When you think diabetes, “blood sugar” or “blood glucose” immediately comes to mind. If you are newly diagnosed you may be surprised to learn that caring for yourself with diabetes doesn’t only involve your blood sugar. For those who have had diabetes a while, you probably are already aware of this. In treating diabetes, you need to think about keeping your whole body healthy. A big part of that is blood sugar control, but it also includes keeping your blood vessels in good health.
Are you saying to yourself; “don’t I have enough to keep me busy already with trying to keep my sugar under control and now I need to worry about my blood vessels too?” Yes! The reason is that high blood sugar levels, along with other factors, may damage your blood vessels over time. Some of the other factors that may affect blood vessel health include uncontrolled high blood pressure, unhealthy eating, visceral fat (stored within the abdomen and around body organs), elevated fat levels in the blood, smoking, and alcohol usage. These factors may result in blood vessel inflammation and damage. Research has found that inflammation may contribute to diabetes onset and that diabetes may then contribute to continued inflammation of the blood vessels over time. Damage can occur to both the small vessels (eyes, kidneys, nerve endings) and the large blood vessels (brain, heart, legs).
The good news is that your diabetes health plan includes guidelines to prevent long term issues. These guidelines are aimed at keeping a person with diabetes healthy in both and the short and long term. Many of these guidelines are just overall healthy behaviors you may already have in place. Think of it as good healthy living.
The organizations involved in creating these guidelines include; The American Diabetes Association (ADA), American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE.). The American Association of Diabetes Educators (AADE) works very closely with doctors and other members of the above organizations to provide you with the information and skills to take care of yourself successfully with diabetes. Specifically, AADE developed the “AADE7 Self Care Behaviors” which outline the behaviors needed to manage your diabetes.
As a Certified Diabetes Educator and member of AADE, I use this framework when coaching people with diabetes on a road to better self-management. Here are some recommendations for keeping yourself healthy based on the AADE7 Self Care Behaviors.
AADE7 Self Care Behaviors:
1. Healthy Eating
This needs to be individualized for you. In general, healthy eating includes portion control, carbohydrate counting (for some people), as well as limiting salt and fat intake.
2. Being Active
Activity has many health benefits such as assisting with weight loss, lowering your blood sugar, lowering fat levels in your blood, improving blood pressure, lowering stress/anxiety, and improving your mood.
Are you currently active? If yes, congratulations-way to go! For those who aren’t active at this time or not sure you are meeting the guidelines set by the American Diabetes Association, I would recommend you visit their website at http://www.diabetes.org. It is best to include both aerobic (such as walking, bike riding, swimming, exercise class) and strength training (such as stretching using your own body weight, weights, resistance bands). Before beginning an exercise program, discuss it with your Health Care Provider for approval and any limitations. When beginning an exercise program, it is important to set reasonable goals that are not too lofty. Start slow and gradually increase as per the recommendations.
3. Taking Medications
There are several types of medications that are often recommended for people with diabetes. Insulin, non-insulin injectable medications for diabetes, pills that lower your blood sugar, aspirin, blood pressure medication, cholesterol-lowering medication, or a number of others may work together to lower your blood sugar levels, reduce your risk of complications and help you feel better.
There are some steps that you can take to make sure you are getting your medication(s) and taking them correctly.
Step one is that your health care provider orders the diabetes medication that they feel may have the best benefits to you based on your needs.
Step two is getting the medication. You may want to ask some questions. Is this medication covered under my insurance plan? If not, your doctor may request that your insurance company make an exception if validated. If not, perhaps there is a similar alternative that is covered? Are there copay/discount cards available from the pharmaceutical company? No prescription coverage? Check with the pharmaceutical company to see if any assistance is available for you. If you cannot obtain/afford the prescribed medication, notify your health care provider to work on an alternative plan.
Step three is taking the medication. Find out information about the medication. How does it work in your body? What’s your dosage, in terms of frequency and time(s) of day to take it? Most medications do need to be taken at a consistent time to do their best job. Make sure you are taking the right medication at the right time. Setting reminders on your cell phone to alert you when you’re supposed to take your medication can be helpful. A big help is keeping the medication visually available. For example, if you need to take it first thing in the morning and you’re are a coffee drinker, place the medication by the coffee pot. Storage of your medication can play a role in keeping the medication working properly. Many diabetes medications such as insulin and other injectable medicines may require refrigeration and storage in particular temperatures to remain active. If your medication requires an injection ask your doctor for instructions on how to correctly prepare and give your injection.
Monitoring includes testing your blood sugar on a regular basis as discussed with your provider. It also includes getting to the doctor for regular testing of your blood pressure, cholesterol levels, yearly kidney function blood work, annual retinal eye exam, annual foot exam, and other testing as needed.
5. Problem Solving
Think of yourself as a detective when having issues related to your diabetes. Let’s say that your blood sugar levels are running high. Does this seem to occur at a fairly consistent time of the day? Does it happen more after eating out? Ask yourself various questions to see if you can pinpoint a possible reason for the high blood sugar, then follow up with your health care provider. Diabetes education classes can be a great way to learn about some problem-solving skills.
6. Reducing Risks
The key to reducing risks is that your treatment plan needs to be individualized to you. You are responsible for keeping your doctor appointments, getting labs and recommended testing done, taking medications, trying to eat healthy, and being active. If relevant to you, quitting smoking and only drinking alcohol in moderation, under the guidance of your doctor, will also help reduce your risks. I also recommend diabetes management classes, which can help you understanding the how and why when it comes to your diabetes and improving your health.
7. Healthy Coping
Do you have a particular hobby or activity that tends to relax you and give you an escape from the daily grind? Do you think this activity helps you to cope with issues in your life? Sometimes a hobby, a walk, or a talk with friend/spouse can really help you with coping. Alcohol may seem like a way to cope, but it may not be a healthy coping method. Alcohol use needs to be discussed with your health care provider.
If you would like more information on the topics discussed there are some great resources available to you. The website for the AADE7 Behaviors can be found by visiting the Patient Resources section of the AADE website. You can also find resources on the American Diabetes Association website’s “Food and Fitness” tab.
If you begin to put the AADE7 Behaviors into practice you will be on the right path to staying healthy with diabetes!
By: Jane Abbey, RN, CDE
Cecelia Health Certified Diabetes Educator