Easy Steps to Improve Your Diabetes Control

The simplest way to improve control of your diabetes is to be proactive about your health care.

1. Be prepared for your doctor visit. An informed patient will reap additional benefits by allowing efficient and effective use of the allotted visit time.

a. You should bring your glucose meter for downloading. How will the provider adjust your medications unless a record of your response to the medications is kept? Test your blood sugar before breakfast (goal 80-120) and 2 hours after meals (goal is less than 180). If you are testing only once a day, vary the times you are checking for the 2 weeks prior to the visit to get a more accurate reflection of your glucose pattern. Not testing? Discuss with your provider the issues that prevent this from happening.

b. If requested always have your lab drawn 10-14 days prior to appointment so the results can be discussed and medical decisions made at the time of the office visit.

c. Bring your list of concerns that you would like to discuss. Be prepared to report any procedure, ER visit, hospitalization or new treatment other providers started since your last visit.

d. Be honest with your provider. If you are not taking medications because of expense or side effects tell your provider so options can be recommended.

e. If you see several providers, keep a list of their names, address, phone, and fax number to share will all your providers.

2. Know your medications. Do your part to reduce medication errors and drug interactions. Every patient should carry a list of all their medications both prescribed and over the counter medications. This list should include medication name, amount, frequency of administration, prescribing doctor and when it was started. This list should be carried at all times and updated with each change.

An additional list of medications that have caused allergies or adverse effects should also be kept. This will prevent a repeat of unpleasant drug effects and potentially is lifesaving.

3. Know your numbers. How can your health improve without knowledge of your starting point?

a. Blood Pressure — Ideal is less than 120/80. If yours is higher, did you know that reduction of dietary salt intake will reduce your blood pressure? Your choice of pain medication may impact your blood pressure. Over the counter pain/ arthritis agents such as ibuprofen, Advil, Nuprin, Motrin, may increase blood pressure. Acetaminophen or Tylenol will not have this effect.

b.Cholesterol — The two most important constituents are the bad cholesterol (LDL) and the non–HDL cholesterol which is equal to your total cholesterol minus your good cholesterol.

i.LDL — should be less than 130 for most people, less than 100 if you have high blood pressure, high cholesterol, or diabetes, and less than 70 if you have known heart disease, stroke or multiple risk factors for heart disease.

ii.Non-HDL — should be less than 160 for most people, less than 130 if you have high blood pressure, high cholesterol, or diabetes, and less than 100 if you have known heart disease, stroke or multiple risk factors for heart disease.

c. HbA1c — This test reflects your average blood sugar control over the preceding 12 weeks with the greatest impact from the past four weeks. You can estimate your HbA1c from your 14 day glucose monitor average if checking before and after meals. For every 30mg% above 100, add 1% to the normal HbA1c of 5.5% .ie: glucose average 190, estimated HbA1c will be approximately 5.5 +3 or 8.5%.

i.Normal — <5.5%

ii.Good Control — 5.6%-6.5%. Continue current therapy for diabetes

iii.Fair Control — 6.6%-7.5%. Therapy changes need to occur such as increased exercise, reduction in calories, and your medication may need to be  adjusted.

iv.Poor control — >7.5%. Major changes are needed in compliance, attitude, exercise routine, calorie reduction, and medication may need to be changed.

d. BMI — This is a measure of your degree of obesity based on your height and weight. BMI between 30-35 reduce life expectancy by 2-4 years and BMI >40 reduce life expectancy by 10 years

Category	BMI range – kg/m2
Severely underweight	less than 16.0
Underweight	from 16.0 to 18.5
Normal	from 18.5 to 25
Overweight	from 25 to 30
Obese Class I	from 30 to 35
Obese Class II	from 35 to 40
Obese Class III	over 40