How Well Do You Know Your Numbers?

If you've been diagnosed with a major illness -- like heart disease, diabetes, heart failure, cancer, or asthma -- you've probably already done a lot of research on your condition. That's a wise move. Staying informed is an important step toward staying healthy.

You can learn a lot about your illness on the Internet or at a hospital library, but no Web site or medical journal in the world can tell you whether your illness is truly under control. If you want to keep track of your health, you need to do more than pay attention to how you feel and how you take care of yourself -- you also need to keep track of your numbers.

What numbers really matter? For starters, there's a reason why you step on a scale and get your blood pressure checked every time you set foot in a doctor's office. Regardless of the condition you have, weight and blood pressure are important measures of health. But even these measurements are more crucial for some patients than for others. If you have heart failure, which means that your heart can't pump enough blood and oxygen to the rest of your body, a few extra pounds on the scale could mean that your condition has taken a serious turn for the worse. And if you have heart disease, a sudden rise or drop in blood pressure -- or a change in pulse rate -- could be a red flag that requires immediate action.

Ask your doctor to explain which numbers are especially important to your health. Depending on your condition, you may have to check them monthly, weekly, or even daily. Here's a look at the crucial numbers for several common diseases.

Heart disease

If you've been diagnosed with coronary heart disease, the arteries around your heart have become partially clogged with plaque. The big danger is that a piece of plaque could break loose, potentially causing a heart attack or stroke.

To fully understand your risk, check your blood pressure regularly. Your doctor may want you to check it every day using a blood pressure cuff at home. According to the American Heart Association, normal blood pressure is considered to be anything less than 120/80. A reading between 120-139/80-89 indicates prehypertension. With a reading of 140-159/90-99 you have high blood pressure (hypertension). Above 160/100 your doctor is likely to diagnose you with stage 2 hypertension. It's good to keep in mind that these numbers can vary depending on the circumstances at the time your blood pressure reading is taken. Be sure to discuss your numbers with your doctor.

If you also have diabetes or kidney disease, your doctors will likely want you to get below 130/80. If you can get below 120/80, you can significantly reduce your risk of heart attack or stroke. But if your pressure doesn't drop to healthy levels, or if it starts climbing, your doctor may want to change your treatments, including medicines or a change in lifestyle (like controlling your weight, being physically active, moderating alcohol intake, and eating more fruits, vegetables, omega-3 fatty acids, and low-fat dairy products).

Your pulse is also important to check when you take certain medicines such as beta blockers: If your pulse drops much below 60, it's important to tell your doctor. Cholesterol is worth watching, too. Cholesterol comes in two major types: LDL ("bad") and HDL ("good.") Too much LDL cholesterol can lead to a heart attack or stroke, but HDL cholesterol can actually help keep your arteries clear. For this reason, it takes two numbers to really describe your cholesterol, which is measured in units called mg/dL, or milligrams per deciliter. According to the latest government guidelines, the ideal total cholesterol is less than 200 mg/dL, and the ideal LDL level should be below 100 mg/dL. (Patients with fewer risk factors may have less rigid goals.) There are two other numbers to keep in mind: Although the government doesn't set target numbers for "good" HDL cholesterol, research suggests that an HDL level below 40 is too low and increases your risk of heart disease; studies also indicate that an HDL level of 60 or more mg/dL decreases your risk.

Your doctor will also want to keep close track of your triglycerides, a fatty substance in the blood that can raise the risk of a heart attack or stroke. 150 mg/dL is borderline high and a reading of 200 mg/dL or above is too high.

Exercise and weight numbers are important, too. For people with heart disease, the American Heart Association/American College of Cardiology recommends an optimal goal of 30 to 60 minutes of exercise each day. (Get tested by your doctor before starting a new exercise program, however.) For weight management, the guidelines recommend a Body Mass Index (BMI) of 18.5 to 24.9.

If your LDL is too high or your HDL is too low, your doctor will probably recommend a change in lifestyle, a cholesterol medicine, or a combination of the two. Your doctor will want to test you again within a few months to see if your numbers are headed in the right direction, and to make sure you are not having any side effects from the medicine.

If your triglycerides are over the 150 mark, you'll probably need treatment to bring them down. This may include diet and exercise, with medicines usually added only if the levels are considerably higher than 150.

Diabetes

If you have diabetes, a blood sugar monitor can give you some of the most important numbers in your life. Keeping your blood sugar under control is the best way to prevent complications such as blindness, nerve damage, and heart attacks. For most people, good numbers would be 70 mg/dL to 130 before meals and less than 180 two hours after starting a meal. (Some doctors prefer to see patients maintain a pre-meal blood sugar closer to 100 than 130, and post-meal glucose closer to 150 than 180.) Talk to your doctor about your personal blood sugar goals.

Also, talk to your doctor about how often you need to check your blood sugar. Many people who are newly diagnosed with type 1 diabetes check their blood sugar at least three times a day -- once before breakfast and once before dinner -- and often at other times of the day so they can learn how the foods they eat affect their blood sugar. Depending on the type of diabetes you have (and which medicines you take), your doctor may ask you to check your sugar several times daily or only once in a while. Write down the numbers in a daily record book so you and your doctor can track your progress.

The blood sugar monitor gives you a snapshot of your diabetes. For a more complete picture, your doctor will want to conduct a blood test called A1c at least twice a year. This test measures how much sugar, or glucose, is binding with the hemoglobin protein found in red blood cells -- the gold standard for measuring long-term glucose control. It will show you how well your blood sugar has been under control for the last few months.

While the A1c goal for diabetic patients in general is an A1c reading of less than 7 percent, individuals may have a lower goal set by their doctor, even less than 6 percent (normal) if they can attain this without significant low blood sugar episodes. The American Academy of Clinical Endocrinologists favors a reading of 6.5 percent or lower. If your A1c is higher than 7, you should work on your diet and exercise to improve your numbers. If it is above 8 percent, your doctor will probably want you to adjust your medicine.

People with diabetes are at high risk for heart trouble, so you and your doctor will also want to keep close track of the numbers that describe heart health: blood pressure and cholesterol. In fact, the "ABCs of Diabetes" is a memory device to remind patients and doctors of the three issues -- A1c, Blood pressure, and Cholesterol -- to help prevent problems like heart attack and stroke, which are the most common causes of death in people with diabetes. The ideal blood pressure goal for people with diabetes is less than 130/80, and total cholesterol should be below 200 mg/dL.

And don't forget your exercise numbers! The National Center for Diabetes Education (part of the National Institutes of Health) recommends you get at least 30 minutes of exercise -- such as brisk walking -- most days of the week.

Heart Failure

Heart failure can make it hard for a body to maintain its delicate balance of fluids. Rapid weight gain is the clearest sign that the balance is breaking down. If you have heart failure, you should weigh yourself every morning, before breakfast but after a visit to the bathroom. Tell your doctor if you gained more than 3 pounds in a day or 5 pounds in a week.

High blood pressure can further weaken an already weak heart, so you'll want to check your pressure regularly, perhaps every day. Anything above 140/90 is especially worrisome. Even if you're below this level, your doctor may recommend blood pressure treatments to get your numbers still lower. (It's also possible to go too low, so talk with your doctor about which range is acceptable for you.)

People with heart failure also benefit from exercise. The American Heart Association recommends slowly working up to 30 minutes a day of exercise (or whatever your doctor recommends). Just be sure to get evaluated first.

Asthma

If you have asthma, a peak flow meter can help you measure the strength of your breaths, in good times and bad. You can learn your "personal best" by giving your meter a strong puff when your asthma is under control. It's a good idea to update your personal best every two weeks. You should also use your peak flow meter when your breathing feels weak. If your peak flow is low or varies a lot from day to day, your asthma may be getting worse.

Keep track of the number of times you need to use your inhaler to stop an attack. If you need your quick-relief "rescue" inhaler more than twice a week, your asthma isn't under control. You may need a change in treatment to prevent more attacks. (It's a good idea to check your peak flow meter after taking a rescue inhaler to monitor how well the treatment is working.) If your peak flow does not improve with the rescue inhaler, see a doctor as soon as possible.

References

Intensive prevention key to fighting coronary artery disease. American Heart Association/American College of Cardiology scientific statement.

National Cholesterol Education Program. Detection, evaluation, and treatment of high blood cholesterol in adults.

American Heart Association. What is high blood pressure?

American Society on Aging/ Centers for Disease Control and Prevention. Diabetes prevention and management.

U.S. Department of Health and Human Services. If you have diabetes, know your blood sugar levels.

Tight Diabetes Control. American Diabetes Association.

American Academy of Family Physicians. Diabetes: Monitoring your blood sugar level.

National Heart Lung and Blood Institute. Living with asthma.

About Heart Disease. Centers for Disease Control and Prevention.

American Diabetes Association. Standards of Medical Care in Diabetes.

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