Diabetes Management
Managing Diabetes – Small Changes make a big difference
Earlier prevention, earlier diagnosis, and very aggressive treatment of diabetes by controlling blood glucose levels, blood pressure, and lipid (i.e. cholesterol) levels have proven to prevent or significantly delay the damage that uncontrolled diabetes can cause to the body's blood
vessels. These encouraging research findings from around the world have spurred some important changes . In terms of both the onset of
diabetes
mellitus and its complications. A much stronger focus
is placed on prevention. “Diabetes doesn't wait. Individuals need to ask, 'Am I at risk and what can I do?'”
The urgent need to identify people at risk is fuelled by expectations that the number of people diagnosed with diabetes will increase by up to 50% over the next 10 to 20
years. “We're in the midst of an epidemic that is going to get a lot worse before it gets better, because the baby boomers are now entering their 5 th decade when the highest prevalence rates of diabetes occur.”
Currently, about half of those diagnosed have already had diabetes
symptom for as long as 7 years, so the clock has already been ticking for some
time. Long enough that 20% to 30% of individuals have already developed complications affecting the heart, eyes, feet, or kidneys.
Sign
of Diabetes - Many diabetes symptoms seem so harmless
“We want to avoid the common scenario where someone finds out they have diabetes only when they're admitted to the hospital with a heart attack.” Given that four in five people with diabetes die of cardiovascular disease such as heart attack and stroke, “We need to recognize that diabetes is a cardiovascular
disease. This is another new focus of these guidelines.”
Screening for high blood glucose is important because it identifies individuals who are at risk of developing not only diabetes, but cardiovascular disease (because of the damage high blood glucose can inflict on their arteries). “In people with diabetes, we often see a clustering of cardiovascular risk factors such as high blood pressure, high cholesterol, and
obesity. What we've learned in the last few years is that [compared to the general population] people with diabetes are at greater risk for all these
complications. That's why having diabetes is about more than managing blood
glucose. You need to manage all these risks aggressively. And targets are more aggressive (i.e. lower) for individuals with diabetes because they are at greatest cardiovascular
risk. Evidence over the last ten years clearly proves that like elevated cholesterol and blood pressure, high blood glucose is a continuous
risk. “That means the higher your levels, the greater your risk of problems.” The connection may be difficult to make, since all three conditions are often silent, so people don't necessarily feel their ill effects.
Data shows that individuals with diabetes die 13 years earlier than those in the general population. Lowering elevated blood glucose, blood pressure, and cholesterol levels significantly reduces individuals' risk for developing diabetes or later complications, and their
longer term risk of dying prematurely.
EATING WELL WITH DIABETES doesn't need to be complicated, individuals with diabetes are advised to eat a balanced diet that's high in
fiber, so it includes plenty of whole grains, fruits and vegetables, and low in fat, so it provides protein from lean meat, fish, and vegetable sources.” As a rule of thumb, portion food so that one-quarter of the plate has some kind of whole grain, such as brown rice or whole wheat pasta, another quarter contains a protein like lean meat, fish, or tofu, and the remaining half of the plate should be taken up with vegetables and
fruits. We advise that of your daily energy intake, 50-55% should be from
carbohydrates, 15-20% from protein, and less than 30% from fat (with less than 10% from saturated
fats).
Moderation is the key to healthy eating as well as to healthy weight loss. “People who are overweight may believe they need to lose 50 pounds, but you only need to lose 5 to 10 percent of your body weight to dramatically improve control of your blood glucose, blood pressure, and lipid
levels”. “By eating just 500 fewer calories per day, you can lose 5% to 10% of your body weight over 6 to 12 months, which translates into a loss of 1 to 2
pounds per week.” Individuals who lose weight gradually have a better chance of keeping it
off. And weight loss efforts must include physical activity if they are to
succeed.
PHYSICAL ACTIVITY
Is another cornerstone of treatment, especially in type 2
diabetes. “Try to find opportunities to increase activity in each day. Take the stairs instead of the elevator, or get off the bus a stop earlier and build a walk into your day.”
Everyone can benefit from more physical activity – it helps build a healthy heart and lungs, keeps your body toned and fit, and helps to relieve stress in a positive
way. “When you have diabetes, it helps your body burn blood glucose more effectively for energy, particularly if you get regular activity at least every other day. It can help lower your blood glucose and keep it controlled.”
In some cases, it could reduce the amount of medication you need.
Exercise is a big help for people who want to lose weight, because as you become more active, you build muscle, which burns more
calories. It needn't be a 45-minute workout to be beneficial – even periods of activity as short as 10 minutes several times a day will help. Start small and gradually increase the length of time or the intensity of your activity – if you start too vigorously, you
may not stick with it.
“We recommend that people with type 2 diabetes accumulate 150 minutes of moderate intensity exercise per week in the form of an aerobic exercise like brisk walking. Resistance activities three times a week, exercise that helps strengthen specific muscle groups, are also recommended .” Individuals should talk to their health care provider before starting an exercise program more vigorous than brisk walking, especially those who have heart disease or hypertension or have been inactive for a long
time.
Keep your eye on your targets
Know your target levels, and remember that every small improvement you achieve in your blood glucose, blood pressure, and lipid levels can make a significant contribution to your long-term
health. Individuals with diabetes should aim for a blood pressure of 130/80 mmHg. Suggested lipid targets are a low-density lipoprotein (LDL) cholesterol of below 2.5 mmol/L, and a total cholesterol (TC) to high-density lipoprotein (HDL) cholesterol ratio of less than 4.
The glycosylated hemoglobin (A1C) measurement represents an average of your overall blood glucose levels over the past 60 - 90 days, and is reported as a percentage.
People should keep their AIC to less than 7, and if possible, less than 6, which is normal. That would be ideal, but is harder for many people to achieve, particularly those taking anti-diabetes medications, since it may increase their risk for [too] low blood glucose, or
hypoglycemia. We need to achieve a balance, but all patients should be asking their doctors, 'What is my A1C, and what can I do to get it down to less than 7%?' .”
Achieving even small reductions in A1C is well worth the effort. A large study (UKPDS) of individuals with type 2 diabetes found that each 1.0% reduction in A1C was associated with a 37% decline in the risk of small blood vessel complications, a 14% lower rate of heart attack, and fewer deaths from diabetes or any cause. Another study (DCCT) of individuals with type 1 diabetes found that a 10% reduction in A1C (e.g. from 8.0 to 7.2%) was associated with a 40% to 50% lower risk of eye disease (retinopathy) progression.
Another small but important measure you can take to maintain your health is to have regular medical check-ups to head off complications. Ask your healthcare provider to check your feet at every appointment,
and see your dentist regularly.
Have your eyes checked by an eye specialist at least once every two
years. Your physician will also monitor your kidney function regularly for signs of kidney-related complications.
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