Managing type 2 diabetes takes time. Primary care teams that include nurses, pharmacists, and social workers provide the time to develop trusting relationships with patients and enable physicians to have more patients in their panels. When nurses and pharmacists have the authority to make changes in treatment without checking with a physician based on a protocol, the blood pressure, glucose, and cholesterol improve. Quality improvement that works for type 2 diabetes requires a comprehensive solution that includes these elements.
(In the Walking Well & modified appropriately for health issues). These numbers are the basis for the PMC motto: “the simultaneous prevention of multiple diseases”.
1. Non-HDL cholesterol: goal less than 90
2. Triglycerides: goal less than 100
3. A1C diabetes test: 5.5 or less at age 55, not above 6.2 at age 62 or older
4. Blood sugar: 90 at 90 minutes after a meal
5. Cardiac HS CRP: 1.0 or less
6. Blood Pressure: near 110/60
7. Less than 12% sodium in any one serving from any one container, at any one meal
8. PSA: 1.0 or less
9. TSH: 0.35-3.50
10. Hemoglobin: about 14
11. Lp (a): goal 15 or less
12. Homocysteine: goal 7 or less
13. Uric Acid: goal 5.5 or less
14. BUN: 12 or less
15. Magnesium: 2.1+: relates to diabetes prevention
16. Potassium: 4.1- 4.5
17. 25 hydroxy (OH) vitamin D3: 50-65 ng/mL
18. Percent body fat: 11-20% in men, 15-24 % in women: manifested as clear lines of definition/demarcation on the abdomen = “CLOD/D”
19. Virtually no one loses weight who eats more than occasional chicken, turkey, rice, sandwiches, cereal, and much fruit
20. If overweight, keep a diet diary of ALL you eat or drink that you should NOT: the diary should be empty
21. Eat foods (exactly) as they grow up out of the ground and in the field: G-V-B (grains, vegetables, beans, fruit, nuts, and seeds)
22. The Food Mantra: Fresh (fruits & vegetables), Whole & Unprocessed (grains & beans), Organic (all) and Fiber (all) at the 90+% level is the goal: 18-19 meals/week
23. If overweight, eat cooked vegetables and vegetable soups before any and all else ALL day long, even breakfast (not red or white potatoes). Intermittent fasting is recommended . Try to finish calorie intake within 9 hours after arising
24. In general, eat only out of a bowl
25. Individuals with the best of these values are vegan (no eggs, fish, fowl, dairy, or meat)
26. Learn about aerobic and interval training: all exercise helps
27. Smoking cessation is best dealt with by a combination of support and medication Chantix, Wellbutrin (bupropion), and the nicotine patch/inhaler/gum/e-cigarette
28. Limit alcohol to 4 six ounce glasses of red wine (or beer or whiskey equivalent) per week or less.
29. Accept & deal with reality: wishing, wanting & hoping are like alcohol, only safe in small doses
30. For high blood pressure, purchase an Omron wrist blood pressure cuff; have it validated at your doctor’s office; check your blood pressure variously before, after, and in between meals
31. Many conditions are vastly improved with 100% avoidance of ALL wheat (rye), dairy, and processed soy other than tempeh or miso
32. Cologuard, colonoscopy, digital rectal exams, mammograms, thermograms as agreed upon
Very helpful! I sent it on to two family members who may not be getting the best care. Thank you, Dr. B.
That is great. I hope they find someone who is excellent!
Here is an offering to fine tune a few of Besterman's excellent suggestions
Preventive Medicine Center Good Health For All
Wellness Protecting Numbers
Preventive Medicine Center’s (PMC) Wellness Protecting & Disease Prevention Goal “Numbers”/Insights
(In the Walking Well & modified appropriately for health issues). These numbers are the basis for the PMC motto: “the simultaneous prevention of multiple diseases”.
1. Non-HDL cholesterol: goal less than 90
2. Triglycerides: goal less than 100
3. A1C diabetes test: 5.5 or less at age 55, not above 6.2 at age 62 or older
4. Blood sugar: 90 at 90 minutes after a meal
5. Cardiac HS CRP: 1.0 or less
6. Blood Pressure: near 110/60
7. Less than 12% sodium in any one serving from any one container, at any one meal
8. PSA: 1.0 or less
9. TSH: 0.35-3.50
10. Hemoglobin: about 14
11. Lp (a): goal 15 or less
12. Homocysteine: goal 7 or less
13. Uric Acid: goal 5.5 or less
14. BUN: 12 or less
15. Magnesium: 2.1+: relates to diabetes prevention
16. Potassium: 4.1- 4.5
17. 25 hydroxy (OH) vitamin D3: 50-65 ng/mL
18. Percent body fat: 11-20% in men, 15-24 % in women: manifested as clear lines of definition/demarcation on the abdomen = “CLOD/D”
19. Virtually no one loses weight who eats more than occasional chicken, turkey, rice, sandwiches, cereal, and much fruit
20. If overweight, keep a diet diary of ALL you eat or drink that you should NOT: the diary should be empty
21. Eat foods (exactly) as they grow up out of the ground and in the field: G-V-B (grains, vegetables, beans, fruit, nuts, and seeds)
22. The Food Mantra: Fresh (fruits & vegetables), Whole & Unprocessed (grains & beans), Organic (all) and Fiber (all) at the 90+% level is the goal: 18-19 meals/week
23. If overweight, eat cooked vegetables and vegetable soups before any and all else ALL day long, even breakfast (not red or white potatoes). Intermittent fasting is recommended . Try to finish calorie intake within 9 hours after arising
24. In general, eat only out of a bowl
25. Individuals with the best of these values are vegan (no eggs, fish, fowl, dairy, or meat)
26. Learn about aerobic and interval training: all exercise helps
27. Smoking cessation is best dealt with by a combination of support and medication Chantix, Wellbutrin (bupropion), and the nicotine patch/inhaler/gum/e-cigarette
28. Limit alcohol to 4 six ounce glasses of red wine (or beer or whiskey equivalent) per week or less.
29. Accept & deal with reality: wishing, wanting & hoping are like alcohol, only safe in small doses
30. For high blood pressure, purchase an Omron wrist blood pressure cuff; have it validated at your doctor’s office; check your blood pressure variously before, after, and in between meals
31. Many conditions are vastly improved with 100% avoidance of ALL wheat (rye), dairy, and processed soy other than tempeh or miso
32. Cologuard, colonoscopy, digital rectal exams, mammograms, thermograms as agreed upon
Thank you for your comprehensive comment. Those who accomplish your recommendations will do well.