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Diabetes Checklist: 8 Tests You Should Have This Year

If you search on the internet for diabetes, you can quickly find a lot to scare you. Rather than get overwhelmed with what could happen, make sure you understand what you can do to prevent your diabetes from getting worse. This know the results of these 8 tests and what to do if they are abnormal will go a long way to preventing diabetes complications. The tests you should have this year include:

  1. A1c. Hemoglobin A1c or HbA1c tells you and your doctor how well your diabetes has been controlled over the last 3 months. Normal is 5% or less. Your doctor will likely ask you to make lifestyle changes or changes to your medication regimen if your A1c is above 7%. Lower A1cs are associated with less complications of the eye, kidney, and nerves.
  2. Blood pressure check. Elevated blood pressure or hypertension has been called the silent killer. Persistent systolic blood pressure greater than 130 mmHg or diastolic blood pressure greater than 80 mmHg is compatible with hypertension. Your blood pressure can be really high and you may not experience any symptoms– so you need to check it regularly. Like diabetes, poorly controlled hypertension can lead to heart disease and stroke. Elevated blood pressure is treated with a combination of lifestyle changes and medication.
  3. Cholesterol check. This will include a blood test checking for both cholesterol and triglycerides and will need to be preformed while fasting. If your cholesterol levels are high, you may need treatment with medication in addition to lifestyle modification. If cholesterol is too high you are at increase risk for heart attack and stroke.
  4. Eye exam. Diabetes is the leading cause of blindness in the U.S. You should have a dilated (the doctor or optometrist will use drops to widen you pupils and better see the back of the eye) eye exam at least yearly. Diabetes can damage the retina (called diabetic retinopathy) and the exam is to look for any early signs of this complication. If diabetic retinopathy is not treated you can lose vision or even become blind.
  5. Foot exam. Diabetes can lead to nerve damage over many years. I am not referring to nerves like anxiety, but the nerves that allow you to feel. The medical term is neuropathy and you basically experience impaired sensation. Patients experiencing nerve damage from diabetes may not be able to feel that they have injured their foot. This can lead to infection and even amputations if not treated appropriately. Your doctor will often assess sensation with a monofilament test at least once per year.
    The doctor will have you close your eyes and say yes when you feel the monofilament on your foot. They will preform the test on several parts of the foot. Additionally, your doctor should inspect your feet for sores at each visit.
  6. Urine for protein. Diabetes is also the leading cause of permanent kidney damage that requires dialysis. This test is looking to see if you are spilling albumin or microalbumin into your urine, which occurs if diabetes has damaged your kidneys. A number of different treatments can slow progression, but it is essential that your diabetes be under good control.
  7. Creatinine. This blood test tells your doctor how well your kidneys are functioning. Creatinine is a waste product normally excreted by the kidney. When the kidneys are damaged and not working, creatinine build up in the blood stream causing the levels to elevate. Your doctor will get this test at least yearly. Again medical treatments are available, but good glucose control is essential.
  8. Oral health assessment. Poor diabetic control is associated with oral complications such as gingivitis (gum disease), periodontitis (extension of gum disease to underlying structure and bone), dry mouth, and oral infections. Your dental health professional can help you prevent and treat any complications of diabetes.

 

Hypoglycemia

Hypoglycemia

Hypoglycemia is an important condition when you have diabetes. It is important to know not only the signs and symptoms, but also how to manage hypoglycemia should you experience it.

Do you experience different signs and symptoms?

Do you have different ways of dealing with hypoglycemia?

Check out the video and share your knowledge.

Would You Have Bariatric Surgery For Your Diabetes?

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What You Need To Know- Diabetes Bariatric Surgery

  • Studies have demonstrated weight loss, improved glucose levels, and remission of diabetes in some patients.
  • Most studies have only looked at 2 years of postoperative data.

What You Need To Do- Diabetes Bariatric Surgery

  • Talk with your doctor to determine if you might be a good candidate for diabetes bariatric surgery.
  • Ask your doctor about the risks and benefits of surgical versus non-surgical treatment.

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Would you have bariatric surgery if it might improve or cure  your diabetes? More and more people are asking there insurance companies to do just that with more than 120,000 bariatric surgical cases per year in the U.S.

Diabetes Bariatric Surgery Questions

What sort of questions would you want to ask before undergoing diabetes bariatric surgery? This is a list of question you might want to discuss with your doctor before considering diabetes bariatric surgery:

  • How much weight might I be able to lose?
  • How long will it take me to lose weight?
  • What sort of changes will I need to make before surgery?
  • What will I be able to eat post-operatively.

What Is Diabetes Bariatric Surgery?

“Bariatric surgery” or weight loss surgery can help you lose weight. In general this is accomplished by making your stomach smaller. Other types of diabetes baraiatric surgery alter how your body absorbs food. No matter which type of surgery, decreased caloric intake will lead to weight loss.

What Are The Types Diabetes Bariatric Surgery?

There are several different types of weight loss surgery. The most common is the ‘gastric band’ where a band is placed around part of the stomach creating a small pouch. Your doctor can adjust the size of your stomach. This is the simplest weight loss surgery and involves the least amount of cutting, but is also associated with the least amount of weight loss.

In the gastric bypass procedure part of the stomach is removed to make a small pouch. This procedure is associated with the most weight loss, but can also cause some nutritional problems as your body may not absorb some nutrients as well after the operation.

A sleeve gastrectomy is a different surgical procedure, but is less likely to cause any of the complications associated with gastric bypass.

Diabetes Bariatric Surgery- Results

Bariatric surgery has demonstrated weight loss and improved diabetic control in patients in studies from 2 – 5 years following surgery.

In one study presented at the 29th Annual Meeting of the American Society for Metabolic and Bariatric Surgery, 67% of gastric bypass patients were in complete remission of their diabetes in the year following gastric bypass surgery. If patients were not on insulin and did not have reduced pancreatic function, the success rate jumped to 96%.  Many patients were off their diabetic medications within a couple of weeks.

In a Cleveland Clinic study, investigators compared gastric bypass, gastric sleeve, and intensive medical therapies and saw remission of diabetes in 42%, 37%, and 12%, respectively. Cleveland Clinic called bariatric surgery one of the “top medical innovations for 2013” and stated in the press release that “many diabetes experts now believe that weight-loss surgery should be offered much earlier as a reasonable treatment option for patients with poorly controlled diabetes —and not as a last resort.”

On the other hand, other scientists question whether or not bariatric surgery is as effective for diabetes. Investigators looked more than 4,000 patients with diabetes who underwent diabetes bariatric surgery, While 68% had a complete remission initially, more than one third of these patients ultimately redeveloped diabetes. Poor diabetic control before surgery, need for insulin before surgery, and longer time with diabetes were all predictors of redevelopment of diabetes.

 Diabetes Bariatric Surgery- Side Effects

Diabetes bariatric surgery is not without risk. While the surgery is generally associated with less than a 1% mortality rate, age greater than 65, BMI > 50, and more chronic medical problems increased the mortality rate. Additionally, when these procedures are preformed by surgeons and hospitals who do more than 100 cases per year, mortality was also lower. Additional potential complications include:

  • Bleeding
  • Wound infections
  • Blood clots
  • Heart and lung problems
  • Tears in your intestines causing leaks

 Diabetes Bariatric Surgery- What Would You Do

So what would you do? While some of the results seem impressive, there are real risks and a fair number of people ultimately redevelop diabetes. Please leave a rsponse- I would love to hear why you would or would not have diabetes bariatric surgery. Do you have other thoughts or concerns?

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Sources

1. Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes. N Engl J Med 2012; 366:1567-1576

2. A multisite study of long-term remission and relapse of type 2 diabetes mellitus following gastric bypass. Obesity Surgery 2013; 23(1):93-102.

3. Top medical innovations for 2013- Cleveland Clinic

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Diabetes Problems and Question

How are you? I hope you are doing well!

I need you to answer one question for me:

Is there anything you want me to write a blog post about? Do you have a diabetes questions or problems you would like me to address on the website?

To be honest, a lot of the content on my blog comes directly from people asking me questions or emails I’ve recieved asking me to cover a certain topic.

Why?

Because you asked for them! The way I see it, there’s no point in writing for me. I should do all in my power to write for you. I want to focus my writing on your questions and diabetes problems.

Anyways – I’d love to hear your suggestions. I’ll do my best to answer as many questions in actual blog posts as I can, or maybe even in a video. I may not be able to get to all of them, but I’ll do my best.

Have You Gotten Your Flu Shot?

I have never understood it, but I see many people who choose not to get flu shots despite knowing better.

Patients will tell me “I never get sick from the flu.” I will then tell them that past wellness is not necessarily indicative of future wellness and that the benefits for flu prevention significantly outweigh the risks. It is also still relatively common for people to to say “the flu shot gave me the flu.” While this is not technically possible for the flu injection, some patients do experience a low grade fever and achiness. Significant side effects from the flu shot are exceedingly rare. Finally, some patients just say, “I’ll get treated if I develop symptoms.”

What do you think about the flu shot? Do you have any other reasons for not wanting to get the flu shot? Do you have any words of encouragement for others not wanting to get the flu shot?

Take Action- Talk with your health care provider about the flu shot– it could be one of the best things you do for your health this year..

Learn More

Like what you read?
If so, please join members of our community who receive exclusive weekly online diabetes tips, and get a FREE COPY of my guide, The Office Visit: What You Need To Know & Do! Just enter your name and email below:

Dilated Eye Exam- What Is The Definition of Dilated Eye Exam

 

What Is the Definition of A Dilated Eye Exam

Getting a comprehensive dilated eye exam is one of the best things you can do to keep your eyes healthy. In this painless procedure, an eye care professional examines your eyes to look for common vision problems and eye diseases, many of which have no early warning signs.

Different from the basic eye exam one has to get for glasses or contact lenses, comprehensive dilated eye exams can help protect your sight by making sure you are seeing your best and detecting eye diseases in their early stages, before vision loss has occurred.

A comprehensive dilated eye exam includes the following:

Dilation—Drops are placed in your eyes to dilate, or widen, the pupils. Your eye care professional uses a special magnifying lens to examine your retina to look for signs of damage and other eye problems, such as diabetic retinopathy or age-related macular degeneration. A dilated eye exam also allows your doctor to check for damage to the optic nerve that occurs when a person has glaucoma. After the examination, your close-up vision may remain blurred for several hours.

Tonometry—This test helps to detect glaucoma by measuring eye pressure. Your eye care professional may direct a quick puff of air onto the eye, or gently apply a pressure-sensitive tip near or against the eye. Numbing drops may be applied to your eye for this test. Elevated pressure is a possible sign of glaucoma.

Visual field testt—This test measures your side (peripheral) vision. It helps your eye care professional find out if you have lost side vision, a sign of glaucoma.

Visual acuity test—This eye chart test measures how well you see at various distances.

Diabetes and Flu Vaccine Side Effects

Are Diabetics More Likely to Suffer Flu Vaccine Side Effects?

[box] What You Need To Know About Diabetes and Flu Vaccine Side Effects

  • Diabetics tolerate the flu vaccine the same as patients without diabetes.
  • The flu vaccine is safe.
  • The flu vaccine does not cause the flu.
  • The flu vaccine does not lead to changes in glucose control.

What You Need To Do About Diabetes and Flu Vaccine Side Effects

  • Get the flu shot, not the nasal mist vaccine.
  • Take precautions to prevent getting the flu.

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In general diabetes patients tolerate the flu vaccine without significant side effects. Based on available data, the flu vaccine appears to be safe and low risk. Common flu vaccine side effects include:

  • Soreness
  • Pain at the injection site
  • Redness or swelling at the injection site
  • Low grade fever
  • Myalgias or muscle aches
  • Headaches

Less common but significant flu vaccine side effects can occur:

  • Severe allergic reaction like anaphylaxis.
  • Guillain-Barre syndrome- a neurological disorder that occurs i about 1 in 1 million people receiving the flu vaccine.

Patients over the age of 65 now often recieve a higher dose inactivated vaccine and stomach problems, especially vomiting, have been reported as a flu vaccine side effect.

Should I Say No If I Have Egg Allergy?

If you have a severe reaction to eggs it is probably reasonable to refuse the flu vaccine.

I am Diabetic And Pregnant: What About Flu Vaccine Side Effects?

If you are pregnant it is important for you to get the flu vaccine because pregnant women develop more severe illness if they get the flu. The flu vaccine has not been shown to affect either mom or baby adversely.

Talk with your health care provider because they may have a preference as to when you receive your vaccine. The flu vaccine does not increase the risk of miscarriage and is not known to cause birth defects. Additionally, the flu vaccine may actually protect a newborn from getting the flu during the first few months of life, and has no effect on mom’s ability to breast feed.

Overall, there do not appear to be any specific concerns related to flu vaccine side effects for pregnant women- diabetic or not.

Is Getting Flu One Of The Flu Vaccine Side Effects?

While sore throat, fever, achiness, and soreness are sometimes reported following a flu vaccination, the flu shot is made from a killed virus. This means that you cannot the flu from getting the flu shot.

What Can I Do To Prevent Flu Vaccine Side Effects

Since the most common side effects are pain at the injection site and fever, a common over the counter pain medication like Tylenol (acetaminophen) or Advil (ibuprofen) will prevent you from experiencing either. Ask your health care provider for one before your injection, or bring one with you to your appointment.

Sources

Autoimmune Disease

What Is the Definition of An Autoimmune Disease

Type 1 diabetes is an autoimmune disease. This means that the powerful cells of your immune system that normally fight off infections as a foreign invaders turn around and actually attack parts of your body thinking they are foreign. In type 1 diabetes your body senses the beta cells of the pancreas as foreign and attacks them. The destruction of the beta cells cause your pancreas to not produce insulin and  leads to the symptoms of diabetes.

Why an autoimmune disease causes your body to sense something as foreign is not very well understood. There are a number of possible factors that could contribute to the development of an autoimmune disease including:
•    Genetic factors
•    Environmental factors
•    Infectious triggers

While type 1 diabetes is an autoimmune disease, type 2 diabetes and gestational diabetes are not an autoimmune disease.

HbA1C

 

What Is The Definition of HbA1c?

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What You Need to Know About Your HbA1c

  • You need to know your HbA1c to understand your control.
  • If your diabetes is well controlled, you may only need a HbA1c test twice per year.
  • Your HbA1c goal is 7% or less.

What You Need to Do–Your HbA1c

  • See a doctor to discuss your HbA1c.
  • Follow your diabetic plan based on your HbA1c results.

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What Is the HbA1C?
Think of your HbA1C as a summary of how your diabetes has been doing over the last several months. The HbA1C test uses your blood sugar to see how well or poorly your diabetes control has been.
The HbA1C measures how much sugar attaches to your red blood cells. Because red blood cells stay in your body for about 3 months, the HbA1C test can measure your diabetes control for about the last 3 months.

What Should My HbA1C Be?
This depends on who you ask, but the lower your HbA1C the better. The American Diabetes Association recommends a HbA1C of less than 7%, while the American Association of Clinical Endocrinologists (doctors that are diabetes specialists) recommend a level of 6.5% or less. The lower you can get your HbA1C,  the less likely you will develop complications. You and your doctor should discuss your goal HbA1C as your age, other medical problems, and risk of hypoglycemia all will affect your target HbA1C.

What Does An Elevated HbA1C Mean?
When your HbA1C is elevated, you increase your risk of diabetes complications. The Diabetes Control and Complications Study demonstrated that your risk of complications from diabetes rises as your HbA1C increases.

How Often Should I Get a HbA1C?
The HbA1c is one of the most important numbers you need to understand about your diabetes. You can think of the HbA1c as a summary of how your blood sugar control has been over the last several months. While you may check and measure your blood sugar several times per day, the A1C determines how well your blood sugar has been controlled over the last 2-3 months.

While your daily checks of your blood sugar are a quick check of your diabetes control, the A1C test is the most accurate measure of your diabetes control. If your diabetes is under good control, you may only need the A1C test twice per year. If your diabetes is not as well controlled, your healthcare provider may check the A1C more often.

Your doctor can often preform the A1C test right in the office and you do not need to avoid eating before you have the A1C test done.

What Does My A1C Mean?
Your goal A1C will depend on a number of factors like age, other medical conditions, and risk of hypoglycemia. In general, your doctor would like to see your A1C less than 7%. When your A1C is at this level, your diabetes plan is working well. In general, the lower your A1C, the less your risk of developing complications. As a result, your doctor may push you to get your A1C even lower.

Why Does Lowering My A1C Matter?
Lowering your A1C decreases your risk of diabetic complications with your:

  • Eyes
  • Kidneys
  • Nerves
  • Heart

For every 1% you lower your A1C, you significantly decrease your risk of developing diabetes complications. In the United Kingdom Prospective Diabetes Study, lowering your Hba1c by 1% (e.g. 8% to 7%) decreases the risk of complications like eye disease by 21% and the risk dying by diabetes by more than 20%.

Tests Other Than A1C Your Doctor May Order

  • Creatinine
  • Thyroid
  • Electrocardiogram
  • Cholesterol

Sources:

American Diabetes Association. Standards of Medical Care in Diabetes—2011 Accessed January 2, 2013.

Have You Gotten Your Flu Shot?

I have never understood it, but I see many people who choose not to get flu shots despite knowing better.

Patients will tell me “I never get sick from the flu.” I will then tell them that past wellness is not necessarily indicative of future wellness and that the benefits for flu prevention significantly outweigh the risks. It is also still relatively common for people to to say “the flu shot gave me the flu.” While this is not technically possible for the flu injection, some patients do experience a low grade fever and achiness. Significant side effects from the flu shot are exceedingly rare. Finally, some patients just say, “I’ll get treated if I develop symptoms.”

What do you think about the flu shot? Do you have any other reasons for not wanting to get the flu shot? Do you have any words of encouragement for others not wanting to get the flu shot?

Take Action- Talk with your health care provider about the flu shot– it could be one of the best things you do for your health this year.