Staying Healthy with Diabetes: a proactive primer

Good health does not happen by accident. It requires a commitment and persistence.

What follows are some guidelines that will help you to stay healthy. People with Type 1 diabetes should begin this program beginning 5 years after diagnosis. People with Type 2 diabetes should begin this program as soon as they are told of their diabetes since the timing of the diagnosis is so imprecise.

You should have:

1. A hemoglobin A1c test done every three months (4 times a year). This test provides you with a summary of your diabetes control for the last 3 months. In general, the higher the value the higher the overall blood sugar has been. Consider a value of 8% or greater as a sign that you need to modify your diabetes plan.

2. Fasting blood tests for lipids (total cholesterol, HDL cholesterol, LDL cholesterol and triglycerides) done every year in the adult with diabetes. In the child with diabetes, they should be done every five years. In adults, if the HDL is <35; or the LDL >/ 130; or if the triglycerides are over 400, the risk of a cardiac event is high; If the HDL is > 45; the LDL < 100; or the triglycerides are <200, you have a low risk. In children with risk factors for heart disease, a LDL> 110 is considered the goal.

3. A urine test for microalbumin done yearly beginning in puberty. The presence of microalbumin suggests that the diabetes is beginning to affect the kidney. It signals the need to intensify glucose control and consider the use of medications such as ACE inhibitors

4. Blood pressure measurement done at least 2 times a year. In adults, a blood pressure of less than 120/80 is associated with the least risk of organ damage. A blood pressure of over 130/85 in an adult is too high. Treatment is likely to include a diet that is lower in salt, and medication (usually with an ACE inhibitor). The best blood pressure for a child depends on the age of the child. So, check with your pediatrician.

5. A dilated eye exam yearly by an ophthalmologist who has special expertise in the management of diabetic retinopathy.

6. Foot examination at least once a year and more often you have decreased sensation or poor blood flow in your feet. The examination should include an assessment of your sensation, circulation, foot structure and the integrity of your skin. If you have decreased sensation, then you should have a foot examination at every visit to your health provider.

7. An annual evaluation of your diet and diabetes regime.

Staying healthy also means’s that you care for your body.

1. Monitor your blood sugar levels to learn the impact of food on your blood sugar. By checking 1 to 2 hours after a meal, you will gain information to decide if you are getting your desired results from your meal and exercise plan and from your diabetes medications.

2. Examine your feet every day. Check them for signs of infection, redness, and the presence of calluses, cuts or open areas. If you notice a problem, contact your health team right away. Do not walk barefoot even at the pool or at the beach. Consider wearing those super looking water sandals.

3. Take good care of your skin. Use mild soaps and lotions to keep your skin soft and supple. Dry skin is more prone to injury and infection. Avoid sunburn Use sunblocks to decrease exposure to harmful UV rays.

4. Consider increasing your activity and getting regular exercise 3 to 4 times a week. The action of insulin (both the body’s own supply and insulin from the bottle) is improved with as little as 20 minutes of activity. .

5. Plan ahead for sick days. Your plan should include:
  • * When to call your health care team
    • a. You have been sick for 3 days or have a fever and you are not getting better
    • b. You have been unable to eat for a day
    • c. You have been vomiting or have had diarrhea for more than 6-8 hours
    • d. Your blood sugar levels is higher than 240 to 300mg/dl
    • e. You have moderate to severe ketones
    • f. You have lost more than 3 pounds in 24 hours
    • g. You have trouble breathing, your breathe is fruity
    • h. You have trouble caring for yourself or you are unsure of how to take care of yourself.
  • * What you should do with your medications if you cannot eat
  • * How often you should measure your blood sugar
  • * How often you should measure your ketones
  • * What medicines are safe to take
  • * How you should eat if you cannot tolerate your usual meals

Staying healthy also means getting vaccinations to avoid certain infections.

In general, persons with diabetes should get:

1. The influenza vaccine every year.

2. One pneumonia shot is usually recommended for adults under the age of 65. However, check with your doctor to see if you should have a shot more often.

3. Tetanus and diphtheria vaccine should be taken every 10years.

4. Vaccination against hepatitis is not generally recommended for adults unless there is high-risk exposure.

Carolyn Robertson, RN, MSN, CS, CDE

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