By Richard Jackson, MD, Joslin Diabetes Center

Heart disease is the leading cause of death in people with diabetes as well as those without. However, recent clinical trials show that it is possible to reduce this risk. Taking these steps to reduce your risk of heart disease will also reduce your risk of stroke and problems with the circulation to your legs—which can protect you from other serious problems like foot ulcers, infections and amputations.

Where Do You Start?

There is so much that you need to do to take care of your diabetes that often it is hard to know where to start. This is where a careful review of your current risk factors, and a meeting with a member of your health care team, can pay off. You may find that in some areas you are doing fine but need to make some changes in others. Don’t try to do everything at once, but pick a few places to start.

Take a few minutes to review each of these different areas. If you don’t know your blood pressure, LDL or A1C results, ask your health care provider’s office for your most recent results. You can’t plan where you are going if you don’t know where you are starting. It is likely that you will find that for some of these factors, you are already in a safe place. For example, you don’t smoke or your blood pressure is very good. For some of the risk factors, you may not be in a safe range. These are where you can make some changes to reduce your risk for heart disease.

How your health care team can help you

Sit down with your health care provider and review your risk factors. Choose some actions that will lower the one or two specific risk factors that you are targeting and set a time to assess your progress. If your risk factors have moved into a safer range, then you are on the right track. If they haven’t changed much, work with your health care team to choose some other approaches. Remember that your health care team includes your doctor, nurse practitioner or physician’s assistant, but there are other key team members who can help you reach your goals.

Worried about the number of pills that you might be taking, whether they work well together, or are causing side effects? Ask your Walgreens pharmacist. Many people with diabetes do not take all of their medications regularly. Your pharmacist can provide you with some practical suggestions. This might involve a different medication, changing the timing of your medications or using new combinations of medications.

Dietitians are important but often overlooked members of your health care team. Too often you feel guilty about the foods that you eat or about your weight; “I know what I need to do, I just need more discipline.” Perhaps your problem is that your approach to food makes the problem seem overwhelming. Instead of trying to eat perfectly, your health will probably benefit from just a few changes. Ask your dietitian for help. Is your LDL cholesterol high? Your dietitian can help you focus on changing the type of fat you eat, for example. If blood pressure is your main problem, plan to increase your fruit and vegetable intake and lower your sodium intake. A dietitian can show you how.

If you have chosen to do more physical activity, ask for advice from an exercise physiologist. He or she can help you develop a plan that is realistic and fits with your lifestyle and schedule.

Feeling stressed? It’s normal to feel overwhelmed and anxious about having diabetes. Stress has also been linked with heart disease. Seek help from a mental health counselor, who may be a social worker, psychologist or psychiatrist.