Know your Numbers and Terms

This is your guide to understanding some of the words and tests used in Diabetes care. Having knowlegde of this will help you achieve your goals and help prevent some of the complications that can arise with diabetes.

The following 3 measurements are called the 3Ts or TTT (Three Treatment Targets).

If these are well controlled the risks of death and complications of diabetes is reduced.

These will be central to the annual review.

What is it? 

• A measure of the force your heart uses to pump blood around your body, which is usually presented as two numbers i.e. 120/80.
• The 1st number is the systolic pressure (the maximum force your heart uses)
• The 2nd number is the diastolic (the minimum force your heart uses)

Targets

• Type 2 diabetes: Below 140/80
• Type 1 diabetes (or Type 2 diabetes with complications of diabetes): Below 130/80

Why do we monitor this?

• High BP combined with Diabetes is associated with increased risk of Cardiovascular disease (e.g. Heart attacks and Strokes)

How to improve Blood Pressure

• Low Salt Diet
• Losing Weight
• Stop Smoking
• Exercise
• Blood pressure tablets may be recommended

Link to Diabetes UK for further information 

What is it?

• A type of fat found in the blood
• Two types of molecules carry cholesterol throughout the body:
• LDL Cholesterol (low-density lipoprotein), or “Bad” Cholesterol, makes up most of your body’s cholesterol. High levels raise your risk for heart disease and stroke 
• HDL Cholesterol (high-density lipoprotein), or “Good” Cholesterol, absorbs cholesterol and carries it to the liver. The liver then flushes it from the body. High levels of HDL cholesterol can lower your risk for heart disease and stroke.

Targets

• Total Cholesterol: under 4.0 mmol/l
• LDL levels: below 2.0 mmol/l
• HDL levels: at least 1.0 mmol/l (men) or 1.2 mmol/l (women)
• Total cholesterol / HDL ratio: less than 5

Why do we monitor this?

• High levels of total or LDL Cholesterol are associated with increased risk of Heart Attacks and Strokes, particularly in Diabetics.

How to improve cholesterol levels

• Diet Modification
• Tablets (Statins)

Link to Diabetes UK for further information

What is it?

• A measurement how much Haemoglobin (the oxygen carrying protein in red blood cells) is saturated with Glucose (glycated).
• This can be obtained from a blood sample and is the best measurement of long-term glucose level as red blood cells live in the body for 8-12 weeks.

Targets

• This may be an individualised target and will be discussed and set at the annual review with the diabetes team.
• In general, 48mmol/mol or under
• 53mmol/mol if on medications with hypo risk
• Up to 69mmol/mol if severe frailty or dementia

Why do we monitor this?

• As our best measurment of glucose control this can help guide our team and you to best achieve your targets and reduce you disease progression.

How to improve cholesterol levels

• Diet Modification
• Optimal Tablet and/or Injectable therapy

Link to Diabetes UK for further information

What is it? 

• A measure that uses your height and weight to work out if your weight is healthy.
• BMI is calculated by dividing your weight in kilograms by your height in metres squared.

Target

• A BMI of 18.5 to 24.9 is considered ideal for most adults.
• A BMI of 25 to 29.9  is considered overweight.
• A BMI of 30 or more is considered Obese.

Why?

• Being overweight or obese is a risk factor for developing Type 2 diabetes and many other poor health outcomes which it why we monitor your weight.

• How to improve BMI
  
  • Increase exercise/activity or changing diet to lose weight

Link to NHS for further information 

This depends on your gender and ethnicity.

For a healthy measurement you need to aim to be less than:

• 80cm (31.5in) for all women
• 94cm (37in) for most men
• 90cm (35in) for South Asian men.

This is because you have a higher risk of Type 2 diabetes if you are of Black or South Asian background

Link for more information and how to measure your waist circumference 

What is it? 

• A term to describe the glucose concentration in your blood (e.g. 5 mmol/l)
• 'BM' is another term you may hear used- it doesn't stand for anything other than the name of the company that first made glucose monitors in this country, and the shorthand 'BM' stuck.

Target

• Before meals (pre-prandial) : 4 to 7 mmol/l for people with type 1 or type 2 diabetes
• After meals (post-prandial) : under 9 mmol/l for people with type 1 diabetes and under 8.5mmol/L for people with type 2 diabetes

• "4 is the floor" -  A glucose of 4mmol/l or below is called Hypoglycaemia or a ‘Hypo’. It is a medical emergency. Click here for more information

• "5 to drive" - Those on treatments that can cause a Hypo must ensure that their blood glucose is 5 mmol/l or above (taken within two hours of setting off) for any journey longer than two hours. Click here to read the driving section for more information

Why?

• High sugar levels are the definition of Diabetes and are associated with progressive multi-organ damage if left unmanaged
• Low sugar level (Hypoglycaemia or Hypos) can be associated with light headedness, fainting and seizures 

How to improve Blood Glucose 

• Alter Lifestyle / Medication therapy / Insulin

What is it?

• A computer program used for predicing outcomes in cardiovascular disease using risk factors and data points (age, height, weight, blood pressure, smoking status, cholesterol levels...etc)
• The risk is given as a percentage (%) chance of having a cardiovascular event (such as heart attack or stroke)

Targets

• Changes with age, but for non-elderly patients a QRISK of 10% indicates therapy with cholesterol lowering medication may be indicated.

Why?

• Increasing QRISK suggests an increased risk of cardiovascular event

How to improve Q RISK

• Diet Modification
• Increase Exercise/Activity
• Stop Smoking
• Cholesterol lowering (Statin) therapy

What is it?

• Adults should get some sort of activity per day

Target

• In general this is 150 mins moderate intensity activity per week/2 activities per week that improve strength / balance / flexibility ( 30 mins per day - does not have to be 30 mins in one go - can be split 20/10 or 15/15 etc)

Why?

• This will improve overall health, mental well-being, insulin sensitivity, weight loss

How to improve activity

•  Find something you like to do and mix things up - its also good to  involve others

Link for further information