The Diabetic Care Checklist
Staying on top of your preventive diabetes care
Managing diabetes, properly, is a team sport requiring input from your doctor, your ophthalmologist, hopefully a dietitian, and of course your own care. This holds true in diabetes perhaps more than any other medical illness because the majority of the care is left up to the patient in between doctor visits. So that leaves a lot to be managed.
To help with this I thought it would be a good idea to give you a checklist of things to know so you can make the most of your visit with your doctor, and make sure that your care is top-notch.
ANNUAL EYE EXAMS
Eye care is essential even if you don't have any visual complaints. You should be seeing your ophthalmologist at least once a year for a thorough eye exam and make sure that you let them know that you are indeed a diabetic.
They will perform special testing for you to make sure that you don't have a thing called diabetic retinopathy. This is a condition in which there are a variety of abnormalities in the retina, which include the leakage of proteins, hemorrhages, and the proliferation of blood vessels, all of which can permanently affect your vision in a negative way.
In the United States, diabetic foot ulcers are one of the most, if not the most common cause of non-traumatic amputation of the lower limbs. The way to prevent this is for you to have an excellent foot care regimen. This would include the following:
Never walk around barefoot
Always wear properly fitting shoes and use socks!
Report any open wound on your feet to your doctor. Early intervention can save a limb!
When you go to the doctor, take off your shoes and socks so they can perform a proper foot exam.
Never trim calluses on your feet; that should be done by a podiatrist
Don’t trim nails too short to avoid risk of trauma and infection.
Never be afraid to seek early intervention for a minor wound on your foot. As I mentioned above, this could be the difference between losing a limb or not. Your doctor will be thankful that you showed up for care sooner rather than later.
By definition, diabetics have a weekend immune system, and therefore are more susceptible to not only getting certain types of infections, but also dying from them. Therefore, it is recommended that they be vaccinated for the following:
Annual Flu vaccine
Shingles vaccine if you are over age 50
Hepatitis vaccines if you are high risk ( work in health care or other occupations that put you at risk)
Tetanus, diptheria and pertussis ( Tdap Vaccine) every 10 years.
HEMOGLOBIN A1C TESTING
Your doctor will determine the frequency of how often you will need this blood test. It usually is done 3 to 4 times per year depending on how well you are controlled.
Patients always ask me how does this test differ from the finger stick testing that people do at home or the readings they get from a continuous glucose monitor (CGM).
I explain it this way – the reading you get by a finger stick or your CGM is basically like a selfie picture. It tells you exactly what's going on at this minute.
The hemoglobin A1c test on the other hand is more like a 24 hour surveillance video that's been running for about the last eight weeks and, measured on a different scale than the blood sugars that you do at home, gives us an idea of how well your sugar has been controlled during that time frame.
In a perfect world we'd like to see that number to be less than 7 however, depending on your circumstances, your other illnesses, and how long you've been a diabetic, a reading below 8 may be acceptable. That will be something for you to discuss with your physician as to what an acceptable goal is for you.
Cholesterol or lipid testing will be done as a minimum of once a year depending on your circumstance.
All diabetics have an increased risk of heart attack and stroke, and therefore should be on lipid lowering medicines to drive their LDL cholesterol below 100. The lower the reading the better when it comes to the LDL cholesterol. I tell my patients that the L stands for "lousy" because it kills you.
I know some of you were reading this and say that you don't want to take medication. I completely understand. And of course I advocate that patients also adopt a healthy diet to help lower their cholesterol along with activity, which includes aerobic exercise.
But you need to understand that the goals that we're striving for with your LDL cholesterol are very difficult to achieve with diet and exercise alone. I didn't say impossible, but indeed, very difficult. And there are significant studies that have proven that cholesterol lowering medication's, the so-called statin drugs, do provide about a 35% to 45% reduction in heart attacks and strokes.
So how much activity do you need?
For heart health current guidelines indicate that you should get 150 minutes a week of aerobic activity divided up anyway that you like. I tell my patients that they don't have to become marathon runners and that walking is just fine. But it has to be a "honey we're late for the plane" walk and not a “ mall stroll”.
BLOOD PRESSURE CONTROL
Hypertension and diabetes are traveling companions. If you have one, there's a high chance that you have the other.
Goals for blood pressure control in diabetic patients is less than 140/90. That would be the bare minimum. If you can achieve a blood pressure of less than 130/80 without significant side effects from medications or other financial burdens to the patient, that is a more optimistic goal.
Your doctor may prescribe medications for you to help to achieve these goals, and again, diet is important. One such diet is the so-called "DASH Diet" which you can find online- I have included the link below. This is a low sodium diet.
My patients say, “I don't eat a lot of salt” and I always explain that I'm sure that they don't use a salt shaker on their food, but they may be inadvertently consuming high levels of sodium in their diet without realizing it. The Dash Diet will help them to be aware of the land mines they may be stepping on.
Well there you have it, a short list of items to be aware of to help you take better care of yourself what it comes to your diabetes.
I hope you found this information useful. I wish you luck with your diabetic health care.
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Remember- the information I present is for your information only , and should not be used to diagnose or treat any medical condition. You should seek medical care from a qualified medical doctor.
Disclaimer- the words and opinions expressed are the author’s and his alone, and not those of his employer.