***Managing Diabetes

Diabetes can be managed effectively and controlled once it has been accurately diagnosed. The goal of diabetes management, according to the American Association of Clinical Endocrinologists, is to prevent short-and long-term complications of diabetes from developing. Without proper management, people with diabetes can develop serious or deadly complications from high glucose levels, including blindness, kidney disease and nerve damage, as well as vascular disease that can lead to amputations, heart disease, and strokes. Uncontrolled diabetes can complicate pregnancy; birth defects are also more common in babies born to women with uncontrolled diabetes. People with type 1 diabetes need to control their blood sugar levels. This means getting three to four (and sometimes more) shots of insulin a day adjusting doses to food and exercise, testing blood glucose up to eight times a day depending on their health care provider’s recommendations, and adhering to a planned diet. Type 2 diabetes may be controlled initially by a planned diet, exercise, and daily monitoring of glucose levels. Frequently, oral drugs that lower blood glucose levels or insulin injections may need to be added to this regimen. Treating diabetes in a comprehensive manner includes not only managing blood glucose but also blood pressure and cholesterol. This is crucial in helping to prevent heart attacks and stroke. There is good news; people with diabetes who maintain lower blood glucose, blood pressure and cholesterol levels can lower their risk of cardiovascular disease. To reduce your risk, follow the “ABC” approach recommended by the National Diabetes Education Program, the National Institute of Health (NIH), and the ADA. The ABCs are easy to remember and stand for: A is for the Alc test (short for “glycated hemoglobin Alc”), which measures average blood glucose over the previous 2 to 3 months B is for blood pressure C is for cholesterol Diabetes treatment guidelines issued by the American College of Physicians (ACP) emphasize the importance of aggressive blood pressure control in lowering the risk for heart disease, stroke, and early death in people with type 2 diabetes. Before these guidelines, most of the focus in diabetes care had been on tightly controlling blood sugar, but new evidence suggests that both blood sugar and blood pressure are very important in managing the disease. The ADA and the NIH recommend that people with diabetes and high blood pressure strive for blood pressure levels of less than 130/80 millimeters of mercury (mm Hg). The ACP recommends both thiazide diuretics and angiotensin-converting enzyme (ACE) inhibitors as first-line agents to control blood pressure in most people with diabetes. How To Seek Treatment If you are diagnosed with diabetes, it’s important that you receive comprehensive information—whether from a primary health care professional, a certified diabetes educator, or an endocrinologist. Special Concerns for Women with Diabetes: In the United States, 9.7 million women age 20 and older have diabetes. Here are some particular health issues of conce for women with diabetes. Heart Disease: Women with diabetes develop heart disease more often than other women, and their heart disease is more severe. Women younger than age 50 with diabetes are more vulnerable to heart attacks and strokes than those without diabetes. The reason seems to be that the disease cancels the protective effects of estrogen on a woman’s heart prior to menopause. Women with diabetes are at greater risk for developing heart disease after menopause. The National Cholesterol Education Program from the National Heart, Lung, and Blood Institute (NHLBI), state that “diabetes poses as great a risk for a person having a heart attack in 10 years as heart disease itself and should be managed just as aggressively.” Heart disease and stroke are the major causes of death for people with diabetes. In fact, approximately two-thirds of people with diabetes die from cardiovascular disease. Cholesterol Levels: Women with diabetes have lower levels of high-density lipoprotein (HDL) cholesterol (the “good” cholesterol) and higher levels of triglycerides, or fats, in the blood. According to the NHLBI’s cholesterol management guidelines, elevated low-density lipoprotein (LDL) cholesterol (the “bad” cholesterol that contributes to plaque buildup in your arteries) is a major cause of coronary heart disease and should be treated aggressively. Although LDL levels are not higher in women with diabetes, studies find that reducing LDL levels to less than 100 mg/dL can prevent heart attacks and strokes in women with diabetes. High cholesterol is typically treated with specially designed diets low in saturated fat, weight loss programs, exercise and if necessary, medication. High blood pressure: The ideal blood pressure for people with diabetes is less than 130/80 mm HG, according to the American Diabetes Association. Urinary tract and vaginal infections: Urinary tract infections (UTIs) and yeast infections are more common in women with diabetes. The fungi and bacteria that cause these infections thrive in a high-sugar environment, and the immune system can’t fight them, as effectively when blood glucose levels are too high. Diabetes Management Strategies People with diabetes need to know how to avoid complications. You should regularly review and revise your strategies for managing the disease under the guidance of health care professionals. The healthcare professional will monitor your diabetes and check for complications. Health care professionals who specialize in diabetes are called endocrinologists. In addition, people with diabetes often see an ophthalmologists for eye examination, podiatrists for routine foot care, dietitians for help in planning meals, and diabetes educators for instruction in day-to-day care. Living with diabetes can be overwhelming at times. But like all chronic diseases it affects every aspect of your daily routine. Diabetes management is more than taking a pill. It requires timing of meals, checking blood sugar, and being vigilant about exercise, all in accordance with a personalized management plan developed in consultation with health care professionals.