Make the Connection Between Diabetes and Heart Failure

ake the connection between diabetes and heart disease

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PRITCHETT & HULL ASSOCIATES, INC. 3440 OAKCLIFF RD NE STE 110 ATLANTA GA 30340-3079

To contact Pritchett & Hull: write Pritchett & Hull Associates, Inc. 3440 Oakcliff Rd., NE, Suite 110 Atlanta, GA 30340-3079 call 1-800-241-4925

Copyright © 2005

by Pritchett & Hull Associates, Inc. All rights reserved. No part of this book may be photocopied, reprinted or otherwise reproduced without written permission from Pritchett & Hull Associates, Inc.

This book is only to help you learn, and should not be used to replace any of your doctor’s advice or treatment.

We do not intend to be sexist, but to keep the text simple, we often say “he” or “him” when referring to the patient.

Published and distributed by: Pritchett & Hull Associates, Inc.

Printed in the U.S.A.

M

ake the connection ...between diabetes and heart disease

Because you have diabetes you are more likely to develop heart disease (cardiovascular disease) or blood vessel problems than someone who does not have it. In fact, your risk is about twice that of a non-diabetic if you are a man. And if you are a woman, your risk is about four times that of a non-diabetic.

With the odds against you, you need to know just what you can do to reduce the risks. This book can help you learn how.

It will teach you: • about heart disease and what it means • how diabetes and heart disease are related • why having diabetes makes you more likely to have problems • the things to do to help reduce your risks

1

T

able of contents

Managing your diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3 About heart disease . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-5 And the connection is . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-7 Know your blood sugar levels . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8 Hemoglobin A1c testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9 Take your medicine

10

.............................................................

Control your blood pressure Control your weight

.......................................................

Lower your cholesterol

11-13

.........................................

..................................................

14-16 17-20

Don’t smoke . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .21 Be more active . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22-23 Learn to relax and control stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .24-26 Eat healthy

......................................................................

27-28

The TLC Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .29 Make the connection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .30-31 For more help . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32

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M

anaging your diabetes

When you have diabetes your body can’t use the energy it gets from food. There is a problem with insulin, a hormone made by your pancreas. Glucose (sugar) cannot get into the cells without insulin helping it. So, sugar stays in your blood and builds up.

Over time, too much sugar in your blood can cause other health problems.

These problems can begin to happen even before you know you have diabetes. So, it is very important to control your diabetes once you know you have it.

Your goal is to get your blood sugar level as normal as possible (80 - 120 mg/dl*) and keep it there. The main parts of your treatment plan are: • • • • •

healthy meal planning exercising on a regular basis taking insulin and/or oral medicines checking your blood sugar levels daily managing the stress in your life

*Or as advised by your doctor.

3

A

bout heart disease

When your coronary arteries become clogged by cholesterol and fat deposits (called plaque) they narrow and do not allow enough blood through to your heart. This is cardiovascular disease. You may also hear it called atherosclerosis (hardening of the arteries), coronary heart disease (CHD), coronary artery disease (CAD) or just heart disease.

Many of the risk factors for heart disease are related to your lifestyle and environment.

• Being overweight. Obesity is related to high blood pressure, diabetes, high cholesterol levels and lack of exercise. All of these can lead to heart disease.

• Having high blood cholesterol. Total cholesterol over 200 mg/dl, triglycerides over 150 and LDL (“bad”) cholesterol over 100 mg/dl).

This is one of the main causes of heart disease.

Note!

High cholesterol levels, high blood pressure and obesity often start in childhood.

• Having low HDL (“good”) cholesterol levels below 40 mg/dl (for men) and 50 mg/dl (for women). Having HDL levels higher than 60 can reduce your risk for developing heart disease.

• Having unmanaged high blood pressure or hypertension (higher than 130/80). When your blood pressure is high for a long time your heart and other organs can be damaged.

4

• Not being physically active. Being inactive can cause you to gain weight and lose muscle tone and strength (including your heart). Regular exercise helps lower your risk for heart disease.

• Smoking or being around others who are smoking. Smoking increases your risk of heart disease. It narrows and harms the walls of arteries and speeds up hardening of the arteries.

• Having unmanaged diabetes.

Research suggests that other factors may also contribute to heart disease: • unmanaged stress • depression • drinking too much alcohol • high levels of homocysteine (an amino acid) in your blood • high levels of CRP (C-reactive protein) in your blood (CRP is a sign of inflammation)

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A

nd the connection is. . .

You are 2 to 4 times more likely to develop cardiovascular disease (like heart attack or stroke) than someone who does not have diabetes. This is due, in part, to high blood pressure, obesity, high cholesterol and fat levels in your blood and insulin resistance (when your body cannot use the insulin it makes).

Not keeping your blood sugar levels in your target range causes high blood sugar. This in turn damages the walls of your blood vessels. They become hard and stiff. When this happens blood cannot flow through them well.

Heart disease happens when not enough blood and oxygen get through to your heart. It is caused by too much cholesterol and plaque (fatty deposits) building up in your blood vessels and blocking blood flow.

Just having diabetes increases the levels of cholesterol and fat in your blood. This is true regardless of how much cholesterol and fat you eat. Because of this, more than 75% of people with uncontrolled diabetes die from some form of heart disease.

artery

fatty deposits

6

But there are things you can do to help reduce your risks: • keep your blood glucose within your target range • take your medicine or insulin when and how you should • if you have high blood pressure, keep it under control • keep your weight in a healthy range • if your cholesterol levels are high, reduce the fat and cholesterol in your diet (if needed, ask your doctor or nurse about medicine to help control your cholesterol) • don’t smoke or be around others who are smoking • exercise regularly • learn to control your stress • control what you eat, how much you eat and when you eat

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K

now your blood sugar levels

Self-testing your blood sugar levels is vital in your management plan. It gives information about how your plan is working. Your blood sugar test results can show if you are: • taking the right amount of medicine • eating the right amount of food • eating the right kinds of food • eating when you should • exercising as you need to • managing stress Your blood sugar goals* are:

Fasting before meals

80–120 mg/dl

1 hour after meals

less than 180 mg/dl

2 hours after meals

less than 140 mg/dl

At bedtime

100–140 mg/dl

*These may be adjusted by your doctor.

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Hemoglobin A1c testing A Hemoglobin A1c test (A1c) measures the amount of sugar in your blood over the last 3 months. It is a way for your doctor to have a very up-to-date measure of your blood sugar control. It does not replace checking your blood sugar on a regular basis.

A good score for this test is 6.5 –7 percent or less*.

Normal is 4 - 6 percent. If you get more than 7 percent, it may mean you need to change your diabetes management plan for better sugar control. Learn your score and what it means to you. A good score can delay or prevent serious problems caused by diabetes.

Everyone who has diabetes should have this test done at least twice a year. If you take insulin, you should have it done 4 times a year.

My latest A1c score is: ___________________________

*Your doctor may suggest another target score.

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T

ake your medicine

If you need to inject insulin or take oral medicine to manage your diabetes, it is important that you take it correctly. Checking your blood sugar levels on a regular basis will help your doctor know if you need medicine to control your diabetes and how much. It can help you see how food, exercise, medicines and illness affect your blood sugar. It may be that you only need medicine at certain times—like when you’re under a lot of stress or when you have an infection.

Some people with type 2 diabetes don’t need medicine. While others need to take pills, inject insulin or do both. The right medicine for you is matched to your needs and how your body reacts when you take it. These medicines work best when taken at the same time each day to match the foods that you eat.

Take your medicine or insulin as your treatment plan says to. And, don’t stop taking it unless your doctor or nurse tells you to.

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C

ontrol your blood pressure

Your blood pressure is the force that moving blood puts on your artery walls. When your blood pressure is taken, two numbers are used to show it, like 120/80 (read 120 over 80).

The first, or top number, is called the systolic pressure. This is how much pressure is on your arteries when the heart pumps blood out to your body. The second, or bottom number, is called the diastolic Have your pressure. This is how much blood pressure pressure is there when your checked regularly. blood vessels relax to let the blood flow back into your heart.

Blood pressure levels* are ranked in stages. Each stage gives a range of blood pressure readings and tells how it ranks. The stages are:

Normal

Systolic

Diastolic

(top number)

(bottom number)

less than 120

and

less than 80

Pre Hypertension

120–139

and

80–89

Stage 1 Hypertension

140–159

or

90–99

Stage 2 Hypertension

160 or more

or

100 or more

*Based on guidelines from the JNC7 Report, 2003.

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When you have diabetes, controlling your blood pressure helps to prevent long-term complications. Therefore your goal is to keep your blood pressure under 130/80.

High blood pressure is a risk factor for heart disease in everyone, not just for you. But because you have diabetes, you are about twice as likely to have high blood pressure (or hypertension) as someone who does not have diabetes.

The way to manage high blood pressure is to make healthy lifestyle choices about: • what you eat and drink • exercising regularly • keeping your weight within a healthy range • not smoking • taking blood pressure medicine (if you need to)

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Your blood pressure is a moving target. It can go up or down depending upon what you are doing. So, when you take your blood pressure, do it after you have rested quietly for at least 5 minutes. This allows your blood pressure to get back to what is more normal for you.

You need to keep track of your blood pressure readings to know what is normal for you. Use this chart to do this.

Date

Time

Systolic Pressure Diastolic Pressure (top number)

(bottom number)

Comments

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C

ontrol your weight

As your body weight increases, your blood pressure rises. Being overweight also makes your body work harder to try to control your blood sugar.

So, by keeping your weight in a healthy range you can: • lower your blood pressure, and • reduce your risk of heart disease The longest-lasting and best way to lose weight is slowly. To do this, you need to use up more calories than you eat.

If you cut back on your calorie intake by 500 calories a day and do 30 minutes of exercising most days of the week, it can help you lose about 1 pound a week.

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Losing weight and keeping it off may mean a new way of eating and adding exercise to your life. Here’s how to do it: • Choose foods low in calories and saturated fat.

• Choose foods high in fiber. (Fiber fills you up, so you feel full.)

• Eat smaller meals more often during the day.

• Limit your serving sizes.

• Increase your physical activity.

• Cut back on snacks. If you do snack, make it fresh fruit, raw vegetables or air-popped popcorn (without salt or butter).

A dietitian can help you learn about healthy eating.

15

Your body mass index (BMI) is a way to tell if you are overweight. The index describes your weight condition: less than 19

underweight

19 - 24

normal healthy weight

25 - 29

overweight

30 or higher

obese

To use this chart, find your height in the first column. Then look across that line and find your weight. If you are between two weights, use the one you are closest to. Then look up to the index at the top of that column. This is your BMI. Your BMI score is:

19 20 21 22 23 24 25 26 27 28 29 30 31 32

Your Height

Your Weight (pounds)

5' 0"

97 102 107 112 118 123 128 133 138 143 148 153 158 163

5' 1"

100 106 111 116 122 127 132 137 143 148 153 158 164 169

5' 2"

104 109 115 120 126 131 136 142 147 153 158 164 169 175

5' 3"

107 113 118 124 130 135 141 146 152 158 163 169 175 180

5' 4"

110 116 122 128 134 140 145 151 157 163 169 174 180 186

5' 5"

114 120 126 132 138 144 150 156 162 168 174 180 186 192

5' 6"

118 124 130 136 142 148 155 161 167 173 179 186 192 198

5' 7"

121 127 134 140 146 153 159 166 172 178 185 191 198 204

5' 8"

125 131 138 144 151 158 164 171 177 184 190 197 203 210

5' 9"

128 135 142 149 155 162 169 176 182 189 196 203 209 216

5' 10" 132 139 146 153 160 167 174 181 188 195 202 209 216 222 5' 11" 136 143 150 157 165 172 179 186 193 200 208 215 222 229

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6' 0"

140 147 154 162 169 177 184 191 199 206 213 221 228 235

6' 1"

144 151 159 166 174 182 189 197 204 212 219 227 235 242

6' 2"

148 155 163 171 179 186 194 202 210 218 225 233 241 249

6' 3"

152 160 168 176 184 192 200 208 216 224 232 240 248 256

6' 4"

156 164 172 180 189 197 205 213 221 230 238 246 254 263

L

a

ower your cholesterol

Cholesterol is a waxy, fat-like substance that occurs naturally in your blood. It helps carry fats through your blood vessels. Your blood cholesterol level is made up of a variety of blood fats that include: • HDL (high density lipoprotein)

• LDL (low density lipoprotein) and • triglycerides (a form of fat)

a LDL

LDL

HDL

HDL

HDL

LDL

HDL

HDL

L DL

L DL

LDL

Lipoproteins are complex molecules made up of fats (lipids) and proteins. Cholesterol attaches to proteins in your blood and move along as these lipoproteins.

LDL cholesterol is called “bad cholesterol” because it tends to build up in arteries as fatty clumps (called plaque). When this happens, your blood vessels narrow and your heart muscle does not get enough blood and oxygen. This leads to heart disease.

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HDL cholesterol is called “good cholesterol” because it picks up some of the LDLs as they pass through your blood vessels and removes them. But if there are too many LDLs, the HDLs cannot get all of them out of your system. So your blood vessels narrow and become blocked.

Your body makes all the cholesterol it needs, but you also get it in some foods you eat. So, the first step in reducing your cholesterol is to change your eating habits. Eating less saturated fat and high cholesterol foods and eating more fiber is the way to start. You may also need to: • be more active • lose weight (if you are overweight) • stop smoking • take cholesterol-lowering drugs (if needed)

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Exercise raises good cholesterol levels.

Begin reading food labels to see how much saturated fat, cholesterol and fiber are in the foods you eat. Choose those that are labeled low-fat or nonfat. Try to eat no more than 20 grams (g) of saturated fat and less than 300 milligrams (mg) of cholesterol a day.

High saturated fat foods mainly come from animals (like beef chicken and pork), but some also come from plants (like coconut oil, palm oil or cocoa butter). These are found in many high calorie snack foods like cookies and snack cakes.

Eat more fresh fruits and vegetables. These contain very little, if any, cholesterol or fat. But be careful how you cook them or what you add to them. For example: 1 cup tossed salad made of lettuce, sliced cucumbers, carrots, spring onions and tomato wedges contains about 41 calories (0 from fat), no cholesterol and 8-9 grams of carbohydrates. But when you add 2 Tbsp. of ranch salad dressing to it, it becomes 201 calories (150 from fat), 10 milligrams of cholesterol and 9-10 grams of carbohydrates.

Nutrition Facts Serving Size 9.0 oz (240 grams) Servings Per Container 1 Amount Per Serving Calories 250 Calories from Fat 18 % Daily Value*

Total Fat 2g Saturated Fat Less than 1g Cholesterol 20mg Sodium 420mg Total Carbohydrate 44g Dietary Fiber 2g Sugars 4g Protein 14g Vitamin A Calcium

50% 25%

• •

3% 5% 7% 18% 15% 8%

Vitamin C 8% Iron 15%

• Percent Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs: Calories 2,000 2,500 Total Fat Less than 65g 80g Sat Fat Less than 20g 25g Cholesterol Less than 300mg 300mg Sodium Less than 2,400mg 2,400mg Total Carbohydrate 300g 375g Dietary Fiber 25g 30g Calories per gram: Fat 9 • Carbohydrates 4

•

Protein 4

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Follow these tips for reducing the fat in your diet and increasing the fiber: • Bake, broil or poach meats • Remove the skin from chicken and turkey before you cook it • Eat more fish and lean cuts of meat • Use low-fat, low-sodium cheeses • Eat more fresh, frozen or canned fruit (in their own juices) • Eat more fresh, frozen or canned vegetables (no salt added) • Use skim milk, 1% milk or evaporated skim milk instead of whole milk or 2% milk • Use less cream and cheese sauces • Eat plain rice and pasta, English muffins, bagels, sandwich breads and soft tortillas • Use food labels to help you find those foods that are high in fat, cholesterol and sodium (read the serving size!)

• Eat whole-grain breads, cereals and rice, dry peas and beans • Eat cold cereals (unsweetened) • Drink more water (unless your doctor has told you to limit how much fluid you drink)—it can help fill you up

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Note!

Be careful of portion sizes too.

D

on’t smoke or be around others who are smoking

Smoking or using other tobacco products puts you at a higher risk for heart disease. When you have diabetes and you smoke, the chance of you having blood vessel problems is much higher, too.

Tobacco smoke (yours or someone else’s): • narrows the blood vessels throughout your body • can cause artery spasm • scars your lungs and reduces the oxygen in your body • increases your heart rate • lowers your good cholesterol (HDL) • shortens your lifespan Not smoking is one of the best things you can do for your heart and coronary arteries. If you need help to quit, talk with your doctor about stop smoking programs available in your area. Or ask about nicotine replacement therapy aids.

21

B

e more active

Being inactive puts you at added risk for having heart disease and stroke. Regular exercise may help you reduce your risk by: • lowering your bad cholesterol (LDL) • raising your good cholesterol (HDL) • lowering your blood pressure • reducing excess weight • toning and strengthening your muscles, including your heart • reducing stress • lowering your blood sugar You should check with your doctor before you begin or increase your physical activity if you: • have high blood pressure • have pains or pressure in your chest or shoulder • feel dizzy or faint • get short of breath with little activity • are middle-aged or older and have not been active • are planning an energetic workout program Talk to your doctor or nurse about an exercise plan that is best for you.

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When you are not physically active you are almost twice as likely to suffer from heart disease as those who are active. Your goal is to do an activity for 30 minutes a day, for most days of the week. Exercises that strengthen your heart and lungs are the best kind, like: • brisk walking • jogging • swimming • bicycling • playing tennis Doing regular exercise every day is the best routine. But, even doing light to moderate activity for a few minutes most days may help you. Try one of these: • walking more • taking the stairs instead of the elevator or escalator • gardening • housework • dancing • park away from a mall, store or building and walk the distance And physical activity can also help you: • feel better • move easier • look better • have more energy • become stronger • feel good about yourself

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R

elax and control stress

Stress (from emotions or an illness) can cause your blood sugar to go up or down. Most often, it will go up. Uncontrolled stress puts you at risk for heart disease too.

So, reducing stress is an important part of your management plan. When stress occurs, your body takes action. Your hormones shoot up to make a lot of energy for your cells (sugar and fat). And, your body has trouble using all this sugar and fat.

Being under stress can also make it hard to take good care of yourself. You may: • not exercise as you should • not follow your meal plan • forget to test your blood sugar levels When this happens you are not managing your diabetes well. This can lead to even bigger problems— like heart disease.

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You have some control over how you react to the stress you face. You can: • learn to relax • learn to accept what you cannot change • fix problems you have some control over • get help or support from others How you choose to manage your stress is up to you. You may not deal with it like someone else would. That’s OK. The important part is that you learn to manage it. Find out what works for you.

Your goal is to learn to control your stress and not let it control you. Sometimes, this is easy to say and hard to do. Try a few of the tips on the next page and see if they help you.

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• Try to be positive about your life.

• Learn to relax. You may want to use some relaxation techniques, like deep breathing exercises, quiet music, yoga, Tai Chi, or meditation.

• Find time to play. Whatever you like to do—golf, tennis, sailing, hiking, reading poetry, etc.—make time to enjoy it.

• If you need to get organized, get help with it.

• Get physical. Exercise is a great stress reducer.

• Take a walk when you are feeling “uptight”.

• Talk with a friend or loved one about how you are feeling.

• Eat healthy. Your body needs good, healthy foods.

Don’t try to feel better by over eating, drinking alcohol or using drugs. These may make you think you feel better for a short while, but your stress will just return when the effects wear off.

• Laugh. Laughter can help reduce your stress.

• Ask for help if you feel overwhelmed or helpless.

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E

at healthy

A healthy meal plan is very much the same for everyone—those with diabetes or heart disease as well as those who don’t have it. For you, carbohydrate (carb) counting is a way to help plan your meals. Your body breaks down the carbs in food into blood sugar.

So, monitoring how many carbs you eat each day can help control blood sugar levels. It is the best way to keep your blood sugar in a good range. And it will help reduce your risk for heart disease, too.

By spreading your carbs out over the course of the day, you can keep your blood sugar from getting too high or too low. To do this you need to know how many carbs to have at each meal or snack.

To know your carb counting plan, ask your doctor or dietitian to help you fill in this chart.

My carb counting plan Breakfast

______

Snack

______

Lunch

______

Snack

______

Dinner

______

Snack

______

Total

______

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You can create a healthy meal plan by making good choices about: • what you eat • how much you eat • when you eat Here are some tips to help you make these choices: • keep track of the carbohydrates you eat (1 serving of carbohydrate = 12 - 15 grams) • cut down on fatty foods— bake, broil or grill lean meats and cut away any fat on them • measure the foods you eat—know the serving sizes (learn to read food labels) • eat 5-6 small meals, instead of 3 big ones, to help keep your blood sugar steady • choose fruits, vegetables and whole grains more often • watch your calories

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T

he TLC* plan

The TLC plan is a healthy way of eating for the whole family.

It is a low saturated fat, low cholesterol diet for your calorie needs. If you follow it, it can help in reducing your total blood cholesterol as well as your LDL cholesterol and triglyceride levels.

Here’s the plan. Eat: • less than 7% of your daily calories in saturated fat • less than 10% of your daily calories in polyunsaturated fat • 25% - 35% or less of your daily calories in all fats • less than 200 milligrams of cholesterol a day • between 50% - 60% of your daily calories in carbohydrates • between 20 - 30 grams of fiber a day • about 15% of your daily calories in proteins • enough calories to get to and keep a healthy weight.

Ask your doctor or nurse how many calories are right for you. Then fill that in here:

I can eat _________ calories a day.

*Therapeutic Lifestyle Changes (TLC) from the Third Adult Treatment Panel (ATPIII), National Institute of Health.

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M

ake the connection!

Managing your diabetes well and reducing your risks for heart disease require some of the same lifestyle changes. It is up to you to reduce your risks. If you don’t know about your risk factors, talk to your doctor or nurse about them.

There is a link between diabetes and heart disease.

Heart disease and blood vessel problems may occur over a period of years. They may or may not happen. But, having diabetes tends to increase your risk for them. And if blood sugar is not controlled, your risk is even greater.

The good news? Your risk of developing heart disease can be reduced. The better you manage your diabetes, the less risk you have for heart disease.

30

Take an active part in managing your diabetes.

Make a plan to help reduce your risks. Here’s how: • keep your blood sugar within your target range • control what you eat, how much you eat and when you eat • do some exercise every day • keep your weight in a healthy range • take your medicines or insulin as you should • if you have high blood pressure, keep it under control • know your blood lipid levels and if they are high, reduce the fat and cholesterol in your diet (if needed, ask your doctor or nurse about medicine to help control your cholesterol) • don’t smoke or be around others who are smoking • manage the stress in your life

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F

or more help American Diabetes Association 1701 N. Beaureguard Street Alexandria, VA 22311 (800) 342-2383 www.diabetes.org American Association of Diabetes Educators (for names of diabetes educators in your area) 100 West Monroe Street, Suite 400 Chicago, IL 60603 (800) 338-3633 www.aadenet.org American Heart Association National Center 7272 Greenville Avenue Dallas, TX 75231 (800) 242-8721 www.americanheart.org American Dietetic Association 120 South Riverside Plaza, Suite 2000 Chicago, IL 60606-6995 (800) 877-1600 www.eatright.org

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N

otes

Reviewers: Nancy Capponi, RN, CEN, CCRN Cardiology Rockdale Medical Center Conyers, GA Melanie Cassity, RN, BSN, CDE Diabetes Education Athens Regional Medical Center Athens, GA

W

e believe that you have the right to know as much as you can about your health. Our goal is to give you enough facts to get the main points clearly in mind. We do this with medical accuracy, warmth and humor. The result for you: less tension, more healing and a good idea of what to ask your doctor, nurse or others.

Suzanne Palo, RN, BC, MA Director Cardiac Fitness and Education St. Francis Hospital Roslyn, NY

速

速

Pritchett & Hull Associates, Inc. 3440 Oakcliff Road, NE, Suite 110 Atlanta, GA 30340-3079 1-800-241-4925

ISBN #0-939838-80-X

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