DR. PONDER: Diabetics require routine maintenance
More diabetics are aware of the annual maintenance required for their new cars than they do for their own bodies. Most of us know that engine oil changes should happen every few months, or that tires should be rotated as they show wear. But ask a diabetic how often they should be screened for kidney disease, or how many times a year they should have their hemoglobin A1C checked and you might get a blank stare.
There are well proven diabetes care milestones that we all should know and practice. It starts by having an up to date diabetes doctor or diabetes team caring for you. The following are things you should know and expect from your diabetes doctor.
You should make visits to the doctor on a regular basis. The recommended frequency is every three months. Sadly, the average visit frequency is only twice a year. At each visit, make sure you are told your blood pressure reading and what (if any) changes have happened in your weight or body mass index (BMI), if your doctor calculates that.
The hemoglobin A1C test is a simple blood check that reflects the average blood sugar reading over the last 3 months. The number is not the same as what you get from your glucose meter, but is often “converted” by the lab or your doctor to give you a number that you can compare to your home readings. Ideally, the A1C should be under 7 percent (this usually means an average of around 150 mg/dl). As the A1C value increases, your doctor and you should discuss making changes in your diabetes care. A high A1C is undesirable: each single point increase equals a 40 percent increased risk of developing long term diabetes complications.
Blood pressure in adults with diabetes is often high. The average adult diabetic may need more than just reductions in daily salt intake and weight loss, but sometimes up to 3 medications are needed to properly maintain control of your high blood pressure. Keeping blood pressure under good control is as important as keeping the A1C as close to normal as possible.
Cholesterol levels are collected by a blood sample and include other fats in the blood, such as triglycerides. The target level of triglycerides for persons with diabetes should be less than 150 mg/dl. If improved blood sugar control doesn’t improve this, oral medications will probably be needed.
The kidneys are damaged by diabetes, especially if blood pressure is poorly controlled. Your doctor will order a blood test to check your overall kidney function, but an even earlier marker of the first signs of diabetic kidney disease can be done at a point when there is still time to slow it down or maybe even reverse it. This test is called the microalbumin test. It is easy to measure: a small urine sample collected at any time. If it’s abnormal, more detailed urine testing can be done to verify it.
Your sensory nerves can be damaged by diabetes over time. Your doctor can check for areas of reduced sensation using a small piece of nylon thread. This should be done at least once a year. Improved control of diabetes and blood pressure can slow down or stop further nerve damage.
Men and women with diabetes are at greater risk of problems with intimacy. If these issues are not discussed at an office visit by your doctor, you should bring it up. Vaginal dryness and erectile dysfunction are the two common signs of diabetes associated sexual problems. Both have effective treatments. Ultimately, improved diabetes control is always the first consideration.
