I am 23 years old, have had type 1 diabetes for about six years, and I have had generally good control with A1cs usually in the 7% range. Not long ago, I finished college and had a number of lifestyle changes. My endocrinologist reported that my cholesterol was too high (187 total, with increases in both HDL and LDL) and diagnosed systolic hypertension (150/70, 160/80, 140/70 on three different visits) which he attributed mainly to anxiety (which I have a history of, but it has not been treated in several years).

The doctor has talked about prescribing an ACE inhibitor for the blood pressure, but he is hesitant to do so right away. The CDE feels that the cholesterol would come down with increased exercise and a better A1c (last visit was 8.0%). All this is alarming to me because I have a slender build, and these increases have happened within the last year or so. I also “feel” different — higher amounts of energy, my pulse feels “stronger.” It is hard to explain here, but it is very frustrating. Are these effects unusual? Are they reversible effects of lifestyle changes? Will I ultimately need to resign myself to the fact that treatment with medication is inevitable?

It’s difficult to answer these important questions with the information you provided. You said you were in good control yet your current hemoglobin A1c of 8% is higher than in the past. This can be reflected in lipid abnormalities as well. Family history of lipid problems is also important to acknowledge but higher blood glucose readings would also often be associated with worsening lipid levels. Exercise and cutting down saturated animal-source fats would decrease lipid elevations at least 10-20%. No smoking is critical and no alcohol intake as well. If none of this works, then lipid medications will be needed.

If you have anxiety, this could certainly cause intermittent hypertension. If this happens enough times, then counseling to help you reduce anxiety, sometimes also medication, may be helpful You should discuss with your physicians and nursing team. If the hypertension is intermittent and anxiety/stress related, then medications such as beta blockers would be a good first choice antihypertensive medication. ACE inhibitors and calcium channel blockers can be used as well. It may be helpful for you to purchase a blood pressure meter and get one or two readings at home/at work for about two weeks to share with your health care team so that you and they can understand how often and how high the blood pressure abnormalities really are.

Information from one of the excellent teaching manuals such as Insulin-Dependent Diabetes in Children, Adolescents and Adults by Ragnar Hanas, M.D. (available on this website) will give you detailed info about lipid and blood pressure problems as well as treatment options to consider. Go back and discuss this with your diabetes team.

SB

[Editor’s comment: Also, be sure that your doctor checks your thyroid gland’s function.

WWQ]