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Why Do I Need to Do This Stuff, Anyway?
September 4, 2013
It was the day I fired my primary-care physician (PCP). He was going over my vital signs with me and noted my blood pressure as being 140/90 (or something like that). “That’s good,” he said.
“No,” I responded — I never could keep my mouth shut — “that’s too high for somebody who has diabetes.”
And that’s when the tirade began, beginning with my audacity in talking back to him and then going into I needed to fire my endocrinologist, who never should have let me have an insulin pump, they’re dangerous, yada, yada, yada.
That was 13 or so years and 4 pumps ago. I still have the endocrinologist.
Because those of us who party with the Diabeastie are at higher risk than the general population for all kinds of nasty things, more than our blood glucose needs to be monitored. By keeping a close eye on all of the other markers that can lead to diabetic complications such as blindness, end-stage renal (kidney) disease, heart attacks, strokes, and more; and by adhering to tighter control of things like — well, blood pressure for example — we can delay or avoid complications.
How often should specific areas be monitored? What numbers should doctors look for? How will they find out? If my former PCP had known that the American Diabetes Association (ADA) publishes an updated Standards of Medical Care in Diabetes as a supplement to the January issue of their official journal each year, he might have known what the optimal blood pressure was for his patients with diabetes. I’ll give you the highlights: If you want to read the whole megillah, go here.
Blood pressure should be monitored at every routine visit. If you have diabetes and high blood pressure, your goal for the systolic (higher) number should be no higher than 140 mmHg. Lower (i.e. no more than 130 mmHg) is even better. And for the diastolic (lower) number? No greater than 80 mmHg. So, that’s no more than 130–140/80.
Those numbers are not your goals, by the way. Normal blood pressure is considered to be no higher than 120/80 mmHg most of the time. Hypertension — high blood pressure — is defined as numbers higher than 140/90 mmHg most of the time.
Why is maintaining a good blood pressure desirable? You may think it’s only to help prevent heart attacks and strokes. But did you know that high blood pressure is also a risk factor for diabetic retinopathy and end-stage renal disease? Several years ago, I met a man who’d had a kidney transplant. I assumed it was from diabetes. Nope. He didn’t have diabetes. It was from hypertension.
While the ADA recommends an annual comprehensive foot examination — which includes a visual inspection, taking the pulses in your feet and checking for sensation using a nylon filament — mine get checked every time I see my endocrinologist and my podiatrist. It’s always been that way, but more so since I had a lower leg amputation due to a bone infection. They’re looking for signs that I may get an ulcer (open wound) or be headed toward amputation.
Now that I only have one foot, I’ve gotten a lot better about checking it myself, too. I look for red spots, blisters, breaks in the skin and such. I make sure to put lotion on my foot, too: Dry feet can develop cracks in the skin that can let bacteria in. My favorite moisturizer? Bag Balm. It comes in a square greenish metal can and can be found in farm supply stores and places like Walmart. Don’t forget to put some old socks over the Bag-Balmed foot so you won’t stick to the floor.
Two to four times a year, your doctor should do an HbA1c test. Get one at least twice a year if you’re meeting goals and your control is fairly steady; more often if your therapy changes or glycemic goals are not being met. Your doctor should be able to tell you what to aim for, depending on your age, >hypoglycemia unawareness, complications and such. Both the ADA and the American Association of Clinical Endocrinologists (AACE) suggest an HbA1c no higher than 6.5%.
At least once a year, you’ll need a fasting lipids test, kidney function tests, and a dilated eye examination.
For the lipids test, look for LDL (“bad”) cholesterol levels of less than 100 mg/dL, HDL (“good”) cholesterol levels of more than 40 mg/dl for men and 50 mg/dl for women, and triglycerides of less than 150 mg/dl.
A test that checks for protein in the urine is call urine albumin excretion (also called urine protein or proteinuria). Albumin is a protein. There shouldn’t be protein in the urine. If there is, it could signal kidney dysfunction. “Modestly elevated” proteinuria is 30–299mg per day. “High” is 300 mg per day or higher. Mine has been 30 for a long time.
Measuring serum creatinine in a blood test, can tell your doctor how well your kidneys are filtering waste products and can help detect the presence of kidney disease. Creatinine is a waste product produced by the muscles that can collect in your blood. It shouldn’t be doing that. It can also be measured via a 24-hour urine test. Results depend on gender, muscle mass, what you’ve eaten, and other factors.
Urine albumin is checked via your urine. Men have the advantage here because they can aim. Ladies, ask the lab folks for a “hat” to put under the seat of the toilet to “go” in. You can then pour the urine from the hat into the little jar they give you. By doing this, you can usually keep your hand dry. Guys, just because you can write your name in the snow doesn’t make you superior, although my grandson might have begged to differ with me when he was younger and delighted in lording it over his little sister.
An annual comprehensive eye exam by an ophthalmologist or optometrist can play a big part in helping you keep your vision. Who could argue with that? If signs of eye disease — i.e., diabetic retinopathy — are found, your visits might happen more frequently. My ophthalmologist asked me to come in twice a year after he found a tiny spot of background retinopathy in each eye.
If you’ve been newly diagnosed with Type 1 diabetes, you may not have to have some of this done until you’re had diabetes for about 5 years. After all, Type 1 happens pretty fast.
Type 2s, on the other hand, should have everything done pretty much immediately. Why? Because none of us “twoies” have a clue as to how long we’ve had diabetes. Our blood glucose may have been elevated — and climbing — for years before we were diagnosed. In that time, high blood glucose has been doing its damage.
I need to get into some of the other things we need to do. But not this week. It’s getting to be bread-baking/chicken-soup-making time.
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