Managing Your Diabetes

The first part of “managing” your diabetes is to accept the fact that glucose (sugar) is not “processed” safely by your body and that the buildup of the blood glucose can damage many parts of the body, including the eyes.

There are many different strategies for living with diabetes. Finding the right one for you involves experience, consultation with knowledgeable health care professionals and education. A good way to approach this is to regard yourself as a “work in progress”. You will change as medical knowledge advances, as you learn more, and as your body changes over time. Good diabetes management means preventing complications to the greatest extent possible while living your life to the fullest.

Diabetes currently affects more than 17 million Americans of which the American Diabetes Association estimates 5 million have not been diagnosed. One and one-half million (8.8%) have Type I diabetes (insulin dependant diabetes mellitus) and 90% of the diabetics are Type II (non-insulin dependent or adult onset diabetes) with the remainder getting diabetes as a result of a specific genetic defect, medications, tumors and other diseases. The incidence of diabetes has increased 44% over the last 10 years.

One point can’t be stressed enough; controlling the “ABC’s” is the key to diabetic management. “A” stands for HbA1c, “B” stands for blood pressure and “C” stands for cholesterol levels.

Diabetes is an endocrine (gland) disorder characterized by either a deficiency of endogenous (substances naturally produced by your own body) insulin, a loss of cellular response to insulin, or both, resulting in a state of chronic hyperglycemia (elevated blood sugar or blood glucose). All cells within the body require a source of energy which generally speaking comes from the foods we eat. Once in the digestive tract sugar molecules are extracted from food and enter the blood stream after absorption by small intestine. To use blood sugar for energy requires that cells bring glucose “inside” of them for nourishment. The outer walls (cell membranes) must become permeable to blood glucose. Too much blood glucose can cause cell damage or death. This process is analogous to the architectural design of a bearing wall being cut in half, the foundation would collapse and diabetes is essentially the breakdown of the vasculature (blood vessels) supply. In this manner elevated blood glucose can have an effect on every organ and gland in the body and controlling that blood glucose is essential to ward off damage. The risk of diabetic complications increases the longer a person has had diabetes and the higher the average blood sugar levels are over time.

The single most important laboratory test for all diabetic patients is Hemoglobin A-1-c.
This test averages the minute-by-minute changes in a person’s blood sugar levels over two to three months, and correlates very highly with the risk of diabetes complications. It is essentially the same as poking your finger and measuring your home blood glucose levels every minute of every day for at least two solid months and then averaging all of those readings. The test works by measuring the amount of blood glucose that is bound to hemoglobin molecules on the red blood cells circulating throughout the body. Because individual red blood cells normally last only 8-12 weeks the amount of glucose bound to old red blood cells shows the average blood glucose level over that period of time. Normal HbA1c values are 4-6% (equivalent to blood glucose average of 60-120mg/dl). An easy way to figure out what percentage equals what blood glucose level is to remember that an HbA1c of 6% equals a blood glucose average of 120/mg/dl and that every 1% change in HbA1c correlates with a 30mg/dl change in average blood glucose (7% equals 150, 5% equals 90, 9.5% equals 225mg/dl). Most diabetics should be 6.5% or less.

Elevated blood sugar (hyperglycemia) can have a deleterious effect on the eye (cataracts, glaucoma, cornea, optic nerve disease (optic neuropathy), liver, kidney, heart and most of the glands and organs of the body. As mentioned earlier the key to reducing damage is to control the ABC’s:
1) HbA1c
2) Blood pressure
3) Cholesterol (blood lipids or fats)

Controlling your diabetes is not a job that you’ll have to do on your own. A team approach consisting of your primary care physician, endocrinologist, eye care provider, dentist, pharmacist, podiatrist, nutritionist and psychologist will be there to assist you. In order to keep yourself in good health, it is imperative that you have routine health care examinations with your team to prevent the negative effects of chronic diseases such as diabetes. Please feel free to contact me or my office if I might be able to assist you on this path to managing your diabetes and maintaining your good health.