The 2013 Standards of Care (Continued)
Three needles for everyone with diabetes
Along with the long-standing recommendation to give an annual flu shot and a onetime Pneumonia shot (with a booster at age 65), the ADA has adopted the Centers for Disease Control's new recommendation that all of us be immunized for Hepatitis B, and going forward, that everyone who joins our party should be immunized as soon after diagnosis as possible. It'll be tricky, as it's a three-shot series—the second shot a month after the first, and the final one six months after the first.
Why? Well, more bad news. It turns out that we dFolk are two times more likely than sugar normals to get Hep B, and are more likely to die from it than infected persons who don't have diabetes. Everyone 19 to 59 years old with diabetes should get the shots. Why not the younger folks? They've already had them. Hep B was added to all childhood immunizations in 1991.
Don't get your blood pressure up
Oh. Wait. Actually, you can. In a move that surprised many people, the ADA actually raised blood pressure targets from 130/80 to 140/80, citing a lack of evidence to support the lower goal having any long-term health benefit; and in fact, the old goal may have created a unnecessary medication burden.
Who should be checked
When it comes to screening for type 2, the ADA recognizes that the best evidence is that there's a huge pool of undiagnosed diabetes in our country (the Feds estimate that there are seven million people out there who have diabetes but aren't aware of it). But the ADA still doesn't believe in mass screening of the general public; they remain unconvinced that it would be effective. Instead, the ADA advises screening anyone who is overweight and north of 45 years old. Or any overweight adult of any age, who has an additional risk factor for diabetes such as a family history of diabetes, hypertension, or high-risk ethnicity. The new Standards state that anyone who fits these criteria and tests negative for diabetes should be re-screened every three years. For kids, the Standards recommend screening if they are overweight and have two other risk factors for diabetes.
No mo' microalbumin
Just when you thought you'd learned your diabetes vocabulary, they've gone and changed it. Microalbumin is out and is replaced with "increased urinary albumin excretion." Oy Vey.
Watch the SSBs!
What's an SSB? Nope, it's not the Society of Saint Bridget, the Secret Service Bureau, or single sideband modulation. It stands for sugar-sweetened beverage. Docs are to urge anyone at risk of type 2 to limit their intake of SSBs.
Dr. Atkins gets a nod
What about a type 2 diabetes treatment diet? This year the ADA gave a green light to low carb diets, low fat calorie-restricted diets, and Mediterranean diets (all with assorted provisions), but only for the short term—up to 2 years.
Cutting out diabetes?
The Standards put bariatric surgery on the table, the operating table, that is. For type 2 patients with a Body Mass Index over 35 dg/m² (which works out to more than 245 pounds for a 5'10" man or more than 205 pounds for a 5'4" woman), whose diabetes or associated conditions are difficult to control, providers are told to "consider" the procedure as a treatment option.
The full game plan
Of course the standards also lay out what labs our healthcare providers should run, how often to run them, and what else to look out for to keep us healthy and happy. They also detail the nitty-gritty of lipid targets, heart care, eye care, foot care, kidney care, hearing, sleep apnea, fatty liver disease, periodontal disease, depression, and more.
Not simple, by any means, but hopefully simplified.
Wil Dubois is the author of four multi-award-winning books about diabetes. He is a PWD type 1, and is the diabetes coordinator for a rural non-profit clinic. Visit his blog, LifeAfterDX.
NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.
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