Diabetes Self-Management Articles

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Questions For Your Doctor
Ensuring Good Care

by Jan Chait

If you are prescribed insulin, you will need instruction on how to balance insulin, food intake, exercise, and other factors. In short, eating makes your blood glucose level rise and insulin makes it come down. Exercise also can make your blood glucose come down (think of it as a natural insulin-sensitizer), while factors such as illness, infection, and even hormone levels can affect your body’s need for and response to insulin.

“What about medical tests?”
Tests to check your average blood glucose values, blood lipid profile (cholesterol and triglycerides), kidney function, and more are done routinely in people with diabetes as a preventive measure. It’s better to catch a potential problem early, when steps can be taken to slow or even reverse damage, than to wait until it has impaired the function of one or more of the body’s organs.

The American Diabetes Association recommends the following schedule for medical tests:

Blood pressure: Every visit. The AACE suggests a blood pressure of less than 130 over 80–80 mm Hg.

HbA1c: At least twice a year in people who are meeting treatment goals; at least four times a year in those who are not meeting treatment goals or whose therapy has changed.

Lipid levels: Once a year, or more often if needed. The ADA recommends an LDL (the “bad” cholesterol) level of less than 100 mg/dl for those without heart disease and suggests a goal of less than 70 mg/dl for those with heart disease. HDL (the “good” cholesterol) recommendations are over 40 mg/dl for men and over 50 mg/dl for women. Why the difference? “Women’s estrogen tends to make [HDL] higher,” Dr. Cobin says. The ADA also recommends a triglyceride level of less than 150 mg/dl.

Microalbuminuria (measures kidney function): Once a year. People with Type 1 diabetes are tested about five years after diagnosis, whereas those with Type 2 diabetes are tested immediately upon diagnosis, since they may already have had diabetes for some time.

Dilated eye exam: Once a year, within five years of diagnosis for people with Type 1 diabetes and upon diagnosis for people with Type 2 diabetes.

Foot exam: Visual exam at each visit and a comprehensive exam once a year.

“Will I need to see any specialists?”
You may need to see one or more specialists immediately upon diagnosis if you have Type 2 diabetes or within five years of a diagnosis of Type 1 diabetes.

Why the discrepancy? “Many people with Type 2…have had diabetes for a significant period of time and not known about it,” says Dr. Fred Williams, an endocrinologist in Louisville, Kentucky, and former chair of the Public and Media Relations Committee for the AACE.

The first specialist somebody with Type 2 diabetes is referred to is an eye doctor — either an optometrist or ophthalmologist — for a dilated eye exam, Dr. Williams says, adding, “It’s striking that so many patients with Type 2 already have complications.” The eye doctor checks for signs of diabetic retinopathy, in which the blood vessels that supply blood to the eye’s light-sensitive retina are damaged. If caught early, it can be treated, but if ignored it can lead to vision loss.

Other specialists you may be referred to on an as-needed basis include the following:

Podiatrist. This foot specialist is recommended “if we identify problems, or if the patient doesn’t see well, can’t trim their nails, or has neuropathy (nerve damage) and shouldn’t be trimming anything,” Dr. Williams says. People with diabetes are prone to nerve damage and reduced circulation in the feet, making it difficult to feel a wound or for a wound to heal. Pressure points or calluses can make the feet vulnerable to further damage such as foot ulcers.

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