Based on the American Diabetes Association Clinical Practice Recommendations 2005 effect on adverse outcomes in patients with type 1 and type 2 diabetes. …
the MVP Newsletter for People with Diabetes
DiabetesNews
Spring/Summer 2005
Protecting Your Kidneys
Diabetic nephropathy kidney disease is the leading cause of kidney failure in the United States Thats the bad news The good news is that the outlook for protecting your kidneys has gotten much brighter over the past decade or so There are now a number of measures you can take that have been scientifically proven to protect your kidneys and lower the risk of developing diabetesrelated kidney disease Your kidneys are essential in regulating the bodys fluid balance When the kidneys are stressed by elevated sugar in the blood and higher blood pressure, the body protein slips through the kidney filters, and out the urine There are no warning signs of damage to the kidneys Damage to your kidneys can be occurring for many years and you will feel fine Keep in mind that what you dont know can be harming you In order to keep things from deteriorating to chronic kidney disease, and even kidney failure requiring dialysis, please get your urine test done yearly as a preventative measure Currently, the American Diabetes Association recommends every one with diabetes should have a yearly
screening test for kidney function starting at diagnosis for type 2 since diabetes may have been developing and causing problems for many years before diagnosis and generally at the fifth year after diagnosis for type 1 All people with diabetes should be screened yearly after their first urine microalbumin test Your doctor may order a 24- hour urine collection as a more definitive way to measure your kidney function Keep in mind that a routine urine test is not sensitive enough to detect tiny albumin proteins The ADA currently advises that tight blood sugar control can significantly lower the risk of developing microalbuminuria and diabetic kidney disease The glycosylated hemoglobin A1C test gives a measure of ones blood sugar average over the previous three months and its recommended two to four times per year with a result under 7 percent Controlling blood pressure is also important not only for reducing the risk of cardiovascular disease but also for protecting the kidneys Suggested resource for people living with kidney disease: Kidney Beginnings Magazine free 1-800-749-2257 or website wwwaakporg
TO DO List for Lifestyle Modification and Kidney Health
Lose weight if
you are over weight Cut back on sodium intake Decrease alcohol consumption Get at least 30 minutes of exercise per day Quit smoking or use of other tobacco products Get treatment for urinary tract infections Practice stress reduction techniques daily Take blood pressure medication as directed, even if you feel fine Ask your doctor if you would be a candidate for a kidney protective medication- either an ACE inhibitor or ARB angiotensin receptor blocker, even if your blood pressure if normal, these drugs appear to have a protective benefit Maintain an A1C of less than 7 Maintain blood pressure less than 130/80 Make sure you have a yearly urine microalbumin test and ask for your results normal range is less than 30 micrograms of protein per milligram of creatinine Things that may elevate urine micro albumin excretion and give you a false positive test result: vigorous exercise within 24 hrs prior to the test, having an infection, fever, very high blood sugars, very high blood pressure, congestive heart failure
Exercise
Based on the American Diabetes Association Clinical Practice Recommendations 2005
Welcome to the Spring/Summer 2005 edition of MVP Health Cares Diabetes News
If you have any questions or comments about this publication, please contact the Health Promotion Department at 1-888-357-4687
Diabetes News is published by the Health Promotion Department of MVP Health Care Jolie Shoemaker RN BS, Health Promotion Manager Linda Richmond RN, CDE Health Promotion Coordinator Kim Zebrowski RPh, Clinical Pharmacist Jerry Salkowe MD ,VP Clinical Quality Improvement
In This Issue
Dental Health page 2 Prevention and Treatment Medications page 2 Smoking page 3
What Does Your
Dental Health
Proper oral hygiene is important for everyone, but having diabetes makes it even more important One reason you may have a higher risk of gum and periodontal disease, is that reduced blood flow to your gum tissue makes it tougher to fight infection High blood sugar also means more sugar in your saliva, providing an environment for natural bacteria in your mouth to turn to infection and possibly gum disease High blood sugar and some medicines can make your mouth dry, making bacteria more concentrated and allowing for a more acid environment, promoting tooth decay and possibly causing mouth soreness
Have To Do With Your Diabetes?
Brush and floss after every meal
it may
cause the gums to pull away from the teeth Like any infection it can cause your blood sugar level to be higher, making both the infection and diabetes harder to control One of the most serious concerns about periodontal disease is its alarming association with heart disease Studies show that people with periodontal disease are nearly twice as likely as the general population to have heart disease
How to Keep Your Teeth and Gums Healthy
If you smoke or use any tobacco products stop Brush and floss after every meal and snack avoid the rush jobs If you are often rushed, in the morning or too tired at night to get to each tooth, consider a power toothbrush, which requires less manual labor and provides excellent cleaning when used properly With soft bristles and small heads that oscillate or pulsate to reach deep into the curves around each tooth, power toothbrushes can loosen and sweep out plaque very effectively If you think your tooth-cleaning technique could be better, ask your dentist or dental hygienist for advise on what dental care products would work best for you Antibacterial mouthwashes are also useful Visit your dentist at least twice per year for cleaning and check
up If you have dentures you still need to look after your mouth Make sure your dentures fit properly, so that they dont cause mouth ulcers that may lead to infection
What is gingivitis? Its an infection that can start when bacteria, normally present in the mouth, forms a sticky plaque on the surface of the teeth If the plaque isnt removed properly and frequently, by regular cleaning and flossing, it can lead to gum disease Symptoms: include red, swollen, and bleeding gums What is periodontal disease? Its an infection in the gums and the bone that support the teeth If this condition worsens,
From the Pharmacist Kim Zebrowski RPh, Clinical Pharmacist
Prevention and Treatment with ACE inhibitors and ARB medications
Maintaining a healthy heart by controlling blood pressure will help people with diabetes avoid long term disease complications The American Diabetes Association ADA recommends using medications known as ACE angiotensin converting enzyme inhibitors or ARB angiotensin II receptor blockers to lower blood pressure and to slow the onset and progression of diabetes related kidney disease A recent study showed that people over the age of 55 with diabetes and at least one other
risk factor such as smoking and high cholesterol reduced their risk for a heart attack, stroke or death by taking an ACE inhibitor Current treatment guidelines recommend a target blood pressure goal for diabetics to be less than130/80 It is estimated that 71 of people with diabetes have high blood pressure, 29 of people with diabetes do not know they have it While lifestyle changes including diet and exercise may help control high blood pressure, medication is often required Although they both lower blood pressure and are considered to be renal-protective, ACEs and ARBs work differently in the body ACE inhibitors block an enzyme that produces Angiotensin This substance causes an increase in salt and water retention Blood pressure is lowered when Angiotensin is not produced in the body Many studies have shown that ACE inhibitors have a positive effect on adverse outcomes in patients with type 1 and type 2 diabetes Most of the current ACE inhibitors are available in a generic form and are a cost-effective recommendation for first line therapy ARBs work by specifically stopping the production of Angiotensin and are often used when a patient cannot tolerate an ACE inhibitor Angiotensin
Converting EnzymeACEInhibitors Generic Name Brand Name Accupril quinapril Aceon perindopril Altace ra 
mipril captopril Capoten Lotensin benazepril Mavik trandolapril fosinopril Monopril Prinivil/Zestril lisinopril Univasc moexipril Vasotec enalapril Angiotensin II Receptor Blockers ARBs Generic Name Brand Name Atacand candesartan Avapro irbesartan Benicar olmesartan Cozaar losartan Diovan valsartan telmisartan Micardis Tevetan eprosartan
MVP preferred drugs are bolded MVP policy recommends ACEs as first line therapy
As with all medications, ACE inhibitors and ARBs have side effects Both may cause dizziness or make you feel tired Some are associated with a dry cough These drugs should not be used if you are pregnant Also, you should not use potassium or salt substitutes without first checking with your doctor If you have diabetes, speak to your doctor to see if you should be taking an ACE or an ARB Remember to keep your blood pressure and blood glucose at recommended levels to avoid long-term complications from diabetes
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Smoking:
Friend or Foe?
Think about the reasons why you smoke Does it help you relax? Do you feel more alert after having a cigarette? Is it a reward for a job
well done? Does it help you control your weight? Smoking becomes part of your daily routine and you can become psychologically tied to it In addition, nicotine is highly addictive Nicotine is a stimulant It raises your blood pressure and makes your heart beat faster and revs up your nervous system If youve ever tried to quit, it is likely that you experienced withdrawal symptoms These symptoms can include headaches, irritability, diarrhea, constipation, sweating, restlessness, fatigue or dizziness Withdrawal symptoms are usually the worst in the beginning and gradually lessen with time Smoking has many bad effects on your health, especially if you have diabetes Kicking the habit is hard but definitely worth the effort Your health will improve after you quit smoking, no matter how long youve been smoking
Blood Glucose Monitors
A blood glucose monitor is the one essential tool that people with diabetes must have to keep their blood glucose levels under control
Talk to your health care provider about your decision to quit
MVPs Preferred Meters
Life Scan One Touch Ultra with alternate site testing and 5-second results Life Scan One Touch Ultra Smart meter and electronic logbook in
one with alternate site testing Life Scan Sure Step with larger strips and easy read display
Set a date and commit to quit
Choose a time when you think your life will be fairly calm Talk to your health care provider about your decision to quit He or she can help you choose the best method for you Dont get discouraged if the first method you try fails Remember, everyone is different, you just need to find the method that works for you to kick the habit permanently You may want to try cold turkey or wean yourself off of smoking cigarettes Some people find that nicotine replacement is helpful You can wear a nicotine patch or chew gum that contains nicotine When you choose the patch or the gum, some of the nicotine enters your blood system which helps to reduce your craving for cigarettes as well as the withdrawal symptoms Staying in touch with your health care provider will be important after you quit smoking Your diabetes control will probably improve and therefore your need for insulin or diabetes pills may change If you are being treated for high blood pressure or high cholesterol, your condition may change so much that your health care provider may change that treatment as well
Remember: The first 3 months after quitting are the hardest You might want to try chewing sugarless gum or have hard candy available when you get the urge to light up
Find your motivation to quit
Sometimes its something that directly affects the smoker such as catching colds more frequently or getting winded when climbing a flight of stairs Now, think about the benefits youll reap if you quit smoking Some big benefits would be setting an example for your children or grandchildren, saving money and having more energy
Accu-Chek Compact strips in the drum no handling, no coding and alternate site testing results in 5 to 10 seconds Accu-Chek Active Results in 5 seconds, 5-10 seconds with alternate site testing Is your glucometer in good working condition or are you in need of a new one? MVP offers its members with diabetes, under most plans, a free preferred glucometer every year
Did you know:
1 That if you have diabetes and smoke, you are 11 times more likely to die of a heart attack or stroke? 2 That if you smoke and develop eye disease, nerve damage or kidney disease they are more likely to progress even if you get treatment? 3 Smoking raises your blood sugar level, making it
harder to control your diabetes? 4 Smoking can cause impotence? 5 Smoking can cause cancer of the mouth, throat, lung and bladder?
To see if you qualify for a free preferred glucometer, call MVP
To see if you qualify, call an MVP Health Care Member Services Representative 1-888-687-6277 In order to receive a free meter you will need to obtain a prescription for the Accu Chek products until further notice The Life Scan products can be mailed to your home by calling our member service department, without a prescription, or if you need a new meter right away, obtain a prescription and get it filled at an MVP participating pharmacy Keep in mind you will need to request prescriptions for the specific test strips and lancets that fit with the meter youve selected
Prepare to quit
The first step to quitting is to find out why you smoke Once you figure it out, look for replacements for smoking If smoking relaxes you, learn another way to relax, such as meditating for 5 minutes or concentrate on taking slow, deep breaths and clearing your mind for a few minutes If you feel that smoking increases your energy, try taking a brisk walk instead of lighting up Also, plan rewards for yourself
when you are successful in fighting the temptation to smoke Tell as many people as you can that you are quitting so that they can support you
NYS Smokers Quit lines: 1-866-697-8487 or 1-888-609-6292 Vermont Quit Bucks Program: 1-877-937-7848
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Diabetes Care Program Incentive Quiz
After reading this issue of Diabetes News, please answer the following questions to test your knowledge Circle either true or false for each statement and either cut out the quiz or make a copy and return the quiz to receive a free gift Deadline for participation is June 15, 2005 Please send to: Health Promotions Dept, MVP Health Care, PO Box 2207, Schenectady, NY 12301-2207 1 A yearly screening to check your kidney function is called a urine microalbumin test 2 Maintaining a blood pressure less than 130/80 is recommended for kidney health 3 Maintaining an A1C level less than 7 is recommended by the ADA to lower risks 4 If your blood pressure is normal you wont need an ACE or ARB medication 5 A routine urine test will be good enough to check kidney function 6 Gingivitis may cause the gums to be red, swollen, and even bleed 7 Periodontal disease can cause high blood sugar 8 Nicotine raises blood sugar 9
Get at least 30 minutes of exercise per day to promote good health 10 A blood glucose monitor is an essential tool to support diabetes self care
Name Address City State ZIP
Whats Happening
MVP Health Care will be trying out a new diabetes outreach computer program–the telephone voice is pleasant, the questions are intended to encourage diabetes self-management and will help us understand how we can best support your needs We hope youll like this informative approach to support you in staying well This telephonic interactive program will take the place of the paper survey this year Tune your television to CNBC, Sunday nights at 7PM EST, for Diabetes Life a brand new program all about diabetes, a 30 minute program for the whole family Diabetes Life website and newsletter available free wwwdLifecom MVP employees will participate in the American Diabetes Association Tour de Cure on Sunday, June 6th If you would like to find out more about this event, sponsor a friend or family member in the ride: check ADAs website wwwdiabetesorg or phone the ADA toll free number 1-800-336-6997 to locate an event in your area MVP website has a diabetes tip of the month wwwmvphealthcarecom click
on health central
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MVP Health Care 625 State Street PO Box 2207 Schenectady, NY 12301-2207
Source:mvphealthcare.com
