TAKE DIABETES SERIOUSLY

Because our society offers many different messages about diabetes, there are a variety of reasons some people with diabetes feel their condition isn't serious. They may believe that their diabetes is not serious because they developed it late in life or because they don't take insulin. There are people who don't take it seriously, believing that they only have a "touch of sugar" or "borderline" diabetes. Nothing could be further from the truth. Diabetes is always a serious disease.

History of the Casual Approach

The idea that diabetes is not a serious disease may have its roots in the 1920s. Before the discovery of insulin, diabetes was most often a fatal disease. Insulin was discovered in 1921, allowing millions of people with diabetes to survive. Insulin was such a dramatic, life saving discovery that many people came to believe that insulin was "the cure" for diabetes and that diabetes was no longer a serious threat. We know today that insulin is not a cure for diabetes, but a treatment to maintain blood glucose levels within target. There are many diabetes-related complications that people can develop over years of having elevated blood glucose levels. However, with proper treatment and good blood glucose control, complications can be delayed or prevented.

Because it is possible to have high blood glucose levels and feel no symptoms, diabetes is often called a silent disease. These high levels of blood glucose may be causing serious damage to the body even though the person with diabetes may not realize it until they have one of the complications.

Whether you take insulin or not, your diabetes puts you at risk for the following:
* Eye disease
* Nerve damage
* Kidney failure
* Heart and blood vessel disease

If you have diabetes, it is most important to know the effect that uncontrolled, elevated glucose levels over time will have on your body, and to make a strong effort to keep your blood glucose as close to normal as possible. Through healthy eating, exercise and, often, medicine, you can manage diabetes. Blood glucose control, however, requires a team effort. This means that you, your family, health care provider, diabetes educator, Costco pharmacist and dietitian must all take your diabetes seriously and work hard to improve your control.

Importance of Keeping Goals

People with diabetes who stick to their goals for lowering their blood pressure, cholesterol and blood glucose, are less likely to suffer from cardiovascular problems than those with less-ambitious treatment goals. In a recent study, people with type 2 diabetes who were given ambitious treatment goals reduced their cardiovascular problems by half, indicating that
this approach works well over time.

The most serious complications of type 2 diabetes heart disease, kidney failure, nerve damage and blindness can be reduced up to 50% by changes in lifestyle, according to Danish investigators led by Dr. Oluf Pedersen as described in the February, 2003 issue of The New England Journal of Medicine. The key was combining improved lifestyle habits and a medication regimen, versus usual care. One hundred and sixty people with diabetes facing the highest risk of heart disease and other diabetes related complications incorporated a "heart smart" diet, moderate exercise and the daily intake of several vitamins, aspirin, and oral diabetes medications currently used by millions to lower blood pressure and cholesterol all strategies that have long been advocated for reducing risks of heart disease. Half the study participants followed Pedersen's combination program, which tackles several risk factors? being overweight, having high cholesterol, high blood pressure, and smoking for eight years.

The program includes:
* A diet of at least six servings of vegetables and one serving of omega-3?rich fish such as herring, salmon or mackerel each day.
* No more than 30% of total calories can come from fat, with no more than 10% from saturated fats, which can increase "bad" LDL cholesterol. With the exception of daily fish consumption, this is similar to the standard low-fat "heart-healthy" diet recommended by doctors.
* At least 30 minutes of light to moderate exercise, three to five times a week, which is actually less than the recommendations of some experts who advocate an hour of exercise each day.
* Quitting smoking.
* Following a regimen of various vitamin supplements and a daily aspirin.

The second group followed the same exercise and non-smoking regimen, along with a diet calling for up to 35% of all calories from fat, three daily servings of vegetables, and fish once a week. They did not receive the oral medications.

The results of the study: in addition to nearly half the rate of death from cardiovascular disease, kidney failure and blindness resulting from diabetes-induced blood vessel problems, 70% of combination therapy participants achieved "low-risk" cholesterol levels, 60% reached ideal triglycerides levels, and more than half achieved good control of their blood pressure. By comparison, fewer than half of those using the conventional approach met these goals.

Goals For Control

What's the "perfect" A1C and before meal blood glucose number for a person with diabetes? There isn't one, as everyone with diabetes will have individual goals for blood glucose and A1C. But here are the target ranges the American Diabetes Association and Joslin Diabetes Center encourage people to achieve: Blood Glucose Levels
* 90-130 mg/dL before meals and100-140 mg/dL at bedtime A1C
* Less than 7% Remember, these are only guidelines. Your health care provider may determine that different target numbers are best for you.

Written by Martha Funnell, MS, RN, CDE