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Type 2 Diabetes: What You Need To Know

Written by Meghan Connelly, MD.

So, you or someone you know has been diagnosed with type 2 diabetes. You’re in the right place if you want to know more about the disease and what you can do to live a healthier life.

First, you must know that diabetes can lead to a number of complications. It leaves you with many new healthcare responsibilities. However, you may be able to control, or at least optimize, your diabetes with a proper diet and exercise regimen. With true conviction and dedication to wellness, you can work towards living a long, enjoyable life despite this disease.

Exercise and diabetes

Diabetes is considered a “cardiovascular equivalent,” which is medical jargon stating that it places people with this disease at increased risk for heart (cardio) and blood vessel (vascular) disease.

Typically, at the very least, adults need to exercise five times a week. The Department of Agriculture and the Department of Health and Human Services 2008 Physical Activity Guidelines for Americans recommends that adults log "two and one half hours a week of moderate intensity aerobic physical activity, or one hour and 15 minutes of vigorous physical activity”, although they also state that older adults “should be as physically active as their abilities and conditions allow”. Older adults or people with chronic medical conditions that limit their ability to exercise may need to meet with their physician to develop an exercise plan that accommodates their physical limitations or exercise restrictions while optimizing their cardiovascular health with exercise.

It is recommended that adults log "two and one half hours a week of moderate intensity aerobic physical activity, or one hour and 15 minutes of vigorous physical activity”

Please understand that this exercise has to result in working your body in a moderate-to-intense manner. Walking to the metro is good, but your physician will likely want you to be exercising to the point where you can't have a cell-phone conversation, in which you're really exercising your heart...and burning calories. Of course, if you have any chest pain or tightness, arm pain, nausea, or flushing/sweatiness out of proportion to what you are used to, stop immediately and let your doctor or local hospital know about the problem.

Additionally, diabetics don't always have the same symptoms as most people when they have heart problems (e.g. diabetics often have nerve problems, so they may not even have chest pain during a heart attack). So, make sure you see your doctor before you begin any exercise routine. You must be sure your workout plan is safe for you.

Monitoring your diabetes

While diabetes is becoming more and more of a prevalent or "common diagnosis," you have to take it seriously. Diabetes can lead to kidney, eye, blood vessel, and nerve problems. And, as above, it is also considered a "cardiovascular", or heart disease, risk factor. Therefore, diabetes requires a lot of attention, care, and monitoring on your part.

Testing your blood sugar

If you’re a diabetic, you need to check your blood sugar, every morning, before you eat or as frequently as advised by your physician. Your physician can write a prescription for a blood sugar monitor and "test strips" which you put into the monitor. It is very helpful for your physician if you either write down these numbers along with dates, times, and if you've eaten (and what), or bring in your monitor (because some monitors actually store this information), so that they can tweak your home medication regimen.

Vaccines

Diabetics should receive the pneumovax (pneumonia) and flu vaccines if they do not have contraindications or previous problem with these vaccines. Diabetics have impaired immune systems and so are particularly vulnerable to both pneumonia and flu infections, so they should receive the vaccines to help protect against them.

Checking your blood pressure

If you are diabetic, ideally, your blood pressure should be below 130/80. You can have it checked at the pharmacy or even some workplaces. Write these numbers down to take to your next doctor's appointment. If you take this step, it allows your doctor to gauge if your blood pressure is simply high in their office because visiting the doctor makes you nervous or anxious, or if your blood pressure is above your goal out of the office as well.

In order to allow your doctor to best interpret your blood pressure record, you should record the time and location of your blood pressure reading, and if you’ve taken any blood pressure medication before the measure (or missed a dose). When you have your blood pressure measured, make sure you’re in a place where you can rest comfortably, sit up straight and uncross your legs. Relax your limbs as you place your forearm in the blood pressure cuff and begin your reading.

It is also a worthwhile investment to buy a home blood pressure cuff, and record your home measurements. Home blood pressure cuffs can be purchased at medical supply stores or at pharmacies. They do not require a prescription, but you can ask your doctor to write one, if your insurance requires physician documentation for reimbursement of your purchase (not all insurance companies will reimburse for these, but many do if you have high blood pressure).You can bring your home cuff to the doctor’s office to have them double check it against their readings to ensure it is accurate.

Taking medications

Diabetes care involves more than just blood sugar medications. Your doctor will likely place you on a medication called an "ACE-inhibitor" and also a "statin". These work to help protect your kidneys and heart. The statin drugs help bring your cholesterol levels down and also have anti-inflammatory properties. In fact, the American Diabetes Association (ADA) has recommended giving statins to any person with diabetes over the age of 40, and with either overt cardiovascular disease OR one additional cardiovascular risk factor, regardless of their cholesterol levels.

Things your doctor will want to check

In regards to labs, there are a number of things that your doctor will be monitoring. They will likely keep close tabs on your "hemoglobin A1c,” which is a marker of your blood glucose control. This number reflects your blood glucose average over the last three months. The goal is for the number to be less than 7% if you have been diagnosed with type 2 diabetes. Your doctor will probably check this lab every six months or so to gauge your blood sugar control.

Your doctor will also probably check a “lipid panel,” which measures both “good” and “bad” cholesterol levels. You need to fast for at least 12 hours before having this lab value checked. This means nothing to eat, no juice, no food --and no Starbucks coffee!-- for 12 hours before you have this blood work done.

As a diabetic, the National Cholesterol Education Program's (NCEP) Adult Treatment Panel (ATP) III says your level of "bad cholesterol" or LDL, should be below 100. Ideally, according to the American Diabetes Association, it should be below 70 mg/dL.

Finally, diabetes can lead to kidney compromise, so, at least once a year, your doctor will probably check your kidney function. This can be done by a blood test to check your "creatinine," which evaluates how well your kidneys are clearing a byproduct of muscle breakdown. Your kidney function can also be measured by a urine test for "microalbumin," which will check to be sure your kidneys are not excreting extra amounts of this protein....and which can be a marker of early kidney disease. If your screening results come back abnormal, your doctor may recommend additional urine or blood testing to help determine additional therapies that may help protect your kidneys, or additional factors that may be contributing to any lab abnormalities

Regular checkups for diabetics

If you have diabetes, your doctor will probably want to see you in the office every 3-4 months. This lets them check up on your blood sugar control, blood pressure, labs, and check up on your lifestyle habits to see if there are any extra services or referrals they can offer you (e.g. referral to a nutritionist) to help you manage this disease.

You should maintain appointments with both an ophthalmologist (for eye care) and podiatrist (for foot care) and see each of these specialists at least one time each year. A mistake a lot of diabetics make is to simply schedule a regular eye exam. Why is this a “mistake”? Well, if you’re a diabetic, you need to specifically ask for a "diabetic eye exam." This is not your standard eye exam, instead, in this kind of exam, your doctor will test for glaucoma. In addition, the doctor will pay special attention to the retina (the back part of the eye) and the blood vessels surrounding the retina. These blood vessels are particularly prone to damage by diabetes.

Note: Your eyes will be dilated during this exam, so have a friend or partner drive you to the appointment. Also, bring a pair of dark sunglasses for the ride home.

Diabetics and their feet

One last tip is that all diabetics need to keep a very close watch on their feet. Diabetics can have compromised nerve function and often don't have as good of sensation in their feet as they used to before diagnosis. So, all diabetics need to either have themselves, a partner, family member, or close friend do regular foot exams. And, ALL diabetics should ALWAYS wear shoes; this includes slippers in the house. Always, always, always wear shoes or slippers to protect your feet if you are diabetic!!! The last thing you want is for something to become lodged in your foot, infected, and not even notice it until it's too late!

So, yes, diabetes entails a lot of responsibility on your part...but by keeping a close watch on your labs, making sure you see the appropriate specialists, and working to control your diet can help limit, or even eliminate, any complications of diabetes. You can do it. You can take control of your health, and ultimately, your life!

DAILY CHECKLIST

Exercise
  • At least  2.5 hours/week of moderate intensity or 1.25 hours/week of vigorous intensity for individuals without physical restrictions.  
  • Should increase heart rate for optimal cardiovascular benefit  - we should write this in simple terms (sumit)
  • You shouldn’t be physically able to carry a conversation while exercising (excessive shortness of breath warrants medical evaluation)
  • Don’t exercise to point of illness, chest pain, or nausea
  • Check with your doctor when beginning a new or vigorous exercise routine to determine what is safe and right for your body
Diet
  • Fresh vegetables
  • Fresh fruit
  • Complex carbohydrates
  • Lean protein (if you do not have advanced kidney disease)
  • Adequate water
  • Avoid processed foods and “simple sugars” as much as possible
  • Eat less than 2 grams of salt/day if you have high blood pressure (this can be tough!)
  • Avoid foods high in saturated fats as much as possible
Medications
  • If you have been prescribed medications for diabetes, take as directed
Glucose Testing
  • Test every morning, before breakfast (or as suggested by your doctor)
  • Write down your glucose numbers and save for next doctor’s appointment. Include date and time you tested your levels (some machines do this automatically)
Checking Feet
  • Wear slippers or shoes around the house and wherever else you walk
  • Check your feet daily to make sure they look normal, no injuries, ulcers, etc.

WEEKLY CHECKLIST

Blood pressure screening
  • Relax
  • Keep a log of what you were doing, where it was taken, if you’d taken your medications, and the time of day it was recorded
  • If you have a home blood pressure cuff, bring it to your next visit so that your doctor can check its measurement against their own, to be sure it’s accurate
  • BP should ideally be below 130/80
  • Be sure to tell your doctor if you’ve had any dizziness or falls while on blood pressure medications

QUARTERLY CHECKLIST

Lab Tests
  • Visit to primary care physician to check your blood sugar control, blood pressure, and to optimize any additional medical conditions you may have
  • Typically labs to test your Hb1Ac will be run either quarterly or twice yearly

YEARLY CHECKLIST

Checkups
  • Ophthalmology checkup for what is specifically called a “Diabetes Eye Exam”
  • Podiatrist checkup
  • Flu vaccine

AT LEAST ONCE

Pneumonia vaccine
  • Once at first diagnosis of diabetes and again at 65 years old
Meghan Connelly, MD
Meghan Connelly, MD

Meghan Connelly grew up in Ohio.  She attended Vanderbilt University for her undergraduate studies majoring in Molecular and Cellular Biology and minoring in both Chemistry and American Political Science. Afterwards, she attended medical school at the University of Southern California. She currently lives in Washington DC and is completing dua.. Read more

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