Contributor: Dr. Staci-Marie Norman, PharmD, DCES
November is Diabetes Awareness Month, and it's a great time to take stock of your diabetes health. A terrific place to start is with the ABCs of diabetes.
A is for A1C. Most people with diabetes watch their A1C, but do you know how your A1C is measured? A1C is basically your average blood glucose, but it is determined by looking at the red blood cells in your body. Red blood cells live for 90 - 120 days, and as they float through your body over this period, they encounter other elements, such as glucose. When red blood cells and glucose collide, the glucose permanently attaches to the red blood cell and a “sugar coating” starts to form. The thicker the coating of glucose, the higher our A1C because more glucose is present in our body. Since the typical life of a red blood cell is about three months, evaluating the coating shows the average glucose present in the body during that time. Since it is an average, it can’t tell if we have had swings from high to low blood sugars, but it is an excellent marker to look at over time for trends.
The American Diabetes Association (ADA) recommends most people strive for an A1C of less than 7%. Since an A1C is a 3-month average, it is recommended that the A1C be done quarterly. Of course, the A1C is not a replacement for checking blood glucose at home, as it does not give an accurate picture of what your blood glucose is doing throughout the day, which can be helpful in therapy adjustments.
B is for blood pressure. Keeping track of our blood pressure and making sure we are treating hypertension is extremely important in diabetes care. People with diabetes are at an increased risk of cardiovascular disease; maintaining our blood pressure can reduce this risk. The ADA goal for blood pressure is below120/80. Getting treatment to lower and maintain your blood pressure is essential if your blood pressure is elevated. Lifestyle modifications like diet and exercise can help, but medication is typically needed. ACE inhibitors and ARBs are usually first-line agents for hypertension in people with diabetes due to their ability to protect the kidneys. But calcium channel blockers (CCBs) or thiazide diuretics are also first-line agent choices, especially if there is no kidney involvement. Your medical team may prescribe a combination of these medications in smaller doses with better results than just one drug. Smaller doses usually mean fewer side effects, so it is a win-win. Many of the most common medications used together come as a combination tablet, so you only take one tablet but are getting the benefit of two medications.
C is for cholesterol. If you've looked at your lab work, you have seen that many cholesterol components make up your total cholesterol. There are three components that we look at, the LDL or "lousy" cholesterol, HDL or "happy" cholesterol, and triglycerides.
LDL cholesterol is the big culprit when it comes to cardiovascular disease. LDL is the cholesterol that gets into the lining of the blood vessels and can cause hardening or a vessel wall to rupture, leading to clot formation. Clots can lead to a heart attack or stroke.
HDL cholesterol acts as the body's "cholesterol vacuum." Its primary purpose is to find excess LDL in the blood system, grab onto it, and escort it to the liver to be disposed of. Having good HDL levels is beneficial, and both increasing exercise and quitting smoking can help with your HDL.
Triglycerides are the third component of the total cholesterol. These fats fluctuate throughout the day as we eat and fast. They are part of the body's system of processing the fats from our diet. We worry about triglycerides when their levels are very high, typically when they are greater than 500mg/dL, putting us at risk of pancreatitis.
Now that you know what the A, B, Cs of diabetes are, I challenge you to use Diabetes Awareness Month to find out your own numbers.
Dr. Staci-Marie Norman, PharmD, DCES received her bachelors from Purdue University (’94) and her Doctor of Pharmacy from the University of Oklahoma (’96). In 2000 Dr. Norman added to her credentials by becoming a Certified Diabetes Care and Education Specialist. She is currently the Clinical Coordinator and staff pharmacist for Martin’s Pharmacy. Dr. Norman is a national faculty member for the American Pharmacist Association, teaching certificate programs in both diabetes and cardiovascular disease. She serves on the advisory board that oversees development and revision of these programs. Along with teaching and development responsibilities for APhA, Dr. Norman serves as a peer reviewer for research grants and publication submission. Dr. Norman has also spoken for Abbott, Bayer, Lilly, Mannkind, and Lifescan as a diabetes specialist.