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Now that you have been diagnosed let’s talk about how you can
best manage your diabetes to delay or even prevent the
complications. We will go over these items more in detail but
there are several points that are very important to get right
at the beginning. The first of these is it is extremely
important if you smoke to stop smoking. Secondly, it is a very
important lifestyle problem that you have to address.
Lifestyle means eating healthy foods and getting regular
physical activity. As well, you have to keep your weight in a
healthy range, we know that if you are over weight just losing
about five to ten percent of your total body weight will have
a dramatic effect in improving your blood sugar control. And
therefore, it is important for you to take control by knowing,
firstly what blood sugar is and what your target is. It is
important for you to know what your blood cholesterol is and
particularly the bad cholesterol, LDL cholesterol and what the
target is for that. It is very important for you to know
whether your blood pressure is normal or not and whether you
are achieving the normal blood pressure target. That blood
pressure target, 130/80 is something we all have to look for.
To do all this you will have take your medicines on a regular
basis and you will have to take the medicines of a different
sort as well, often to prevent other complications. It does
not mean necessarily that because you need to take a lot of
medicines you are sicker. It just means you are able by taking
these medications to prevent yourself from getting sicker.
That is the important thing. We really want to avoid the
complications and medicines will help you to do it.
Healthy Eating
If a person has diabetes we want them to eat most things that
anybody else will eat. It just depends on the portion sizes.
Diet is the cornerstone of good treatment of diabetes. Since
just about everything that one eats is turned into sugar the
exception being fat, the bigger the meal, the higher the blood
sugar. We know that if you have diabetes, your insulin
reserve, in other words, your ability to secrete insulin is
impaired. Therefore, the bigger the meal you eat the less
likely it will be that your body can produce sufficient
insulin. The second important point about diet is that certain
foods turn into sugar faster than others. At one end of the
spectrum we have sugar, which turns into sugar instantly once
it gets into your stomach. At the other end of the spectrum we
have vegetables which turn into sugar very slowly.
Things that have carbohydrate in them raises blood sugar
counts but carbohydrates are found in a wide variety of foods.
Carbohydrates are found in fruits and vegetables, they are
found in breads, they are found in pastas, they are found in
starchy foods. That encompasses a wide variety of foods right
there and if we told people who have diabetes you can never
have carbohydrates they could never get the luxury of having
the wonderful nutrition that they would get normally from
those foods if they did not have diabetes. They must have
those foods to be healthy. It just depends on the portion
sizes so that they do not have increasing fluctuations in
their blood sugar counts. It is a good idea to avoid things
that are highly concentrated in sugar in large portions. But
they do not have to avoid it all the time. I think it is
important that if it is their birthday they have that piece of
birthday cake. If it is Christmas, they have a small piece of
cheesecake if that is what it is offered and they are not
depriving themselves of the good things in life but it is a
balance.
Lets review healthy eating for a moment. People with diabetes
do not secrete enough insulin, which is absolutely essential
for getting carbohydrate or sugar into the cells of the body.
If carbohydrate is in the form of pure sugar or even fruit
sugars it gets into the cells much quicker and it needs a much
bigger dose of insulin. If the carbohydrate is in the form of
starches, such as, pasta, bread, etc. that takes less abrupt
insulin rise and since a person with diabetes cannot secrete
enough insulin fast enough it is important that you realize
that and restrict that type of carbohydrate and always eat
meals that contain not just pure and large amounts of
carbohydrates but also other items such as meat, fish,
vegetables, milk and dairy products, as well as the
carbohydrate. This way you can control the blood sugar much
more easily. As well, there are differences in the types of
carbohydrates. There are what we call the low glycemic index
and high glycemic index carbohydrates and you need to look at
a list on those because sometimes it is quite surprising. For
example, two different types of breads can have two different
glycemic indices. Two different types of rice can be quite
different. If you use brown rice for example, it does not
cause the sugar to rise as quickly or need as much insulin as
if you would use purified white rice or eat purified white
rice. So there are differences. As well, if you really want to
be smart about it, you might learn how to count the amount of
carbohydrates that you eat in a diet. If you eat a breakfast
with a high amount, for example, orange juice and then have
carbohydrate cereals, that is going to be a bigger demand on
your insulin secretion in the morning than if you have some
protein and some fatty intake, as well as the carbohydrate.
This is important and it is very important perhaps that you
meet with a nutrition expert and get guidance on these items.
It is also important that we try to avoid large amounts of
fried and fatty foods high in cholesterol. We do know that
eating fatty foods to excess not only puts on weight but
causes clotting in arteries and blockage of the arteries
called arteriolosclerosis. Trans fatty acids and fried fatty
foods are very important to try and limit. Finally, it is very
important in understand if you are overweight we do not need
to necessarily get you down to your ideal body weight, that is
almost a hopeless goal. But we have learned that there is a
dramatic benefit in managing diabetes by losing just five to
ten percent of your total body weight bringing it down towards
normal. You will find if you are able to do so, managing your
blood sugar would be much easier and may even mean that you do
not need to take pills or even take insulin, so this is
important.
There is an incredible variety of food and one of the best
ways to enjoy food is to go see a professional dietician,
someone who is experienced with managing an individual who has
diabetes. They can make the appropriate recommendations, they
can change the food types, adjusting carbohydrate, fat and
protein so that the person can still eat a really varied diet
and continue to enjoy food the way they should.
For people who have diabetes, what we are promoting is healthy
eating. There is not any special diet that they necessary need
to follow. We ask people to follow Canada’s Food Guide. We
encourage people to eat lots of whole grains, fruits and
vegetables as you are going to see here today. We ask you to
eat moderate amounts of fish and chicken and meat and then to
use your fats in your fried food sparingly. We are really just
encouraging people to eat healthy and it is my philosophy that
there is not any food that you cannot eat. Even things that
people would often think are forbidden like cake and ice cream
and some of the other sweet things, certainly there are ways
to work that into your diet as long as you are eating overall
healthy. Certainly some of those things are fine to have on
occasion. So if you think of the four food groups, one being
breads and cereals, the other one is fruits and vegetables,
and then there are meats and alternates, so that would be the
chicken and the fish, and tofu. Then your milk and your diary
products. If you are having at least three out of the four of
those groups at each meal we considered that to be well
balanced. What that does is that it ensures that the protein
mixes with the carbohydrate and helps to slow the release of
the sugar. We are looking for a balance or a mix at each of
our meals. Even with the healthy types of oil, when you are
using oil or fat we want you to use all of your fat sparingly.
The heart healthy recommendation is for added fats. If you’re
using oil or butter or margarine to use no more than 3-6
teaspoons per day. If you want to use it all for olive all,
excellent, but you really should not be dousing everything
with olive oil; it still needs to be used sparingly no more
than 6 teaspoons per day. I think it is just the matter of
adjusting your attitude. I think it is just what people are
used to, people getting into ruts a little bit. There are
certainly a lot of ways. You can buy bag salads that are ready
to go, you can buy vegetables that are washed and peeled and
all you need to do is to add them to your pan. I think there
are certainly ways around it if you do not enjoy doing a lot
of the work yourself.
I think this highlight is for healthy eating and what we are
really suggesting for people who have diabetes. We encourage
them to eat lots of whole grains, lots of fruits and
vegetables, smaller amounts of meats, fish and chicken and use
your fats and fried food very sparingly. It does not have to
be boring and if people are wondering a little about how to
include some of their favorite foods that perhaps are a little
bit high in fat and sugar, that certainly can be worked in,
but you want a good healthy diet to start with and have the
others in moderation. I would recommend that you have a good
doctor and that you come to a diabetes center and you see a
nurse educator or a dietitian who would work with you as a
team. Perhaps give you some ideas and suggestions you then
take away and see whether they work for you or not. People do
not just have diabetes, they have food allergies as we have
talked about, things that they cannot tolerate, things they do
not like to eat.
There is another element to diet, which I think is a more
useful as a concept than as something that people practice.
That is what I call a Grazing Diet. If we consume the same
amount of calories in 10 meals, our blood sugar is much more
likely to be normal than if we consume it in 1 meal. The more
we spread out our calories through the day, the better our
blood sugar control will be.
Nutrition management is a key
component for the long –term health and quality of life for
people with diabetes.
A registered dietitian should be consulted to help plan
nutritionally adequate meals.
You should be constantly seeking out the foods and portion
sizes that you know enable you
to achieve your blood sugar goals.
If you eat a well-rounded diet that includes different food
types such as meat or fish, vegetables, milk and other dairy
products, as well as carbohydrate, you are able to control the
blood sugar
better than if your meal is just a large quantity of
carbohydrate.
If you are overweight, a remarkable benefit can be achieved by
losing 5-10% of your total body weight.
The person with diabetes and the health care team should
determine appropriate meal intervals.
We are all different and we all have different tastes. Seek
variety and balanced nutrition and
enjoy food the way you should.
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Physical Activities
Physical activities is an important part of diabetes
treatment. As your aerobic capacity improves and your stamina
increases the insulin in your body works better. We can in
part reverse that insulin resistance that you inherited from
your parents that you are born with. So number one, we can
improve insulin action.
Physical activities is going to burn up the sugar because the
muscles will need to use some of this sugar. But even more
importantly what exercise will do is it actually reduces the
resistance to insulin. 20-30 minutes every single day is
enough, it makes a huge difference in a person’s blood sugar
levels.
One of the best things that you can do for yourself if you
have diabetes is to get out and get some exercise. Start up
slow, pick up the pace and be your own best judge. It will
lower your blood sugars and also it will lower your blood
pressure, your cholesterol, you’ll probably lose some weight
and more importantly it will reduce the long-term
complications of diabetes. But first and foremost just get out
there and do it and have fun doing it, pick something that you
enjoy. It will reduce your stress. If you need something a
little more structured to get started, I would recommend that
you go to your local hospital and check out the healthy heart
program.
We are running a research project to look at the effect of
exercise and how it helps diabetics control their blood sugar
and perhaps reduce their medications. I know that exercise is
really helpful as far as day-to-day quality of life and how
they feel. We have seen some evidence that home monitor blood
glucose levels are better and early results are positive.
Positive results in that exercise is beneficial. We knew that
exercise is very useful in controlling diabetes and helping to
delay long-term complications but it had not been seen before
whether this held true in women. Post-menopausal women are a
group that are at more risk for the complications of diabetes
especially heart disease. It is a group that we are interested
in getting the results for as well. It is not hard, I think
that the women who come and who did and do participate, enjoy
it. Exercise should be enjoyable if you stick with it because
if it is something that is not done properly that you are not
finding comfortable then you are not going to stick with it.
It is part of the teams job to teach how to do it so that they
get the enjoyment, get the good feelings out of it and they do
not do it incorrectly so that it is difficult or hurting or
straining. People who do exercise feel better physically, they
feel better more on a mental level as well, so self-esteem is
higher, self efficacy is higher and that again as well is
documented. In a population who has a chronic disease or
disorder like diabetes or like cardiac disease, they need to
do something that they feel is positive and doing something to
better their health.
Another way of looking at insulin resistance is like a
receptor site on the door. The insulin has to open this up to
get the sugar into the cell. Insulin resistance can be
compared to this door being locked and even though the insulin
is there on the other side trying to unlock this door, what
happens is the door gets stuck. To build in the idea of extra
weight, imagine having all the fats cells blocking this door,
the insulin is there, ready to do its job but what happens is
that the resistance is too great for the insulin to work very
well. What happens then is that when the insulin by itself
cannot be opened up the door the pancreas revs harder trying
to make more insulin. If I had a twin sister or somebody else
to help me, maybe I can open up this door and reduce that
resistance. If I build on that with exercise, exercises
naturally reduces the resistance there. It is almost like if I
have WD 40 and I am going to lubricate these doors here.
Exercise will allow now the insulin to more easily open up the
door because the hinges are now lubricated. And exercise does
not just reduce that resistance for the time you are
exercising; it actually reduces the resistance for up to 12-24
hrs. I find a lot of people in my practice they diet a lot,
but really what they want to do is focus more on exercise and
they will see that their blood sugar count and their weight
and their attitude all improves quite nicely.
They tell me that they are feeling much better, much stronger,
more energy so things in their day-to-day life that they used
to do are feeling easier and they feel able to do more than
they used to. They feel better about themselves. Almost all of
them told me that they have noticed changes. That they are
getting a waist now that they did not have a waist before and
they are starting to notice change physically. Noticing muscle
tone in areas that women often would prefer a little bit more
muscle tone and things like that start within the few weeks of
the exercise. Of course we document the more physiological,
more research changes as far as the diabetic control and body
compositions later on but the women feel it early.
Anybody who has a risk for heart disease as with somebody with
diabetes, they should get a medical professional’s acceptance
so they can start an exercise program. People think that when
we say exercise it means hard work and lots of sweating and
lots of money because they have to join the gym. But when we
think of exercise it really means a brisk walk as one of the
best kinds of exercises that a person can do. We are looking
at about 20 minutes worth of walking if that is what the
person chooses for their exercise every single day at a
moderate intensity. And that moderate intensity might be
different from me compared to another person and so it is what
is moderate for them, whatever is a little hard for them to
do.
Exercise is no longer a burden. I do not see that it is a
burden anymore. I used to think that when I am not doing it
regularly but now it is not. If I am not able to do exercise
in the gym, there are other ways of compensating for it.
Instead of walking slowly I may take a brisk walk to wherever
I am going and also in the evening I do the Yoga exercises.
That compensates for it. So you can do it at least minimum of
four days a week or so.
Now lets again look at physical activity or exercise. It is a
very important aspect of treatment in patients with diabetes.
If for example you can make it a priority to do 35-45 minutes
of exercise or other activity everyday or at least the every
second day we now know it has a major effect on reducing
insulin resistance, a major component of your diabetes
problem. We know that if you could do that, the muscles learn
that they can burn sugar better and therefore, insulin
resistance goes down. It is also true that doing exercise it
delays carbohydrate absorption from your stomach and it will
slow the rise in blood sugar and it is also true that doing
exercise does burn off carbohydrates. However, the best
advantage from exercise is having the muscles learn to reduce
insulin resistance. It is also important that exercise is a
great way to prevent heart disease and to prevent high blood
pressure. If you have heart disease or have high blood
pressure it is important that you to do some regular exercise
within the limit of capacity to keep yourself in good
shape. We know that reduces the reoccurrence of heart disease.
It has to become a priority for anybody who has diabetes. Some
of you may have health problems such as arthritis or other
limitations that make it very difficult for you to do the
easiest form of exercise, which is just taking a walk everyday
or every second day. We now know from recent studies that
doing resistance exercises or even milder forms of exercises
such as swimming, makes a big difference. If you are unable to
walk and you wanted to exercise just sitting in a chair and
lifting weights or doing exercise like that helps. We know
that resistance exercise can also benefit blood sugars.
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Managing Stress
Stress is a part of our lives everyday whether we want it
there or not. Stress could be both positive such as, marriage
or birth of a baby or it could also be negative in terms of
loss of a job as an example or getting into a car accident.
Those are all the negative kinds of stresses. Stress affects
blood sugar levels and most people will say when they have
stress that their blood sugar levels go up. We often ask
people if it is a short-term stress, to check their blood
sugar level more often so they could keep things under control
as good as possible. But if the stress does carry on over the
long-term and is something that is not going to be resolved
very quickly they may need to talk to somebody more about
that. It could be their family doctor or it could be their
family counselor. Having diabetes itself can be stressful,
even just making the decision of what kind of glucose meter am
I going to get. There are such a number of different ones out
there that making that choice can be stressful. When you look
at diabetes care overall, we are actually asking quite a
number of different things from an individual. We are asking
people to check their blood sugars, make changes in their
diet, and maybe exercise more often. If we have to list all
the different things that an individual may be asked to do
that list can really add up very quickly. One way to cope with
stress may be to choose one thing at a time to work on. Once
you start to feel you have a handle on that thing then taking
another piece and tear that one off and working on that one.
Choosing one thing to do at a time, rather than looking at
everything that needed to happen, can often help to deal with
stress.
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Medication
People ask when is the time to start medication for diabetes?
The time to start medication is when despite good effort at
diet and exercise your blood sugar is above the target your
doctor has set for you. If after a decent trial of diet and
exercise, and I would say that should be at least a month and
some would say 3 months, then it is time to start on
medication.
What are some of the medications that we have available? You
may be prescribed by your physician a drug called Metformin or
Glucophage. This is probably the first therapy used in most
cases nowadays because in people who are overweight this is an
effective therapy. It lowers blood sugar and it allows you
usually to lose weight a little bit. It is taken 1-3 times a
day and dose ranges from 500 mg (one pill) up to 2500 mg in a
day. One of the advantages of this medication is it never
causes you a low blood sugar and it is able to reduce your
blood sugar without the necessarily to make it go too low. One
of the side effects, however, of Metformin which occurs in
maybe 7-15 percent of people is that they may get some
gastro-intestinal or stomach side effects. That could be some
nausea, some indigestion and some loose bowel movements. There
is some abdominal cramps in some patients that can be very
bothersome. However, usually if you reduce the dose, take the
pills with food and take it for 2-3 weeks at a lower dose, you
will find that those symptoms will go away and you will know
you are then able to take that medication.
The second major
group that we use is called Sulfonylureas and these are drugs
that stimulate insulin to be secreted by your pancreas. The
commonest one that we use is Glyburide or Diabeta, but there
are other agents as well. A second one is Gliclazide or
Diamicron and a third one is Glimepiride or Amaryl. All of
these agents stimulate the pancreas to secrete insulin and the
ones that I have just described are pretty long acting. You
take them once or twice a day and they last for the full day
and they are effective for the whole 24hours. These agents,
however, may cause the sugar levels to go down too low. For
example, if you do not eat a regular meal and you do a large
amount of exercise you can get a hypoglycemic reaction,
particularly with Diabeta. It is less common with Diamicron
and it is also less common with Amaryl. Finally there are 2
very short acting types of agents in the same group of these
agents that stimulate insulin release in the pancreas. These 2
other agents are called GlucoNorm and Starlix. GlucoNorm has
to be taken just before you eat and it keeps the sugar down
after you have eaten food. Similarly, Starlix does the same
thing, has to be taken 2, 3 or whatever number of times a day
whenever you eat. It acts very swiftly and holds the sugar
down. Those are the insulin stimulating type of agents that we
have available.
Finally, there is
a third group, which reduce insulin resistance. These are
called either Avandia or Actos. Both of these agents need only
be taken once a day or perhaps twice a day. They act for a
long period of time and they never cause a low blood sugar.
They reduce the blood sugar but never to excess. These agents
do not really have their full action for 8-12 weeks so do not
look for a dramatic fall in your blood sugar. It may take 2
months to have that good effect appear. These agents are very
successful in lowering sugar without causing low sugar side
effects.
Those are the
major groups of what we call oral agents or pills treating
diabetes. If these agents taken either by themselves or in
combination do not lower your sugar sufficiently to your goal
level, which as you know is an A 1 C less than 7, then you
have to figure you also need to take insulin. The commonest
approach in using insulin is to take a single injection at
bedtime while continuing your pills. It has been shown that
that simple procedure, that is taking only one injection when
going to bed, has a very good affect for at least 2-3 years in
reducing sugar to goal levels. You take your pills just as you
did before, but take one long acting form of insulin usually
at bedtime. This is usually an insulin called NPH and it has
its peak action, 7 hours later. So you take it at bedtime and
you wake up with a good blood sugar. If your blood sugar is
still high in the morning and you have taken the insulin then
you increase the dose to the point where the sugar is normal
when you start off the day.
Now let me emphasize one thing. When you take pills for your
diabetes it will destroy the beneficial effect when you do not
stay on a healthy eating regimen or you do not stay doing
regular exercise, because the gain that you had before from
the diet and the physical activity will immediately be lost
when you stop it. The pills may not be able to hold your sugar
down if you do not continue with the physical activity and the
healthy eating.
Let me explain a
little bit about some of the other insulins as well. I have
mentioned to you the one that is given most commonly when you
go to bed that is called NPH insulin. It has its peak action
about 7 hours later and becomes weakly active for up to about
15 hours. You may find that you need to take insulin more
frequently than just a single dose at bedtime. Then your
physician may or may not stop or decrease some of your pills
you are taking and have you take insulin injections 2 or 3 or
even 4 times a day. Insulin injections are not a big problem
nowadays. It is absolutely amazingly these “pens” that we
have, that look like a fountain pen that you administer
insulin with. It has a teeny needle that really has about the
amount of pain of an insect bite, such as a mosquito bite. So
it really is not a painful thing. Do not fear the fact that
you need to take insulin. It is something that really makes it
very easy for you to control your blood sugar. NPH is the one
that you start with and if you needed it more often you would
take NPH twice a day because it does not act for a full
24hours. Most people combine it with a shorter acting insulin
at the same time. For example, if you take NPH in the morning
it is going to control your blood sugar in the afternoon
before supper, but it would not control your blood sugar right
after breakfast. So, if you then add to the NPH some short
acting insulin, as we call it regular insulin, that would
control your blood sugar in the morning after breakfast. Then
for supper you would only need to take a second injection of
NPH insulin and some regular insulin at supper to control your
blood sugar after supper before going to bed. The regular
insulin taken at breakfast peaks in about 3 hours and lasts
for 5 or so hours. The NPH starts in 4-5 hours, peaks at 7
hours and lasts for 15 hours. I should now mention that there
is one additional form of new insulin which has been approved
in Canada and hopefully will be available by the time you hear
this story. This new insulin is called Lantus or Glargine
insulin. It does have just about a 24-hour duration of action.
Whether you take it at bedtime or whether you take it in the
morning, it lasts for about the full 24 hours and the
advantage of that insulin is it does not give you a peak
effect. You remember that I have said that NPH peaks at about
7 hours and that regular insulin peaks at about 3 hours.
Glargine maintains a steady level right through, essentially
through 24hrs. Therefore, you can give that as a basal insulin
and then every time you eat your meal you might take a very
short acting insulin. Now I have mentioned very short acting
insulin and there are 2 other new insulins we have available.
One is called Humolog and the other is Novorapid. Both of
these are very short acting insulins that start within 10 to
15 minutes of taking the injection, peak at about 1 hour and
are gone in 3 hours. These are very good forms of insulin for
taking when you eat a meal and if you eat a bigger meal, you
would take a little higher dose. If you eat a smaller meal,
you would take a lower dose. If you take a high amount of
carbohydrate, you would take a higher dose and if you take a
smaller amount of carbohydrate, you would take a lower dose of
this very short acting insulin called Humolog or Aspart. Other
insulins may soon be available, which will add to this. There
is this new long acting form of insulin that would probably be
out in the near future. You may have some other insulins
prescribed for you, but basically those are the groups that we
are using in the current time.
Taking insulin is
not as difficult as most people think. It is a relief to a lot
of people who have been unable to control their blood sugars
and when they finally take insulin they say, “Oh gosh, I wish
I would have taken those earlier because at last I am able to
control my blood sugar. I am having goal level A1cs of less
than 7 and I feel so much better”. So, insulin is a major form
of therapy that a lot of people will ultimately need to have.
Most people with diabetes for 15 or 20 years will probably
need insulin in the future at some point and in some form. It
is not something you should fear. It is a method of therapy,
which really will make you feel much better.
I’ve got people telling me that, “I have to go on a diet and
exercise and take 1, 2, 3 or even a 4th medication and insulin
to control my diabetes and why am I doing that”? Well, the
reason why you are doing that is by controlling your blood
sugar; you are remarkably reducing your risk for developing
further complications for your diabetes. In fact, you may
completely eliminate the chances of complications.
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Lab Tests and targets
Doctor examination
has to be supplemented by some laboratory tests. The
Laboratory tests are very important because there are some
magical tests that are available to us. The most important one
is the Hemoglobin A1c, which we now call just A1c. That test
is a single blood test that tells you what your average blood
sugar has been for the past three months. It sort of gives you
an average and lets you know when your blood sugar goes up
after a meal and comes back down when you are fasting. The
average sugar is indicated by your hemoglobin A1c.
You should know that a normal Hemoglobin A1c is actually less
than about 6.1. However, our goal with most people who have
diabetes is to keep the Hemoglobin A1c less than 7. If you are
in excellent shape we would like you to be down as low as 6,
but it is really important to be less than 7. We have the
following information available now, that is, if you can keep
your A1c level down below 7, it is very likely that you can
avoid all of the eye complications, you can avoid the kidney
complications and you can avoid the nerve complications of
diabetes. That is three out of the major four groups of
complications.
However, keeping
the blood sugar down to an A1c less than 7 may not be enough
to prevent the cardiac disease, the heart problems, that also
occur with diabetes. To do that you have to look at several
other blood tests to indicate whether you are in good control
or not. What are some of these tests? Well, the first is the
Cholesterol Test and the most important of those is the LDL
(Low-density Lipoprotein) or the “bad” cholesterol. It is
important that that level be kept down to less than 2.5mmol/L.
The HDL is good cholesterol and hopefully that is greater than
1 because that is a very important co-factor. Thirdly, we have
to check the urine for the presence of what is called the
Microalbumin or very small amounts of protein in the urine. It
is not just an ordinary urine protein test, it is a special
one. It can be done on just a specimen of urine drawn at any
time of the day or first thing in the morning. That test is
very important. You should know that the goal level for a
woman is to have the Microalbumin to Creatinine ratio less
than 2.8mmols/mg and for a man, less than 2.0 mmols/mg. There
is a slight difference between the sexes. Microalbumin is
extremely important because it becomes elevated way before
kidney disease is really bad. If you recognize the elevation
and get the appropriate treatment for it it can be prevented
from getting up high and can prevent you from losing kidney
function. Of these various tests, the Hemoglobin A1c test or
A1c should probably be done every 3 months in most patients.
However, the Cholesterol test probably only needs be done once
a year, unless it is elevated. And similarly the Microalbumin
urine test needs to be done once a year unless it has been
elevated.
Finally, your
blood pressure goal is important for you to understand. It is
now recognized that having a high blood pressure and having
high blood sugar really aggravates cardiac disease. Therefore,
you should keep your blood pressure down to less than 130/80
and you should know those numbers since that is your goal. You
should always ask your physician, “what is my blood pressure
and is it below 130/80”.
Your Goal
-HbA1c down to less than 7%
-The LDL, or “bad cholesterol” less than 2.5 mmol/L
-The HDL, or “good cholesterol” greater than 1.0 mmol/L
-Less than 2.8 mmols/mg of Creatinine (women)
-Less than 2.0 mmols/mg of Creatinine (men)
-Blood pressure less than 130/80 mm Hg
Top
Does it work?
With good diet and physical activities you can postpone the
requirement of medication. It would be unreasonable of me to
suggest that you could prevent entirely the need for
medication in the future. But you are most certainly
postponing that requirement and by being fit and healthy you
will feel better and by feeling better you have better quality
in life and that is what life is all about after all.
Now we have gone through the whole discussion of diagnoses of
diabetes, how do you treat with diet or healthy eating, how do
you treat with physical activity and then what are the various
medications that are available. As you can see, we have got a
vast group of therapies, a vast number of different therapies,
which I can promise you are all very effective. Most of them
do not have bad side effects. They are readily and easily
taken and they will make you feel better. So, the good news is
that if you can really control this disease if you are able to
keep your A1c down to less than 7, control your blood pressure
with blood pressure pills and control your cholesterol,
perhaps with a cholesterol lowering pill you should live a
long life like any other person should and you should be
feeling healthy while you do it. That is the good news and I
hope that this will help.
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