When was the last time my hemoglobin A1c was tested? What were the results, and what did they mean? How often does my physician do such testing?
Hemoglobin A1c is a measure of diabetes control over the past 2-3 months. The Diabetes Control and Complications Trial, completed in the 1990s, showed that tight blood glucose control can conclusively lower the risk of certain diabetes complications. Your healthcare provider should be ordering an A1c test at least 2-4 times per year. Ideally your results should be below 7. If your results are over 7, and are running closer to 8.0 or above, your physician and healthcare team should be discussing with you potential changes in your treatment plan to improve your diabetes control, because your risks of developing diabetes complications are higher. If you are experiencing frequent low blood glucose (hypoglycemic reactions), your healthcare team should be discussing possible changes in your treatment plan to lower your risk of low blood glucose while keeping your A1C as low as safely possible.
When was the last time I had a "lipid profile" done? What were the results and what did they mean? How often does my physician do such testing?
This test measures the level of blood fats in your blood. People with diabetes are prone to higher levels of blood fats in their systems — which puts them at increased risk of heart and blood vessel disease. You should have these tests done at least once a year. Your levels of HDL (so-called good fats) should be greater than 45. Your levels of LDL (so-called bad fats) should be less than 100, and your triglyceride levels should be under 150. If you have heart or blood vessel disease, these levels may have to be even lower to prevent more problems. If your test results don't fall in these ranges, your physician should be referring you to a dietitian for help with lowering the overall fat content in your diet, and help in losing weight, if that is a problem. Improved blood sugar control may also improve your blood fat levels, so if your blood sugars are not under control, you will need to work on this. Your healthcare team should also encourage you to begin an exercise program — and should recommend an exercise tolerance test before you embark on an exercise program if you are over age 35 or have any diabetes complications. If you have any diabetes complications, your team should be referring you to an exercise specialist (usually an exercise physiologist). These are usually the first courses of treatment for a lipid problem. They may also prescribe lipid lowering medications, if you have found that these changes aren't having the desired effect.
How frequently should I be checking my blood glucose at home? What should my target blood glucose be?
Patients and their physicians should work out an individualized testing program that works well for them. For patients who are not on insulin, Joslin clinicians still encourage daily blood glucose monitoring at least twice a day. Patients on insulin should be checking their blood glucose at least four times per day, (before meals and at bedtime).
Additional testing should be done before and after exercising, and if you feel like you are having a low blood glucose. Normal fasting plasma blood glucose for a person without diabetes is under 126 mg/dl. Although people with diabetes can't be expected to hit these target levels all the time, blood glucose levels that are over 180 two hours after eating or above 140 mg/dl before eating in a person with diabetes are considered high. Your treatment plan may need adjustment if your blood glucose stays above this level for a period of time. If your physician recommends higher target goals for blood glucose, ask why. There may be circumstances associated with your overall medical condition — such as frequent hypoglycemic reactions, an inability on your part to be able to identify low blood glucose, etc. — why a higher target is better for you. For information on target blood glucose goals at various times during the day,
click here.
Can I eat foods with sugar in them? What dietary guidelines should I be following?
"If the only dietary advice you have is a preprinted meal plan, or if you believe that to manage your diabetes you need to just avoid foods with sugar in them and lose some weight, you are misinformed," says Hill. Recent American Diabetes Association guidelines have loosened restrictions on the use of foods containing sugar in the diet of someone with diabetes as long as the person is incorporating them as part of an eating program tailored by their diabetes treatment team. Many people with diabetes have a specially tailored meal plan that takes into account their lifestyle, eating likes and dislikes, medication requirements, their need to lose weight or cut back on fat in their diet, and more. Unless you are absolutely clear about what your diabetes meal program is, and have had your meal plan updated in the past year, you should probably ask your physician for a referral to a dietitian. If your medical plan will not pay for this, the investment of about $70 for an hour's consultation may be well worth it to improve the variety of foods you can eat.
When was the last time I had my feet examined? Are there any problems with my feet?
At each visit, your physician should be looking at your feet. Feet should be screened at least annually by your physician, and more frequently if you are at risk for foot problems. Risk factors include smoking, having blood vessel problems, having diabetic eye disease, having a history of foot ulcers or other foot problems, having neuropathy, or being unable to examine your own feet on a daily basis. Symptoms of foot problems (primarily the result of poor circulation and/or nerve damage) can include decreased feeling in your feet, cramps that occur when walking but go away after resting, slow healing cuts and scratches, redness of your feet when sitting, or whiteness when they are propped up on a stool or chair, lack of normal hair growth on the legs and feet, or pain in your feet or legs. Even if you don't have any of these problems, your physician or a member of your healthcare team should instruct you on how to care for your feet, and impress upon you the importance of inspecting your feet daily for cuts or injuries that need attention to prevent infection or other problems. If you have any of these problems, you may want to discuss whether it would be appropriate for you to be seen by a specialist, such as a vascular surgeon or podiatrist.
When was the last time I had a dilated eye exam by an ophthalmologist? What were the results? How often should I have a dilated eye exam?
People with diabetes need yearly eye exams in which drops are put in their eyes to dilate the pupils, which will enable the ophthalmologist to see inside the eyes clearly to detect signs of possible eye disease. Having your primary care physician look in your eyes during your regular physical is good to do, but the dilated exam is vital. People with diabetes are more prone to eye complications, specifically retinopathy, macular edema, and cataracts, among other problems. If your physician or eye doctor has mentioned that you have any of these conditions, ask what treatment is being recommended. Frequently laser surgery or other types of surgery are needed for more advanced eye problems. But if you have eye disease, early detection and treatment can minimize the risks of severe sight loss.
When was the last time I was tested for microalbuminuria (the earliest benchmark for kidney disease). What were the results? How often does my physician order this test performed? What should I do if I have microalbuminuria?
If you do not have any signs of kidney disease, your physician should be ordering microalbuminuria/proteinuria testing by checking urine albumin/creatinine (A/C ratio) at least once a year. Your target number should be less than 30. If over 30, you should see your physician more frequently for evaluation, including regular blood pressure checks. You will also want to discuss whether you should be taking blood pressure lowering medication and/or making adjustments in your diet or other aspects of your diabetes treatment plan. You may also want to discuss whether you should see a kidney specialist (nephrologist) for ongoing follow-up.
What's my blood pressure? Is it OK? If not, what should I be doing?
High blood pressure increases the risk of stroke. People with diabetes are at an increased risk of having a stroke, so high blood pressure is important to treat. Have your blood pressure checked at least twice a year. If your blood pressure is over 130/80, (a lower target than for people who do not have diabetes) ask your doctor what you should do. Patients with kidney disease may have slightly different goals. If it is at a higher level three visits in a row, weight loss, following a low sodium diet, increasing your exercise, lowering stress, and/or taking blood pressure medications should be discussed.
What other diabetes complications do I have? What should I be doing about them?
If you have any complications, such as blood vessel disease, a recent heart attack, eye problems, any signs of early kidney disease, neuropathy, etc., you may want to ask for a referral to the appropriate specialist to have the complication checked out further.
Find more information about diabetes in What You Need to Know about Diabetes – A Short Guide available from the Joslin Online Store.
