“If one does not know to which port one is sailing, no wind is favorable.”
—Seneca the Elder
Diabetes is a chronic condition, meaning that once you are diagnosed, it’s there to stay. While this idea can be daunting and even overwhelming at times, the good news is that with regular medical care and optimal blood glucose control, you can live a long, healthy life. With the proper training in diabetes self-management, you will become the navigator of your daily care, while your physician and other health-care professionals act as both the compass that helps guide you in the right direction and the crew that helps to troubleshoot any changes in course.
Charting the course
When you choose a destination, a map can be the most useful tool to help get you there. In diabetes management, guidelines for care that are based on both research studies and practical experience act like a map for health-care professionals to help them provide the safest, most effective plan for their patients with diabetes. Every year, the American Diabetes Association (ADA) publishes a supplement to the medical journal Diabetes Care that includes updated “Standards of Medical Care in Diabetes.” While this publication is written for health-care professionals, you should also be aware of these standards so that you can work with your diabetes care team in using them to chart the course toward your optimal diabetes health.
All adults 45 years of age and over should be screened for diabetes, and if the results are normal, the screening test should be repeated every three years. However, people who have additional risk factors for diabetes may need to be tested at a younger age, more frequently, or both. These risk factors include being overweight, having a first-degree relative with diabetes (a parent, child, or sibling), having high blood pressure or abnormal blood lipid (cholesterol and triglyceride) levels, having had gestational diabetes (diabetes that occurs during pregnancy) or having delivered a baby that weighed more than nine pounds, as well as being a member of an ethnic group that has a high rate of diabetes.
A fasting plasma glucose test is the preferred method for diagnosing diabetes in most people, although a different test is preferred for women who are pregnant. It is necessary to fast for at least eight hours before having blood drawn for this test to get an accurate result. A fasting plasma glucose level of 126 mg/dl or higher, with a repeat test with similar results on a different day, confirms the diagnosis.
Other acceptable criteria for a diagnosis of diabetes include a combination of symptoms of diabetes (see “Symptoms of Diabetes”) and a casual (nonfasting) plasma glucose level of 200 mg/dl or higher. Again, it is recommended that the blood test be repeated to confirm diagnosis.
A third test, called the oral glucose tolerance test, can also be used to diagnose diabetes. In this test, a person’s fasting plasma glucose level is measured before he drinks a solution that contains a specific amount of glucose. Subsequent blood tests are then done one, two, and usually three hours after the glucose solution is consumed. A plasma glucose level of 200 mg/dl or greater at the two-hour mark indicates diabetes. The oral glucose tolerance test is not routinely used to diagnose either Type 1 or Type 2 diabetes. However, it is sometimes used in diagnosing impaired glucose tolerance, which indicates prediabetes, a strong risk factor for developing diabetes, and the oral glucose tolerance test should be used to diagnose gestational diabetes.