Business of Well-being

5 Steps to Better Diabetes Self-Management

When you have diabetes, much of your treatment and care comes from the decisions you make on a daily basis. Navigating through these daily decisions can sometimes be challenging if you don't know where to start. Use these "5 Steps to Better Diabetes Self-Management" as a road map to begin your journey toward well-controlled diabetes.

  1. Monitor your glucose.
  2. Take your medications!
  3. Be mindful of your food choices.
  4. Get up and get moving!
  5. Keep your doctor's appointments.

Step 1:  Monitor your glucose.

Part of having diabetes is knowing how to monitor your glucose. It is an essential key to good blood sugar control because it is the only way to know (between doctor's appointments) where you stand with your diabetes control. "Do I have to?" or "Ouch that hurts!" are common sentiments I hear from patients. My answer is usually YES and it's not that bad! Fortunately, glucometers (blood sugar machine) have come a long way.

They require a very small amount of blood (about the size of pin-head)  and the needles are fine and hurt less when changed often. Also, many offer the option of checking your hand or arm versus the fingertip. The frequency should be discussed with your physician but in general at least one to times per day is recommended.

According to the American Diabetes Association (ADA) and the American College of Endocrinology (ACE), the recommendation for a Fasting Blood Sugar (when you just woke up BEFORE your morning coffee) is less than 110 mg/dl. The guidelines for post-meal glucose differ slightly. The ADA states a post-meal goal of less than 180mg/dl.

This is for immediately following a meal at its peak. The ACE guidelines state the goal two hours after a meal should be less than 140 mg/dl. Remember: checking your blood sugar keeps you in control of your diabetes.

Step 2:  Take your medications!

This may seem like simple advice but it is a key step that is often overlooked by diabetics. "Now that my sugars are controlled I don't need to take my pills anymore" or "Once I start taking medications I can never stop" are phrases I hear often when counseling someone with diabetes. The truth is that medications really do serve a purpose in glucose control.  

There are several different types of medications to take for diabetes, and they work on different parts of the body. One type of medication works on the pancreas by stimulating it to excrete more insulin. Insulin is a hormone that helps lower blood glucose by helping it enter the  blood cells to be converted into energy. Another type of medication works on fat and muscle cells to make them sensitive to the body's own insulin.

Often in Type 2 diabetics, the body becomes resistant to using the insulin, even though it may still be produced. Yet another type of medication works on the liver by controlling the amount of sugar that the liver makes. One of the newer medications is injectable and works on all 3 areas (pancreas, cells and liver) and has the added benefit of slowing down the digestion of food which promotes weight loss.

Type 2 diabetes is a progressive disease, and often pills fail to work because the body no longer produces a sufficient amount of insulin. At this point insulin by injection becomes necessary. Taking insulin can give you greater flexibility for your glucose management. You can work with your doctor or diabetes educator to learn how to adjust your insulin.  Taking insulin can be the key to lowering your blood sugar average and may help prevent the chronic complications associated with diabetes like kidney or eye disease.

Step 3:  Be mindful of your food choices.

A key part of managing your diabetes is eating healthy foods every day. You want to know which foods to increase and which foods to limit. The "diabetic diet" can seem ominous and confusing. There are many messages that can confuse any diabetic: Don't eat sugar, count your carbohydrates, watch out for high glycemic index foods, eat good fat but limit bad fat, and eat more fiber! Learning about how different foods affect your blood sugar is important and can be done by scheduling a visit with a Registered Dietitian who can help you plan your meals to meet your health goals.

When discussing the effects of carbohydrates, protein and fat on blood sugar, carbohydrate portion control will help control blood glucose. One hundred percent of the carbohydrates you eat turn into sugar within a few hours of eating. Carbohydrates are any starch, fruit, milk, yogurt or sweet that you eat. Fortunately you don't have to avoid these foods, but be aware of your portions.

Some "carbs" (such as candy, cookies, ice cream, sodas and juices) turn into sugar faster. The goal is to eat high-fiber carbohydrates because they are absorbed into the blood stream at a slower rate. For example, eat  fruits with skins and seeds, (apples, strawberries, etc.), choose whole grains like whole wheat bread and wild rice, and stick with fat free yogurt or skim milk. Remember to choose wisely and control the amount of carbohydrates you eat to notice the positive effect on your blood sugars.

Step 4:  Get up and get moving!

The purpose of glucose (or blood sugar) in the bloodstream is to provide energy. Since exercise requires energy, it helps you "use up" your blood sugar. Not only will exercise lower your blood sugar, it can also lower your blood pressure, improve circulation, decrease stress, improve sleep and aid in digestion. It is recommended that you add 150 minutes of exercise per week to promote and maintain a healthy weight. This equates to 30 minutes 5 times per week. There is no rule stating this 30 minutes must be done consecutively.  

If you only have time for 15 minutes in the morning and 15 at lunch time, do it! The most important part is to get up and get moving. One precaution to take when you have diabetes is to check your blood sugar before you exercise. If it is less than 100 mg/dl then eat a snack containing carbohydrates (like crackers or fruit) prior to exercise.

This will help to prevent hypoglycemia (low blood sugar). Hypoglycemia is defined as a blood sugar less than 70 mg/dl. If your blood sugar gets too low during exercise you should drink 4 oz of juice, sports drink or soda to raise it quickly and stop exercising until you feel better. Once your sugar is above 70 mg/dl make sure to have a snack that has protein (like cheese , nuts or peanut butter).

The protein stays in your bloodstream longer and can help prevent a rebound low blood sugar once you resume your exercise. Once you become consistent with your exercise, your blood sugar be better controlled, and you will also feel better and more energized!

Step 5:  Keep your doctor's appointments.

You know the old saying "An apple a day keeps the doctor away?" But with diabetes it's "See your physician today and keep complications away!" This might sound cheesy but it will help you remember why you need to see your doctor on a regular basis. Depending on your glucose control, you may need to see your physician every six months or even every three months (maybe even monthly ). That will be up to you and your physician.

It is recommended that diabetics get the following exams yearly: Eye Exam, Foot Exam, Kidney Function Blood Test, Urinalysis, Cholesterol (including Total Cholesterol, HDL Cholesterol and Triglycerides) and a Flu Shot. In addition, your physician will monitor your "A1C" test two to four times per year. The A1C test measures blood glucose over a two to threemonth period. ADA recommends an A1C under 7 percent, which is an estimated average under 150 mg/dl.  

Higher A1C levels have been associated with increased risk for chronic complications like eye disease, heart disease, kidney damage and nerve damage which can lead to amputations. At your physician appointment, you should take your blood sugar journal so the physician can compare your A1C to your actual daily blood sugars. He/she will use this to adjust your medications and help you with your health goals.  

This is also your time to ask questions. If you are unsure about how a medication works or why a treatment your doctor has recommended is important, this is the time to educate yourself. Your physician may also refer you to a specialist if needed. I always encourage patients to see the doctor and remind them that they are there to help you manage your Diabetes. Keep these 5 steps in mind as you make your health goals for optimal diabetes control.

You may not do all of them every day but they are there to help you remember what is important. Identify the area(s) that may need improvement and set one goal. Write your goal down and share it with someone who can be your support to help you reach it.

Using these steps may be as simple as checking your blood sugar in the morning before your healthy breakfast of cup oatmeal strawberries and almonds, going on a 15 min walk at lunch, calling your physician to confirm your three month appointment and checking your pill box each night to make sure you took your medication!

About The Author

Carina Saez is a Registered and Licensed Dietitian as well as a Certified Diabetes Educator specializing in diabetes education and weight management. She is a graduate of Texas Christian University and has been counseling patients for the past 16 years. Carina evaluates and counsels patients in diabetes management, cholesterol and hypertension control.  She is currently the Diabetes Care Manager at Viverae. Viverae helps corporations reduce health care costs through improved employee health.  

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