Wednesday, October 15, 2008

Health Care and Diabetes

Millions of Americans suffer from Diabetes. Diabetes is infamous for leading to a slew of serious complications such as blindness and amputations. But complications don't have to be a fact of life for those with the condition according to Managing your glucose levels can be challenging when you have diabetes. You need to plan what you eat, take glucose readings, take your medication, see your doctor and more. Moreover, how your body responds is quite individual, but most people aren’t doing a very good job of taking care of themselves--and good, consistent care is what it takes if you want to live to 90 without complications.

Diabetes is a disease in which the body does not produce or properly use insulin as stated by the American Diabetes Association. Insulin is a hormone that is needed to convert sugar, starches and other food into energy needed for daily life. The cause of diabetes continues to be a mystery, although both genetics and environmental factors such as obesity and lack of exercise appear to play roles. There are 23.6 million children and adults in the United States, or 7.8% of the population, who have diabetes. While an estimated 17.9 million have been diagnosed with diabetes, unfortunately, 5.7 million people (or nearly one quarter) are unaware that they have the disease.

According to the American Diabetes Association, in order to determine whether or not a patient has pre-diabetes or diabetes, health care providers conduct a Fasting Plasma Glucose Test (FPG) or an Oral Glucose Tolerance Test (OGTT). Either test can be used to diagnose pre-diabetes or diabetes. The American Diabetes Association recommends the FPG because it is easier, faster, and less expensive to perform. With the FPG test, a fasting blood glucose level between 100 and 125 mg/dl signals pre-diabetes. A person with a fasting blood glucose level of 126 mg/dl or higher has diabetes. In the OGTT test, a person's blood glucose level is measured after a fast and two hours after drinking a glucose-rich beverage. If the two-hour blood glucose level is between 140 and 199 mg/dl, the person tested has pre-diabetes. If the two-hour blood glucose level is at 200 mg/dl or higher, the person tested has diabetes.

The American Diabetes Association indicates several types of diabetes:
--Type 1 diabetes: Results from the body's failure to produce insulin, the hormone that "unlocks" the cells of the body, allowing glucose to enter and fuel them. It is estimated that 5-10% of Americans who are diagnosed with diabetes have type 1 diabetes.
--Type 2 diabetes: Results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Most Americans who are diagnosed with diabetes have type 2 diabetes.
--Gestational diabetes: Immediately after pregnancy, 5% to 10% of women with gestational diabetes are found to have diabetes, usually, type 2.
--Pre-diabetes: Pre-diabetes is a condition that occurs when a person's blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. There are 57 million Americans who have pre-diabetes, in addition to the 23.6 million with diabetes.

Diabetes is complex, and effective management takes effort according to It doesn’t hurt to have a few tricks up your sleeve. To help you stay on top of it all and avoid complications, here are 6 ways to take control:

1.) Stay Regular. Eat and test your blood on a schedule. Your readings will be more informative and dependable if you mostly take them at the same time under the same conditions, and you’ll also be more likely to take them if you are on an uninterrupted schedule. Getting in a hurry, losing your monitor or running out of test strips—that is, becoming too flustered to stay on top of things—is much less likely to happen when you make a schedule and stick to it.

2.) Set Goals. Diabetes can seem overwhelming at times, but the more you feel in control, the better you’ll do. Setting goals not only gives you something to aim for, it helps you know when to swing into action. This kind of attitude keeps you in charge, rather than your condition.

3.) Keep a Diary. Write everything down, not just your blood sugar readings but all your numbers: weight, blood pressure, cholesterol, along with what you eat. Each body responds differently to various food and medications, and the only way you’ll know how your body responds to the many variables is to pay attention and keep track.

4.) Make notes on the kind of day you are having as well: All sorts of things, such as menstrual cycles and stress or activity levels, can affect glucose readings. A week or so later, when you are noting those patterns, it will help to know which morning you missed your bus and had to walk extra blocks to work, or which afternoon you had a fight with your spouse.

5.) Join a Team. Diabetes management is not a solo job, so get support from your physician, a diabetes educator or dietitian, a personal trainer and other specialists, such as an eye doctor or podiatrist. They all will work with you to keep you healthy. However, they won’t do you as much good if you don’t keep them informed. This is one diary you’ll want to let other people read.

6.) Cut Yourself Some Slack. It is crucial to stay on top of your diabetes care if you want to avoid complications, but don’t be too hard on yourself. Trying to be too organized can backfire for some people causing them, for example, to get discouraged and not do anything at all. For those types, a more flexible approach works better. In order to develop a management plan that works, you have to know yourself. If one approach turns out not to work well for you, try something else.

The American Diabetes Association advises that people suffering from this disease build a health care team to help manage diabetes. No matter what type of diabetes you have, it affects many parts of your life. You can get help from health professionals trained to focus on different areas, from head to toe. A health care team helps you use the health care system to its fullest.

1.) Your Health Care Team: In centers that focus on diabetes care, health care professionals often already work as a team. Sometimes, your primary diabetes doctor (internist, family practice doctor, or endocrinologist) will refer you to other health care providers in the same clinic or a building nearby. Or you may need to work with your doctor to build a health care team, adding members as the need arises.

2.) Other Specialists: As your health care needs change, you may need to add other members to your team. If you plan a pregnancy, for example, you will need to bring an obstetrician onto your team. If you have blood flow problems in your legs or feet, you may need the help of a vascular surgeon. Your primary care doctor can help find the specialist you need and work with you and that specialist to coordinate your care.

3.) Visiting Your Health Care Team: The American Diabetes Association provides standards of medical care for people with diabetes. These guidelines give the most up-to-date information on taking care of your diabetes. Also, the guidelines let you know what to expect from your doctor and health care team.
--The First Visit: Your first visit to a doctor who will treat your diabetes should have four parts. Learn what those parts are.
--Future Visits: How often you should return to your diabetes doctor depends on many things. Learn what those things are in this section.
--Visits for Children and Teens: Standards of care for children are somewhat different. Children whose diabetes is not well controlled sometimes are slow to grow and mature.
--Visit with the Pharmacist: Make sure that you talk with the pharmacist about how to use medications and supplies for administering insulin and other medications to managet diabetes. Understand how the medications work and interact with other prescriptions and over the counter medications and supplements.

Most people with diabetes have health problems -- or risk factors -- such as high blood pressure and cholesterol that increase one's risk for heart disease and stroke. As noted by the American Diabetes Association, when combined with diabetes, these risk factors add up to big trouble. In fact, more than 65% of people with diabetes die from heart disease or stroke. With diabetes, heart attacks occur earlier in life and often result in death. By managing diabetes, high blood pressure and cholesterol, people with diabetes can reduce their risk. Nearly all people with diabetes have abnormal cholesterol levels which contribute to their increased risk for heart attack and stroke. By choosing foods wisely, increasing physical activity and taking medications, you can improve your cholesterol.

Diabetes if managed well is a disease that can be maintained with a healthy lifestyle. Make sure that you monitor blood sugar levels and wisely manage medications. Part of the fallout with the disease is emotional difficulties and mental denial of how severe the problems can be if diabetes is not regularly monitored. Get a support system in place to help you. Seek guidance from medical professionals, family, and friends in addition to the myriad of available resources to help maintain a healthy life.

Until next time. Let me know what you think.

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