From the office of Robert S. Grimshaw Jr MD FACP Internal Medicine 3535 Hill Blvd Yorktown Hts NY 914 962-3180 GUIDES Recognized Provider  by the American Diabetes Association/National Committee for Quality Assurance 2/99-2/05

Your Guide to Diabetes 2002
part 1

What is Diabetes? Diabetes mellitus is the increase in blood sugar that happens either because there’s too little insulin (type 1 diabetes) or because the body’s cells can’t use insulin properly (type 2). Insulin is made by beta cells in the Islets of Langerhans in the pancreas, deep within the abdomen.
Who Gets It?  Some 15.7 million people - 5.9% of us - have it in the U.S.  It’s even more common in those over 65: 18.4%. You are more likely to get type 2 if:

‚    you’re over 45

‚    there’s a family history of it

‚    you’re overweight

‚    you don’t exercise much

‚    you have cholesterol issues

‚    your heritage is African,

Hispanic, Asia/Pacific Island or Native American

‚    you had gestational diabetes

(increased sugar during pregnancy)
“Pre-Diabetic” Conditions include Impaired Glucose Tolerance, (IGT), found in 20 million Americans or 11% of us.  They have the same heart and blood vessel risks that diabetics have.  About 40-45% of those over 65 have IGT or type 2 diabetes!  Impaired Fasting Glucose is when a fasting sugar is above 110, but less than the 126 which defines diabetes. Some will have IGT, some not (they “just have a high number”).
How Does It Hurt You?

‚    Diabetes kills 187,000 yearly

‚    12-24,000 go blind annually

‚    27,900 start dialysis annually

‚    56,000 have an amputation

‚    heart attack & stroke are

2-4 times more likely: 77,000 yearly

‚    impotence can run 50-60%

Costs of Diabetes were estimated at $98 billion in 1997: $44.1 billion for treatment and $54 billion for disability and death.

What Do I Recommend on Checking Your Sugars?    
You should have a fasting (at least 8 hours and preferably 12) blood sugar at age 45 -- sooner if diabetes is in your family, or if your have any of <<< these other risk factors.  Venous blood processed in a good lab (our accuracy is 0.2 mg) is the best way to do it.  If you’re high risk, you should get checked at least every 2-3 years.
If your sugar is over 126 mg, this should be confirmed with a second test.
If your sugar is between 110 and 126, I recommend a formal Glucose Tolerance Test (that’s the one with the over-sugared cola or orange drink) to see if you’re diabetic or Impaired Glucose Tolerance or “just a high number.”
Provider Recognition:
Dr. Grimshaw won recognition in 1999, and again in 2001 from the American Diabetes Association and the National Committee for Quality Assurance.  It means that we met goals for  sugar and blood pressure control and education.
Here’s How We’ll Help:

‚    Diet: with our dietician,

Kathy Berkowitz RD MS CDN & CDE (that last is Certified Diabetes Educator) we'll aim for at least an annual review of your diet.

‚    Blood Pressure should

be 130/85 or less.

‚    Sugar Checks you’ll be

checking your blood yourself

‚    Urine Checks looking for

early damage (“protein leak”): a level under 30 is ideal.

‚    Long-Range Sugar

Check every 3-6 months with a hemoglobin A-1C (a protein in your red blood cells)

under 6%    Ideal

under 7%    Excellent

under 8%    Good

under 9%    Fair (but needs help)

under 10%    Suboptimal

Over 10%    Poor!

‚    Eyes: a yearly check with

an eye doctor is needed

‚    Feet: checked regularly for

sensation, blood flow and ulcers

‚    Lousy LDL Cholesterol

should be under 100

‚    Smoking: if you do, we’ll

help you stop!