Dr Randal’s Corner

Diabetes is a worldwide health problem of enormous importance. It is associated with horrible health complications such as heart attack, stroke, loss of vision, limbs, kidney function, and painful loss of nerve function. High blood pressure, abnormalities of cholesterol ( and other fats in the blood), obesity, and other health problems are associated with the loss of blood sugar control that establishes the diagnosis of diabetes, and are important in the mechanism of damage resulting in the complications.

Because of the enormous cost of complications, both in quality of life and financially, all aspects of diabetes and the many associated conditions are controversial, with competition for resources to study, diagnose, prevent and treat these conditions. Finding information is not difficult, indeed there is an overload of information and trying to find information that is not tied to some kind of promotion on television, print media, and on the internet is very difficult. Education (counselling) , diet, paid exercise, and paid monitoring and medications represent enormous costs for both individuals and for society.

A respected source of information comes from the Joslin Diabetes Center, and for this introductory article, simple diagnostic criteria and treatment goals are quoted from their Guidelines published in 2017. A single blood sugar of over 200 mg/dl with symptoms of excessive urine production, abnormal thirst, or unexplained weight loss, OR a fasting blood sugar over 126 mg./dl, OR a blood sugar 2 hours after an overnight fast followed by a glucose load of 75 gm. OR a Glycated Hemoglobin ( HbA1C) of greater than 6.5% are all DIAGNOSTIC for diabetes. The good news is that over the counter testing is available for each of these, but any abnormality should be followed by a proper diagnostic evaluation to exclude conditions that require more than just treatment for diabetes.

Most diabetes is type 2, and should include lifestyle alteration as the most important long term treatment. Otherwise uncomplicated diabetes starts with a treatment goal of a glycated hemoglobin of less than 7%, ( target of the Am. Diabetes Assn.) but other experts suggest less than 6.5%. For treatment that is exclusively lifestyle management , normal levels are considered 6.0 %. The Mayflower Clinic will be offering a monthly support and education group experinece to discuss diabetes, and any interested person is welcome.