HeartAge+ Diabetes Pathway

1. Diabetes and your heart 2. Your numbers: A1C and glucose 3. Your targets (the ABCDES3 plan) 4. Low blood sugar and the 15-15 rule 5. High blood sugar and sick days 6. Your medications (and why they protect your heart) 7. Foot care and yearly checks 8. Eating, activity, and weight 9. The daily log and what we watch 10. Getting help and what to watch for

1. Diabetes and your heart

Type 2 diabetes means your blood sugar (glucose) runs higher than healthy because your body does not make enough insulin or does not use it well. Over time, high glucose damages blood vessels — which is why diabetes is, above all, a cardiovascular condition. That is exactly why a heart clinic manages it.

The encouraging part: the same plan that controls your sugar also protects your heart, kidneys, eyes, and nerves. Several of the newer diabetes medications were proven in large trials to prevent heart attacks, heart-failure hospitalizations, and kidney decline — not just lower glucose.

The big idea: in diabetes we treat the whole cardiovascular picture — sugar, blood pressure, cholesterol, and heart/kidney protection together — using the Diabetes Canada ABCDES3 checklist (A1C, Blood pressure, Cholesterol, Drugs for heart protection, Exercise/Eating, Screening, Smoking, Self-management).

2. Your numbers: A1C and glucose

A1C <=7.0%

3-month average sugar (typical goal)

4.0-7.0

fasting glucose, mmol/L

A1C is a blood test reflecting your average sugar over ~3 months. For most people the goal is 7.0% or below, but your personal target may be tighter or more relaxed (see §3).
Fasting / before-meal glucose goal is 4.0-7.0 mmol/L; 2 hours after meals, 5.0-10.0 mmol/L.

Check your glucose at the times your team recommends and log the readings in the app so we can see trends together.

3. Your targets (the ABCDES3 plan)

Area	Target
A — A1C	Usually <=7.0% (individualized: <=6.5% for some; up to <=8.0% if frail or at high risk of lows)
B — Blood pressure	<130/80 mmHg
C — Cholesterol	LDL <2.0 mmol/L, usually with a statin
D — Drugs for heart protection	An SGLT2 inhibitor and/or GLP-1 medication if you have heart, kidney, or vascular disease (see §6)
E — Exercise & Eating	150 min/week activity + resistance training 2-3x/week; balanced, portion-aware eating
S — Screening	Yearly kidney (blood + urine), eye, and foot checks
S — Smoking	Cessation — smoking roughly doubles vascular risk in diabetes
S — Self-management	Glucose monitoring, this app, and your care team

4. Low blood sugar and the 15-15 rule

Low blood sugar (hypoglycemia, below 4.0 mmol/L) can happen with insulin or some pills (sulfonylureas). Signs: shaky, sweaty, dizzy, confused, very hungry.

The 15-15 rule: Take 15 g of fast sugar (4 glucose tablets, 3/4 cup juice or regular pop, or 1 tbsp honey). Wait 15 minutes and recheck. Still below 4.0? Repeat. Once recovered, have a snack or meal if your next one is more than an hour away. Always carry fast sugar.

Severe low (you needed someone's help, passed out, or had a seizure): treat, then contact your care team — your medication likely needs adjusting. Repeated lows are a reason to loosen, not tighten, your targets.

5. High blood sugar and sick days

Occasional highs happen. Persistent readings above ~13 mmol/L, or any reading with thirst, frequent urination, and fatigue, mean your plan needs review.

Urgent: very high sugar (>20 mmol/L) with nausea/vomiting, abdominal pain, or fast/deep breathing can signal a dangerous condition (DKA). Seek urgent care or call 911.

Sick-day rule — the SADMANS medications: when you are acutely unwell with vomiting, diarrhea, fever, or you can't eat/drink normally, several medicines can stress your kidneys if you're dehydrated. The memory aid is SADMANS — temporarily hold these and contact your care team:

Letter	Medication group	Examples
S	Sulfonylureas	gliclazide, glyburide, glimepiride
A	ACE inhibitors	ramipril, perindopril, lisinopril (names ending in -pril)
D	Diuretics (water pills) + direct renin inhibitors	hydrochlorothiazide, furosemide, indapamide; aliskiren
M	Metformin	metformin (also in combination pills)
A	ARBs	candesartan, telmisartan, valsartan (names ending in -sartan)
N	NSAIDs (anti-inflammatories)	ibuprofen (Advil), naproxen (Aleve), diclofenac
S	SGLT2 inhibitors	empagliflozin, dapagliflozin, canagliflozin

Restart them once you have been eating and drinking normally for 24-48 hours — and confirm with your care team. Keep taking your other regular medications unless told otherwise.

SGLT2 inhibitors in particular: these can rarely cause ketoacidosis even when your sugars look normal, so holding them when you're sick or not eating is especially important.

6. Your medications (and why they protect your heart)

Metformin — usual first medication; lowers sugar safely with little risk of lows.
heart/kidney protective SGLT2 inhibitors (empagliflozin, dapagliflozin, canagliflozin) — proven to reduce heart-failure hospitalizations and protect kidneys. Often prescribed for the heart even when sugar is near target.
heart protective GLP-1 medications (semaglutide, dulaglutide, liraglutide) — lower sugar, support weight loss, and reduce cardiovascular events. Start low and increase slowly to limit nausea; eat smaller meals and stay hydrated.
Others — DPP-4 inhibitors, sulfonylureas, insulin, and pioglitazone may be part of your plan.

Never change or stop a diabetes medication — especially insulin or a sulfonylurea — on your own. Talk to your team first.

7. Foot care and yearly checks

Check your feet every day

Look for cuts, blisters, redness, or sores — use a mirror for the soles. Diabetes can dull sensation, so small problems go unnoticed and worsen fast.

Report any wound promptly

A new foot sore needs attention within a day. Keep weight off it and contact your care team.

Keep your yearly screens

Annual kidney blood + urine test, a dilated eye exam, and a foot exam catch complications early, when they are most treatable. The app reminds you when each is due.

8. Eating, activity, and weight

Plate method: half non-starchy vegetables, a quarter lean protein, a quarter whole-grain carbohydrate. Consistent carbohydrate portions steady your sugar.
Activity: aim for 150 minutes/week (e.g., 30 min, 5 days) plus resistance training twice weekly. Activity lowers sugar for hours afterward.
Weight: even a 5-10% loss meaningfully improves glucose, blood pressure, and cholesterol. If a GLP-1 is part of your plan, it helps here too.
Smoking: stopping is one of the highest-impact things you can do for your blood vessels.

9. The daily log and what we watch

What you log	Why
Fasting / pre-meal glucose	Core trend; flags lows and highs early
2-hour post-meal glucose (when asked)	Shows how meals affect you
Low-sugar episodes (and if you needed help)	Repeated or severe lows mean we adjust your plan
New foot sore / wound	Triggers prompt foot assessment
Took your medication	Adherence is the most common reason numbers drift

10. Getting help and what to watch for

Call 911 or seek urgent care if you have:

A severe low you couldn't treat yourself, fainting, or a seizure
Very high sugar with vomiting, abdominal pain, or fast/deep breathing (possible DKA)
Confusion or inability to keep fluids down

Contact your care team soon if: you're having repeated lows, your sugars run persistently high, you have a new foot wound, or you're unwell and unsure whether to hold your SGLT2 inhibitor.