Regular checks are key to diagnosing diabetes early, Austin-area doctor says
Doctors say they are still seeing patients put off care or not come back for annual wellness exams since the coronavirus pandemic began in March 2020.
The Peterson-Kaiser Family Foundation Health System Tracker found that 25% of people delayed care because of COVID-19. The National Poll on Healthy Aging found that 29% had care delayed in 2021.
Good diabetes prevention and care start with that annual wellness exam.
"I see them once a year," said Dr. Connie Pham, a primary care physician with Village Medical in Kyle. "I'm not trying to kidnap them and see them all the time. I'm trying to prevent them from needing to come more often."
That wellness exam focuses on checking blood levels and symptoms to see if anything has changed or needs to be addressed. It helps doctors and patients determine what path they might be on, whether it's developing diabetes, heart disease or another chronic illness.
Then they can do early interventions before an illness becomes more serious.
For diabetes, those interventions might be making changes to diet, adding the recommended 150 minutes a week of moderate activity that gets the heart rate up, and getting more than six hours of sleep a night, Pham said. Sleep is important because a lack of it increases the risk of obesity, Pham said.
When it comes to diets, she recommends that people see a nutritionist and opt for something sustainable, not one that causes dramatic weight loss early on, but then leads to weight gain because they are not able to stick with it.
Having diabetes doesn't mean no sugar at all, Pham said, because our brain needs glucose to work. "Everything in moderation," she said.
"I do actually have a few (diabetic) patients who are managed fully on diet," Pham said. "After they made changes, all of their numbers came down."
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There is a genetic component to diabetes, but Pham said that "just because everyone (in your family) has diabetes does not mean you have to have it, too."
In her current practice, Pham is seeing people in their late 30s and early 40s get new diabetes diagnoses. She attributes that to an increase in obesity rates.
Folks who come for their annual exams can be diagnosed with diabetes or even prediabetes earlier, making it easier to manage, compared with folks who get diagnosed in the emergency room when their diabetes has begun to create serious symptoms such as severe abdominal pain, nausea and vomiting.
Early symptoms can be excessive thirst, excessive need to urinate, feeling really hungry and feeling fatigued. Check in with your primary doctor if you're feeling those symptoms, Pham said.
The goal for people with diabetes is to have their A1C — the measurement of the blood's hemoglobin that indicates the blood sugar level for the past three months — less than 7. A 5.6 or below is considered normal, 5.7 to 6.4 is prediabetes, and 6.5 and above are diabetes. For daily blood sugar measures, Pham said, you want to be below 126, especially if you haven't eaten recently, and less than 100 if it's a fasting blood sugar level.
Not having a blood sugar level or A1C level that is under control puts you at risk for things such as organ failure, especially kidney and heart; a weakened immune system and infection; and blindness. A study released this year by the University of Virginia School of Medicine found that diabetics who went to their annual wellness exams were 36% less likely to need an amputation.
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Most diabetics can be monitored by their primary care doctor, she said. Endocrinologists enter the equation when people have tried a number of different medications and still have blood sugar levels that are not well-controlled, or they use an insulin pump to deliver their medication.
Medications to control diabetes are getting better, Pham said, including new once-a-week injections as well as improved daily medications.
There are also more options now, she said. "If it doesn't work, we can always switch it up," she said. The important thing is finding the one that works and that a patient will take properly.
She is also a fan of continuous glucose monitors that test blood levels and send out an alarm when the blood sugar level is too high or too low. It's especially helpful for patients that get anxious about finger pricks to test their blood.
Pham also recommends that people with diabetes work with their pharmacy and insurance to find less expensive ways to receive their medications because they can be costly, and that they enroll in programs that help them remember to take their medications and monitor their blood sugar levels.
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This article originally appeared on Austin American-Statesman: Checkups key to diagnosing diabetes early, Austin-area doctor says
