Managing your diabetes – Know what to do in order to manage your diabetes
Trying to keep your blood sugar levels within the range recommended by your doctor can be very challenging. This is because many things make your blood sugar levels change unexpectedly. Managing diabetes can refer to dealing with short-term events such as high and low sugar to controlling it over the long term such as getting to grips with understanding the condition. It involves more than just keeping blood sugar levels under control. Managing diabetes should also encompass keeping blood pressure and cholesterol levels under control, maintaining weight and dealing with the emotional impact of the condition. How you manage your diabetes can at times involve striking a balance between how strictly you wish to control sugar levels and how much freedom to allow yourself to live as full a life as possible. Diabetes is far from an easy condition to keep under control to the extent that there are a number of different educational courses designed to help people cope with the daily challenges the condition can present.
Learning how to control diabetes can be done for both type 1 and type 2 diabetes with food, diet, and regular blood testing. The main goal of diabetes management is, as far as possible, to restore carbohydrate metabolism to a normal state. To achieve this goal, individuals with an absolute deficiency of insulin require insulin replacement therapy, which is given through injections or an insulin pump. Insulin resistance, in contrast, can be corrected by dietary modifications and exercise. Other goals of diabetes management are to prevent or treat the many complications that can result from the disease itself and from its treatment.
The treatment goals are related to effective control of blood glucose, blood pressure and lipid, to minimize the risk of long-term consequences associated with diabetes. They are suggested in clinical practice guidelines released by various national and international diabetes agencies.
Modern approaches to diabetes primarily rely upon dietary and llifestyle management, often combined with regular ongoing blood glucose level monitoring. Diet management allows control and awareness of the types of nutrients entering the digestive system, and hence allows indirectly, significant control over changes in blood glucose levels. Blood glucose monitoring allows verification of these, and closer control, especially important since some symptoms of diabetes are not easy for the patient to notice without actual measurement. Other approaches include exercise and other lifestyle changes which impact the glucose cycle.
In addition, a strong partnership between the patient and the primary healthcare provider is an essential tool in the successful management of diabetes. Often the primary care doctor makes the initial diagnosis of diabetes and provides the basic tools to get the patient started on a management program. Regular appointments with the primary care physician and a certified diabetes educator are some of the best things a patient can do in the early weeks after a diagnosis of diabetes.
Diabetes can be very complicated, and the physician needs to have as much information as possible to help the patient establish an effective management plan.
Managing your Diabetes
Blood Sugar Level
Blood sugar level is measured by means of a glucose metre, with the result either in mg/dL or mmol/L of blood. The average normal person has an average fasting glucose level of 4.5mmol/L (81mg/dL), with a low of down to 2.5 and up to 5.4mmol/L (65 to 98mg/dL). Optimal management of diabetes involves patients measuring and recording their own blood glucose levels. By keeping a diary of their own blood glucose measurements and noting the effect of food and exercise, patients can modify their lifestyle to better control their diabetes. For patients on insulin, patient’s involvement is important in achieving effective dosing and timing.
- Hypoglycemia and hyperglycemia: Levels are significantly above or below this range are problematic and can in some cases be dangerous. A level of <3.8mmol/L (<70mg/dL) is usually described as a hypoglycemic attack (low blood sugar). Most diabetics know when they are going to “go hypo” and usually are able to eat some food or drink something sweet to raise levels. A patient who is hyperglycemic (high glucose) can also become temporarily hypoglycemic under certain conditions (e.g not eating regularly or after strenuous exercise, followed by fatigue). Levels greater than 13 – 15mmol/L (230 – 270mg/dL) are considered high, and should be monitored closely to ensure that they reduce rather than continue to remain high. If left untreated, this can result in diabetic coma and death.
- Glycemic control: Glycemic control is a medical term referring to the typical levels of blood sugar (glucose) in a person with diabetes mellitus. Much evidence suggests that many of the long-term complications of diabetes, especially the microvascular complications, result from many years of hyperglycemia. Good glycemic control, in the sense of a “target” for treatment, has become an important goal of diabetes care, although recent research suggests that the complications of diabetes may be caused by genetic factors or in type 1 diabetes, by the continuing effects of the autoimmune disease which first caused the pancreas to lose its insulin-producing ability.
- Personal (home) glucose monitoring: Control and outcomes of both type 1 and type 2 diabetes may be improved by patients using home glucose metres to regularly measure their glucose levels. Glucose monitoring is both expensive and requires a significant commitment on the part of the patient. The effort and expense may be worthwhile for patients when they use the valves to sensibly adjust food, exercise, and oral medications or insulin. These adjustments are generally made by the patients themselves following training by a clinician. There are many (at least 20+) different types of blood monitoring devices available on the market today, not every metre suits all patients and it is a specific matter of choice for the patient, in consultation with a physician or other experienced professional, to find a metre that they personally find comfortable to use.
- HbA1c test: A useful test that has usually been done in a laboratory is the measurement of blood HbA1c levels. This is the ratio of glycated haemoglobin in relation to the total haemoglobin. Persistently raised plasma glucose levels cause the proportion of these molecules to go up. This is a test that measures the average amount of diabetic control over a period originally thought to be about 3 months (the average red blood cell lifetime), but more recently thought to be more strongly weighted to the most recent 2 to 4 weeks. In non-diabetic, the HbA1c level ranges from 4.0 – 6.0%; patients with diabetes mellitus who manage to keep their HbA1c level below 6.5% are considered to have good glycemic control. The HbA1c test is not appropriate if there have been changes to diet or treatment within the shorter time periods than 6 weeks or there is a disturbance or red cell ageing (e.g recent bleeding or hemolytic anaemia) or a haemoglobinopathy (e.g sickle cell disease). In such cases, the alternative Fructosamine test is used to indicate average control in the preceding 2 to 3 weeks.
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- Diet: For type 1 diabetics, there will always be a need for insulin infections throughout their life. However, both type 1 and type 2 diabetes can see dramatic effects in their blood sugars through controlling their diet, and some type 2 diabetics can fully control the disease by dietary modification. As diabetes can lead to many other complications, it is critical to maintaining blood sugars as close to normal as possible and diet is the leading factor in this level of control. The first steps in diabetes management should be for patients to be put on a low carb diet. Patients that are put on a high carb diet find it very difficult to maintain normal blood glucose levels.
- Exercise: Physical activity is another important part of your diabetes management. When you exercise, your muscles use sugar (glucose) for energy. Regular physical activity also helps your body use insulin more efficiently. These factors work together to lower your blood sugar level.
- Medication: Insulin and other diabetes medication are designed to lower your blood sugar levels when diet and exercise alone are not sufficient for managing diabetes. But the effectiveness of these medications depends on the timing and size of the dose. Medications you take for conditions other than diabetes also can affect your blood sugar levels.
Visit your doctor or healthcare provider for more medical advice on how to control/manage your diabetes.