Other valuable resources are The National Diabetes The American Diabetes Association recommends further lowering blood pressure to …
ACP
SPECIAL
REPORT
Managing the ABCs of
Diabetes
Living Well
Diabetes is a lifelong disease
that makes it harder for the body to turn food into energy
It can cause sugar to build up in the blood, and high levels of blood sugar can damage blood vessels in the heart, kidneys, and eyes, as well as nerves in the feet Type 1 diabetes is usually diagnosed in children, teenagers, or adults younger than 30, although it can occur at any age It is treated by taking insulin shots daily and following a meal plan Type 2 diabetes is the most common form It is usually found in people aged 40 years or older, overweight people, or those with a family history of the disease, but it is sometimes found in children and adolescents, as well Treatment includes meal planning, exercise, and medications if necessary
Symptoms of diabetes
may include: Increased thirst Increased urination Increased hunger Blurred vision Fatigue Dry mouth Unexplained weight loss Numbness of the hands or feet Impotence Dark, velvety-looking skin in the armpit or back of the neck However, no physical problems may be evident until you experience complications, such as a heart attack, stroke, or a foot infection that does not
heal When you have diabetes, you need to take special care of yourself But diabetes doesnt have to stop you from living a full life By working with your health care team, you can learn to manage blood sugar levels and reduce your risk of related health problems
Talk to your doctor, use this guide, and call 1-800-DIABETES 342-2383 wwwdiabetesorg wwwdoctorsforadultscom to learn more Other valuable resources are The National Diabetes Education Program at 1-800-438-5383 and the following Web sites: wwwndepnihgov Learning Your ABCs Blood Sugar and the A1C Meal Planning Tips Regular Exercise Managing Medications Doctors for Adults
This ACP Special Report is brought to you by Make the Link Diabetes,Heart Disease and Stroke, an American Diabetes AssociationAmerican College of Cardiology initiative funded by the following corporate partners: Aventis Pharmaceuticals; AstraZeneca LP; Bristol-Myers Squibb Co; Eli Lilly Co; GlaxoSmithKline; Merck Co, Inc, and Merck/Schering-Plough Pharmaceuticals; Monarch Pharmaceuticals and Wyeth Pharmaceuticals; Novartis Pharmaceuticals Corp; and Pfizer, Inc
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2003 The StayWell Company 407
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2
Learning Your
ABCs
T Manage o
the Risks
If you have diabetes, your risk of heart attack or stroke is increased Risk factors include: High blood pressure Abnormal blood fat cholesterol levels Obesity Protein in the urine Insulin resistance, a condition most often seen with type 2 diabetes
By managing the ABCs of diabetes, you can reduce your risk of heart disease, stroke, kidney failure, and blindness
following important recommendations: Blood pressure control must be a priority if you have hypertension and type 2 diabetes You should have your blood pressure checked each time you visit your doctor, and your goal should be a reading of no more than 135/80 Thiazide diuretics or ACE inhibitors are types of medications that your doctor might prescribe to help control your blood pressure C is for cholesterol Your cholesterol numbers tell the amount of fat in your blood HDL cholesterol helps protect the heart LDL cholesterol can clog arteries and lead to heart disease Triglycerides are another kind of blood fat that can affect the risk of heart attack or stroke Get your cholesterol checked at least once a
year
What are the ABCs of Diabetes?
A is for A1C This blood test shows average blood sugar for the past 2 to 3 months An A1C test can help you monitor how well your treatment plan is working Have an A1C test at least twice a year B is for blood pressure American College of Physicians has made the
Talk with your doctor about the best ABC goals for you Then, record your goals and results in the chart below
ABCs A1C Blood pressure Cholesterol–Total LDL HDL Triglycerides Suggested Goals
US Units Intl Units
My Goals
My Results
Dates Numbers
Below 7 Below 135/80 Below 200 Below 100 Above 40 Below 150
Below 7 Below 135/80 Below 52 Below 26 Above 10 Below 17
The American Diabetes Association recommends further lowering blood pressure to 130/80 to prevent complications
3
Blood Sugar
AND THE A1C
Learning About the
A1C T est
Checking your blood sugar throughout the day provides an important– but limited–measure of how well you are managing your diabetes Daily checks are like a snapshot of blood sugar control at any given time The A1C test shows a much bigger picture This test measures average blood sugar levels over a 2- to 3-month period and is the only accurate measure of
overall diabetes control
Your health care provider may suggest having the A1C test twice a year If your treatment plan changes, you may be tested more often This simple blood test can be done in your doctors office, and you dont have to avoid eating before taking the test
Understanding the Numbers
Talk with your doctor about your personal A1C goal Then, you can work together to find ways of meeting this goal By lowering your A1C value just 1 percentage point, you greatly reduce the risk for eye, kidney, and nerve problems In general, if your A1C value is: Less than 7, your diabetes treatment plan is currently working This helps reduce the risk of health problems Be sure to get your A1C checked at least twice a year Over time, adjustments in your treatment plan may be needed Greater than 7, reducing your blood sugar levels will be a priority Each point over 7 greatly increases a persons risk for developing diabetesrelated complications
Other Tests Other Tests
Your Doctor May Recommend Your Doctor May Recommend
Serum creatinine–A blood test that evaluates kidney function Thyroid hormones–A blood test that evaluates thyroid function Electrocardiogram ECG–A noninvasive test that
records the electrical activity of the heart
4
Meal Planning
TIPS
Making Wise
Food Choices
Good eating habits benefit everyone, but theyre even more important for people with diabetes A healthy diet and exercise will help you lose weight and control your blood sugar Losing even 10 pounds will improve your bodys ability to use sugar for energy Good control of your blood sugar will help reduce your chances of problems, such as kidney damage and blindness A dietitian can help you set up a meal plan that suits the way you live and includes foods you like Balance Your Meals
Healthy food choices are vital to controlling blood sugar, blood pressure, and cholesterol Choose a variety of foods Eating less fat and salt will help, too Start with t 
he meal planning tips shown here Fill 1/4 of your plate with grains or other starches Choices include breads, tortillas, rice, pasta, dried beans, corn, peas, potatoes, and yams Cover 1/4 of the plate with fish, meat, poultry, or other protein sources Grill or broil meats, and trim fat and skin Put color on your plate Choose a mix of nonstarch vegetables, such as salad, broccoli, cabbage, carrots, and cauliflower Fill 1/2 of the plate with these
foods Add a piece of fruit or a roll to finish the meal Reduce salt by eating fresh vegetables instead of canned Also, try using half the salt a recipe calls for Season with fresh herbs or lemon instead of salt and butter Use canola or olive oil instead of butter or lard Split sweets and treats with a friend or family member Or save the rest for another day
5
Carbohydrates carbs include starches and sugars They are found in many foods, such as fruit, bread, potatoes, pasta, milk, and sweets Of all the foods you eat, carbs have the most effect on blood sugar Your dietitian can help you plan how many carbohydrates to eat at each meal Eating about the same amount of carbs each day can help you reach your A1C goal
Regular
EXERCISE
Fitness Matters
Fitness plays a special role for people with diabetes Getting fit can help you lose extra weight, lower blood pressure, and control blood sugar Pacing yourself is key Start small Choose activities you know you can do As your comfort level rises, you can move on to brisk exercise
Start with More Movement
Being more active really isnt hard To start, work toward being active for 30 minutes a day You can do it all at once Or, you can break it
into three 10-minute sessions To add movement to your day: Go for a 10-minute walk after each meal Take along the dog or a family member for added fun Explore a museum, aquarium, or zoo Go to a farmers market This is a great way to exercise and get fresh air Its also a good place to buy healthy fruits and vegetables Use stairs instead of the elevator Park your car in the space farthest from where youre going Walk around the store or the mall before you shop Put on music and dance for a few songs Rake leaves or pull weeds
Stay Safe
Wear the proper footwear for the activity Be sure to dress for the weather Drink a glass of water before and after exercise Also, carry a bottle of water with you during activity Keep a carb source, such as glucose tablets or hard candy, with you Wear identification that says you have diabetes, in case of emergency
For best results, mix fitness with fun That way youll be more likely to stick with your plan
6
Managing
MEDICATIONS
your doctor prescribes a medicine Write the answers in pencil so that you can make changes if your medications change When do I take the medicine before a meal, with a meal, after a meal? How often should I take the medicine?
Should I take the medicine at the same time every day? What should I do if I forget to take my medicine? What side effects may occur? What should I do if I experience side effects? I should call my doctor if I have any of the following problems with my medicines I should call my doctor if my blood sugar is too low or too high for several days Too low is ________ mg/dL for ________ days Too high is ________ mg/dL for ________ days My blood sugar should be between __________ mg/dL and __________ mg/dL before my first meal of the day My blood sugar should be between __________ mg/dL and __________ mg/dL 1 to 2 hours after a meal My A1C should be ____________
Ask these questionswhen
Fill in the names of your medicines, what they are for, when you should take them, and how much you should take Use pencil so that you can make changes if your medications change Name of medicine: ___________________________ What it is for:_______________ Time: ______ Meal: _________ How much:_________________ Name of medicine: ___________________________ What it is for:_______________ Time: ______ Meal: _________ How much:_________________ Name of medicine: ___________________________ What it is
for:_______________ Time: ______ Meal: _________ How much:_________________ Source: wwwniddknihgov
FOR MORE INFORMATION AND ADDITIONAL RESOURCES For managing your blood pressure and cholesterol, you may also go to
wwwdoctorsforadultscom wwwdiabetesorg/makethelink wwwamericanheartorg
7
Doctors for
ADULTS
What is a doctor of internal medicine?
Doctors of internal medicine, often called internists, focus on adult medicine They care for their patients for life–from the teen years through old age Internists have had special study and training focusing on the prevention and treatment of adult diseases At least 3 of their 7 or more years of medical school and postgraduate training are dedicated to learning how to prevent, diagnose, and treat diseases that affect adults Internists are sometimes referred to as the doctors doctor, because they are called upon to act as consultants to other physicians and help solve puzzling diagnostic problems
Why choose an internist for your health care?
An internist, just like a family or general practitioner, can serve as your primary care doctor But internists are unique because they focus on adult medicine Internists dont deliver babies, they dont
treat children, and they dont do surgery They do, however, have wide-ranging knowledge of complex diseases that affect adults With in-depth training in adult medicine, an internist is your best choice to help you navigate the increasingly complex world of medical care An internist can treat you for something as routine as the flu or fatigue or provide in-depth care for diseases such as diabetes, depression, cancer, or heart disease Internists often coordinate the subspecialists a patient might see in the process of treating an illness Internists patients like knowing that they have a relationship with a physician who is equipped to deal with whatever problem the patient may have–no matter how simple or complex
What is American College of Physicians?
American College of Physicians ACP is the nations largest medical specialty organization and second-largest physician group Its membership includes more than 115,000 internal medicine physicians, related subspecialists, and medical students Internists treat the majority of adults in the United States The ACP mission is to enhance the quality and effectiveness of health care by fostering excellence and professionalism in the practice
of medicine ACP is headquartered in Philadelphia, with an office focusing on public policy in Washington, DC
For more information about internists and internal medicine, visit wwwdoctorsforadultscom
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Source:acponline.org
