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By Lisa Foster-McNulty, MSN, RN, CDE

Most people with Type 1 don’t give a lot of thought to heart disease as a complication of diabetes…it’s kind of the furthest thing from most of our minds! That’s more likely to happen in people with T2, right? Let’s look a bit further, maybe we shouldn’t be so fast to come to that conclusion.

I never thought much about aging until recently, and now I find myself thinking about it a lot. Suddenly my parents are having all sorts of health issues, and it worries me. Then I realized that I’m getting older right along with them! Along with that comes thinking about how my body changes over time, and new diagnoses that could get added to my list.

Poorly controlled diabetes (both type 1 and type 2) is a major risk factor for cardiovascular complications, and adults with diabetes are 2 to 4 times more likely than those without diabetes to suffer from heart disease or stroke. Cardiovascular disease death rates are about 1.7 times higher among adults with diabetes age 18 and older than rates for our counterparts without diabetes. Poor glucose control can contribute to the development of cardiovascular risk. And heart disease is the #1 cause of death in people with diabetes.

Maybe you even know someone, or have heard of someone, who lead a healthy lifestyle, but has diabetes and developed cardiovascular disease seemingly out of the blue. We’ve all heard horror stories; there’s no need to dwell on them. I realize that none of this is pleasant to think about. You want to do all you can to make sure this stuff doesn’t happen to you!

The best defense is a good offense. Start doing the right things now, so that you don’t have regrets later. Are you with me?

First things first. Work with your provider—your doctor, nurse practitioner, or physician assistant. You need them for a treatment plan and for your ongoing care. He or she prescribes the medications you may need to stay healthy.

There are multiple ways to modify your risk! Most of the risk factors are things that you can control. Many of them involve lifestyle adjustment. That’s your point of power, even if it is easier said than done. If you smoke, quit. If you are sedentary, move more. If your cholesterol or blood pressure is too high, work on getting it under control. If you are overweight, get help with weight loss. If your BG is too high, get it under control. If you have a lot of stress, learn some techniques to reduce stress.

Take the bull by the horns, so to speak. Managing multiple risk factors helps a lot—it leads to significant risk reduction. Some of the changes that you might make can lead to improvements in multiple areas. Take physical activity, for example. Exercise lowers high blood pressure and high cholesterol. It lowers BG, can help you to lose weight (or maintain weight loss), and helps with stress management. That’s a ton of improvement out of one non-drug intervention – and it’s free to take a walk outside!

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Another healthy lifestyle behavior is choosing to eat a healthy, heart-smart diet. This includes consuming a variety of fruits and vegetables, whole grains, lots of fiber, low fat dairy, lean proteins, and low sodium. Portion control is an important part of healthy eating. If you need to clean up your act in this area, make it fun. Involve your social support system if you can. Try a new food that you’ve never eaten before. Visit the cookbook section of a bookstore, or go on-line to look for some new recipes that appeal to you. Shop at the local farmer’s market to buy produce that is in-season, or just go to a different grocery store for a change of pace. Try to shop the perimeter of the grocery store for the most nutrient dense foods – the fresh produce, lean meats in the deli, the dairy section for low fat milk/yogurt or milk alternatives and choose hearty whole grain breads. Visit the aisles for things like dry grains (wild rice, quinoa, barley) and seasonings to enhance food flavors. Choose less processed and packaged foods. Make plans for growing some of your own food next year, even if it is a container garden on your patio. There are lots of ways to turn this into an adventure!

People with T1 are now living into old age, well into their 80s and 90s. Many of them are accomplishing great things in sports and fitness. I see this as positive evidence that making smart choices in our daily lives pays off big dividends in the long term.

If you don’t know where to begin, ask for help. You are not alone! Diabetes educators are skilled at getting you pointed in the right direction, and we’re more than happy to help.

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