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Diabetic Complication Screening: What You Need to Know – Dr. Bingham, January 18, 2012

lwaecker 18:57:55:
How often should you screen for diabetes?
Dr. Bingham @ Unity 19:00:32:
Welcome to the Unity Diabetes Online Community! I’m Dr. Bingham. I’m glad you could join us for our latest online chat today. Today I will share some advice on diabetic complication screening and answer as many of your questions as possible during our allotted time together.

Before we get started let me just tell you how we’ll address your questions and comments today. I answer questions one at a time, in the order that they are posted to the site, and there might be a slight delay as I respond to each question.
Dr. Bingham @ Unity 19:02:55:
It may take a few minutes for me to type answers to your questions, so please stay logged-in to the chat to see my response, even if it takes a few minutes. And you might need to refresh every few minutes to keep up with the latest posts in the chat if you switch to another application on your computer.
Dr. Bingham @ Unity 19:03:26:
Tonight we have a specific topic that we want to focus on for the most part, but please feel free to ask any questions you might have, whether they’re related to the topic or not – we want this chat to benefit you in any way possible! Let’s get started.
lwaecker 19:04:21:
How often should you screen for diabetes?
Dr. Bingham @ Unity 19:04:38:
In reference to the question of how often to screen for diabetes – I don't believe that there is any one single recommendation for everyone. The frequency depends upon the person's risk of diabetes.
Dr. Bingham @ Unity 19:05:48:
Typically I think that patients should be screened for diabetes whenever they have a complete physical exam with their primary care doctor. The frequency of physical exams increases as we get older.
Dr. Bingham @ Unity 19:07:03:
If someone is diagnosed with pre-diabetes – they should be screened yearly for evidence of progression to diabetes. Also – if a patient has multiple risk factors for diabetes, if they are thinking of starting a family – it is good to screen prior to getting pregnant.
K77DF 19:07:38:
My doctor does an A1C test every year -- what kind of results should I look for?
K77DF 19:08:04:
And what does an A1C test tell you?
Dr. Bingham @ Unity 19:09:16:
Great question – most labs have a normal range where < 6% is normal. According to the newest guidelines an A1C of 5.7-6.5% indicates pre-diabetes and an A1C > 6.5% indicates evidence of diabetes.
J&R2001 19:09:41:
What do you think about being a male with diabetes having a test for testosterone if you are tired?
Dr. Bingham @ Unity 19:10:42:
The hemoglobin A1C measures the amount of sugar that "sticks" to red cells. Amazingly, this measurement tells us what your average blood sugar over the last three months has been. For example, an A1C of 7.0% indicates an average blood sugar of 170 mg/dl.
Dr. Bingham @ Unity 19:12:21:
Fatigue or feeling tired is one of the toughest symptoms to track down as almost any medical condition can cause fatigue. About 2 out of 3 men with diabetes have erectile dysfunction.
K77DF 19:13:14:
I see – so what if your A1C keeps creeping higher each year, but not quite to that pre-diabetes point? What should you do?
Dr. Bingham @ Unity 19:14:04:
Unlike what the TV commercials would suggest, fatigue is very rarely due to a low testosterone level. The commercials fail to mention that as we get older, testosterone levels in men tend to decrease. If the testosterone level is normal (even at the lower end of normal) – this is not usually the cause for fatigue or erectile dysfunction.
Dr. Bingham @ Unity 19:15:28:
If a person with diabetes has a screening testosterone level drawn it is extremely important to have the blood drawn first thing in the morning. There is a cycle of testosterone levels in men that varies based on the time of day – and it is completely normal for men to have "low" testosterone levels in the afternoon.
Dr. Bingham @ Unity 19:18:09:
If hemoglobin A1C is rising over time, I would recommend finding out what your estimated ideal body weight/BMI is (there are multiple websites for this). If you are substantially overweight, even a small amount of weight loss can lower average blood sugars and lower the A1C.
Dr. Bingham @ Unity 19:19:43:
The other excellent way to lower a "high normal" A1C is to exercise. Aerobic exercise (walking) has been shown to prevent the progression from pre-diabetes to diabetes. This effect was essentially regardless of weight loss.
Dr. Bingham @ Unity 19:23:00:
Jane, would you suggest someone to carry a journal about what they have done in accomplishing their overall goals? I know I have thought about a food journal to count calories but do you think that is effective?
Jane@Unity 19:20:23:
Is there anyone online who might want to share with the group their experience from a diabetes complication?
lwaecker 19:23:51:
That is a great point about the exercising. I know that my friend who has diabetes makes sure to do at least 30 minutes of cardio a day.
J&R2001 19:26:10:
What do you think is an important kidney test? How often should I check the health of my kidneys?
Dr. Bingham @ Unity 19:27:25:
Excellent. And when we talk about cardio, it doesn't have to mean joining a gym. In the largest study that was done to try and prevent diabetes, the exercise that was recommended was plain old walking. For patients with knee issues, a recumbent bicycle is often a good choice, or an elliptical machine.
K77DF 19:28:32:
What about eye health – any special exams diabetics need?
dhooper 19:28:34:
I use an elliptical machine. You will get in shape quickly on one of those.
lwaecker 19:30:17:
Yes you will dhooper :)
Dr. Bingham @ Unity 19:30:28:
For patients with diabetes I usually check a blood test called creatinine each time I have them check blood work for a hemoglobin A1C. It is recommended that you have a special urine test called microalbumin. This is usually the earliest sign of diabetic kidney damage.
Dr. Bingham @ Unity 19:31:46:
We recommend that you have an eye exam once a year. If the eye doctor states that you can return in two years – that is fine.
J&R2001 19:32:36:
What is the leading diabetes problem?
K77DF 19:33:33:
What eye complications do I need to worry about?
J&R2001 19:34:41:
My triglycerides are 950. How do I lower them?
Dr. Bingham @ Unity 19:35:08:
The biggest complication from diabetes is heart disease. Not to be morbid, but when someone with diabetes dies – the studies suggest that 75% of the time they die due to heart disease.
Dr. Bingham @ Unity 19:37:01:
There are many complications that can occur in the eye from diabetes. The two most common are fluid around the center part of the eye (macular edema) and bleeding in the retina.
K77DF 19:38:55:
I have to ask about the heart disease...is that because doctors miss it in diabetics for some reason?
Dr. Bingham @ Unity 19:39:21:
There are many causes for high triglycerides – this can run in families (genetic) – and we can't change genes (yet). Out of control diabetes can raise triglycerides, and they will come down quickly when the blood sugars are controlled. Alcohol is a huge cause of high triglycerides. Even relatively modest amounts of alcohol (2 drinks) can raise triglycerides for up to 4 days.
Dr. Bingham @ Unity 19:39:46:
Finally oral estrogen (either in birth control pills or estrogen replacement therapy) can raise triglycerides.
J&R2001 19:41:52:
Thank you Dr. Bingham...very helpful information.
Dr. Bingham @ Unity 19:42:41:
Heart disease is usually not "missed" – in fact primary care doctors are often very aggressive about screening for heart disease. To try and prevent patients with diabetes from developing heart disease we obviously try to control the blood sugars – but we are also very aggressive with other risk factors for heart disease (blood pressure, cholesterol, stopping smoking, etc.).
J&R2001 19:49:38:
One more question in regards to lipids. My HDL, someone told me is the good cholesterol, mine is low. What can I do to raise my HDL?
Dr. Bingham @ Unity 19:53:25:
HDL or good cholesterol is often low in people with diabetes. Unfortunately, again it is partially due to genetics. Lowering triglycerides can also raise HDL. Regular aerobic exercise can also raise HDL. Also stopping smoking can raise HDL.
Dr. Bingham @ Unity 19:54:15:
It is almost the top of the hour – are there any more questions out there?
Jbauch 19:56:27:
Thanks Dr. B, lots of great information!
J&R2001 19:58:28:
Jbauch, I agree. Great information Dr. Bingham.
Dr. Bingham @ Unity 19:58:28:
If there are no further questions – hope everyone has a good night.
Dr. Bingham @ Unity 19:58:50:
SIGN-OFF That’s all the time we have for today. I’ve really enjoyed our conversation and hope that I was able to provide some insight for you about setting goals for managing your diabetes this year. If we didn’t get to your question today or if you think of another question later on – feel free to jump into the conversation in the forum, or submit a question using our “Ask an expert” feature.
Dr. Bingham @ Unity 19:59:11:
Be sure to join us for our next chat Wednesday, February 1 at 7 p.m. with Jane Giambrone, Part 2 of her session on setting – and achieving – goals this year.
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