Checking Your Blood Glucose | Diabetes Discharge | Nucleus Health
Monitoring Type 2 Diabetes
Self-care is a lifelong commitment, but it's key to reducing the risk of serious complications.
By Dr. Sanjay Gupta
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For Pablo Sierra, life with type 2 diabetes is “an ongoing battle, but one I know I have control over.” It’s been 17 years since Sierra was diagnosed with the condition, but “I’m still trying different techniques of eating, exercising, and changing medications,” he said.
There’s no cure for type 2 diabetes, so managing the condition means a commitment for life. Fortunately, a report earlier this year from the National Institutes of Health and the U.S. Centers for Disease Control and Prevention found that Americans like Sierra are doing a better job of taking care of themselves by meeting key goals known as the ABCs of diabetes.
What are the ABCs of diabetes? The ABCs, as defined by the American Diabetes Association and American College of Physicians, refer to a person’s A1C blood glucose level, or average glucose level for the past two to three months, blood pressure, and cholesterol. Managing these ABCs is critical to reduce the risk for potential complications of diabetes such as heart disease, stroke, kidney failure, and blindness.
According to the NIH-CDC study, the number of patients meeting all three ABC goals climbed from about 2 percent to 19 percent, between the years 1988 and 2010. On the other hand, nearly half of Americans with diabetes didn’t meet any ABC goal, and eight out of 10 didn’t achieve all three.
“It’s overwhelming to learn everything about diabetes,” said Betul Hatipoglu, MD, an endocrinologist at the Cleveland Clinic, who recommends having the ABCs checked at least every six months. “It’s a lot to digest, but it’s important for the patient to not quit, learn how to manage the disease, and take care of themselves.”
A1C Blood Glucose
Checking your blood sugar daily gives you a valuable snapshot of how you’re managing your condition during the course of the day. The A1C test gives you a bigger picture by measuring average blood sugar levels over a 2- or 3-month period. “We look at it as a marker of health,” said Joel Zonszein, MD, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City. “It’s also a very important marker of complications.”
What does A1C measure? The A1C test measures what percentage of hemoglobin — the protein in red blood cells that carries oxygen — is coated with sugar. The higher your A1C, the less effective your diabetes treatment plan is. Most doctors consider an A1C level below 7 percent as an indication that your type 2 diabetes is well controlled. The test is usually given twice a year, though your doctor may recommend having it done more often if there are any changes to your treatment plan.
Sierra, 57, was displaced from his home when Hurricane Sandy hit New York City last year. Forced to stay with family, he was eating out at restaurants more than usual and his A1C level rose to around 9 percent. “It was hard because I’d be depressed one day about my housing situation and go out and have a triple cheeseburger,” he said. “But I knew my diet is something I needed to change, and it’s something I could manage myself.”
According to the American Diabetes Association, hypertension is very common among people with diabetes, affecting as much as 60 percent of patients. In type 2 diabetes, hypertension is often present as part of the metabolic syndrome of insulin resistance. People with diabetes who also have hypertension have approximately twice the risk of cardiovascular disease.
The American College of Physicians recommends that people with type 2 diabetes have their blood pressure checked every time they go to the doctor and that their goal should be a reading of no more than 135/80 millimeters of mercury (mm Hg).
“If a diabetic patient has high blood pressure, they need to be treated right away,” said Hatipoglu. “If it’s high, they’re more prone to kidney disease and stroke, which are some of the worst complications. But they can be prevented by controlling blood pressure,” with diet and lifestyle changes and, if needed, medication.
People with diabetes are more likely to have unhealthy cholesterol levels — high levels of LDL or “bad” cholesterol and low levels of HDL or “good” cholesterol — a condition known as diabetic dyslipidemia. The ADA reports that type 2 diabetes is associated with as much as a fourfold excess risk of coronary heart disease.
“We’re strict with controlling cholesterol because the higher it is, the higher the risk for heart disease,” said Hatipoglu.
Sometimes cholesterol can be controlled through weight loss and exercise, but your doctor may also prescribe cholesterol-lowering medications such as statins.
For diabetes patients, trying to meet all their ABC goals can be very challenging. Zonszein recommends working with your physician to set priorities and tailor a treatment plan based on your condition. “They’re all interrelated, and it’s common for patients to have more than one of these factors,” he said. “We want to treat everything, not just abnormality. It’s something patients should discuss with their doctors — how to prioritize what should be treated first and with what medications to stabilize their condition.”
“I go through little spurts where I go off my routine, but then I get myself back on track,” said Sierra.
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