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If you
have been diagnosed with diabetes you need to have this
Comprehensive Diabetes Health Tracking.
The CDHT includes parameters recommended by the American Diabetes
Association and which need to be checked by your Doctor at the time of you
visits. You can therefore track your improve: The components tracked by the
CDHT are the following:
Food Plan Compliance
Eating the right food is
one of the most basic and important tool for diabetes care. Eating right can
help control blood sugar. And good control protects your long term health.
Whether you are following a calorie level meal plan, counting carbohydrates,
using exchanges, or just trying to improve overall nutritional value of your
current eating habits, keep in mind that every person with diabetes should
have a personal meal plan. A registered Dietitian (RD) can work with you to
develop the plan that best meets your needs. A personalized plan will give
you more freedom and choices. Ask your doctor, diabetes educator, hospital,
or local diabetes association for the names of dietitians in your area who
specialize in diabetes.
Exercise Program
Physical activity is
beneficial to everyone's health, regardless of their initial level of
fitness. The most significant benefits are experienced by those at the
lowest fitness level who become more active, even in very-low-level
activities. For those who wish to begin a new exercise program, it is
important to consider the guidelines for beginning and maintaining exercise
programs provided by the American College of Sports Medicine. For the
general population, a program of regular aerobic exercise (20- to 30-minute
sessions, at least 3 times per week), combined with a hypocaloric, low-fat
diet (<30% energy from fat) is most effective for achieving desirable
changes in body composition and body weight. Using such a program, muscle
mass can be better maintained while body fat is reduced
Medications Follow up
For many people with non-insuline
dependent diabetes mellitus (NIDDM), blood glucose can be kept under control
by watching your diet, losing weight, and exercising regularly. You may,
however, need to take medication, if diet and exercise are not enough to do
the job. If your have been prescribed diabetes tablets to help you keep your
blood glucose level under control, it is important that you take them as
directed. If tablets alone are not enough to control your blood glucose
level, you may have to take insulin by injection. You will be instructed on
how and when to inject your insulin, how to store it, how to check to see
whether it is all right to use; how to handle used syringes; and, if
necessary, how to mix different kinds of insulin in one syringe.
Systolic Blood Pressure
Your Systolic Blood
Pressure is the highest pressure reached in your arteries during and at the
end of the contraction of your heart. Your blood pressure may vary
throughout the day and may be altered by many factors physical and/or
emotional. Intake of too much salt or liquids, stress, strenous physical
exercise and emotions such as frustration, anger and hostility may increase
your blood pressure if they persist over a long period of time. Chronically
high blood pressure may create damages to your brain, kidneys, eyes and
heart.
Diastolic Blood Pressure
Your Diastolic Blood
Pressure is the lowest pressure reached in your arteries and is recorded
when your heart reaches its resting phase called diastole. Differently then
the systolic the diastolic blood pressure takes time to change and when it
reaches 90 millimeters of mercury or more is diagnostic for Hypertension.
Proper diet, relaxation exercises and exercise can help in reducing your
Diastolic Blood Pressure.
Heart
Rhythm
Your heart beats an average
of approximately 100.000 times every 24 hours. Your resting heart rate
represents the condition of your cardiac health and workload. The heart has
only two mechanisms to adjust itself to changing working demands: the
strength of its muscle (contractility) and the frequency its contractions (
heart rate ). Usually, the lower your heart rate, the healthier your heart.
Exercise, proper nutrition, and avoidance of tobacco, caffeine, and alcohol
will reduce your heart rate. By lowering your heart rate 10 beats per
minute, your heart will save over 14,000 beats per day and over 5,000,000
beats per year.
Presence of
Complications
Complications of diabetes
can be severe, including heart disease, kidney failure, blindness,
amputations, strokes, nerve damage and death. Uncontrolled diabetes can
complicate pregnancy, and birth defects are more common in babies born to
women with diabetes. Complications from diabetes are almost always traceable
to the presence of excessive sugar in the blood over many years. However the
results from the The Diabetes Control and Complications Trial (DCCT) have
shown that by keeping the blood sugar values within the normal range you may
be able to prevent or delay the long-term complications of diabetes.
Therefore the goal of an individual with diabetes should be to maintain the
best control of glucose levels as possible.
Blood Glucose in Target
Checking your own blood
sugar level is essential in managing your diabetes. Appropriate decisions
regarding changes in your medications, meal plan, and exercise program can
be made only if the results of your blood tests are accurate. frequent
self-monitoring is the key to managing your diabetes. How often you test
will vary according to your type of diabetes, the amount and frequency of
your medications, and how much your blood glucose changes during the day.
General testing guidelines can help, but personal motivation and the advice
of your healthcare team are important to your testing regimen. Type I: For
people with Type I diabetes, self-monitoring four times or more per day is
recommended to maintain near-normal blood glucose levels and gain tight
control. Testing four times a day, before each meal and at bedtime,
facilitates frequent adjustments to insulin, meals and exercise programs.
Type II: For people with Type II diabetes, self-monitoring one to two times
per day is recommended to avoid hypoglycemia and hyperglycemia symptoms.
Foot Health
People with diabetes need
to take special care of their feet. Neuropathy and blood vessel disease both
increase the risk of foot ulcers. The nerves to the feet are the longest in
the body, and are most often affected by neuropathy. Because of the loss of
sensation caused by neuropathy, sores or injuries to the feet may not be
noticed and may become ulcerated. At least 15 percent of all people with
diabetes eventually have a foot ulcer, and 6 out of every 1,000 people with
diabetes have an amputation. However, healthcare providers estimate that
nearly three quarters of all amputations caused by neuropathy and poor
circulation could be prevented with careful foot care. There’s a lot you can
do to prevent problems with your feet. Keeping your blood sugar level in
good control and taking care of your feet can help protect them.
Glycated Hemoglobin
The Glycated Hemoglobin
test measures how well you control your diabetes mellitus. The test checks
for a process called "glycosylation" which is the entrance of blood sugar
inside the circulating red cells of your blood and its combination with the
content of the red cell which is the hemoglobin. The glycosylation of your
red cells (erythroctytes) occurs at a constant rate during the 120-day life
of a red cell. Glycosylated hemoglobin levels reflect the average blood
glucose level during the preceding two to three months, and therefore can be
used to evaluate the long-term effectiveness of diabetes therapy. As
effective therapy brings diabetes under control, glycosylated hemoglobin
levels approach the normal range.
Cholesterol Level
Experts recommend a
cholesterol level below 200 for good health. Between 200 and 239 is
borderline and above 240 is dangerous. When associated with at least two
risk factors such as high blood pressure, diabetes, previous heart disease
or stroke, excess weight and being a smoker, it increases the incidence of
having coronary artery disease and heart attacks.
HDL ( Good Cholesterol )
Cholesterol is a necessary substance in your body from your first day of
life. Experts recommend a cholesterol level below 200 for good health.
Between 200 and 239 is borderline and above 240 is dangerous. When
associated with at least two risk factors such as high blood pressure,
diabetes, previous heart disease or stroke, excess weight and being a
smoker, it increases the incidence of having coronary artery disease and
heart attacks.
LDL (Bad Cholesterol)
Low density lipoproteins (LDL) transport one half to two thirds of all blood
cholesterol to various body tissues. A certain amount of LDL cholesterol (up
to 130) is normal. But when the level increases, LDL promotes plaque
development on the walls of the coronary arteries, slowing the flow of blood
and sometimes blocking the artery entirely. Levels of 130-160 are considered
borderline high and levels of 160 or higher are definitely abnormal and
should be reduced with rigorous diet, other lifestyle changes, and/or with
drug therapy.
Controversies are now surfacing on the danger of having LDL blood levels
which are too low. The relation to some type of cancers and other diseases
have been noticed with LDL levels reduced below 90 and closer to 50.
Therefore is unclear today how safe is to lower your LDL blood level. A
safer level seems to be between 90-130 and should be associated with an
increase in the HDL levels.
Triglycerides
Triglycerides are a type of
fatty substance which must be measured together with your cholesterol for a
complete picture of your circulating blood fats. Blood triglycerides tend to
be elevated in people who have high cholesterol levels, in people wiht
dibetes or chronic kidney disease, and in those who are obese. The
relationship between triglycerides and coronary artery disease is still
controversial. Some studies suggest that high blood triglycerides might
increase the risk of coronary artery disease. If your blood level of
triglycerides is elevated you sould consult your doctor for dietary changes
and weight loss and exercise program or for the use of medication which may
be necessary in some cases.
Cholesterol/HDL Ratio
The HDL in the blood is
believed to serve two functions: 1) it coats the inside of the artery wall
and provide a kind of protective layer of grease to prevent fat deposits
from building up and 2) it serves as scavenger by actually helping dissolve
fatty deposits when they occur. The basic rule of balance for your blood is
to have a relatively high amount of HDL in your body in relation to your
total amount of cholesterol. This is called the Cholesterol/HDl Ratio.
The ratio in men should always be less than 5.0, and preferably less than
4.5. For women, the ratio should be lower and always under 4.0 and
preferably under 3.5. In other words the man's HDL should always represent
at least 20% of the total cholesterol count (and preferably should be 25% or
greater). For a woman the HDL cholesterol should make up at least 25% (or
preferably 30%) of the total cholesterol. The Cholesterol/HDL Ratio is
probably the best predictor of future coronary disease. Active people with
low levels of body fat tend to show the best cholesterol balance (ratio) in
their blood.
Proteinuria
Each year in the United
States, more than 50,000 people are diagnosed with end-stage renal disease (ESRD),
a serious condition in which the kidneys fail to rid the body of wastes.
ESRD is the final stage of a slow deterioration of the kidneys, a process
known as nephropathy. Measure your glycohemoglobin regularly. The HbA1c test
averages your level of blood sugar for the previous 1-3 months. Have your
blood pressure checked several times a year. If blood pressure is high,
follow your healthcare provider's plan for keeping it near normal levels.
Ask your healthcare provider whether you might benefit from receiving an ACE
inhibitor. Have your urine checked yearly for microalbumin and protein. If
there is protein in your urine, have your blood checked for elevated amounts
of waste products such as creatinine.
Microalbuminuria
Diabetes is a chronic
condition which poses a risk for three major complications. They are
diabetic retinopathy, nephropathy and neuropathy. Almost one third of
diabetic patients insuline or non-insuline dependent, develop diabetic
nephropathy in their lifetime. Because of increased vascular permeability in
chronic conditions, increased urinary albumin excretion in the range of
30–200 mg/L (microalbuminuria) gives an early signal of incipient diabetic
nephropathy. The prevalence of microalbuminuria was found to be 41% in
diabetic patients with duration of more than 5 years. Seventy percent of
diabetic patients with microalbuminuria were hypertensive. ACE inhibitors
are shown to have significant effects on microalbuminuria and hypertension.
We conclude that microalbuminuria is an early feature of excessive capillary
leakage and its assessment in diabetic patients with duration of more than 5
years provides a simple non-invasive method of early diagnosis of incipient
diabetic nephropathy. An early intervention may retard the progression to
end-stage renal disease (ESRD).
Eye Health
Diabetic eye disease is the
leading cause of blindness for young adults in the United States.
Presumably, early detection and intervention could have a significant impact
on the incidence of blindness among diabetics. Healthy People 2000 contains
a goal to reduce the incidence of blindness as a complication of diabetes to
less than 1.4 per 1000. Diabetic eye disease may include: Diabetic
retinopathy, the leading cause of blindness in American adults. It is caused
by changes in the blood vessels of the retina. In some people with diabetic
retinopathy, retinal blood vessels may swell and leak fluid. In other
people, abnormal new blood vessels grow on the surface of the retina. These
changes may result in vision loss or blindness. Anyone with diabetes may get
diabetic retinopathy. The longer someone has diabetes, the more likely he or
she will get diabetic retinopathy. Nearly half of all people with diabetes
will develop some degree of diabetic retinopathy during their lifetime.
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