Ounce of prevention is worth a pound of cure

"Diabetics need to take an active role in their own health," said Michael Crim, D.O., Nevada Medical Center, at a diabetic group education meeting held Monday at the Vernon County Senior Center.

Diabetics often do not take enough ownership in their own health. Diabetes requires constant vigilance. According to the doctor, a lot of people do not follow up like they should. They are not sure what medications are being taken. Most who are disillusioned with their health care need to do something about it.

Patients need to take a more active role with their doctors, including being aware of the medications they are taking. Regular screenings are needed.

When a patient realizes that something should be done about their condition, that person should ask the doctor, "What about this?' Many are not as aggressive with diabetes as they should be. Ownership for the health program should be with the patient. Often the physician is focusing on other conditions of the patient and may overlook some factors relating to diabetes, he said.

Dr. Crim named things that diabetics need to make sure is done. An HbA1C which is a test that will show the average of the blood level for the past 2 or 3 months is needed. Many diabetics are not aware or their HbA1C and many have never had one.

This test came on the scene in recent years. He said that many people have become diabetic but do not live a diabetic lifestyle. The HbA1C has revolutionized things. For those not on insulin and keeping their sugar under control, it has cut down on the daily monitoring. He likes to have the HbA1C checked every three months -- at least every six months. The ideal level is that it needs to be less than 7.0. Dr Crim likes to have it down to 6.5, normal for those who are not diabetic is a level of 4 to 6.

If the sugar level is not controlled it causes damage to the blood veins. People die from disease and complications. This is the reason to keep, it below 7 -- ideally 6.5. There is a risk for a heart attack and stroke. Blood pressure and cholesterol should be low, with blood pressure being less than 130/80. Normal for those without diabetes is 140/90.

An effort is made to get diabetics smoking to stop. Cholesterol needs to be checked annually. If it is high, it needs to be checked every six to eight weeks. For foot care, a podiatrist should be seen regularly, every six months, ideally every three to six months. An eye exam is needed once a year. Kidneys need to be checked for protein, and be monitored closely. Spot checks for micro albumin should be monitored annually or every six months.

He suggested taking off the shoes and socks each physician visit. This will indicate to the doctor that you want your feet check. Feet need to be checked with a monofilament every six months to one year.

Dr. Crim reviewed the different classifications of medications in each classification. Some medications are expensive and costly. When going on medications it is often with trial and error. Medications will act differently with different individuals. What might work with one person, may not work with another person. Price may determine what medications are used, often determined by what the insurance will pay. Some of the newer drugs are getting good results, but generally high price. Many of the older drugs which are cheaper still get good results, but may not be as effective.

Most do not want to go on insulin; still those who are running 7 to 8 with their HbA1C are running on the edge of needing to take insulin. These persons may want to consider using insulin. At some point each diabetic will need to use insulin.

There are diabetics that go five or 10 years without being diagnosed with diabetes. Screening is needed.

Eating a diabetic diet is a challenge, the doctor told the group. He is right. It definitely is a challenge. His advice is to eat the right things and the right portions. Often the flexibleness in the blood glucose test is related to the diet. Stress will also cause high sugars. By eating inappropriately when using insulin the sugars will be converted to fat.

Patients have to have vigilance, he said. An ounce of prevention is worth a pound of cure.

Dr. Crim provided good advice to those in attendance, increasing the knowledge and understanding of what the patient needs to do toward controlling diabetes. There is much to learn and a productive education session of this type increases awareness and knowledge.

Next month the group diabetes education program will be led by Darla Engelbrecht, diabetes nurse educator on foot care tips. It will include foot screening. The session will be held at 10 a.m., Monday, March 19, at the Vernon County Senior Center. For additional information contact Darla by calling (417) 448-2016 or (417) 262-0447.