Many patients with diabetes focus a great deal of their energy on controlling their blood sugar levels. This is important, but is only one of the important goals of an overall treatment plan for a diabetic patient. The major long term problems related to type 2 diabetes are related to the cardiovascular system, and include heart attacks, strokes and peripheral artery disease. There is a large body of evidence that supports aggressive control of blood pressure and cholesterol as well as smoking cessation as factors at least as important as blood sugar control in the prevention or delay of development of these diabetes complications.
Smoking cessation: Quitting smoking may be the most important of all the things you can do as a diabetic to prevent cardiovascular complications. Your risk of these problems goes down dramatically and quickly after quitting, so work with your physician to find a way to quit.
Optimal Blood Pressure Control: For patients with diabetes the goal blood pressure is lower than in the non-diabetic patient, and many if not most patients require a blood pressure medication to achieve the typical goal blood pressure of >120/80. The blood pressure medications in the class called ACE inhibitors or ARBs have the added benefit of protecting the kidney function, and are often the first choice of blood pressure medication for diabetic patients. Many patients will require a combination of 2 or more blood pressure medications to achieve their goal numbers.
Cholesterol Control: Diet, exercise and achieving optimal weight are important in keeping the LDL cholesterol at the goal for diabetic patients of <100, with ideal LDL <70. With goals this low most patients require treatment with a statin class of medication to get to goal. Good news is that most of these drugs are now available as generics at very affordable prices and they are very effective at lowering LDL cholesterol.
Blood Sugar Control: I list this last on purpose. Although it is important to keep blood sugars in control, it can be among the most difficult aspects of diabetes management for many patients. Getting the HbA1C, which measures blood sugar levels over the last month, under 8% is very important, and goal for many patients is <6.5%, but this is not more important than the control of blood pressure and LDL cholesterol which may be easier to achieve.
Be sure to discuss with your physician your progress towards all of these important aspects of diabetes care, and work with them to be sure you don’t neglect any of these issues.