laboratories.

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diabetes: the silent pandemic and its impact on Australia

Diabetes is a challenging problem for public health worldwide.  It is a chronic disorder in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond adequately to the insulin that is produced. As there is currently no cure for diabetes, the condition requires lifelong management.

Check this out - A Must read for Aussies!

Diabetes: the silent pandemic and its impact on Australia

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Diabetes Globally

Diabetes is the world’s fastest growing chronic disease.   

On 20 December 2006 the UN General Assembly passed UN Resolution 61/225 recognising diabetes as a major health crisis facing all nations of the world. The Resolution designates 14 November each year as the United Nations World Diabetes Day and calls on all nations to develop national policies for the prevention, treatment and care of people living with diabetes and those at risk of developing diabetes.

World Diabetes Day 2011 marked the release of the International Diabetes Federation's 5th edition of the Diabetes Atlas.  New figures indicate that the number of people living with diabetes is expected to rise from 366 million in 2011 to 552 million by 2030, if no urgent action is taken.  This equates to approximately three new cases every ten seconds or almost ten million per year. IDF also estimates that as many as 183 million people are unaware that they have diabetes.

Fast Facts

• 366 million people have diabetes in 2011; by 2030 this will have risen to 552 million
• The number of people with type 2 diabetes is increasing in every country
• 80% of people with diabetes live in low- and middle-income countries
• The greatest number of people with diabetes are between 40 to 59 years of age
• 183 million people (50%) with diabetes are undiagnosed
• Diabetes caused 4.6 million deaths in 2011
• Diabetes caused at least USD 465 billion dollars in healthcare expenditures in 2011; 11% of total healthcare expenditures in adults (20-79 years)
• 78,000 children develop type 1 diabetes every year
• Africa: 78% of people with diabetes are undiagnosed
• Europe: the highest prevalence of type 1 diabetes in children
• Middle East and North Africa: 6 of the top 10 countries by diabetes prevalence
• North America and Caribbean: 1 adult in 10 has diabetes
• South and Central America: 12.3% of all deaths were due to diabetes
• South-East Asia: almost one-fifth of the world's people with diabetes live in just seven countries
• Western Pacific: 132 million adults have diabetes, the largest number of any region
• All nations—rich and poor—are suffering the impact of the diabetes epidemic
• Diabetes particularly affects those who are socially and economically disadvantaged
• Diabetes increases the risk of developing tuberculosis
• Diabetes threatens achievement of the Millennium Development GoalsIDF links the local to the global: from grass-roots activism, through programmes with health professionals, to influencing global health and development policy
• IDF elevated diabetes onto the global agenda through the UN High-level Meeting on NCDs
• IDF supports a global network of health professionals from over 170 countries working in diabetes education
• The IDF World Diabetes Congress is the only global event that brings together the whole diabetes community
• IDF leads the World Diabetes Day campaign: over 1,000 buildings around the world illuminated in blue on 14 November
• There are solutions for managing and curbing the diabetes epidemic
• IDF has a suite of position statements and clinical guidelines for health professionals
• IDF is the legitimate voice of people with diabetes

Source:
Diabetes Atlas, fifth edition, International Diabetes Federation, 2011

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