Diabetes Primer

If you have diabetes, there are several things you should know and do. Once you have the diagnosis of diabetes, your risk for having a heart attack is the same as someone who has already had a heart attack. For this reason, goals for cholesterol and blood pressure change significantly. Having diabetes also increases your risk of peripheral vascular disease, kidney disease, visual problems (retinopathy), infection, and even impotence. I strongly recommend that if you have diabetes, you go through diabetes education classes. I also strongly recommend that you adhere to what the nutritionist there says regarding diet. Exercise, too!

Recommended supplements for a diabetic
ASA 81mg
fish oil 1g twice a day

Things for you to do (aside from exercising and watching your diet):
Yearly flu shot
Pneumovax or pneumonia shot
Check your feet daily—both for cuts or peeling and for numbness.
Opthalmologic exams yearly to check for retinopathy


Goals
Blood pressure ideally should now be less than 130/80
LDL, the bad cholesterol, should be less than 100 and as close as possible to 70
Triglycerides should be less than 150
HDL, the good cholesterol, should be 45 or greater
Hgba1c—the “three month sugar level”, should be 6.5 or lower

I also periodically check a urine test for microalbumin. This is a test showing loss of proteins through the kidneys that is the earliest indicator of kidney problems. If you have a positive test, it can still be reversible.

I often screen for hypothyroidism as well, as a low thyroid is associated with diabetes.

Why does it seem that I am quick to give you more medicines? Because it is all about preventing complications. I would rather give you a medicine for your blood pressure now, than three medicines for heart disease later. Some of the medicines do more than one thing, for example a class of blood pressure medicines called ACE inhibitors (lisinopril, etc) not only lower the blood pressure, but they also protect the kidneys and help with the loss of protein from the kidneys, and they have been shown to lower the incidence of stroke. The cholesterol medicines not only lower the cholesterol, but also stabilize plaques in the arteries (so they don’t break off and head to your noggin), and lower inflammatory markers in the blood that are associated with heart disease. Incidentally, if you get achey with a cholesterol medicine, try some coenzyme Q10, an over the counter supplement. It is thought that the muscle aches due to the cholesterol medicines is caused by a decrease in CoQ10 in the body.