Diabetes Management Options
Diabetes Support Group Meeting Highlights
July 17, 2007
Dr. Trevver Buss spoke at the monthly diabetes support group meeting on
management options of diabetes. The goal of therapy is to get the sugar out of
the blood and into the cells where it can be put to use. If sugar stays in the
blood stream, damage can occur to the vessels.
Insulin, produced in the pancreas, allows glucose (sugar) from the blood to
enter the cells. High blood sugars from eating, trigger insulin production. In
type 1 diabetes, the pancreas no longer makes insulin, so insulin injections
are required to help the sugar get into the cells. In type 2 diabetes, the main
problem is insulin resistance. Dr. Buss compared insulin resistance to that of
a "gummed up lock". Insulin then acts as a key to get sugar into the cells, but
if the lock is "gummed up", the sugar cannot get into the cells.
Many complications of diabetes occur when the arteries become damaged. If
the larger vessels get plugged, a stroke or heart attack can result, but even
damage to smaller vessels can cause health problems. Diabetes is the number one
cause of retinopathy (eye disease) and nephropathy (kidney disease). Neuropathy
(nerve damage), another complication of diabetes, is the leading cause of lower
extremity amputations. Blood sugars can be damaging to the blood vessels;
therefore, we need to manage diabetes and blood sugar levels in the blood.
There are several risk factors that contribute to the chance of diabetes:
family history, age and being overweight. A person with a family history of
diabetes can develop insulin resistance. As we age, our risk for diabetes also
increases. Treatment for diabetes includes eating less and consuming fewer
calcories. We cannot change our family history or our age, but we can work on
what we eat and weight control. Anyone with diabetes should meet with a
registered dietician for guideance.
Exercise is also a part of the treatment for diabetes. Exercise helps the
body use the sugar right away, helps with weight loss, boosts metabolism and
can also improve cholesterol levels.
Dietary changes also influence blood sugars. Dr. Buss suggests decreasing
portion sizes, and shifting more of the calories consumed to earlier in the day,
the opposite of American culture. He also warned that some diabetes medications
require consistency and predictability of meals.
A1c is the abbreviation for glycosolated hemoglobin, a blood test that shows
the blood sugar average over the last three months. The goal for A1c is to
be less than seven. If a person's A1c result is elevated, change in treatment
is recommended. Since the effects of treatment changes aren't always immediately
apparent, self testing remains important. If a person with diabetes is doing
self testing, adjustments to treatment can be made as often as every 2-3 weeks.
The goal of diabetes is to control the blood sugars. The therapy required to
control blood sugars needs to be individualized to each person's needs. The
foundation of any diabetes care plan is dietary changes and increased physical
activity. If diet and excercise are not effective in achieving blood sugar
control, medications (often more than one) and possibly insulin would be added
or adjusted to bring blood sugars under control.
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