KNOW WHAT COUNTS

The balance of blood glucose/blood pressure/cholesterol and medication/nutrition/exercise in a person with diabetes is critical to controlling one's diabetes.

BLOOD GLUCOSE (blood sugar)

Know your blood sugar (blood glucose) number. There are two different tests to measure your blood sugar. You need to do both to always have a complete picture of your diabetes. Hemoglobin A1c test shows how your blood sugar control has been over the previous 3 months. Target value is 6.5. Target values are 80-120 for fasting sugars and less than 140 for evening readings. Self monitoring of your blood sugar should be done everyday. You need to do both to always have a complete picture of your diabetes. Here is some detailed information from the National Institutes of Health National Diabetes Education Program (NDEP) about measuring your blood sugar.


BLOOD PRESSURE

A diagnosis of type 2 diabetes is often taken lightly. Many people with diabetes initially feel okay, don't need insulin or medication, and are told that serious complications are years down the road. But people with diabetes are twice as likely to develop high blood pressure--hypertension--as those without diabetes, and they are frequently hypertensive at the time they are diagnosed with the disease. About 60 to 65 percent of people with diabetes also have high blood pressure.

If left uncontrolled, diabetes and hypertension are a dangerous combination. Diabetes alone is a major risk factor for stroke. That risk increases significantly when high blood pressure is added to the mix. People with diabetes are almost twice as likely to develop heart disease as people without diabetes. Hypertension is a major contributor to deaths from stroke and heart disease for people with diabetes.1 In addition, uncontrolled hypertension increases the risk of kidney damage for diabetics. Hypertension needs to be recognized and treated early. The blood pressure goal if you have diabetes is 130/80 or less. To learn more about high blood pressure and blood pressure control go to Hypertension HealthModelsOnline.


CHOLESTEROL (LDL)

The National Diabetes Education Program 2 (NDEP) recommends that along with blood sugar and blood pressure control, people with Diabetes should maintain a desirable cholesterol level. This is important to protect blood vessels and the heart. LDL or the "bad cholesterol" is especially important to control. LDL should be ‹= 100 if you have diabetes. Here you can download the guidelines and a record form for your convenience from the NDEP.


MEDICATION

Type 1 diabetes mellitus requires the injection of insulin throughout life, daily monitoring of blood sugar (glucose) levels, and adjustments in diet and other aspects of daily living.

Type 2 diabetes mellitus may be controlled with oral medications and/or dietary management. Insulin may also be needed. If you have type 2 diabetes, your pancreas usually makes insulin. But your body cannot correctly use the insulin you make. You might get this type of diabetes if members of your family have or had diabetes. You might also get type 2 diabetes if you weigh too much or do not exercise enough. After you have had type 2 diabetes for a few years, your body may stop making enough insulin. Then you will need to take diabetes pills or insulin. Diabetes medicines that lower blood glucose never take the place of healthy eating and exercise. If your blood glucose gets too low more than a few times in a few days, call your doctor. Take your diabetes pills even if you are sick. If you cannot eat much, call your doctor. Here is some information about the types of Diabetes medications for Type 2. 3


TAKE YOUR MEDICATION AS PRESCRIBED BY YOUR PHYSICIAN

• Many medicines must be taken for a lifetime.

• Stopping medicine and/or changing dosage should not be done without consultation with your physician.

• Make sure to get your medication refilled on a regular shedule so you never run out.

• Keep a check on the expiration dates of medicines. Have a plan for remembering to take your medication. For example, combine taking medicine with a regular activity: meals, bedtime, brushing teeth, etc.

1 National Institutes of Health National Institute of Diabetes, Digestive and Kidney Disease http://www.niddk.nih.gov/welcome/releases/5_23_00.htm
2 The National Diabetes Education Program is a joint program of the National Institutes of Health and the Centers for Disease Control and Prevention
3 National Institutes of Health National Diabetics Information Center. http://www.niddk.nih.gov/health/diabetes/pubs/med/index.htm#4

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REDUCING YOUR RISK FACTORS FOR DIABETES RELATED PROBLEMS

In addition to managing your blood glucose/blood pressure/cholesterol and medication/nutrition/exercise there are several important steps you need to take to reduce your risk of Diabetes related problems.

Kidney Disease Risk Reduction

Kidney damage is a serious possible complication of diabetes. The best way to reduce your risk is to keep your blood sugar and your blood pressure in the recommended ranges. If you smoke, quit. Smoking has been shown to increase your risk for diabetic kidney damage. A simple urine test can detect low levels of albumin in the urine - an early sign of kidney damage.

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Smoking

Because poorly controlled diabetes can damage your blood vessels, it is especially important to protect them. Smoking can narrow the blood vessels, leading to heart disease and stroke. In addition, smoking increases your risk for kidney disease and diabetic eye disease (retinopathy). If you smoke, get help to quit!

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Nutrition

Medical Nutrition Therapy (MNT) is a cornerstone of diabetes care. It helps to support your goals to achieve and maintain normal blood glucose levels. It also helps achieve lipid (cholesterol) and blood pressure goals as established by your doctor. Since weight loss has been shown to improve blood glucose control, overweight persons with diabetes should have a weight management program in place. A weight loss of 8-10 pounds, irrespective of initial weight, has been shown to reduce hyperglycemia, dyslipidemia, and hypertension.

No longer is there a one-size-fits-all diabetic diet. Your nutrition plan needs to be individualized, based on the Diabetes Food Pyramid, the clinical goals set with your physician and your personal factors such as lifestyle, food likes and dislikes. The American Diabetes Association recommends that a registered dietitian be involved with your nutritional therapy and education. The use of a registered dietitian is cost-effective since understanding of and compliance with the nutritional plan is essential for glycemic (blood sugar) control. Your doctor can refer you to a registered dietitian.

The registered dietitian will design with you a nutrition program specific to your needs and lifestyle. In general The Diabetes Food Pyramid calls for daily intake of:

• Six or more servings of grains, beans, and starchy vegetables.
• Three to five servings of vegetables.
• Three to four servings of fruits.
• Two to three servings of dairy.
• Two to three servings of meat, fish, and eggs.
• Sparing use of fats, sweets, and alcohol*.

*If alcohol is consumed without food by a person using insulin or oral glucose-lowing agents, hypoglycemia can result.

The National Institute of Diabetes, Digestive and Kidney Diseases says that people with diabetes do not need special foods. Keep your blood glucose at a healthy level by eating about the same amount of carbohydrate foods at about the same times each day. Carbohydrate foods, also called carbs, provide glucose for energy. Starches, fruits, milk, starchy vegetables such as corn, and sweets are all carbohydrate foods. Talk with your doctor or diabetes teacher about how many meals and snacks to eat each day.

http://diabetes.niddk.nih.gov/dm/pubs/eating_ez/index.htm

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Exercise

Before starting an exercise program, you need to discuss it with your physician. Exercise plans should be individualized and consider your physical condition, diabetic status and personal preferences. Choose an exercise enjoyable to foster regularity, perseverance, convenience and cost. Proper footwear and appropriate protective equipment should be used. Blood glucose should be monitored before, during, and after exercise. According to the American Heart Association physical inactivity is a major risk factor for developing coronary artery disease. It also contributes to other risk factors, including obesity, high blood pressure, a low level of HDL ("good") cholesterol and diabetes. Even moderately intense physical activity such as brisk walking is beneficial when done regularly for a total of 30 minutes or longer on most days. Exercise may also decrease a diabetic's insulin requirements. 1

1 American Heart Association 2001 http://www.americanheart.org/presenter.jhtml?identifier=4563

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Dental Care

People with diabetes have a higher than normal risk for infections of the gums and bones that hold your teeth in place (periodontal disease). This can lead to chewing problems and even tooth loss. Make sure that you tell the dentist that you have diabetes during your dental visits. You can view tips for keeping your teeth and gums healthy from the National Diabetes Information Clearinghouse for Diabetes, Digestive and Kidney Diseases of the National Institutes of Health (NIH).

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Foot Care and Skin Care

One of the extremely serious side effects of diabetes is the potential of amputation. More than half of lower limb amputations in the United States occur among people with diabetes. 1 Approximately 20% to 25% of diabetic hospitalizations are for foot problems. 2 Meticulous foot care and skin care can play a major role in the prevention of complications and amputation.

Foot care is very important for people with diabetes. The disease can lower blood supply to the limbs and reduce feeling in the feet. People with diabetes should check their feet every day and watch for any scratches, cracks, unusual spots, hot spots, redness, or dry skin. Sores, blisters, breaks in the skin, infections or buildup of calluses should be reported right away to your doctor. In addition to checking your own feet each day, whenever visiting the doctor take off your shoes and socks and ask the doctor to take a look at your feet.

Skin care is also very important. Because people with diabetes may have more injuries and infections, you should protect your skin by keeping it clean, using skin softeners to treat dryness, and taking care of minor cuts and bruises right away. 3