I have been a type 1 diabetic for 26 years and have no complications. My A1cs range from 6.3 to 7 and my blood pressure and cholesteral have always been normal. I am very athletic and often go for two 4-mile walks per day. I have been monitoring my blood pressure at home and have been getting readings such as 120/63 and 126/64. I do not take blood pressure medicine and am very concerned about the low diastolic readings. I have read that this can be a sign of heart problems or autonomic neuropathy. My doctor is not concerned as my diastolic readings tend to be between 70 and 80 in his office (those readings are probably higher due to nerves.) Does this sound like something I should be worried about? If so, how should I handle it?

Low blood pressure is a concern if the low pressures are associated with symptoms or signs of poor perfusion. If there are no symptoms, no negative signs associated with the low pressure, there is usually not a need to pursue a medical treatment. In fact, individuals with low pressure continue to have good cardiovascular outcomes, as long as they are not from neuropathy. Neuropathy would be associated with dizziness upon changing position, fatigue, or some other indicator that perfusion is not normal, especially with changes in posture (from sitting to standing, for example). When you see your physician, you may ask him/her to perform orthostatic blood pressure measurements. I congratulate you on your excellent control. I would continue to have a dialogue with your physician, but I do not see any immediate “red flag” in the description of your condition.

JTL