Patients have to be more involved in their healthcare, or else they can anticipate uneven, less effective, and even disastrous results.

Diabetes

Diabetes is a very complex disease, and if you “forget” to pay attention to all of the details, then you may suffer unnecessary heart attacks, strokes, kidney failure, foot amputation, blindness or early death.  It’s important to me that you have the best chance to understand what you can do to get your head around the essentials of what you need to pay attention to. There are a zillion websites out there that have good informations about diabetes; so, to make things easier for you, I’m going to lead you through some information that I want you to print out, and then I’ll tell you the easiest way to use these handouts.  (In general, we’ll be talking about Type 2 Diabetes; but people with Type 1 Diabetes will also find some good info here.) (Note:  “Blood sugar” and “blood glucose” are used interchangeably.)

I want you to get a yellow highlighter, or a red pen, and when I say “highlight” below, then highlight, underline, or circle that information, so you can come back to that handout and easily see what the most important thing there is.

(Printing:  At the diabetes.webmd.com websites, use the “Print Article” link at the right top of the WebMD page, in order to get the whole handout.  If you just use your print command, you’ll only get the first page of the whole handout.)

- If you don’t understand the symptoms of diabetes:  Go to http://diabetes.webmd.com/guide/understanding-diabetes-symptomsPrint this out if you want.  Label it “Symptoms of Diabetes.”

- If you want general information about “what is diabetes“:  Go to http://diabetes.webmd.com/guide/understanding-diabetes-basics. Print this out if you want.   Label it “Basics of Diabetes.”

- To see the complications of uncontrolled diabetes:  Go to http://diabetes.webmd.com/preventing-diabetes-complications.  Note that the 10 areas of health that are majorly affected by uncontrolled or poorly-controlled diabetes are:  1) the heart (heart attacks); 2) the brain (strokes); 3) the kidneys (kidney failure); 4) the feet (nerve damage, so you don’t feel injuries to the feet plus poor circulation so your feet can’t heal well when they get injured); 5) eye damage (blindess); 6) stomach dysfunction; 7) impotence (erectile dysfunction or ED); 8 ) skin problems (increased infections); 9) infections (generally more susceptible); 10) dental problems (more infections).  Print this out—you need to keep these things in mind. Label this  “Complications of Diabetes.”

- If you need to learn how to check your blood sugar:  Go to http://diabetes.webmd.com/guide/how-test-blood-glucosePrint out, using the WebMD ”Print article” command.  Label it “Blood sugar testing.”

     – Most of you will be doing “Traditional home blood sugar monitoring,” so read (highlight) that paragraph.  (Also note that complete directions on how to do your blood testing will be in the box with your new blood glucose monitor that you will get at the drugstore.)

     – Read (highlight) the paragraph “When should I test my blood sugar?” where it says when you should check your blood sugar.  (Note:  after meals is usually not needed, so before meals and at bedtime are the 4 usual times, if your blood sugar is under control.)

     – Under “Conditions that affect you blood sugar,” note (highlight) the chart that shows you what your values should be before meals, and after meals (after meals applies to bedtime value).

     – Under “When should I call my doctor about my blood sugar,” note (highlight) that it advises you to call your doctor if you have blood sugars more than 180 for more than a week, or 2 consecutive readings greater than 300.

     – Print out a Log Sheet to enter your values as you monitor your blood sugar: http://www.cautiouspatient.org/resources-1. Label this “Blood sugar testing – Log sheet.”

- You need to start knowing what your doctor should be checking, and what your values should be:

     -  A1c (<7) – Go tohttp://diabetes.webmd.com/guide/7-principles-for-controlling-diabetes, and see (highlight) Principle 5 where it says how often your A1C should be done (at least twice a year, and often every 3 months), and what your target A1C is (less than 7). Your A1C, a blood test, tells how well your blood sugar has been under control for the last 3 months—it is vitally important to get this checked by your doctor, and if not under 7, then to ask your doctor to alter your meds so you can get there! (Label this “A1C, BP, Cholesterol.”)

     - BP (blood pressure) (<130/80) - Go to:  same website as just above, under Principle 5, and see (highlight) what your blood pressure should be (less than 130/80).  Ask your doctor to give you whatever meds you need to keep your BP below 130/80.

     –  Cholesterol (LDL <100 or <70) – Go to: same website as just above, under Principle 6, and see (highlight) what your LDL cholesterol should be (less than 100; but many experts say it should be less than 70, so aim closer to 70).  Ask your doctor to give you whatever meds you need to get your LDL cholesterol to at least less than 100, and preferably, less than 70.

     – ACE Inhibitor (Be on this med!) - Go to: http://diabetes.webmd.com/features/diabetes-kidney-disease, and under the section “How is diabetic nephropathy treated,” note (highlight) the 3 sentences that discuss ACE inhibitors. MOST diabetics should be on an ACE inhibitor, unless it is otherwise contraindicated—diabetics on this drug do better.  Ask your doctor to place you on an ACE inhibitor, and make sure you stay on it.  (And if you have diabetes with kidney disease, you absolutely must be on this.) Label this “ACE inhibitor.”

     – Eye Exams (yearly) – Go tohttp://diabetes.webmd.com/eye-problems, and print out. Go to the section on the last page, “How can I prevent eye problems with diabetes,” and read (highlight) that entire section, AND the paragraph just before that section that tells you to have a yearly exam.  Also read (highlight) the last section, “When to  contact your doctor about eye problems in diabetes.” Label this “Eye exams.”

Unfinished.