Living Well

Diabetes Must Know Facts - Expert Tips from Dr. Lena Shalem

Last updated: Mar 22, 2018

Diabetes that is left untreated may lead to complications. Fortunately, there are steps you can take to manage diabetes, which can reduce these risks.

Step 1: Learn about diabetes.

What are the symptoms of diabetes?

  • Although some people display classic symptoms of increased urination, increased thirst, blurry vision, and weight loss, many people, especially those with type 2 diabetes, do not show any symptoms.

How do I know if I have diabetes?

  • Your doctor can do a blood test—a fasting glucose level and a hemoglobin A1C (HbA1C). The HbA1C measures the average glucose in your blood over the past three months. If the glucose is at least 126 mg/dL or the HbA1C is at least 6.5 percent, then you have diabetes.

How is diabetes treated?

  • Type 1 diabetes is characterized by insulin deficiency and is often treated with multiple daily injections of insulin. Generally, people with type 1 diabetes are on two types of insulin, one that is long acting and lasts the entire day, and one that is rapid acting, which is taken before meals. Another option is to use an insulin pump that is constantly infusing rapid-acting insulin and can give extra doses while you eat.
  • Type 2 diabetes treatment is more variable. Some people can control their Type 2 diabetes with a low-carb diet, exercise and weight loss alone; some take pills daily; some use non-insulin injections daily or weekly; some need one or multiple daily injections of insulin.


Step 2: Know your diabetes.

How do I know if my diabetes is controlled?

  • Without testing your blood sugar levels or HbA1C it is impossible to know if your diabetes is controlled. Many people mistakenly think that avoiding sugary foods and taking their medications is enough to ensure good control of type 2 diabetes.
  • Your HbA1C should be measured every 3-6 months. The American Diabetes Association recommends keeping the HbA1C at least under 7 percent for most adults. However, for an elderly person or someone with many other medical problems, your doctor might recommend a higher HbA1C target.
  • Testing your own blood sugar levels to make sure they are in range is also important. Self-monitoring of blood glucose multiple times a day is imperative for anyone who is taking insulin. It is necessary to avoid hypoglycemia (low blood sugar) and identify when you are having hyperglycemia (high blood sugar). Insulin doses can be adjusted to hopefully avoid extremely high or low glucose numbers.

But I take (some of) my diabetes medications and I feel fine. Why do I need to make sure my diabetes numbers are perfect? It’s not causing me any problems.

  • It’s not causing you any problems yet, but there is a reason why diabetes is called the silent killer. Uncontrolled diabetes causes retinopathy—damage to the tiny blood vessels in the back of the eye (retina); nephropathy—damage to the function of the kidney; and neuropathy—nerve damage, which most commonly causes tingling, pain or numbness of the feet. Diabetes can lead to blindness, end-stage kidney disease requiring dialysis and foot ulcers that do not heal and necessitate amputation.
  • Fortunately, the complications of diabetes develop slowly over time, often occurring many years after the initial diagnosis of diabetes. The longer the diabetes is poorly controlled, the faster the complications develop. You might be unknowingly in the process of developing irreversible complications from diabetes. Now is the time to start controlling your diabetes before it gets worse.

How can I find out if I have complications from diabetes?

  • An eye doctor can examine your retina for retinopathy. A simple blood and urine test can indicate the beginnings of diabetic kidney disease. A foot exam can diagnose neuropathy.
  • Diabetes also causes heart disease, including heart attacks. Although there is no specific screening test that is recommended to all patients to identify heart disease, it is important for everyone with diabetes to follow up with their doctor regularly to see if there are cardiac tests that would be helpful in their situation. They should also make sure their cholesterol and blood pressure levels are controlled as well.


Step 3: Learn how to monitor your diabetes.

What options do I have for testing my blood glucose levels?

  • It is important for patients diagnosed with diabetes to check blood sugar levels regularly. This is most often done by applying a very small drop of blood, usually from the finger, to a glucometer test strip. Some patients need more frequent glucose monitoring to manage their diabetes. For these patients, there are continuous glucose monitors available that measures glucose levels every few minutes. Some of these devices can alert you if the glucose is going dangerously low or very high and are especially helpful to individuals who have had problems with hypoglycemia in the past.

Please reach out to your primary care provider or endocrinologist for more information on monitoring and controlling diabetes in your life.

 

By Lena Shalem, M.D.
Lena Shalem, M.D. is a member of Summit Medical Group’s Endocrinology team. Dr. Shalem comes to us with a clinical focus in pituitary disease and has expertise in thyroid and adrenal diseases, polycystic ovarian syndrome (PCOS) and general endocrinology. She is trained to perform in-office, fine-needle thyroid nodule biopsies.
Dr. Shalem is board certified in internal medicine and in endocrinology, diabetes and metabolism. She graduated Stony Brook Medical School in 2012 and continued to complete her Internal Medicine residency at Winthrop University Hospital in Long Island, NY.  Subsequently, she spent two years as an Endocrinology fellow at Rutgers New Jersey Medical School. She is also a proud diplomate of the American Board of Internal Medicine.
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