Rand David, MD
Director, Ambulatory Care Department
Elmhurst Hospital Center
Q. Can I get a flu shot if I take insulin?
A. Yes. The influenza vaccine does not interfere with the insulin. In fact, the immune systems of people with diabetes aren't always as strong as those of people without diabetes, so it's particularly important for people with diabetes to get their flu vaccinations.
Q. What are the signs and symptoms of diabetes?
A. A person develops diabetes when the levels of glucose (sugar) in their blood become high. Some of the glucose spills into the urine. Since sugar and water are being lost, the person becomes dehydrated and loses weight. So they feel thirsty and they find themselves urinating a lot. And as they lose weight they feel hungry. They may feel tired and irritable. The high glucose can also cause blurry vision. All of these symptoms usually get better with treatment.
Q. If I take medicine for my diabetes, will I end up on insulin?
A. You may not. It's hard to predict. Diabetes does tend to get more difficult to control as the years go by. One reason is that as we get older, our weight tends to go up. But diet has a lot to do with that. So it's not inevitable to end up on insulin. Some people with Type 2 diabetes will be able to control the disorder with diet and exercise, others will need oral medication, and still others will need oral medication and insulin.
Q. How often should I get a physical exam?
A. I recommend to my patients that they get checked every three months. We use a blood test called the “Hemoglobin A1C” level, which tells us the average glucose level over approximately a three-month period. A level under 7 is generally the goal. That's one of the best ways to tell how well diabetes is controlled.
Other tests and exams, which should be done annually, are targeted at preventing complications of diabetes. The feet should be examined by the doctor to check sensation and circulation. Regular eye examinations are important. Blood and urine tests are done to see if the diabetes is affecting the kidneys. Also, we screen diabetic patients for depression. People tend to not take as good care of themselves if they're depressed, so this is important to diagnose and treat promptly.
Q. What are the complications of diabetes?
A. Several problems that can occur when diabetes is not well controlled are related to changes in the blood vessels in the body. These can manifest as heart attacks and strokes of the brain.
The blood vessels in the eyes can also be affected by high blood sugar levels, which interfere with vision. This is called diabetic “retinopathy.” This can lead to blindness if not properly treated.
With poorly controlled diabetes, the patient's sensation in the feet can be diminished. When this is combined with poor circulation, even a small sore on the foot can threaten the limb and lead to amputation.
Another complication of poorly controlled diabetes causes the kidney to lose its ability to work properly. This is called diabetic “nephropathy.” This is a leading cause of end- stage kidney disease that requires dialysis or kidney transplantation.
Having diabetes does require a certain amount of attention on a daily basis to optimize health. That certainly can be a challenge. But it's a challenge worth taking because the complications of diabetes can largely be avoided by applying a small amount of effort on an ongoing basis. Choosing a healthier lifestyle that includes sensible food choices and an increase in physical activity goes a long way towards better health for anyone, but can be lifesaving for a person with diabetes. It's fortunate that here at Elmhurst and in all our HHC public hospitals there are so many tools available to assist patients with diabetes so they can maintain excellent control of the disorder and lead healthy, happy lives.