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Control Your Diabetes

Diabetes Health Information

Blood Glucose Averages

Daily To-Do List: Check My Blood Glucose!

Every person with diabetes (Type 1 or 2) needs to check their blood glucose numbers daily, and to do a quarterly A1C test, which measures blood glucose levels over the past three months. This provides an accurate picture of how well you are controlling your blood glucose levels. This test can be done in a lab setting or at home. Before doing the A1C test at home, check with your doctor.

In-home monitoring: The blood glucose you do each day is the Self Monitoring of Blood Glucose (SMBG). A drop of blood and a meter measures the level of glucose in your blood at the time of testing. Check with your pharmacy, diabetes educator, durable medical equipment provider, or your physician about a meter suited to your type of diabetes and lifestyle. Newer meters allow testing from the upper arm, forearm, base of the thumb, and thigh. However, other testing sites may yield levels different from the traditional test site.

The American Diabetes Association (ADA) suggests the following blood glucose levels for adults with diabetes:

  • Before meals: 80-120 mg/dL
  • Before bedtime snack: 100-150 mg/dL, and two hours after eating, 140 or less

The average blood glucose level over three months is shown in the table below. The higher that HbA1c average reading is, the less well your blood glucose is being controlled.

Control Level A1C Number


6 or less


Less than 6.5

Take Action

7 or more

In most cases, a fasting blood glucose level of more than 180mg/dL is too high, and less than 70 mg/dL is too low. If you have more than one unexplained blood glucose level of less than 70 mg/dL in one week, or a blood glucose level greater than 180 mg/dl in one week, contact your physician.

Remember:  Keeping your blood sugar glucose under control can reduce your risk of long-term complications with circulation, your nervous system, kidneys, and eyes.

Source: ADA and National Diabetes Education Task Force

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Diabetes - Preparing for Emergencies

Emergencies: Are You Prepared?

Should a natural or man-made disaster occur, a diabetic needs to have an emergency supply kit ready to grab and go. Immediate disaster response is uncertain. A stockpile of diabetic supplies and other medications for 7-10 days is prudent. You may need to talk to your physician and obtain a special prescription for this emergency supply.

An emergency supply kit, depending on how you manage your diabetes, might include:

  • Oral medications
  • Insulin and insulin delivery supplies
  • Lancets
  • Extra meter batteries
  • Quick acting, but non-perishable supplies of glucose
  • Emergency contacts and telephone numbers, including physician, health provider, and health history information
  • If your child has diabetes, identify in advance which school staff members will assist your child in an emergency
  • Wear a medical alert bracelet that identifies your diabetic condition
  • Other medications taken for other conditions.

McLaren Health Management Group is pleased to offer diabetics with America's most trusted medical alert service - Lifeline.

Source: ADA

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Diabetes and Nutritional Counseling

The Diabetes and Nutritional Counseling Center provides personalized nutrition counseling by a registered dietitian for conditions other than diabetes. Those conditions may include, but are not limited to:

  • Weight management – adults and children
  • Celiac disease
  • Chronic kidney disease
  • Heart disease
  • Liver disease

The registered dietitian will help patients identify practical and achievable ways of meeting their nutritional goals.

A referral for nutritional counseling services is required from the medical provider.

There is a fee for these services, however Medical Nutrition Therapy (MNT) is a covered benefit on many health insurance plans. Please check your insurance coverage prior to your initial assessment. (Billing codes CPT 97802 for initial visit and CPT 97803 for returns).

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Diabetes Terminology

Blood glucose: Main sugar the body makes from food that is eaten. Blood glucose is also called blood sugar. Glucose is carried through the bloodstream to provide energy to cells. Cells cannot use glucose without the hormone, insulin.

Diabetes mellitus: A condition where the body is unable to use blood glucose for energy. In Type 1 diabetes, the pancreas no longer makes insulin and blood glucose cannot enter cells. In Type 2 diabetes, the pancreas does not make enough insulin, or the body is not able to use the insulin efficiently.

Diabetic Ketoacidosis: A life-threatening condition in those with Type 1 diabetes that requires immediate treatment. It shows up with extremely high blood glucose levels and ketones in the urine and bloodstream. If not treated, this condition can lead to coma and death. Symptoms: nausea and vomiting, stomach pain, fruity breath odor, rapid breathing.

Dilated eye exam: An eye exam that tests the pupil of the eye. Eye drops dilate the pupil, so the ophthalmologist can see inside the eye. This exam is important for people with diabetes for early detection of eye problems resulting from diabetes.

Dialysis: An artificial process for cleansing wastes from the blood.

Gestational diabetes: Diabetes that develops only during pregnancy and usually disappears after the baby’s birth. The diabetes must be managed while the mother is carrying the baby – through diet, exercise and medications. The mother remains at risk for diabetes later in life.

Hemoglobin A1C: A test showing how much blood glucose is sticking to red blood cells over a period of 3-4 months. Since red blood cells regenerate every four months, doctors can see how glucose has affected cell life during that time period.

Hypoglycemia: Low blood glucose. Symptoms: Feeling nervous or anxious, feeling numb in arms and hands, shakiness, and dizziness.

Hyperglycemia: High blood glucose. Symptoms: frequent urination, unusual thirst, weight loss.

Impaired Glucose Tolerance: Condition where blood glucose levels are higher than normal, but not high enough for a diagnosis of diabetes. The condition is also called pre-diabetes.

Insulin: Hormone that helps the body use blood glucose for energy. Beta cells of the pancreas make insulin.

Insulin Resistance: A condition that occurs when the body cannot use the insulin it makes effectively and blood glucose levels rise.

Ketones: Chemical substances the body produces when it does not have enough insulin in the blood.

Pancreas: An organ that makes insulin and enzymes for digestion.

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Two tests can determine whether a person is pre-diabetic:

  • The Fasting Plasma Glucose (FPG) Test (100-125 mg/dL of glucose in the bloodstream)
  • Oral Glucose Tolerance (OGTT) Test (140-199 mg/dL of glucose in the bloodstream)

If your fasting blood glucose level is within the above ranges, your glucose tolerance is impaired. Make an appointment with your primary care physician to discuss strategies to reduce your blood glucose levels.

Diabetes occurs in individuals of all ages and races, but African-Americans, Latinos, Native Americans and Asian Americans/Pacific Islanders are at higher risk for developing diabetes.

Source: ADA

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What is Diabetes

Those with this metabolic disorder must manage high blood sugar (glucose) levels in their blood. Diabetes appears in those whose body is unable to produce or use insulin efficiently. Insulin is a hormone produced by the pancreas, which converts glucose into a form that the body's cells can use for energy and growth. Diabetes has no cure, so blood sugar levels must be taken several times a day, so dietary and medication adjustments can be made.

For some individuals, diabetes can be managed by changes in diet and regular aerobic exercise. Most often, diabetics must also take some type of oral medication or insulin to regulate blood sugar levels. Diabetes, if not managed properly, can contribute to heart disease or stroke, circulatory or nervous system dysfunction, and problems with eyesight and kidney function.

Type 1, Type 2, Gestational Diabetes

Type 1 Diabetes

Five-10% of diabetics have Type 1 diabetes, an autoimmune disease, where the body's immune system destroys insulin-producing cells in the pancreas. Type 1 diabetes is often associated with children and young adults, but can occur at any age. Type 1 diabetics must take insulin to manage their blood sugar levels.

In most cases, individuals need to inherit diabetic genes (HLA-DR3 or HLA-DR4) from both parents. Caucasians have the highest rate of Type 1 diabetes. Type 1 diabetes is most often found in colder climates, more common in those who were not breastfed and who first ate solid foods at later ages.

Type 2 Diabetes

Ninety percent of the approximately 18 million diabetics in the U.S. have Type 2 diabetes. In most cases, Type 2 diabetics produce enough insulin, but are unable to use it efficiently. One of the most significant risk factors for diabetes is obesity -- eating too dietary fat, and too little carbohydrates and fiber. Lack of daily exercise is a strong contributing factor to the onset of diabetes. If both parents have Type 2 diabetes, your children's risk of getting diabetes is 1 in 2.

Gestational Diabetes

This occurs in about 4% of pregnant women, and usually goes away after childbirth. It's not known what causes gestational diabetes, but hormones from the placenta may cause insulin resistance. This makes it hard for the mother's body to use insulin produced by the pancreas.

Gestational diabetes can affect the mother's and baby's health. Gestational diabetes can lead to a larger baby, making for a difficult delivery. The baby may weigh more than is normal, and may have a low blood sugar level or jaundice. Generally, gestational diabetes begins in the 5th or 6th month of pregnancy.

The obstetrician will frequently check blood sugar levels, and encourage a change in diet, more daily exercise, and in some cases, medication. A birth mother with gestational diabetes is at higher risk for diabetes in any future pregnancy and later in life.

Source: ADA

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When Diabetes Shuts Down the Body's Kidney Function

Fatigue. Nausea. Lack of appetite. Those are the most common symptoms kidney specialist Carlos Marchena, M.D. , notices in patients with diabetes, whose kidney function has declined to the point that they would need dialysis.

"Not everyone with diabetes develops kidney disease," says Dr. Marchena, "and even then, it's a slow-build up over many years. In fact, in the first years, those with diabetes that develop kidney involvement, have a higher filtering function. That function subsequently declines to levels that alter their well-being. They develop progressive weakness, tiredness, poor appetite, and anemia. Eventually, their kidney disease is a life-threatening situation. At that stage, the patient needs dialysis to prolong life.

  • There are different types of diabetes. Type 1, comprises 10% of all patients with diabetes, and results from the destruction of pancreatic cells that produce insulin.

  • The other, Type 2, which comprises 80 % of all patients with diabetes, results from variable degrees of insulin resistance. African Americans, Native Americans and Hispanics are more prone to develop end stage kidney failure than non-Hispanic Caucasians.

  • About 10% of patients acquire diabetes during pregancy (gestational diabetes). With strict blood sugar control, diabetes goes away once the mother gives birth. Even so, women who have had diabetes while pregnant can be prone to Type 2 diabetes later in life.

  • Spilling albumin in urine (microalbuminuria) is the first evidence of kidney damage, due to diabetes (diabetic nephropathy). Subsequently, the amount of proteins in the urine increase (proteinuria), and the capacity of the kidneys to excrete "waste", progressively decreases at variable speeds, over time.

  • About 27% of patients diagnosed with diabetes, with no protein in the urine, but poorly controlled blood sugar over a 61/2-7-year period, will develop protein in their urine. However, only 16 % of that number will develop protein in their urine, if their blood sugar was well controlled. Multiple studies have proven that good control of blood sugar prevents or delays the onset of diabetic nephropathy. .If patients with small amounts of albumin in urine (microalbuminuria) are treated with a strict regimen to control blood sugar, the amount of the protein will remain relatively stable, or it may decrease over time. If the blood sugar is not controlled strictly, the amount of the protein in the urine will increase progressively in 6.5 % of patients per year. So, in patients with early diabetic nephropathy, strict control of blood sugar improves or delays progression to renal failure. Once the patient has developed massive proteinuria, strict control of blood sugar may not influence significantly the progression of renal failure. At this stage, good control of blood pressure, and the use of ACE drugs (angiotensive- converting enzyme inhibitors) and/or ARB's (angiotensive receptor blockers), plus a low protein diet, may play a more important role in slowing the progression of the renal disease, than strict control of blood sugar.

  • Strict control of blood sugar, good control of blood pressure and cholesterol, and weight reduction, if indicated, may prevent or slow the progression of microvascular damage to the kidneys, retina and nerves.

  • In general terms, about 30 to 40 % of patients with diabetes will develop some evidence of kidney damage, which may progress to end stage chronic renal failure requiring dialysis. In the U.S., about 40 % of all patients on dialysis are diabetic.

Once the patient has developed renal failure, and the renal function is below 30 %, they may start experiencing weakness, tiredness, poor appetite, or anemia. When the renal function declines to about 15 %, they need dialysis to improve the feeling of well-being, and to prolong life.

Dr. Marchena says: "We really encourage everyone, in particular those who have diabetes in their families, to see their doctor regularly and get a test of their blood glucose sugar levels and their renal function. The earlier we catch diabetes, the better able we are to manage or prevent complications. If a person has diabetes, he/she must cooperate closely with their family physician, or diabetic specialist to manage their diabetic treatment."

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