Breast-feeding by nursing mothers, and eating and drinking milk products by men and women have been shown to lower weight, increase insulin’s ability to work, and reduce the risk for type 2 diabetes. 

BREAST-FEEDING
One of the studies, looking into the link between breast-feeding and lowering of risk for type 2 diabetes, appeared in the Journal of American Medical Association in 2005. The study covered more than 157,000 mothers who breast-fed their babies. The researchers found that each year of breast-feeding reduced the mother’s risk of developing type 2 diabetes by 15 percent in the next 15 years. Scientists believe that breast-feeding influences milk secretion in nursing mothers, which somehow improves insulin efficiency, contributing to long-term protection against type 2 diabetes.

 Breast-feeding not only helps the mothers to reduce their risk for diabetes, it also helps reduce the risk in breast-fed children. A study involving more than 1, 5000 boys and girls (9 to 14 years old), was conducted by the Harvard School of Public Health to look into the relationship between breast-feeding and weight increase. The study results published recently in Diabetes Care have shown that babies who were breast-fed during the first year of life, even when their mothers were obese and had diabetes, were less likely to become obese as they grew older. A healthier weight in these people reduced their risk for type 2 diabetes nearly by 15 percent.

 MILK AND OTHER DAIRY PRODUCTS
Several studies, including the one appearing in the journal Obesity Research in 2004, showed that consumption of dairy foods such as milk, cheese, and yogurt has a weight lowering effect. Weight loss, in turn, reduces the risk for type 2 diabetes.

Evidence has emerged, proving that when you follow a low calorie eating plan, and include at least 3 cups (8-ounce each) of fat free or low fat milk daily, you will achieve accelerated weight loss. Research suggests that it is calcium present in milk that speeds up the natural burning of body fat while maintaining muscle mass. Interestingly, the research has also shown that using calcium supplements is not as effective in cutting down excess weight as taking milk, cheese, or yogurt, which are rich in calcium.

 Here is more. An article published in the Journal of the American Medical Association in 2002 reported a Harvard Medical School study, which showed that overweight young adults who drink milk and eat more dairy products may be at reduced risk of developing insulin resistance. Lowering of insulin resistance cuts the risk of developing type 2 diabetes.

 You may try to achieve your weight management goals by following daily a low-calorie diet, comprising of at least 3 cups of milk or an equivalent combination of milk, cheese, and yogurt. (1 cup of milk equals 1 cup yogurt or 1 to 1.5 ounces of natural cheese such as Cheddar or Mozzarella.). Do not forget to include exercise on a regular basis in your weight management plan.

Raised LDL (bad) cholesterol is the key factor contributing to heart and blood vessel diseases, and it is now regarded as the most reliable indicator of the risk for heart attack and stroke.  Even if total cholesterol and HDL (good)cholesterol are in the desirable ranges, raised LDL- cholesterol poses a high risk for heart disease. Most people with diabetes, especially type 2, tend to have cholesterol disorder and are two to four times more likely to have a heart attack or stroke than the general population. However, a good control of blood cholesterol has been shown to reduce this risk by 20 to 50 percent.

Miracle Substances 

Science has discovered powerful food substances that naturally and remarkably reduce unhealthy cholesterol in your blood. These substances called plant stanols/sterols help you achieve significant reduction in the risk for heart attack and stroke. To provide stanol/sterol in diet, these substances are extracted from their natural sources and mixed in various food products such as margarines spreads, milk, yogurt, cheese, orange juice, cookies, chocolates, chips, and salad dressings. Choose any of these products according to your taste buds. The products are now easily available in many food stores in the United States. Plant stanols and sterols are also available in the form of  tablets and capsules as dietary supplements, but they may not fully dissolve in the digestive tract.

What are Plant Stanols /Sterols? 

Simply stated, plant stanols and plant sterols are “cholesterol” found in plants just as cholesterol is found in your blood. Plant stanols and sterols occur in tiny amounts in many fruits, vegetables, nuts, seeds, legumes, wood pulp, and plant oils such as soybean and pine tree oils. Although plant stanols and sterols are similar to cholesterol in their structure; they have a unique feature: unlike cholesterol, they are not absorbed or absorbed poorly by your body. 

How Do These Substances Work? 

Plant stanols and sterols help reduce your total cholesterol and LDL (bad) cholesterol in two ways. First, these substances, working through a number of mechanisms in the digestive tract, prevent the body from absorbing cholesterol from food. Second, in the absence of cholesterol absorbed from food, the liver uses up LDL cholesterol from the blood for digestion. Both these effects contribute to lowering of total cholesterol and LDL cholesterol, leading to significant reduction in the risk for heart attack and stroke. 

 Important Facts 

Here are some important facts about cholesterol-lowering power of pant stanols and sterols:  

• These substances lower LDL (bad) cholesterol, but do not affect HDL (good) cholesterol and triglyceride.

• A daily food serving with 2 grams of plant sterol or stanol, as recommended by the National Cholesterol Education Program, lowers LDL (bad) cholesterol
  up to 14 percent. Taking these substances in higher doses, however, has not been shown to achieve any extra benefit.

•  A study published in the European Journal of Clinical Nutrition in 2000 reported that taking the recommended amount of these plant compounds in one single meal or spread over several meals a day has a similar cholesterol-lowering effect.

•  Foods with plant stanol or sterol  may be added to cholesterol-lowering medicine of the statin family(such as Lipitor, Zocor) to achieve accelerated reduction in LDL cholesterol. Such a combination has been shown to achieve an additional 17 percent reduction in raised LDL cholesterol levels.

• Adding stanol/sterol enriched foods to a medicine of the statin family is more effective and safe in lowering cholesterol than doubling the dose of the medicine.

• Both plant sterols and stanols are equally effective in reducing raised LDL cholesterol. Some food preparations contain plant stanols, others add sterols
  (see their nutrition facts labels). You can choose either of the two for getting cholesterol-lowering benefit.

• To get maximum cholesterol reduction from these substances, follow a low fat, low cholesterol diet. 

• A 2006 review published in The International Journal of Clinical   Pharmacolog   and Therapeutics suggests that eating foods enriched with stanols and sterols  leads  to a 20 percent   reduction  in the risk for heart disease. 

• A research article appearing in the American Journal of Clinical Nutrition in 2006 indicates that consumption of  low calorie foods fortified with these compounds may significantly cut raised CRP  (C-reactive protein) levels in the blood, reducing the risk for heart disease.  CRP is an indicator of inflammation in the body; its raised levels are now regarded as a strong risk   factor for coronary heart disease. 

•  The American Heart Association suggests that people whose LDL-cholesterol levels are high may consume stanol-sterol-enriched foods as part of treatment to lower their LDL. By this recommendation, the following people may consider to consume foods fortified with plant stanols and sterols:

• Those with total cholesterol of 200 mg d/dL (5.2 mmol/L) or above.
• Those with LDL cholesterol of 130 mg/dL(3.3 mmol/L) or higher.
• People with diabetes whose LDL cholesterol is 100 mg/dL (2.6mmol/L) or higher.  

 To continue with cholesterol reduction from plant stanols or sterols,you should consume foods fortified with these substances every day.  

Limitations of Stanols/Sterols 

 Research has not shown any serious side effect from consumption of plant sterols and stanols. However:  

• Long-term use of these substances may cause lowering of beta carotene levels in the blood. Beta carotene (which gives carrot its yellow color) is an antioxidant that performs many important functions including protecting your body from damaging chemicals called free radicals. Studies, however, suggest that eating  dark green and yellow colored vegetables and fruits every day in a sufficient quantity will cancel any beta carotene deficiency occurring from consuming stanols and sterols.
• One study published in the Journal of the American College of Nutrition in1999  reported mild gastrointestinal complaints from the use of  plant stanols/sterols in a few young children. 

Source: M.K.Ansari, Ph.D. Unusual Methods of Preventing Diabetes and Related Complications, eBook, 2011. 

High blood pressure (140/90 mmHg or higher) is recognized as one of the risk factors for developing type 2 diabetes. In addition, long-standing high blood pressure is a strong risk factor for heart attack and stroke.

More than 25 percent of adults in the world have high blood pressure. In people with diabetes, high blood pressure is about two times more common than the non-diabetic people. The coexistence of high blood pressure with diabetes is critical because such a combination increases the chances of having a heart attack, stroke, kidney failure, blindness, and amputation of legs and feet.

The standard methods to control blood pressure include adopting healthy lifestyle measures such as reduced intake of salt, low- fat, low- cholesterol diet, regular exercise (preferably walking), weight loss if overweight or obese, no smoking, sparing use of alcohol if you drink, relaxation to cope with stress, and addition of medication when necessary. A variety of drugs are available to treat high blood pressure, and many people,   including people with diabetes, have to take several drugs at a  time for controlling high blood pressure.

Here is, however, a novel method that helps control high blood pressure. Research has found that drinking beetroot juice significantly lowers high blood pressure. An article appearing in the American Heart Association journal Hypertension in June 2010 has reported a study carried out in England, which found that people who drank just 250 mL of beetroot juice had a significant reduction in their blood pressure. The reduction in blood pressure occurred within 1 hour of drinking the juice, and some of the blood- pressure lowering effect continued up to 24 hours.

The investigators found that it is the nitrate content in the beetroot juice that causes lowering of high blood pressure. Nitrate is a chemical compound that dilates blood vessels, resulting in smoother flow of blood with reduced pressure in the blood vessels. The researchers also noted that the higher the blood pressure was at the start of the study, the greater the decrease caused by the nitrate.

Dietary nitrate in the beetroot juice may be a natural approach to control high blood pressure. However, it will be a good idea to talk to your doctor before using beetroot juice as a blood pressure-lowering remedy.

Source: M.K.Ansari. Unusual Methods of Preventing Diabetes and Related Complications, eBook, 2011.

Excretion of excess amount of protein (albumin) in the urine is an indicator of kidney damage, and it is now recognized as a strong predictor of heart disease. To check  the the presence of protein in urine,you can give a spot urine sample at a aboratory at any time of the day. Protein excretion between 30 to 299 mg per day is called microalbuminuria, a condition that indicates that the tiny vessels of the kidneys have been affected. Even moderate kidney disease has been shown to increase the risk for heart attack and stroke. According to an estimate, more than 60 million people in the world have some degree of chronic kidney disease that significantly increases their risk of death from heart attack and stroke. This risk becomes extremely high in people with kidney failure who are on dialysis. Kidney dysfunction (probably because it impairs filtration of body wastes) tends to cause increased inflammation in the coronary arteries. As a result, the arteries become hard and narrow, and the chances of heart attack become very high.

TREATING PROTEIN EXCRETION
The measures listed below help treat excretion of protein in the urine, thereby significantly reducing the risk for heart disease and kidney failure:

• Reduction and control of high blood pressure.

• Controlling blood cholesterol.

• Limiting daily protein intake to 0. 6 gram per 1 kg of body weight.

• Taking an ACE inhibitor class of drug every day. These drugs include enalapril (Vasotec) and ramipril (Altace).

• Timely treatment of urinary tract infections.

• Care in using pain-relieving drugs of the NSAID class such as Advil, Voltaren, and Motrin.

As in preventing heart disease (coronary heart disease); two measures are of primary importance in its treatment:

FOLLOW HEALTHY LIFESTYLE
Eat healthy, lose weight if you are obese or overweight, be physically active (after consulting your doctor), and avoid smoking.

MODIFY THE RISK FACTORS
As in preventing heart disease,the first step in its treatment is to control the risk factors. This means, for example, that you should control your blood sugar, blood pressure, and blood cholesterol.

When nutrition, lifestyle modifications, and management of other risk factors fail to control heart disease, the doctor may add medicines. In extreme cases, surgery may be required to clear blockages in the coronary arteries. However, keep in mind that a healthy lifestyle is of primary importance in preventing and treating heart disease. Even when heart disease is treated with drugs or surgery, a healthy lifestyle must remain in place or the benefits of treatment will be lost.

DRUG TREATMENT
There are no drugs that can directly reverse heart disease. Drugs are given for relieving the symptoms of angina, and to reduce the risk of heart attack. These drugs include:

Nitroglycerin
Nitroglycerin dilates coronary arteries temporarily. The dilation allows an increased amount of blood and oxygen to pass through the blocked arteries, an effect that relieves angina and lowers high blood pressure. Nitroglycerin medications are available in two forms: quick-acting and long-acting. The quick-acting nitroglycerin includes nitroglycerin tablets for use under the tongue (sublingual) or in the cheek (buccal), and sublingual sprays. These medications are used to treat angina that has already occurred. The long-acting nitroglycerin, on the other hand, is used to prevent angina from occurring, which include: isorbide dinitrate and sorbide mononitrate tablets or capsules for swallowing, and ointment and time released medicated patches for application to the skin. Because constant use of nitroglycerin tends to lessen its effect in the body, give a gap of at least 8 to 12 hours in its use during every 24 hours to get good results.

Blood Pressure-Lowering Drugs
Blood pressure-lowering drugs belonging to the classes of beta-blockers and calcium channel blockers reduce the heart’s need for oxygen during physical activity.  Such an effect helps prevent the onset of angina and reduce its intensity if it occurs.

Heart Protective Medicines
Several heart protective medicines such as aspirin, clopidogrel (Plavix), ACE inhibitors (such as enalapril, ramipril), and ARBs (such as  losartan) are available.
Aspirin and clopidodrel (Plavix) help prevent the formation of blood clots, an action that reduces the risk for heart attack. Regular use of low strength aspirin, 75 to325 mg per day, has been shown to reduce the risk for heart attack and stroke.

ACE inhibitors and ARBs (noted abovel) are drugs that provide heart protective effect by blocking the production of a hormone called angiotensinII. (Excess of angiotensinII contributes to formation of blockages and weakening of heart muscle.)

A study published in the British Medical Journal suggests that preventive medication can reduce the risk for heart attack and stroke by more than 80 percent. The doctor will decide if you are a candidate for such treatment; if yes, he or she will choose a drug that will be right for you

Cholesterol-Lowering Drugs
Strong evidence is emerging that when raised LDL (bad) cholesterol is treated with strong doses of cholesterol-lowering medicines of the “statin” class (such as Lipitor, Zocor), blockages in the coronary arteries decrease. Such a reduction in clogging helps reduce the risk of heart disease.

HEART SURGERY
Angina not relieved by life-style changes, nutrition, and drug therapy is a sign that coronary heart disease has already become fairly severe. In such situations, surgery may be the only option left for treatment of angina. Before performing heart surgery, the doctor orders an angiogram to find out the location and the extent of blockages in the coronary artery or arteries.

Surgery options may include procedures such as balloon angioplasty or coronary stenting or both, or bypass surgery. (To be discussed in detail later).
Today, technological advances made in these procedures have brought a revolution in heart disease treatment.

A healthy diet and healthful life- style changes play a key part in preventing and lowering high blood pressure. A healthy diet is low in total fat, saturated fat, trans fat, and cholesterol; and high in potassium, magnesium, calcium, and fiber. Follow the Eat-Right model for healthy eating. The low fat, low cholesterol, and high fiber diet (balanced by daily exercise) suggested in this model helps  not only control blood pressure, but also reduces the risk of chronic diseases. When modification of diet and life style measures alone is not enough to control high blood pressure, medication may be added.

The measures outlined below are effective in preventing and lowering high blood pressure.

Reduced Salt Intake
Salt has a direct effect on raising blood pressure. The more you reduce your salt intake, the greater will be the reduction in your blood pressure.

• When you reduce your salt-intake, your systolic blood pressure will decline even without weight loss.

• Reduced intake of salt will cut the dose of your blood pressure medication.

• People with and without diabetes should limit their daily salt intake to less than 2,300 mg of sodium (less than 1 teaspoon of salt). An average person’s daily need for salt can be met even by less than 1/4 teaspoon of salt.

• People with diabetes who are salt sensitive should especially restrict their salt intake.

Increased Potassium Intake
Potassium-rich diets reduce high blood pressure. The recommended intake of potassium for adults and adolescents is 4,700 mg per day. You should get your potassium from food sources.

Exercise
Regular physical activity has been shown to lower high blood pressure.

• Regular aerobic exercise of moderate intensity such as brisk walking for at least 30 to 60 minutes every day will reduce your high blood pressure, especially systolic blood pressure.

• Also, a brisk walk will help you cope with stress, resulting in reduction of high blood pressure.

Weight Loss
Excess weight is strongly related to high blood pressure.

• Weight loss even without salt restriction will lower high blood pressure.

• Weight reduction even by a few pounds (5 to 10 pounds) generally reduces high blood pressure, and also has a favorable effect on blood sugar and blood fat levels.

• A healthy weight range of BMI 18.5 to less than 25 is helpful in controlling blood pressure.

• Waist measurement not exceeding 40 inches in men, and not exceeding 35 inches in women help blood pressure control.

Stop Tobacco Smoking
If you smoke, you must quit smoking because:

• Tobacco smoking raises blood pressure, harms red blood cells, and is a strong risk factor for heart disease, lung disease, and stroke.

• Each cigarette you smoke raises your blood pressure.

• If you continue smoking and also take medications to control high blood pressure, you will still be exposed to the risk of heart attack and stroke.

Moderate Use of Alcohol
Excessive consumption of alcohol raises blood pressure, reduces the effect of blood pressure medications, and increases the risk for stroke. So:

• If you choose to drink alcohol, drink in moderation after consulting your doctor.

• If you drink alcohol in excess, reduce its intake gradually; abrupt reduction or withdrawal of alcohol can raise your blood pressure.

Relaxation
Sympathetic nerves are a part of your nervous system. Arousal of the sympathetic nerves causes stress, increases your heart rate, and raises your blood pressure. Relaxation techniques such as deep breathing are helpful in reducing the intensity and duration of nervous agitation, leading to improvement in blood pressure. Evidence shows that breathing exercises, over the course of 8 weeks, provide relaxation, reduce stress, and lower blood pressure in a safe manner. Include relaxation techniques in your treatment plan of high blood pressure.

TREATMENT OF HIGH BLOOD PRESSURE
To prevent and reduce the risk of organ damage, including heart attack, stroke, and kidney failure, latest research strongly recommends to have a tight control on blood pressure. The Joint National Committee (JNC) on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in its current guidelines (summarized below) provide useful insight and proven steps to treat high blood pressure:

Prehypertension
The JNC has introduced the term of prehypertension for systolic blood pressure 120 to 139 mmHg, or diastolic blood pressure 80 to 89 mmHg. Prehypertension is a condition which, though, is not high blood pressure, it is likely to change into high blood pressure if healthy lifestyle changes are not made. The JNC suggests to take prehypertension seriously. Because high blood pressure is associated with very high health risks in people with diabetes, even prehypertension in these people should straightaway be treated with drugs to prevent it from developing into high blood pressure. People without diabetes, however, should first try to control prehypertension without drugs by making healthy lifestyle changes.

Treatment Goal
The goal of blood pressure-lowering therapy is to reduce the risk for heart attack, stroke, and kidney failure by bringing down raised blood pressure to:

• Less than 130/80 mmHg in people with diabetes

• Less than 140/90 mmHg in people without diabetes

(These are not the ideal numbers, but they help reduce the risk of organ damage from high blood pressure.)

Priority Treatment of Systolic Blood Pressure
Raised systolic blood pressure (upper number) is a greater risk factor for heart attack and stroke than raised diastolic blood pressure (lower number) in people who are 50 years or older. For this reason, priority should be given to bring down raised systolic blood pressure in these people. Normally, when raised systolic blood pressure is brought down, diastolic blood pressure is also lowered.

Treatment of Stage 1 High Blood Pressure
Thiazide-type diuretic is the drug of choice for most people having stage 1 high blood pressure (systolic blood pressure 140 to 159, or diastolic blood pressure 90 to 99). The therapy is started in a low dose. The low dose will minimize side effects, if any. If response to the low dose is good, but high blood pressure is not adequately lowered, and the diuretic is well tolerated, its dose may be increased. However, when the diuretic in a sufficient dose fails to achieve your blood pressure goal, your doctor may add a different class of drug to the diuretic. Adding a different class of drug will enhance the blood pressure-lowering effect of the combination. The other classes of drugs in the combination may include an ACE inhibitor (ACEI), angiotensin receptor blocker (ARB), beta-blocker (BB) or calcium channel blocker (CCB). Or, if the diuretic does not suit you at all, the doctor may choose any of the above different classes of blood pressure-lowering drugs.

Treatment of Stage 2 High Blood Pressure
A combination of at least two different classes of blood pressure-lowering drugs will be required to treat most people having stage 2 high blood pressure (systolic blood pressure 160 mmHg or greater, or diastolic blood pressure 100 mmHg or greater). The combination should usually consist of a thiazide-type diuretic plus ACEI, or ARB, or BB, or CCB class of blood pressure-lowering drug.

Intensifying the Treatment
If your blood pressure treatment goal is not achieved, doses of the drugs used in the combination may be increased, or additional classes of blood pressure-lowering drugs may be added.

Healthy Lifestyle
Even when high blood pressure is treated with drugs, healthy life style (laid out in boxes in this chapter) must remain in place.

Treatment of high blood pressure continues for life. If you discontinue the treatment, high blood pressure will come back. When you have successfully controlled your high blood pressure over a long period and continue to follow a healthy lifestyle, it may be possible for you to reduce the dose and number of blood pressure-lowering drugs.

HIGH BLOOD PRESSURE EMERGENCIES
Sometimes blood pressure may suddenly become very high (180/110 or higher). Very high blood pressure can cause angina and convulsions, increasing the risk for coma, heart attack, and stroke. High blood pressure emergencies are handled in the following manner:

• High blood pressure emergencies are treated in a hospital by intravenous administration of blood pressure-lowering drugs belonging to the class of vasodilators, beta-blockers, or alpha-blockers.

• Taking fast-acting blood pressure-lowering drugs by mouth and having bed rest can treat uncomplicated emergencies of high blood pressure. The fast-acting drugs include loop diuretics, betablockers, ACE inhibitors, and calcium channel blockers.

• In the emergency therapy, the first goal is to reduce high blood pressure to about 160/100 within 2 to 6 hours. Rapid fall of blood pressure is not advisable because this may decrease blood flow to the brain, heart, and kidneys, increasing the risk for stroke, heart attack, or kidney failure.

• Blood pressure should be monitored every 15 to 30 minutes in an emergency treatment. If it continues to remain greater than 180/120, a different combination of blood pressure-lowering drugs may be tried.

• If high blood pressure emergencies occur frequently, regular medical treatment and blood pressure monitoring are necessary.

DIETARY APPROACHES TO STOP HIGH BLOOD PRESSURE
A clinical study known as DASH (Dietary Approaches to Stop Hypertension) was conducted with the help of the National Heart, Lung, and Blood Institute, the National Center for Research Resources, and the Office of Research on Minority Health. The study results (1997) demonstrated that the DASH diet, a “combination” eating plan that is low in total fat, saturated fat, and cholesterol and rich in fruits and vegetables, reduces high blood pressure. The DASH eating plan based on a 2,000- calorie level comprises of:

• Grains: 7 to 8 servings

• Vegetables: 4 to 5 servings

• Fruits: 4 to 5 servings

• Low fat or fat free dairy foods: 2 to 3 servings

• Meats, poultry, and fish: 2 or less servings (All the above servings are per day)

• Nuts, seeds, and dry beans: 4 to 5 servings per week

Note: The size of servings in the DASH diet are almost the same as in the Eat-Right model noted before. Here you can find details of the DASH diet.

High blood pressure affects about 1 billion people in the world. In the United States more than 50 million people have high blood pressure, but because high blood pressure usually has no symptoms, one-third of these people are not even aware that they have this disorder. And many people who know they have high blood pressure are not treating it at all, or treating it in a loose manner. High blood pressure poses a high risk for organ damage or organ failure, including heart attack, kidney failure, sight loss, and stroke. This risk is much higher in people with diabetes than the nondiabetic people. However, a landmark study, namely, the UK Prospective Diabetes Study (UKPDS) has shown that a tight control of blood pressure in people with diabetes reduces all diabetes complications by 24 percent, strokes by 44 percent, heart failure by 56 percent, and damage to minute blood vessels by 37 percent. Recent studies have further confirmed that a strict control of blood pressure will significantly reduce these risks both in people with type 1 and type 2 diabetes. To protect yourself from the serious consequences of high blood pressure, you must lower it and keep it within the acceptable range.

WHAT IS BLOOD PRESSURE
Blood pressure is the force exerted by blood on the walls of blood vessels (arteries). When the heart pumps blood into the arteries, the pressure is called systolic pressure. On the other hand, the force with which the arteries resist the flow of the blood from the heart is called diastolic pressure. To say in other words, systolic pressure is when the heart beats, and diastolic pressure is when the heart relaxes between the beats, and the blood pumped by the heart travels through the blood vessels in the body. Blood pressure is measured into milligrams of mercury (mmHg). In a blood pressure reading of 140/90, for example, the upper number 140 is called systolic blood pressure, and the lower number 90 is called diastolic blood pressure.

WHAT IS HIGH BLOOD PRESSURE
When blood exerts more than the normal force on the walls of the arteries, the pressure is called high blood pressure. According to the current standard, a blood pressure reading of 140/90 or greater is classified as high blood pressure, whereas a reading of 120/80 is classified as prehypertension. (Prehypertension is a condition in which blood pressure is yet not so high as to be classified as high blood pressure but will change into it if healthy lifestyle changes are not made.)

CLASSIFICATION OF BLOOD PRESSURE
Currently, blood pressure in adults is classified into three main categories:

SYMPTOMS OF HIGH BLOOD PRESSURE
High blood pressure generally has no signs, and yet it is dangerous; this is why it is called a “silent killer.” When high blood pressure is severe, or remains untreated for long, it causes symptoms such as nausea, vomiting, fatigue, restlessness, dizziness, and shortness of breath. These symptoms appear late when high blood pressure has already caused some damage to the heart, brain, and kidneys. Highblood pressure when severe, may cause swelling in the brain, making you drowsy or unconscious.

CAUSE OF HIGH BLOOD PRESSURE
High blood pressure can be essential (primary) or secondary. The specific cause of essential high blood pressure is not known, whereas the cause of secondary high blood pressure can be identified. Essential high blood pressure is the most common form of high blood pressure, occurring in more than 90 percent of patients, including people with type 2 diabetes. Heredity, obesity, body’s resistance to the action of insulin, low levels of nitric oxide (this substance keeps blood vessels relaxed), and low birth weights are suspected to cause essential high blood pressure. Causes of secondary high blood pressure are identifiable. These may include such medical conditions as hardening of the arteries (see Part 5) in which the heart has to use greater force to pump the blood through clogged arteries, kidney disease, and liver disease. Also, long-term use of nonsteroidal and anti-inflammatory drugs (NSAID) such as diclofenac (Voltaren) and ibuprofen (Advil), oral contraceptive pills, nasal decongestants, appetite suppressants, alcohol consumption, tobacco smoking, taking coffee in excess, stress, and exposure to lead even at low levels, can contribute to high blood pressure.

EFFECTS OF HIGH BLOOD PRESSURE
Your arteries, due to constant exposure to high blood pressure, can become injured and scarred. When the arteries are injured, cholesterol and fat circulating in the blood tend to pile up on the site of injury. The fat and cholesterol deposits tend to clog the arteries, making them hard and narrow. As a result, the heart has to work hard to pump the blood through clogged arteries, a condition that raises blood pressure. When this condition continues for long, the heart gets enlarged and becomes weak. A weak heart cannot pump enough blood, and, as a result, blood flow to various parts of the body is decreased. When the affected organs of the body do not get enough supply of the blood, they become weak, damaged, and their functions are impaired. Long-standing high blood pressure contributes to serious organ damage, including heart attack, stroke, kidney failure, and eye damage.

THE RIGHT WAY TO MEASURE BLOOD PRESSURE
Blood pressure should be measured with a blood pressure instrument using mercury (sphygmomanometer)or a non-mercury device giving correct readings. For correct measurement of your blood pressure:

• Sit down on a chair comfortably for at least 5 minutes before your blood pressure is measured. Your feet should be on the floor and not hanging as at an examination table in a doctor’s office.

• Refrain from smoking and taking tea and coffee about 30 minutes before measuring blood pressure.

• You should not be taking blood pressure-lowering medication when blood pressure is measured for diagnosing high blood pressure.

• Use a blood pressure measuring cuff of appropriate size (not too loose or too tight); your arm should be supported at your heart level.

• Blood pressure should be measured in both the arms; if readings are different, the higher value should be used for diagnosis.

• Two or more readings separated by 2 minutes should be averaged to estimate your blood pressure.

• To detect any abnormal fall in blood pressure such as when you rise from a sitting position to a standing position your blood pressure should be periodically checked in a standing position also.

Injecting insulin by itself does not make you fat. But when you eat more food than your body needs, excess sugar will be produced in the body. One of the functions of insulin is to convert a part of excessive blood sugar into fat. This fat is deposited in the fatty cells of your body, adding to your weight.

Also, insulin controls blood sugar and prevents loss of nutrients in the urine caused by uncontrolled diabetes. As a result of better control of your blood sugar and better utilization of nutrients, your body is nourished in a better way and you tend to gain weight.

To control your weight, watch your calorie intake and exercise regularly. If you take insulin injections to control blood sugar, do not skip your insulin dose in an attempt to lose weight. Skipping the insulin dose can shoot up your blood sugar to dangerously high levels.

As women grow older and by the time they are in their 40’s, the balance of estrogen and progesterone in their bodies does not remain as good as it had been when they were young. As a result, the monthly periods of these women become irregular and stop at the age of about 51 years (menopause). In context of diabetes, the hormonal imbalance and the resulting menopause in women reduce their sensitivity to insulin. As a result, their blood sugar control becomes worse, and they are exposed to increased risks for heart disease, stroke, nerve damage, brittle bones, and vaginal disease. In addition, these women face hot flashes, vaginal dryness, and other discomfort associated with menopause.

Hormone replacement therapy (HRT) aims to restore hormonal balance in the menopaused women and protect them from the related risks. The therapy includes daily intake of estrogen supplements (with or without progestin) on a long term basis. In 2002, however, a large study on hormone replacement therapy in the United States was abruptly stopped because the HRT, instead of reducing the risk for heart attack, actually increased the risks for heart disease, stroke, and breast cancer in women. There are, however, other studies that indicate the HRTis beneficial for menopaused women with diabetes: it helps control their blood cholesterol and bloodsugar. Also, hormones are the only drugs that can relieve symptoms such as hot flashes and vaginal dryness and irritation in menopaused women. Considering the benefits of HRT, the Food and Drug Administration (FDA) is currently suggesting that HRT, when used cautiously, can be useful for many women. The FDA advises that because HRT is also associated with risks, it should be taken in the lowest effective dose for the shortest possible length of time, and should be re-evaluated every 6 months.

Discuss with your doctor the risk and benefit of hormonal replacement therapy, and ask if this therapy is right for you.

To reduce the risk of low blood sugar while driving, take following precautions:

• Test your blood sugar before driving.

• If blood sugar is below 100 mg/dL (5.6 mmol/L), take a snack such as 1/2 cup of orange juice or regular soda drink, or 1cup of regular or skimmed milk.

• Test blood sugar after 30 minutes; if it is above 100 mg/dL (5.6 mmol/L), go for driving.

• Take your glucose meter with you in the vehicle for testing your blood sugar.

• Make sure you carry  in the vehicle and with you some fast-acting source of glucose such as glucose tablets.

• If you are on a long trip, take your usual snacks and meals.

• Stop driving if you feel symptoms of low blood sugar such as:

-Nervousness

- Hunger

- Trembling

- Headache

- Fatigue

- Nausea

- Anxiety

- Slurred speech

- Irritability

- Blurred vision

- Sweating

- High pulse rate

- Dizziness

- Light-headedness

- Drowsiness

- Mental confusion

• Test your blood sugar. If it is low, treat it with the fast-acting glucose you are carrying with you. Wait for an hour till your blood sugar normalizes and you regain your normal reflexes; then start driving again.