Learning the ABCDEs of diabetes

Although getting a diagnosis of type 2 diabetes can be frightening, it is important to keep in mind that most people with this disease can:

• Continue to lead full and active lives
• Enjoy the foods and activities they have always enjoyed
• Take part in almost any form of regular physical activity

The key to leading a healthy life with diabetes is taking care of yourself. Remember, when it comes to taking care of yourself, you’re not in it by yourself. You have some powerful resources on your side, including your healthcare provider (doctor, nurse practitioner [NP], or physician assistant [PA]), your diabetes educator, and various specialists you will see (eg, optometrist or ophthamologist, registered dietician, podiatrist) . You also have a large community of people who, just like you, are living with diabetes and making healthy choices to control their blood glucose and prevent complications. So, remember, reach out to your healthcare provider and your community to get the information and support that will allow you live a healthy life with diabetes.

You can learn more about these and other key healthcare professionals at the American Diabetes Association website (www.diabetes.org).

Take advantage of Diabetes Self-Management Education and Support (DSMES)!

Medicare and by most private health insurance plans will cover DSMES services if you have type 2 diabetes. These service cover diabetes education and support provided by a American Association of Diabetes Educators (AADE)-certified diabetes educator. A diabetes educator is a healthcare professional who specializes in helping people with and at risk for diabetes and related complications to make behavioral changes designed to help them better manage their condition and lead a healthier life. DSMES services focus on seven important self-care behaviors that are keys to living a healthy life with type 2 diabetes:

• Healthy eating
• Being active
• Monitoring blood glucose
• Taking medication
• Problem solving
• Healthy coping
• Reducing risks for health complications

Ask your doctor, PA, or NP to refer you to a local DSMES provider. If your provider is not familiar with DSMES services or the referral process, you can direct them to the AADE website or download and print DSMES information and a referral form and give it to your provider yourself.

^{*Unless your doctor sets a different goal.}

Back to school... learning the ABCDEs of diabetes!

As complicated as diabetes may seem, there are some simple guidelines that you can follow to control your blood sugar and reduce your risk of diabetes-related health complications. Learning these rules is as simple as remembering your ABCDEs.

The letter A stands for the hemoglobin A1C test (A1C for short). If you have been diagnosed with type 2 diabetes, regular A1C testing will play a role in monitoring how well your blood glucose is under control. The information that your healthcare provider gets from regular A1C testing will help him or her and you make adjustments to your care plan that will help you better control your blood sugar and reduce your risk for a range of diabetes-related complications.

The ADA recommends that A1C testing be performed at least 2 times a year in people who are achieving their treatment goals (keeping blood glucose under control). A1C testing should be done quarterly (every 3 months) in people whose treatment has recently been changed or who have not achieved their blood glucose treatment goal.

A1C targets. Your A1C treatment goal or target will depend to some degree on individual factors, including your age and health status. However, keeping A1C around or under 7% has been shown to decrease the risk of microvascular complications (these include complications where small blood vessels are affected, such as retinopathy and kidney disease). Keeping A1C levels under 7% is a reasonable goal for many non-pregnant adults. However, your healthcare provider may suggest an even lower A1C target of 6.5% or under, if you can achieve this goal without developing hypoglycemia or having side effects due to medication. Younger people who are diagnosed with type 2 diabetes sometimes use this lower A1C target. A higher A1C target of 8% or less may be appropriate for people who are affected by severe hypoglycemia, older people, or people with advanced cardiovascular disease, kidney disease, or other complications.³

Learn more about A1C testing and blood glucose monitoring.

The letter B stands for blood pressure. High blood pressure or hypertension is common in people who have diabetes, affecting an estimated 40% to 80% of people with the disease.²

High blood pressure plays an important role in increasing the risk of cardiovascular disease (including heart attack and stroke).³ For this reason, all of the major guidelines outlining care for people with diabetes who also have high blood pressure recommend aggressive measures, including healthy lifestyle changes and medication, as needed, to control high blood pressure.⁴

People with diabetes (who do not have kidney complications) should maintain blood pressure below 140/80 mmHg. Blood pressure below 130/80 mmHg may be appropriate for certain patient groups. Talk to your doctor about what your blood pressure target should be.⁵

People with diabetes (who do not have kidney complications) should maintain blood pressure below 140/90 mmHg and perhaps below 130/80 mmHg. Doctors recommend the lower goal (less than 130/80 mmHg) for people with diabetes who have kidney disease. Talk to your doctor about what your blood pressure target should be and how you can achieve that target.⁵

Learn more about high blood pressure and what you can do to control it.

The letter C stands for cholesterol, a type of lipid, a waxy substance (also called lipoprotein) that circulates in your bloodstream. The main lipids found in your blood include low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, and triglycerides.⁶LDL cholesterol. LDL cholesterol is often called “bad” cholesterol (think of “L” standing for “lousy”). High levels of LDL cholesterol are associated with cardiovascular disease, including heart disease. This type of cholesterol is linked to atherosclerosis, the formation of plaques on the inner walls of your arteries resulting in hardening and narrowing of the arteries and increased risk for several cardiovascular events, including heart attack and stroke.

HDL cholesterol. HDL cholesterol is often called “good” cholesterol (think of “H” standing for “healthy”). High levels of HDL cholesterol are actually associated with decreased risk for cardiovascular disease, including heart disease. That is, the higher your HDL cholesterol, the better (within certain limits).

Triglycerides. Triglycerides are another type of lipid associated with cardiovascular disease, including heart disease.

If you have type 2 diabetes, you are at increased risk for heart disease. Therefore, your LDL cholesterol level should generally be below 100 mg/dL, your triglycerides should be be below 150 mg/dL, and your HDL cholesterol should be greater than 40 mg/dL (for men) and greater than 50 mg/dL (for women). If you have heart disease and diabetes, you should aim to keep your LDL cholesterol lower—below 70 mg/dL.⁴

However, there are some exceptions to this. For instance, in some older persons, the decision whether to treat high cholesterol will depend on whether there is an underlying illness or health condition that makes the individual a poor candidate for drug or other treatment.⁴

Your doctor can help you determine exactly what your lipid targets should be and how to best achieve them (with lifestyle changes and/or medication) by considering various risk factors for heart disease, including^1,6:

• Your gender
• Your age
• Blood pressure
• Total cholesterol
• Your specific lipid profile (levels of LDL and HDL cholesterol and triglycerides)
• Whether you currently take one or more blood pressure medications
• Whether you smoke
• Whether you have diabetes

Learn more about high cholesterol and other lipids and how you can lower your LDL cholesterol.

The letter D stands for “drugs”. Specifically, these are drugs to protect your heart, including angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers (ARBs), and aspirin. These drugs have been shown to have benefits for certain people with type 2 diabetes in providing protection from cardiovascular disease, including heart disease and stroke. Talk to your healthcare provider about whether you would benefit from treatment with one or more of these drugs.

The letter E stands for “exercise”. Regular physical activity can help you with your weight loss and blood glucose goals, lower your risk for heart disease, and benefit you in many other ways if you have diabetes. Talk to your doctor before you start a program of regular physical activity.

Learn more about how I make regular physical activity part of my diabetes care plan.

The letter S stands for “smoking”. Cigarette smoking promotes a number of health problems, including cerebrovascular disease. If you have type 2 diabetes and smoke, you should consider stopping. Talk with your doctor about your options for quitting smoking. There are many smoking cessation programs and some medications that you can use to help you kick the habit. Keep in mind that quitting smoking is hard to do and often takes several attempts. You may need some help, so talk to your doctor about what you can do to kick the habit and don’t give up until you’ve succeeded!