Diabetes Monitoring

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Are you worrying about diabetes? Do you have diabetes? Then it is time to visit us and get tested for diabetes. This disease affects millions of people around the world and there are things you can do to prevent the complications. Dr.Paul’s extensive training in diabetes puts you in right hands when you seek treatment for diabetes.

Dr.Paul Kattupalli recommends ‘ABCs’ to every patient with diabetes:

“A” stands for “A1C” – A1C is a blood test that shows what your average blood sugar level has been during the last few months.

“B” stands for “blood pressure” – If you have diabetes, controlling your blood pressure is just as important as controlling your blood sugar. High blood pressure puts you at risk for heart attack, stroke, and kidney disease.

“C” stands for “cholesterol” – Cholesterol is a waxy substance found in the blood. High cholesterol is another factor that increases your risk of heart attacks, strokes, and other serious problems.

Why are my ABCs so important? — Compared with people who do not have diabetes, people who have diabetes are 2 to 3 times more likely to have a heart attack or a stroke. People with diabetes also have heart attacks at a younger age, and that are more severe and more deadly. Plus, people with diabetes are much more likely to get kidney disease. By keeping your ABCs under control, you can lower your risk of these problems by a lot.

Isn’t my blood sugar the most important thing? — Keeping blood sugar low is important in preventing some problems caused by diabetes, including:

Eye diseases that lead to vision loss or blindness

Kidney disease

Nerve damage (called “neuropathy”) that can cause numbness or pain in the hands and feet

The need to have toes, fingers, or other body parts removed by surgery (amputated)

Even so, blood sugar is just one of the things that should get your attention. That’s because the problems caused by high blood pressure and high cholesterol are often more serious than the ones caused by high blood sugar.

What should my ABC levels be? — The levels you should aim for will depend on how severe your diabetes is, how old you are, and what other health problems you have. Ask your doctor or nurse what your target levels should be.

Many people with diabetes aim for:

A1C levels below 7 percent

Blood pressure below 140/90, or lower in some cases

LDL cholesterol level below 100 (LDL is one type of cholesterol, often called the “bad cholesterol” or “lousy cholesterol”)

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Losing weight is an important step in controlling diabetes. You can join in our Weight Loss Program to lose weight.

How can I control my ABCs? — You and your doctor will work together to create a plan to keep your ABCs under control. Your plan might include:

Medicines – Most people with diabetes take medicine every day to control their blood sugar. They might also need to check their blood sugar level every day. Plus, many people with diabetes need medicines every day to treat high blood pressure or high cholesterol, or to prevent future health problems. If you have any problems with your medicines, or you cannot afford them, talk to your doctor or nurse about these issues.

Lifestyle changes – Choices you make every day about the foods you eat and the way you live can have a big impact on your ABCs and your general health. Here are some things you can do to help keep your ABCs under control or reduce your health risks:

Make healthy food choices – Eat lots of fruits, vegetables, whole grains, and low-fat dairy products. Limit the amount of meat and fried or fatty foods that you eat.

Be active – Walk, garden, or do something active for 30 minutes or more on most days of the week.

Stop smoking – Smoking increases the chance that you will have a heart attack or stroke, or develop cancer.

Lose weight – Being overweight increases the risk of many health problems.

Avoid alcohol – Alcohol can increase blood sugar and blood pressure.

Luckily, many of the lifestyle changes above can improve all 3 of the ABCs. For instance, being active and losing weight can help control blood sugar, blood pressure, and cholesterol levels.

DIABETES COMPLICATIONS: — Diabetes mellitus is a chronic condition that can lead to complications over time. These complications can include:

Coronary heart disease, which can lead to a heart attack

Cerebrovascular disease, which can lead to stroke

Retinopathy (disease of the eye), which can lead to blindness

Nephropathy (disease of the kidney), which can lead to kidney failure and the need for dialysis

Neuropathy (disease of the nerves), which can lead to, among other things, ulceration of the foot requiring amputation.

Many of these complications produce no symptoms in the early stages, and most can be prevented or minimized with a combination of regular medical care and blood sugar monitoring.

CARDIOVASCULAR COMPLICATIONS IN DIABETES — A number of measures are important to reduce the risk of cardiovascular (heart and blood vessel) disease.

Quit smoking.

Manage high blood pressure with lifestyle modifications and/or medication(s).

Have a blood test to measure cholesterol and triglyceride levels, and modify the diet if needed. Some people will also need a medication to lower their low-density lipoprotein (LDL) (“bad cholesterol”) or triglycerides.

If medication is needed, a statin drug should be included whenever possible. The statin drugs have been shown to decrease the future risk of heart attacks, strokes, and death in people with diabetes who are over age 40 years, even when cholesterol levels are normal.

The initiation of statins should be based upon cardiovascular risk rather than an LDL cholesterol level. Statins are recommended for anyone with clinical cardiovascular disease or over age 40 years, regardless of baseline lipid levels. For patients without clinical cardiovascular disease and under age 40 years, statins can be added (in addition to lifestyle intervention) if there are multiple cardiovascular disease risk factors. The intensity of statin therapy can be adjusted based upon side effects, tolerability, and LDL cholesterol levels. The American Diabetes Association (ADA) recommends that people with diabetes have an LDL cholesterol level less than 100 mg/dL (2.59 mmol/L). Some studies suggest lowering LDL even further, to 70 to 80 mg/dL (1.81 to 2.07 mmol/L).

Aspirin (81 to 100 mg per day) is recommended for anyone with diabetes who already has or is at increased risk of cardiovascular disease.

Some studies have shown that lowering glycated hemoglobin (A1C) levels with specific diabetes drugs may also reduce risk for cardiovascular disease.

CONTROLLING BLOOD SUGAR IN DIABETES — The long-term complications of diabetes are caused by the effect of high blood sugar levels on blood vessels.

Thus, keeping blood sugars close to normal can help prevent the long-term complications of diabetes mellitus. However, there are some risks associated with tight control, particularly an increased risk of hypoglycemia (low blood sugar).

Monitoring blood sugar levels — Monitoring blood sugar with fingersticks at home can indicate how well diabetes is controlled and serves as a guide to adjusting therapy. For most people, a target for fasting blood sugar and for blood sugar levels before each meal is 80 to 120 mg/dL (4.4 to 6.6 mmol/L); however, these targets may need to be individualized.

A blood test called A1C (glycated hemoglobin) is also used to monitor blood sugar control; the result provides an average of blood sugar levels during the previous one to three months. An A1C of 7 percent or less is recommended; this corresponds to an average blood sugar of 150 mg/dL (8.3 mmol/L).

The A1C target may be somewhat higher in people who are older or who have conditions that increase the risks associated with hypoglycemia. Even small decreases in the A1C lower the risk of diabetes-related complications to some degree.

The combination of A1C and fingerstick blood sugars provides information about the average and daily blood sugar levels.

Type 1 diabetes — Blood sugar control in type 1 diabetes requires some form of insulin, which can be given with insulin injections or an insulin pump. Most health care providers recommend intensive insulin therapy, which requires frequent blood sugar monitoring in addition to frequent injections or use of an insulin pump.

Intensive insulin therapy increases the risk of low blood sugar, is more expensive than traditional insulin therapy, and requires that the person monitor their blood sugar levels, diet, and activities. Some people who use intensive insulin therapy gain weight, although regular exercise and controlling the amount eaten can prevent weight gain.

Type 2 diabetes — With type 2 diabetes, it is sometimes possible to control blood sugar levels with lifestyle changes, often in combination with oral medications. Insulin injections may be needed when a person is first diagnosed or later in the course of treatment. Most people with type 2 diabetes who take insulin require only one or two injections per day. In 2015, an inhaled form of insulin became available for clinical use. Inhaled insulins have not been shown to be effective in reducing A1C levels to the goal of less than 7 percent that is often recommended.

EYE COMPLICATIONS IN DIABETES — Regular eye examinations are essential for detecting eye complications (called retinopathy) at an early stage, when the condition can be monitored and treated to preserve vision.

An eye exam should include dilating the pupils (with medicated eye drops) to completely examine the retina. Unless the pupils are medicated, they contract in response to light, making it impossible to view the entire retina. In some people with retinopathy, photographs of the retina will be taken to monitor the changes. This examination should be performed by a doctor who specializes in the eyes (called an ophthalmologist or optometrist).

The risk of diabetic retinopathy varies with the type and duration of diabetes and with other life events. Thus, the screening guidelines differ from one person to another.

Type 1 diabetes — People with type 1 diabetes should have an eye examination by an ophthalmologist or optometrist beginning five years after they are diagnosed with diabetes, although screening is usually not necessary before puberty. People who have difficulty with their vision or who require glasses or contacts may need to be seen sooner. The frequency of subsequent examinations will depend upon the results of the initial exam. An eye exam is usually recommended every one to two years after the initial examination.

Type 2 diabetes — People with type 2 diabetes should have an eye examination by an ophthalmologist or optometrist when they are first diagnosed with diabetes. The reason for this is that blood sugar levels often increase over a period of several years before the person is diagnosed. Eye complications can develop during this time and often have no symptoms. Having an eye examination soon after diagnosis can help to determine if there are eye complications, the extent or severity of the complications, and if treatment is needed.

The frequency of subsequent exams will depend upon the results of the initial examination. An eye exam is usually recommended every one to two years after the initial examination.

FOOT CARE WITH DIABETES — Diabetes can decrease the blood supply to the feet and damage the nerves that carry sensation. These changes put the feet at risk for developing potentially serious complications such as ulcers. Foot complications are very common among people with diabetes, and may go unnoticed until the condition is severe.

Self-exam — People with diabetes should examine their feet every day. It is important to examine all parts of the feet, especially the area between the toes. Look for broken skin, ulcers, blisters, areas of increased warmth or redness, or changes in callus formation; a health care provider should be notified if any of these changes are found.

This examination can be a part of the daily bathing or dressing routine. It may be necessary to use a mirror to see the bottoms of the feet clearly. Anyone who is unable to reach their feet or see them completely, even with the help of a mirror, should have someone else (such as a spouse or other family member) assist with the examination.

Clinical exam — During a routine medical visit, the clinician will check the blood flow and sensation in the feet. In people with type 1 diabetes, annual foot examinations should begin five years after diagnosis. In people with type 2 diabetes, annual foot exams should begin at the time of diagnosis.

During a foot examination, the clinician will look for changes such as ulcers, cold feet, thin skin, bluish skin color, and skin breaks associated with athlete’s foot. The clinician will also test the sensation in the feet to determine if it is normal or diminished. People with decreased sensation are at risk for foot injuries that can go unnoticed due to lack of pain.

KIDNEY COMPLICATIONS IN DIABETES — Diabetes can alter the normal function of the kidneys. A urine test that measures the amount of protein (albumin) in the urine can determine if diabetes is affecting the kidney’s filtering action. Microscopic amounts of albumin in the urine (microalbuminuria) can be an early indicator of diabetes-related kidney complications (called nephropathy). The amount of albumin in the urine can also help the provider determine if nephropathy is worsening.

Urine screening tests should begin in people with type 1 diabetes approximately five years after diagnosis and, in people with type 2 diabetes, at the time of diagnosis. If the test shows that there is protein in the urine, tight blood sugar and lipid (cholesterol and triglyceride) control are recommended.

A blood pressure medication (an angiotensin-converting enzyme [ACE] inhibitor or angiotensin receptor blocker [ARB]) is generally recommended if albuminuria does not improve, even if the blood pressure is normal. People with elevated blood pressure and albuminuria are also treated with an ACE inhibitor or ARB. These medications decrease the amount of protein in the urine and can prevent or slow the progression of diabetes-related kidney disease.

HYPERTENSION AND RELATED COMPLICATIONS IN DIABETES — Many people with diabetes have hypertension (high blood pressure). Although high blood pressure causes few symptoms, it has two negative effects: it stresses the cardiovascular system and speeds the development of diabetic complications of the kidney and eye. A health care provider can diagnose high blood pressure by measuring blood pressure on a regular basis.

In general, experts recommend a blood pressure below 130/80 mmHg for adults with diabetes. If you need to lower your blood pressure, your doctor will probably recommend lifestyle changes such as weight loss, exercise, decreasing the amount of salt in your diet, quitting smoking, and cutting back on alcohol. Some people also need to take medications to keep their blood pressure within the goal range. Your doctor can talk to you about the benefits and risks of the different treatment options.

PREGNANCY AND DIABETES — Control of diabetes and its potential complications is especially important for women who are planning to become pregnant, as well as in those who already are pregnant. Controlling blood sugar levels before and during pregnancy decreases the risk of many complications in both the mother and the baby.

If you want to talk to Dr.Paul Kattupalli about diabetes care and medications, please visit our clinic.

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