Diabetes is a chronic disease with serious complications if left without proper management and monitoring. Key management points include healthy eating and achieving a healthy weight, regular physical activity, self-monitoring of blood glucose, and regular checkups to monitor the onset and progression of complications (e.g. eye test, kidney test, A1C, etc.).
In this section, we will focus on self-monitoring of blood glucose and A1C, as well as the prevention of complications.
The A1C test is a blood test that reflects blood glucose control during the preceding 2 to 3 months. It refers to the attachment of glucose to hemoglobin (in Red Blood Cells, RBC). A1C levels in diabetes patients should be below 6.5% or 7% as per physician prescription.
However, it is not enough to test you A1C. Daily glucose monitoring and education is essential for anyone living with diabetes.
In normal cases, blood pressure should be lower than 120/80 mmHg. High blood pressure and diabetes are often correlated highlighting the need to prevent and manage both diseases through lifestyle modifications, physical activity and regular checkups at the physician. Diabetes patients should have their blood pressure checked at every routine visit to their physician.
People with diabetes and hypertension should maintain their blood pressure below 140/80 mmHg. Younger people may be advised to keep BP below 130/80 mmHg.
How to manage high blood pressure (Hypertension) in diabetes?
Adults with diabetes should keep their lipid profile under control by keeping LDL below 100 mg/dL and even 70 when you have overt cardiovascular disease; HDL above 50 mg/dL in women and above 40 mg/dL in men;and TG below 150 mg/dL.
This can be achieved through dietary modifications, physical activity and sometimes medications.
What is cholesterol? Triglycerides?
Cholesterol is a lipid made by our body. It can also be obtained from the food we eat. Cholesterol coming from food is poorly absorbed by the gut.
Cholesterol cannot be dissolved in the blood leading to the need for carriers called lipoproteins (LDL, HDL).
HDL (High Density Lipoprotein) is commonly known as the "good cholesterol" that carries cholesterol away from the arteries to the liver. LDL (High Density Lipoprotein) or also "bad cholesterol", should be lower than 100 mg/dL. An elevated level of LDL increases the risk of heart attack and stroke.
Triglycerides are a type of fat that our body produces.
Not everyone with diabetes develops kidney disease.
Diabetes can alter the delicate filtration role of the kidney. Excessive blood glucose makes the kidney get tired from filtering too much blood.
Key recommendations for kidney disease prevention and management target mainly blood glucose control and blood pressure control.
Routine checkup and laboratory tests are essential to detect kidney problems early and manage accordingly.
A urine test can measure protein in the urine (albumin) that should not be present in normal cases. This test should be performed once a year for diabetes patients.
Eye Care and Exam
Eye care is very important for people with diabetes. Diabetes can harm the small blood vessels in the eyes and lead to what is called "diabetic retinopathy". To reduce the risk of retinopathy and to slow its progression, it is recommended to optimize blood glucose control and blood pressure control along with other lifestyle enhancements, such as quitting smoking.
Seeing your ophthalmologist regularly (as guided by your physician) is essential for eye care and complication management even if your sight seems "ok" to you. Do not wait for signs and symptoms!
Foot Care and Exam
Foot care is essential in diabetes management, especially since prolonged periods of high blood glucose levels can affect your foot nerves and lead to serious complications. Foot problems are mainly due to neuropathy (damage of nerves) resulting from a poorly controlled diabetes. Smoking also affects the small vessels in your feet.
A foot checkup is necessary at every visit to your physician and a simple check can be performed daily at home.
Some essentials of foot care:
- Wash your feet daily and clean them very well especially between the toes
- Check your feet daily for any lesions and ulcers (you can use a mirror if you cannot see the bottom of your feet)
- Keep blood glucose under control
- Always wear well-fitting shoes
- Do not walk barefoot
- Keep blood flowing to your feet
- Consult your doctor for all your concerns