Other Things You Need to Do For You and Your Diabetes
By Wil Dubois
A super-quick review for those of you who snuck into this article from the back door: we dFolk are bombarded with numbers, goals, and targets. We're frequently told where we should be, but not how high our risk is when we can't reach our targets. In this series of discussions we look at all of our important numbers and break them down into a simple green light, yellow light, red light format to put all of your critical numbers into a useful context. To give you perspective on when and how much to worry. When to relax, when to call your doc, and when to call 911.
This discussion deals with the things you need to do for your diabetes once per year. The so-called "ones." These things are so simple there's no yellow light. If you've done them you have a green light. If you haven't done them you have a red light, and must get them done now!
So. Elevated blood sugar will tear up your smallest of blood vessels, called capillaries. Why am I telling you this? Because your eyes function using capillaries. Every year, without fail, you need to get a dilated retinal exam. Yep. That's the one where they drop stinging drops into your eyes, the world is blurry for hours, and you have to leave the doctor's office wearing dorky disposable sunglasses. Type 2s need this exam every year, starting with diagnosis. Type 1s can wait for five years before their first exam, but then need it every year as well. Getting this screening done is critical, because if trouble starts, there are things that can be done to save your sight. But not if you wait until you're blind.
Those same capillaries are involved in feeding the nerves in your feet. Lots of people with diabetes are at risk of losing sensation in their feet. If this happens, you can injure yourself and not know it. That's where most diabetic amputations come from. Forewarned is forearmed. You should have a complete foot exam once per year as part of your routine care. They'll carefully inspect your feet, check your pulses, and either use a tuning fork or monofilament (medical grade fishing line), see how well you fell minor sensations.
Also, once per year you need to pee in a cup. They aren't testing you for bad habits. They're checking for a very small protein molecule called "microalbumin," which is to kidney trouble what canaries are to coal mines. If the kidneys are beginning to suffer damage from either high blood pressure or high blood sugar, they become Swiss cheese — full of holes. The tiny little microalbumin molecules are the first things that leak out of the kidneys, alerting you to damage. Detecting them early is a warning sign that there's trouble on the horizon that needs to be aggressively addressed.
The winning numbers in the microalbumin lottery are less than 30 mg of albumin per gram of creatine.
And last on our list is to go see the dentist. Or his hygienist. Twice per year. dFolk are at a much, much higher risk of gum disease than other people, and minor, low-grade dental problems can wreak havoc on your blood sugar control. A twice-per-year dental cleaning has been shown to be as effective at lowering your blood sugar as a diabetes medication.
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My diabetes is changing. Until a few years ago, my morning readings were reasonable and within the desired range of under 100 mg/dl. About two years ago, they started slipping upwards into the less-desirable but apparently not-worrisome range of 100-110 mg/dl. Now, this was what was recorded by my Abbott Freestyle Lite meter, which is known to record at the lower end of the home-glucometer variability range, but with my A1c firmly in the high 5s and low 6s, the meter's tendency to...