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My Health Counts! Guidelines for Diabetes Care
Your health care team is an important part of your diabetes management. The people on your team can help you set and achieve goals, manage any problems that you have and keep you on track to a healthier you. But they can’t do it alone. For the best results you need to take an active role—ask questions, conduct your own research and follow the advice and recommendations that you health care team give you.
There’s a lot you and your team can do to reduce your risks for complications. The most common complications can involve your heart, blood vessels, eyes, kidneys and nerves.
Learn about tests and exams that will help you stay healthy. Be sure to ask for your results.
Your Health Care Team Should:
AT EVERY VISIT:
EVERY 3-6 MONTHS:
AT LEAST ONCE A YEAR:
ONCE AFTER DIAGNOSIS:
Also ask your doctor about a daily aspirin therapy to prevent heart disease.
Tips on Working with Your Team
Ask questions, conduct your own research, bring someone with you, write down questions and follow the advice and recommendations that your health care team give you. Ask for specifics—your doctor may say “Your levels look good”—ask what the numbers are and write them down.
Know Your ABCs:
By learning the ABCs of diabetes, you can reduce your risk of heart disease, stroke, kidney failure and blindness. Ask your doctor how to manage your A1C, Blood pressure, and Cholesterol to help lower your changes of heart attack, stroke, or other diabetes problems.
A — A1C or “hemoglobin A1c”
What is it?
This blood test measures your average blood glucose over the past 2-3 months.
It can help you monitor how well your treatment plan is working. It is the best way to measure your over-all glucose control.
2-4 times a year
Target or goal:
The A1C goal for most people is below 7%. Your goal may be different. Ask!
B— Blood Pressure
What is it?
A measure of the pressure against the walls of your blood vessels.
High blood pressure makes your heart work harder and can cause heart attack, stroke and kidney disease. High blood pressure is more common in diabetes.
At every check-up. Consider getting a blood pressure monitor so you keep track of daily readings at home.
The goal for most people is 130/80.
Cholesterol is a waxy, fat-like substance in the blood used by the body to build cell walls. Too much of it can block arteries.
Diabetes increases your risk of heart disease. Adults with diabetes have heart disease death rates about 2 to 4 times higher than adults without diabetes. The risk for stroke is 2 to 4 times higher among people with diabetes If you catch problems early they can be treated.
You should have a lab test to check your cholesterol and blood lipids at least once a year. Your doctor may want to test more often if levels are high.
LDL (bad) cholesterol should be less than 100—less than 70 for people at high risk for cardiovascular disease.
HDL (good) cholesterol should be more than 40 for men and more than 50 for women.
Your triglycerides (type of fat in the blood) should be less than 150.
My Health Counts! Risk Factors, Diagnosis and Complications
One out of every three people with diabetes is unaware they have this chronic condition. The American Diabetes Association estimates that amounts to 8 million Americans. Are you one of them?
Risk Factors for type 1 diabetes
With type 1 diabetes the pancreas abruptly stops producing insulin. Insulin is the hormone your body uses to use the energy—glucose—found in food. The primary risk factor for type 1 diabetes is family history.
Risk Factors for type 2 diabetes
Everyone over 45 should have a blood sugar (glucose) test at least every 3 years. Regular testing of blood sugar levels should begin at a younger age, and be performed more often if you are at higher risk for diabetes.
Symptoms of diabetes can be subtle and many of the symptoms can seem harmless. You could have diabetes for months or even years and not have any symptoms at all. The American Diabetes Association estimates that more than 6 million people in the United States alone are unaware they have the disease.
Understanding possible risks and symptoms can lead to early diagnosis and treatment—and a lifetime of better health! If you or someone you love have one or more of these symptoms see your doctor and ask to get tested.
Blurry vision-High levels of sugar (glucose) in the blood pull fluid from your tissues, including the lenses of your eyes, affecting your ability to focus. Left untreated, diabetes can cause serious damage to the eyes which can lead to vision loss and blindness.
Excessive thirst and increased urination-These are classic diabetes symptoms. When you have diabetes, excessive sugar (glucose) builds up in your blood. Your kidneys work overtime to filter and absorb the excess sugar. The sugar is excreted into you urine along with fluids drawn from your tissues. This triggers more frequent urination, which can leave you dehydrated. As you drink more fluids to quench your thirst, you’ll urinate even more.
Being very hungry-With diabetes, your body cannot move the sugar into your cells to be used as energy. This leads to hunger.
Being more tired than usual-You may feel fatigued or even irritable. Many factors contribute to this including dehydrations from increased urination and your body’s inability to use sugar for energy.
Losing weight when you are not on a diet-Diabetes keeps the sugar (glucose) in the food you eat from reaching your cells. The excess sugar is eventually excreted in your urine.
Cuts/bruises that are slow to heal-High levels of blood sugar may impair your body's natural healing process and your ability to fight infections.
Dry skin and mouth
Frequent infections-High levels of blood sugar may impair your body's natural healing process and your ability to fight infections. For women vaginal and bladder infections are especially common.
Tingling/numbness in the hands/feet-Excess sugar in your blood can lead to nerve damage. You may notice tingling and loss of sensation in your hands and feet, as well as burning pain in your arms, hands, legs and feet.
Keep in mind that like many people with type 2 diabetes you may have NO symptoms.
Your doctor can test your blood to see if you have diabetes. There are several tests that measure the amount of glucose in your blood including:
Fasting Plasma Glucose Test —this is the simplest and fastest way to measure blood glucose and diagnose diabetes. Your doctor will ask you to fast (having nothing to eat or drink except water) for 8-12 hours before the test. Blood is drawn and the level of glucose in the blood is measured.
Oral Glucose Tolerance Test —this test measures how you body responds to a set amount of glucose (sugar) in beverage form. The level of glucose in your blood is measured after fasting for 8-12 hours and after drinking a sweet beverage containing 75 grams of glucose. Your blood is tested 1, 2 and possibly three hours later. A urine test may also be done with each blood test.
The Fasting Plasma Glucose test is the preferred test for diagnosing diabetes because of its convenience and low cost. However, it will miss some diabetes or pre-diabetes that can be found with the Oral Glucose Tolerance Test. The Fasting Plasma Glucose test is most reliable when done in the morning.
Living well with diabetes requires both good medical care and effective self-management. The key is knowing and controlling your blood sugar levels. There is a lot that health care providers can do but you must take an active role in managing in managing your diabetes.
Poorly controlled diabetes can lead to many serious health conditions affecting nearly every organ in your body. Complications include heart disease, stroke, high blood pressure, blindness, kidney disease, complicated pregnancy, sexual dysfunction, nerve diseases, and amputation. If you don’t take the time for diabetes now, diabetes will make you take the time later. Work with your doctor and other members of your health care team to decrease your risk for these complications.
Learn more about Possible Complications from the American Diabetes Association.
My Health Counts! Types of Diabetes
What is diabetes?
Diabetes is a disease that makes it difficult for your body to turn the food you eat into fuel. The problem is closely tied to how your body makes and uses insulin, a hormone made in your pancreas (an organ in your body). Without insulin you cannot to take food into your body and use it as energy. With diabetes the body does not make or use insulin in the right way.
When everything is working right, here’s what happens when happens when you eat:
With diabetes, your body cannot move the sugar into your cells so it can be used as energy, so sugar builds up in your bloodstream. If this happens and you do not take steps to control your blood glucose levels you are putting yourself at risk for many challenging health conditions. But, by taking action, you can control your blood glucose levels, manage your diabetes and live a healthy, normal life.
There are two common types of diabetes and each type is treated a little differently.
Type 1 Diabetes
People with type 1 diabetes don’t make any insulin, the hormone needed to allow sugar (glucose) to enter cells to produce energy. It is an auto-immune disease. An autoimmune disease results when the body’s system for fighting infection—the immune system—turns against a part of the body. In diabetes, the immune system attacks and destroys the insulin-producing beta cells in the pancreas. The pancreas then produces little or no insulin. A person who has type 1 diabetes must take insulin daily to live. At present, scientists do not know exactly what causes the body’s immune system to attack the beta cells, but they believe that autoimmune, genetic, and environmental factors, possibly viruses, are involved.
Type 1 diabetes accounts for about 5 to 10 percent of diagnosed diabetes in the United States. It is sometimes referred to as insulin dependent or juvenile diabetes. It develops most often in children and young adults but it can occur at any age.
Symptoms of type 1 diabetes usually develop over a short period, although beta cell destruction can begin years earlier. Symptoms may include increased thirst and urination, constant hunger, weight loss, blurred vision, and extreme fatigue. If not diagnosed and treated with insulin, a person with type 1 diabetes can lapse into a life-threatening diabetic coma, also known as diabetic ketoacidosis. There's nothing you can do to prevent type 1 diabetes; there is currently no known way to prevent the disease. Anyone with a parent or sibling with type 1 diabetes has a slightly increased risk of developing the condition.
Type 2 Diabetes
The most common form of diabetes is type 2 diabetes. About 90 to 95 percent of people with diabetes have type 2. People with type 2 diabetes either don’t make enough insulin or it doesn’t work well. Historically this form of diabetes is most often associated with older age, obesity, family history of diabetes, previous history of gestational diabetes, physical inactivity, and certain ethnicities. In recent years however, there has been a steep increase in the number of children and teens with type 2 diabetes because of the increase in obesity among these are groups. About 80 percent of people with type 2 diabetes are overweight.
When type 2 diabetes is diagnosed, the pancreas is usually producing enough insulin, but for unknown reasons the body cannot use the insulin effectively, a condition called insulin resistance. After several years, insulin production decreases. The result is the same as for type 1 diabetes—glucose builds up in the blood and the body cannot make efficient use of its main source of fuel.
About 6 million people in the United States with type 2 diabetes don’t even know they have it yet. The symptoms of type 2 diabetes develop gradually. Their onset is not as sudden as in type 1 diabetes. Symptoms may include fatigue, frequent urination, increased thirst and hunger, weight loss, blurred vision, and slow healing of wounds or sores. Some people have no symptoms. Often, type 2 diabetes is diagnosed during a routine medical check-up from a blood test where no symptoms are present.
There's no cure for type 2 diabetes, but you can manage — or even prevent — the condition. Start by eating healthy foods, exercising and maintaining a healthy weight. If diet and exercise aren't enough, you may need diabetes medications or insulin therapy to manage your blood sugar. Even if type 2 diabetes runs in your family, diet and exercise can help prevent the disease. If you’ve already been diagnosed with type 2 diabetes, the same healthy lifestyle choices can help you prevent serious complications.
Eat healthy foods -- Choose foods low in fat and calories. Focus on fruits, vegetables and whole grains.
Get more physical activity -- Aim for 30 minutes of moderate physical activity a day.
Lose excess pounds -- If you're overweight, losing 5 to 10 percent of your body weight can reduce the risk of diabetes.
Type 1 Diabetes
Little or no insulin is produced by the pancreas
May or may not need insulin and may need oral medications
The pancreas produces insulin, but it may not be enough or it cannot be used by the body.
Usually begins before age 20, but can occur in adults
Usually begins after age 40, but can occur earlier
Males and females equally affected
More females are affected
Some heredity tendancy
Strong heredity tendancy
Majority experience weight loss and are thin
Majority are overweight
Ketones found in the urine
Usually there are no ketones in the urine
Insulin, diet, exercise, self-management
Diet, exercise, self-management, and when necessary, oral medication and/or insulin
57 million people in the United States are estimated to have pre-diabetes. People with blood glucose levels that are higher than normal but not yet high enough to be diagnosed with type 2 diabetes are defined as having pre-diabetes. If a person does not make changes to their lifestyle and diet they will develop type 2 diabetes in ten years or less. And if you have pre-diabetes, the long-term damage of diabetes — especially to your heart and circulatory system — may already be starting.
The ball is in your court. The progression of pre-diabetes to type 2 diabetes is not inevitable. With healthy lifestyle changes including eating healthy foods, including physical activity in your daily routine and maintaining a healthy weight you may be able to get your blood sugar level back to normal. And you’ll feel a lot better too.
The exact cause of pre-diabetes is unknown, although researchers have discovered some genes that are related to insulin resistance. Excess fat — especially abdominal fat — and inactivity also seem to be important factors in the development of pre-diabetes. What is clear is that people who have pre-diabetes aren't quite processing sugar (glucose) properly anymore.
The American Diabetes Association recommends blood glucose screening if you have any risk factors for pre-diabetes. This includes if:
Gestational diabetes is a type of diabetes that occurs only during pregnancy. Like other forms of diabetes, gestational diabetes affects the way your body uses sugar (glucose) — your body's main source of fuel. Most women who have gestational diabetes can work with their health care team and deliver healthy babies. However, gestational diabetes that's not carefully managed can lead to uncontrolled blood sugar levels and cause problems for you and your baby. You can manage gestational diabetes by eating healthy foods, exercising regularly and, if necessary, taking medication. Fortunately, blood sugar levels typically return to normal soon after delivery. Immediately after pregnancy, 5% to 10% of women with gestational diabetes are found to have diabetes, usually type 2. Women who have had gestational diabetes have a 40% to 60% chance of developing diabetes in the next 5–10 years. Gestational diabetes occurs more frequently among African Americans, Hispanic/Latino Americans, and American Indians. It is also more common among obese women and women with a family history of diabetes.
Diabetes Statistics for the United States
American Diabetes Association, 2007
My Health Counts! Where to Find Information on Quality
One of the most powerful forces driving improvement in health care is the educated consumer.
Consumers who make informed choices and are engaged in their own care not only experience better health outcomes, they also help reward doctors, hospitals and health plans that deliver better care and service. [i] To make sure you and your family get good quality care, you need to be actively involved in finding and using information that tells about health care quality.
Finding and using information about quality care can help you stay healthy and help you make good decisions about treatment when you need it. Below are resources that tell more about what you can do to help make sure that you and your family are getting good quality care.
Materials You Can Print
Resources for "Quality" Information
www.ahrq.gov – sponsored by the Agency for Healthcare Research and Quality. Click on “Consumers & Patients” to find information and resources on quality of care, medical errors and patient safety, various clinical conditions, prevention and wellness, prescription medicines, smoking cessation, choosing a health plan, and many other topics. Call the AHRQ Publications Clearinghouse at 1-800-358-9295.
www.guideline.gov – sponsored by the Agency for Healthcare Research and Quality. Quality Tools is a clearinghouse of practical, ready-to-use tools for measuring and improving the quality of health care. Information is provided for patients and consumers, health care providers, policymakers, and payers and purchasers.
www.nih.gov – sponsored by the National Institutes of Health (NIH), the government's primary source for conducting and funding clinical research. This is the main NIH website through which you can access information on many health topics and link to the various Institutes that make up the NIH. These include the National Cancer Institute, the National Heart, Lung, and Blood Institute and many others. Click on “Institutes” or search the Web site for your topic.
clinicaltrials.gov – sponsored by the National Institutes of Health provides regularly updated information about federally and privately supported research in human subjects. You can browse the site or enter specific location, condition, or other search topic.
www.medicare.gov – sponsored by the Center for Medicare & Medicaid Services can help you compare hospitals and nursing homes in your area. Phone 1-800-MEDICARE.
www.healthfinder.gov – sponsored by the U.S. Department of Health and Human Services. It offers links to hundreds of sites on the internet that contain reliable health care information. Click on “Health Care” and then “Health Care Quality” for links to many government and nongovernment sources of information on health care quality.
www.jcaho.org – sponsored by the Joint Commission on Accreditation of Healthcare Organizations. Click on “Quality Check” to locate JCAHO accredited hospitals, assisted living facilities, laboratories, and other types of health care facilities and services in your area. Phone 1-630-792-5000.
www.ncqa.org – sponsored by the National Committee for Quality Assurance. Click on “Report Cards” to access a variety of health care quality information, including reports on health care quality, report cards for physicians and health plans and more. Phone 1-888-275-7585.
www.ahqa.org – sponsored by the American Health Quality Association (AHQA). AHQA represents the national network of Quality Improvement Organizations (QIOs) that helps physicians, hospitals, health plans, nursing homes and home health agencies improve the quality of care they deliver. QIOs focus on the adoption of best practices to provide safe, effective and patient centered care. Go to www.ahqa.org/quality-improvement-organizations/whats-next-for-qios to locate a QIO near you or find out more about health care quality.
www.nahc.org – sponsored by the National Association for Home Care and Hospice. Click on “Consumers” to located home care, hospice services and other resources in your state. Phone 1-202-547-7424.
www.aaahc.org – sponsored by the Accreditation Association for Ambulatory Health Care. Click on “Search for Accredited Organizations” to locate outpatient health care services, such as freestanding surgery centers, radiology facilities, podiatrists, pain management clinics and many other types of outpatient facilities accredited by the Association. Phone 1-847-853-6060.
www.ama-assn.org – sponsored by the American Medical Association. Click on “For Patients” to access “DoctorFinder” with information about virtually every licensed physician in the United States , as well as links to other helpful web sites. Phone 1-800-621-8335.
www.docboard.org – sponsored by the National Organization for State Medical and Osteopathic Board Executive Directors. Click on “DocFinder” to access the physician database, which contains information from state government licensing board on the licensing background and disciplinary information of physicians and other health care providers.
www.fsmb.org – sponsored by the Federation of State Medical Boards. The Federation collects information on disciplinary actions taken against physicians by regulatory and licensing agencies, such as state medical boards, the National Board of Medical Examiners, various Federal agencies and other licensing authorities. Click on “Public Access” to search the web site to learn if your physician has any disciplinary history. Phone 1-817-868-4000.
www.naic.org – sponsored by the National Association of Insurance Commissioners. Click on “Consumer Information Source” and then “Health Insurance” to access information about the different types of health insurance, you rights as a consumer, consumer fact sheets and other information. Phone 1-816-842-3600.
[i] National Committee for Quality Assurance Web site. “The Basics: Public Reporting.“ (assessed Oct. 24, 2008).
My Health Counts! More About Partnering With Your Doctor
For many people, having quality care means getting peace of mind, beginning with their relationship with their doctor. The key is finding the right doctor—one who values relationships based on openness and trust and provides high quality care.
Quality care is care that works, is safe and is tailored for patients. The federal Agency for Health Care Research and Quality defines quality care as “doing the right thing for the right patient, at the right time, in the right way to achieve the best possible results.” [i]
Quality health care is: [ii]
“I tell groups of patients you're in charge of your own health,” says Dr. Michael Parkinson, President of the American College of Preventive Medicine. “I oftentimes say the new role of physicians, my colleagues, should be that of a Sherpa. I'm not going to climb your mountain, but I will help you climb your mountain to get healthier, to understand your medications, to help prevent unnecessary hospital admissions or complications from drugs you don't need to be on. I'm going to help you, and you need to help yourself. It starts with you being informed, and there are some very simple things you can do to begin on that journey to become a more informed patient and increase the likelihood of safe and effective care.”
So, how do you build a good partnership with your doctor? Talk to your doctors about your goals. At your next appointment say, “I want to take a more active role in my health and healthcare. Are you ready to work with me on this partnership?”
Let your Doctor be your teacher and guide. Prepare for every doctor's visit.
Take an active role in every visit.
Learn all you can about your health problem - to get the best health care you need information whether it comes form your doctor, the library or the internet.
What are some indicators of a quality doctor?
They're willing to talk, they're not afraid of questions, they welcome second opinions, they're not afraid if you'd like to bring somebody else with you to the visit, they use an electronic medical record or have a system in place to remind you when you need preventive care and they try to connect you with a counseling service or coach or somebody in their office to help you understand your medications and your care management plan.
[i] Guide to Health Care Quality: How to Know it When You See It . Rockville, MD: Agency for Healthcare Research and Quality, 2005. (No authors given.)
[ii] Committee on Quality of Health Care in America , Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century . Washington : National Academies Press, 2001.
Quick Tips - When Talking With Your Doctor
Help Your Doctor Help You
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Toronto, ON M5V 3E7
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