November 14th marks an important date in the world of diabetes management and prevention. Yesterday was World Diabetes Day, a global campaign to bring awareness to the disease and those living with it. I don’t know what your community is doing for diabetes day, but if you noticed more people wearing blue, blue lights lighting up the sky or see blue circles around, know it’s for diabetes!
As a diabetes educator, I try to enlighten as many people as possible around the issues surrounding the prevention and management of diabetes. I also try to discuss openly the stigma that those living with Type 2 Diabetes face daily, and I am sure everyone is tired of me correcting them from saying someone is a “diabetic” to a “person living with diabetes” (I cringe when I hear it… people are actually not their disease, they are so much more!). Anywhoooooo. Today I wanted to talk a little more in-depth about the management of diabetes and some common messages I would tell my clients when they come in to see me.
Step 1: Learn about your diabetes.
What is diabetes? There are three main types of diabetes and some variations in between:
- Type 1 diabetes– Your body does not make insulin. This is a problem because you need insulin to take the sugar (glucose) from the foods you eat and turn it into energy for your body. You need to take insulin every day to live.
- Type 2 diabetes– Your body does not make enough or use insulin well. You may need to take pills or insulin to help control your diabetes. Type 2 is the most common type of diabetes with 90% of those living with diabetes living with type 2 diabetes.
- If you start taking insulin to help manage your blood sugar, this does not mean you then move into having type 1 diabetes. You are still living with type 2 diabetes, but are managing with insulin. Remember, type 1 diabetes occurs after an autoimmune response.
- Gestational diabetes– Some women get this kind of diabetes when they are pregnant. Most of the time, it goes away after the baby is born. But even if it goes away, these women and their children have a greater chance of getting diabetes later in life.
You are the most important member of your healthcare team.
As a dietitian and diabetes educator, I remind my client that I am a backseat driver when it comes to managing their diabetes. I can provide information, directions, suggestions and so on, but ultimately, you are the driver and you are the one steering your management. In the end, you are the one who manages your diabetes day by day, but there are many people available to help you with that. Talk to your doctor about how you can best care for your diabetes to stay healthy. Some others who can help are:
- diabetes doctor
- diabetes educator
- eye doctor
- foot doctor
- friends and family
- mental health counselor
- nurse practitioner
- social worker
Take diabetes seriously.
You may have heard people say they have “almost have diabetes”, that their “sugar is a little high” or that they “just have diabetes.” These words suggest that diabetes is not a serious disease. That is not correct. Diabetes is serious, but you can learn to manage it and live an extremely healthful life, like everyone else.
People with diabetes need to make healthy food choices, move more every day, take their medications and check their blood sugar even when they feel good. It can be a lot to do, it may not always be easy, but in the end, it’s worth it!
But it’s “just” diabetes, what could happen?
Taking care of yourself and your diabetes can help prevent complications from living with diabetes. When your blood sugar (glucose) is close to normal you will have more energy, heal better and have fewer infections. You will also be at less risk of developing a complication such as the following:
- heart attack or stroke
- eye problems that can lead to trouble seeing or going blind
- pain, tingling, or numbness in your hands and feet, also called nerve damage
- kidney problems that can cause your kidneys to stop working
- teeth and gum problems
What can you do?
- Ask your primary care provider what type of diabetes you have and what your HbA1c is.
- Learn where you can go for support, like a dietitian or diabetes educator.
- Learn how caring for your diabetes helps you feel good today and in the future.
Step 2: Know your diabetes ABCDEs
Talk to your health care team about how to manage your A1C, Blood pressure, Cholesterol, Drugs, Exercise and Eating along with Smoking. This can help lower your chances of having a heart attack, stroke, or other diabetes problems. Discuss with your primary care provider about a referral to a dietitian to help you manage the above.
A is for the Hemoglobin A1C test (A1C).
What is it?
Your A1C is a blood test that measures your average blood sugar level over the past three months. It is different from the blood sugar checks you do each day, which give you a picture of what your blood sugar is at that very moment in time.
Why is it important?
Having an average of what your blood sugar is over about 3 months gives us a good idea of how your management is going and if we need to make any adjustments to your treatment.
What is the A1C goal?
The A1C goal for many people with diabetes is between 6.5% to 7.0%. Your goal may be slightly different depending on the type of diabetes you have, your age, your medications and your health history. It’s best to talk to your healthcare provider to find the best target for you.
B for Blood pressure
What is it?
Blood pressure is the force of your blood against the wall of your blood vessels.
Why is it important?
If your blood pressure gets too high, it makes your heart work too hard. It can cause a heart attack, stroke, and damage your kidneys and eyes.
What is the blood pressure goal?
The blood pressure goal for most people with diabetes is 130/80 or less. Talk with your health care provider to discuss your goal and your management.
C for Cholesterol.
What is it?
Cholesterol is a waxy, fat-like substance found in all of our cells in our body. It’s used to make hormones, vitamin D and enzymes that help us digest food. Your body naturally makes cholesterol and we also get some from food. We have two main kinds of lipoproteins that carry our cholesterol for us, LDL and HDL lipoproteins.
LDL is sometimes called “bad” cholesterol as it can build up and clog your blood vessels. It can cause a heart attack or stroke.
HDL is sometimes called “good” cholesterol as it carries cholesterol back to your liver to be removed from your body.
What are the LDL and HDL goals?
For adults living with diabetes, we look at your LDL cholesterol to ensure it is 2.0 mmol/L or less.
D is for Drugs
Drugs to protect the heart even if the baseline blood pressure or LDL cholesterol is already at target. We have medications that can help protect our heart and organs in other ways. (see algorithm and Risk Assessment Tool.
E is for Exercise and Eating
Regular physical activity is important in maintaining our cardiovascular health, muscle strength and managing our blood sugar. The more we use our muscles, the more sugar they need for energy!
Healthy Eating is another key component to managing our diabetes. I follow a philosophy of all food fit, we can eat anything, we just eat everything. See a dietitian to find out how to balance your diet to best manage your blood sugar!
S is for Smoking Cessation
Smoking is bad for everyone. It increases your risk for lung cancer, heart attack, and stroke. Each day, 100 Canadians die of a smoking-related illness. If you currently smoke and are looking to stop, see your health care provider about support in doing so. People with diabetes face an even greater risk from smoking: just like high blood sugar levels, the poisonous chemicals in cigarette smoke attack our blood vessels. This can lead to hardening of the arteries which impairs the blood’s ability to carry oxygen throughout the body, which is key to our cell’s health.
Step 3: Learn how to live with diabetes.
It is common to feel overwhelmed, sad, or angry when you are living with diabetes. Sometimes people go through a grieving period when they first diagnosed, this is normal. Many people grieve the life they once lived and learn to live a new, slightly altered life while living with diabetes. This life can be just and fun and fulfilling! You may know the steps you should take to stay healthy, but have trouble sticking with your plan over time. This section has tips on how to cope with your diabetes, eat well, and be active.
Cope with your diabetes.
- Stress can raise your blood sugar. Learn ways to lower your stress. Try deep breathing, gardening, taking a walk, meditating, working on your hobby, or listening to your favorite music.
- Ask for help if you feel down. A mental health counselor, support group, member of the clergy, friend, or family member who will listen to your concerns may help you feel better.
- Meet with a registered dietitian to learn how to balance your plate to manage your blood sugar.
- Eat foods with more fiber, such as whole grain cereals, breads, crackers, rice, or pasta.
- Drink water instead of juice and regular soda.
- When eating a meal, fill half of your plate with vegetables, one quarter with a lean protein, such as beans, or chicken or turkey, and one quarter with a whole grain, such as brown rice or whole wheat pasta.
- Set a goal to be more active most days of the week. Start slow by taking 10-minute walks and increase in time and frequency over time. The goal is to spend more time up and moving, and less time sitting.
- Twice a week, work to increase your muscle strength. Use stretch bands, do yoga, heavy gardening (digging and planting with tools), or try push-ups.
Step 4: Get routine care to stay healthy.
Diabetes is what we call a progressive disease, it typically gets worse over time. This is why it is so important for you to visit health care provider at least 2 times per year to have a physical completed and regular blood work. If you are newly diagnosed or your blood sugar is not yet to target, it will be important for you to see your health care provider more regularly, every 3-4 months. It may seem like a lot of visits if you’re not used to seeing your health care provider, but regular visits can help prevent any serious complications from happening if we can spot them early on and treat.
At each visit, be sure you have a:
- blood pressure check
- foot check
- review of your self-care plan
- and order for a HbA1c
Annually, be sure to ask for:
- cholesterol test
- complete foot exam
- dental exam to check teeth and gums
- dilated eye exam to check for eye problems
- flu shot
- urine and a blood test to check for kidney problems
Take Home Message:
- You are the most important member of your health care team.
- Follow the four steps in this guide to help you learn how to manage your diabetes.
- Learn how to reach your diabetes ABCDEs goals.
- Ask your health care team for help.
If you have any questions from any of the information here, please feel free to give me a call. I can help you navigate how to best manage your diabetes.