The last four weeks have been an overview of the different types of diabetes. This week I want to address the complications and what one can do to avoid them. According to the Center for Disease Control the price tag for diabetes related complications is up to $174 billion annually. This figure does not include the cost of individual pain and suffering and the cost of family caregivers. Persons with diabetes can expect to have annual medical expenses that are five times higher than someone without diabetes.
Self-management is the key to preventing or lowering the risk for any of these complications and the associated costs. The first step in self-management is to lower ones’ blood sugar. Work with a health care provider and ask to meet with a diabetes educator to learn about the condition and start down this important path. For some patients, weight loss and increase activity are a starting point along with lifestyle changes. If these aren’t enough to lower the blood sugar, your health care provider may start oral medications or insulin.
Self-management includes taking medications as prescribed, keeping appointments with ones’ health care provider and getting blood work as ordered. One blood test, the HgA1c is usually ordered every three to six months. This test lets the individual and health care provider know what the average blood sugar has been over the last three months as it is the weighted average of the amount of glucose glycated or “stuck” to the red blood cells.
Self-management includes regular foot checks, regular dental checks and eye exams that include the visualization of the retina. 60-70 percent of diabetics have some form of nerve damage, which could result in impaired sensation or pain in hands and/or feet.
More than 60 percent of non-traumatic lower limb amputations occur in people with diabetes. Nerve damage could also result in slowed digestion of food in the stomach, carpal tunnel syndrome, erectile dysfunction or other nerve problems. Periodontal (gum) disease is more common in individuals with diabetes. Gum disease is usually silent and can make it harder to control blood sugars. Almost one-third of diabetics have severe periodontal disease with the gums losing attachment to the teeth.
Diabetic retinopathy is the leading cause of blindness among diabetics 20-74 years of age with 12,000-24,000 new cases of blindness each year. Diabetes is the leading cause of kidney failure. According to the CDC, diabetics are the fastest growing group of dialysis patients and transplant recipients. According to the American Diabetes Association (ADA), in 2000, 41,046 diabetics started treatment for kidney disease and another 129,183 started dialysis or had a kidney transplant.
The risk for stroke is 2-4 times higher in diabetics than those without diabetes, and heart disease strikes twice as often in people with diabetes. According to the ADA, deaths in women from heart disease has increased 23 percent over the last 30 years compared to a decrease of 27 percent in women without diabetes. During the same time period, heart disease in men has decreased 13 percent compared to a decrease of 35 percent in men without diabetes. Self-management includes knowing your ABCs:
Page 2 of 2 - n A — HgA1c. The goal from the ADA is HgA1c less than 7 percent. For every percentage point decrease in A1c, the risk of kidney, eye and nerve complications decreases.
n B — Blood pressure. The goal from the ADA is less than 130/80. Controlling blood pressure will reduce the risk for diabetes related complications.
n C — Cholesterol. The goal from the ADA is LDL cholesterol less than 100mg. Controlling LDL cholesterol can reduce the risk for complications 20-50 percent.
I close this series with a challenge to all diabetics and pre-diabetics. Get educated and if you have had diabetes education, get updated. Learn about the condition and treatment options to make sure you have the most current information and tools to keep your blood sugar in the normal range. Take charge of the disease before it takes charge of you. Most insurance companies understand the importance of diabetes education and cover the education in an ADA Recognized Diabetes Program with a Certified Diabetes Educator and Registered Dietitian. Take charge and ask your Health Care Provider for a referral to a Diabetes Program and Certified Diabetes Educator near you and get involved.
To find the Certified Diabetes Educator closest to you, go to the American Association of Diabetes Educators website. To find the nearest ADA Recognized Diabetes Education Program go the website of the American Diabetes Association.
Noyes Hospital has a Diabetes Education Program recognized by the ADA; staff members include a registered nurse, certified diabetes educator and registered dietician. If you do not have insurance or your insurance does not yet cover diabetes education, ask about assistance from the Noyes Hospital Diabetes Education Program. Call 585-335-4355 for additional information.
Nancy M. Johnsen, RN, CDE, is a certified diabetes educator, community health education coordinator and coordinator of the Diabetes Education Program at Noyes Memorial Hospital.