About Diabetes

September 10, 2007

Over 20 million people in the United States have diabetes.

One of the most important things you can do to decrease your risk of complications is to get your blood sugar under control.  Improved glucose control can help save your eyesight, your kidneys, and even your life.  But what exactly does “improved glucose control” mean?  How do you know when you’re doing it right?

One of the most important tests in diabetes care is the “hemoglobin A1C.”  This test tells how well you’ve been doing at controlling your diabetes over the past three months.  When blood sugar is high it causes changes in hemoglobin, a molecule that carries oxygen in your blood.  The new form of hemoglobin is called hemoglobin A1C.  The more hemoglobin A1C you have, the higher the number—and high numbers mean your blood sugar is out of control.  The American Diabetes Association says a safe A1C number in diabetes is 7.0.  People without diabetes usually have an A1C number less than 6. 

How do you get that number down?  You have to monitor your blood sugar daily.  If your blood sugars are pretty good but your A1C is still too high, you may need to check your postprandial glucose level.  That’s a fancy way of saying that you should check your blood sugar one to two hours after the start of a meal.  The reasons are convincing.  Not only does that postprandial glucose level contribute a lot to your A1C, it’s been shown that high blood glucose levels following meals is a risk factor for death!

If you check your levels after you eat, you will see firsthand the effects that different foods have on your blood sugar.  Maybe you’ll see that your blood sugar tends to be high after breakfast or that a large bowl of pasta may not be the best choice for lunch.  If you know this from checking your postprandial glucose level, you will be able to make better food choices in an effort to fix it.  Further, if you keep a log of your levels, you will be able to aid your doctor in adjusting your medication schedule.  The American Diabetes Association recommends aiming for a postprandial glucose level less than 180 mg/dl.

If your doctor hasn’t mentioned postprandial blood glucose monitoring, it may be because he or she doesn’t know the importance of it.  Information in medicine changes quickly and it can be difficult to keep up.  The next time you visit your doctor, ask about postprandial glucose monitoring. It is, without question, another way that you can help keep your diabetes in optimal control. 

Related Links:

About Dr. John Whyte

Diabetes Health Center

Nutrition Advice from Discovery Health Experts

Unfortunately, many of them will develop serious complications of the disease.  Diabetes is a major cause of heart attacks, blindness, and limb amputation.  If you have diabetes, are you doing all you can to prevent these from happening to you? 

Comments

[Round and Brown]

Diabetes is a disease more dangerous yet one of the best can be controlled ... exercising and eating right are the solutions to have a normal life

[cheap viagra]

Diabetes is a disease more dangerous yet one of the best can be controlled ... exercising and eating right are the solutions to have a normal life

[tumor cells]

Patients (usually with type 1 diabetes) may also initially present with diabetic ketoacidosis (DKA), an extreme state of metabolic dysregulation characterized by the smell of acetone on the patient's breath; a rapid, deep breathing known as Kussmaul breathing; polyuria; nausea; vomiting and abdominal pain; and any of many altered states of consciousness or arousal (such as hostility and mania or, equally, confusion and lethargy). In severe DKA, coma may follow, progressing to death. Diabetic ketoacidosis is a medical emergency and requires immediate hospitalization.

[TSBergeron]

When I was diagnosed with Diabetes,I was told that if I lost weight and became active, I could possibly get off my diabetes medication. Well, my A1C levels have been 5.9, 5.6 and now 5.2 over the past 2 years. Should I discuss being able to stop the medication and possibly not be labelled as diabetic? There is no medical insurance available to me because of this "label".

[Health Care Services]

Good information it really helps me a lot in my research about Diabetes. I have only one question, is Diabetes is hereditary.?

[Joseph B. Savage MD, FACE]

I read one post where a person asked 'why were the "numbers" BP and CHolesterol Not given?'
I agree.
I tell my patients to watch their "ABCD" to reduce risk of the Cardiovascular Complications of Diabetes:
A stands for ANti-Platelet. The ADA and the AACE recommend an Aspirin a day to reduce the risk of platelets sticking together and forming clots. Many take a baby Aspirin 81 mg. others take a full 325 mg of Aspirin. Your best choice should be made after discussion with your physician.
B stands for BP. The ADA recommends an optimal BP goal below 130/80 for all patients with diabetes. The ADA recommends a BP goal of below 120/80 for those with diabetic kidney disease as shown by another important number, the Microalbumin/Creatinine Ratio. Early diabetic Kidney disease is revealed by a Microalbumin/Creatinine Ratio of 30 to 300 mg/gram. More advanced Diabetic Kidney Disease is shown by a Microalbumin/Creatinine Ratio of more than 300 mg/gram and normal is below 30 mg/gram.
C stands for Cholesterol Profile thich includes Total Cholesterol, Triglycerides, HDL, and LDL. Ideally total Cholesterol should be less then 200, Triglicerides should be less than 150, HDL should be above 40, and LDL should be less than 100.
HDL is high density lipoprotein and can be remembered as the "healthy" cholesterol. Higher HDL is better. LDL is Low Density LIpoprotein and can be remembered as the Lousy or Lethal" cholesterol. In patients with Coronary Disease or Diabetes and other risk factors a lower level of LDL eg <70 mg/dl may be recommended.
D stands for Diabetes. HgbA1c is just one number. Although the ADA (American Diabetes Association)has recommended 7% or less in past publications. In the 2008 ADA guidelines published in Diabetes Care in Feb 2008 they recommend a level of 6% if this can be achieved safely. The European Diabetes Society recommends the 6% goal and AACE (American Association of Clinical Endocrinologists) recommends 6.5% goal.
However A1c is not the whole story. How are your home BG levels? If you are a Type I Diabetic with an A1c of 6% but you have widely variable BG's, fequent hypoglycemia, this may not be a good A1c for you. IF you are a pregnant Diabetic very tight control is recommended with 1 o r 2 hour post meal BG targets less than 120 mg recommended.
Please ask your physician, your health care provider, or Diabetic Specialist what numbers are recommended. ALso you may review the yearly guidelines by ADA in Diabetes Care which is available online. Just google "Diabetes Care"

Joseph B. Savage MD, FACE
Clinical Endocrinologist

[Joseph B. Savage MD, FACE]

HgbA1c is Not Safe. It has a lower risk than HbgA1c of 9%

Patients with pre-diabetes with fasting BG 100-125 will often have HgbA1c's in thsi range. The Cardiovascular Risk (risk for ANgina, Heart Attack, Stroke, Leg ischemia) is increased in this group compared to those with normal fasting Glucose (<100 mg/dl).

ALthough this level of control HgbA1c of 7% may be safe for retinal complications (Eye Disease related to Diabetes), both nerve disease (neuropathy) and kidney disease (Nephropathy ) may begin and progress with HbgA1c in the range 6 to 7%.

Clearly a HgbA1c is not "safe."

Joseph B. Savage MD, FACE
Clinical Endocrinologist

[kimberly pettit]

iam 43 and iam a diabitic . diabetes runs strong in my family and i know nothing about it my dr has not told me anything but watch what i eat try and loose weight,an take my meds.i need info. how do i live healty with this iam currently 311lbs.iam trying to loose weight i know nothing please help kimberly

[Marcie-]

I read this article and found the info helpful and interesting.

I wondered, though, since the topic is the "good numbers" that we with diabetes should have, why aren't blood pressure and lipids included?

Thanks

[Anthony Martinez]

On my left arm I get this Burning filling from the elbow to my hand, I would like to know what is it and what can I do for it?

[Sandra House]

my sugar level seems to be higher in the mornings before eating anything. for example 145 and after eating all the wrong things its 138 before bed, then the next morning it was 118. i am currently taking 2mgs of amarly in the morning and 2mgs aat nite. should i be going to a specialist verus a regular md.

[Sylvia]

I only caught a little bit of a show that aired on May 18, 2008. My husband has had trouble losing weight and one of three doctors gave a couple of mediciations for diabetics that help with weight loss. I have only heard of Byeta but this was not one of the medications. Are there any other medications that can help with weight loss.

[William Quirk]

Saw the last part of the program on diabetres on discovery health for CME.
Can you provide the references that were listed there or make the transcript or URL available?
Seemed to me like some of the information was improtant to all diabetics type 1 and 2.
Thanks
Bill Quirk Ph.D.

[jay]

Dr. Whyte,
You should read Dr. Richard Berstein's book "Diabetes Solutions". The ADA's recommendations are way to high.