The possible complications from diabetes can be extremely serious. There is strong evidence from clinical trials that many of these complications may be delayed or prevented by carefully controlling blood glucose levels, blood pressure, and LDL cholesterol levels.74 To help manage diabetes, individuals should discuss, create, and follow a diabetes management plan with a health care provider and set goals for a treatment plan. The following are some specific suggestions to consider:
- Ask health care providers about the ABCs of diabetes. “A” is HbA1c, a measure of average blood glucose; “B” is blood pressure; and “C” is LDL-cholesterol. Patients should determine what their levels are, what they should be, and what steps they can take to reach those goals.75
- Work with health care providers to establish and maintain individualized target blood glucose levels. Ask how often and when to measure blood glucose levels. Individuals should keep a record of blood glucose readings to show their health care provider so they can better regulate their blood glucose.
- Be aware of the symptoms for hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar). Individuals who experience these symptoms, should adjust their treatment plan and seek medical advice on how to maintain healthy blood glucose levels. Table 3 presents symptoms of hypoglycemia and hyperglycemia.
- Follow a meal plan developed with a health care provider. This can be an important step for maintaining desirable blood glucose levels and avoiding complications.
- Work with a health care provider to develop an appropriate exercise program and follow this plan. Appropriate exercise can be important for people with diabetes because it can help insulin work better to lower blood glucose levels and improve cardiovascular health.
- Follow a health care provider’s recommendations for how and when to take diabetes medications. Discuss with a health care provider if medications do not seem to be working properly.
- Individuals should ask their primary care provider about a dilated eye exam at least once a year as people with diabetes are at higher risk for vision problems and blindness. Early detection and treatment of diabetic eye disease can prevent or delay vision loss.
- Request regular blood pressure checks at every medical visit and cholesterol checks at least once per year because people with diabetes are at higher risk for heart disease and stroke. Lowering blood pressure and cholesterol can reduce the risk of heart attack and stroke, the major cause of death in people with diabetes.
- Individuals, who smoke cigarettes, should seek help from a health care provider to quit smoking to further reduce their risk for heart disease.
- Brush teeth regularly and visit a dentist at least once every six months because people with diabetes are at higher risk for gum disease.
- Check feet for sores and calluses every day, wear shoes that fit properly, and get a comprehensive foot exam at least once per year with a health care professional since people with diabetes are at a higher risk for foot problems that can be caused by neuropathy (nerve damage) or poor blood flow to the feet.
- Ask for a urine test by a health professional at least once a year to monitor the level of protein in urine, a measure of kidney function.
- If planning a pregnancy, consult a health care provider to make a care plan that focuses on good blood glucose control before and during the pregnancy.
- Maintain records of daily self-management activities and medical visits. The checklist in Table 4 can help individuals and healthcare providers keep track of diabetes care. Other materials for managing diabetes can be found at http://www.ndep.nih.gov/diabetes/control/control.htm or by calling 1-800-860-8747.
- Ask a health care provider about new medicines and medical devices, such as blood glucose meters and insulin pens and pumps that could help manage diabetes.
- Seek the help of qualified health care professionals—such as a primary care provider, an endocrinologist, a certified diabetes educator or a registered dietician—to help with diabetes management.
- Seek help and encouragement through a diabetes support group.
- Continue to obtain information on diabetes. The National Diabetes Education Program (http://www.ndep.nih.gov/ or 1-800-438-5383) and organizations such as the American Diabetes Association (http://www.diabetes.org/home.jsp or 1-800-DIABETES), the American Association of Diabetes Educators and the Juvenile Diabetes Research Foundation International (http://www.jdrf.org/ or 1-800-533-CURE) can be excellent resources to help in learning more about caring for diabetes.
- Get information about clinical trials in progress that may identify new and more effective medicines and treatment regimens to treat diabetes (Available at: http://www.clinicaltrials.gov).
- Talk about diabetes with family and friends to make them aware of ways they can help with diabetes management.
Table 3. Symptoms of Hypoglycemia and Hyperglycemia
Symptoms of hypoglycemia
- Feel weak, confused, irritable, hungry, or tired
- Sweat a lot or get a headache
- Feel shaky
Symptoms of hyperglycemia
- Feel very thirsty and tired
- Have blurry vision
- Have to go to the bathroom often
SOURCE: National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Your guide to diabetes—type 1 and type 2. Available at: http://diabetes.niddk.nih.gov/dm/pubs/type1and2/lowglucose.htm.
Hypoglycemia is a low blood sugar. Hyperglycemia is a high blood sugar.
Table 4. Diabetes Care Checklist
Daily diabetes care activities
- Follow meal plan
- Take diabetes medicine
- Check blood glucose as recommended by a health care provider
- Check feet for sores that are not healing properly
- Brush teeth and floss
At doctor visits
- Get feet checked
- Check blood pressure
At least twice per year
- Get an HbA1c test
- Get a dental check-up and have teeth cleaned by a dental professional
At least once per year
- Get a dilated eye exam
- Get a complete foot exam—checking circulation and for changes in foot shape
- Get a urine test for kidney function
- Get a flu shot
- Get blood lipid levels (cholesterol) checked
SOURCE: National Diabetes Education Program. (2001). 7 principles for controlling your diabetes for life. NIH Publication No. 99-4343L. Available at: http://www.ndep.nih.gov/diabetes/pubs/7Principles_Eng.pdf.
74 The Diabetes Control and Complications Trial Research Group, op.cit; and Turner, RC, opt.cit
75 The ABCs of Diabetes refers to knowing the patient’s blood glucose level through the HbA1c test and making sure blood pressure and cholesterol are at recommended levels. Information on “Knowing your ABCs” can be found at: http://www.ndep.nih.gov/diabetes/control/4Steps.htm#Step2.