Because diabetes can affect many parts of the body, there's a lot to remember for self-management.
Because diabetes can affect many parts of the body, there’s a lot to remember for self-management. Fortunately, diabetes self-management education can be made easy.
Given that glucose isn’t good for patients with diabetes, here’s a mnemonic I learned in pharmacy school that can help health providers and patients recall what’s needed for diabetes self-management: “GLUCOSE BAD.”
G: Glycemic control
To ensure effective glycemic control, keep a daily log. Be sure to wash hands with soap and warm water and dry them prior to using a glucometer.
According to the American Diabetes Association, targets for most non-pregnant adults with diabetes are:
Some signs and symptoms of hypoglycemia (<70 mg/dL) include shakiness, sweating, dizziness, or fatigue. Treat hypoglycemia with 15-20 g of glucose or simple carbohydrates, such as a half cup of juice or 2 tablespoons of raisins. Then, recheck blood glucose after 15 minutes. Repeat treatment and recheck until blood glucose is no longer low.
Hypoglycemia left untreated may lead to a seizure or passing out, so a prescribed glucagon injection will be needed to stimulate the liver to release stored glucose into the bloodstream.
Low-density lipoprotein cholesterol (LDL-C) should be <100 mg/dL. Adult patients not taking a statin should obtain a lipid profile at diabetes diagnosis, initial medical evaluation, and every 3-5 years thereafter if the patient’s LDL-C is <100 mg/dL. Adult patients with abnormal lipids taking a statin should obtain a lipid panel at initiation of statin therapy and annually thereafter.
Some lifestyle changes for lipid management include losing weight if the patient is overweight; reducing intake of saturated fat, trans fat, and cholesterol; increasing intake of omega-3 fatty acids, viscous fiber, and plant stanols/sterols; and increasing physical activity.
U: Urine screening
Patients with type 1 diabetes for at least 5 years, patients with type 2 diabetes starting at diagnosis, and all patients with hypertension should get their urine screened annually for albumin and estimated glomerular filtration rate.
Patients who smoke should be encouraged to quit, as smoking affects small blood vessels, which consequently decreases blood flow to the feet and makes wounds heal slowly.
O: Ophthalmic exams
Patients with diabetes are at a higher risk of blindness. With regular checkups, health care providers and patients can keep minor eye disorders from progressing or treat major problems right away when available treatment options are still effective.
Patients with type 1 diabetes should get an initial dilated and comprehensive eye exam within 5 years of diabetes onset, while patients with type 2 diabetes should get an initial dilated and comprehensive eye exam at time of diabetes diagnosis.
If there’s no evidence of retinopathy during 1 or more annual eye exams, exams every 2 years can be considered. Otherwise, more frequent dilated retinal exams are recommended. For pregnant patients, eye exams should occur before pregnancy or in the first trimester and monitored every trimester and for 1 year postpartum.
S: Sexual dysfunction
Patients should be asked about sexual dysfunction. Treatment options include phosphodiesterase type 5 inhibitors such as sildenafil or tadalafil.
Annual comprehensive foot exams should be conducted to look for risk factors predictive of ulcers and amputations. Patients should be provided foot self-care education such as:
B: Blood pressure (BP)
BP should be measured at every patient visit, and elevated BP should be confirmed on a different day. The goal is typically <140/90, but it’s <130/80 if the patent is younger, has albuminuria, and/or has hypertension with 1 or more additional atherosclerotic cardiovascular disease (ASCVD) risk factor. A pregnant patient’s BP goal is 110-129/65-79.
Patients with BP >120/80 should modify their lifestyle through weight loss, reducing sodium intake to <2300 mg/day, increasing potassium intake, increasing fruit and vegetable intake to 8-10 servings/day, and increasing physical activity. Patients should consult their primary care provider before modifying their lifestyle. Because of other diabetes complications that a patient may have such as retinopathy, autonomic neuropathy, and peripheral neuropathy, increasing physical activity or engaging in weight-bearing activity may not be options.
Patients with BP >140/90 should be initiated on pharmacologic therapy.
Consider daily aspirin therapy (75-162 mg/day) as primary prevention for type 1 or 2 diabetes patients who are at increased ASCVD risk (10-year risk >10%) and not at risk of bleeding. Aspirin therapy should also be considered for secondary prevention for diabetes patients with a history of ASCVD. If the patient has an aspirin allergy, clopidogrel 75 mg/day can be used instead.
D: Dental exams
Twice-yearly dental exams are recommended.