What kind of DIABETES do you have?
Type 1 diabetes, formerly called juvenile diabetes or insulin-dependent diabetes, is usually first diagnosed before age 40 (in children, teenagers, or young adults). It is a disorder in which the body does not produce insulin (a hormone that aids in moving sugar from the blood to the cells). This type of diabetes can be due to a virus or autoimmune disorder in which the body does not recognize an organ as its own and attacks it. In this case the body attacks an organ known as the pancreas where insulin is made. Those with type 1 diabetes require insulin injections to move sugar from the bloodstream.

Type 2 diabetes, formerly called adult-onset diabetes or noninsulin-dependent diabetes, is the most common form of diabetes. People typically develop type 2 diabetes at a later age, however, nowadays, even children have it. This form of diabetes usually begins with insulin resistance, a condition in which fat, muscle, and liver cells do not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, it loses the ability to secrete enough insulin in response to meals. Being overweight and inactive increases the chances of developing type 2 diabetes.

Some women develop gestational diabetes during the late stages of pregnancy which is caused by the hormones of pregnancy or a shortage in insulin. Although this form of diabetes usually goes away after the baby is born, a woman who had it is more likely to develop type 2 diabetes later in life.

Why do you need to take care of your diabetes?
After many years, diabetes can lead to serious problems with your eyes, kidneys, nerves, gums, and most importantly, your heart. When you have diabetes, you are more than twice as likely as people without diabetes to have heart disease or stroke. Much worse, when you have diabetes, the risk of a heart attack is the same as someone who has already had a heart attack.

Most of diabetes management falls on the person living with the disease. The best way to take care of your health is to work with your health care team composed of your doctor, nurse, diabetes educator and dietitian, to keep your blood glucose, blood pressure, and cholesterol in your target range.

The Philippine Center for Diabetes Education Foundation, Inc (PCDEF) or “Diabetes Center Philippines” and the American Association of Diabetes Educators (AADE) believe that measurable behavior change is the desired outcome of diabetes education. Diabetes educators are healthcare professionals who focus on helping people with diabetes, their families and the community to understand the disease and learn how to promote healthy lifestyle, prevent diabetes and its complications and develop diabetes self-management skills.

Below are the 7 self-care behaviors that are keys to diabetes management as adapted from the AADE guidelines. These are the tools the patient needs to have a healthy and happy diabetes life.

1. Healthy Eating
There are four specific diet behaviors that have the most influence on improving glucose control:

• Being consistent with a meal plan
• Treating hypoglycemia appropriately
• Responding to hyperglycemia (more insulin and/or less food)
• Being consistent with an evening snack, if prescribed.

People with diabetes don’t have to eat special foods but should have their own meal plan. Your dietitian can help you plan heart-healthy meals that include foods that you and your family like to eat and are good for you too. Your diabetes meal plan will include breads, cereals, rice and grains, fruits and vegetables, meat and meat substitutes, dairy products, and fats.

2. Being active
Exercise is perhaps the most underutilized way to help control diabetes. Regular activity is important for overall fitness, weight management and blood glucose control. Being active can also help improve body mass index, enhance weight loss, help control lipids and blood pressure, and reduce stress.

Unless your physician has advised you not to, exercise is good medicine. The challenge is making it a part of a daily routine. You don’t have to go to an expensive gym to get the benefits: improved cardiovascular function, strength, and glucose control. Wear a pedometer and try to work up to 10,000 steps a day—it’s just as effective as a 30-minute walk. Start with three sessions a week, for 20 to 30 minutes per session, and gradually build up to 60 minutes. Trying to lose weight? The American Diabetes Association (ADA) recommends 90 minutes of daily exercise. Many people with diabetes find exercise one of the easiest things to do.

When you exercise, carry glucose tablets or a carbohydrate snack with you in case you get hypoglycemia. Wear or carry an identification tag or card saying that you have diabetes.

3. Monitoring
Self-monitoring of blood glucose has transformed diabetes self-management. You can know your glucose levels by performing a simple blood test, practically anywhere.

Daily self-monitoring of blood glucose provides people with diabetes the information they need to assess how food, physical activity and medications affect their blood glucose levels. Ask your doctor how often you should check your blood glucose. Some people check their blood glucose once a day. Others do it three or four times a day. You may check before and after eating, before bed, and sometimes in the middle of the night.

Your doctor or diabetes educator will show you how to check your blood glucose level using a blood glucose meter. Checking your blood glucose will help you see if your diabetes treatment plan is working.

4. Taking medication
Medication is oftentimes needed to achieve glucose control. Did you know that approximately 50 percent of people do not take prescriptions correctly? The patient should be well informed that diabetes is a progressive condition. Depending on what type a person has, the healthcare team will be able to determine which medications one should be taking and help one understand how medications work. The team can even demonstrate how to inject insulin.

Effective drug therapy in combination with healthy lifestyle choices, can lower blood glucose levels, reduce the risk for diabetes complications and produce other clinical benefits. The goal is for the patient to be knowledgeable about each medication, its action, side effects, efficacy, toxicity, dosage, appropriate timing and frequency of administration, effect of missed and delayed doses, and instructions for storage, travel and safety.

5. Problem solving
A person with diabetes must keep problem-solving skills sharp because on any given day, a high or low blood glucose episode or illness will require them to make rapid, informed decisions about food, activity and medications. This skill is continuously put to use because even after decades of living with the disease, stability may not be fully attained: the disease is progressive, chronic complications emerge, life situations change and the patient ages.

Collaboratively, diabetes educators and patients address barriers, such as physical, emotional, cognitive, and financial obstacles, and develop coping strategies.

6. Reducing risks
Effective risk reduction behaviors such as smoking cessation, and regular eye, foot, and dental examinations reduce diabetes complications and maximize health and quality of life. An important part of self-care is learning to understand, seek and regularly obtain an array of preventive services.

Diabetes educators assist patients in gaining knowledge about standards of care, therapeutic goals, and preventive care services to decrease risks. Skills taught include smoking cessation, foot inspections, blood pressure monitoring, self-monitoring of blood glucose, aspirin use and maintenance of personal care records.

7. Healthy coping
Health status and quality of life are affected by psychological and social factors. Psychological distress directly affects health and indirectly influences a person’s motivation to keep their diabetes in control. When motivation is dampened, the commitments required for effective self-care are difficult to maintain. When barriers seem insurmountable, good intentions alone cannot sustain the behavior. Coping becomes difficult and a person’s ability to self-manage their diabetes deteriorates.

An important part of the diabetes educator’s work is identifying the individual’s motivation to change behavior, then helping set achievable behavioral goals and guiding the patient through multiple obstacles. They can provide support by encouraging you to talk about your concerns and fears and help you learn to cope.

This self-care behavior is like the car maintenance schedule of diabetes management. Certain tests need to be done at specific times to prolong the life and efficiency of your car, and likewise, your body.

Related terms:

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• family influences on diabetes the self-care health practices of women with diabetes type 2 in the philippines
• philippine center for diabetes education foundation instruction for diabetes
• walking using pedometer for diabetes

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