Welcome to America Diabetes Advocates

Understanding Your A1c
Heart and Stroke
Kidney
Foot
Eye
Skin
Depression
Oral and Hygiene

Understanding Your A1c

Because your sugar level can change from hour to hour, we required you to test your blood four time per day (daily A1c). A test that sums up how much glucose has been sticking to part of the hemoglobin during the past 3–4 months. Hemoglobin is a substance in the red blood cells that supplies oxygen to the cells of the body.

A1c Levels	Glucose Range
Normal
4.0	65 mg/dL
4.2	72 mg/dL
4.4	79 mg/dL
4.6	86 mg/dL
Good
4.7	90 mg/dL
4.9	97 mg/dL
5.0	101 mg/dL
5.1	104 mg/dL
5.2	108 mg/dL
** High
5.3	111 mg/dL
5.6	122 mg/dL
5.8	129 mg/dL
5.9	133 mg/dL
*** Diabetes
6.0	136 mg/dL
6.2	143 mg/dL
6.4	151 mg/dL
6.6	158 mg/dL
6.8	165 mg/dL
6.9	168 mg/dL
Deathly
7.0	172 mg/dL
7.2	180 mg/dL
7.4	186 mg/dL
7.6	193 mg/dL
7.8	200 mg/dL
8.0	207 mg/dL
8.2	215 mg/dL
8.4	222 mg/dL
8.6	229 mg/dL
8.8	236 mg/dL
9.0	243 mg/dL
10.00	279 mg/dL
A1c test and calculator

The table to convert Hb-A1c to Mean Plasma Glucose (MPG) is based on the following formulas:

HbA1c = (Mean Plasma Glucose (mg/dl) + 75) / 35
HbA1c = (Mean Plasma Glucose (mmol/l) + 4.5) / 2
Mean Plasma Glucose (mg/dl) = (HbA1c x 35) - 75
Mean Plasma Glucose( mmol/dl) = (HbA1c x 2) - 4.5

(To convert from (mg/dl )to (mmol/l), divide (mg/dl) by 18... or multiply (mmol/l) by 18 to get mg/dl)

Note:
** complications such as eye, heart, kidney disease, Diabetic Neuropathy / Foot Complications, Oral, Health / Hygiene and more.
*** complications such as eye, heart, kidney disease, Diabetic Neuropathy / Foot Complications, Oral, Health / Hygiene and more.

Heart Disease and Stroke <Click Here for more information>
People with diabetes have extra reason to be mindful of heart and blood vessel disease. Diabetes carries an increased risk for heart attack, stroke, and complications related to poor circulation:

Irregular heartbeats
Dizzy spells
Chest pains
Slow healing of cuts and sores
Numbness or weakness in an arm or leg
Leg cramps
Swollen ankles
Shortness of breath

Note: These symptoms may also be caused by some medical condition besides blood vessel damage.

Things you need to know

Smoking and blood fat level can cause blood vessels to narrow, which makes it difficult for the blood to flow throughout the body. Both can increase the chance of a heart attack. Diabetes can also damage the blood vessels that supply blood to all parts of the body, increasing the risk of heart attack.
What can you do? Test your blood every 3 to 4 months.

Total Cholesterol
LDL (bad) Cholesterol
HDL (good) Cholesterol
Triglycerides
EKG
Blood Pressure (Every Week)

Kidney Disease <Click Here for more information>
Diabetes can damage the kidneys, which not only can cause them to fail, but can also ability to filter out waste products.

Complications

Dialysis and Transplantation

Symptoms

There are none. Kidney disease can be detected through a regular visit to your doctor and testing your blood and urine.
High Blood Pressure

Things you need to know

Diabetics are 19 times more likely than those without diabetes to develop problems with the kidney.
Chronic Kidney Disease is called Nephropathy

To prevent keep your blood sugar levels close to normal range.

Before meal < 100 (mg/dL)
2 hours after meal < 140 (mg/dL)

Neuropathy / Foot Complications <Click Here for more information>
The most common complications of diabetes is diabetic neuropathy. Neuropathy means damage to the nerve cells that run throughout the body, connecting the spinal cord to muscles, skin, blood vessels, and other organs.

Complications

Due to loss of feeling in your feet, you may not notice cuts and infections.
People with diabetes are far more likely (65%) to have a foot or leg amputated than other people. The problem? Many people with diabetes have artery disease, which reduces blood flow to the feet. Also, many people with diabetes have nerve disease, which reduces sensation. Together, these problems make it easy to get ulcers and infections that may lead to amputation. Most amputations are preventable with regular care and proper footwear.
Ulcers - Ulcers occur most often on the ball of the foot or on the bottom of the big toe. Ulcers on the sides of the foot are usually due to poorly fitting shoes. Remember, even though some ulcers do not hurt, every ulcer should be seen by your health care provider right away. Neglecting ulcers can result in infections, which in turn can lead to loss of a limb.

Symptoms

Tingle, burn, ache, or throb on your feet and lower legs.
Numbness in feet, hands and lower legs.
Diarrhea that will not stop.
Impotence in men.
Less able to have an orgasm or climax.
Abdominal pain.
Feet that feel cold to the touch.
Lack of hair on your feet.

Things you need to know

Check your feet daily for any changes, such as blisters, cuts, ulcers, redness and large calluses.

Foot Care

Avoid using anything hot (heating pads, hot water bottles or hot bath water) on your feet.
Trim your toenails carefully. Injuries from cutting your toenails can lead to infection, ulcers and finally amputations.
Help prevent bunions and calluses by wearing well fitting shoes.
Always check your shoes for any rough edges, sand and any object that may cause irritation.
Dry your feet with a soft towel after bathing. Wetness between your toes allow fungus to grow, which can lead to serious infection.
Inspect your feet with a mirror daily. If your feet are dry and cracked use a moisturizer cream (avoid cream between your toes).

Eye Complications <Click Here for more information>
Diabetes can cause eye problems and may lead to blindness. People with diabetes do have a higher risk of blindness than people without diabetes. Early detection and treatment of eye problems can save your sight.

Complications

Diabetes retinopathy – damage to the blood vessels in the retina (back of the eye).
Cataract – clouding of the eye lens.
Glaucoma – increase in fluid pressure inside the eye that leads to optic nerve damage and loss of vision.

Symptoms

There are none. The vision may not change until the disease becomes severe.

Things you need to know

70% of loss of vision or blindness in the United States from diabetes retinopathy.

Skin Complications
Your body loses of fluids through frequent urination. This loss of fluids (dehydration) will make your skin and body dry. In fact, such problems are sometimes the first sign that a person has diabetes. It can damage nerves that produce oil and can make your body sweat less. Your skin relies on oil and sweat to keep it moist so the loss of oil and sweat can make it dry.

Complications

Dry skin cracks easily, letting germs enter.

Easily infected: Infections spread faster.
Infections are harder to treat
Infections take longer to heal.

Symptoms

Extra dry skin
Rashes
Itchy skin
Boils
Pimples

Things you need to know

Itchy skin in the vaginal, groin or foot areas may indicate an infection.
Avoid lotions and creams that contain alcohol, additive, dyes and fragrances (perfume).

Skin Care

Use a very mild soap that will not cause irritation and remove oil from your skin.
Always use warm water, hot water can cause irritation.
Always rinse off soap cleansers completely.
Avoid rubbing, Dry well between all folds (toes, armpits, and breasts).
Drink 4 glasses (8 oz) of water (ARP required 4 glasses of water per day) to give your body more fluid.
Avoid lotions and creams that contain alcohol, additive dyes and fragrances (perfume).

Depression
Feeling down once in a while is normal. But some people feel a sadness that just won't go away. Life seems hopeless. Feeling this way most of the day for two weeks or more is a sign of serious depression. That is why you choose Hope Diabetes Center as your diabetes care provider. Because taking care of your diabetes was a 24/7 job filled with responsibility and worries, Hope Diabetes Center created a program that will make your diabetes care easy to control. We understand that your emotional adjustment to diabetes is the key to good self-care and a long healthy life.

Complications
- Stress can trigger a downward spiral on your health and high blood sugar.
- alcohol or drug abuse
- thyroid problems
- side effects from some medications
Symptoms

Loss of pleasure You no longer take interest in doing things you used to enjoy.
Change in sleep patterns You have trouble falling asleep, you wake often during the night, or you want to sleep more than usual, including during the day.
Early to rise You wake up earlier than usual and cannot to get back to sleep.
Change in appetite You eat more or less than you used to, resulting in a quick weight gain or weight loss.
Trouble concentrating You can't watch a TV program or read an article because other thoughts or feelings get in the way.
Loss of energy You feel tired all the time.
Nervousness You always feel so anxious you can't sit still.
Guilt You feel you "never do anything right" and worry that you are a burden to others.
Morning sadness You feel worse in the morning than you do the rest of the day.
Suicidal thoughts You feel you want to die or are thinking about ways to hurt yourself.

Things you need to know

Stress of being sick may cause your blood sugar level to go higher.

Oral Health and Hygiene <Click Here for more information>
There are more bacteria in your mouth right now than there are people on Earth. If those germs settle into your gums, you've got gum disease. "Not me?" you say.

Complications

Yeast infection (white spot on the tongue)
Gingivitis – first stage of gums disease, redness around the gums, swelling and pain.
Damaged blood vessels, thus increasing your chance of infection.
Plaque – yellow sticky film, which leads to tartar formation and eventual tooth and bone loss.

Symptoms

Bleeding gums – when you eat or brush teeth.
Pain when eating or drinking cold or hot.
Loose teeth, ulcers or sores.
Bad breath.
Problems with dentures fitting properly.

Things you need to know

Dental exam every six months.
Avoid high sugar food.
Stop smoking.
Make sure that your dentist knows about your diabetes.

What is insulin resistance?

Insulin resistance is a condition in which the body produces insulin but does not use it properly. Insulin, a hormone made by the pancreas, helps the body use glucose for energy. Glucose is a form of sugar that is the body’s main source of energy.

The body’s digestive system breaks food down into glucose, which then travels in the bloodstream to cells throughout the body. Glucose in the blood is called blood glucose, also known as blood sugar. As the blood glucose level rises after a meal, the pancreas releases insulin to help cells take in and use the glucose.

When people are insulin resistant, their muscle, fat, and liver cells do not respond properly to insulin. As a result, their bodies need more insulin to help glucose enter cells. The pancreas tries to keep up with this increased demand for insulin by producing more. Eventually, the pancreas fails to keep up with the body’s need for insulin. Excess glucose builds up in the bloodstream, setting the stage for diabetes. Many people with insulin resistance have high levels of both glucose and insulin circulating in their blood at the same time.

Insulin resistance increases the chance of developing type 2 diabetes and heart disease. Learning about insulin resistance is the first step toward making lifestyle changes that can help prevent diabetes and other health problems.
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What causes insulin resistance?

Scientists have identified specific genes that make people more likely to develop insulin resistance and diabetes. Excess weight and lack of physical activity also contribute to insulin resistance.

Many people with insulin resistance and high blood glucose have other conditions that increase the risk of developing type 2 diabetes and damage to the heart and blood vessels, also called cardiovascular disease. These conditions include having excess weight around the waist, high blood pressure, and abnormal levels of cholesterol and triglycerides in the blood. Having several of these problems is called metabolic syndrome or insulin resistance syndrome, formerly called syndrome X.
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Metabolic Syndrome

Metabolic syndrome is defined as the presence of any three of the following conditions:

Source: Grundy SM, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Circulation. 2005;112:2735–2752.

Similar definitions have been developed by the World Health Organization and the American Association of Clinical Endocrinologists.
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What is pre-diabetes?

Pre-diabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. This condition is sometimes called impaired fasting glucose (IFG) or impaired glucose tolerance (IGT), depending on the test used to diagnose it. The U.S. Department of Health and Human Services estimates that about one in four U.S. adults aged 20 years or older—or 57 million people—had pre-diabetes in 2007.

People with pre-diabetes are at increased risk of developing type 2 diabetes, formerly called adult-onset diabetes or noninsulin-dependent diabetes. Type 2 diabetes is sometimes defined as the form of diabetes that develops when the body does not respond properly to insulin, as opposed to type 1 diabetes, in which the pancreas makes little or no insulin.

Studies have shown that most people with pre-diabetes develop type 2 diabetes within 10 years, unless they lose 5 to 7 percent of their body weight—about 10 to 15 pounds for someone who weighs 200 pounds—by making changes in their diet and level of physical activity. People with pre-diabetes also are at increased risk of developing cardiovascular disease.
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What are the symptoms of insulin resistance and pre-diabetes?

Insulin resistance and pre-diabetes usually have no symptoms. People may have one or both conditions for several years without noticing anything. People with a severe form of insulin resistance may have dark patches of skin, usually on the back of the neck. Sometimes people have a dark ring around their neck. Other possible sites for dark patches include elbows, knees, knuckles, and armpits. This condition is called acanthosis nigricans.
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How are insulin resistance and pre-diabetes diagnosed?

Health care providers use blood tests to determine whether a person has pre-diabetes but do not usually test for insulin resistance. Insulin resistance can be assessed by measuring the level of insulin in the blood. However, the test that most accurately measures insulin resistance, called the euglycemic clamp, is too costly and complicated to be used in most doctors’ offices. The clamp is a research tool used by scientists to learn more about glucose metabolism. If tests indicate pre-diabetes or metabolic syndrome, insulin resistance most likely is present.

Diabetes and pre-diabetes can be detected with one of the following tests:

People whose test results indicate they have pre-diabetes should have their blood glucose levels checked again in 1 to 2 years.
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Risk Factors for Pre-diabetes and Type 2 Diabetes

The American Diabetes Association recommends that testing to detect pre-diabetes and type 2 diabetes be considered in adults without symptoms who are overweight or obese and have one or more additional risk factors for diabetes. In those without these risk factors, testing should begin at age 45.
Risk factors for pre-diabetes and diabetes—in addition to being overweight or obese or being age 45 or older—include the following:

If test results are normal, testing should be repeated at least every year. Health care providers may recommend more frequent testing depending on initial results and risk status.
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Can insulin resistance and pre-diabetes be reversed?

Yes. Physical activity and weight loss help the body respond better to insulin. By losing weight and being more physically active, people with insulin resistance or pre-diabetes may avoid developing type 2 diabetes.

The Diabetes Prevention Program (DPP) and other large studies have shown that people with pre-diabetes can often prevent or delay diabetes if they lose a modest amount of weight by cutting fat and calorie intake and increasing physical activity—for example, walking 30 minutes a day 5 days a week. Losing just 5 to 7 percent of body weight prevents or delays diabetes by nearly 60 percent. In the DPP, people aged 60 or older who made lifestyle changes lowered their chances of developing diabetes by 70 percent. Many participants in the lifestyle intervention group returned to normal blood glucose levels and lowered their risk for developing heart disease and other problems associated with diabetes. The DPP also showed that the diabetes drug metformin reduced the risk of developing diabetes by 31 percent.

People with insulin resistance or pre-diabetes can help their body use insulin normally by being physically active, making wise food choices, and reaching and maintaining a healthy weight. Physical activity helps muscle cells use blood glucose for energy by making the cells more sensitive to insulin.
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Body Mass Index (BMI)

BMI is a measurement of body weight relative to height. Adults aged 20 or older can use the BMI table below to find out whether they are normal weight, overweight, obese, or extremely obese. To use the table, follow these steps:

The number at the top of the column is the person’s BMI. The words above the BMI number indicate whether the person is normal weight, overweight, obese, or extremely obese. People who are overweight, obese, or extremely obese should consider talking with a doctor about ways to lose weight to reduce the risk of diabetes.

The BMI table has certain limitations. It may overestimate body fat in athletes and others who have a muscular build and underestimate body fat in older adults and others who have lost muscle. BMI for children and teens must be determined based on age and sex in addition to height and weight. Information about BMI in children and teens, including a BMI calculator, is available from the Centers for Disease Control and Prevention (CDC) at www.cdc.gov/nccdphp/dnpa/bmi. The CDC website also has a BMI calculator for adults.

Body Mass Index Table

Source: Adapted from Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults: The Evidence Report, National Institutes of Health, 1998.
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Can Ambulatory Reversal Program help reverse insulin resistance or pre-diabetes?

Clinical trials have shown that people at high risk for developing diabetes can be given treatments that delay or prevent onset of diabetes.
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