Rule Number One
Diet, exercise, and weight control should be the cornerstone of management for all diabetics. In fact, a healthful lifestyle can prevent many, if not most, cases of type 2 diabetes, and it can lower blood sugar levels and improve the outcome for all patients with the disease.
Rule Number Two
Good blood sugar control is important for all diabetics. Tight control reduces the risk of complications (kidney disease, nerve damage, and eye disease) in type 1 diabetes. It also helps protect type 1 patients from complications (heart attack, stroke, and cardiovascular death); it may have similar benefits for patients with newly diagnosed type 2 diabetes and healthy blood vessels, but is unlikely to help patients with longstanding type 2 diabetes and cardiovascular disease. Patients who can achieve near-normal blood sugar levels with lifestyle therapy and simple drug programs should do so.
Rule Number Three
Patients who take insulin and others who aim for tight blood sugar control should monitor their own blood sugar levels. They should also learn to recognize symptoms of hypoglycemia, including anxiety, racing heart, sweating, tremors, and confusion, and they should know how to raise excessively low sugar levels and how to get help in emergencies. While the ADA guidelines remain important, many experts believe that one size does not fit all, that blood sugar goals should be adjusted according to the needs of individual patients.
Rule Number Four
Because diabetes is a major cause of cardiovascular disease and premature death, patients should carefully control other risk factors. Current guidelines set targets for diabetics below targets for otherwise healthy individuals.
Rule Number Five
Because special medications can slow the progression of diabetic kidney disease, patients should have regular urine tests; blood tests of kidney function may also help. Regular screening for eye disease will also lead to helpful preventive treatment. Foot care is important, too. Diabetes is a chronic condition, and it is a serious illness. Lifelong attention to lifestyle, medication, and monitoring is the key to a good outcome. It’s a challenge for patients, their families, and their doctors but new emphasis on flexibility and moderation promises to make life easier and better.
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