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How Diabetes Is Managed

Diabetes Home

Diabetes Prevention and Control Program
275 E. Main St.
Frankfort, KY  40621
(502) 564-7996
 

How Diabetes Is Managed

Living with diabetes requires effective self-management of the disease as well as quality care on an ongoing basis by a multidisciplinary health care team.  The health care team may consist of a provider responsible for continuing care and skilled in its delivery, a diabetes educator, a dietitian, a pharmacist, and any other health care professionals that may be needed by an individual. The person with diabetes is the most important member of the team. Early detection of diabetes and/or any of its related problems, appropriate professional health care and better education for diabetes self-management can prevent or control diabetes complications.

Management of type 1 diabetes: People with type 1 diabetes need daily injections of insulin because their bodies no longer produce insulin. Treatment includes taking insulin shots or using an insulin pump, making wise food choices, exercising regularly, taking aspirin daily (for some), and controlling blood pressure and cholesterol.

Management of type 2 diabetes: Many people with type 2 diabetes can control their blood glucose by following a healthy meal plan and exercise program, losing excess weight and taking oral medication. Some people with type 2 diabetes may also need to take insulin to control their blood glucose. Everyone with type 2 diabetes should also control their blood pressure and cholesterol.
 
The goal of diabetes management is to keep blood glucose levels as close to a normal range as safely possible, while avoiding blood glucose levels that are too high (hyperglycemia) or too low (hypoglycemia). A 1993 study called the Diabetes Control and Complications Trial (DCCT), conclusively showed that intensive glucose control delayed the onset and progression of eye disease, kidney disease and nerve disease by "a range of 35 to more than 70 percent." In fact, it demonstrated that any sustained lowering of blood glucose helps, even if the person has a history of poor control. This study was conducted by the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health.

4 Steps to Manage Your Diabetes for Life

Treatment Goals: The ABCs of Diabetes

(Target levels should be individualized as needed)

A1C - Every percentage point drop in A1C blood test results can reduce the risk of microvascular complications (eye, kidney, and nerve diseases) by 40 percent.

A1C - less than 7 percent* for many people

Preprandial capillary plasma glucose 70-130 mg/dl
Peak postprandial capillary plasma glucose less than 180 mg/dl (usually 1 to 2 hours after the start of a meal)
Blood pressure - less than 130/80 mmHg for most people

Cholesterol - Lipid Profile

LDL Cholesterol - less than 100 mg/dl
HDL Cholesterol - Men over 40 mg/dl, Women over 50 mg/dl
Triglycerides - less than 150 mg/dl
*An A1C of 7 equals an average plasma glucose of 154.

Individuals with diabetes should have their A1C checked 2 to 4 times a year.

    Blood pressure - Control of blood pressure reduces the risk of cardiovascular disease (heart disease or stroke) among persons with diabetes by 33 percent to 59 percent and the risk of microvascular complications by approximately 33 percent. In general, for every 10 mm Hg reduction in systolic blood pressure (the top number), risk for any complication related to diabetes is reduced by 12 percent.

    • Individuals with diabetes should have their blood pressure measured at every routine diabetes visit.

    Cholesterol - Improved control of LDL cholesterol can reduce cardiovascular complications 20 percent to 50 percent.

    • Individuals with diabetes should have a fasting lipid profile at least annually (every two years if have low-risk lipid values).

    Complications of Diabetes and Preventive Care

    Heart Disease, Stroke and High Blood Pressure

    heart logoHeart disease is the leading cause of death in individuals with diabetes. Death rates from heart disease are about 2 to 4 times higher among adults with diabetes than adults without diabetes. The risk for stroke is 2 to 4 times higher among people with diabetes. About 67 percent of adults with diabetes have blood pressure that is equal to or higher than 130/80 or take prescription medication for high blood pressure. Studies have shown the importance of reducing cardiovascular risk factors (such as diabetes, high blood pressure, high cholesterol levels, smoking, a positive family history of early heart disease, and the presence of albumin in the urine) to prevent or slow heart disease.


    Eye Disease and Blindness

    Diabetes is the leading cause of blindness in adults aged 20-74 years. Research has shown that early detection and treatment of diabetes eye diseases with laser therapy can reduce development of severe vision loss by an estimated 50-60 percent. Optimal blood glucose control and blood pressure control can reduce the risk and progression of diabetic eye disease called retinopathy. Diabetic retinopathy causes 12,000 to 24,000 new cases of blindness each year. 

    • Adults and children aged 10 years or older with type 1 diabetes should have an initial dilated and comprehensive eye examination within 5 years after the onset of diabetes.
    • Individuals with type 2 diabetes should have an initial dilated and comprehensive eye examination shortly after being diagnosed with diabetes.
    • Examinations should be repeated annually.
    • Women with preexisting diabetes who are planning a pregnancy or who are pregnant should have a comprehensive eye examination in the first trimester with follow-up throughout the pregnancy and for 1 year after delivery.


    Kidney Disease

    Diabetes is the leading cause of end stage renal disease or kidney failure. In 2008, 48,374 people with diabetes began treatment for end stage renal disease and a total of 202,290 people with end-stage renal disease due to diabetes were living with chronic dialysis or with a kidney transplant. Optimal blood glucose control and blood pressure control can reduce the risk and/or slow the progression of diabetic kidney disease. In fact, lowering blood pressure can reduce decline in kidney function by 30-70 percent.

    • Individuals with type 1 diabetes for five years or more should have an annual test to assess urine albumin excretion for kidney disease.
    • Individuals with type 2 diabetes should have an annual test to assess urine albumin excretion for kidney disease starting at diagnosis of diabetes. 
    • All adults with diabetes regardless of degree of urine albumin excretion should be measured for serum creatinine at least annually. The serum creatinine should be used to estimate GFR (glomerular filtration rate) to stage the level of chronic kidney disease, if present.


    Nervous System Disease

    About 60-70 percent of people with diabetes have mild to severe forms of nervous system damage. The damage could include decreased sensation and/or pain in the feet or hands, problems with digestion, erectile dysfunction, carpal tunnel syndrome and other nerve problems.

    • Individuals with diabetes should learn how to provide good self-care to their feet and should inspect their feet daily.
    • Individuals with diabetes should have an annual comprehensive foot exam (including assessment of protective sensation) by their health care provider and a visual inspection at each routine visit.


    Dental Disease

    Gum disease is more common among people with diabetes. Adults with poorly controlled diabetes (A1C over 9 percent) were nearly three times more likely to have severe gum disease than those without diabetes. The likelihood was even greater among smokers with poorly controlled diabetes. Keeping blood glucose levels near normal may help prevent dental complications.

    • Individuals with diabetes should see a dentist every six months (or more frequently if gum disease exists).
    • Individuals with diabetes should routinely brush and floss teeth.


    Complications of Pregnancy

    Poorly controlled diabetes before conception and during the first trimester of pregnancy can cause major birth defects in five-10 percent of pregnancies and spontaneous abortions in 15-20 percent of pregnancies.  Poorly controlled diabetes during the second and third trimesters of pregnancy can result in excessively large babies, which poses a risk to both the mother and the baby.

    • Women with diabetes should maintain average blood glucose levels (AIC levels) as close to normal as possible before pregnancy occurs.
    • Women with diabetes planning a pregnancy should be assisted and treated if needed for diabetes complications such as eye, kidney, nerve and heart disease.


    Influenza and Pneumonia

    Individuals with diabetes are at risk for problems resulting from influenza (flu) and pneumonia.  Data indicate that only half of Kentuckians who have diabetes get the recommended flu shot and/or pneumonia shot. 

    • People with diabetes (6 months old or older) should receive a yearly flu shot beginning when it is made available.
    • People with diabetes should receive a flu shot (inactivated) and should not receive flu mist or intranasal (live) flu vaccine.
    • People with diabetes (age 2 or older) should receive vaccination against pneumococcal disease.
    • Contact your healthcare provider or local health department for annual updates on flu and/or pneumonia vaccine administration. 


    Diabetes and Smoking

    Smoking has severe effects on your diabetes and your health. You can help to prevent and reduce the serious problems of diabetes by quitting. When you quit smoking, you can have more energy, a longer life, better control of your diabetes, and less chance of a heart attack or stroke.

    Smoking:

    • Makes vision problems worse which can lead to blindness.
    • Raises your risk of getting gum disease and losing your teeth.
    • Raises your risk of nerve damage and causes numbness, pain and problems with digestion.
    • Makes people with diabetes 11 times more likely to have a heart attack or stroke than people who don't have diabetes and don't smoke.
    • Can lead to serious foot and leg problems like infections, ulcers, and poor blood flow and raises your risk of amputation.
    • Makes it more difficult to control your diabetes by raising your blood glucose and reducing your body's ability to use insulin.

    Quit smoking today. Call Kentucky's Tobacco Quit Line at (800) Quit-Now or (800) 784-8669.

     

    Last Updated 2/27/2014
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