So I am a diabetic, now what?

So your doctor calls and tells you are a diabetic, as if you know what that actually means...She tells you some mumbo-jumbo about goals, medications--none of which you actually understand. So let's break it down:


Goals: Your goal at this point is to get your HgbA1C below 7%. Whether that is through diet, oral medication, insulin--you and your doctor are going to have to figure out a goal and plan--which may change a few times along the way. Some medications are pretty standard, some are better than others, some are more expensive than others. This is where we talk about the art of medicine.


Medications: there are some medications that every diabetic should be on (if tolerated):

Metformin: this is going to make your own insulin receptors more sensitive. Some people will have GI issues associated, or other reasons why it is not tolerated. Though for the most part, this is one you want to be on. Metformin has gotten a bad rap in the past, though the benefits strongly outweigh the risks.


Statins: by default, a diabetic has vascular disease. The statins in this case are used for plaque stabilization. Whether you actually have "high cholesterol" or not, this is will decrease you risk of heart attack and/or stroke.


ACE-inhibitor/ARB: These are renal protective in diabetics. These are traditionally used for high blood pressure, though in diabetics they can serve a dual purpose of renal protection. You doctor will follow your microalbumin/creatinine ratio. If this is greater than 30, you really want to be on one of these medications.


Obviously there is more to being a diabetic. Though this is a great start, and may trigger some questions you have for your own doctor. Everyone is going to have different goals, tolerances, side effects...these need to be directed therapies to each individual!


...until next time.

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