The ABCs Of Diabetes

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s of people — even some doctors — think of diabetes as just a "sugar disease," a failure of the body to manage the levels of glucose in the blood. But as a growing number of studies have shown, folks with diabetes have to do a lot more to stay healthy than control their blood sugar. They need to take extra care to make sure that their blood pressure and cholesterol levels stay well within the normal range. To that end, the American College of Physicians (ACP) issued new guidelines last week that will help ensure that doctors treating diabetics take all aspects of the condition into account.

For reasons that are not entirely clear, diabetes triggers a wide range of health problems. Uncontrolled glucose levels increase the risk of blindness, kidney disease and nerve damage. On top of that, the 16 million Americans who have Type 2 (once known as adult-onset) diabetes are much more likely than the general population to develop high blood pressure, which increases their risk of heart disease and stroke. Indeed, high blood pressure appears to be even more damaging in diabetics than in nondiabetics. And yet, says Dr. Vincenza Snow of the ACP, "we found that blood pressure was being slightly overlooked" by doctors.

Normal blood pressure is 140/90 mm Hg or lower; the new guidelines suggest that diabetics set their goal somewhat below that, at about 135/80 mm Hg, which studies have shown is safer for them. If you can't get your blood pressure that low, even a drop of a few points can make a big difference.

Of course, any time you're trying to prevent heart disease, you have to take cholesterol into account. The ACP hopes to publish new guidelines on cholesterol levels for diabetes within the next year. But the National Institutes of Health and the American Diabetes Association are already advising diabetics to try to keep their levels of LDL, the so-called bad cholesterol, below 100 mg/dL. Note that this number is different from total cholesterol, which shouldn't be more than 200 mg/dL.

Diabetics still have to keep an eye on their glucose levels, and nowadays that means more than just the traditional glucose test that measures blood-sugar levels. The new gold standard is the A1C test, which measures levels of a substance in the blood called hemoglobin A1C. The A1C test tells you how well you've been controlling your glucose levels for the past three months. The FDA has approved several A1C monitors for home use; the ideal A1C number for diabetics is less than 7%.

Human nature being what it is, many patients with Type 2 diabetes get serious about taking their medication only the day before their doctor's appointment so they can pass the test. The growing use of A1C tests — at home and at the doctor's office — may help put a stop to such self-defeating habits.

Managing diabetes demands more of a commitment from patients than almost any other illness. But if you work on your ABCs — A1C, blood pressure and cholesterol — your chances of staying healthy can only improve.