In my last post, I ranted and raved about an article in the New York Times that tried to document how little information people with diabetes (and maybe their doctors?) have about their condition. In all the excitement, I neglected to outline what I think people with diabetes should know about their diabetes.
Summary of diabetes complications
We can divide diabetes complications into 2 major categories, short-term, and long-term. The short-term problems include hypoglycemia (low blood sugar levels) and keto-acidosis, a condition that mostly affects people with type 1 diabetes and is the result of severe insulin deficiency. This most often occurs in newly-diagnosed cases and in established cases with acute illnesses or other stresses that increase insulin requirements or with poor adherence to the care plan (e.g., missed insulin doses).
The second category, and the one I want to emphasize here includes chronic complications that are specific to diabetes- eye, kidney, and nerve diseases, and those that can also occur in people without diabetes but are more frequent in people with diabetes. These include heart disease, stroke, and peripheral vascular diseases.
Preventing diabetes chronic complications
As I have discussed in an earlier posting, we now understand quite a bit about diabetes complications including how to prevent them. That’s the good news. The bad news is that diabetes chronic complications still occur frequently. Why is that? In my opinion the answer is not a simple one but includes societal barriers to optimal health care (e.g., no insurance, poor insurance, insufficient skilled health-care providers) and poor education of our health-care providers and patients with diabetes. In addition, doing well with diabetes is hard work and even with all the knowledge necessary to do well, it still takes quite an effort to be successful.
A check-list of basic diabetes care requirements
If all people with diabetes had just the most basic of care in monitoring for diabetes complications, we could achieve dramatic improvements in outcomes. This would be nice for the person with diabetes and their loved ones, and for the society which would save big bucks. Experts could disagree with my choices but I can handle the criticism.
1. 2X/year- Medical check-up by a physician or other health-care provider who is up-to-date on managing diabetes. The check-up should include examination of the weight, blood pressure, eyes, and feet. Cardiovascular assessment should include detailed history and examination of the heart and peripheral pulses. Laboratory testing should include hemoglobin A1c testing (a way of assessing blood sugar levels during the previous 2-3 months)
2. 1X/yr- dilated eye examination
3. 1X/yr- kidney protein test (called microalbumin). If + protein, measure serum creatinine
4. 1X/2yr- fasting lipid profile (triglycerides, LDL- and HDL-cholesterol and total cholesterol (more frequently if being treated with lipid-lowering agents)
5. ECG and/or other cardiac testing- frequency depends on clinical situation and risk factors (e.g., hypertension, pooly-controlled blood sugars long-term, hyperlipidemia, previous heart attack, angina, stroke)
That’s the list. It’s not very complicated but obviously many people with diabetes do not get these very basic assessments as needed. Of course, just doing the tests is not enough. People with diabetes and their health-care providers need to understand what the test results mean and what to do about the infomation. Once a person is diagnosed as having diabetes, it should be virtually automatic that we teach the patient what they need to know and set up the monitoring plan. Remember, we really do know how to prevent diabetes conmplications.
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