Close Monitoring of Blood Sugar Is Key to Managing Diabetes
Sugar often gets a bad rap, but there is one kind of sugar you can’t live without--glucose. It provides energy for every cell in your body.
Good health depends on having just the right level of it at all times, and the level is regulated primarily by insulin, a hormone secreted by the pancreas.
People with diabetes are unable to control their sugar level, however, either because their pancreas cannot make insulin or because their body is “resistant” to it. Those who cannot make the hormone must have daily injections of it. Those who are resistant to it may be helped by dietary changes, exercise and weight loss. Prescription drugs also can make the body more responsive to the natural insulin that is present.
The goal of diabetes treatment is to keep blood sugar within a safe and healthy range 24 hours a day. Recent research has shown that the desirable level is much lower than previously believed, because even mild elevations of blood sugar--too slight to cause recognizable symptoms--can damage organs throughout the body. If allowed to persist over long periods of time, these mild blood sugar elevations greatly increase the risk of catastrophic diabetes complications, including heart attack, stroke, kidney failure and blindness.
Unfortunately, many people being treated for diabetes are unaware that their blood sugar level is too high. Some are not receiving adequately aggressive treatment; others are not adhering to the treatment they were prescribed. Moreover, many diabetics are not getting recommended medical services, such as screening tests that could identify complications in the earliest stages.
If you have diabetes, monitor your blood glucose level closely. Test your blood according to the precise schedule prescribed by your doctor or diabetes educator (the frequency and timing will vary according to the severity of the disease and your individual needs and treatment goals).
Be aware that the standard glucose test measures the blood sugar level only at the precise moment the test is performed; that measurement may not be representative of your blood sugar level the rest of the day. For example, if you do a test for glucose only in the morning--when it is most likely to be at a desirable level--you will have no way of knowing if it is dangerously elevated in the afternoon or evening. Keep meticulous records of all your measurements; they will help your doctor determine if your therapy needs to be modified.
Have your blood tested at regular intervals to measure hemoglobin A1c (HgA1c) levels. This test (which must be ordered by your physician and sent to a laboratory for analysis) reveals the average amount of glucose present in the blood for the previous two to three months and provides a good check on the adequacy of your glucose self-tests. If your glucose is well controlled, the American Diabetes Assn. recommends that hemoglobin A1c testing be performed at least twice a year. More frequent testing is indicated, however, if your glucose is poorly controlled or your therapy has recently changed.
Even with aggressive treatment and blood sugar monitoring, complications of diabetes can develop. To detect them early--when they are more easily treated--have the following screenings:
* A thorough examination of the feet at least once a year. Because diabetes can impair circulation, foot ulcers are common. If the ulcers are left untreated, they can cause gangrene, which can lead to an amputation.
* Annual eye examinations for signs of diabetes-related eye disease (retinopathy). This complication results from damage to the small blood vessels in the retina, the light-sensitive tissue at the back of the eye. If such damage is detected, laser surgery can reduce the risk of further visual loss. (Individuals who already have retinopathy should be examined more often.)
* A urine test for protein at least once a year. The kidneys are at risk of being damaged by diabetes, possibly leading to kidney failure--and either a lifetime of dialysis or a kidney transplant. Medications can slow progression of the damage.
* Finally, continuous monitoring of heart health. Because diabetes greatly magnifies the danger of developing heart disease, people with diabetes must identify and eliminate every risk possible. Blood pressure should be measured at every routine diabetes visit, and blood lipid levels should be measured regularly (every one to two years depending on how high they are). High blood pressure and elevated lipid levels should be treated vigorously, excess weight should be lost, and smoking should be avoided completely.
The American Diabetic Assn. recommends the use of aspirin in people who have diabetes and evidence of existing cardiovascular disease; this includes men and women who have already had a heart attack or stroke, those who have atherosclerosis or peripheral artery disease, and individuals who experience anginal chest pain. Aspirin should also be considered for men and women believed to be at increased risk of a heart attack because they smoke, have high blood pressure or elevated cholesterol levels, are obese or have a family history of coronary heart disease.
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A Final Word of Caution
Diabetes impairs the ability of the immune system to function properly, making diabetics more prone to certain types of infection (and more likely to develop severe infections when they do occur). For this reason, diabetics should be immunized against influenza every year and be vaccinated at least once with the pneumococcal vaccine. A one-time revaccination is recommended for individuals 65 and older who received the vaccine more than five years ago.
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Dr. Jonathan Fielding is the director of public health and the health officer for the Los Angeles County Department of Health Services. Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. Send questions to ourhealth@dhs.co.la.ca.us. Their column appears the second and fourth Mondays of the month.
