A major concern is to prevent coronary artery disease (the most com- mon form of cardiovascular disease), which can lead to a heart attack.

Your doctor will work with you to make the lifestyle changes that will help you minimize your risk of heart attack. Your goal is to keep your blood glucose, blood pressure, and cholesterol levels appropriately controlled.
• Controlling your blood glucose level requires careful monitoring. Your doctor may show you how to check your blood glucose levels at home every day. Your doctor will also probably do a test called an HbA1C: a blood glucose test that measures the amount of sugar attached to the hemoglobin mole- cule. This estimates the average blood sugar level for the last 2 to
3 months and shows how well the blood sugar is controlled over time. Your target will be an HbA1C of less than 7, which means that throughout the day for the period being measured, your blood sugar levels averaged less than 150.

• Controlling your blood pressure to a level below 130/80 mm Hg will ease the load on your heart and help preserve kidney function.
• Controlling your cholesterol involves target rates for each of three different types of blood lipids (fats): LDL, HDL, and triglycerides (see pages 26–29). For those with type 2 diabetes, the the goal is to achieve an LDL level of 100 mg/dL, or even better, less than 70 mg/dL.

Taking Aspirin to Prevent Heart Attacks

Your doctor may recommend that you take a low-dose aspirin every day, in addition to any other medications you may take. A person with diabetes tends to form blood clots more easily than most people, and aspirin appears to keep red blood cells from forming clots.
Your doctor can recommend the lowest pos- sible effective dosage for you, usually between
81 and 162 milligrams. Because some people experience irritation of the stomach lining from taking aspirin, you may prefer to take enteric- coated aspirin tablets. The coating enables the aspirin to pass through your stomach without dissolving. It dissolves in your intestine instead, reducing the risk of unpleasant side effects such as stomach pain or nausea.
Some people cannot safely take aspirin every day. You should not take it if you know you are allergic to it, you have a tendency to bleed easily, you have had bleeding from your diges- tive tract recently, you have liver disease, or you are under 21 years old (the effects of aspirin on younger people have not been fully studied). For those who cannot take aspirin, your doctor may prescribe an alternative such as clopidogrel.

Warning Signs of a Heart Attack
Call 911 or the emergency number for your area right away if you experience any of these symp- toms of a heart attack:
• Chest pain or discomfort
• Pain or discomfort in your arms, back, face, neck, or stomach
• Shortness of breath
• Sweating or light-headedness
• Indigestion or nausea
It is vital to get help immediately because treat- ment within the first hour of symptoms of a heart attack can be lifesaving. Diabetes can affect your nervous system, so that you may not experience any symptoms, or the symptoms may be milder than in most people. It is especially important that you and your family know the signs so that you can respond to them quickly and seek treatment if they occur.