Blood glucose roundup

During your first visit with your diabetes care provider, you’ll come up with a plan for managing your diabetes. Work with your provider to determine clear goals for your blood glucose, including if and when to check it with a blood glucose meter on your own. Your provider may say you don’t need to check it at all if you’re not taking medications, or you may need to check it several times a day if you take insulin. Ask your provider what she recommends.

Part of this discussion is creating a plan for your daily blood glucose targets. For example, many people with diabetes shoot for a fasting blood glucose of 80–130 mg/dL. Your fasting blood glucose is normally the test that you do in the morning before you eat anything. Another common target is 2 hours after a meal of less than 180 mg/dL.

When you check your blood glucose levels, the numbers will be stored in your blood glucose meter. (See more about meters and how to check your blood glucose in Chapter 7.) Your provider may recommend that you write these numbers down in a separate paper logbook or record them in an app or spreadsheet. This can help you see trends in your blood glucose, especially in reaction to changes of medications, foods, or physical activity.

The A1C test is another way to measure your blood glucose over time; your provider does this simple blood test in the office. It’s usually done two or more times a year, depending on your health and blood glucose control.

A1C is a measure of your average blood glucose over 3 months, so this number is helpful for both you and your provider to measure how your overall diabetes plan is working. Many people with type 2 diabetes have an A1C goal of less than 7 percent. However, you and your provider may decide that you want a more or less stringent goal for your A1C. Ask your provider to tell you your A1C level and write it down so you remember it later. Ask your provider whether your A1C is on target; if it’s not, ask how you can improve it. A1C is used to evaluate key points in your blood glucose management including your medication, food choices, weight, and physical activity. Don’t be shy about knowing this number and whether it’s in the ideal range.

Your provider may also give your A1C result as eAG or estimated average glucose. This unit of measurement is similar to the units given during readings from the blood glucose meter that you use on your own. A1C is a percentage; eAG is given in mg/dL.

Many people with diabetes try for an A1C of 7 percent or less, so ask your provider if this number is right for you.

Weight matters

You’ll step on the scale during each visit to see whether you’ve lost or gained weight. Losing or maintaining weight can help you keep your blood glucose in your target range, so it’s an important measurement for anyone with type 2 diabetes.

Your height will also be recorded. The ratio of your height and weight is called body mass index (BMI), and it’s used to determine whether you’re underweight, normal, overweight, or obese. A BMI of 25 mg/k² (23 mg/k² for Asian Americans) or higher could mean that you need to lose weight, and a BMI of 27 mg/k² or higher, coupled with your diabetes, could mean you’re a candidate for weight-loss medications. If you have type 2 diabetes and a BMI of 35 mg/k² or higher, you may consider bariatric surgery. See more about bariatric surgery in Chapter 6.

Fluctuations in weight — up or down — may also mean you need to adjust your medications, meals, or physical activity.

Setting goals for food and exercise

Work with your provider to come up with a plan for healthy eating and more physical activity. This includes both a discussion of daily food goals and weekly exercise goals. See more about both in Chapters 12 and 13.

Ask whether to plan for a certain number of calories or carbohydrates per day. Ask whether to target specific goals for limiting sodium or sugar. Write these goals down so you can refer to them later. Bring up any concerns you’re having at mealtimes or difficulties you’re having with eating or avoiding certain foods. Your provider may recommend that you see a certified diabetes educator (CDE) or dietitian to work on a more detailed plan.

Exercise is another topic of discussion during your checkup. Ask how long and how often to exercise every week. Write the plan down so you can refer to it later. Then keep track of your physical activity so you can talk about it with your provider at your next visit.

Tell your provider if you’re having trouble getting started or keeping up with regular physical activity. Pain, soreness, and fatigue are common symptoms that get in the way of being active, so tell your provider if you’re experiencing these issues so you can find treatments or alternative exercises.

Medication roundup

You can also expect to run through your medications and how they’re working with your provider. Your provider will use your A1C test and perhaps your blood glucose readings to evaluate how well your medications are working to manage your blood glucose.

Tell your provider about any new medications or supplements you may have started taking since your last appointment. It’s important for your provider to have the most up-to-date list of your current medications and doses. If you’re seeing a new provider, consider putting all the medications from your medicine cabinet into a brown bag and taking it with you to the appointment. That way, you won’t forget the name and doses of any medications.

If you’re experiencing new symptoms or side effects, tell your provider. They may be linked to a medication and its dosage. Or that medication could be interacting with another medication. Your provider’s job is to troubleshoot these issues, so don’t be afraid to bring up any concerns.

Ask your doctor about the dose and timing of each medication you’re taking, especially if he prescribes a new one. Some medications may be taken with food, so you need to know these details. See Chapter 6 for more about medications.

Targets for blood pressure and cholesterol

Your blood pressure and cholesterol are also closely linked to your diabetes and overall health. People with diabetes are at risk for damage to blood vessels in their heart, eyes, kidneys, feet, and other parts of their body. This can lead to all kinds of problems such as heart attacks, blindness, kidney failure, and amputation.

High blood pressure and bad cholesterol can both exacerbate blood vessel damage, so the goal is to keep these numbers low. Good cholesterol keeps blood vessels healthy. Eating wholesome nutritious foods, losing or maintaining a healthy weight, exercising, and taking medications can all reduce blood pressure and bad cholesterol and raise good cholesterol.

You’ll have your blood pressure taken at each checkup. Most people with diabetes have a goal of less than 140 mmHg systolic blood pressure and less than 90 mmHg diastolic blood pressure. If your blood pressure is higher than this, your provider may recommend changes to your foods, exercise, or new medications. Reducing salt, quitting smoking, and eating whole-grain foods can lower blood pressure.

You’re not alone if you have high blood pressure. One in three Americans has high blood pressure, and two in three people with diabetes have high blood pressure or take medications to lower it. Keeping an eye on blood pressure is a good idea because high blood pressure increases the risk of stroke and heart disease — problems that people with diabetes already have a higher risk for.

Peripheral arterial disease (PAD) occurs when arteries in your legs narrow and become blocked; it can cause pain in your legs, hips, and other parts of the body. Tell your provider if you have these symptoms so she can test for PAD using a simple test that measures blood pressure at your arm and ankle. It’s called the ankle/brachial index. (See Chapter 8 for more about PAD.)

You’ll have a blood test for your cholesterol when you’re first diagnosed with diabetes, and then every 5 years or more frequently depending on your doctor’s recommendation. You can lower your bad cholesterol and boost your good cholesterol by reducing animal fats and eating plant fats like avocados, olive oil, and legumes. You can also take medications such as statins to lower your bad cholesterol.

Cholesterol is a type of blood fat, and it can clog arteries and lead to heart disease, stroke, and other blood vessel problems. Cholesterol is divided into two types:

• Low-density lipoprotein (LDL) cholesterol is called “bad” cholesterol because it can build up in your arteries. The lower your LDL cholesterol, the better.
• High-density lipoprotein (HDL) cholesterol is called “good” cholesterol because it removes cholesterol from the body. In this case, the higher, the better.

Triglycerides are another blood fat that increases your risk of heart disease and stroke. Again, the lower, the better.

Kidney tests

Kidneys are the underappreciated workhorses of our bodies, filtering out toxins through our urine and returning necessary nutrients to our bodies. However, this amazing filtration system can deteriorate when blood vessels in your kidneys narrow and clog. This can lead to kidney disease and, in some cases, kidney failure.

Two simple tests measure your kidney function, and they both have funky names. Serum creatinine/eGFR is a blood test, and urine albumin-to-creatinine ratio is a urine test. Get both tests yearly if you have type 2 diabetes.

Foot check

Take off your socks and shoes when you enter the exam room so both you and your provider remember to do a foot check. Your provider should carefully examine your feet for any sores, cuts, or other visible problems. He should also test for signs of nerve damage by examining your reflexes and asking you about pain or loss of sensation. Tell your physician about any problems you’ve experienced with your feet or nail care. Your diabetes care provider or podiatrist should do a foot evaluation every year or more frequently if you have foot issues.

Vaccinations

Get a flu shot each year to try to prevent influenza, which can be more severe for people over 65 years of age or those with an underlying condition like diabetes. Ask about vaccinations against pneumococcal pneumonia, which is a common complication of the flu and can cause dangerous infections.

The American Diabetes Association also recommends that people with diabetes 19–59 years old have the hepatitis B vaccine because they are at higher risk for this infection. Get the Tdap (whooping cough, diphtheria, tetanus), Zoster (shingles) if 60 years of age or older, Varicella (chicken pox), and MMR (measles, mumps, rubella) vaccines.

You can find a vaccination list schedule for adults and children at the website of the Centers for Disease Control and Prevention (www.cdc.gov/vaccines/schedules).

Here’s a handy list you can refer to in order to make sure you’re getting the right vaccinations to keep you healthy:

• Flu vaccine: A shot once a year, ideally in the fall. Doctor’s offices and pharmacies carry the flu vaccine, which is reformulated each year to combat the most common strains expected that year.
• Pneumococcal pneumonia: The two types of pneumococcal pneumonia vaccines are PCV13 and PPSV23. Vaccination with PCV13 is recommended for children before age 2 years. People with diabetes ages 2–64 years should also receive PPSV23. For all adults 65 years or older, regardless of vaccination history, an additional PPSV23 vaccination is necessary.
• Hepatitis B: A series of three vaccines for adults with diabetes ages 19–59 years (may be considered in people 60 years and older). Given as a 3-dose series.
• Tdap: For whooping cough, diphtheria, and tetanus. All adults who did not get Tdap during adolescence should get one dose. A Tdap booster should be given every 10 years.
• Zoster: For shingles if you’re 60 or older. It’s a one-time dose.
• Varicella: To prevent chicken pox. If never received as a child, 1–2 doses, with timing determined by the doctor.
• MMR: To prevent measles, mumps, and rubella. If never received as a child, ask your provider about her recommendation.

Extra time for questions and concerns

It may seem like all of the above is a lot to cover in one checkup. And it is. But all these tests and discussions are important components of your diabetes care.

Make time for any questions or concerns at the beginning or end of your checkup. It may be helpful for you to write down your questions ahead of time and bring them with you. And it can be a good idea to start the appointment by telling your provider that you have questions and asking her about an ideal time to discuss them during the checkup.