A Diabetes Doctor’s Wish List

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A Diabetes Doctor’s Wish List

Frank Lavernia, MDContributor: Frank Lavernia, MD

As we know, diabetes is a chronic disorder that needs to be managed in both the short and long term to increase quality of life. In an ideal world, there are a few tips and topics that I think most of us diabetes docs wish ALL of our patients would keep in mind:

Set goals for diabetes numbers: blood glucose/BG range, A1C, blood pressure, LDL cholesterol, and renal function. Keep track of those values over time, and discuss with your doc: As a diabetes specialist, one of the first questions I ask a new patient is the A1C question: what is an A1C, and what was their last A1C value? Fortunately for me, I practice near a well-traveled road called A1A in eastern South Florida. As A1C is the diabetes road, this mnemonic is an easy one to teach and remember! This leads to an understanding of goal numbers, not only for A1Cs but also for fasting BGs and 2-hour post-meal BGs. We ask patients to either write down all of their BG values in a logbook that they bring to their appointment, or bring their meter to download in my office. Our staff stresses the importance of this, especially if we are trying to tweak insulin dosing. Without this information, it is almost impossible to determine updates to insulin needs.

Find out what your prescribed medications are meant to do for you. Take your meds as prescribed. Talk with your diabetes doc if something gets in the way of taking your meds (cost, side effects, timing, etc.), and/or if you think you have to stop taking one or more meds: If someone is on an extensive list of medications that have different mechanisms of action, I stress the importance of the medication plan. We ask them to notify us immediately if they experience an adverse reaction. I always remind them that their goal is to get to their goal number or range, be it an A1C, blood pressure, or LDL-cholesterol.

We ask patients to write down their questions (about their meds or any other part of their diabetes plan) and bring them to their next office visit. Along with the questions, we ask them to bring a list of the meds and supplements they are presently taking (or the actual bottles, or smartphone photos of the bottles). Often I find that patients may be taking two medications within the same group, which could be harmful. This also happens with supplements taken alongside prescription meds that, when combined, may be hazardous to someone's health.

Try to stick with lifestyle modification plans, even if it gets hard (it will likely get hard at some point). Be proactive in following lifestyle and behavioral changes, and talk with your diabetes team if it's too hard to follow. That's what they're there to do – help make it possible: The educational process carried out by a CDCES (certified diabetes care and education specialist) is started after the initial visit and revisited yearly if the patient needs help with their diabetes management, to keep from overwhelming our patients. I enjoy working with patients that want to learn about diabetes lifestyle modifications, newer meds, BG monitoring techniques, ways to prevent complications...and the list goes on.

Understand the interrelationships between various chronic conditions (diabetes, heart problems, kidney problems, etc.) and what you can do to feel your best: We recommend that people with diabetes have a team of specialists they visit regularly, including an ophthalmologist (yearly), dentist (biannually - diabetes increases the risk for periodontal disease), and a CDCES. You may also wish to see a counselor if you feel depression or anxiety settling in. We ask patients about the other members of their diabetes team and encourage them to expand their team with more expertise.

Dr. Lavernia has been a practicing diabetologist in South Florida for more than 35 years. He was the founder and director of the North Broward Diabetes Center in Florida. He is an adjunct faculty member of the National Diabetes Education Initiative (NDEI), Vascular Biology Working Group (VBWG), and for the Coalition for the Advancement of Cardiovascular Health (COACH). He is also a member of the American Diabetes Association, American Association of Clinical Endocrinology, European Association for the Study of Diabetes, and the National Hispanic Medical Association. He is a member of the DiabetesSisters Board of Directors.