So you have diabetes, now what?

khan_headshotBy Dr. Sonya Khan

Every visit, patients get a quick finger stick and hold their breath to find out what their Hemoglobin A1C is.  This magic number defines whether or not they were on track the last three months.  Why is this number so important?  A Hemoglobin A1C measures what percentage of hemoglobin — a protein in red blood cells that carries oxygen — is coated with sugar (glycated). The higher the Hemoglobin A1C level, the poorer the blood sugar control – which means an increased risk for diabetic complications.  This number basically tells the doctor how good or bad you’ve been since your last visit.   Based on age and other medical conditions, the target Hemoglobin A1C is usually 6.5 to 7.0 percent.  This comes out to an average fasting (before breakfast) blood sugar less than 110 mg/dl and daytime blood sugar less than 140 mg/dl.

However, is it all about the sugars?  Though much of diabetes care is centered around the blood sugars, it is also important to look at other factors and measure other goals.  Diabetes is a disease that is not only a dysregulation of carbohydrates, but also a leading cause of heart attacks, blindness, kidney failure, and amputations. On a microvascular and macrovascular scale, the whole body is affected by diabetes so it is important not to concentrate on only the numbers.

The most effective way to protect against a heart attack and kidney failure as a complication of diabetes is to control blood pressure.  Many times doctors will prescribe a blood pressure medication to keep your numbers at a goal—less than 140/90 (per American Diabetes Association guidelines).  Ask your doctor if this medication will also help with kidney protection, because certain blood pressure medications are also kidney protective.  The most effective way to maintain proper blood pressure control is to avoid excess salt in your food.  Canned foods and restaurant/fast foods are very high in salt.  Items such as instant noodles are also very high in salt or sodium. Monitor blood pressure daily with an arm cuff that can be purchased at a local drug store.  A combination of controlling your blood pressure and limiting fried or fatty foods is the key to a healthy heart.

To avoid the complications leading to blindness, prevention is the key.  Retinopathy or damage to the blood vessels in the eye is a severe complication of uncontrolled diabetes.  According to the American Diabetic Association, every diabetic should have a dilated eye exam yearly.  There is no way to predict which diabetics will have eye disease, so everyone should be vigilant and have their eyes examined regularly.    There are little to no symptoms for retinopathy so it is important to be monitored even before developing any signs.

Another complication that can be prevented is amputations.  Though most people claim to have good foot care, many of us rarely actually look at the bottom of our feet.  It is important to have a complete foot exam regularly with your doctor.  Diabetics have an increased risk of amputations due to uncontrolled sugars.  The nerves in the feet get damaged which leads to numbness, and this numbness allows cuts, scrapes, and bruises to go unnoticed.  The way to avoid this complication is to have good foot hygiene.  Check your feet daily and report any abnormalities to your doctor right away.

Many of my patients, who are diagnosed with diabetes, live long and healthy lives.  Establish a good relationship with your doctor and find a regimen that fits your lifestyle and brings you to your glycemic goals.  Make sure you keep up with your blood pressure goals, cholesterol goals, and your eye and foot care.  Your weight is the last important metric.   Discuss with your doctor your proper weight because the proper weight for your body type will make all the things discussed above easier to maintain.

Diabetes is an all-encompassing disease, but when you are well informed and regular with your follow up appointments, it is not difficult to prevent complications.  Make sure you discuss these goals with your doctor on your next visit and start the conversation to a healthier you.

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