The Diabetic Diary:

Diabetes is a tough disease that can progress rapidly or slowly and involves every organ system in the body. It is hard work to stay on top of the many requirements needed to maximize wellness.

When coping with diabetes it is not enough to guess how well it is going. Every person with diabetes must become something of a scientist. Close monitoring of every aspect of diabetic care is essential. Directed care and some trial and error personal findings empower a person with diabetes to attain better control.  To help monitor your wellness, you ought to keep a diary.

One of the greatest concerns is the progression of blood vessel damage that will shut down heart, kidneys, vision, or compromise blood flow to the legs. Many of the complications of diabetes can be slowed by close control of blood sugar. Lipid control is tough but also essential to diabetic care.

Include the following in your diary:

• Blood sugar checks should be done often. Blood sugar values should be placed in a diary showing blood sugars at different times of the day. These are to be reviewed with the physician so a mutually acceptable improved plan of control can be developed.
   
• Hemoglobin A1c monitoring. Every three to four months it is important to have blood drawn to evaluate Hemoglobin A1c. Red cells live about 120 days. This blood work is a measure of the percent of red cells of the blood which are "sugar coated" over the 3 to 4 months of the red cell’s life time. The ideal is between 5 and 6 percent. This reflects a blood sugar between 80 to 120. For each percent the average blood sugar rises 30 points. The value of Hemoglobin A1c placed in the diabetic diary allows evaluation of true long term success of blood sugar control. A value of 8 reveals an average blood sugar greater than 200 over three months. This is very poor blood sugar control. Most are content with a value of 7 or less.
   
• Some foods may increase or lower blood sugars. Make note of which foods do this in your chart. Some are common to all. Simple sugars make it hard to control diabetes. For some tomatoes or peaches may raise blood sugar to very high levels. By logging good foods and dangerous foods it is possible to develop a menu that gives day to day control and long term control of blood sugars.
   
• Even with good cholesterol levels, diabetes causes heart disease. Controlling fats in the blood stream protects the kidneys and slows the rate of other vascular disease. When blood is drawn for the Hemoglobin Alc, a lipid profile can also be gotten. Total cholesterol goal is 160, bad (low density lipids) 100, good cholesterol (high density lipids) 45 or better. Triglycerides should be below 200. Low fat diets are tough to do in the United States, but those with diabetes must be tougher still. Dieticians and health care providers can help with proper diet advice.
   
• Blood pressure control is essential. It is worth the investment to obtain a blood pressure kit that is easy to read, with both blood pressure and pulse monitoring. A pulse in the fifties or lower or in the high eighties or higher can signal heart disease. By reviewing this information in the diary, a physician can choose medicines safer or more helpful to the person with diabetes.
   
• Exercise is vital to blood sugar control. By logging the nature and length of exercise done, it is possible to see if new regimens need to be developed. Sometimes simple adaptations make exercise feasible. Exercise helps also to keep blood clots (thrombosis) from damaging heart, legs, eyes, by activating the bodies natural clot busters.
   
• Medication schedules and over the counter medicines need to be in the diabetic diary. It is helpful to keep track of old and new regimens. Some medicines might not have been well tolerated, or worked really well. Personal notes regarding these are invaluable.
   
• Eyes, thyroid and kidney function is also to be checked at least each year. Feet more often. Please tell your medical care provider of any eye problems or foot wounds or numbness.

The reward for all this hard work is better health and a smile of joy from the health care folks.