Diabetes:                                                                                        Michelle Wyatt , M.D.

What is diabetes?  Insulin, a hormone that is naturally made by the pancreas, is no longer made in type 1 diabetics, and no longer works correctly in type 2 diabetics.  When you ingest food, digestion breaks down carbohydrates into sugars, taken up by the blood, and moved to the organs/muscles for energy. Insulin helps move sugar from the blood into the cells. When it isn’t present or working correctly, the blood glucose level increases.  Elevated blood glucose in both type 1 and type 2 diabetes increases your risk for other health problems. 

Once someone is diagnosed with diabetes, or high blood glucose, it is important to keep it under control to prevent complications.  Sometimes the initial diagnosis isn’t found until a complication has already occurred if one does not seek regular wellness care, meaning a patient had been living with diabetes for many years without treating it.

Over time, high blood sugar levels (uncontrolled diabetes) can harm many parts of the body.

These include:

1. Eye/retina: potentially leading to vision loss (blindness)

2. Heart and brain: atherosclerosis (clogged arteries) leading to heart attack and stroke

3. Kidneys: potentially leading to kidney failure and needing dialysis

4. Peripheral vascular disease: leading to poor circulation in the feet and possible amputation

5. Erectile dysfunction in men/impotence

6. Feet:  neuropathy (nerve damage) can lead to loss of sensation causing numbness and/or pain

How medications work:  some help the body release more insulin.  Some lower the amount of sugar the liver makes. Some help insulin work better in muscle and fat, turning food into energy. Insulin injections replace insulin no longer made by the body.

What you can do to prevent complications, besides following your diet and exercise plan and taking your medications as prescribed:

1. Every visit with your doctor:  review your weight and blood pressure. Have your feet checked.
2. Every 3-6 months: lab testing for Hemoglobin A1c = long-term blood sugar, or average over 3-4 months.
3. Every year: 

1. blood test for Cholesterol (Lipid) profile includes:

HDL (“good cholesterol” =   heart protective)

LDL (“bad cholesterol” = artery-clogging)

TG ( triglycerides)

2. Urine testing for microalbuminuria (kidneys leaking protein)

3. Retinal eye exam (not just vision)

4. Dental exam

5. Flu shot

1. At least once, plus booster at age 65:  pneumonia vaccine

Have you reviewed with your healthcare practitioner?

 Meal Plan/diet, Exercise Plan/activity, Low/High blood sugar, Glucometer testing, Aspirin Therapy, Foot care, Injecting insulin correctly, Syringe Disposal, Stress management, Sick Day Management

A1c test = average blood sugar over 3-4 months.  Goal < 7.0

Every diabetic should know when their last A1c was and what the result was!

If it was above 7, what was the plan to improve diabetic control and prevent complications?

When are you due to have it checked again to see if you are closer to your goal?

How to compare to the readings from your glucometer or lab testing:

A1C of 5% = average blood glucose (mg/dL) is 100 over 3-4 months

  6% = 135

  7% = 170

  8% = 205

  9% = 240

10% = 275

11% = 310

12% = 345

13% = 380

Foot care Do’s and Don’ts:

Do: Wear shoes or slippers at all times.

Don’t:  go barefoot.

Do:  Keep skin soft, put lotion on top and bottom of feet.

Don’t:  Let feet get dry and cracked.

Do:  Use only lukewarm water.

Don’t:  use hot water.

Do:  Wear comfortable shoes.

Don’t:  Wear torn or tight shoes.

Do:  Wear socks or hose.

Don’t:  Wear tight socks that leave marks.

Do:  Look and feel feet daily for open sores, cuts, or color changes.

Don’t:  Use corn medicines or razors.

Do:  Have feet checked by your doctor or podiatrist.

Don’t: use heating pads, hot water bottles or iodine; they can cause harm.

Do:  Keep feet dry, especially between toes; use powder if needed.

Don’t:  Cut off calluses or use other sharp instruments that can cause infection.

Websites:  www.bd.com/us/diabetes and select Diabetes Learning Center

                   www.dlife.com  for recipes, nutritional content

                   www.ada.org for all resources from the American Diabetes Association