Diabetes
Breastfeeding • Diabetes • Exercise • Hypertension • Preventive Medicine
Why does it matter if your blood sugar is high?
Routine medical follow up is recommended to help reduce the risk of diabetic complications. When you visit with your doctor for evaluation of diabetes a blood test known as a hemoglobin a1c will often be evaluated. This number gives your doctor an idea about your average blood sugar over the preceding 3 months. We know that your risk for diabetic complications increases significantly when your Hemoglobin a1c rises above 7 (average blood sugar of 150) as demonstrated in the following graph.
The most common complications of diabetes include diabetic retinopathy, neuropathy, nephropathy, and large vessel damage leading to heart disease.
These complications are discussed in further detail below.
Retinopathy (eye disease): chronically elevated blood sugars can lead to damage to the small vessels in the retina. Screening for diabetic eye changes is recommended annually with your eye doctor. Annual screening can find early diabetic eye changes that can be addressed to prevent significant vision loss.
Neuropathy (nerve disease): chronically elevated blood sugars can lead to damage to large vessels in the extremities as well as to nerves in the feet. Poor blood supply and reduced sensation in the feet then increases risk for ulceration and infection in the feet. In its most severe form this can lead to amputation. Routine screening with your doctor should include evaluation of the feet including examination for ulceration, examination of sensation in the feet and examination of circulation. If there is evidence of decreased sensation in the feet, specialized care with a podiatrist experienced in the care of the diabetic foot may be recommended.
Nephropathy (Kidney disease): chronically elevated blood sugars may cause damage to small vessels in the kidney resulting in decreasing kidney function. In its most severe form this ultimately can result in kidney failure requiring dialysis. In its earliest form this can be detected by small amounts of protein in the urine. Annual evaluation of the urine of diabetic patients for small amounts of protein (microalbumin) should be performed. We have good evidence to show that progression from this earliest form of kidney disease to more severe kidney disease can be slowed by both adequate blood sugar control as well as by the use of particular blood pressure medications known as ACE inhibitors or ARB’s. If your doctor finds protein on this annual screening he/she may recommend treatment with one of these medications to slow progression of kidney disease.
Heart Disease: chronically elevated blood sugars can lead to large vessel damage throughout the body as well as the small vessel damage discussed above. Key large vessels in the body are those providing blood to the heart and brain. Diabetes contributes significantly to the development of “blockage” within these significant vessels and therefore diabetes is one of the strongest contributors to overall risk for heart attack and stroke.
Consistent follow up: for diabetes and working closely with your doctor to obtain adequate control of diabetes (a1c less than 7, average blood sugar less than 150) can help to prevent the severe complications discussed. In addition, early detection of these complications can often lead to adjustments in management that may slow or halt the progression of these complications. Most patients, through lifestyle change and medication, are able to obtain adequate diabetic control and avoid diabetic complications.
What can you do without prescription medications to treat your diabetes?
- Smoking Cessation: Smoking does not worsen diabetic blood sugar control but does contribute significantly to blood vessel damage thereby increasing the risk for diabetic complications. The single most important lifestyle change for a smoker who is diagnosed with diabetes is to quit smoking.
- Aspirin therapy: A daily baby aspirin (81mg) can help to reduce risk for heart attack and stroke in diabetics over age 50 and is generally recommended. Please review this with your doctor to see if it is a good option for you.
- Blood Pressure Control: Because diabetes is a major risk factor for heart attack and stroke, guidelines for the control of other cardiovascular risk factors are more stringent for diabetic patients. Recommended blood pressure ideals are somewhat lower for diabetics at 130/80 or less. Please see information about hypertension on this website.
- Weight Reduction: Most adult onset diabetics are overweight. Striving to attain a normal weight (BMI <25) (bmi calculator click here.) is an important long term goal for anyone diagnosed with diabetes. Significant improvements in blood sugar control can also be seen with 10% body weight reductions.
Note: Dietary management is a complicated subject that is best managed through a diabetes educator/nutritionist/dietician and your physician may refer you for diabetes education classes. Some basic information can be obtained here.
Type II Diabetes and Diet – Exercise recommendations would be the same as those recommended in the section on hypertension. Please refer to the following for additional reliable information about Type 2 diabetes: Up to Date Information on Type II Diabetes in Adults