As Educators we know that as diabetes is on the rise, patient education becomes more vital in successful diabetes management. Most patients with diabetes struggle with comprehension of important numbers at their visits with their health care provider. Patients are focused on how they are doing and what their blood sugar numbers are, but tend to be quite clueless when we review the essentials with them.
In reviewing lab work with a patient with diabetes, the health care provider discusses A1C results, cholesterol profile, fasting blood sugars, blood pressure, medications and weight. The most common measures discussed are referred to as the ABC’s of diabetes. These are the basic elements of a diabetes visit that we, as educators, need to ensure that our patients completely understand.
It’s important to empower our patient with the knowledge of the ABCs. When a patient can identify targets for A1c, Blood Pressure and Cholesterol, and learn how to manage these three key elements through lifestyle modification, we are doing a wonderful job at helping them lead a healthy life. We are helping them decrease their risk of having a heart attack, stroke or other complications of diabetes.
Diabetes management requires good blood glucose, blood pressure and cholesterol control.
As we work with our patients with diabetes, and particularly those who are newly diagnosed, it’s good to remember that keeping it simple is as easy as ABC.
A if for A1c
Glycated hemoglobin (HbA1c, or A1c) is a test that measures the average blood glucose level over the past 2 to 3 months. It is the amount of glucose that sticks to the red blood cells, which is proportional to the amount of glucose in the blood. For most individuals with diabetes, A1c should be measured every 3 months to ensure glycemic goals are being met or maintained (CDA, 2013).
This measure of glycemic control is essential to the overall management of diabetes. When the Diabetes Control and Complications Trial (DCCT) was completed, the importance of A1c as an indicator for risks for complications of diabetes was established (NDIC, 2012). The new CPG guidelines tell us that a glycated hemoglobin level > 6.5% is associated with a significant increase in risk of both microvascular and macrovascular complications. The optimal goal is to keep the A1c under 7% (CDA, 2013).
As A1c increases, so does the risk of complications. This association needs to be clearly conveyed to the patient. The nature of managing diabetes has a personalized approach and varies from one patient to the other. A range of A1c targets are used for patients of different age and health circumstances. It is often balanced against the risk of hypoglycemia. Whichever A1c target is determined for your patient, communicate this to them and ensure they understand why their target is set at a specific level and what the implications mean to them and their overall management.
B if for Blood pressure
Blood pressure is the measurement of the force of your blood against the blood vessel walls. The top number is the pressure when your heart contracts and pushes blood out (systolic) and the bottom number is the pressure when the heart relaxes between beats (diastolic) (CDA, 2013). This simple explanation is what patients need to know and understand about their blood pressure.
Individuals may not know that they have high blood pressure and this is one of the reasons why it is a high risk for heart attack and other cardiovascular complications. Having high blood pressure puts a stress on the body. This can cause damage to the heart, brain, kidneys and eyes.
Hypertension affects the vast majority of individuals with type 2 diabetes and many of those with type 1 diabetes as well. Having high blood glucose is a risk factor for hypertension as it can lead to hardening of the arteries. Optimal blood pressure control for people with diabetes is < 130/80 mmHg.
Some simple ways to lower your blood pressure
- Maintain a healthy weight.
- Eat regular, healthy balanced meals: increase your fruits and vegetables intake and watch out for the sodium in your diet whether it is at home or when eating out (EatRight Ontario 2013a).
- Physical activity: aim at 150 minutes of physical activity per week (PHAC, 2011).
- Have your blood pressure checked regularly. Your BP should be checked at every visit to your healthcare team.
- If you smoke, quit smoking.
- Try your best to control the stress in your life. Try relaxation techniques or prioritize your daily tasks.
- Limit your alcohol intake (EatRight Ontario, 2013b).
C is for Cholesterol
Cholesterol is a fat-like substance that is part of the body’s cells and helps you make vitamin D and certain hormones.
One’s body naturally makes cholesterol in the liver and is circulated in the blood, i.e. blood cholesterol. Cholesterol also comes from the foods that we eat, i.e. dietary cholesterol. The major source is from animal sources such as meat, poultry, milk products, eggs and shellfish. (EatRight, 2013c).
There are two types of cholesterol (CDA, 2013):
LDL cholesterol: Otherwise known as the “bad cholesterol”. This can lead to build up of plaque in the arteries, which is a risk factor for heart disease.
HDL cholesterol: Otherwise known as “good cholesterol”. This helps protect the arteries and lowers the amount of plaque that is in one’s bloodstream.
Triglycerides are also a form of fat that the body makes from sugar, alcohol or other food sources.
Elevated cholesterol usually refers to having high LDL cholesterol. For most adults with type 1 or type 2 diabetes having high cholesterol puts them at higher risk for heart disease and stroke. Adults with diabetes should have their cholesterol tested yearly or as indicated by their healthcare provider.
The goal for cholesterol management is to keep your LDL-C to under 2.0 mmol/L.
Some simple ways to lower your LDL & triglyceride levels, and raise your HDL levels:
• Choose foods lower in saturated fats
• Manage your weight
• Be physically active
• Avoid smoking
• Limit alcohol intake
• Limit added sugars
• Achieve and maintain excellent blood glucose control
Helping our patients achieve good blood glucose, blood pressure and cholesterol control is the way towards optimal management of their diabetes. It is important to remember that in order to achieve this, we need to take a step back and ensure that our patients understand the basics, i.e. the ABCs of diabetes. They need to know the terminology, know their numbers and how those numbers translate into actions towards better health.
Canadian Diabetes Association. (2013). At the tipping point: Diabetes in Ontario. Retrieved from
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Canadian Diabetes Association. (2013). Monitoring Glycemic Control. Retrieved from http://guidelines.diabetes.ca/Browse/Chapter9#tbl1
Canadian Diabetes Association. (2013). Targets for Glycemic Control. Retrieved from http://guidelines.diabetes.ca/Browse/Chapter8
EatRight Ontario. (2013). Cut out the salt. Retrieved from http://www.eatrightontario.ca/en/Articles/Heart-Health/Cut-out-the-Salt.aspx
EatRight Ontario. (2013c). Facts on cholesterol. Retrieved form http://www.eatrightontario.ca/en/Articles/Heart-Health/Facts-on-Cholesterol.aspx
EatRight Ontario. (2013b). Hypertension: How to prevent and treat the silent killer. Retrieved from http://www.eatrightontario.ca/en/Articles/Heart-Health/Hypertension–How-to-prevent-and-treat-the-silent.aspx
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Public Health Agency of Canada. (2011). Physical activity. Retrieved from http://www.phac-aspc.gc.ca/hp-ps/hl-mvs/pa-ap/index-eng.php
The National Diabetes Information Clearinghouse. (2012). DCCT and EDIC: The Diabetes Control and Complications Trial and follow-up study. Retrieved from http://diabetes.niddk.nih.gov/dm/pubs/control/
U.S. Department of Health and human Services National Institute of Health. (2011). The A1C test ad diabetes. Retrieved from http://diabetes.niddk.nih.gov/dm/pubs/A1CTest/A1C_Test_DM_508.pdf