Susan has been seeing the same family doctor since she was a young girl. She explains to Dr. Smith that she has been feeling very tired and weak. Her eyes have been bothering her, and words are often blurry. She also cannot seem to drink enough and is always thirsty.Dr. Smith listens carefully. He tells Susan that these are possible symptoms of diabetes. Since Susan is of Indian descent, she has a higher chance of developing Type 2 diabetes, (as do people of Aboriginal, Hispanic, Asian or African descent).
Dr. Smith wants Susan to go to the lab for a test to confirm whether she has diabetes. She is told not to eat or drink anything for at least eight hours before the test. At the lab, Susan has her blood glucose checked while she is still fasting. If her blood glucose at this time is between 5.7 to 6.9, she would then given an orange drink. Her blood would be tested two hours after she finishes the drink. This is called an oral glucose tolerance test.
If Susan’s fasting blood glucose level is 7 mmol/L or more or her blood glucose level 2 hours after the orange drink is equal to or greater than 11.1 mmol/L, she will be diagnosed with diabetes. The test shows Susan’s fasting blood glucose is 6.8 mmol/L and her blood glucose two hours after the orange drink is 16.7 mmol/L.
When Susan returns to her doctor’s office, Dr. Smith tells her the readings from the test confirm she has diabetes. He reassures her that the disease can be controlled. She leaves with a prescription and a referral to the local diabetes education centre, where she can learn more about her diabetes and how to treat it.
Barbara is one of the diabetes educators on staff. She has extensive training, knowledge and experience working with people who have diabetes.
Kathy is a registered dietitian and nutritionist. Together Kathy and Barbara teach people about diabetes and how to manage it. In class, Susan learns about diabetes and its possible complications, the importance of healthy eating and physical activity, how to control her diabetes, and also why people with diabetes should monitor their blood glucose several times a day.
Sam is the pharmacist at Susan’s local Safeway Pharmacy. Susan brings in the prescription Dr. Smith gave her. She also wants to choose a blood glucose monitor to help manage her diabetes. Sam explains her medication, describing how it works, when to take it and what possible side effects might happen. He says that as time goes by, Dr Smith may prescribe more medications to help her to better manage her diabetes.
Sam demonstrates several blood glucose monitors to help Susan choose the most suitable one for her. He explains to Susan why it is important to monitor her blood glucose and at what different times to perform the test. The general goal for the best blood glucose range before meals is between 4 to 7 mmol/L. Two hours after a meal the best range is between 5 to 10 mmol/L. Sam reminds Susan to check with Dr. Smith or Barbara to see if they have other individual goals for her. She can check her blood glucose just before a meal and again two hours after a meal. This time frame will give her a good idea about how different foods she eats affect her blood glucose levels. Susan will record the values in a logbook so that she can discuss her results with anyone on her diabetes team. Susan feels much more confident now that she has taken a diabetes education class and talked to her team members. She understands how to use her diabetes medication, the new monitor, test strips, lancets and the container for disposal of sharps.
Susan will visit the lab several times a year to have her blood tested. Every three months she will have a test called Hemoglobin A1C. This test reflects an average of her blood glucose levels over the past three months. The goal for most people is to have an A1C of less than 7.0 per cent. Once each year Susan will have her blood tested for lipid levels (blood fats such as cholesterol and triglycerides). While at the lab she should also have her urine tested for albumin once a year. Over time, high blood glucose levels can damage tiny blood vessels in the kidney. As a result albumin, a protein in the blood, can leak into the urine. Although high blood pressure can contribute to the damage to these blood vessels, even people with normal blood pressure may develop this complication. Checking Susan’s urine for albumin will tell her team how her kidneys and blood vessels are doing. It is important to diagnose such problems early so they are treated before they get worse.
Eye DoctorOnce a year, Susan will also visit the eye doctor for an eye exam. The eye doctor will check for any changes caused by her diabetes. High blood glucose levels can also damage the tiny blood vessels in the eyes. Having an annual eye exam helps ensure that any changes will be found at an early stage.
At the diabetes education centre, Susan learns why she must check her feet daily. She remembers to examine her feet every day, dry carefully between her toes, and never to walk barefoot. Dr. Smith will do a foot exam about every three to six months and send her to a podiatrist (a doctor specializing in the feet) if necessary. Careful maintenance keeps her feet in good health and ensures no cuts or sores will lead to serious infections.
Dr. MillerAt her next appointment, Susan informs her dentist, Dr. Miller, that she has been diagnosed with diabetes. Dr. Miller reminds her to brush and floss carefully each day, as her diabetes may make her more inclined to gum disease.
Susan may have diabetes, but she is not alone. A team of experts works with Susan to keep her diabetes under the best possible control. Susan’s team help her monitor and control her blood glucose, allowing her to live well and stay healthy with diabetes. The team consists of Susan, her family doctor, diabetes educator, dietitian, pharmacist, eye doctor, podiatrist, dentist and any other medical specialist she may require. She is glad to be part of her own diabetes team and knows she is the key player. Do you know who is on your diabetes team?