If you’ve just been diagnosed with diabetes, or have had it for many years, how do you know if you’re getting the best care? See if your care is meeting the new standards for people with diabetes outlined below.
Diabetes is one of the most complex diseases, requiring attention to every aspect of your health. It’s a lot more than just managing your blood glucose levels. Careful management of diabetes is essential to stay healthy and avoid its many complications, including blindness, amputations, nerve disease and kidney failure.
The National Institutes of Health’s focus on diabetes says these 10 areas should be your focus for care.
- Test for diabetes
Because risk increases with age, you should be screened for diabetes beginning at age 45; earlier if you have symptoms (excessive thirst, increase in urine, fatigue or unexplained weight loss). If you are overweight or have other risk factors (family history of diabetes, high blood pressure, not much exercise, high cholesterol, problems with sleep or depression) you should be screened regardless of age. Screening should be repeated every one to three years, depending on your risk level.
- Prevent diabetes
If your doctor determines you have prediabetes, the next step is to prevent you from developing type 2 diabetes. Losing 5-10 percent of your body weight, increasing physical activity and possibly adding a medication have been successful in keeping prediabetes from advancing to type 2 diabetes.
- Provide patient education
If you have diabetes, you carry most of the load in managing it. You should ask your health care provider about being referred to a diabetes self-management education (DSME) class if you’ve never attended one. DSME incorporates your personal needs, goals and life experiences. It teaches you how to make good lifestyle choices, do self-care, and work with your health care team. You’ll learn what to eat, how much physical activity you need, safe medication use, how to monitor/manage blood glucose and blood pressure, and develop strategies to address mental health issues such as depression.
- Energy balance
It’s important to balance what you eat with the amount of physical activity you get each day. When you’re in balance, it’s easier to manage your blood glucose levels, avoid complications, and meet your goals for weight, activity, blood pressure and cholesterol.
Ask for a referral to a registered dietitian (RD) or other nutrition therapy. The RD can help you develop an individualized meal plan to help you make healthy food/beverage choices as part of a well-balanced diet. Aim for 1,200-1,500 calories a day for a woman; 1,500-1,800 calories for a man.
Physical activity of any type that burns an additional 500-1,000 calories a day can result in progressive weight loss of one to two pounds per week.
- Control blood glucose
When you’re able to keep your blood glucose under control, it improves your quality of life, you can be more productive and lower your risk of developing diabetes complications. Are you testing your blood glucose as often as your doctor has asked you to? Are you meeting the glycemic target your doctor has set for you?
The new guidelines recommend an increase in blood sugar targets – from the previous target of 70-130 mg/dl to 80-130 mg/dl. However, older patients may not require as strict blood sugar control. For this age group, hypoglycemia is a more important indicator on which to focus.
Good control helps prevent hypoglycemia – when your blood glucose goes too low. Severe hypoglycemia can cause falls, seizures, car accidents or other injuries. Too much physical activity or missed meals can trigger hypoglycemia. Symptoms include feeling light-headed or fainting, fatigue, sweating, becoming pale, loss of coordination or ability to think clearly or seizures. Learning to recognize and manage hypoglycemia is taught in the DSME classes.
- Reduce heart disease risks
High blood pressure (hypertension) and high cholesterol are common for people with diabetes. Controlling them helps you effectively manage diabetes. Ask your doctor what blood pressure (BP) and cholesterol numbers are best for you. Generally, people with diabetes should keep their BP at or below 140/80. Strategies for keeping your BP under control include checking it regularly, reducing salt and salty foods, following the DASH diet, quitting smoking and getting at least 150 minutes of exercise every week.
Ask your doctor if you need to take a baby aspirin or a statin medication. The guidelines now say that treating high cholesterol with statin medications should be based on age and risk factors. Additionally, more aggressive prevention strategies for atherosclerotic disease (hardening of the arteries) is recommended to reduce your risk of heart attacks and strokes.
- Patient-centered care
Experts have found that individualized, patient-centered care for diabetes results in better health outcomes. Patient-centered care means treatment that mirrors your preferences, needs and values. It includes sharing the decision-making about diabetes treatment with your health care team. You and your team will develop an individual care plan. Using the team approach (called the medical home model) can provide continuous, comprehensive and coordinated care. Individual care also includes sensitivity to what’s affordable for you, and consideration of your other mental and physical health needs.
In addition to your primary doctor, your treatment team may include the following:
- Endocrinologist for more specialized diabetes care
- Dietitian, nurse or certified diabetes educator to provide training and support
- Mental health professional
- Ophthalmologist or optometrist for eye care
- Podiatrist for foot care
- You, the most important team member
- Regular health care
Your health care provider should be scheduling visits at least two times a year for an A1C test and to check on how well you are meeting your treatment goals and managing your medications, if applicable. If your A1C number is over 7, you may need more frequent visits and/or A1C checks.
At each visit he or she should check:
- A1C level
- how often you have hypoglycemia
- blood pressure
- how well you are sticking to your self-care plan and medications
- if you are tobacco free
- if you are managing stress and other mental health issues
At least once a year, you may need:
- cholesterol test
- triglyceride test (checks for a type of blood fat)
- flu shot
- urine and blood test to check for kidney problems
- evaluation and treatment of declining kidney function
Ask your primary doctor when you should have the series of two pneumonia shots. Get a tetanus booster every 10 years.
You may need to be referred to some or all of these specialists:
- dilated eye exam, annually
- complete foot exam, annually
- complete dental exam (be sure your dentist knows you have diabetes), at least annually
- weight management, if it is not under control
- mental health, if applicable
- sleep specialist, if applicable
- Weight control essential
The 2017 updated standards of care for diabetes “…revolve around the premise that obesity and lifestyle, for the most part, cause type 2 diabetes in this country,” according to Caroline Apovian, MD and professor of medicine at Boston University School of Medicine, in her review of the standards.
Without weight control, self-management of diabetes will always fall short. The new standards recommend a referral to a specialist to consider metabolic surgery (weight-loss surgery that restricts the amount of food you can eat). The new standards recommend treating obesity as a separate chronic disease. Guidelines recommend that a person with a body mass index (BMI) of 30 (rather than the previously recommended 40) is a candidate for bariatric or metabolic surgery, if they cannot achieve control of their type 2 diabetes. The guidelines also note that this surgery can help you meet blood pressure and cholesterol goals.
- Sleep well
Research is increasingly finding that adequate sleep is essential to good diabetes control, mental health and controlling heart disease. Tell your doctor if you regularly have any of the following symptoms. Sleep deficiencies can show up as:
- feeling like you could doze off while reading, watching television, in a meeting or riding in a car
- unrefreshing sleep
- falling asleep at inappropriate times
- loud snoring and pauses in breathing
- difficulty falling asleep
- waking up and not being able to go back to sleep
- morning headaches
For more information on diabetes care standards, visit https://www.niddk.nih.gov/health-information/health-communication-programs/ndep/health-care-professionals/practice-transformation/care-standards/Pages/default.aspx