Important Questions About Diabetes Care

The following includes some questions you may wish to discuss with your doctor.

Blood Glucose Levels

How often should I test my blood glucose levels at home?
What should my target blood glucose levels be?

You should work with your doctor to develop a blood glucose monitoring schedule that works for you. The frequency of testing will depend on whether you take insulin and various other factors. Make sure you understand how to use your glucose meter, how to interpret results and how to modify treatment based on results. Keep records of your blood glucose levels and review them with your doctor at your next appointment. Once a year you should have your glucose meter checked to make sure it is working properly.

You and your doctor should also set targets for blood glucose levels. Target levels for most people will be 4 to 7 before a meal and 5 to 10 after a meal. You can't be expected to reach these target levels all the time, but if your levels remain high for a prolonged period, your treatment plan may need to be changed. If your doctor recommends higher target values, there may be a good medical reason - such as frequent hypoglycemia (low blood sugar).

A1C - Blood Glucose Control

When was the last time my hemoglobin A1C was tested?
What were the results and what did they mean?
How often should I have this test?

A1C (also known as hemoglobin A1C or HbA1C) is a blood test that measures blood glucose control over the past 2 to 3 months. Tight blood glucose control can lower the risk of diabetes complications. Your doctor should order A1C every 3 months. Ideally, your results should be less than 7% (0.07). If your results are too high, your doctor will discuss potential changes in your treatment plan because your risk of developing complications increases. If you frequently have problems with low blood sugar (hypoglycemia), your doctor may decide that a higher A1C result is acceptable.

Lipids (cholesterol)

When was the last time I had a lipid profile test?
What were the results and what did they mean?
How often should I have this test?

Cholesterol is the best known of several types of lipids (fats in the blood). The lipid profile measures cholesterol, high-density lipoprotein (HDL - the so-called 'good' fats), low-density lipoprotein (LDL - the so-called 'bad' fats) and triglycerides. Most people with diabetes are at high risk of heart disease and stroke. If you are considered a high-risk patient, your ratio of total cholesterol to HDL ('good' fat) should be less than 4.0 and your LDL ('bad' fat) levels should be less than 2.5. Some people with diabetes (younger, no complications, no other cardiovascular risk factors) may be considered at moderate risk for heart disease and stroke. If you are at moderate risk, your ratio should be less than 5.0 and your LDL less than 3.5. If you have trouble reaching these levels, your doctor may refer you to a dietitian or the local DEC to help you lower the fat content in your diet and/or lose weight. Your doctor will also encourage you to begin an exercise program and may refer you to an exercise specialist if you have diabetes complications. Diet and exercise changes are usually the first course of treatment to lower your lipid levels. If your lipid levels remain high after you've made a serious attempt to change diet and exercise habits, then your doctor may prescribe lipid-lowering medications.

Kidneys

Am I at risk for kidney disease (nephropathy)?
When was the last time my microalbumin and serum creatinine were tested?
What were the results and what do they mean?
How often should I have these tests?

Your kidneys filter out waste products from your blood into your urine. Chronic high blood sugar levels, over time, damage the filtering units in your kidneys. For this reason, diabetes is a very common cause of kidney failure. Identifying the very early stages of kidney disease helps patients and doctors adjust treatment. Better blood glucose control and control of high blood pressure can slow or prevent the progression of diabetic kidney disease. There are two tests used to detect early kidney damage: the microalbumin (albumin/creatinine ratio or ACR) and the serum creatinine. You should have both tests at least once a year. Normal levels of micoralbumin should be less than 2.8 for women and less than 2.0 for men. Most labs will report serum creatinine results as estimated glomerular filtration rate (eGFR), because eGFR is a better measure of overall kdiney function. eGFR values less than 90 may indicate kidney problems.

Eyes

Am I at risk for eye disease?
When was the last time I had a dilated eye exam?
What were the results and what do they mean?
How often should I have a dilated eye exam?

Diabetes can lead to a number of eye complications, including retinopathy (damage to the small blood vessels of the retina), macular edema (fluid build-up in retina) and cataracts (clouding of the lens). Early detection and treatment can minimize the risk of vision loss. A dilated eye exam is used to detect signs of possible eye disease. This test must be done by an ophthalmologist or an optometrist. Drops will be put into your eyes to dilate your pupils. If you have Type II diabetes, you should be tested when first diagnosed and every 1 to 2 years thereafter. If you are over 15 and have had Type I diabetes for 5 years or more, you should be tested every year. More frequent tests will be required if your eyes are already damaged.

High Blood Pressure (Hypertension)

What is my blood pressure?
Is it ok? If not, what should I be doing?
How often should I have my blood pressure checked?

High blood ressure is common in people with diabetes and increases the risk of serious complications such as heart disease, kidney disease, stroke, and eye problems. Your blood pressure is as important as your blood glucose - particularly if you have Type II diabetes. You should have your blood pressure checked every time you see your doctor. If your blood pressure is over 130/80, ask your doctor what you should do to lower it. You may need to follow a low sodium diet, increase your exercise, lose weight and/or take blood pressure medications.

Feet

When was the last time I had my feet examined?
Are there any problems with my feet?
What should I be doing to keep my feet healthy?

Diabetes can cause both nerve damage (peripheral neuropathy) and poor circulation in your legs and feet. If you have nerve damage, you may injure your feet without even knowing it. If you have poor circulation, cuts and sores may heal slowly. Untreated sores or cuts can lead to serious infection or even amputation. Your doctor should check your feet frequently and make sure you know how to care for your feet. Your doctor may refer you to a podiatrist for treatment of foot problems. You should inspect your feet every day for cuts or injuries, including the area between your toes. Do not wear shoes that fit too tightly or pinch your feet.

Nerve Damage (Neuropathy)

Am I at risk for nerve damage?
How often should I be checked for nerve damage?
Do I have nerve damage? If so, can it be treated?

Chronic high blood glucose levels can lead to nerve damage (neuropathy). The most common form of nerve damage in diabetes is pain or numbness in the feet and legs. However, depending on which nerves are affected, symptoms of nerve damage can include:

• Bladder problems
• Nausea, vomiting, abdominal fullness or bloating, diarrhea or constipation
• Loss of sensation, tingling, 'pins and needles' sensation, pain in legs, arms, hands, feet, chest or abdomen
• Fainting or dizziness upon standing
• Trouble getting or keeping an erection

Nutrition and Diet

Why is diet so important for people with diabetes?
How can I keep on my diet when eating away from home?

Healthy eating and exercise are important for everyone - but they are especially important for people with diabetes. Diabetes is a disease in which your body cannot convert sugar (glucose) into energy. The unused glucose remains in your blood and causes symptoms of diabetes. If untreated, prolonged high blood glucose levels can lead to serious complications. Both diet and exercise can help control your blood glucose levels. If you have diabetes, you need to eat a certain amount of carbohydrates, protein and fat at each meal in order to control the amount of glucose that enters the blood after a meal. This does not mean avoiding sugary foods or following a restrictive diet. It does mean that you need to choose your foods carefully and balance the kind and amount of food eaten along with the time it is consumed. With proper planning, you can still enjoy a wide variety of your favourite foods.

Managing your food intake away from home involves estimating appropriate amounts of these foods and keeping your calorie intake close to your usual level. It is a good idea to visit a registered dietitian to learn how to estimate serving sizes and vary the type of food you eat. Generally, most restaurants provide food that can be included in a typical diabetes meal.

For more information, see Diet and Nutrition.

Exercise

Why is exercise so important for people with diabetes?

Exercising regularly is one of the most important things you can do to improve your overall health. The benefits of exercise for people with diabetes include:

• Lowering your blood sugar
• Lowering your blood pressure
• Help you lose or maintain your weight
• Improve your heart and lung health
• Improve your well being
• Improve your muscle tone and strength

Last Revised: February 14, 2007