by Stewart B. Segal, MD
SERVICE MANUAL – DIABETES
Patients with diabetes require the same routine yearly preventative exams as those without diabetes. In addition, they require both daily home monitoring and quarterly office visits to maximize their care. Diabetes, unlike many other diseases, can only be controlled if the patient, his family and doctor work in tandem. While most diseases take control away from my patients, diabetes demands that the patient with diabetes takes control of his/her own diabetes.
Daily home maintenance is essential and not just restricted to blood sugar monitoring. Patients with diabetes should monitor their diets closely. There are two basic diets for controlling diabetes, the exchange diet and carbohydrate counting techniques. Patients with diabetes should study the effects of nutrition on their blood glucose levels and disease and monitor intake and output of their daily ingestion of carbohydrates/exchanges carefully. Daily foot inspection, careful attention to personal hygiene and weekly weigh-ins are all essential.
Quarterly medical checkups should include a careful review of your home blood glucose (sugar) measurements, blood pressure monitoring, an exam of heart and lungs, a monofilament test for neuropathy and laboratory testing including a hemoglobin A1C to monitor overall sugar control, urine microalbumin to check for early diabetic nephropathy ( kidney damage), chemistry panel and cholesterol levels.
Yearly, patients with diabetes should have an eye exam by an ophthalmologist to look for early signs of diabetic retinopathy (eye damage), a podiatric exam and thyroid testing. They often develop heart disease at an early stage and I believe that they should undergo a cardiac stress test at/or around the age of fifty and then every five years afterwards. Unfortunately, I do not know of any insurance company that agrees with me.
When caught early and treated aggressively with diet, exercise and medication (when needed), many people with diabetes can reverse or markedly slow the progression of this disease. As demonstrated by the patient I wrote about on Tuesday, November 9th, living a medication free lifestyle is possible. However, even when blood glucose control is achieved, you have to adhere to the maintenance routine for life. You cannot go back to ignorance and assume you are cured.