How to reduce your risk of complications by up to 75%.

(also known as: Dr. Blumer's Ten Golden Rules for Preventing Complications)

People routinely ask me if there will be a cure for diabetes anytime soon. Well, I wish I could say there is something just around the corner, but I'm afraid if there is, it's a pretty long block. But, let me stress that even if research stood still; even if we never had better therapy than we have right now; we (note that I am including you when I say we) have the means today to REDUCE YOUR RISK OF COMPLICATIONS FROM DIABETES BY UP TO 75 PERCENT!

The following recommendations apply to the great majority of people with diabetes, but not to every single person. (Note that the list does not include those measures - like seeing an eye doctor regularly - that you can use to reduce progression of already existing complications).

So then, here are my TEN GOLDEN RULES FOR PREVENTING COMPLICATIONS:
  1. Eat healthfully
  2. Don't smoke and don't drink excess alcohol.
  3. Exercise.
  4. Achieve and maintain a proper weight.
  5. Maintain excellent blood glucose levels (4 to 7 before meals, 5 to 10 two hours after meals, A1C under 7 percent).
  6. Keep your LDL cholesterol under 2.0
  7. Keep your blood pressure no higher than 130/80.
  8. If you are over the age of 55 and/or at risk of a heart attack or stroke, take an ACE inhibitor.
  9. If you have high cholesterol or are 40 or older, take a statin.
  10. Take an aspirin a day.
Uncertain about the details? Have a look at my Top Ten List as well as other pages on this site. Below, I answer a few questions that might arise. (Most questions that might arise are answered on a variety of other pages on this site). As much as I hate to sound like a broken record, I'll say again; please remember that not all these answers apply to everybody. 

Are all these recommendations realistic? 
Yes. But it isn't easy to achieve them all.
 
Am I doomed if I am unable to achieve these targets?
Most definitely NOT. Even if you do not achieve all these targets, the closer you come to them, the more you reduce your risk of complications. So, aim for the stars and if you don't get there, be reassured that with each step in that direction you have improved your chances of avoiding complications and premature death. 

Are ARBs (such as Diovan) as good as ACE inhibitors (such as ramipril)? 
Probably, but we don't know this for certain. 

Should I take an ACE inhibitor (such as ramipril) if I'm under 55? 
It depends on your individual circumstances. For example, If you have certain other health problems such as microalbuminuria, then yes, you should. 

Should I take a statin (such as Lipitor) if I'm under 40? 
You should if your LDL is 2.0 or higher (unless you are considered at low risk of heart disease such as if you are very young). 

Should I take 81 or 325 mg of aspirin a day? it probably doesn't matter. 81 is likely just as good as 325 and probably not as likely to cause stomach upset. 

What about my HDL and triglycerides? 
Most studies have paid more attention to LDL and we have a clearer idea of the importance of its role in hardening of the arteries (atherosclerosis). Worry about the LDL first; then the HDL and triglycerides.
 
What is "excess" alcohol? 
Max is 1 drink per day for a woman; 2 per day for a man. Alcohol has some health benefits (on lipids for example), but provides unnecessary calories and - you may find this surprising - puts you at risk of low blood sugar (hypoglycemia) because it blocks release of glucose from the liver. Also, if you are experiencing hypoglycemia and you are inebriated (a fancy word for, ahem, drunk) then you are not going to be as likely to detect the typical symptoms of hypoglycemia and you may not take appropriate corrective action (such as taking Dextrosol or drinking juice). If you've had a few drinks in the evening, it would be wise to set your alarm to test your blood glucose during the middle of the night. Also, when consuming alcohol, make sure you've had some food with it. Cheers!