The Diagnosis is made and you fit into the Canadian Diabetes Association's definition of a fasting glucose above 7.0 mmol/L or a random glucose over 11.0 mmol/L; what are we going to do now?
The trouble with Diabetes is two fold. Firstly high glucose levels rob you of energy and ambition, compromising your life style. A normal glucose level will make you feel and function better. Secondly, diabetes has been associated with a high incidence of potentially devastating complications including:
- Kidney Failure
- Heart Attacks
You can do something about it
The Diabetes Control and Complication Trial, a very well designed and significant research study published in 1993; showed that the rate of Diabetic Complications is directly related to blood glucose levels. This study has shown we can do something to reduce complications, now how do we go about setting goals for our glucose levels?
We use the blood test called A1c or Glycosylated Hemoglobin to determine average glucose over a 3 month period. (Alternatively we could do frequent monitoring with a glucose meter and calculate an Average Glucose). The Canadian Diabetes Association has already had a panel of experts give us recommendations on goals for glucose control:
- Normal blood glucose levels are 3.5-6.5 mmol/L
- Ideal control, normal risk of complications, glucose levels normally 3.5-6.5 mmol/L
- Optimal control, minimal risk of complication, glucose levels up to 3.5 -7.4 mmol/L
- Sub-optimal control, moderate risk of complication, glucose levels are 7.4-9.1 mmol/L
- Inadequate control, excessive risk of complication, glucose levels are over 9.1 mmol/L
Where do you fit in?
If your risk of complications is unacceptable to you, we should be talking about how to lower your glucose. Life style measures of diet and exercise are the cornerstones of treating diabetes. The reason for treatment is to make you feel and function better and to reduce the risk of the long term complications of Diabetes.
You should be exercising for 30 minutes a day, every day of the week. Exercise decreases insulin resistance and improves glucose control
If you are overweight, modest weight loss (5% of total body weight) will decrease insulin resistance and may bring you back into balance. In order to prevent weight gain you need to limit your fat intake (because fat is the most concentrated form of energy). A dietitian should see you for diet counseling and to learn the principles of the diabetic way of eating.
Diabetes is a self controlled disease, in order to be able to treat your disease you need to learn about it so that you can make reasonable & educated choices. We will be referring you to a Diabetes Education Program.
If glucose levels cannot be controlled to the target levels recommended by the Canadian Diabetes Association on Diet & Exercise alone you will need medications. There are several different classes of medications including drugs to decrease insulin resistance, drugs to reduce excess glucose formation, drugs to reduce carbohydrate absorption and drugs to increase insulin production. We will work together to choose rational combinations to help restore normal glucose control.
Diabetics have a high level of blood vessel and heart complications, in fact 80% of Diabetics will die from heart disease and the American Diabetes Association has stated that “Diabetes is a Cardiovascular Disease”. In order to reduce the risk of these complications we will look at your blood pressure level, kidney functions and level of cholesterol and other fats in the blood, then treat any abnormalities that we see in order that you can achieve the best quality of life possible with minimal complications.