Management Key

Management is Key to Living Well with Diabetes

Although diabetes is a chronic and potentially life-threatening condition, it can be effectively controlled and managed once it has been accurately diagnosed. The goal of diabetes management, according to the American Association of Clinical Endocrinologists, is to prevent short-term and long-term complications of diabetes from developing.

Without proper management, individuals with either type 1 or type 2 diabetes can develop serious or deadly complications from high glucose levels including blindness, kidney disease and nerve damage, as well as vascular disease that can lead to amputations, heart disease and strokes. Uncontrolled diabetes can complicate pregnancy; birth defects also are more common in babies born to women with uncontrolled diabetes.

For women with type 1 diabetes, controlling blood sugar levels means three to four (and sometimes more) shots of insulin a day, adjusting insulin doses to food and exercise, testing blood glucose up to eight times a day depending on their health care provider's recommendations and adhering to a planned diet.

Type 2 diabetes may be controlled initially by a planned diet, exercise and daily monitoring of glucose levels. Frequently, oral drugs that lower blood glucose levels or insulin injections need to be added to this regimen.

Treating diabetes comprehensively—that is, managing not only blood glucose, but also blood pressure and cholesterol—is crucial to helping prevent heart attacks and stroke. The good news is that women with diabetes who maintain lower blood glucose, blood pressure and cholesterol levels can lower their risk of cardiovascular disease. To reduce your risk, follow the "ABC" approach recommended by the National Diabetes Education Program, National Institute of Health and the American Diabetes Association. The ABCs are easy to remember:

• A stands for the A1C, or hemoglobin A1C test, which measures average blood glucose over the previous two to three months
• B is for blood pressure
• C is for cholesterol

Diabetes treatment guidelines issued by the American College of Physicians (ACP) and published in the April 2003 issue of the Annals of Internal Medicine emphasize the importance of aggressive blood pressure control in lowering the risk for heart disease, stroke and early death in type 2 diabetes patients. Until these guidelines were released, most of the focus in diabetes care has been on tightly controlling blood sugar, but new evidence suggests that both blood sugar and blood pressure are very important in managing the disease.

The ACP recommends that patients with diabetes and high blood pressure strive for blood pressure levels of less than 130/80 mm/Hg, and that both thiazide diuretics and angiotensin-converting enzyme (ACE) inhibitors be used as first-line agents to control blood pressure in most patients with diabetes.