Standards of Care for People With Diabetes
The list below is a detailed guide to the basic standards of care that an individual of with diabetes must be aware of. It is not a completely comprehensive list, so remember to consult your physician for any additional matter of care pertaining to your condition.
This blood test measures blood glucose control over the past 90 days. The closer your A1C is to that of people who do not have diabetes, the less chance you have of damage to your heart, eyes, kidneys, and blood vessels. A1C should be tested every three to six months, depending on the level of blood glucose control. The American Diabetes Association (ADA) recommends that A1C be less than 7% for most adults. The American College of Endocrinology (ACE) recommends an A1C of 6.5% or less.
You should inspect your feet every day. People with diabetes should have a foot inspection by a health care team member during each doctor visit. Redness, warmth, swelling, calluses, and any breaks in the skin can be warning sign that prevention needs to be taken to avoid more serious problems with your feet.
Taking care of your feet is one of the most important things you can do for yourself. For a detailed list of how to care for your feet, click here.
Loss of feeling in the feet is a major sign of damage or injury, which can lead to amputation. An annual comprehensive foot examination will include an inspection, foot pulse check, and testing for loss of protective sensation with a monofilament plus one of the following: tests for pinprick sensations, vibration perception or ankle reflexes to determine the need for current treatment or preventative measures.
Dilated Retinal Eye Examination
A dilated eye examination is important in order to find any changes in the eyes. Left untreated, problems can lead to blindness. This exam should be done every year by an ophthalmologist or optometrist trained to look for diabetic eye disease. For persons with type 2 diabetes, the exam should be done shortly after diagnosis. For those with type 1, the exam should be performed within five years after the onset of diabetes.
Oral Health Care
Whether you have type 1 diabetes or type 2 diabetes, managing your blood sugar level is key. The higher your blood sugar level, the higher your risk of tooth decay, early gum disease (gingivitis), and advanced gum disease (periodontitis). Diabetes reduces your ability to fight bacteria, which can cause more plaque to build up on your teeth. If you don't remove plaque with regular brushing and flossing, it'll harden under your gumline into a substance called tartar. The longer plaque and tartar remain on your teeth, the more they irritate the gingiva- the part of your gum around the base of your teeth. In time, your gums become swollen and bleed easily and can potentially damage the soft tissue and bone that support your teeth.
Fasting Lipid Profile
People with Diabetes have heart attacks at a higher rate and at an earlier age than people without diabetes. High levels of lipids (fats) in the blood can lead to a heart attack. By knowing what your lipids are, you and your doctor can work together to develop a plan to decrease your risk of a heart attack. Your doctor can test your lipid levels by doing a simple blood test. Done once a year, this blood test includes LDL level, HDL level, and triglyceride level. Goals for these tests are: LDL- less than 100 mg/dl or less than 70 mg/dl for a person with very high risk; HDL- higher than 40 mg/dl for men and higher than 50 mg/dl for women; triglyceride- less than 150 mg/dl.
Diabetes and high blood pressure (hypertension) can lead to heart attacks, strokes, and/or kidney disease. It is important to have your blood pressure checked at every doctor visit. If your blood pressure is high, your doctor may prescribe medicine that reduces blood pressure and the chance of having complications related to high blood pressure. ADA recommends the blood pressure goal be less than 130/80 mmHg.
It is important for kidney function to be monitored to ensure that kidneys are working well or to determine need for treatment. There will be a yearly test for the presence of albumin in the urine for persons who have had type 1 diabetes for 5 years or more and for all those with type 2 diabetes starting at diagnosis and during pregnancy. A serum creatinine test will be performed yearly in order for the doctor to estimate the glumerular filtration rate (GFR) which indicates the body's ability to filter waste.
In persons who have diabetes and are overweight, reasonable weight loss is recommended. It is important to participate in programs which emphasize regular physical activity. Behavioral changes are usually necessary. Individualized treatment goals and education should be reviewed and provided by a registered dietitian.
For people who have diabetes, the flu can be much more serious than for people without diabetes. A yearly flu vaccination for all people with diabetes greater than 6 months of age can help avoid most kinds of flu.
Pneumonia can be a serious problem for people with diabetes. Vaccination against pneumonia is recommended for people with diabetes greater than 2 years of age. People over 65 should check with their doctor about a follow-up vaccine.
Aspirin therapy (75-162 mg/day) is recommended by the ADA for individuals 40 years old or older who are at increased cardiovascular risk. Information on women's health, men's health, smoking cessation, dental health (an exam two times a year), Diabetes Self-management Education and other topics are available to you from your health care team.