Do You Know the ABC's of Diabetes?

By Mary Ellen Ritchie, MD

Montgomery Internal Medicine Associates, P.A.

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Do You Know the ABC's of Diabetes?

Diabetes is a chronic disease that affects 17 million Americans. Diabetes is caused by either lack of insulin (Type 1 diabetes) or the inability of the body to use insulin (Type 2 diabetes). The vast majority of patients have Type 2 diabetes. Diabetes is associated with many complications that can be prevented. These complications include retinopathy (an eye disease that can cause blindness), nephropathy (kidney disease that can require dialysis), neuropathy (nerve disease that can cause pain and disability), peripheral vascular disease (disease of blood vessels of arms and legs that can contribute to amputations), coronary artery disease (disease of blood vessels of heart that leads to heart attacks or need for bypass surgery) and cerebrovascular disease (disease of blood vessels of the brain that can cause strokes).
Diabetes is a chronic disease that requires self-management. That means the patient must take responsibility to make changes to their treatment regimen in between doctor visits. The patient plays a major role in the healthcare team. The team includes the doctors, nurses, diabetes educators, podiatrists, family members, friends and the patient. The role of the doctor is much like the coach of a football team. They will give the patient advice, education, monitor lab tests and write prescriptions. The tests they do are like the statistics of the game, they give the overall picture and progress. Their advice is like a play book. The patient has the role of quarterback. They need to call the plays, make changes in the game and know when to call time out. Like the quarterback, the patient needs to understand the game and use the correct play as the game changes. When they need advice they can call a time out and get assistance from the coach. Just like the quarterback needs to get the most out of practices, the patient must get the most out of their doctor visits.
One of the first things the patient needs to know to manage their diabetes are the goals of the game the ABC’s of diabetes. These goals need to be individualized for each patient, but here are some general guidelines each patient should know.
A stands for A1c. An A1c is a blood test that is generally done every three months. It gives the physician an indication of the blood sugar control for the last six to eight weeks. The goal for most patients is for their level to be less than 6.5 to 7%. Studies have shown that good blood sugar control can prevent or delay many of the complications of diabetes. Although the blood test is only done once every three months, patients can check their blood sugars throughout the day to measure their daily progress. The goals for these blood sugars are established by their physician. With good education, patients can make changes to their diet and exercise plan to improve their blood sugars between visits. With guidance from their physician, they can adjust their medications as well. Blood sugars may increase if the patient is sick or if their medication is not working, If blood sugars start to increase significantly between visits, the physician or nurse educator should be called to ask for some assistance. There may need to be changes made in medication. Making changes between visits will help keep the patients A1c at their goal.
B stands for blood pressure. High blood pressure also increases the risk of complications in patients with diabetes. The goal for most patients is to have a blood pressure less than 130/80, However, some patients may need their blood pressure less than 125/75 if they have complications. It is a good idea for patients to keep a log of their blood pressures measured at every doctors visit. Many patients with diabetes have several different doctors they see. Writing down blood pressures from all visits gives doctors a better picture of blood pressure control. In between visits, it is important for the patient to take prescribed medications. If side effects develop from the medication and the patient decides to stop it, they should call the physician first. The physician may be able to change the medication to one with fewer side effects and still keep the blood pressure controlled. Other factors that affect blood pressure include smoking, amount of salt in the diet, stress and exercise. These are factors patients can control between doctors -visits. With the doctor’s approval, an exercise plan may help decrease blood pressure.
C is for cholesterol. High cholesterol increases the risk of cardiovascular disease. Patients with diabetes are considered as high a risk for heart attack as someone who has
already had a heart attack. Therefore physicians and patients need to be very aggressive at reaching their cholesterol goals. There are several types of cholesterol, The “bad cholesterol” or LDL cholesterol is the one that should be low. For most patients with diabetes it should be less than 100. Some physicians are even more aggressive and would like this to be lower. Animal fats increase LDL cholesterol, so a diet low in fat can help decrease this. Doctors often prescribe drugs called statins to help lower LDL. This includes drags like crestor, lescol, mevacor, lipitor, and zocor. HDL cholesterol is the good cholesterol and should be over 40. The best way to increase this is through exercise. There are some medications that increase HDL, but they also may affect blood sugar control. Triglycerides are also part of a typical cholesterol panel. They should be less than 150 mg/dl in most patients. Many patients with diabetes have increased triglycerides. High blood sugars increase triglycerides as well as diets high in simple sugar. Avoiding excessive amounts of bread and pasta and controlling blood sugar can help control triglycerides. However, if blood sugars are good and the diet is reasonable, the patient may still need another medication.
With good education, patients can keep their ABC’s in control between visits to the doctor. They can also learn to monitor for side effects of medication and complications of their disease and report these to their physician at the appropriate time. This helps patients receive the best care and get intervention early so the devastating complications of this disease can be prevented.