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DIABETES-HEART DISEASE, BLOOD GLUCOSE

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Diabetes+Heart Disease – An Intimate Connection

A strong link between diabetes and heart disease is now well established. Women with diabetes have an even greater risk of heart disease compared with those of similar age who do not have diabetes. In fact, cardiovascular disease leading to heart attack or stroke is by far the leading cause of death in both men and women with diabetes. Another major component of cardiovascular disease is poor circulation in the legs, which contributes to a greatly increased risk of foot ulcers and amputations.

Several advances in the treatment of heart disease over the past two decades have improved the chances of surviving a heart attack or stroke. However, as the incidence of diabetes steadily increases, so has the number of new cases of heart disease and cardiovascular complications. Unfortunately, in patients with diabetes, improvement in survival has been less than half as much as in the general population.

Why Is Heart Disease So Common in People With Diabetes?

Diabetes by itself is now regarded as the strongest risk factor for heart disease; however, a variety of mechanisms—not solely blood glucose levels—most likely come into play. The blood vessels in patients with diabetes are more susceptible to other well-established risk factors, such as smoking, high cholesterol and high blood pressure, and more than 90% of patients with diabetes have one or more of these additional risk factors.

Some of the increased susceptibility to blood vessel damage that people with diabetes have could be due to the long-term effects of inadequate control of blood glucose levels on the tissues or as a result of other cell damage related to diabetes. There is also evidence that being overweight, having a sedentary lifestyle and poor blood glucose control contribute to the increased chance of high blood pressure and abnormalities in blood lipids (i.e., high cholesterol, high triglycerides and a low level of HDL cholesterol—the “good” cholesterol.

Research on the role of additional risk factors is being conducted. Evidence shows that patients with diabetes have an increased level of low-grade inflammation of their arterial lining, a process that initiates the blood vessel changes leading to heart disease. Some of the new tests to assess this inflammation are being evaluated, including C-reactive protein and homocysteine.

How to Prevent or Delay Heart Disease

The best way to prevent or delay the development of cardiovascular disease is to prevent diabetes itself. People with increased risk for diabetes can be identified. A large National Institutes of Health-sponsored study, the Diabetes Prevention Program, and other studies have proven that modest weight reduction and a 30-minute exercise routine five days a week can reduce the development of type 2 diabetes over three years by more than 50%. Moreover, even people at risk for diabetes or those with prediabetes, in addition to those with diabetes, frequently have abnormalities in blood pressure and lipid levels that can be detected and treated to prevent cardiovascular disease.

Weight control and smoking cessation are two important lifestyle measures that have an impact on preventing heart disease. Studies show that even in overweight people, regular physical activity has major cardiovascular benefits.

In the last 10 years, large-scale research studies around the world have shown that optimal control of LDL cholesterol (the “bad” cholesterol) and blood pressure can prevent adverse cardiovascular outcomes by 30% to 50%. The American Diabetes Association and the American Heart Association recommend an LDL cholesterol goal in all adults with diabetes at less than 100 mg/dl. In people who already have heart disease, a more desirable LDL cholesterol goal should be less than 70 mg/dl, based on evidence from more recent studies. The blood pressure goal in all patients with diabetes is less than 130/80. In most patients with diabetes, reaching these targets for blood pressure could require two or more medications. Fortunately, we have safe and effective medications available to help patients meet their lipid and blood pressure goals.

In addition, good control of blood glucose levels and low-dose aspirin can add to these benefits. For A1C tests—a measure of average blood glucose levels over the preceding two to three months—the goal is less than 7%..

Take Action

To sum up:  there’s no totally certain way to avoid heart disease and circulation problems. But there are lots of things to do to cut your risk.

  • If you smoke, stop.
  • Lose weight if you are overweight
  • Keep your blood pressure in the proper range
  • Get regular physical activity
  • Keep your blood fats and cholesterol levels in a healthy range
  • Keep your blood glucose under control

Stop Smoking

This is the single most important thing you can do! Nicotine narrows and restricts blood vessels. So does having diabetes. You can’t change having diabetes. But you can stop damage caused by nicotine. Join a stop smoking group. Get support. Plan to quit. Cut back. And then, stop!

Lose Weight If Overweight

Being overweight tends to increase your blood glucose, blood pressure and blood fat levels. Even a modest 10-20 pound weight loss will improve your levels. To lose weight, skip crash weight loss programs. Emphasize eating healthy foods that are low-fat and high-fiber and increase your physical activity. These will help keep your blood glucose and blood fat levels in a healthy range. Check with your healthcare provider to determine how to safely increase your physical activity.

Keep Blood Pressure in Control

High blood pressure increases the risk of stroke. Have your blood pressure tested at least twice a year. If your blood pressure is over 130/80, lose weight. This is a lower target than for people who don’t have diabetes. Follow a low-salt meal plan. Increase your physical activity. And ask your healthcare provider about medications to lower blood pressure.

Get More Physical Activity

Physical Activity keeps your heart healthy, and helps keep blood glucose and blood fat levels in control. So don’t be a couch potato. Talk with an exercise specialist to start a sensible physical activity program. Be sure to check with your healthcare provider before beginning or increaseing you physical activity program. Also be sure to ask if there are types of exercise you should not do because of other diabetes complications you have.

Define a set schedule for physical activity. Put it in your calendar. Stick to it. You’ll be surprised how much better you feel!

Keep Your Blood Fats and Cholesterol in Control

High levels of blood fats, including cholesterol, increase the risk of heart disease. Because you have diabetes, you are more likely to have high blood fat levels. So pay special attention! Know your blood fat levels. There is now proof that lowering levels of so-called bad cholesterol (LDL cholesterol) in persons with diabetes greatly lowers the risk of a heart attack. Your target levels should be lower than those of someone without diabetes.

Your level of HDL (so-called good cholesterol) should be greater than 40 for men and  greater than 50 for women. Your level of LDL (so-called bad cholesterol) should be under 100. Your triglyceride level (another bad fat) should be under 150.

To reach these goals, follow a low-fat, high-fiber, lower calorie meal plan — weight loss decreases blood fat levels. See a dietitian for help. Get more physical activity, because physical activity lowers levels of bad fats and increases levels of good fats. Blood fat lowering medications may be needed if your cholesterol levels don’t respond to these treatments.

Keep Blood Glucose in Check

Monitor your blood glucose regularly (according to how you were taught). Know how to take action based on your blood glucose checks. Know how to adjust your medication, exercise and meal plan if plasma blood glucose is unusually high (higher than 180 mg/dl two hours after eating or higher than 130 mg/dl before eating) or unusually low (lower than 70 mg/dl or below 90mg/dl with symptoms). High blood glucose increases the risk for all other complications of diabetes, so it’s important to know your blood glucose levels.

Know your target A1C. Hemoglobin A1C is a blood test your healthcare provider performs to tell how well your blood glucose has been controlled over the past two months or so. Your A1C should be lower than 7%. If it is running higher than 7% and nearer to 8.0%, or even higher, ask your diabetes treatment team for help with your treatment plan.

High Blood Glucose: What It Means and How To Treat It

What is high blood glucose?

People who do not have diabetes typically have fasting plasma blood glucose levels that run under 100 mg/dl.

Your physician will define for you what your target blood glucose should be — identifying a blood glucose target that is as close to normal as possible that you can safely achieve given your overall medical health. In general, high blood glucose, also called ‘hyperglycemia’, is considered “high” when it is 160 mg/dl or above your individual blood glucose target. Be sure to ask your healthcare provider what he or she thinks is a safe target for you for blood glucose before and after meals.

If your blood glucose runs high for long periods of time, this can pose significant problems for you long-term — increased risk of complications, such as eye disease, KIDNEY DISEASE, heart attacks and strokes and more. High blood glucose can pose health problems in the short-term as well. Your treatment plan may need adjustment if the blood glucose stays over 180 mg/dl for 3 days in a row. It is important to aim to keep your blood glucose under control, and treat hyperglycemia when it occurs.

What are the symptoms of high blood glucose?

  • Increased urination
  • Dry mouth or skin
  • Tiredness or fatigue
  • Blurred vision
  • More frequent infections
  • Slow healing cuts and sores
  • Unexplainedweight loss
  • Too much food
  • Too little exercise or physical activity
  • Skipped or not enough diabetes pills or insulin
  • Insulin that has spoiled after being exposed to extreme heat or freezing cold
  • Stress, illness, infection, injury orsurgery
  • A bloodglucose meter that is not reading accurately
  • Be sure to drink plenty of water. It is recommended to drink a minimum of 8 glasses each day.
  • If your blood glucose is 250 or greater and you are on insulin, check your urine forketones. If you have ketones, follow your sick day rules or call your healthcare team if you are not sure what to do.
  • Ask yourself what may have caused the high blood sugar, and take action to correct it. Ask yourhealthcare team if you are not sure what to do.
  • Try to determine if there is a pattern to your blood glucose levels.
    • Check your blood glucose before meals 3 days in a row.
    • If greater than your target level for 3 days, a change in medication may be needed.
    • Call your healthcare team or adjust your insulin dose following well day rules.
    • Call your healthcare team if you are currently using diabetes pills.

Determine why your blood glucose is high

Ask yourself the questions outlined below. The answers will give you the information you need to determine what to do about the hyperglycemia.

 

Causes

Ask These Questions

Take Action

If your answers to the questions are yes, follow these
suggestions.
Food Have you increased your portion sizes? Have you changed
your eating habits or food choices? Have you eaten too many high-fat foods?
You may need to measure food more accurately to check portion
control. If you think your eating pattern is changing, your medication
or exercise plan may need to change.
Activity Have you decreased or eliminated your usual activity? Are
you doing too little physical activity?
Physical activity is a key to BLOOD
GLUCOSE CONTROL. Ask your healthcare team about starting a program.
Medication Have you been taking the prescribed doses? Have you been taking the
medication at the right time? Do you have “spoiled” insulin?

  • Does your insulin look different?
  • Was your insulin exposed to very hot or cold temperatures?
  • Has your insulin expired?
Take the right dose at the right time. If you have any questions
ask a diabetes educator.   Throw away the bottle and open a new bottle.
Check the expiration date on bottle.
Monitoring Is the drop of blood too small? Are you using the correct
technique? Could your meter be dirty? Have your strips expired? Have your
strips been exposed to very hot or cold temperatures or not been kept
in an airtight, dry, container? Is your meter calibrated to the current
bottle of strips?
See a nurse educator to be sure your technique is correct
and your meter is functioning the right way. Learn how to clean the meter.
Throw away the strips and get a new bottle. Check the code on the strip
bottle.
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