Every year in November, communities across the country team up to raise awareness about diabetes, a disorder which has become a national health crisis. Diabetes affects 37 million Americans, and many are undiagnosed.
Most patients affected have Type 2 Diabetes, a disorder associated with insulin resistance and beta cell dysfunction leading to a deficiency of insulin. Uncontrolled diabetes can lead to numerous devastating complications triggered by damage to both the small and large blood vessels of the body. Small blood vessel disease can lead to damage to the retina of the eye, the kidneys, and the nerves. Large blood vessel disease leads to heart disease, stroke and peripheral vascular disease. Many with diabetes have poor control of their disease even though there are more effective treatments for diabetes than ever before.
In my 25 years as an endocrinologist, there has been an explosion of treatments that have improved the lives of patients with both Type 1 and Type 2 Diabetes. For example, when I started my fellowship in Endocrinology and Diabetes, we had three treatments for diabetes: insulin, sulfonylureas and metformin. We now have more than 80 treatments in the form of “designer” insulins, insulin pumps, continuous glucose monitoring, non-insulin injectables, inhaled insulin and many oral drugs and combinations.
Treating diabetes has always been my passion. It is also personal for me. I received my Type 1 diagnosis at age 15. As someone with diabetes and a doctor, I was always frustrated by the side effects of the older treatments, namely weight gain and hypoglycemia (low blood sugar). Fortunately, we now have drugs that help patients lose weight that do not typically cause hypoglycemia. Some of these drugs have also been shown to reduce the risk of heart disease and heart failure. With the main cause of death for a person with Type 2 diabetes being heart disease, it is wonderful to have pharmaceuticals that not only lower blood sugars, but also improve longevity.
This year, the focus of National Diabetes month is based on building a team of health care professionals, each with the common goal of improving the lives of patients with diabetes through lifestyle choices, prevention, and management of complications. It is essential that patients be their own health care advocates and seek help from those that are experts in diabetes care.
Are you at Risk for Diabetes? Follow the ABCs
What can YOU do, as a person who is either at risk for, or already diagnosed with diabetes? There are three areas of high importance for optimal metabolic control. These are commonly called the ABCs of diabetes.
A stands for A1C
The A1C test measures a 90 day blood sugar average. A non-diabetic A1C typically averages around 5.5%. Optimal glycemic control in patients with diabetes is accepted to be less than 6.5 to 7% depending on the patient’s individual situation. The A1C should be measured every three months in diabetic patients so that providers and patients can determine what the average blood sugar has been. The A1C does not give information on highs and lows. It simply gives an estimate of overall control.
B stands for Blood Pressure Control
It is essential for patients with diabetes to have blood pressure measurements that are as close to normal as possible, thus helping protect the damage that can occur in the vasculature of the body. In general, patients with diabetes should maintain a blood pressure less than 140/90 mmHg.
C stands for Cholesterol
Cholesterol management is important to keep the blood vessels of the body clean and free of plaque. The most important number to watch is the LDL, which represents the bad cholesterol that leads to heart disease. The goal LDL in most diabetics is less than 70 mg/dl although for those with pre-existing heart disease, I sometimes strive to achieve LDL levels less than 55 mg/dl.
I hope everyone will take the following advice – not just this November but throughout the year: Know your ABCs and be pro-active in your own health care. Find a health care provider that has expertise in treating patients with diabetes. Establish a meal plan that is effective in managing your blood sugar and weight goals and most importantly, one that you can stick with life-long. Make physical activity an enjoyable and regular part of your lifestyle. Take your medicines as prescribed and check your blood sugar regularly. Inquire about continuous blood sugar monitors so that you know what your sugar is all the time, not just a couple of times per day. Manage stress through exercise and healthy support systems.
