Obesity Morbid obesity; Fat - obese Last reviewed: October 12, 2010.

Obesity is a term used to describe body weight that is much greater than what is healthy. If you are obese, you also have a much higher amount of body fat than is healthy or desirable. Adults with a body mass index (BMI, calculated as weight in kilograms divided by height in meters squared) between 25 kg/m2 and 30 kg/m2 are considered overweight. Adults with a BMI greater than or equal to 30 kg/m2 are considered obese. Anyone who is more than 100 pounds overweight or who has a BMI greater than or equal to 40 kg/m 2 is considered morbidly obese. Causes, incidence, and risk factors Taking in more calories than you burn leads to being overweight and, eventually, obesity. The body stores unused calories as fat. Obesity can be the result of:

Eating more food than your body can use Drinking too much alcohol Not getting enough exercise

An underactive thyroid (hypothyroidism) may lead to 5 - 10 pounds of weight gain. Some antidepressants and antipsychotic medicines may also contribute to weight gain and obesity. Genetic factors play some part in the development of obesity -- children of obese parents are 10 times more likely to be obese than children with parents of normal weight. People who are at higher risk for obesity include:

Lower income groups Former smokers People with chronic mental illness People with disabilities People with a sedentary lifestyle

Signs and tests The health care provider will perform a physical exam and ask questions about your medical history, eating habits, and exercise routine. Skin fold measurements may be taken to check your body fat percentage. Blood tests may be done to look for thyroid or endocrine problems, which could lead to weight gain. Treatment Regular exercise and a healthy diet are crucial when it comes to controlling your weight. Although there are many programs advertised to help you lose weight, the only method proven safe over the long-term is to burn more calories than you consume.

Exercising and eating right must become as much a part of your routine as bathing and brushing your teeth. Unless you are convinced of the benefits, you will not succeed. DIET Most people can lose weight by eating a healthier diet and exercising more. Even modest weight loss can improve your health. Sticking to a weight reduction program is not easy. You will need a lot of support from family and friends. When dieting, your main goal should be to learn new, healthy ways of eating and make them a part of your everyday routine. Learn to read the nutrition labels and ingredients of all the foods you eat. Work with your health care provider and dietitian to set realistic, safe daily calorie counts that help you lose weight while staying healthy. Remember that if you drop pounds slowly and steadily, you are more likely to keep them off. Your dietitian can teach you about healthy food choices, portion sizes, and new ways to prepare food. Extreme diets (fewer than 1,100 calories per day) are not thought to be safe or to work very well. These types of diets often do not contain enough vitamins and minerals. People who are on these diets may experience symptoms such as fatigue, feeling cold most of the time, hair loss, or dizziness. There is a risk for gallbladder stones, changes in menstrual periods, and rarely, dangerous heart rhythms. Most people who lose weight this way return to overeating and become obese again.

See also: Sweeteners Other changes can have an impact on your weight loss success: Eat only at the table. No snacking in front of the TV, in bed, while driving, or while standing in front of the open refrigerator. Learn about appropriate portion sizes. Choose low-calorie snacks, such as raw vegetables. Learn new ways to manage stress, rather than snacking. Examples may be meditation, yoga, or exercise. Keep a diet and exercise journal. This may help you identify overeating triggers in your life. If you are depressed, seek medical treatment rather than eating excessively to help cope with your depression. Find a support group or consider psychotherapy to help you achieve your weight loss goal.

EXERCISE To lose weight, you must burn more calories than you eat. Exercise is a key way to do this. Walking a mile a day for 30 days will help you burn off 1 pound of fat, as long as you don't eat more than usual. If you have not been active, start slowly and build up over weeks or even months. Walking can be a good exercise to start with. Talk to your health care provider before starting.

Every week, increase the amount of time you spend doing the activity. Do it more often or add a second activity. You can increase the speed or difficulty of the activity (for example, by going up hills). All adults should get 2 1/2 hours of aerobic exercise each week. Spread the exercise out over the week. Exercise for at least 10 minutes at a time. Find ways to increase your activity level very day. Walk instead of driving. If you have to drive, park several blocks away from your destination. Climb stairs instead of using an elevator or escalator. Do other house activities, such as gardening.

In addition to burning off extra calories, exercise will also:

Lift your mood and help with anxiety Make your bones stronger Reduce your chance of having a heart attack or stroke Help you manage high blood pressure and cholesterol

MEDICATIONS AND HERBAL REMEDIES There are many over-the-counter diet products. These include herbal remedies. Most of these products do not work and some can be dangerous. Before using an over-the-counter or herbal diet remedy, talk to your health care provider. Several prescription weight loss drugs are available, including orlistat (Xenical) and phentermine (Ionamin, Adipex-P, Fastin). Sibutramine (Meridia) is no longer on the market. Ask your health care provider if these are right for you. Usually, you can lose between 5 and 10 pounds by taking these drugs. People usually regain the weight when they stop taking the medication, unless they have made lasting lifestyle changes. SURGERY Weight-loss surgery may be done to help you lose weight if you are very obese and have not been able to lose weight with diet and exercise. Surgery alone is not the answer for weight loss. It can train you to eat less, but you still have to do much of the work. You must be committed to diet and exercise after the surgery.Talk to your doctor to learn if this is a good option for you. The two most common weight-loss surgeries are: Laparoscopic gastric banding -- the surgeon places a band around the upper part of your stomach, creating a small pouch to hold food. The band helps you limit how much food you eat by making you feel full after eating small amounts. Gastric bypass surgery -- helps you lose weight by changing how your stomach and small intestine handle the food you eat. After the surgery, you will not be able to eat as much as before, and your body will not absorb all the calories and other nutrients from the food you eat.

You may have complications from these surgeries. One problem some people have is throwing up if they eat more than their new small stomach can hold. Support Groups Many people find it easier to follow a diet and exercise program if they join a group of people with similar problems. See: Eating disorders - support group Complications Obesity is a significant health threat. The extra weight puts added stress on all parts of your body. Medical problems commonly resulting from untreated obesity and morbid obesity include:

Type 2 diabetes and metabolic syndrome High blood pressure, heart disease, and stroke Obstructive sleep apnea and other sleep disorders Certain cancers, including breast and colon cancer Depression Osteoarthritis

Extreme obesity can lead to a gradual decrease in the level of oxygen in your blood, a condition called hypoxemia. Decreased blood oxygen levels and sleep apnea may cause a person to feel sleepy during the day. These conditions may also lead to high blood pressure and pulmonary hypertension. In extreme cases, especially when left untreated, this can lead to right-sided heart failure and ultimately death. Calling your health care provider Schedule an appointment with your health care provider if you or your child is obese or gaining weight at an extremely rapid rate. Remember that catching the problem early is much simpler than trying to fix it after the person has gained an excessive amount of weight.

Hypertension
High blood pressure; HBP; Blood pressure - high
Last reviewed: July 29, 2010.

Hypertension is the term used to describe high blood pressure. Blood pressure is a measurement of the force against the walls of your arteries as the heart pumps blood through the body. Blood pressure readings are measured in millimeters of mercury (mmHg) and usually given as two numbers -- for example, 120 over 80 (written as 120/80 mmHg). One or both of these numbers can be too high. The top number is your systolic pressure. It is considered high if it is over 140 most of the time. It is considered normal if it is below 120 most of the time.

The bottom number is your diastolic pressure. It is considered high if it is over 90 most of the time. It is considered normal if it is below 80 most of the time.

Pre-hypertension may be considered when your: Top number (systolic blood pressure) is between 120 and 139 most of the time, or Bottom number (diastolic blood pressure) is between 80 and 89 most of the time

If you have pre-hypertension, you are more likely to develop high blood pressure. If you have heart or kidney problems, or if you had a stroke, your doctor may want your blood pressure to be even lower than that of people who do not have these conditions. See also: Blood pressure

Causes, incidence, and risk factors

Many factors can affect blood pressure, including: How much water and salt you have in your body The condition of your kidneys, nervous system, or blood vessels The levels of different body hormones

You are more likely to be told your blood pressure is too high as you get older. This is because your blood vessels become stiffer as you age. When that happens, your blood pressure goes up. High blood pressure increases your chance of having a stroke, heart attack, heart failure, kidney disease, and early death. You have a higher risk of high blood pressure if you: Are African American Are obese Are often stressed or anxious Eat too much salt in your diet Have a family history of high blood pressure Have diabetes Smoke

Most of the time, no cause is identified. This is called essential hypertension. High blood pressure that is caused by another medical condition or medication is called secondary hypertension. Secondary hypertension may be due to: Alcohol abuse Atherosclerosis Autoimmune disorders such as periarteritis nodosa Chronic kidney disease Coarctation of the aorta Cocaine use Diabetes (if it causes kidney damage) Endocrine disorders, such as adrenal tumors (pheochromocytoma, aldosteronism), thyroid disorders, and Cushing syndrome Medications Appetite suppressants Birth control pills Certain cold medications

Corticosteroids Migraine medications Renal artery stenosis

Symptoms
Most of the time, there are no symptoms. Symptoms that may occur include: Confusion Ear noise or buzzing Fatigue Headache Irregular heartbeat Nosebleed Vision changes

If you have a severe headache or any of the symptoms above, see your doctor right away. These may be signs of a complication or dangerously high blood pressure called malignant hypertension.

Signs and tests

Your health care provider will perform a physical exam and check your blood pressure. If the measurement is high, your health care provider may think you have high blood pressure. The measurements need to be repeated over time, so that the diagnosis can be confirmed. If you monitor your blood pressure at home, you may be asked the following questions: What was your most recent blood pressure reading? What was the previous blood pressure reading? What is the average systolic (top number) and diastolic (bottom number) reading? Has your blood pressure increased recently?

Other tests may be done to look for blood in the urine or heart failure. Your doctor will look for signs of complications in your heart, kidneys, eyes, and other organs in your body. These tests may include: Blood tests Echocardiogram Electrocardiogram Urinalysis Ultrasound of the kidneys

Treatment
The goal of treatment is to reduce blood pressure so that you have a lower risk of complications. You and your health care provider should set a blood pressure goal for you. There are many different medicines that can be used to treat high blood pressure, including: Alpha blockers Angiotensin-converting enzyme (ACE) inhibitors Angiotensin receptor blockers (ARBs) Beta blockers Calcium channel blockers Central alpha agonists

Diuretics Renin inhibitors, including aliskiren (Tekturna) Vasodilators

Your health care provider may also tell you to exercise, lose weight, and follow a healthier diet. If you have pre-hypertension, your health care provider will recommend the same lifestyle changes to bring your blood pressure down to a normal range. Often, a single blood pressure drug may not be enough to control your blood pressure, and you may need to take two or more drugs. It is very important that you take the medications prescribed to you. If you have side effects, your health care provider can substitute a different medication. In addition to taking medicine, you can do many things to help control your blood pressure, including: Eat a heart-healthy diet, including potassium and fiber, and drink plenty of water. Exercise regularly -- at least 30 minutes a day. If you smoke, quit -- find a program that will help you stop. Limit how much alcohol you drink -- 1 drink a day for women, 2 a day for men. Limit the amount of sodium (salt) you eat -- aim for less than 1,500 mg per day. Reduce stress -- try to avoid things that cause stress for you. You can also try meditation or yoga. Stay at a healthy body weight -- find a weight-loss program to help you, if you need it.

Your health care provider can help you find programs for losing weight, stopping smoking, and exercising. You can also get a referral from your doctor to a dietitian, who can help you plan a diet that is healthy for you. Your health care provider may ask you to keep track of your blood pressure at home. Make sure you get a good quality, well-fitting home device. It will probably have a cuff with a stethoscope or a digital readout. Practice with your health care provider or nurse to make sure you are taking your blood pressure correctly.

Expectations (prognosis)
Most of the time, high blood pressure can be controlled with medicine and lifestyle changes.

Complications
Aortic dissection Blood vessel damage (arteriosclerosis) Brain damage Congestive heart failure Chronic kidney disease Heart attack Hypertensive heart disease Peripheral artery disease Pregnancy complications Stroke Vision loss

Calling your health care provider

If you have high blood pressure, you will have regularly scheduled appointments with your doctor. Even if you have not been diagnosed with high blood pressure, it is important to have your blood pressure checked during your yearly check-up, especially if someone in your family has or had high blood pressure. Call your health care provider right away if home monitoring shows that your blood pressure remains high or you have any of the following symptoms:

Chest pain Confusion Excessive tiredness Headache Nausea and vomiting Shortness of breath Significant sweating Vision changes

Prevention
Adults over 18 should have their blood pressure checked routinely. Lifestyle changes may help control your blood pressure: Avoid smoking. (See: Nicotine withdrawal) Do not consume more than 1 drink a day for women, 2 a day for men. Eat a diet rich in fruits, vegetables, and low-fat dairy products while reducing total and saturated fat intake (the DASH diet is one way of achieving this kind of dietary plan). (See: Heart disease and diet) Exercise regularly. If possible, exercise for 30 minutes on most days. If you have diabetes, keep your blood sugar under control. Lose weight if you are overweight. Excess weight adds to strain on the heart. In some cases, weight loss may be the only treatment needed. Try to manage your stress. Follow your health care provider's recommendations to modify, treat, or control possible causes of secondary hypertension.

Gastritis
Last reviewed: January 28, 2009. Gastritis is an inflammation (irritation and swelling) of the lining of the stomach. Causes, incidence, and risk factors There are many causes of gastritis. The most common are: Alcohol Erosion (loss) of the protective layer of the stomach lining Infection of the stomach with Helicobacter pylori bacteria Medications such as aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) Smoking

Less common causes are: Autoimmune disorders (such as pernicious anemia) Backflow of bile into the stomach (bile reflux) Eating or drinking caustic or corrosive substances (such as poisons) Excess gastric acid secretion (such as from stress) Viral infection, especially in people with a weak immune system

Gastritis can last a short time (acute gastritis) or for months to years (chronic gastritis). Symptoms

Abdominal pain Abdominal indigestion Dark stools Loss of appetite Nausea Vomiting Vomiting blood or coffee-ground like material

Signs and tests Tests vary depending on the specific cause. An X-ray of the upper digestive tract, EGD, or other tests may be advised. Treatment Treatment depends on the specific cause. Some of the causes will disappear over time. Medications to neutralize stomach acid or decrease its production may be recommended. Expectations (prognosis) The outlook depends on the cause, but is usually good. Prevention Complications See the specific types of gastritis. Calling your health care provider Avoid long-term use of irritants (such as aspirin, antiinflammatory drugs, or alcohol). Call for an appointment with your health care provider if you develop gastritis symptoms.

Diabetes
Last reviewed: May 10, 2010.

Diabetes is a chronic (lifelong) disease marked by high levels of sugar in the blood. See also: Gestational diabetes Metabolic syndrome Type 1 diabetes Type 2 diabetes

Causes, incidence, and risk factors

Insulin is a hormone produced by the pancreas to control blood sugar. Diabetes can be caused by too little insulin, resistance to insulin, or both. To understand diabetes, it is important to first understand the normal process by which food is broken down and used by the body for energy. Several things happen when food is digested: A sugar called glucose enters the bloodstream. Glucose is a source of fuel for the body. An organ called the pancreas makes insulin. The role of insulin is to move glucose from the bloodstream into muscle, fat, and liver cells, where it can be used as fuel. People with diabetes have high blood sugar. This is because: Their pancreas does not make enough insulin

Their muscle, fat, and liver cells do not respond to insulin normally Both of the above

There are three major types of diabetes: Type 1 diabetes is usually diagnosed in childhood. Many patients are diagnosed when they are older than age 20. In this disease, the body makes little or no insulin. Daily injections of insulin are needed. The exact cause is unknown. Genetics, viruses, and autoimmune problems may play a role. Type 2 diabetes is far more common than type 1. It makes up most of diabetes cases. It usually occurs in adulthood, but young people are increasingly being diagnosed with this disease. The pancreas does not make enough insulin to keep blood glucose levels normal, often because the body does not respond well to insulin. Many people with type 2 diabetes do not know they have it, although it is a serious condition. Type 2 diabetes is becoming more common due to increasing obesity and failure to exercise. Gestational diabetes is high blood glucose that develops at any time during pregnancy in a woman who does not have diabetes. Women who have gestational diabetes are at high risk of type 2 diabetes and cardiovascular disease later in life. Diabetes affects more than 20 million Americans. Over 40 million Americans have pre-diabetes (early type 2 diabetes). There are many risk factors for type 2 diabetes, including: Age over 45 years A parent, brother, or sister with diabetes Gestational diabetes or delivering a baby weighing more than 9 pounds Heart disease High blood cholesterol level Obesity Not getting enough exercise Polycystic ovary disease (in women) Previous impaired glucose tolerance Some ethnic groups (particularly African Americans, Native Americans, Asians, Pacific Islanders, and Hispanic Americans)

Symptoms
High blood levels of glucose can cause several problems, including: Blurry vision Excessive thirst Fatigue Frequent urination Hunger Weight loss

However, because type 2 diabetes develops slowly, some people with high blood sugar experience no symptoms at all. Symptoms of type 1 diabetes: Fatigue Increased thirst Increased urination Nausea Vomiting Weight loss in spite of increased appetite

Patients with type 1 diabetes usually develop symptoms over a short period of time. The condition is often diagnosed in an emergency setting.

Symptoms of type 2 diabetes: Blurred vision Fatigue Increased appetite Increased thirst Increased urination

Signs and tests

A urine analysis may be used to look for glucose and ketones from the breakdown of fat. However, a urine test alone does not diagnose diabetes. The following blood tests are used to diagnose diabetes: Fasting blood glucose level -- diabetes is diagnosed if higher than 126 mg/dL on two occasions. Levels between 100 and 126 mg/dL are referred to as impaired fasting glucose or prediabetes. These levels are considered to be risk factors for type 2 diabetes and its complications. Hemoglobin A1c test -- this test has been used in the past to help patients monitor how well they are controlling their blood glucose levels. In 2010, the American Diabetes Association recommended that the test be used as another option for diagnosing diabetes and identifying pre-diabetes. Levels indicate: Normal: Less than 5.7% Pre-diabetes: Between 5.7% - 6.4% Diabetes: 6.5% or higher Oral glucose tolerance test -- diabetes is diagnosed if glucose level is higher than 200 mg/dL after 2 hours. (This test is used more for type 2 diabetes.) Random (non-fasting) blood glucose level -- diabetes is suspected if higher than 200 mg/dL and accompanied by the classic diabetes symptoms of increased thirst, urination, and fatigue. (This test must be confirmed with a fasting blood glucose test.) Persons with diabetes need to have their hemoglobin A1c (HbA1c) level checked every 3 - 6 months. The HbA1c is a measure of average blood glucose during the previous 2 - 3 months. It is a very helpful way to determine how well treatment is working. Have your cholesterol and triglyceride levels checked each year (aim for LDL levels below 100 mg/dL).

Treatment
The immediate goals are to treat diabetic ketoacidosis and high blood glucose levels. Because type 1 diabetes can start suddenly and have severe symptoms, people who are newly diagnosed may need to go to the hospital. The long-term goals of treatment are to: Prolong life Reduce symptoms Prevent diabetes-related complications such as blindness, heart disease, kidney failure, and amputation of limbs These goals are accomplished through: Blood pressure and cholesterol control Careful self testing of blood glucose levels Education Exercise Foot care Meal planning and weight control Medication or insulin use

There is no cure for diabetes. Treatment involves medicines, diet, and exercise to control blood sugar and prevent symptoms. LEARN THESE SKILLS Basic diabetes management skills will help prevent the need for emergency care. These skills include: How to recognize and treat low blood sugar (hypoglycemia) and high blood sugar (hyperglycemia) What to eat and when How to take insulin or oral medication How to test and record blood glucose How to test urine for ketones (type 1 diabetes only) How to adjust insulin or food intake when changing exercise and eating habits How to handle sick days Where to buy diabetes supplies and how to store them

After you learn the basics of diabetes care, learn how the disease can cause long-term health problems and the best ways to prevent these problems. Review and update your knowledge, because new research and improved ways to treat diabetes are constantly being developed. SELF-TESTING If you have diabetes, your doctor may tell you to regularly check your blood sugar levels at home. There are a number of devices available, and they use only a drop of blood. Self-monitoring tells you how well diet, medication, and exercise are working together to control your diabetes. It can help your doctor prevent complications. The American Diabetes Association recommends keeping blood sugar levels in a range based on your age. Discuss these goals with your doctor and diabetes educator. Before meals: At bedtime: WHAT TO EAT You should work closely with your health care provider to learn how much fat, protein, and carbohydrates you need in your diet. A registered dietician can help you plan your dietary needs. People with type 1 diabetes should eat at about the same times each day and try to be consistent with the types of food they choose. This helps to prevent blood sugar from becoming extremely high or low. People with type 2 diabetes should follow a well-balanced and low-fat diet. See: Diabetes diet HOW TO TAKE MEDICATION Less than 180 mg/dL for adults 110 - 200 mg/dL for children under age 6 100 - 180 mg/dL for children 6 - 12 years old 90 - 150 mg/dL for children 13 - 19 years old 70 - 130 mg/dL for adults 100 - 180 mg/dL for children under age 6 90 - 180 mg/dL for children 6 - 12 years old 90 - 130 mg/dL for children 13 - 19 years old

Medications to treat diabetes include insulin and glucose-lowering pills called oral hypoglycemic drugs. People with type 1 diabetes cannot make their own insulin. They need daily insulin injections. Insulin does not come in pill form. Injections are generally needed one to four times per day. Some people use an insulin pump. It is worn at all times and delivers a steady flow of insulin throughout the day. Other people may use inhaled insulin. See also: Type 1 diabetes Unlike type 1 diabetes, type 2 diabetes may respond to treatment with exercise, diet, and medicines taken by mouth. There are several types of medicines used to lower blood glucose in type 2 diabetes. See also: Type 2 diabetes Medications may be switched to insulin during pregnancy and while breastfeeding. Gestational diabetes may be treated with exercise and changes in diet. EXERCISE Regular exercise is especially important for people with diabetes. It helps with blood sugar control, weight loss, and high blood pressure. People with diabetes who exercise are less likely to experience a heart attack or stroke than those who do not exercise regularly. Here are some exercise considerations: Always check with your doctor before starting a new exercise program. Ask your doctor or nurse if you have the right footwear. Choose an enjoyable physical activity that is appropriate for your current fitness level. Exercise every day, and at the same time of day, if possible. Monitor blood glucose levels before and after exercise. Carry food that contains a fast-acting carbohydrate in case you become hypoglycemic during or after exercise. Carry a diabetes identification card and a cell phone in case of emergency. Drink extra fluids that do not contain sugar before, during, and after exercise. You may need to change your diet or medication dose if you change your exercise intensity or duration to keep blood sugar levels from going too high or low. FOOT CARE People with diabetes are more likely to have foot problems. Diabetes can damage blood vessels and nerves and decrease the body's ability to fight infection. You may not notice a foot injury until an infection develops. Death of skin and other tissue can occur. If left untreated, the affected foot may need to be amputated. Diabetes is the most common condition leading to amputations. To prevent injury to the feet, check and care for your feet every day. For more information, see: Diabetes foot care Type 1 diabetes Type 2 diabetes

Support Groups
For additional information, see diabetes resources.

Expectations (prognosis)

With good blood glucose and blood pressure control, many of the complications of diabetes can be prevented. Studies have shown that strict control of blood sugar, cholesterol, and blood pressure levels in persons with diabetes helps reduce the risk of kidney disease, eye disease, nervous system disease, heart attack, and stroke.

Complications
Emergency complications include: Diabetic hyperglycemic hyperosmolar coma Diabetic ketoacidosis

Long-term complications include: Atherosclerosis Coronary artery disease Diabetic nephropathy Diabetic neuropathy Diabetic retinopathy Erection problems Hyperlipidemia Hypertension Infections of the skin, female urinary tract, and urinary tract Peripheral vascular disease Stroke

Calling your health care provider

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of ketoacidosis: Abdominal pain Deep and rapid breathing Increased thirst and urination Loss of consciousness Nausea Sweet-smelling breath

Go to the emergency room or call the local emergency number (such as 911) if you have symptoms of extremely low blood sugar (hypoglycemic coma or severe insulin reaction): Confusion Convulsions or unconsciousness Dizziness Double vision Drowsiness Headache Lack of coordination Weakness

Prevention
Maintaining an ideal body weight and an active lifestyle may prevent type 2 diabetes. Currently there is no way to prevent type 1 diabetes. There is no effective screening test for type 1 diabetes in people who don't have symptoms.

Screening for type 2 diabetes in people with no symptoms is recommended for: Overweight children who have other risk factors for diabetes starting at age 10 and repeating every 2 years Overweight adults (BMI greater than 25) who have other risk factors Adults over 45, repeated every 3 years To prevent complications of diabetes, visit your health care provider or diabetes educator at least four times a year. Talk about any problems you are having. Regularly have the following tests: Have your blood pressure checked every year (blood pressure goals should be 130/80 mm/Hg or lower). Have your glycosylated hemoglobin (HbA1c) checked every 6 months if your diabetes is well controlled, otherwise every 3 months. Have your cholesterol and triglyceride levels checked yearly (aim for LDL levels below 100 mg/dL, less than 70 mg/dL in high-risk patients). Get yearly tests to make sure your kidneys are working well (microalbuminuria and serum creatinine). Visit your ophthalmologist (preferably one who specializes in diabetic retinopathy) at least once a year, or more often if you have signs of diabetic retinopathy. See the dentist every 6 months for a thorough dental cleaning and exam. Make sure your dentist and hygienist know that you have diabetes. Make sure your health care provider inspects your feet at each visit. Stay up-to-date with all of your vaccinations and get a flu shot every year in the fall.