Diabetes For Dummies Cheat Sheet

Screening guidelines for diabetes

The American Diabetes Association created guidelines to screen for diabetes at the earliest possible appropriate time. Take a look at these guidelines to find out when to get tested for diabetes:

• People with symptoms of thirst, frequent urination, and weight loss should be tested immediately.
• People older than age 45 should be tested every three years if normal.
• People should be tested at a younger age and more often if
  • They are obese
  • They have a parent or sibling with diabetes
  • They are from a high-risk group, such as African American, Latino, Asian, or Native American
  • They have delivered a baby more than 9 pounds or had gestational diabetes
  • They have high blood pressure
  • They have low HDL cholesterol or high triglycerides

7 rules for diabetes control

Diabetes doesn’t have to rule your life. Be proactive! Follow these guidelines for controlling your diabetes, and your problems should be few and far between:

• A positive attitude: View diabetes as an opportunity to make healthier choices; a positive attitude results in better control of your blood sugar.
• Proper nutrition: Work with a dietitian to develop a great eating plan.
• Enthusiastic exercising: Burn off calories and help your heart.
• Preventive planning: Practice meal planning at home and review the menu before you go out to eat.
• Major monitoring: Monitor your blood sugar before and after exercising and meals.
• Tenacious testing: Check your blood glucose at correct intervals and have your doctors regularly screen you for complications.
• Lifelong learning: New things are being discovered and you need to know about them.

Standards for continuing your diabetes care

Managing diabetes requires regular doctor visits that include standard monitoring of various diabetic factors. Following, are guidelines for your diabetes care — like when to see your doctor, what should happen at each visit, when to have lab tests done, and how often to self-monitor blood glucose.

Consistent diabetes management is key; if test results show any change from your history, then you and your doctor can address them before any problem worsens.

Frequency of visits:

• Daily if starting insulin

• Weekly if starting oral drugs

• Monthly if not stable

• Quarterly if stable

History at each visit:

• Frequency of hypoglycemia

• Results of blood glucose self-monitoring

• Changes in treatment

• Symptoms of complications

• Psychosocial issues

• New medications

Physical at each visit:

• Blood pressure

• Weight

• Foot exam

Physical at least annually or every two years if eyes are stable:

• Dilated eye exam by eye doctor

• Filament test for foot sensation

Lab tests:

• Hemoglobin A1c every three months

• Fasting lipid profile yearly

• Microalbumin measurement yearly if urine protein negative

Frequency of blood glucose self-monitoring:

• Before meals and bedtime for person with type 1 diabetes

• Before breakfast and supper for person with type 2 diabetes

• Once daily for person with stable diabetes

• Before and one hour after meals for pregnant woman with type 1 diabetes or gestational diabetes

Oral drugs for Type 2 diabetes

Insulin shots aren’t the only drug treatment for diabetes. Oral medications are the first line of treatment if diet and lifestyle strategies aren’t enough to control your HbA1c, with insulin reserved for those who don’t respond sufficiently to tablets.

The following describes the most commonly prescribed groups of medications for treating diabetes. Remember, there may be several drugs in each class, with different brand names that vary between countries.

Metformin

Often the first line medication, with low risk of hypoglycemia side effects

Sulfonylureas

Powerful medications that reduce blood sugar very effectively and can be associated with hypoglycemia

SGLT2 inhibitors or flozins

A newer group of drugs that are less likely to cause hypoglycemia and are particularly useful to add protection for people who are at increased risk of heart disease or heart failure.

Thiazolidineones or glitazones

The first group of medications that act by reducing insulin resistance. The first example of this class of drugs has been the subject of controversy about possible associations with serious side effects.

DPP-4 inhibitors or gliptins

A group of drugs that work by effecting hormones that are produced when you eat. This class of medications is becoming more popular to gain better control of glucose metabolism.

Meglitinides

These medications encourage the pancreas to produce more insulin. They’re increasingly used in combination with other medications

Navigating the U.S. health care system

Here we explore some of the issues that specifically relate to the U.S health care system.

In the United States, you can get insurance for your medical care several ways. The Patient Protection and Affordable Care Act (also known as ACA, PPACA, or Obamacare) has made it possible for many people who didn’t have health insurance to have some coverage. The following sections explain how the ACA  works with private insurance, Medicare, and Medicaid.

For more information on the Affordable Care Act and its provisions in your state, visit the Obamacare Facts website.

Employer insurance

Half of the U.S. population has insurance through its employer. Any employer with 50 or more employees must provide health insurance under ACA .

Employers with fewer than 50 employees have marketplaces set up by the government where they can buy less expensive insurance and may get tax breaks if they do. These marketplaces can’t charge more if the employee is sick or for a preexisting condition.

Government insurance

A third of the U.S. population has government insurance. Under the ACA, Medicare (elderly) insurance is similar to what it was before the act, but Medicaid has expanded to cover more poor people. However, the governor of each state must decide whether to allow Medicaid expansion in that state.

In states that agree to expand Medicaid, the government covers most of the costs. In those that don’t, no more poor people are covered than before.

Private insurance

A tenth of the population (30 million people) buys insurance. Currently, there are two major forms of payment for medical care — fee-for-service and capitated payment — with a lot of hybrids in between.

The old fee-for-service method pays the medical provider — whether a physician, a lab, or a hospital — based on the number of services provided. More services and procedures mean more profit for the provider. So, the incentive is to do more to make more money (not that providers would ever do more than is necessary for the money).

The other main method of reimbursement is capitation. Here, the provider gets a fixed amount of money for each patient. The risk is divided among many patients so that if one costs more, ideally another will cost less.

This system is the basis of the health maintenance organization (HMO), which hires physicians to provide the care. HMOs look to enroll people who cost as little as possible for their medical care.

Because they seem to end up costing less money overall, capitation plans are growing while fee-for-service plans are declining. The government is even encouraging HMOs to enroll Medicare recipients to reduce costs.

At the same time, the government requires HMOs to enroll people who cost more, like most people with diabetes.

Each state has a health insurance marketplace where insurance companies compete for your business by offering plans with more or less coverage that vary in cost from expensive to cheap.

These plans can’t charge more for people who are sick or have preexisting conditions. The federal government gives tax credits to those individuals with incomes below a certain level.

Regardless of cost, all plans cover doctor visits, hospital visits, maternity visits, and mental health visits. Children can remain on their parents’ plan until age 26 and can buy low-cost catastrophic coverage until age 30.

If you don’t know what your state marketplace is, start with Healthcare.gov.

As a health care consumer, you want to look for a large group containing many patients because such a group can spread out your extra expenses among many people who don’t consume as much medical care. Before you sign up, ask several questions:

• What is your total annual cost, and how often is a payment required?
• Will you have a deductible, meaning that you have to pay the first so-many dollars before the insurance starts paying?
• Will you have a copayment, meaning that every time you use a provider, you have to pay some dollars?
• Does your plan pay for durable medical equipment, like an insulin pump (see Chapter 11), which can be very expensive? (You want to ask this even if, when you sign up, you may not foresee a need for it.)
• Will your plan pay for your diabetes medication and diabetes supplies, and to what extent?
• Can your physician order any medications you need, or are they restricted to certain medications?
• How often will you need to travel to the pharmacy to pick up medications? (Some plans make you go back every 30 days.)
• Are you covered for specialists, particularly eye doctors and foot doctors?
• Are you limited to certain hospitals, certain physicians, and certain laboratories? (If so, this restriction may be inconvenient for you, not to mention possibly requiring you to change from a physician with whom you’re very comfortable.)
• Is home health care included in the plan, and to what extent?

After you sign up for a plan, you need to be vigilant to be sure you’re getting what you paid for. You and your physician may need to make many phone calls to get what you need, but if you persist, you can often come away with a “Yes.” The insurance company may provide goods and services that are excluded in your original contract if you’re persistent.

Supplemental insurance and brokers

Many Americans, especially elderly ones or those with chronic health concerns, invest in supplemental insurance care. Medicare Supplement Insurance (Medigap), for example, helps fill “gaps” in original Medicare coverage and is sold by private companies.

For more info, visit the Medicare supplement insurance web page. You can also ask your doctor or contact your state for specific additional programs in your area that would best meet your needs.

State-run Department of Aging or Office of the Aging services are free to qualifying residents. Many offer the services of insurance brokers who can help you get the best coverage possible within your budget.

No insurance

Another significant amount  of the U.S. population doesn’t have any insurance, even under ACA (PPACA), which mandates a fine if you have no insurance, but the government waves the fine if you absolutely can’t afford to buy insurance.