Welcome to Dr Edelman's Corner, the ultimate personal resource for people living with diabetes.
The Diabetes Warranty Program
One of the most powerful and simple tools that you can use to take control of your diabetes is to follow a diabetes warranty program. The concept is simple, and is similar to the warranty program that accompanies a new automobile. If you follow the regularly scheduled maintenance program that is recommended by the manufacturer, your new car will run better and last longer. I designed the Diabetes Warranty Program in order to help you to prevent the onset and delay the progression of the complications of diabetes. If you follow the regularly scheduled maintenance program that is recommended by the American Diabetes Association and leaders in the field of diabetes, you will feel better and last longer!
All of us with diabetes need a maintenance record book that lists the recommended tests with dates and results (table 1). This information is vital, primarily to all of us with diabetes, and secondarily, to our physicians, to help them diagnose and track the common problems that occur with diabetes. In many cases, your record will be more orderly and complete than the one in your medical chart. It is also not uncommon to change physicians, especially in the new managed care environment, so that record keeping by you takes on an even greater importance. The Individual Items in table 1 are discussed in the appropriate chapters throughout the TCOYD book. REMEMBER TO KEEP UPDATED AND ORGANIZED RECORDS.
*This may not be necessary since you should examine your own feet as discussed in chapter 4.
**Glycosylated Hemoglobin and Fructosamine are long- term diabetes control factors.
How often should you be seen?
If you are currently on insulin, you should be seen approximately every 3 to 4 months. If you are not on insulin, you should be seen approximately every 3 to 6 months. The frequency of visits obviously depends on how well or poorly you are doing, and if you have taken control of your diabetes. For example, if your home glucose monitoring values are consistently good, and your diabetes regimen is stable, then you do not need to see your care giver as often as someone who never tests their own blood sugar levels at home and has no clue how they are doing.
When you visit your physician you should be prepared to discuss any issues that you have questions about. Table 2 lists some of the areas that you may want to discuss with your care giver. There is obviously not enough time at any one visit to discuss all of these issues, however you should decide which one(s) is the most important to you at the time of your visit.
Table 2: What Should You Discuss With Your Care Giver?
- Home glucose monitoring results
- Problems with hypoglycemia
- Medication questions
- Test or exam results and options for therapy, if appropriate
- Pregnancy issues
- Exercise routine
- Meal Planning
- Immunization requirements (i.e., yearly flu shot)
- Any tests or exams not completed that are recommended by your Diabetes Warranty Program
It is also helpful to have a basic information sheet about your medical history (table 3). Much of your medical history does not change and is easy to update periodically. You can then bring a copy of your medical history, along with your Diabetes Warranty Program sheet, to any of your health care providers, such as your dentist, physician, nurse or pharmacist. It makes life a lot easier for them, and will allow more time for other important things during your appointment. As an example, I have listed my medical information in table 3.
Table 3: Diabetes Medical History
Name: Steven V. Edelman
Date of Birth: Sept. 6, 1955
Date of Diabetes Diagnosis: 1971
Type of Diabetes Therapy:
1971-1976: One injection per day (NPH/Reg.)
1976-1982: Two or three injections per day
1982 to present: Insulin Pump (Basal rate 0.7 units per hour and 5 to 10 units of Reg. pre-meals.
Incidence of hypoglycemia: once or twice a week, not at any consistent time, with symptoms of light headedness and dizziness. I no longer get palpitations and sweaty.
Other Medical Problems
- Retinopathy diagnosed in 1979 (received laser treatment to both eyes) Dr. Paul Tornambe is my Ophthalmologist (619) 558-9666
- Kidney disease diagnosed ~ 1985 (see Diabetes Warranty sheet for most recent Kidney tests) Dr. David Ward is my kidney doctor (619) 543-6737
- High blood pressure diagnosed ~ 1985 on 3 different medications (see list below)
- High cholesterol levels diagnosed ~ 1989 on medication
Recent Hospitalizations
None
Surgery or Operations
- Right middle trigger finger repair 1997
Medications
- Lispro (Humalog) Insulin in my pump (~45 units/day)
- Indapamide (Lozol) 2.5 mg one each morning
- Fosinopril (Monopril) 20 mg twice a day
- Diltiazem HCI (Cardizem CD) 180 mg twice a day
- Atorvastatin (Lipitor) 20 mg once a day at bedtime
- Aspirin 81 mg once a day
- Vitamin E 400 IU two capsules twice a day (4 total)
- Vitamin C 1000 mg twice a day (2 total)
Allergies
None
Important Family History (Heart disease, Cancer, Diabetes)
- Great Uncle (mothers side) and Grandmother (fathers side) with diabetes
- Grandfather (mothers side) died of a heart attack at the age of 65
- Several relatives on my father's side of the family died of stomach cancer.
If you discover that a test or exam has not been done, and is needed to comply with your Diabetes Warranty Program, you should discuss this with your care giver and request the test or exam. Phrase your comments and questions constructively and not too aggressive (i.e. Is it possible to please check my cholesterol levels next visit? My last values were done over a year ago and I am concerned about them.) Remember some physicians aren't accustomed to getting suggestions from their patients. You must work with your care giver in order to maintain your health and quality of life. Staying healthy is much easier when preventative measures are taken early. If your doctor has a hissy fit that you are taking responsibility for your health, then get a new doctor! It is that plain and simple.
In addition to following the Diabetes Warranty Program, you must be knowledgeable about the tests and be aware of what kinds of therapies are available for any abnormality or problem. Remember, it is not enough to just know your results. You must also understand them, and thus be able to seek out the best therapy available, if necessary. This is what Taking Control of Your Diabetes is all about.
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