Dr. Warren Butler handles all the broken arms and sore throats of a family-medicine practice, but he particularly emphasizes diabetes and how to best manage the disease.
That’s because, he says, diabetes encompasses many other disorders that affect his patients’ quality of life.
The goal, he said, is to keep the kidney healthy. “I always tell my patients that the kidney is the pivotal organ,” he said. “If you keep it healthy, chances are you’ll do much better down the road.”
When patients are diagnosed with diabetes — types 1 and 2, but usually type 2 — Dr. Butler sets them up on a quarterly appointment schedule. In these regular visits to the doctor’s office, the first order of business is to check the patient’s A1C level.
Dr. Butler said the A1C test is used to diagnose diabetes and, once diagnosed, to guide the management of the disease.
This test, which measures the glucose in the blood and averages it over the previous three months, is the yardstick by which a diabetic’s health is determined. A person without diabetes would expect to be at a level of 4 to 6, he said. Prediabetes occurs at about 5.7, and insulin would be required at levels above 8, he said.
Dr. Butler explains what patients with diabetes can expect at each regular appointment:
Every three months
▸ A1C test to determine glucose readings for the previous three months
▸ Physical foot checks for damage caused by neuropathy
▸ Blood pressure
Diabetes doesn’t necessarily raise blood pressure and cholesterol levels, but “they often go hand in hand,” said Dr. Butler. Again, the goal is a healthy kidney. He adds, “There are some tricks and things to know about diabetes that are unique and different from a population that only has hypertension or high cholesterol.”
Every six months
▸ Blood work to measure kidney function
▸ Microalbumin (urine) test to measure kidney function. The test measures the amount of protein in the blood and is one of the first indicators of kidney damage
▸ Liver function tests
Every 12 months
▸ An eye exam by an ophthalmologist
A dilated-pupil exam allows detection of retinal damage, a side effect of diabetes. The test is important because there are no other early signs of eye damage. “Eye damage is not symptomatic early on,” he said. “If it is? symptomatic, it’s probably too late to reverse the damage.”
Dr. Butler said that among patients with uncontrolled diabetes the A1C level tends to seesaw by as much as several points. “A well-controlled patient may stay in the 6 level range for years,” he said. “But we also have patients who may fluctuate by two or three points based on their motivation and their interest.”
The goal is to keep that number from climbing too high, he said. “The higher a number gets, the more aggressive the physician needs to be to control the diabetes to avoid the complications,” he added.
Many tools to help with healthy lifestyle
Dr. Butler notes that the older we get, the more difficult it is to maintain a lifestyle that’s focused positively on diet, exercise, weight and attitude.
However, he adds, “the options available to patients keep expanding all the time.” Among the tools he uses to control diabetes are medications that use different mechanisms, insulin and injections of hormone-like substances that help control sugars.
When patients do have a hard time maintaining their weight, exercise and diet, “we have the tools to help them,” he said.
“I always tell people that I like to use the least amount of medication as possible,” he said. “So if they work with me and work with their diet and exercise, that allows me as a physician to use less of the pills and shots.”