Joslin Answers Your Questions

Joslin Diabetes Center experts answer commonly asked questions about diabetes monitoring, treatment, self-care, meal planning, and more.
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Topic: General Concerns
Question: I'm afraid of diabetes-related complications, but all the self-care steps seem cumbersome. Where do I begin?

Answer: Rest assured that you're not alone. Everyone with diabetes feels overwhelmed at some point. And many people are afraid of getting diabetes complications, so much so that they often don't take any steps toward self-care.

While it's true that there's a lot involved in diabetes self-management—from checking your blood glucose to following a meal plan to making sure you have all the important tests and exams you need—it's also true that you don't have to do everything at once. In fact, people are more successful at managing their diabetes when they break everything down into more manageable goals.

If your question is really "What are my chances of having future complications?" the answer is provided by the results of five tests that will tell you whether your chance of future complications is high or low:
  1. A1C
  2. Blood pressure
  3. Lipid results (cholesterol and triglycerides)
  4. Microalbumin (a sensitive kidney test done on a urine sample)
  5. Dilated eye exam

We know that most people will already have one or more of these tests in a very good range. For any test that is out of range, several different approaches can be used to bring it back into range. The best way to learn about what you need to do to stay healthy and prevent complications is to set up a game plan with your diabetes team. Your team ideally should consist of your physician, a dietitian, and a diabetes nurse educator. You also might work with a pharmacist, an exercise physiologist, and a mental health specialist.

No matter who is on your team, make sure that you decide what's most important for you to focus on at a particular time. For example, maybe you're doing fine with monitoring your blood glucose levels, but you really need some help with making healthier food choices. If that's the case, talk with your team about how you can eat better. Or perhaps you'd like to learn more about other medication options to help you lower your A1C. If so, your physician can talk with you about various medications that can help you meet your A1C target. You're probably doing fine in some areas, but need some help in other areas. Your team can help you figure out which areas you might work on and outline steps to help you get there—much like you'd use a roadmap to help you reach a destination.

Remember: Let your numbers be your guide. If your A1C target is 7 percent, for example, think about what you might need to do to help you get there, such as making better food choices, switching your diabetes medications, or ramping up your physical activity level. For every 1 percent that you lower your A1C, you lower your risk of complications by 40 percent. Or, if you're worried about heart disease, find out if your cholesterol or blood pressure levels are above target. If so, what steps can you take to manage them? Perhaps you could start on a cholesterol- or blood pressure-lowering medication, eat less sodium or saturated fat, and go for a daily 30-minute walk.

Having diabetes doesn't mean that you will get complications. Remember that there is a lot you can do to prevent complications and stay healthy, and that your diabetes team is there to help you.

Personalize a diabetes care plan.

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