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Manage Type 2 Diabetes by Tracking 2 Key Numbers

Four months ago, Jonathan Katz learned he was borderline type 2 diabetic. If he didn’t get his blood sugar under control, his doctor told him, he’d have to start taking insulin.

With a family history of both type 1 and type 2 diabetes, the 62-year-old wasn’t shocked by the news. But having watched his father struggle with type 2, Jonathan knew he did not want his condition to worsen. “I’m determined not to become insulin dependent,” he says.

In fact, Jonathan has learned, it doesn’t take much. Keeping his disease from progressing is mostly a matter of taking his medication, watching his diet and exercise — and making sure he monitors two key numbers: those for his blood sugar and for his kidney function.

Measurement is the key to management

Diabetes is a disease in which sugar, in the form of glucose, stays in the bloodstream instead of fueling the body. Over time, high levels of blood sugar, or blood glucose, damage the kidneys, heart, nerves and eyes. To prevent this damage, people with diabetes must lower their blood glucose levels. People with type 2 diabetes can do this with medication, diet and exercise. But to stay in control, they need to know what their glucose levels are, says Justine Fierman, a nurse practitioner and certified diabetes educator who leads the team at Memorial Hospital’s Miranda Diabetes Care Center in North Conway, New Hampshire. “You can’t manage what you don’t measure,” she says.

Two essential tests

The most important measure is a blood test called hemoglobin A1c, HbA1c or simply A1c. Conducted every two to three months, it evaluates the average amount of glucose in the blood over the previous 60 to 90 days. This gives health care providers, says Fierman, the big-picture insight they need to customize daily treatment plans. “Getting diabetes under control is all about coming up with the right recipe for the right person,” she says. 

An HbA1c test can be done in your doctor’s office, at a laboratory or even at home if you purchase an at-home testing kit at your local pharmacy or online. Home kits are particularly attractive now, during the COVID-19 crisis.   

Understanding A1c

Early detection prevents complications

Kidney function is the other important thing people should monitor. Functioning kidneys remove waste products from the blood and expel them in urine. Like high blood pressure, having too much blood glucose damages the small blood vessels that do this vital filtering. “Your kidneys are like a coffee filter,” Fierman explains. “Overwhelm them, and they can’t do their job.” If the damage continues, the kidneys will eventually fail. Fierman says that can happen in people who don’t get tested regularly, since often they experience no symptoms. People whose kidneys fail need dialysis or a kidney transplant. 

Doctors can detect kidney damage early enough to arrest it or even reverse it by testing regularly for the presence of a particular protein — albumin — in a person’s urine. A urine protein test known as UACR (for urine albumin-to-creatinine ratio) measures albumin in relation to creatinine, a waste product normally filtered out by the kidneys. A UACR between 30 and 299 indicates that the kidneys are leaking tiny amounts of protein, a sign of kidney damage. Microalbuminuria, as this condition is called, can also be detected by a urine dipstick test. Since damaged kidneys have difficulty removing waste from the blood as well, doctors often order blood tests in addition to urine tests. “If we catch the damage at the onset, in some cases we can resolve kidney disease completely,” says Fierman. 

By regularly testing kidney function as well as blood glucose levels, health care providers can help prevent more-serious health issues. “Early detection and treatment can prevent not only kidney disease, but complications like heart attack, stroke, blindness and amputation,” Fierman explains. “That’s why it’s so important that people with early-onset diabetes get regular screenings.”

Diet, exercise and medication matter too

Effective management of type 2 diabetes begins, but certainly doesn’t end, with regular blood and urine tests. Keeping the disease in check often requires getting exercise more regularly, eating differently and taking pills or insulin exactly as prescribed. Still, because each person is different, treatments and outcomes will vary, stresses Fierman. “Baby steps are okay,” she says. “The important thing is to stay on track.”

For Jonathan, who has been a vegetarian for most of his life, improving his numbers doesn’t demand he change his diet. But he has chosen to double the amount of time he works out each week. His doctor has also asked him to take twice the dose of metformin, a medication used to lower blood sugar, than he was originally prescribed. 

So far, Jonathan’s treatment appears to be working. While everyone’s goals will be different, Jonathan’s HbA1c has dropped from 6.5 percent — the threshold for a type 2 diagnosis — to 6.13. Although he hasn’t yet reached his individual target, which he discussed with his doctor, Jonathan is encouraged. “At this rate, I can hold off insulin,” he says. 

Tech can help you stay on track

The more data that people have at their fingertips, Fierman believes, the better they can manage their disease. So in addition to recommending screenings, she advises patients to get a blood glucose meter, a small device that reads sugar levels based on a tiny pinprick of blood. Continuous glucose monitors (CGMs) give readings without pinpricks. People with CGMs can use their smartphone to scan a sensor placed under their skin to generate readings on demand. 

Other smartphone apps help people track things like the amount of carbohydrate they’ve eaten or the number of steps they’ve taken. MyFitnessPal, one of the most popular trackers, makes it easy to get nutrition information on thousands of foods, including restaurant menu items. It also helps patients keep tabs on calories consumed and calories burned. Another tracker, MyNetDiary, reminds users to check their blood sugar and gives summary reports that make clear how glucose, diet and exercise are related. “There are even apps that allow my patients to send me their glucose readings,” says Fierman. “Advances in technology are making diabetes management easier every day.”

For now, Jonathan is taking a low-tech approach to managing his disease. “I’m going to be affirmative and aggressive about seeing my doctor every three months and getting my numbers checked,” he says. “And whatever he asks me to do, I’m going to do it.”  

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