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HYANNIS – Diabetes is one of the most common chronic conditions in the United States, and people with diabetes and prediabetes are at a significantly higher risk of hospitalization than those without the disease.
“If poorly controlled, diabetes can damage blood vessels in the legs, lead to nerve damage and result in wounds and infections,” said Cape Cod Hospital hospitalist Benjamin Levin, MD. “There is also a higher risk of heart disease and kidney failure. But in many cases people do not manage it well. One reason is a lack of understanding, but it’s also because the disease is hard to manage on your own. It’s a lot of work and very challenging.”
Here are a few strategies offered by Dr. Levin that will help people with diabetes manage their disease, keep them out of the hospital, and allow them to remain healthy and active.
1. Take A Team Approach. Diabetes is complex and should not be tackled alone. “One of the first things we do is send patients to a podiatrist, ophthalmologist and nutritionist,” Dr. Levin said. “That kind of attention and team approach is really important, especially early on.”
Foot care is vital, he said, because diabetics can often suffer a foot injury without realizing it due to numbness, or neuropathy, resulting in advanced ulcerations that lead to hospitalization. “You could have an infection in your foot that you don’t even know about because you can’t feel anything.”
Ophthalmologists can closely monitor if vision is deteriorating, while nutritionists will make sure your diet is right for you. “You might think you’re eating healthy and be surprised at what the nutritionist tells you,” he said.
Eye and foot exams are recommended every year, with two to four visits to your primary care physician, and at least two dentist visits annually.
2. Track Your ABCs. The “A” stands for A1c, which is the test that measures blood sugar over two or three months. The goal is to maintain a score of seven percent or less. The “B” stands for blood pressure. People with diabetes are more likely to have high blood pressure, so be sure to regularly have your BP checked. The “C” stands for cholesterol, which is also at risk of being higher with diabetics. You should be tested once a year.
Dr. Levin recommends keeping a daily log of blood sugar, checking it at least twice a day. “That way, your primary care physician can see where your levels are in the morning and night, and can adjust your medication accordingly.”
Your doctor can show you how to track your blood sugar and how to avoid highs and lows.
3. Maintain a Balanced Diet. One key to managing diabetes is learning how to count carbohydrates, which have a major impact on blood sugar levels. Learn what portion size is appropriate for each meal, use measuring cups and write down the portions for the food you eat often. Plan for every meal to have a good mix of starches, fruits, vegetables, proteins and fats. Coordinate your meals and medications to avoid dangerously high or low blood sugar levels. And avoid sugar-sweetened beverages.
“Diet, along with exercise, can treat many conditions and keep people out of the hospital, but it’s especially true with diabetes,” Dr. Levin said. “In some cases, people with Type 2 diabetes who are obese can actually get off insulin by losing enough weight.”
4. Get Fit. When you exercise, your muscles use sugar for energy and your body uses insulin more effectively, which works to lower your blood sugar level. In general, 30 minutes of daily exercise is recommended, but work with your doctor to develop an exercise plan. Keep an exercise schedule so that your workout routine is coordinated with your meal and medication schedule, and check your blood sugar level before, during and after exercise. Be aware of warning signs of low blood sugar, such as feeling shaky, weak, tired, hungry, lightheaded, irritable, anxious or confused.
5. Manage Stress. Your body produces hormones in response to stress that may cause a rise in blood sugar level. Look for patterns of stress by logging your stress level on a scale of 1 to 10 each time you check your blood sugar level. If you see a pattern develop where stress is affecting your blood sugar level, learn relaxation techniques and avoid situations as much as possible that commonly lead to stress. Working with a psychologist or clinical social worker can help you learn how to cope with stress.
Know the warning signs of common complications, such as numbness, tingling, burning, cuts or sores that heal slowly, blurry vision, eye pain or pressure and spots before your eyes.
Diabetes is a difficult disease to manage, but it can be done. With education, professional guidance and a few helpful strategies, you will be less likely to end up in the hospital.