Treatment for type 2 diabetes

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1 Fall 2003 A nonprofit independent licensee of the BlueCross BlueShield Association Formerly known as Healthy Horizons Health and wellness news for members with diabetes Treatment for type 2 diabetes Type 2 diabetes usually affects will decide the best diabetes plan adults over age 40. However, it is for you. also possible for younger people to develop this disease. Why do I need medicines If you are diagnosed with type 2 for type 2 diabetes? diabetes, healthy eating, exercise With type 2 diabetes, the pancreas produces enough insulin, and weight loss may help lower your blood glucose (also called but the body doesn t properly blood sugar). If these treatments use it. You might also get type 2 do not work, you may need one diabetes if you weigh too much or more types of diabetes pills or don t exercise enough. to lower your blood glucose. Once you ve had type 2 diabetes for a few years, your body may Eventually, you may need to take insulin shots if your body doesn t stop producing enough insulin. make enough insulin on its own. You will then need to take insulin You, your health-care practitioner and your diabetes educator Continued on page injections to supply what your 2 Welcome! We are pleased to bring you our latest disease management newsletter, designed especially for you and others living with diabetes. In this issue, you ll learn about medications to control type 2 diabetes, the ABCs of diabetes control, the importance of micro management and a new education and support service available to help you manage your diabetes over the phone in the comfort of your own home! We hope you enjoy this newsletter, and we re pleased that you are part of our Diabetes Management Program. If you do not wish to be enrolled in our program, please call Disease Management toll free at (Utica, Central New York and Central New York Southern Tier Regions) or (Rochester Region) to be removed from our mailing list. November is National Diabetes Month!

2 Treatment for type 2 diabetes Continued from front page body can no longer make on its own. What do I need to know about insulin? If your pancreas no longer makes enough insulin, you will need to take insulin injections. The insulin is injected just under the skin with a small, short needle. Can insulin be taken as a pill? No. Since insulin is a protein, your body would quickly break an insulin pill down and digest it before it could get into your blood to lower your blood glucose. How does insulin work? Insulin lowers blood glucose by moving Control your diabetes the ABC way Because heart disease is more likely to strike someone with diabetes and at an earlier age than someone without the disease, we want you to be heart smart. The good news is that you can take control of your diabetes and live a longer, healthier life by knowing your ABCs. A is for A1C The A1C (A-one-C) Tip Tip Never skip a meal when taking insulin injections. test (short for hemoglobin A1C) measures average blood glucose (sugar) over a threemonth period. Suggested target: below 7 percent B is for blood pressure High blood pressure makes the heart work too hard, so it is important to keep it in control. Suggested target: below 130/80 mm Hg glucose from the blood into the cells of your body. Once inside the cells, glucose provides your body with energy. Insulin will lower your blood glucose whether you eat or not, so you should always eat on time when taking insulin. C is for cholesterol Bad cholesterol, or LDL, builds up and clogs the arteries. Suggested LDL target: below 100 mg/dl Questions to ask your health-care practitioner: Take action now Lower your risk for heart attack, stroke and diabetes problems by: Getting physical activity every day. Eating less fat and salt. Eating more fiber choose whole grains, fruits, vegetables and beans. Maintaining a healthy weight. Quitting smoking ask your health-care practitioner for help. Taking medicines as prescribed. Asking your doctor about taking aspirin. Asking others to help you manage your diabetes. What are my ABC numbers? What should my ABC target numbers be? What should I do to reach my ABC target numbers? 2

3 About the doctor... Frank Dubeck, M.D. has served as the chief medical officer of Excellus BlueCross BlueShield, Utica Region, since 1999 and has had medical oversight responsibility for all areas of managed care in the region, including utilization management, quality, credentialing and medical policy. He is the Excellus BCBS medical director in charge of diabetes disease management. Prior to joining Excellus BlueCross BlueShield, Dr. Dubeck practiced internal medicine for 20 years. Do: Seek treatment as soon as you notice any problem with your feet. Check your feet daily for redness or sores. Wear well-fitting shoes. Visit a foot care specialist (podiatrist) to treat all foot concerns, such as corns, ingrown toenails and sores. Don t: Wear sandals or go barefoot, even around your house. Treat corns, calluses, bunions, ingrown toenails or other foot problems without first visiting your health-care practitioner. We re excited to announce that we ll be adding an Ask the Doctor column beginning in our next issue. These answers are not a substitute for seeking medical care from your health-care practitioner. Questions will be printed anonymously, along with answers provided by Frank Dubeck, M.D., Regional Vice President and Chief Medical Officer for Excellus Foot care dos and don ts Use heating pads, electric blankets or hot water bottles on your feet. Wear garters or tightfitting knee-high stockings. Trim your toenails. If you can t easily reach your toes, or if you have loss of feeling in your feet, have your nails professionally trimmed. Use scissors, clippers, sandpaper or any other tool to cut off calluses or dead skin from your feet. Wait! When you notice something serious with your feet, get treatment immediately. Got questions? Ask the doctor BlueCross BlueShield, Utica Region. If you have a question for this column, you can it to: or mail it to: Diane Butler, R.N. Excellus BlueCross BlueShield 12 Rhoads Drive Utica, NY

4 Your body.. The good news is that it is never too late to start exercising. It wouldn t make sense to take better care of your car than you would your own body, would it? Yet that s exactly what many of us do. We fill our cars with premium fuel and take them in for regular preventive maintenance. Chances are, most of us give our car s engine a workout every day to keep it running smoothly and reliably. Just think how difficult it is to start a car after it has been sitting idle for several weeks or months due to inactivity. Perhaps we should think of our bodies in terms of cars when it comes to staying healthy. Imagine if our bodies came with the following warranty information: Fill your body with recommended fuel from the U.S. Department of Agriculture s Food Guide Pyramid. Add water daily (six to eight glasses). Schedule regular maintenance tune-ups with your health-care practitioner. Try to get at least 30 minutes of physical activity/exercise most days to work your engine. It is also important to park your body in the garage for about eight hours of rest each night, with additional rest/relaxation periods as needed. 4 No excuses for ignoring your warranty We ve all heard the usual excuses for not exercising. Too old, too busy, too tired, too out of shape,

5 .the car? too something... Maybe you ve never exercised. Maybe you used to, but stopped. Maybe you ve just been diagnosed with diabetes and feel like you ll never be fit again. Exercise is not just for people with diabetes it s something nearly all of us should be doing to be healthier and improve our fitness levels. The good news is that it is never too late to start exercising. Once you start, you ll be amazed how quickly the excuses fade, and you ll wonder why you didn t begin sooner! A thousand-mile journey begins with the first step We know that the first step is always the toughest. Before you begin any exercise program, you should visit your health-care practitioner to get a thorough medical exam. He or she should help determine your level of fitness and, in some instances, provide an exercise prescription for types of exercise or exercise programs that are good choices for you. Some complications of diabetes make certain types of physical activity bad choices, so ask your health-care practitioner if you are unsure. Walking, for example, is good exercise, but may not be the best exercise for everybody. There are individuals who need to try nonweight-bearing exercise such as swimming. Some people may need to begin with exercise they can do while sitting. Remember, the benefits of an exercise program need to outweigh the potential risks. What s next? Once your health-care practitioner has given the go-ahead to start exercising and provided some recommendations, what s next? For many, it will be overcoming psychological barriers. Some people believe they aren t exercising properly unless they re sweating bullets and completely exhausted. The truth is, exercise can still be beneficial and enjoyable without reaching a no pain, no gain level. Remember that even some activity is better than none at all! How much exercise is enough? The 1996 Surgeon General s Report on Physical Activity and Health says people should get at least 30 minutes of moderate exercise five days a week. If that seems too intense, try making exercise a regular part of your day by doing shorter bouts of activity, multiple times a day. Breaking up exercise into smaller amounts can help make what once seemed like an overwhelming task more manageable and you ll be more likely to stick with it. For example, try walking for 10 minutes, three times a day; or for five minutes, six times a day. In general, 20- to 30-minute exercise sessions are recommended to improve heart and lung function, but the right length and type of exercise is different for everyone. Check with your healthcare practitioner to see what starting amount is best for you. 5

6 Tip 6 To enroll in the Care Calls program, call , option 1. New program offers diabetes support over the phone Living with diabetes can be challenging, regardless of the stage of the disease. To help our members meet the challenges of living with diabetes, Excellus BlueCross BlueShield offers a free, new telephone education and support program specially created to help you better understand and manage your diabetes. Known as Diabetes Care Calls, the program pairs eligible participants with a registered nurse knowledgeable in diabetes care. That person will work with you to design a personalized program based on your individualized needs. The nurse can also help you understand the link between diabetes and heart attacks, stroke, high blood pressure, high cholesterol, depression, kidney or nerve damage and loss of sight or blindness. A Care Calls nurse can also discuss: An overall view of diabetes and diabetes care. Blood glucose goals and how to achieve the best glucose readings for good health. Lifestyle changes associated with improving blood glucose readings (i.e., discussions about nutrition, activity, coping strategies for stress management and smoking cessation, if desired). Medications you might be using to help with diabetes, blood pressure and cholesterol control. Prevention of short- and longterm diabetes-related problems. Your nurse will even help you obtain a new glucose meter if you need one, as well as provide information about community and online resources helpful for managing your diabetes. Who benefits? Members with questions about living with diabetes. Members recently diagnosed with diabetes. Members who want information focused on skills and tools for effective self-monitoring and self-management of diabetes. Anyone who would like to review and update their current knowledge of diabetes information. Anyone who has difficulty controlling or managing any aspect of diabetes care (i.e., blood sugar readings, nutrition, high blood pressure and high cholesterol). Anyone overwhelmed with all the different aspects of diabetes care. How do I enroll in the Care Calls program? If you would like to enroll or if you are interested in more information about the Care Calls program, you may call toll free and press option 1. One of our Care Calls nurses will be happy to speak with you. The Care Calls program is just one of our many disease management programs that provide education, management tools and support to our members who live with chronic illnesses, such as diabetes.

7 New Web site offers diabetes care tips A new Web site is available to help educate Excellus BlueCross BlueShield members with diabetes. By visiting educationcenter.com, you will find a wealth of information regarding foot care, eye care, blood pressure and much more. To access this site, just follow these easy steps: 1. Type center.com into your browser bar. 2. Click on the language that you prefer English or Spanish. Micro management Microalbuminuria is an important test that detects and measures microscopic amounts of protein in the urine that can lead to kidney disease. People with diabetes should get a microalbuminuria (MAU) test every year because they are more prone to 3. Type in EXC for your ID. 4. Type in your password. You will choose your own password consisting of three letters and six numbers. Example: abc Click the box that says Click here if you are a new user. The first box only needs to be checked the first time you visit the Web site. 6. Click whether you are male or female. 7. Now you re ready to get started. The Web site includes information on the following elements of diabetes care: have damage to the small blood vessels in the kidneys than someone without diabetes. The MAU test is usually done in a laboratory where a small urine sample is collected. If protein is found, your health-care practitioner can order medication for you (usually an ACE inhibitor) that may actually lessen Eye care A1C levels Foot care (there is a magnifying glass that you can wave over a foot to see why routine foot care is so important) Cholesterol Microalbuminuria (protein in the urine) Blood pressure When you go through the six interactive sections, you ll also find useful tip boxes and tasty, diabetes-friendly recipes to try at home. the protein that is present, which, in turn, could prevent kidney disease. Be sure to discuss this important test with your health-care practitioner during your next visit. This newsletter is sponsored by an educational grant from the following companies: Roche, LifeScan, Aventis and Lilly. Member information is not provided to any pharmaceutical company without member permission. 7

8 Diabetes standards of care Test Recommended Dates completed Complete physical exam Yearly Foot exam (always remove your socks At each doctor visit and shoes) (self-exam daily) A1C test (a blood test ordered by your Two to four times a year health-care practitioner that gives your average blood sugar over a three-month period) A1C level (if the level is 7 percent or more, Less than 7 percent work with your health-care practitioner to make changes on your diabetes management care plan) Dilated retinal eye exam (performed by an ophthalmologist or Yearly optometrist) Cholesterol/triglycerides Yearly Microalbuminuria (urine test for protein) The American Diabetes Association recommends that people with diabetes have the following tests. Speak with your health-care practitioner about these important tests. You can cut out the table below and carry it with you as a reminder. Yearly Healthier Living is published as an informational service for our members. The information contained in this newsletter is not intended to provide medical advice to take the place of medical care. Any questions you have should be brought to the attention of your health-care practitioner. We welcome your comments and suggestions by writing to the editor at: Healthier Living c/o Quality Management Department P.O. Box 4809 Syracuse, NY HLN15123 Diabetes Control Network available Excellus BlueCross BlueShield invites you to join a diabetes education and management program specially developed for people with diabetes. The Diabetes Control Network is a free patient support program that can help you learn more about diabetes and how to control it. Once enrolled, you will receive: Monthly newsletters A goal-setting journal Tools such as a foot mirror, pedometer and pill box If you would like to join, please call (toll free) This program is supported by Pfizer pharmaceuticals.

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