Higher standards of care better manage diabetes
The following information and guidlines from Dr. Garrett Shaw were originally published in the Gothenburg Times in an article written by Beth Barrett in August of 2016. Dr. Shaw has updated the information to ensure accuracy and relevance.
Treating Diabetic Patients to Goal is the New Standard
As a doctor recognized for meeting standards of high-quality care for diabetes patients, by the National Committee for Quality Assurance (NCQA), Dr. Garret Shaw follows a specific protocol in seeing and treating people with diabetes.
For example, the Gothenburg Health physician said he sees diabetic patients every three months instead of less frequently, to make sure the patient is meeting the newer standards established by the American Diabetic Association. During those visits, blood sugar is tested to see how sugar is incorporated into the cell wall of the red blood cell—the hemoglobin A1c. “Instead of a snapshot, we can get an idea of the blood sugar control over 2-3 months,” he said.
Shaw describes type 2 diabetes, the most common form of diabetes, as insulin resistance, as opposed to not having enough insulin—type 1 diabetes, which is generally diagnosed at an earlier age, and has an autoimmune component, where the body attacks and destroys the cells that produce insulin. In type 2 diabetes, if a patient’s own pancreas is “maxed out” producing insulin, Shaw said more insulin generally isn't the answer. “Glucose is not taken up as well in muscle and fat cells, he explained. “As a result, blood sugar levels remain high, and diabetes continues its progression.”
Diagnosis of Diabetes is on the Rise
Shaw said he diagnoses one to two patients weekly with pre-diabetes, or diabetes, and sees at least a couple a day, who have been diagnosed as having diabetes.
Standards of care for managing diabetes patients include monitoring blood pressure, weight, activity, regular eye exams, going to the dentist, regular foot exams, checking cholesterol, checking urine for protein, as well as the A1c. At the frequent visits, a discussion is also held regarding monitoring carbohydrate intake. Carbohydrates are starches and sugars, and break down into glucose, and will raise the blood sugar. Restricting carbs is a crucial component of helping with weight loss, and controlling, or eliminating diabetes.
Because high blood pressure is closely linked to heart attacks, Shaw monitors it closely. The goal blood pressure is lower in diabetics than in the general population.
In addition, Shaw said all diabetic patients should take cholesterol medicine, as they are at the same risk to have a heart attack as someone who has already had a heart attack.
“You can’t see the build-up of plaque in the arteries, but you can see protein in the urine, which is an indicator of plaque in the arteries, as well as kidney damage,” he explained.
Shaw said weight gain can cause diabetes, which is exacerbated by a sedentary lifestyle. “Farming is not as physical as it once was, and many of us work from chairs behind desks,” he explained. “It is recommended to get 150 minutes of mild-to-moderate (walking) activity per week.”
From a treatment standpoint, diet is paramount. “Bodies must have fat and protein, but not carbohydrates,” said Shaw. “Yet a western-style diet loaded with carbohydrates is typical in the United States. Carbs include starches, as well as sweets.”
In addition to eliminating or cutting back on carbohydrates, Shaw said exercise is key to losing weight and battling diabetes.
Shaw said the obesity epidemic now occurring in the United States is also causing a diabetes epidemic. "Unfortunately," he noted, "portion sizes are larger in restaurants, fast-food locations, and homes and often contain high amounts of carbohydrates and fat."
In fact, Shaw said the average restaurant meal is four times larger than it was in the 1950s, with sugary drinks increasing the most—from 7 ounces to 42 ounces, according to the Centers for Disease Control.
“And the American Health Association recommends no more than 50 grams of carbs per day,” he noted. Convenience has also become a part of the nation’s eating habit, with Americans consuming more prepared foods loaded with carbohydrates, salt and sugar.
Unfortunately, Shaw said humans are hard-wired to like sugar, and many prepared foods have sugar added to make their product taste better and increase market share. “Obesity has exploded, and it has something to do with the amount of sugar Americans consume,” he said, adding that sweetened drinks are the only specific food directly linked to weight gain.
Mindless eating, while watching television, also packs on pounds, Shaw said. To lose weight and/or eat healthier, Shaw said consulting with a dietician is helpful.
Artificial sweeteners cause the same cravings as processed sugar, he said. The number of products containing artificial sweeteners has exploded the last decade, yet obesity rates continue to climb. So there must be something more to weight gain that we don’t yet understand.
As far as a diabetes treatment, Shaw said there are newer injectable medications, which can be used less frequently. “It’s possible for diabetes patients to lose weight and quit taking medicine for diabetes,” Shaw explained, “ but you’ve got to change what you eat and start exercising.”
