Start taking the LEAD by asking the right questions

By initiating a better dialogue about your health and treatment with your doctor, you increase your awareness of your own unique needs and educate yourself about available options for blood sugar control. Start by reading about diabetes and talking to your doctor. Then, ask your doctor questions like:

• What is a normal blood sugar level?
  Normal blood sugar levels should be between 80 and 110 mg/dl before meals and between 100 and 140 mg/dl at bedtime. Your bi-yearly hemoglobin A1c tests (a lab test that measures your blood sugar over a three month period) should be below 7 percent.
  
• How can I get my blood sugar in the normal range?
  To keep blood sugar as close to normal as possible, you must achieve a balance between your diet, exercise and treatment program (either insulin injections, an insulin pump or pills). This requires intensive control, starting with self-testing your blood sugar (via a glucose monitoring system) multiple times each day. You should also adjust your food intake and physical activity as they relate to your blood sugar levels. If you require insulin, your treatment program should include multiple daily injections.
  
• How often and under what conditions should I test my blood sugar to get the best results?
  At a minimum, self-testing should be done before meals, at bedtime and when you wake in the morning. You should also get a hemoglobin A1c test done through your doctor at least twice each year.
  
• What changes should I make in my program to reduce my chances of complications?
  The Diabetes Control and Complications Trial proved that you can delay the onset or slow the progression of complications through intensive control, which includes more frequent blood sugar tests, insulin injections (using shots or an insulin pump) and careful monitoring of your diet and exercise. If you do not require insulin, it's important you take your medication exactly as directed while more closely monitoring the food you eat and making exercise a priority.
  
• How could I find out if I have kidney disease or other complications?
  A thorough physical examination with lab tests can detect complications. This includes the following types of diagnostic tools: blood pressure, opthalmoscopy (a look at the interior vessels of your eyes) cholesterol screening, urinalysis, blood test and a cardiovascular examination (i.e., electrocardiography, stress test).
  
• What long-term effects does diabetes have on my eyes, kidneys and nerves? 
  High blood-sugar levels over time destroy cells. In your eyes, that means your vision can become blurred or lost through conditions such as glaucoma, cataracts and retinopathy. In your kidneys, the damage causes blood vessels to lose their ability to filter waste products from your blood. And finally, in the case of your nerves, the effects include muscle weakness, loss of sensation (i.e., an inability to detect pain, heat, cold, etc.) and loss of functions normally under unconscious control (i.e. digestion).
  
• When should I get together with a dietitian to review what I eat?
  As soon as you are diagnosed with diabetes, you should begin paying more attention to your diet. A dietician can help you get started on a meal plan appropriate for better control. You should also see a dietician if you have been unable to achieve near-normal blood sugar levels. He or she can then make adjustments in your diet to work within a more intensive treatment program.
  
• What exercises are best for me? What adjustments to my food or insulin should I make if I plan to exercise?
  People living with diabetes can engage in pretty much any exercise program as long as they understand the close relationship between food, insulin and their body's use of sugar as fuel during exercise. To determine what adjustments you need to make, start by closely monitoring your blood sugar before, after and even during exercise. Once you know how your body responds to physical activity, you can increase or decrease your insulin and food intake. Typically, exercise causes blood sugar to drop. Therefore, you would not want to administer too much insulin before exercise, yet you would want to eat before so that you have an adequate supply of fuel. Sometimes it's also necessary to eat or drink something during exercise to combat low blood sugar levels.
  
• What should my family and friends do if my blood sugar goes so low that I need their help?
  Your friends and family can give you food or drink that contains high levels of sugar to help you. Orange juice or hard candy is a good choice. You can also purchase glucose tablets at a drug store for this purpose. You might want to teach your friends and family how to administer "glucagon" as well. This injected substance, available through your doctor, can be used in case of emergency if you pass out during an episode of low blood sugar.
  
• What should I do about taking care of my diabetes if I plan to become pregnant?
  Pregnancy can cause a lot of stress on a woman's body, thereby requiring more intensive therapy. Working with your doctor, you can outline a program that involves more frequent blood sugar testing and insulin injections while adjusting your food intake to meet the needs of you and your baby. Many doctors recommend insulin pump therapy during pregnancy, which allows more flexibility in eating and sleeping -- two of the most important aspects of a healthy pregnancy.
  
• How should I take care of my feet?
  Besides making regular visits to a podiatrist, you can ensure the health of your feet through careful self-examination every day, watching for changes in the skin or loss of sensation due to nerve damage. It's also recommended you wear shoes that fit properly, apply moisturizers and exercise to promote good circulation.
  
• Are there any diabetes groups that I could attend in my area?
  The American Diabetes Association and Juvenile Diabetes Research Foundation have local chapters you can attend. You can also check with your community hospital to see if they have a program for people living with diabetes.