The Guiding Principles for Diabetes Care are written for people with diabetes, their families, health care providers, and those who pay for health care. The principles describe the key points of good diabetes care and are based upon current research, guidelines, and standards of care. But because each person with diabetes has different needs, he or she should talk with a health care provider about the treatment plan that works best for him or her and why.
Taking proper care of diabetes can lower the chances of getting eye disease, kidney disease, nerve damage, and other problems linked to diabetes. With proper education and good self-care, people with diabetes should expect to lead long and active lives at work, home and during leisure time.
Principle 1: Screening High-Risk People and Diagnosing Diabetes
One-third of people with diabetes remain undiagnosed. Finding and treating diabetes early can improve health outcomes for people with diabetes. Therefore, routine screening and correct diagnosis are essential.
Diabetes is more common among people who are older, overweight, have a family history of diabetes, have had gestational diabetes (diabetes during pregnancy), and are of certain ethnic backgrounds. People at high risk for diabetes should have frequent, routine testing for diabetes. Finding and treating diabetes early can lower a person's chances of getting diabetes problems such as eye disease, kidney disease, nerve disease, and heart disease. You should be told right away that you have diabetes and the type of diabetes you have. Terms such as "a touch of diabetes," "borderline diabetes," or "sugar's a little high" are not correct and are no longer used.
Principle 2: On-Going Care
People with diabetes should always receive high-quality care on an ongoing basis to ensure that they are taking good care of their diabetes, and to make changes to their treatment plan when needed to achieve control of the disease.
People with diabetes should always expect to receive care and support that is positive and helpful. You should not have trouble getting care, and you should be able to see your health care provider on a regular basis. In addition to your physician, you should be able to see other types of health care providers who can help you manage your disease such as a diabetes educator or a nutritionist. People of certain ethnic backgrounds, children, teenagers, pregnant women and older adults have very special needs that need special treatment. People with diabetes also need support from their family, friends, and co-workers. You should not be prevented from getting the proper education, equipment, supplies and medicine because of lack of money. You should not be discriminated against in your work, getting insurance, and obtaining licenses.
Principle 3: Diabetes Education
People with diabetes and their family members have the right to accurate information and education needed for diabetes self-care.
People with diabetes should be able to get the education they need to become active in treating and managing their disease. Taking an active role in managing your diabetes will help you stay healthier. This education should be ongoing and should address your unique needs and the needs of your family.
Principle 4: Treating Hyperglycemia (High Blood Sugar)
Blood sugar levels should be kept as near to normal levels as is safely possible. The target range should be based on an overall assessment of the person's health.
The number one goal of diabetes treatment is to control high blood sugar levels. Over time, high blood sugar has been shown to cause eye disease, kidney disease and nerve damage, and may also be linked to heart disease and stroke.
There are many methods to control high blood sugar. These methods will vary from person to person and will depend on your unique needs. In type 1 diabetes, the treatment plan includes a healthy diet and regular physical activity coordinated with an insulin schedule. Treatment for type 2 diabetes often includes a healthy diet, physical activity, and in some cases, pills and/or insulin. You should be involved in creating your treatment plan and making decisions about your diabetes care.
Principle 5: Self-Monitoring of Blood Glucose and Hemoglobin A1c (HbA1c)
Blood sugar levels and hemoglobin A1c values should be measured on a routine basis using current, reliable methods.
Diabetes is sometimes called the "silent disease" because it can cause serious damage to the body without showing any signs or symptoms. You may need to self-test your blood sugar on a regular basis to measure your blood sugar levels and help you manage your diabetes. You should work with your health care provider to decide how often to test, the type of test to use, and how often to report the test results. You should talk to your health care provider about getting the supplies you need to self-test.
Hemoglobin A1c, or H-b-A-one-c, is a test that gives the average amount of sugar in the blood over the last 2 to 3 months. This test is very important because it tells how well you are managing your diabetes. Lowering the HbA1c number by any amount improves your chances of staying healthy and lowers your chances of having diabetes problems. You should talk to your health care provider about your HbA1c number and your own target goal.
Principle 6: Preventing and Diagnosing Long-term Diabetes Problems
Excellent diabetes care can greatly lower the chances of developing long-term diabetes problems.
People with diabetes must control their blood sugar levels to prevent diabetes problems such as eye disease, kidney disease, nerve damage, heart disease and stroke. People with diabetes should also ask their health care provider for regular blood pressure checks, cholesterol tests, and other blood fat tests (HDL or "good cholesterol" and LDL or "bad cholesterol"). Routine testing of these factors is also part of good diabetes care.
You should work with your health care provider to make healthy lifestyle choices to help control and manage your diabetes. Eating to control blood sugar and blood fat levels, taking prescribed diabetes medicine, getting regular physical activity, and getting regular foot and eye exams are all important for good health and to help control diabetes.
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Principle 7: Screening For and Treating Long-Term Diabetes Problems
People with diabetes should have regular exams to help find and treat long-term diabetes problems. All long-term diabetes problems have effective treatments.
All people with diabetes should be examined by their health care providers for the problems that can occur with diabetes. Regular exams by a health care provider can help find problems at a time when they can be treated and managed successfully. You should have your feet, eyes and kidneys checked on a regular basis. Other tests may also be needed.
The long-term problems that occur in people with diabetes can usually be prevented or delayed if they are found and treated at an early stage. For example, kidney disease can be slowed or prevented by controlling high blood pressure and high blood sugar and by taking special medicines. Severe eye disease can be managed by laser surgery. Problems of circulation in the legs, heart or brain can be improved by treatments that may or may not involve surgery. These examples show that it is important for people with diabetes to be treated for diabetes problems at any stage of the disease to prevent the problems from getting worse.
National Diabetes Education Program (NDEP)