Making diabetes care less costly

Dr. Victor Sierpina

Dr. Victor Sierpina

Some good news came out recently for those with type 2, non-insulin dependent diabetics that will lower the burden and costs of your care. If your hemoglobin A1C (HbA1C) level is under 8 and you are on oral medications, you don’t need to monitor your glucose daily beyond the first 6 months of starting therapy. This is also true of those on medical nutrition therapy. A review of multiple studies by the Cochrane Collaboration found that monitoring home blood sugars 4-7 times a week in such patients does not reduce the HbA1C more than less frequent self-monitoring of 1-2 times a week.

This is good news since the cost of glucose strips and the discomfort and inconvenience of daily finger sticks has long been a nuisance to patients. Diabetes is a costly disease already in terms of human suffering from serious issues such as heart disease, kidney failure, blindness, and circulatory problems sometimes requiring amputation. It is also expensive to manage diabetes due to the costs of medications, monitoring, doctor visits, testing supplies, special shoes, and hospitalizations.

So at least, this one component of perhaps reducing your monitoring frequency should make your life easier.  Consult with your doctor about this change in recommendations to make sure it is appropriate in your case.

There are a lot of other changes you can make personally to improve control of diabetes in your life. Of course, prevention is the best medicine. Even if you have a genetic, familial tendency to diabetes, heredity is not destiny. Maintaining a healthy weight throughout the lifespan, from childhood into the geriatric era is perhaps the single most powerful influence to prevent the development of diabetes.

Next, regular physical activity and exercise helps not only maintain a healthy weight but also improves how your body handles blood sugar, secretes insulin and other hormones. Regular exercise reduces the risk of developing diabetes and reduces risks of diabetes if you have it.

Some of my favorite recommendations for those who are at risk for diabetes, have the so-called metabolic syndrome or “pre-diabetes,” or have full blown diabetes are the following: 

  • Eat brown instead of white foods. Instead of just focusing on avoiding sweets and sugar, focus more on eating whole grains such as brown rice, whole wheat bread, and other grains like barley, farro, quinoa, sweet potatoes, and whole grain pasta. Eat these instead of white flour, white rice, white bread and pastry, white potatoes, and white pasta. Brown carbohydrates are higher in fiber, lower in glycemic load, and help keep sugars in better control
  • Eat lots of anti-oxidants which means abundance of fruits, vegetables, berries, nuts, even dark chocolate as my recent columns discussed. These can help improve eye health, reduce cardiovascular risk, the leading killer in diabetics, and also reduce cancer risk.
  • Consider supplements that may further improve diabetic control or reduce risk such as chromium, cinnamon, fish oil, bitter melon, or nopales.
  • Learn to manage stress as effectively as you can as stress hormones like cortisol and epinephrine worsen diabetes control, raise blood pressure, and negatively impact the cardiovascular system.
  • Don’t smoke. Smoking tobacco if you are diabetic is like pouring gasoline on a fire in accelerating progression of the disease.

 Diabetes, or “diabesity” is now epidemic in our country among children and adults. Following some of these simple guidelines can help protect you from the ravages of this disease.  Work closely with your healthcare team including your nurse, dietician, fitness instructor, and physician to optimize monitoring, adjust drug therapy, and to minimize complications.

Dr. Sierpina is the W.D. and Laura Nell Nicholson Family Professor of Integrative Medicine and Professor of Family Medicine at UTMB. Published in the Galveston County Daily News.

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