Know Your Numbers

By Kalia Doner

When it comes to managing type 1 diabetes, there’s a lot of pressure on you to hit your target blood glucose levels day in and day out. That can make worrying about other measurements of your overall health—cholesterol, blood pressure, body weight—seem like more than you want to take on. “But the goal is mastery—not perfection,” explains cardiologist S. Robert Levine, M.D., a longtime volunteer and member of JDRF’s Board of Chancellors. “Everyone with type 1 diabetes is different, and you need to learn about your body, your diabetes, and your best options for a long and healthy life. All the guidelines are there so you and your doctor can work together to improve your self-care and reduce your long-term health risks.”

To help you do just that, check out our guide to optimizing your health.

Weighty Matters

  • Why waist size and body mass index are important—and how to establish your goals

The Lipid Lowdown

  • The newest recommendations on triglycerides, plus the scoop on cholesterol, LDL and HDL numbers

Taking the Pressure Off

  • What you need to know about controlling your blood pressure

PLUS! Take Our Quiz
Do You Understand Your Blood Glucose Numbers?

  • Click here to discover the true meaning of A1C and more!

The Skinny on Weighty Matters

Maintaining a healthy weight is essential for anyone who wants to reduce the risk of problems such as atherosclerosis, osteoarthritis, or even dementia. For those with type 1, however, the hazards associated with being overweight are even greater. Here are two simple measurements that can help you keep track of your weight, and reduce your health risks: Body Mass Index and Waist Circumference.

Know Your BMI

Body Mass Index (BMI) uses your weight and height to estimate your body fat and to determine if you are overweight. “BMI is very useful, even if it is not perfect,” says Frank Hu, M.D., Ph.D., director of the Boston Obesity Nutrition Research Center Epidemiology and Genetics Core and co-director of the Harvard School of Public Health’s Program in Obesity Epidemiology and Prevention. It may overestimate body fat in athletes and people with muscular builds and underestimate body fat in the elderly and those who have lost muscle mass because of illness or inactivity. (Access a BMI calculator in Help & Resources.)

The Numbers for Adults:

BMI                      Weight Status

Below 18.5          Underweight

18.5 – 24.9          Normal

25.0 – 29.9          Overweight

30.0 – 39.9          Obese

40 and above      Morbidly obese

“For people who want to watch their weight, combining information about their BMI with information about their waist circumference provides the best assessment of where they are and whether they are too heavy,” says Dr. Hu. (See the information on waist circumference below.)

The Numbers for Children and Teens:

For children ages 2 through 19 the BMI is calculated by using their height and weight, but their results are ranked according to their peer group. For example: If your 7-year-old daughter is 3 feet 3 inches tall and weighs 65 pounds, she would have a BMI of 30.0, placing her above the 99th percentile for girls age 7 years. This means that this child has a higher BMI than 99 percent of her peers. With this ranking, this child is likely obese and should be seen by a healthcare provider for further assessment.

To calculate your child’s BMI, click here.

The Risks: According to the National Heart, Lung and Blood Institute, the higher your BMI, the higher your risk for heart disease, high blood pressure, type 2 diabetes, gallstones, breathing problems, and certain cancers. Another risk of being overweight or obese is that it may lead to insulin resistance, a condition in which the body cannot properly use insulin that is readily available, even if injected. Traditionally, insulin resistance has been the hallmark of type 2 diabetes, but there may be a subset of people with type 1 diabetes who have a predisposition to it. “Add to that the fact that our population is becoming more and more overweight and you may have people with type 1 battling type 2 issues as well,” says Dr. Hu. “For people with type 1 diabetes, an elevated BMI can increase their risk for insulin resistance and make them even more vulnerable to heart disease.”

For children and teenagers with type 1, “an elevated BMI may be associated with high blood pressure and elevated cholesterol,” says JDRF-funded researcher David B. Dunger, M.D., professor of pediatrics at the University of Cambridge in the United Kingdom. “And those are well-known risk factors for both micro- and macrovascular complications of diabetes.”

Microvascular complications result from damage to and dysfunction of the small blood vessels that feed the eyes, nerves, and kidneys and that contribute to the development of diabetic retinopathy, neuropathy, and nephropathy. Macrovascular complications result from damage to and dysfunction of the large blood vessels and arteries that feed the heart and circulatory system and that contribute to cardiovascular disease, heart attacks, and stroke.

The Benefits: Studies show that losing as little as 5 percent of your body weight can lessen or reverse insulin resistance, making it easier to manage blood glucose levels and reduce the risk of complications. Talk to your doctor about how to proceed so you don’t risk having low blood glucose episodes.

Measure Your Waist Size
Another important measurement of your overall health and risk for heart disease is waist circumference. “It is an important measurement for the general public to be aware of because we all focus on weight so much,” says Dr. Hu. “For people who are a normal weight, but are large through the midsection, waist size it is an important indicator of health risks.”

The Numbers: Regardless of your height, a waist that is 40 inches or larger for men or 35 inches or larger for women indicates an increased chance of developing health problems—and the larger your waist, the greater the risk.

The Risks: Even if your BMI falls within the normal range, an oversized waist (also called central obesity) is associated with insulin resistance and high levels of a type of fat called triglycerides, which are found in the blood. A high BMI may also predispose you to low levels of a heart-healthy type of fat called high-density lipoprotein, or HDL, the “good” cholesterol. Skewed levels of these fats, or lipids, in turn contribute to heart disease and other vascular problems and can also jeopardize your kidneys. “When the body becomes overwhelmed by too much fat, production of a kidney-protecting protein called adiponectin declines,” says Kumar Sharma, M.D., F.A.H.A., director of the Center for Renal Translational Medicine at the University of California, San Diego (UCSD). “The unprotected kidneys become vulnerable to damage from elevated glucose levels and vascular problems.”

Help & Resources

  1. BMI Calculator: Click here to calculate your Body Mass Index
  2. Waist Circumference & Your Health: The Weight Control Information Network, run by the National Institute of Diabetes and Digestive and Kidney Diseases, offers information
  3. Nutritional Know How: For a very helpful array of tools and information to help you improve your nutrition, click here

The Lipid Lowdown

  • Find out about the newest triglyceride recommendations, and the recommended cholesterol, LDL, and HDL numbers

When blood glucose levels are not controlled, people with type 1 diabetes must take extra care to monitor the fats that circulate throughout the blood. Uncontrolled glucose levels may not only lead to high triglyceride levels and low heart-healthy HDL levels, but also to high levels of the “bad” type of artery-clogging cholesterol known as low-density lipoprotein, or LDL. People with type 1 diabetes who are also overweight further heighten their risk of developing complications associated with elevated triglycerides and HDL levels. However, having sufficient insulin available in the body may be able to return blood lipid levels to normal. Talk with your doctor to determine how often you should have your blood lipids checked.

The Numbers: The American Diabetes Association and the American Heart Association recommends that LDL cholesterol be below 100 mg/dL and that HDL cholesterol be over 50 mg/dL. A new set of recommendations for triglyceride levels has just been released by the American Heart Association: The optimal triglyceride level is now set at less than 100mg/dL; a normal level is set at 150mg/dL or less.

The Risks: Elevated blood lipids not only damage blood vessels and increase the risk of heart disease, but in people with diabetes, when combined with uncontrolled glucose levels, they dramatically increase the risk of severe complications, from eye disease (retinopathy) and kidney problems (nephropathy) to nerve damage (neuropathy) and amputation.

The Benefits: One major study of people with elevated cholesterol who took a cholesterol-lowering drug known as a statin found that deaths from heart disease were reduced by 42 percent. Also, the chance of having a nonfatal heart attack was reduced by 37 percent, and the need for bypass surgery or angioplasty was reduced by 37 percent.

INSERT ANIMATION OF FORMATION OF PLAQUE AND OBSTRUCTION OF AN ARTERY

http://post.americanheart.org/media/news_media_relations/animation/Atherosclerosis-to-clot-formation2.mov

CAPTION: Atherosclerosis is caused by the formation of plaques in and along the inner walls of the blood vessels. Plagues are a semi-hardened accumulation of cholesterol and other fats, and conditions such as diabetes, high blood pressure, elevated cholesterol and triglycerides can accelerate their formation. As arteries become ever narrower and blood flow decreases through them, the oxygen supply to the cells also decreases. Plaques that rupture cause the formation of blood clots that can either block blood flow or break off and travel to the brain, causing a stroke.

Taking the Pressure Off: What you need to know about controlling your blood pressure

It is estimated that two-thirds of all people with diabetes have hypertension, or high blood pressure. “It is very important to control both blood glucose and blood pressure because elevated blood pressure substantially increases your risks for diabetes-related complications,” says UCSD’s Dr. Sharma.

The Numbers: Blood pressure measures the force of blood that is released into your vessels when the heart beats. Because high blood pressure poses such an added health risk, the National Institutes of Health has set a lower target blood pressure for people with diabetes than for those without the disease. The goal: less than 130/80 mmHg. The top number is called the systolic pressure, which represents the force of the circulating blood pushing against the blood vessels when your heart contracts. The lower number is the diastolic pressure, which represents the force when your heart is at rest. The Joslin Diabetes Center in Boston recommends that you have your blood pressure checked at every doctor’s visit.

The Risks: If a person has high blood pressure and diabetes, their risk of cardiovascular disease doubles. “The long-term consequences to the heart, as well as the brain, eyes and kidneys are potentially very serious,” explains Dr. Sharma.

The Benefits: If you reduce your blood pressure, you get great rewards: The United Kingdom Prospective Diabetes Study found that for each 10-mmHg decrease in systolic blood pressure there was a 12 percent reduction of risk for any diabetes-related problems, 15 percent reduction for death related to diabetes, 11 percent for heart attacks, and 13 percent for microvascular complications such as eye or kidney disease.

http://care.diabetesjournals.org/content/27/suppl_1/s65.full