What you need to do to stay free of diabetes-related complications.
Diabetes-related complications can be prevented with good management. This also includes foot, dental and eye checks. Learn what your goals should be. The risk of diabetes-related complications is reduced when blood glucose levels, blood pressure and blood lipids are kept as close to normal as possible.
Target 1: Blood Glucose Levels
Regular testing can reinforce healthy lifestyle choices. It also gives information on responses to medication and other influences.
Even if you monitor levels on a glucometer regularly, check it in a laboratory at least once a month or once in three months. More frequent checks maybe needed if control is not adequate.
Aim for lower targets for younger people when compared to those above the age of 65.
* Fasting should be less than 100-110 mg/dl
* Post-prandial should be less than 140-160 mg/dl
* Random less than 140 mg/dl.
Target 2: HbA1c
The HbA1c, also referred to as glycosylated haemoglobin, shows an average of your Blood glucose level (expressed as a percentage) over the past three months. It does not show highs and lows but gives an overall picture of your blood glucose management i.e. an average value.
* Target level is 7 per cent or lower
Target 3: Blood pressure (BP)
This is the pressure at which your heart pumps blood. High blood pressure can increase risk of heart disease, stroke, kidney and eye disease.
Blood pressure should be checked regularly (at least at every doctor’s visit) and treated if necessary. Check the blood pressure every three months or more frequently if not under control.
* For a diabetic, the target BP is 130/80 or lower
Target 4: Lipids
Dyslipidemia (High LDL (bad) cholesterol, Low HDL (good) cholesterol and high Triglyceride levels) is common in people with diabetes. LDL cholesterol can narrow your blood vessels. It is important to keep these at a low level to protect the heart. Higher levels of these are beneficial for the heart. Lipid profile should be tested every 6-12 months.
* Total cholesterol should be less than 180 mg/dl
* LDL cholesterol should be below 70-100 mg/dl
* HDL cholesterol should be above 40mg/dl in men and above 50 mg/dl in women.
* Triglyceride less than 150 mg/dl
Target 5: Eyes
Uncontrolled diabetes can cause blurred vision, cataracts, glaucoma and retinopathy. Many people don’t notice vision problems until retinopathy is well advanced, which is why regular testing is important. If you notice any changes in your vision, speak with your doctor or eye specialist immediately.
Let the doctor know that you have diabetes or hypertension so that they dilate your eyes to view the retina. This is most important for those who have diabetes and hypertension.
Your eyes should be checked every year, or more frequently if you have retinopathy.
Target 6: Feet
People with uncontrolled diabetes can develop changes in skin condition, calluses, dry skin, foot ulcers, nerve damage (neuropathy), and decrease in blood supply.
So it’s important to take good care of your feet and do daily foot checks. Check your feet every day See your doctor immediately if you have any of the above problems
Target 7: Kidneys
Over time, people with uncontrolled diabetes face increased risk of damage to their kidneys (nephropathy). Very early signs of kidney problems can be detected through a urine test called Microalbuminuria. Almost always it is possible to prevent kidney damage even at this stage, if efforts are taken to maintain a strict Diabetic control. Your kidney function (which includes microalbuminuria, urea, creatinine, and eGFR) should be checked at least once a year or earlier if advised by your doctor.
These targets and frequency of check-ups are general recommendations and can vary from person-to-person and time to time in the same individual. Check with your doctor for a correct schedule and target for your needs.
Many people do not do even a basic blood sugar test regularly. Lack of time, motivation and financial constraints are some of the main reasons. But well controlled diabetes seldom causes complications. Developing complications means neglect to take regular medications, failure in going for regular check-ups, not achieving targets and not consulting a doctor. Remember check-ups and targets are a continuous process and not a one-time achievement.
Dr. V Balaji is Director, Dr. Balaji Diabetes Care Centre. Dr. V. Seshiah is Chairman, Dr. V. Seshiah Diabetes Research Institute.