Wednesday, 30 July 2014
What Does Good Care Look Like? - Part 2

While we specialize in eliminating eye problems, the eyes are really a reflection of your overall health status. Therefore, it is helpful to review what good care looks like. In this second part of our summary, we want to focus on diabetes.

Become more educated about diabetes 
Few family doctors have the time needed to answer a patient's many questions about their diabetes. But a doctor can refer you to diabetes educators who can provide added help and education. For example, a registered dietician may develop a meal plan that will help you manage diabetes and lose weight if necessary. If a doctor says "just avoid eating sweets" in response to dietary questions, this approach is too simple. Seek more detailed care elsewhere.

Doctors frequently work with certified educational programs so patients can learn skills such as blood sugar monitoring and how to incorporate exercise into diabetes care. If test results indicate early signs of kidney disease, eye disease, or out-of-control diabetes, referral to a specialist, like your eye doctor at Cool Springs or Donelson EyeCare, is customary.

Referrals, insurance and physicians
In addition to a family doctor, people with diabetes need to see diabetes specialists and other types of specialists. People treated with insulin and those with complications see specialists more often. 

The latest on preventing complications
People with diabetes are more likely to develop heart and blood vessel disease than non-diabetics. You can reduce the risk of developing these problems, but it involves more than just treating the sugar levels. Blood pressure and cholesterol (lipid) target levels for people with diabetes are lower than for those who don't have diabetes because of the risk of cardiovascular complications. Unless there is a reason that it would be unsafe, doctors recommend taking blood pressure-lowering medications and an aspirin a day to keep blood vessels healthy and prevent cardiac disease. Feet should be examined at every office visit for signs of circulation, nerve problems or unhealed sores. Patients with diabetes need yearly eye exams as well. These are just some of the vital basics of diabetes care - make sure you are getting them! Dr. Keg
Adapted from the article What Does Good Diabetes Care Look Like?  Richard S. Beaser, M.D., Director, Professional Education, Joslin Diabetes Center

Posted on 07/30/2014 1:26 PM by Dr. Susan Kegarise
Tuesday, 8 July 2014
What Does Good Diabetic Care Look Like?

While we specialize in eliminating eye problems, the eyes are really a reflection of your overall health status. In this summary we focus on diabetes. The eyes can be a reflection of diabetic control and care. People with diabetes need to be active participants in their medical care to know what excellent diabetic care looks like. Here are some things you should look for --whether you are newly diagnosed or have had diabetes for awhile:

What tests to do when
Below are tests everyone with diabetes should have, when they should have them and what the target results are.

Key Diabetes Tests
Test                       Frequency            Target
Hemoglobin A1c      2-4 times yearly    Under 7
HDL cholesterol       Yearly                  Over 45
LDL cholesterol        Yearly                 Under 100
Triglycerides            Yearly                 Under 150
Blood Pressure        At least 2x yearly  Less than 130/80
Microalbumin           Yearly                  Under 30
Eye exam                Yearly                  Discuss problems
Foot exam               At east visit          Discuss problems

If the doctor says test results are good, but doesn't say what the actual results are, ask. Compare what is said with the results above. If the doctor has different target levels than those listed (which is certainly possible for various medical reasons), ask why. Both Optos retinal imaging and dilated retinal exams have been proven effective in monitoring the retina for diabetic changes. Our doctors make it a point to discuss your retinal findings with you. There are other eye changes that can result more often in our patients with diabetes. However, as a general rule, the better you maintain your systemic diabetic health, the fewer eye complications you will have.

Posted on 07/08/2014 9:37 AM by Dr. Susan Kegarise
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