Diabetes Management – 5 Step Program

1962_Control Diabetes for Life

You have Diabetes”, is not something easy to hear for anyone. Millions of thoughts and questions spiral through your mind and you become boggled and confused. “What now? Do I need insulin? Will I need to go on a diabetic diet? Will I get better”? These are just some of the questions people face when they get diagnosed.

It is easy to get overwhelmed as you face different challenges and obstacles brought on by the diagnosis of a chronic disease, such as Diabetes.

A chronic disease can be a burden on the person and the person’s family from both a financial and emotional perspective. Chronic disease is a long-lasting condition that can be controlled but not cured and in the case of Diabetes, it’s a progressive chronic disease; which means it gets worse as time passes — therefore, it’s very important to have optimal blood glucose control in order to slow the progression of diabetes and prevent any complications.

Many people control Type 2 Diabetes by following appropriate meals plans, participating in exercise and using medications. Initially, people may be able to manage blood glucose by eating healthy, but as the disease progresses, treatment may expand to include various oral medications or even insulin.

There are several things you can do to live well with Diabetes, starting with these five steps:

  1. Manage your weight
  2. Take your medication as prescribed
  3. Know your targets
  4. Engage in exercise
  5. Stay positive
  1. Managing your weight can help improve blood sugars and reduce risks of other metabolic conditions such as hypertension (high blood pressure), dyslipidemia (high cholesterol) and cardiovascular disease (heart attack and stroke)). An estimated 80-90% of persons with Type 2 Diabetes are either overweight or obese and studies have indicated a 7-fold increase in obesity in 20 years.  Even losing a little bit of weight such as a modest weight loss of 5-10% of initial body weight can significantly improve blood sugar control and reduce cardiovascular disease risk factors. In particular, losing excess weight around the midsection can reduce insulin resistance and improve glucose uptake of cells (Rawlings). This insulin resistance resulting in poor glucose update is at the centre of Type 2 Diabetes. Making healthy lifestyle choices such as eating healthy and exercising are the key to losing weight and keeping it off.
  1. Taking your medication as prescribed by your doctor is very important in achieving your target blood glucose levels. Medications are effective means to manage a chronic disease like Diabetes, however their full benefits are often not realized because approximately 50% of people do not take their medication as prescribed by their doctors (Brown et. al.). One of the explanations for why people don’t take their medication as prescribed is because they don’t understand their disease and how the medication they’ve been prescribed works to manage their disease (Brown et. al.). People with Diabetes who are prescribed medication by their doctors need to understand Diabetes itself and how the medication can improve their condition. There are several different Diabetes oral agents on the market and they differ in how they work, timing of administration and their effect on the Hemoglobin A1C (HbA1C) which reflects the average blood glucose concentration over the past 120 days. The table below describes some commonly used Diabetes oral agents;
MEDICATION SITE OF ACTION FUNCTION WHEN TO TAKE EXPECTED DECREASE IN HbA1C
Metformin Liver, peripheral cells (muscle, fat) reduces glucose produced in the liver; increases insulin sensitivity; improves glucose uptake of the cells take with meals to prevent abdominal discomfort 1.0-1.5%
Diamicron(Gliclazide) pancreas stimulate the cells in the pancreas to secrete insulin take with meals; do not skip meals to prevent low blood glucose (hypoglycemia) 0.8%
Acrabose(Glucobay) intestines slows the absorption of glucose in the intestines take with first bite of food 0.6%
Linagliptin(Trajenta) intestinal hormones increases the action time of insulin take once a day with or without food 0.7%

(derived from Canadian Diabetes Practice Guidelines)

  1. Knowing your target blood glucose levels will better prepare you in making the right choices so that you can keep blood glucose in target and preventing diabetes related complications. Both fasting blood glucose level and post meal blood glucose level are directly related to the risk of diabetes-related complications so monitoring both of those is important. Research seems to indicate that post meal blood glucose levels is a stronger predictor of cardiovascular risks. An HbA1C greater than 7% has been linked to a significantly higher risk of microvascular(kidneys, eyes, nerves) and macrovascular (cardiovascular) complications. What makes monitoring your target blood glucose levels so important is that there is evidence that lowering your HbA1C significantly reduces your risk of cardiovascular complications.  For example, studies have shown that for every 1.0% HbA1C is lowered that there is a 37% reduction in the risk of microvascular complications, a 14% lower rate of myocardial infarctions (heart attacks) and 21% reduction in Diabetes-related death. Monitoring your blood glucose levels first thing in the morning and after and between meals (self-testing) is the only way to know if you are reaching your targets.

Target Blood Glucose levels

BEFORE MEAL TARGET AFTER MEAL TARGET TARGET HbA1C
4.0 mmol/L – 7.0 mmol/L 5.0 mmol/L – 10.0 mmol/L Less than or equal to 7.0%
  1. Engage in Exercise – For people with type 2 Diabetes, engaging in daily physical activity can significantly improve glycemic (blood sugar) control. It is recommended that people with Diabetes are physically active for at least 30 minutes a day, 5 times a week in order to benefit from improved cardiovascular health, increase strength and to help maintain a healthy weight (Rawlings). Engaging in moderately intensity exercise such as brisk walking, biking, or dancing can help muscle cells respond better to insulin; responding better to insulin allows the cells to take up glucose more effectively therefore resulting in better blood sugar control. Exercise can also lower fat which in return allows insulin to work more effectively in the body.
  1. Stay positive! Being diagnosed with Diabetes can be an emotional experience. Some people get angry or are in denial, while others become depressed, feel a tremendous amount of shame or have fear of what the future will hold. The intensity of emotions vary from person to person and for some will gradually decrease over time. However for others it becomes a life-long struggle coping with Diabetes on top of other stress factors. Research has demonstrated a relationship between Diabetes and mental health disorders; with approximately 30% of people with diabetes having depressive symptoms. There are many risk factors for developing depression in individuals with Diabetes, one of them being lack of social support. Sharing feelings and concerns with family members can often help lower the sense of frustration and have a healthy outlet for bottled up emotions. While the tendency is to want to shut out people who care, it is more helpful to invite them to be a part of your support circle (Rawlings).

Diabetes is a chronic disease which often gets worse over time, but with being diligent it can be controlled although not cured.  Remember to take your Diabetes medication as prescribed by your doctor, know and stay within your blood glucose targets, engage in regular physical activity and develop a good network of support so you can stay positive.

If you need some help to get your weight down or to plan your meals and snacks for optimal blood glucose levels, our Dietitian who specializes in Diabetes can help. Please click on the Contact Us tab above to send us a note.

References

1. 2013 Canadian Diabetes Association Clinical Practice Guidelines (CPGs)

2.Brown, Marie, and Jennifer Bussel. “Medication Adherence: WHO Cares?” Mayo Clinic Proceedings 86.4: 304-14. NCBI. NCBI. Web. 26 June 2015. www.ncbi.nlm.nih.gov/pmc/articles/PMC3068890/pdf/mayoclinproc_86_4_007.pdf

3.Rawlings, Kelly. Diabetes: What to Eat. New York: Houghton Mifflin Harcourt, 2011. Print.