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Diabetes

Joy K. Richardson, RD, CDE, has been a Registered Dietitian for over 35 years and a Certified Diabetes Educator more than 20 years. She has worked in clinics and outpatient education programs as well as private practice. Joy’s career path was inspired by family members battling the disease, starting with her grandmother who lived with it for over forty years until she was in her late 80s. Look for Joy’s diabetes forum launching soon on parentgiving.com.
Q:

I have type 2 diabetes with severe neuropathy of the feet. My last A1c was 6.2, down from 6.8 three months ago. My new concern is the elevated levels of creatinine serum, which is high at 1.59—three months ago it was 1.49. Is my diabetes affecting my kidney functions? What, if any, treatments are there? Thank you. 


Jack from NC
A:

Yes, diabetes affects our kidneys as well. There are also other reasons kidneys may be affected, but diabetes for many years is right at the top. I would encourage you to seek out a nephrologist (a doctor who specializes in kidney problems). There are some medications that may be prescribed and in some cases a lower protein diet is recommended. In either case, a specialist is the one to make a diagnosis of exactly what the kidney issue is related to and how best to approach medications and/or diet. Wishing you the best.  

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Q: My parent is not able to manage insulin testing. How can I help?
A:

Caregivers should be taught by a diabetes educator how to test. No, it is not rocket science, but technique is very important. All of the meters on the market are pretty good. All require a finger stick even though some of the ads imply that they do not (quite a disservice to the diabetes public). Meters should be replaced every one to three years. Using a meter older than two or three years may mean inaccurate readings, even if the technique is done well. Strips can become outdated or ruined by exposure to heat or humidity, so take care to check them. Folks on insulin often need to test before meals and sometimes afterwards to make sure the dose is correct. It is not unusual for people on insulin to test 6 to 8 times a day—it all depends on the individual.

Blood sugar testing is vital for non-insulin taking patients, too. They need to properly do blood sugar testing within 15 to 30 minutes of waking up. Normal Fasting Blood Sugars (FBS) should be below 100, in some cases perhaps up to 120 depending on one’s doctor. There is some thought that as we age the range of normal should go up. I don’t think there is a fast rule, but most doctors would likely say an 80 year old with an FBS of 121 is just fine. There is more of an issue of blood sugars being too low causing more problems. Other testing times would be two hours after meals—normal would be less than 140 (in some cases, less than 160). There are two or three major medical associations that all have different opinions on the levels of blood sugar—it does not make it easy for the consumer! For folks in fairly good control, probably testing FBS and 2 hours after a meal twice a week is enough! If folks are struggling with highs and/or lows, testing 2 hours after each meal will start to solve the problem as we can see what foods or meals are causing the problem (or the need for more or different meds). For folks in good control I often suggest this pattern for one to two weeks: FBS daily PLUS two hours after breakfast on Day One; two hours after lunch on Day Two, and two hours after dinner on Day Three, then repeat the pattern. That way a person is only testing twice a day, but you can glean a clearer picture as to any possible trouble spots.

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Q: Why is my father ignoring his diabetes diagnosis?
A:

Very often, when a person is initially told that they have diabetes, there are two things that happen: (1) the patient ignores the whole idea, and that leads to (2) “denial.” There are some legitimate reasons for this. In most cases, when a doctor tells a patient that he has diabetes, the patient is surprised or shocked to hear the news as he may have no symptoms and feel perfectly fine. The biggest issue with finding out a person has type 2 diabetes is that there may not be any obvious symptoms. Patients do not feel “sick.” There is no pain involved—other than our normal creaky arthritic bones. There is no fever or nausea, vomiting or diarrhea, no obvious wounds or infections. I often will have patients tell me that their doctor tells them that they have diabetes, but they (the patients) do not believe it. This leads right to denial, which can last from a few weeks to a year or two. Meantime, there are, shall we say, “things” unattended to going on. Some new medication may be ordered, but never picked up or rarely taken, food habits do not change and the patient may go to the doctor less often as he does not want to hear what the doctor has to say.

Type 2 diabetes creeps up on us and things continue to happen inside our bodies that we are unaware of…until symptoms may become evident. It is not too late to do something about it at that point, however, precious time has been wasted and some damage has been done. Getting your parent educated about diabetes is one of the best things you can do for your entire family. Throughout the country, there are many centers and individual practitioners who can give you updated and correct information about how to manage diabetes. Diabetes can be controlled and the term we use is “self-management,” which involves getting your parent to a program led by diabetes educators. The world of diabetes is ever changing with new medications, updated research and so on. Connecting with a diabetes educator is your parent’s best bet to keep updated. While not a requirement to be a good diabetes educator, there is a national organization of diabetes educators and the standards are pretty high to be a member. Doctors, nurses, pharmacists, podiatrists, dietitians and social workers are the primary professionals who become Certified Diabetes Educators. Another source of information is the American Diabetes Association; it has been around for many decades and supports not only people with diabetes, but also the professionals involved in education and medical care as well. The American Diabetes Association, as well as some other diabetes related companies, often offer wonderful publications you can subscribe to in order to stay updated. The internet is often a good source of information as well, but be cautious as to the credentials of the authors of the articles and statements. Old and inappropriate information abounds.

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