Updated October 11, 2007

Avoiding Complications:
Nurturing Your “Health Bank”

by Amy Tenderich, M.A.

People are often surprised by their test results. Those who’ve spent months fretting about their HbA1c might find it at a respectable level (around 7.5%), while their blood pressure is dangerously high (over 140 mm Hg systolic, for example). What the “diabetes health account” approach does is allow you to pinpoint any results that are out of range, so you can focus on the one or two issues currently most critical for you personally. It’s essentially a do-it-yourself approach to good health. That means it’s your job (not your doctor’s) to collect those health dollars—by knowing your test results and taking the most effective actions to improve them where needed.

Active improvement
So what do you do about your health risks once you identify them? That’s an excellent question, and the answer depends on where your problem areas are and how far you are from your goal range. If you are very far from goal range, immediate and aggressive action—most likely requiring the involvement of your physician—is needed.

If you are close but not quite in goal range, there are a number of very effective strategies that you can “cycle through” to bring your test scores into target range. The idea in this case is to start with the least invasive approach, such as lifestyle changes like diet and exercise, then progress to more aggressive treatments such as medication as necessary. If the first recommendation doesn’t yield results, you can move on to the second, and so on.

The idea here is not to bypass professional medical care but rather to work together with your doctor, diabetes educator, dietitian, or other health professional at a new proactive level, taking initiative and full “ownership” of your diabetes care. Dr. Jackson advises people to think of their diabetes as a small business and their health-care team as their consultants. The objective is to go into appointments armed with information on where the “business” stands, and be prepared with clear goals and/or questions you want your consultants to advise you on. This way, rather than just passively answering questions, you can get a whole lot more meaningful input from your interactions with your health-care team.

In the case of high blood pressure, you might start by investing in a home blood pressure monitor, then talk to your doctor about taking blood-pressure-lowering drugs such as ACE inhibitors, angiotensin II receptor blockers (ARBs), or beta-blockers. Aerobic exercise can be very beneficial when done regularly, and there are many specific—but not drastic—changes you can make in your diet to help bring blood pressure levels down.

Lowering your microalbumin test result is almost always a matter of lowering your blood pressure. ACE inhibitors and ARBs also have a directly protective effect on your kidneys, separate from their effect on lowering your blood pressure. When taken together, the two types of drugs are even more helpful. So a drug from one of these two classes is almost always the first choice in treating high blood pressure—and at the same time lowering microalbumin—in people with diabetes. You can also improve your kidney health by lowering your blood pressure target and working to reduce your HbA1c if it is high.

The point is that you’re much more likely to significantly improve your health if you pinpoint your focus, then take a step-by-step approach to addressing your most critical risks.

Confidence is key
In October 2006, Forbes reported that “diabetes is dragging down America’s health (statistics).” According to new data from the U.S. Centers for Disease Control and Prevention, a good half of the estimated 21 million adult Americans with diabetes currently rate themselves as having only “fair” or “poor” health—levels that are associated with diabetes-related complications.

Amy Tenderich is the author of the blog Diabetes Mine, which can be read at www.diabetesmine.com, and coauthor, along with Richard Jackson, M.D., of Know Your Numbers, Outlive Your Diabetes, published in 2007 by Marlowe & Company. Dr. Jackson is Director of Outreach at the Joslin Diabetes Center in Boston and an Assistant Professor of Medicine at Harvard Medical School.

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