Maintenance of diabetes is an ongoing process that requires regular testing. It is very important that patients with Diabetes keep a close eye on not only their blood sugar levels, but other conditions that also impact overall health such as blood pressure and cholesterol. Ideal Lab Values for Diabetes These blood work goals represent the lab values that should be maintained in order to reduce risk of complications in the diabetic patient. A1c  should be at <7.0 or lower Before meal glucose level should be between  70-130 mg/dL After meal glucose  levels should be less than 180 mg/dL Blood pressure should be below <130/80 Cholesterol LDL: less than <100 in those without heart disease  and less than <70 in those with cardiovascular disease HDL: greater than >40 in males  and greater than >50 in females TG:  should be below <150

Health Maintenance Schedule For Diabetes The maintenance schedules are used to ensure treatment goals are maintained. Schedules for checking lab values are individualized and the discretion of your provider, but guidelines suggest At least once a year test the following Kidney function tests (GFR, albumin in urine) Eye exam with ophthalmologist Foot exam with podiatrist Influenza vaccine Cholesterol if stable, more frequently if not at target or after starting a new medication and/or implementing lifestyle changes Every 3-6 Months Check A1c 2x year in controlled and 4x year in uncontrolled or after change in medication regimen Have a dental cleaning Every Doctor’s Visit Weight Blood pressure Foot exam

Healthy food choices are a critical component of diabetes care. Choosing the correct foods and avoiding others will help patients keep their blood sugar in check and reduce the side effects that occur with wide fluctuations in blood sugar. Diet is also important for keeping other factors such as weight, cholesterol, and blood pressure within healthy ranges. Diabetic Diet Recommendations Snack between meals (every 3-4 hours) to avoid overeating at meal time Increase fiber intake, which improves blood sugar control and helps lower cholesterol Use plate method 1/2 plate vegetables 1/4 plate bread, pasta, rice, potato 1/4 plate meat, poultry, fish Foods for Diabetes Lean meats Fish Vegetables Beans Whole grains Non-fat dairy Fruits (in moderation due to high sugar content) Nuts (in moderation due to high fat content) Foods to Avoid with Diabetes High in sugar (high glycemic load) Simple carbohydrates (high glycemic index) High saturated fat foods Highly processed foods

What should I do on days I’m sick? Many people think they should stop taking their insulin on days they are sick and not eating as much. DO NOT stop taking insulin; increased dosing is often required because the body is stressed. Steps to take when sick Monitor blood sugar every 2-4 hrs Do not exercise Increase fluids Check urine for ketones if blood sugar >240 Notify clinican if moderate or large ketones Make appointment with doctor What is proper foot care for diabetic patients? Foot care is extremely important for diabetic patients because improper care can lead to foot ulcers, infection, and even amputation.  Many patients with diabetes have decreased sensation in the feet, therefore they may not notice if they have a cut on their foot, which increases risk for infection. In addition patients with diabetes are at risk for slow wound healing. Guidelines suggest you should check feet at least once daily always wear socks and well fitting shoes avoid walking barefoot when soaking feet, check temperature first lotion to prevent dryness and cracking, but not between toes cut toenails straight across, file edges notify health care provider immediately if any foot problems occur Why am I waking up with high blood sugar?

Type 1 Diabetes is much less common than type 2, accounting for only 5-10% of diabetes cases. Unlike type 2 which is more common in older adults, type 1 is typically diagnosed before the age of 30. What is Type 1 Diabetes? Diabetes type 1 is an autoimmune disease in which the beta cells (insulin producing cells) located in the pancreas are destroyed over a period of time. The more beta cells are destroyed the less insulin that can be made. This results in a lifelong deficiency of insulin and dependency on insulin from external sources. Autoimmune refers to a condition in which the body mistakes its own cells (the beta cells) for invader cells and destroys them. While the exact cause is unknown, the autoimmune process is thought to be the result of genetic predisposition and an environmental trigger. This event sets off a chain reaction that causes the B cells of the immune system to creates proteins called antibodies that mark the beta cells and signal for their destruction by other parts of the immune response team. The CD4 and CD8T Cells are the soldiers who sniff out and destroy the tagged beta cells Progression of Type 1 Diabetes Before overt diabetes occurs the patient will be in a phase called pre-diabetes.