What I wish all patients knew about Diabetes
Contributed by Dr. Darlene Dunn, PhD, ANP-C
Hey there, I work as an adult care advanced nurse practitioner at Altair Integrative Wellness in Wasilla. I have over 35 years of experience in primary care medical provision, and greatly enjoy educating my patients in how to take better care of their health.
As a primary health care provider, I have taken care of hundreds of diabetic patients throughout my years of practice. I have found each and everyone of them to be unique in their desire to control their disease. Having said such, the diabetic patient is one of the most common problems we see in primary care, and patients generally will experience many additional complications as a ramification of their disease if it is not well controlled. Some patients do not care if they are compliant with their treatment regimen, which of course is a provider’s greatest frustration, while others consider control of their diabetes a challenge they face head on with the greatest of health priority; such patients do very well.
Diabetes is 100% a metabolic and cardiovascular disease. It is a disease that lasts a lifetime which can not be ‘cured’ but can be controlled with stringent monitoring and care on behalf of
a diabetic. If not controlled, the complications can be devastating, and not often able to be reversed. As providers, the saddest story we often see is that of a diabetic who is not compliant with their treatment who ends up with the three most prevalent and devastating complications: on dialysis due to kidney failure, blindness from diabetic retinopathy, or limb amputation
due to compromised blood flow.
Remember the earlier declaration that diabetes is actually a cardiovascular disease? Large blood vessel disease leads to heart disease, stroke, or gangrene. Our smaller blood vessel disease leads to eye disease, kidney disease, or limb gangrene. Also when the blood vessels are damaged, our nerve pathways do not receive adequate oxygenation supply, and nerve problems known as neuropathy or ‘tingling’, ‘stabbing’ or ‘numbing’ pain in our extremities occur, which can push a person into that ‘chronic pain’ arena that no one wants to experience. Simply put, our blood vessels do not respond well to higher circulating sugar levels in blood vessels. One can imagine the delicate blood vessels wear and tear through long-term high glucose levels cruising through the blood vessels instead of being properly absorbed to give the body it’s needed ‘energy’.
Nature designed us to be able to metabolize our ingested sugar’ to provide us the energy
necessary to live our lives. Diabetics can’t do that when the pancreas does not produce enough vital insulin to make that metabolic conversion. Such is why diabetics feel tired and void of energy; they simply are.
So what can a person do to prevent those devastating diabetic complications:
1. Follow a diabetic meal plan, which is a healthy meal plan for anyone, that controls calories, carbohydrates, and fats. Diabetics need to see a diabetic nutritionist every few years for a meal plan check-up. If you are overweight, even a 20- pound weight loss can help improve your blood sugar a bit, as well as your blood pressure. I have seen many a ‘pre’ or early diabetic ‘reverse’ their mild or pre-diabetes by losing weight, properly exercising, and controlling their diet plan.
2. Take your medications as prescribed. Make sure your care provider knows all the medications you take, as well as any medications that were ‘tried’ that you did not do well with. There are actually eight different categories of ‘antidiabetic’ medications, and for uncontrolled diabetes, it may take several necessary medications combined, or even insulin, but your diabetes CAN be controlled with good compliance.
3. Know your A1C number. Sugar attaches to our red blood cells, and the life of a red blood cell is approximately 3 months. Today providers can ‘measure’ your solid 24/7 round-the-clock blood glucose average over a 3 - month period, based on that one test. This is how we can add, or modify your medications. As your A1C climbs consistently above 6 – 7, complications may begin to occur. A1C values consistently in the ‘double digit’ arena will lead to serious, often irreversible complications.
4. See your care provider every 4 – 6 months for regular monitoring, as well as medication review and care. Also see an eye doctor yearly; immediately if you develop ‘blurry’ vision. Keep yearly dental appointments since diabetics have an increased rate of gum disease due to a poorer oxygen blood vessel supply. If ever any chest pain or shortness of breath, see your cardiologist, since diabetics have a greatly increased risk of heart attacks and cardiovascular disease. And don’t smoke! Smoking cuts off oxygen to the tissues, a cardiovascular problem diabetics already have.
5. Remember to check your feet daily, especially on the bottom soles and between your toes. Diabetic nerve damage may prevent you from feeling the pain of an injury, and due to slow tissue healing and a high infection risk, diabetic ulcers can easily occur, resulting in a high risk of gangrene and amputation.
6. Evidence-based health providers still recommend patients receive and update their vaccinations. Today a young, healthy individual may still do well if they come down with influenza or even covid, but a diabetic runs the complication of developing a secondary pneumonia as a result since they are at a high risk for any infection; such can be life-threatening.
Finally, All individuals should know their glucose levels; if you don’t, see your primary care provider. Everyone should have an annual exam for screening and good preventative care; your life may depend on it!