Dr Aidin Rawshani

Diabetes: follow your risk factors closely

Contents

A cornerstone in the treatment of diabetes is to regularly monitor various risk factors, especially blood sugar levels. It is important to measure their sugar levels to adjust treatment and the same applies to blood pressure, blood lipids and kidney function.

Everyone should know various factors about their state of health, such as their height, weight, blood pressure, cholesterol and blood sugar levels. Knowing this information is all the more important for people with diabetes, as type 2 diabetes (non-insulin-dependent diabetes) is strongly related to overweight. Blood sugar levels and other risk factors affect your risk of cardiovascular disease. In addition, these risk factors are modifiable, which means that they can be improved with treatments or other interventions. Individuals with type 1 diabetes also need to control these factors.

Waist circumference

Waist circumference indicates how much extra fat you carry around, central abdominal obesity is associated with an increased risk of cardiovascular disease and diabetes. Central abdominal obesity leads to reduced insulin sensitivity in the liver, increased fat deposits in the liver and pancreas, which contributes to more pronounced insulin resistance in muscles and adipose tissue.

Insulin resistance is associated with increased atherosclerosis of blood vessels (arteries), extensive atherosclerosis of blood vessels can cause blockage of blood flow, which leads to a stroke or heart attack.

Measure waist range

All you need is a tape measure:

Put the tape measure around your stomach at the level with your navel.Stand straight up, but make sure that the abdominal muscles are completely relaxed.

Men

Normal waist circumference for men is 94 cm or less. In men from South Asian or Chinese ethnicities, 90 cm or less are classified as normal.

If the circumference of the waist is 94-102 cm, your cardiovascular risk increases by 1.5 to 2 times.If your waist measures more than 102 cm, your cardiovascular risk increases approximately 5 times.

Women

Normal waist circumference for women is 80 cm or less in women from all ethnic groups.

If the circumference of the waist is 80-88 cm, your cardiovascular risk increases by 1.5 to 2 times.If your waist measures more than 88 cm, your cardiovascular risk increases approximately 3 times.

Body mass index (BMI)

Overweight and obesity are associated with high blood pressure, increased risk of cardiovascular diseases, diabetes, shorter life expectancy and some cancer formsBody mass index (BMI) is used to assess fat mass and is based on two simple metrics, namely weight and height. In many cases, BMI is a bad tool for estimating the fat mass.

Calculate your BMI

Examples

If you weigh 80 kg and are 1.7 m long:Take your weight (80 kg) Multiply your height by yourself (1.7 x 1.7 = 2.89) Divide your weight by this figure (80/2,89) .80 ÷ 2,89 = 27.7.

Your BMI is 27.7 kg/m2. In order to calculate your BMI, you need to know your weight in kilograms and your height in meters. Then take your weight and divide it by the square of your height.

Guidelines for BMI

BMI of 20-24.9 is normal weight (18.5 to 22.9 in South Asians) .BMI of 25-30 is overweight (23 to 28 in South Asians) .BMI of more than 30 means obesity (more than 28 in South Asians).

Being overweight means shortening your life expectancy by several years. For non-smoking 40-year-olds:

If you are overweight, you lose over three years of life.If you are male and overweight, you shorten your life expectancy by over six years.If you are a woman and overweight, you shorten your life expectancy by over seven years.

If you are an active smoker and at the same time overweight, both sexes lose over 13 years of age, compared to non-smokers with normal BMI.

Blood pressure

Everyone with diabetes should know their blood pressure because high blood pressure, like diabetes, increases the risk of heart disease.

Find out your blood pressure

Your doctor or other healthcare professional usually measures your blood pressure, usually it happens in conjunction with annual diabetes checks. Blood pressure can also be measured at home using an automatic meter. Automatic meters are now quite accurate and affordable.

Target values of blood pressure in people with diabetes

Systolic pressure less than 140 mmHg (guidelines are likely to change to 130 mmHg eventually) diastolic pressure less than 80 mmHg.

Long-term blood sugar (haemoglobin A1c, HbA1c)

Years of high blood sugar levels lead to damage to the blood vessels, especially the small blood vessels. High blood sugar levels increase the risk of developing complications such as eye disease, kidney disease, nervous and cardiovascular disease

Examine your blood sugar levels

If you have diabetes, you will probably have your own blood glucose meter to use at home. HbA1c or blood glucose can also be examined by your doctor or at your diabetes clinic. HbA1c is a blood test that examines what the average blood sugar level has been in the last 2-3 months.

Blood sugar levels

The ideal values for blood sugar levels are as follows:

Before meals: 4 to 7 mmol/lefter meals: less than 11 mmol/l for 120 minutesAt bedtime: 8 mmol/l.

Long-term blood sugar (HbA1c)

The ideal value of HbA1c depends on a variety of factors, such as if you have heart or kidney disease, your age, how long you have had diabetes and your risk of hypoglycaemia (low blood sugar levels). You should check with your diabetes care professional what level of blood sugar control you should strive for.

General guidelines for long-term blood sugar (HbA1c)

By keeping the blood sugar level within these limits, you significantly reduce the risk of these complications.

HbA1c less than 42 mmol/mol means that you do not have diabeteshba1c of 48 mmol/mol or less means a very good glucose controlHbA1c 58 mmol/mol or less means good glucose controlHbA1c of 68 mmol/mol means moderately good glucose controlHbA1c of 75 mmol/mol is considered to be high glucose levels, but this may be appropriate in some people.

Cholesterol

Blood cholesterol is an important factor to monitor, as individuals with diabetes also have a slightly higher level of cholesterol and increased risk of heart disease

Examine blood cholesterol

Studies have shown that most people with diabetes (especially type 2) would benefit from lowering their cholesterol by taking a drug called statin. Several experts in the field believe that the lower the blood lipids (LDL cholesterol), the lower the risk of heart attack and stroke.

Doctors use risk calculators that consist of charts to match your cholesterol level to other factors such as:

Age Gender blood pressure smoking history. Occurrence of diabetes.

These graphs give a figure called “10-year coronary”. You can access your coronary risk using an online risk calculator. The reason why it is called “coronary” is for the blood vessels supplying the heart muscle is called coronary vessels or coronary arteries. Risk calculators give a percentage probability of myocardial infarction in the next 10 years for someone who has not yet any signs of heart disease or damage from hypertension or diabetes.

Individuals who have already suffered from cardiovascular diseases and have high blood lipids need drug therapy and lifestyle changes to achieve blood lipids lower than 2.5 mmol/l, if possible, preferably less than 1.8 mmol/l.

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