Diabetes

Diabetes is a lifelong, chronic condition where there is not enough insulin in the body to effectively assist with digestion after eating.  Food is broken down during digestion into sugar.  Insulin is used to change the sugar and starches into energy that the body needs through the day.  Without enough insulin, glucose builds up in the blood and is indicative of Diabetes.

• Type 1 Diabetes is an autoimmune condition where the body does not produce any insulin.
• Type 2 Diabetes is when the pancreas cannot make enough insulin, or the body has problems using the insulin.

High blood sugar can harm many parts of the body, such as the eyes, heart, blood vessels, nerves, and kidneys. It can also increase your risk for other health problems and complications.

Self-Care

Daily care of diabetes includes self-care:

• Make a list of what you need to do every day to manage diabetes
  • blood sugar checks
  • foot check
  • take medications
  • physical activity
  • healthy eating
• Report to your doctor any change in symptoms
• Ask questions if you do not understand
• Make and keep all doctors’ appointments

Healthy Lifestyle Choices 

Treatment and management of both Type 1 and Type 2 diabetes begins with healthy lifestyle choices:  

• Take your medicine as your doctor told you
• Do health checks at home (test blood sugars as suggested by doctor)
• Know your goal blood sugars
• American Diabetes Association goals for Blood Sugar (your doctor’s targets for you may differ)
  • Before meals:  80-130 mg/dl
  • 1-2 hours after meals: Below 180mg/dl
• Know how to treat low and high blood sugars
• Keep active and exercise
• Know the signs your condition is getting worse
• Eat well (see below)
• Pay attention to your feet (https://www.cdc.gov/diabetes/library/features/healthy-feet.html)
• Maintain your weight

Healthy Eating 

Healthy Eating with Diabetes (https://www.diabetes.org/healthy-living/recipes-nutrition/eating-well):

• Manage your portions
• Balance your plate with healthy and colorful foods

Management and Treatment by Your Provider

The diagnosis of diabetes can come with many unknowns and concerns about what to do next.  Your provider will tell you how often they would like to see you to monitor your diabetes.  At a minimum you should have yearly monitoring at your annual wellness visit or physical exam. Below is recommended monitoring that should be performed yearly for patients who have known diabetes Type 1 or Type 2.

• Annual Physical Exam: This is the most important doctor visit of the year. This is a visit for you to update your personalized prevention plan and discuss any chronic conditions and monitoring needs.  This visit can last up to an hour, so time can be taken to answer questions and review your testing.
• Hemoglobin A1c: This blood test gives a picture of your average blood sugar level over the past two to three months. The higher the level, the greater your risk of developing complications. Talk with your doctor about your numbers—the national recommendation is to remain below an A1c of 8 (American Diabetes Association).  A provider should monitor your A1c every 2-3 months, especially if your A1c remains above 8.0.
• Kidney Disease: One of the ways that your provider can monitor your kidney health is yearly blood work and urine test. Kidney disease is one of the common complications of diabetes, especially in those whose A1c levels are difficult to control. 
• Hypertension: Hypertension is when your blood pressure remains consistently above 140/90. Often your doctor will prescribe medications and monitoring to lower your blood pressure. Contact Member Services to see if your benefit covers a blood pressure monitoring device to use in your home.Eye Disease: Eye disease is a common complication of diabetes. A disease of the eye called retinopathy can happen. Retinopathy is when the retina develops a hole and can lead to blindness in one or both eyes. A yearly dilated-eye exam is recommended for all patients with diabetes. Finding and treating this condition early can help maintain your eyesight. 
• Neuropathy: Neuropathy is a condition that affects the circulation in your legs and feet.  This can be monitored by regular foot exams at your provider’s office during your Annual Wellness Visit or diabetic visit. During this foot exam, your doctor will look for any concerning wounds, check sensation, and look for any discoloration which may be a sign of concern.

Diabetes Medication

You may be prescribed any one of these medications to treat your diabetes.  Always be sure you get specific information on the medicine you're taking. For a full list of side effects, check the information that came with the medicine you're using. If you have questions, talk to your pharmacist or doctor.

Insulin: Insulin helps keep your blood sugar level tightly controlled and within a target range. It can be taken by an injection, or through an insulin pump. Rapid-acting insulin is also available as a powder that you inhale. The amount and type of insulin you need changes over time, depending on age, hormones (such as during rapid growth or pregnancy), and changes in exercise routine. You may need higher doses of insulin during times of illness or emotional stress.

• Know the dose of each type of insulin you take, when you take the doses, how long it takes for each type of insulin to start working (onset), when it will have its greatest effect (peak), and how long it will work (duration).
• Never skip a dose of insulin without the advice of your doctor.

Non-Insulin Medications: Non-insulin medicines for diabetes help you control blood sugar. Each type works in a different way to help you control your blood sugar. For example, some types of non-insulin medicines help your body make insulin to lower your blood sugar. Others lower how much insulin your body needs. Some types can slow how quickly your body digests sugars or can remove extra glucose through your urine.

Medications to Help Reduce the Risks of Heart Disease in Patients with Diabetes

Over time, high blood sugar can cause damage to blood vessels and nerves. This can increase the risk for cardiovascular disease, which includes heart disease, stroke, and blood vessel damage. Controlling blood sugars, following recommended lifestyle changes, and using preventive medications can all help to reduce the risk for heart disease. Additionally, controlling other risk factors for heart disease, such as high blood pressure and high cholesterol, can help to reduce the risk of heart disease events, including heart attack and stroke.

As always, it is recommended that you speak with your provider before adding new medications and to determine if additional therapy is recommended for you. Medications commonly used in diabetes to prevent cardiovascular complications include:

Aspirin: Aspirin is recommended in diabetic patients with a history of heart attack, vascular bypass, stroke or transient ischemic attack (TIA), peripheral vascular disease (PVD), and other cardiovascular diseases. In patients without cardiovascular disease history, aspirin may be recommended depending on the patient’s overall risk (aspirin is not recommended in patients considered low-risk). The decision to use aspirin for the prevention of cardiovascular events in patients with diabetes should be made on an individual basis in discussion with your doctor, considering potential benefits and risks.

HMG-CoA Reductase Inhibitors, “Statin” Medications: In diabetic patients with cardiovascular disease, statin therapy should usually be added to lifestyle changes regardless of cholesterol levels. For patients without cardiovascular disease, you and your doctor should discuss whether taking a statin medication is a good choice given your individual risk factors. Typically, diabetic patients over age 40 years will be on statin therapy to help control cholesterol. 

Renin-Angiotensin System Inhibitors (angiotensin-converting enzyme [ACE] inhibitors or angiotensin receptor blockers [ARBs]) for Diabetics with Kidney Disease and High Blood Pressure: Patients with diabetic kidney disease may benefit from taking an ACE inhibitor or ARB, as these medications may slow kidney disease progression while working to lower blood pressure.

• ACE inhibitors are medications which commonly end with “pril” (lisinopril, ramipril, and enalapril).
• ARBs are medications which commonly end with “sartan” (losartan, valsartan and irbesartan).

For more information please go to  
https://martinspoint.org/for-members-and-patients/health-and-wellness