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Diabetic Protocols


In this post I continue exploring Type 2 Diabetes.  This time I share common labs and protocols followed when caring for the Type 2 Diabetic.  I hope this short message will help you understand the reasons for recurrent testing and follow up routines.

Diabetic Protocols:

1)Routine office visits every 3-6 months:  Usual tests for average blood sugar control only change… slowly over 3-4 months.  So a minimum of 3 month intervals is usually preferred for retesting.  This also allows for visitation time to discuss diet and lifestyle changes which make the most difference for diabetics.

2)Routine Labs:

  • Hga1c (Hemoglobin A-ONE-SEE) This is the average blood sugar test.  It measures your average sugar over a 3 month period.  It is a scaled number corresponding to blood sugar.  (Example:  Hga1c >6.5 usually indicates average blood sugar 126+.)
  • Fasting Cholesterol Panel:  Usually performed every 6 months.  Cholesterol is not disease but high readings or irregular cholesterol profiles provide clues as to the overall health of your metabolism.
  • Microalbumin:  Specialized urine test screening for leakage of vital proteins into the urine.  This protein leakage is an indicator of damage in the kidneys due to diabetes.

3)Lifestyle Factors

  • Diet:  At FFFM we believe that diet plays a huge role in diabetes development and recovery.  We in fact believe that patients can actually acheive Diabetic Remission.  (Listen here for Podcast on Diabetic Remission).  At nearly every visit you should be asked about meals, snacks, and your typical eating habits.  Eating simple sugars (Bread, cereals, potatoes, sweets, candy, sodas, and alchohol account for the vast majority of dietary triggers for diabetes)  Get rid of those foods and you are a long way to conquering diabetes.
  • Fitness:  Latest research in fitness and human health suggests we are aerobic creatures.  We were meant to move miles daily.  Inactivity fuels the sluggish metabolism that causes diabetes.  The more muscles you build typically the better diabetic control you will have.  You should be prepared to discuss fitness routines at each diabetic office visit.

4)Physical exams

  • Yearly Retinal Exams:  Small vessels in the back of the eyes are very susceptible to damage from diabetes.  Even if you vision seems “Good” yearly screenings are imperative.  Damage can occur without obvious symptoms….initially.  Diligence pays off for saving eyesight.
  • Foot Exams:  Annual examinations are recommended to check nerve conduction and assess for areas of concern.  Diabetics often develop neuropathy (painful or deteriorating sensation) in their feet.  Remember to take your shoes off for the doctor when starting your routine diabetic exams.
  • Blood Pressure Monitor:  Diabetics with High blood pressure are at higher risk of heart attack, stroke, and kidney disease.  Our goal would be to keep your bp below 120/80 or less.

5)Medication Adherence 

Medications do not prevent diabetes.  Medications do not necessarily save someone from the disease of diabetes.  Diet and lifestyle choices play the biggest role in actual treatment.  That said, in some instances medications are used.  If offered medications for blood pressure or blood sugar, one should consider this a serious step and take as routinely as possible.  Report side effects to your doctor and continue to strive for necessary lifestyle modifications.  Medications can be removed!

I hope you will look forward to the next post on Diabetes….on Diabetic Remission


Diabetic Facts

Diabetic Statistics

(2012 National Diabetes Statistics Report, 2014 released June 10, 2014)

  • 29.1 Million Americans are diagnosed with Type 2 Diabetes (Nearly 10% Population!)
  • 22 Million more Americans are undiagnosed
  • 25% Americans over 65 years old have Type 2 Diabetes
  • In 2010, 86 million people over 20 years of age have Pre-Diabetes
  • In 2012, 1.7 million new cases were reported

Diabetic Complications

Type 2 Diabetes is certainly commmon, affecting nearly 30% of the American population in some capacity.  But why do we care?  What’s the fuss?  Unfortunately diabetes has numerous major life-threatening consequences given enough years or when ignored.

  • Hypoglycemia: In 2011, about 282,000 emergency room visits for adults aged 18 years or older had hypoglycemia (LOW BLOOD SUGAR) as the first-listed diagnosis and diabetes as another diagnosis.
  • Hypertension: In 2009–2012, of adults aged 18 years or older with diagnosed diabetes, 71% had blood pressure greater than or equal to 140/90 millimeters of mercury or used prescription medications to lower high blood pressure.
  • CVD Death Rates: In 2003–2006, after adjusting for population age differences, cardiovascular disease death rates were about 1.7 times higher among adults aged 18 years or older with diagnosed diabetes than among adults without diagnosed diabetes.
  • Heart Attack Rates: In 2010, hospitalization rates for heart attack were 1.8 times higher among adults aged 20 years or older with diagnosed diabetes than among adults without diagnosed diabetes.
  • Stroke: In 2010, hospitalization rates for stroke were 1.5 times higher among adults with diagnosed diabetes aged 20 years or older compared to those without diagnosed diabetes.
  • Blindness and Eye Problems: In 2005–2008, of adults with diabetes aged 40 years or older, 4.2 million (28.5%) people had diabetic retinopathy, damage to the small blood vessels in the retina that may result in loss of vision.
  • Kidney Disease: Diabetes was listed as the primary cause of kidney failure in 44% of all new cases in 2011.
    • In 2011, 49,677 people of all ages began treatment for kidney failure due to diabetes.
    • In 2011, a total of 228,924 people of all ages with kidney failure due to diabetes were living on chronic dialysis or with a kidney transplant.
  • Amputations: In 2010, about 73,000 lower-limb amputations were performed in adults aged 20 years or older with diagnosed diabetes.
    • About 60% of non-traumatic lower-limb amputations among people aged 20 years or older occur in people with diagnosed diabetes.

    – See more at: http://www.diabetes.org/diabetes-basics/statistics/?referrer=https://www.google.com/#sthash.frAjP0Zh.dpuf

Diabetic Good News

At Future Focus Family Medicine we believe that diabetes doesn’t have to be a death sentence!  The sobering statistics I listed above serve as a reminder of the magnitude of the problem.

My clinical experience however reveals that with SPECIFIC lifestyle interventions can make enormous changes for individuals willing to explore those options.



Facing Challenges

“Sometimes even to live is an act of courage”

I have a family member having a major surgery today. I am reminded how quickly life can change and how the best plans must face contact with the world.

We all must play the hand we are dealt in life. I believe our attitude during turmoil or rocky times defines our life. Negativity, pessimism, despair, and anger are natural tendencies for many but choices all the same.

You got this!


Food Journaling


Food journals are a great tool to identify areas of your diet which could use improvement.  We often do not realize the type and quantity of foods we blinded graze upon.  My patients often express surprise when they journal daily consumption habits.

Food journaling is a measurement tool.  That which we measure gets managed.

In this post I will give tips on how to food journal and provide key tips for improving dietary habits. [click to continue…]


Fail Forward Fast


Failures, repeated failures, are finger posts on the road to achievement. One fails forward toward success.  

C.S. Lewis


My topics often focus on motivational themes, fitness, proper nutrition and general higher function living. We all secretly want to be high performing goal crushing machines.

But sometimes that doesn’t happen. [click to continue…]