By Dr. Beth G. Hodges
In my 27 years as a family doctor treating patients with diabetes mellitus, there are many things that I wish for them to understand. Here are just the Top 5:
1. Your Hemoglobin A1c (also known as A1c or glycosylated hemoglobin) is your main report card on how your diabetes is doing. It is the 3-month average of all your blood sugars and is reported as a low number: 6.5% or less is considered ideal for younger people or those not on insulin. A more relaxed goal of 7% is preferable for older individuals and those on insulin to reduce the risk of blood sugars that are too low (a.k.a. hypoglycemia). The higher the average of your blood sugars, the more you are at risk of damage to your heart, your brain, your eyes, your kidneys, and wound healing. Getting your A1c checked at least once yearly but preferably 2 to 4 times per year is important in understanding your true level of disease control.
2. Check your feet every day. Diabetes tends to attack the small nerve endings in the feet and legs over time. This decreases sensation, and it is very common to develop a wound on the bottom of the foot and not realize it. Subsequently, the wound can get infected. This can lead to diabetic ulcerations, which ultimately can lead to infections of the bone, necessitating prolonged antibiotics. If this treatment is not successful, it can lead to amputations. People with diabetes should get out of the habit of walking around barefoot outside but even also inside. Wearing shoes or slippers decreases the chances of stepping on something that can later cause a wound.
3. Get an annual eye exam. Diabetes is one of the world’s leading causes of blindness. There are several different diseases of the eye that are related to diabetes, but the most common one is diabetic retinopathy. Retinopathy is caused by damage to blood vessels in the back of the eye. Although this eventually leads to partial or total vision loss, in the early stages, people with diabetic retinopathy have no symptoms and without regular eye exams, the condition can go untreated until it is too late to save the vision.
4. Have an annual urine screening for microalbuminuria. Microalbuminuria is a condition where small amounts of protein called albumin leak into the urine. This presence signals early damage to the kidneys and is commonly seen in people with longstanding diabetes mellitus.
Like with eye disease, early kidney damage in diabetes causes no physical symptoms, so people do not realize the danger. Without proper treatment, damage to the kidneys can eventually lead to complete kidney failure, and this is how some diabetics end up on renal dialysis.
5. Having diabetes mellitus is a major risk factor for heart disease and strokes, so all diabetics are recommended to be on a class of medications called statins (unless a contraindication exists, such as pregnancy or severe liver disease). Statins tremendously reduce the risk of a heart attack or a stroke in a diabetic, regardless of that person’s baseline cholesterol level.
And there you have it. My Top 5 list might not be as interesting as David Letterman’s, but I can guarantee that it is more important to the health of a diabetic. If you have diabetes mellitus, make sure this list is your Top 5 as well.
Dr. Beth Hodges is a family practice and palliative care/hospice physician in Asheboro, N.C., as well as a part-time medical director for HealthTeam Advantage.