This week in diabetes management sessions, I counseled a 63-year old gentleman who has had type 2 diabetes for 5 years and was being treated with Metformin, 1000mg, twice a day. He never attended diabetes or nutritional education and had very little understanding of proper self care except for taking his “two diabetes pills”. He did all the food shopping and preparation since his original diagnosis. His present blood sugars, cholesterol, and blood pressure had gone way out of control along with a recent unexplained 51-pound weight loss from a normal weight of 172 to 121. His answer to the weight loss was to eat anything he could find that seemed high calorie without making wise choices due to his lack of knowledge. He refused to do any exercise including walking for fear of losing more weight. While he is being medically evaluated for his unexpected weight loss and high blood numbers, we needed to get him get back on track with lifestyle changes. He understands that he may need additional medications but was willing to learn good health habits as well. He was unaware that “hypertension” meant the same thing as high blood pressure and thought he was just “too tense”. He was anxious and upset about his unexplained weight loss which did not help his pressure or cholesterol levels. In the meantime, we reviewed lifestyle changes to help lower his numbers.
Today, I will focus on blood pressure and cholesterol.
Blood pressure can elevate from mental stress, physical stress or physical activities. This is normally expected, and if blood pressure goes down with activity, it may signal heart disease. The current acceptable reading for blood pressure with diabetes is 140/80 or below. Most patients are familiar with “white coat syndrome” which used to have a benign connotation. Recent research done in Italy confirms “if blood pressure in the doctors office rises due to stress from the visit or from possible negative news, then the stress of daily life may also have you running around with high numbers”. Elevated blood pressure rarely comes with symptoms. This confirms that driving in traffic, work problems, having an argument, or worrying about finances may leave you with permanent high blood pressure. Uncontrolled blood pressure can lead to a heart attack, stroke, heart arrhythmias, and heart or kidney failure.
To help track your blood pressure, bring your home blood pressure machine to the doctor visit and compare numbers. Do not use a wrist or finger monitor which is less accurate. Sit at least 3-5 minutes prior to having it tested. Your arm should be held at a 90 degree angle and preferably tested in both arms. Make sure the cuff fits completely on the upper arm. Simply using a wrong size cuff may lead to inaccurate results; staff can be rushing without changing the cuff size, so be aware. Many offices will average 2-3 readings during each visit. If your physician is still uncertain, they may order a 24-hour monitor which will automatically test your blood pressure every 20 minutes. High cholesterol can be related to your eating but mostly is determined by your genetics. Many patients choose not to take statins due to the potential side effects. It can be difficult to reach the desired cholesterol numbers without pills but as always, your physician will weigh the risks and benefits but ultimately it is you will make the final decision about taking medication. In the meantime, some of these lifestyle suggestions should help!
Here are a few ways to naturally control blood pressure and LDL/HDL cholesterol:
- Get it together. Feelings of stress, anger, emptiness, despair and anxiety can lead to blood pressure elevation which is called Essential Hypertension. Essential Hypertension indicates there is no specific medical reason. One of the questions asked on the diabetes assessment is “how well do you deal with stress?” since it can influence your overall health. Challenge yourself if you suffer from these conditions by learning to meditate. There are free internet sites which will encourage you with uplifting messages or soft music. There are local mediation classes offered at the YMCA and neighborhood community centers. You can even find a quiet place to sit with no distractions and focus “on absolutely nothing”. This helps free your mind of the constant chatter which never allows you to fully relax and often adds to the stress. Consider getting acupuncture which is an ancient Chinese technique of placing thin sterile needles in certain body meridians to lower cortisol levels and stress. Develop your own plan by trying yoga, deep breathing or Tai Chi. If you are not making progress against your negative feelings, consider seeking help from a trained mental health therapist or social worker. They may recommend support groups, group or individual counseling or medication.
- Quit Smoking or never start. Blood pressure and heart rate will decrease when smoking stops. HDL levels rise to protect heart health. After one year of no smoking, your heart disease risk goes down by 50% and after 15 years you will have a similar risk of never having smoked.
- Happy hour or not. Drinking too much alcohol can affect blood sugars as well as increasing blood pressure, risk of stroke and heart failure. Moderate alcohol intake may lead to raising HDL values (good cholesterol) but the advice is “do not start drinking solely for this purpose”. After you discuss your situation with your health care provider, the guidelines remain – one alcoholic beverage for a female or male 65 or over and two beverages for a younger male. People often drink more alcohol when under stress which can play havoc with your blood chemistry and pressure. Always watch total ounces and mixers for the least impact on all your numbers.
- Forget about sitting and move. The above patient walked daily for 30-40 minutes and now became afraid to lose more weight so he stopped walking completely. We reviewed basic exercises including walking, swimming and bike riding. Getting back at it will have a huge impact on blood sugar, blood pressure and cholesterol values but little affect on weight loss (if done with low intensity). He agreed to start back immediately. Even adding 10-minute intervals several times a day will help. Stand up for 5 minutes for every hour you do of sitting. Walk after every meal; just a 2-minute walk can help blood chemistry numbers. Take the stairs, walk to the store and just become more active.
- Modest weight loss. As with diabetes, both blood pressure and LDL cholesterol numbers will generally decrease with modest weight loss between 5-10 percent of your total body weight. Pay attention to mindless eating. Get a support system or take control on your own. Find out what your biggest challenge to weight reduction is and work to tackle it. Start with small changes that you can build on. Reward yourself with anything except food.
- Sleep. I often counsel patients with chronic sleep problems including insomnia or sleep apnea which elevate blood sugars, blood pressure and cholesterol. Poor or restless sleep can lead to high numbers. Find techniques which may help you sleep better including a cool, dark and quiet room, not exercising for 2 hours prior to sleep, having a light snack including a protein and carbohydrate 30 minutes prior to sleep and shutting down electronic devices 2 hours before bed. If these or other OTC basic remedies do not work, it is important to talk to your physician about a sleep study. This may lead to a sleep apnea diagnosis (common with diabetes) and Be concerned with what you eat. As my patient realized, eating just to put weight on can be dangerous to your health. The focus on improved blood pressure includes reducing sodium to 1500mg a day. Although not everyone is salt sensitive, this remains the current guideline. Learn to read labels, limit deli meats, prepared chicken, frozen meals and packaged goods. Restaurants often add extra sodium for flavor. Try to prepare home-cooked meals as much as possible so you are aware of all ingredients. Diet sodas and seltzer water are high in sodium. Think about the DASH or Mediterranean diet. As for helping cholesterol levels, decrease saturated fat including butter, fried foods, whole fat cheese, milk and fatty meats. There is a current controversy regarding saturated fat intake, so check with your physician for the best advice. Completely eliminate trans-fats which have recently been banned by the FDA and will slowly be removed from all foods. Trans-fats are usually present in bagged and boxed foods along with many fast foods. Avoid partially hydrogenated oils. Choose foods high in Omega 3 fatty acids including salmon, mackerel, herring, sardines, trout, tuna, Chia, hemp, flax seeds, almonds and walnuts. These foods can elevate HDL s, lower triglycerides and reduce blood pressure. Eat fiber, especially soluble fiber which can lower LDL levels. Add oatmeal, beans, vegetables, lentils, oat bran and fruits to your daily plan.
If these life style adjustments are not enough to get your numbers where they need to be, work with your health care provider to find the best balance of medication and lifestyle for you. Remember you may still require medications but the doses will certainly be lower than if you had made no changes!
NOTE: Consult your Doctor first to make sure my recommendations fit your special health needs.
She is a member of the American Diabetes Association as well as the South Florida Association of Diabetes Educators. She worked with the education department of NBMC to help educate the hospital's in-patient nurses about diabetes. She practices a healthy lifestyle and has worked as a personal fitness trainer in the past.
She was one of the initiators of the North Broward Diabetes Center (NBMC) which started in 1990 and was one of the first American Diabetes Association (ADA) certified programs in Broward County, Florida for nearly two decades. Robbie has educated patients to care for themselves and has counseled them on healthy eating, heart disease, high lipids, use of glucometers, insulin and many other aspects of diabetes care. The NBMC Diabetes Center received the Valor Award from the American Diabetes Center for excellent care to their patients. Robbie has volunteered over the years as leader of many diabetes support groups.