Caring for Your Diabetes

What is Type 2 Diabetes?

Patients with diabetes have too much glucose in their blood. Normally your body breaks down the food you eat into glucose (blood sugar) and the glucose goes into your bloodstream. Your pancreas then releases insulin, which helps the glucose enter your cells, where it can be used for energy. Patients with Type 2 Diabetes either don't make enough insulin or the insulin you do make doesn't work very well (or both). This leads to an elevation in your blood glucose level. Diabetics have fasting glucose levels greater than 126 mg/dl.

What are the risk factors?

There are several factors which can increase your risk for developing Type 2 Diabetes, including:

• Weight. Patients who are overweight or obese tend to be "insulin resistant" - this means that the insulin doesn't work as well as it should to keep blood glucose levels in the normal range.
  
  
• Sedentary lifestyle. Patients who are more active tend to keep their weight down, use more glucose as energy, and are more sensitive to insulin (that is, it takes less insulin to bring down your glucose levels).
  
  
• Family History. Type 2 Diabetes tends to run in families.
  
  
• Race. Blacks and Hispanics are at greater risk for developing Type 2 Diabetes.
  
  
• Age. The risk increases as you get older, particularly after age 45. However, due to the increasing prevalence of obesity in children and adolescents, there is an increasing frequency of type 2 Diabetes in younger patients.
  
  
• Gestational Diabetes. If a woman develops gestational diabetes during pregnancy and/or gives birth to a child weighing more than 9 pounds then the risk of diabetes increases.
  
  
• Polycystic Ovarian Syndrome. Women with this disorder (characterized by obesity, excess hair growth and irregular periods) are at increased risk for diabetes.

What are the symptoms?

Many patients with Type 2 Diabetes may not have symptoms for months or even years. That is why it is important to get your fasting glucose level checked as part of a physical exam, especially if you have any of the above risk factors. Symptoms include excessive thirst or hunger, frequent urination, blurred vision, and unexplained weight loss.

What are the complications?

Complications of diabetes include increased risk for heart attack and stroke. Patients can develop eye damage (retinopathy) which can lead to blindness. Kidney damage (nephropathy) can lead to dialysis or even kidney transplantation. Nerve damage can lead to tingling, sharp pain, or numbness in the feet; it can also cause problems with digestion (nausea and vomiting). It can also lead to erectile dysfunction in men. Diabetics are also prone to foot problems which can arise from nerve damage as well as poor circulation. Small cuts can lead to serious infections and in some cases amputation of a toe or foot may be necessary.

What do I need to do?

It is important that you take an active role in treating your diabetes. Make sure you know how to use your glucometer. Find out how often you need to check your glucose and what your target glucose levels are supposed to be (the American Diabetes Association recommends a target pre-meal glucose level between 90 and 130). Keep a log of your glucose readings and bring the log to your follow up visit so your provider can review the results. Remember to take your medications regularly. See your provider on a regular basis, and make sure all questions and concerns are addressed to your satisfaction. Schedule an annual diabetic eye exam.

Strive for healthy lifestyle changes, including:

• Meal Planning. Most people tend to eat too much food at one sitting; try to lessen the amount you eat at each meal. Try to consume more healthy carbohydrates (sugars) such as fruits and whole grains. Limit the less healthy carbohydrates such as sweets. Try to eat high-fiber foods such as vegetables, cereals, and legumes (beans, peas, and lentils). Limit the amount of foods that are high in saturated fats and trans fats, such as meats, whole milk, cream, butter, and many baked goods. Try to eat more heart-healthy seafood such as tuna, salmon and cod. Making all the necessary changes to your diet can be difficult; it may be a good idea to see a registered dietician who can help you create a suitable meal plan.
  
  
• Exercise. Aerobic exercise such as walking, jogging, swimming or cycling lowers your blood pressure and glucose levels. It also increases. your HDL (good) cholesterol. Exercise is also a great way to deal with stress. Work your way up to 30 minutes of aerobic exercise at least 3 times per week. Adding in some strength training (such as weight lifting) as well. Add exercise to your daily routine; for example, take the stairs instead of the elevator. If you have not exercised in a long time it may be a good idea to get a cardiac stress test prior to starting an exercise program. Be sure to discuss this with your provider.
  
  
• Smoking Cessation. If you do smoke, ask your provider to help you quit. Diabetics who smoke are three times more likely to have a heart attack or stroke compared to nonsmoking diabetics.

Although a foot exam is part of a routine diabetes appointment, it is essential that you check your feet regularly. Watch for any cuts or sores. Keep your toenails trimmed. Wash them with soap and lukewarm water and dry them gently. Ifthe skin on the bottom of your feet is dry then use a moisturizing lotion on a regular basis. Contact your provider if you see any cuts or sores that do not heal within a few days.

What are my goals?

You and your health care provider should discuss your goals and work out a plan to reach them. Some common goals for diabetics include:

• A1C < 7%. A Hemoglobin A1C test indicates how well controlled your diabetes has been for the past 2-3 months. In general, a lower A1C indicates a lower average glucose. Keeping your average glucose in an acceptable range reduc~s the risk of diabetic complications such as eye and nerve damage. A common target for diabetics is an A1C less than 7%.

• Blood pressure. Keeping your blood pressure under control reduces the risk for heart attack and stroke. A reasonable target blood pressure for most patients is 130/80; however, if you have protein in your urine your provider may suggest a target blood pressure of 125/75.

• Cholesterol. Your provider will typically check your total cholesterol, triglycerides and your HDL (good) and LDL (bad) cholesterol. A lower LDL cholesterol means there is less ' bad ' cholesterol in your bloodstream which can clog your arteries. In contrast, high "good" cholesterol can protect you from heart disease. Common targets include an HDL over 40, an LDL less than 70, and triglycerides less than 150.

What will happen at my diabetic follow-up appointment?

Before you arrive for your appointment check to make sure you have enough refills on your medications; if not, be sure to let your provider know. Write down any questions you may have. Bring your glucose logs for review. You will have your blood pressure and weight checked at each visit. Your provider will perform an exam, including checking your feet for adequate circulation and sensation. Usually an A1C is done at each visit; your lipid profile (cholesterol and triglycerides) are checked 1-2 times yearly and a urine protein test is done annually. Make sure you are up to date on your immunizations. Get a flu shot every year and a tetanus booster every 10 years. Check with your provider about other vaccinations such as the pneumonia vaccine and the shingles vaccine.

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