Since I started my practice as an endocrinologist, I’ve had tens of thousands of office visits, mainly seeing people with diabetes. Here’s my wish list of some of the things people with diabetes should know, and do, to succeed. My “best” patients may not be the ones who do every single one of these, but all are important – and not so difficult!
1. Know your numbers. Diabetes is, like it or not, a condition with a lot of different numbers to understand and keep track of, and they’re important.
A. Hemoglobin A1c. This test gives an indirect way of understanding what the average blood glucose level has been for many weeks. Because it is indirect, other factors, such as anemia, infections, and kidney problems, can affect the A1c level – but it is a key way of getting a sense of how well the diabetes is doing.
B. Most of the increase in diabetes over the past thirty years or so is related to weight gain. Most of us live in an environment with too much food and too little opportunity for exercise, and keeping track of weight is an important way of reminding yourself how you are doing. Two related numbers are the body mass index, or BMI, which adjusts the weight for the height, and the waist circumference, which gives particular focus to the important area of fat in the abdomen, which is particularly bad for diabetes.
C. Blood pressure. Diabetes is not just about blood sugar, and proper treatment of the blood pressure is of great importance
D. There are several related numbers, the total cholesterol, the LDL cholesterol, the HDL cholesterol, what is called the non-HDL cholesterol, and the triglyceride level. All can be important, and because of this the majority of people with diabetes are (or should be) treated with cholesterol-lowering medicines.
E. Kidney function tests – the most important are the blood creatinine and the urine microalbumin. The kidneys play many roles in controlling the blood glucose level, and damage to the kidneys is another serious problem that can be caused by diabetes.
2. Monitor your blood sugar levels. The optimal frequency of testing differs from person to person, but I’ve found that nearly everyone does better if they understand what their blood glucose (or sugar) levels actually does. What is the effect of exercise, or certain foods, of changes in medicine dosage (particularly insulin) – there’s no way of knowing all of this without testing the blood glucose level. Recently, a number of web sites have become available allowing easy upload of glucose meters to look at the pattern of glucose over time. These can be very useful. If your doctor does not do this analysis (unfortunately many physicians do not), learn how to do it yourself and bring it in when you have your next visit!
3. See an ophthalmologist. Fortunately, eye problems do not affect many people with diabetes – but, when these occur, they can be very bothersome, and there are now extremely effective ways of preventing and of treating most of them. Check with your doctor if you have not seen an ophthalmologist within the past year – it might be time to schedule a visit
4. See the dentist. Common dental problems can have important effects on diabetes, and most people with diabetes should have at least two dental examinations every year.
5. Look at your feet every day. Because diabetes can reduce nerve function, one group of problems that can affect people with diabetes is related to injuries, such as small bruises or cuts on the feet, which would ordinarily cause pain and be easily noticed. If you look at your feet, feel the bottom of your feet, rub skin cream on your feet at night, make sure to have shoes that fit properly – and ask your doctor to look at your feet at every office visit (some doctors don’t do this, but it’s important!), the chance of developing a serious infection is greatly reduced. Podiatrists, specialists in foot care, are very important.
6. Know all your medicines. Many people with diabetes take one or two medicines each for diabetes, for cholesterol-lowering, for blood pressure, and then may have other conditions, so it’s not unusual for my patients to take eight or ten or twelve different drugs. My medical assistant and I spend a lot of time going over this with people when they come – and it’s not unusual to find that another doctor has suggested a change, or given a medicine that can have a negative interaction. At the end of every visit I give a printed list of all the medicines to everyone, and knowing about all of them is important for everyone. Check the medicines online, to try to understand what they do and what might be side effects of a particular treatment. Some useful sites are MedicineNet, WebMD, the U.S. Food and Drug Administration, and the U.S. National Library of Medicine. Or, look on the manufacturer’s web site for information about the medicines you take.
7. This is a huge topic – but not mentioning the importance of diet in a list of the “top things to know” would be unfair
8. Ditto. Exercise should be part of the way you treat your diabetes every day! There are now step counter apps available for most smartphones. These may be somewhat inaccurate – but that’s not the point, they will help you to understand how much you’re doing in this very healthful way of controlling your diabetes.
9. Come in to the doctor with a list. To make the most of the time with the doctor, having a few questions written down can be very helpful. Show it to the doctor to make sure you go over the points. What you are concerned about is very important – make sure you both go over this.
10. Be aware of emotional stresses, and let your doctor know if you are anxious, or angry, or depressed. Diabetes certainly can cause stress, and emotional stress in turn may worsen diabetes. This is an area where your doctor can help!
Remember, your doctor wants you to feel well, and to do well. These are just some of the points to think about with diabetes – add more of you own!
Dr. Bloomgarden is a clinician in private practice with an international reputation for writing and lecturing on diabetes, having authored more than 450 articles. He is Clinical Professor at the Icahn School of Medicine at Mount Sinai, and is Editor of the Journal of Diabetes. He has served on the Board of the American Association of Clinical Endocrinologists, the Journals Managing Subcommittee of the Endocrine Society, and the Editorial Board of Diabetes Care, and has been principal investigator in numerous studies. In 2012, Dr. Bloomgarden was awarded the title of Master of the American College of Endocrinology. He has been listed for many years in the “Castle Connolly Guide: The Best Doctors New York Metro Area.”