Editor’s Note: In this column, Dr. Erin Marcus offers practical information on one of the most prevalent and potentially harmful diseases from the perspective of a patient who is managing his chronic Type 2 diabetes. Dr. Marcus is associate professor of clinical medicine at the University of Miami Miller School of Medicine. A Doctor's Word is supported by a grant from the Ford Foundation.
“Self-management” isn’t a term you’ll hear doctors use much when they’re discussing illnesses such as cancer or heart disease. But when doctors talk about diabetes - a blood sugar condition that affects more than one in 10 Native Americans, African Americans, and Latinos - the conversation is different. To stay healthy, most people diagnosed with diabetes need to make lots of changes in their everyday life. They often need to modify the food they eat, get more physical activity, and frequently check their blood sugar levels.
These changes sound daunting, but many diabetics have been able to incorporate them into their daily lives - without giving up their favorite foods or changing jobs. Al Whitaker, 54, an associate church pastor in Boston, is one. Al was diagnosed with diabetes nine years ago, after he found himself too thin to fit into a suit he had purchased five days earlier. He had lost 30 pounds in eight months, but had delayed getting a check-up because he was afraid he might have cancer - and felt unprepared to cope. Instead, his doctor told him that his sugar was four times normal, and that he had Type 2 diabetes, the most common type.
“I had never thought about diabetes,” he said recently. “And lo and behold, my sugar was 450.”
The diagnosis was a bit scary at first. One of Al’s cousins with diabetes had had a toe amputated, and Al experienced several episodes of low blood sugar after beginning medication. But Al felt reassured after reading about diabetes on the web and in brochures he found at his pharmacy.
“The fear I had subsided once I realized that if I changed my diet I could manage” diabetes, he said. “There’s such a wealth of knowledge out there.”
A year ago, Al took a job with the American Diabetes Association, organizing community programs to educate the public about diabetes. Below is some of his advice, as well as tips from other diabetics and from Kellie Rodriguez, a veteran nurse educator at the Diabetes Research Institute at the University of Miami Miller School of Medicine (full disclosure - I work for the same school, in a different department):
• Regularly check your blood sugar, and write the results in a log book. This is important because your blood sugars can be dangerously high or low without your experiencing any symptoms. Persistently elevated sugars increase your risk of heart disease, stroke, blindness, kidney failure, and circulation and nerve problems in your feet.
Glucometers, the machines that test blood sugar levels, usually cost less than $100, and sometimes you can get these for free from a diabetes educator. But the test strips, which cost up to $1 each, can add up. Medicare and Medicaid and private insurance plans usually cover test strips and glucometers. If you lack insurance and can’t afford to test your sugars every day, Kellie recommends checking at different times - one day before breakfast, another day before lunch or dinner, and another day two hours after your largest carbohydrate meal (more on carbohydrates later). If you and a family member are trying to economize, it’s okay to share a glucometer, but you should never share the lancets that you use to stick your fingers since the blood could transmit disease.
The American Association of Clinical Endocrinologists, a group of specialist doctors, recommends a blood sugar goal of 110 or less in the morning before eating and a blood sugar rise of no more than 140 points at 2 hours after a meal. But it’s important to try to remain calm about your numbers and not get upset if they’re not at goal. Kellie urges people to think of their sugars as “high,” “low,” or “target,” not “good” or “bad.” “Don’t be afraid to go to the doctor because you’re embarrassed,” she told me recently. “We need the numbers to identify the problem. It’s not about me being happy, it’s about your sugar.”
• Make sure you meet with a diabetes educator, or enroll in a diabetes class, to learn how to manage your disease successfully. “It’s really important for people to understand diabetes, to break down some of the mystery of it all,” Al said. The American Association of Diabetes Educators lists diabetes educators on its website (http://www.diabeteseducator.org/). The American Diabetes Association (http://www.diabetes.org/) also has a toll-free number you can call for more information - 1 800-342-2383 (1-800-DIABETES).
• Learn to recognize carbohydrate-rich foods (which make your blood sugar rise quickly), to read food labels, and to identify how much certain foods will increase your blood sugar. High carbohydrate foods include breads, cereals, fruits, juices, vegetables, pastas, rice and milk, as well as sugar-containing sodas and sweet deserts. Kellie advises people to shop mainly on the perimeter of the supermarket, where they’re more likely to find fresh produce, meats and fish, and avoid the center, where processed foods are usually stocked. Al said he always eats a meal before going to the grocery store, because if he’s hungry he’s more likely to buy impulsively.
• Ask a diabetes educator or dietician about ways to alter your favorite foods to make them a bit healthier. Al recently prepared collard greens and black eyed beans and rice for the holidays using turkey broth instead of ham hock, for example. When he orders food at restaurants, he immediately requests a to-go container - and puts half his meal in it before he eats. Kellie tells patients they can eat smaller portions of foods like rice, but should check their sugar two hours after the meal to see how much they can tolerate.
• Stop smoking This adds to your risk of heart and blood circulation problems.
• Prepare before doctor appointments by writing down your questions in advance, and don’t be afraid to ask. Al recommends bringing a friend or relative. “You feel empowered, and also the doctor’s going to say, ‘Wow, here’s someone who cares about their condition,’” he said.
Kellie recommends asking about the following numbers: glycohemoglobin (a blood test measurement that indicates long-term sugar levels); blood pressure (the goal for diabetics is less than 130/80) and cholesterol, including the LDL (bad) and HDL (good) cholesterol.
• For Type 2 diabetics: don’t be unduly afraid if pills aren’t enough, and if you need insulin. Many doctors now prescribe insulin pens, devices that usually aren’t painful and that generally control blood sugar better than syringes. Unfortunately, pens can be expensive and aren’t always covered by insurance plans. Some drug companies have patient assistance plans that provide pens for free; check www.needymeds.org for more information.
• Find ways to move your body. For Al, this means walking for a short errand instead of taking his car and using the stairs instead of the escalator. Kellie recommends walking around the room while watching TV and lifting heavy cans or bags of rice while sitting in a chair, as well as going for walks with a friend or neighbor.
• Take care of your eyes (by getting eye exams annually) and feet (which are at increased risk of infection and poor circulation). Avoid going to the beach barefoot and check your feet each night.
• Find a buddy who can provide you with emotional support. Al was able to talk with a woman in his church who also had diabetes. “I could call her up and say, ‘I’m feeling miserable,’” he said. “A lot of people don’t understand how when your sugar levels are high you can become cranky. I appreciated having her around to share.”
“Self-management” isn’t a term you’ll hear doctors use much when they’re discussing illnesses such as cancer or heart disease. But when doctors talk about diabetes - a blood sugar condition that affects more than one in 10 Native Americans, African Americans, and Latinos - the conversation is different. To stay healthy, most people diagnosed with diabetes need to make lots of changes in their everyday life. They often need to modify the food they eat, get more physical activity, and frequently check their blood sugar levels.
These changes sound daunting, but many diabetics have been able to incorporate them into their daily lives - without giving up their favorite foods or changing jobs. Al Whitaker, 54, an associate church pastor in Boston, is one. Al was diagnosed with diabetes nine years ago, after he found himself too thin to fit into a suit he had purchased five days earlier. He had lost 30 pounds in eight months, but had delayed getting a check-up because he was afraid he might have cancer - and felt unprepared to cope. Instead, his doctor told him that his sugar was four times normal, and that he had Type 2 diabetes, the most common type.
“I had never thought about diabetes,” he said recently. “And lo and behold, my sugar was 450.”
The diagnosis was a bit scary at first. One of Al’s cousins with diabetes had had a toe amputated, and Al experienced several episodes of low blood sugar after beginning medication. But Al felt reassured after reading about diabetes on the web and in brochures he found at his pharmacy.
“The fear I had subsided once I realized that if I changed my diet I could manage” diabetes, he said. “There’s such a wealth of knowledge out there.”
A year ago, Al took a job with the American Diabetes Association, organizing community programs to educate the public about diabetes. Below is some of his advice, as well as tips from other diabetics and from Kellie Rodriguez, a veteran nurse educator at the Diabetes Research Institute at the University of Miami Miller School of Medicine (full disclosure - I work for the same school, in a different department):
• Regularly check your blood sugar, and write the results in a log book. This is important because your blood sugars can be dangerously high or low without your experiencing any symptoms. Persistently elevated sugars increase your risk of heart disease, stroke, blindness, kidney failure, and circulation and nerve problems in your feet.
Glucometers, the machines that test blood sugar levels, usually cost less than $100, and sometimes you can get these for free from a diabetes educator. But the test strips, which cost up to $1 each, can add up. Medicare and Medicaid and private insurance plans usually cover test strips and glucometers. If you lack insurance and can’t afford to test your sugars every day, Kellie recommends checking at different times - one day before breakfast, another day before lunch or dinner, and another day two hours after your largest carbohydrate meal (more on carbohydrates later). If you and a family member are trying to economize, it’s okay to share a glucometer, but you should never share the lancets that you use to stick your fingers since the blood could transmit disease.
The American Association of Clinical Endocrinologists, a group of specialist doctors, recommends a blood sugar goal of 110 or less in the morning before eating and a blood sugar rise of no more than 140 points at 2 hours after a meal. But it’s important to try to remain calm about your numbers and not get upset if they’re not at goal. Kellie urges people to think of their sugars as “high,” “low,” or “target,” not “good” or “bad.” “Don’t be afraid to go to the doctor because you’re embarrassed,” she told me recently. “We need the numbers to identify the problem. It’s not about me being happy, it’s about your sugar.”
• Make sure you meet with a diabetes educator, or enroll in a diabetes class, to learn how to manage your disease successfully. “It’s really important for people to understand diabetes, to break down some of the mystery of it all,” Al said. The American Association of Diabetes Educators lists diabetes educators on its website (http://www.diabeteseducator.org/). The American Diabetes Association (http://www.diabetes.org/) also has a toll-free number you can call for more information - 1 800-342-2383 (1-800-DIABETES).
• Learn to recognize carbohydrate-rich foods (which make your blood sugar rise quickly), to read food labels, and to identify how much certain foods will increase your blood sugar. High carbohydrate foods include breads, cereals, fruits, juices, vegetables, pastas, rice and milk, as well as sugar-containing sodas and sweet deserts. Kellie advises people to shop mainly on the perimeter of the supermarket, where they’re more likely to find fresh produce, meats and fish, and avoid the center, where processed foods are usually stocked. Al said he always eats a meal before going to the grocery store, because if he’s hungry he’s more likely to buy impulsively.
• Ask a diabetes educator or dietician about ways to alter your favorite foods to make them a bit healthier. Al recently prepared collard greens and black eyed beans and rice for the holidays using turkey broth instead of ham hock, for example. When he orders food at restaurants, he immediately requests a to-go container - and puts half his meal in it before he eats. Kellie tells patients they can eat smaller portions of foods like rice, but should check their sugar two hours after the meal to see how much they can tolerate.
• Stop smoking This adds to your risk of heart and blood circulation problems.
• Prepare before doctor appointments by writing down your questions in advance, and don’t be afraid to ask. Al recommends bringing a friend or relative. “You feel empowered, and also the doctor’s going to say, ‘Wow, here’s someone who cares about their condition,’” he said.
Kellie recommends asking about the following numbers: glycohemoglobin (a blood test measurement that indicates long-term sugar levels); blood pressure (the goal for diabetics is less than 130/80) and cholesterol, including the LDL (bad) and HDL (good) cholesterol.
• For Type 2 diabetics: don’t be unduly afraid if pills aren’t enough, and if you need insulin. Many doctors now prescribe insulin pens, devices that usually aren’t painful and that generally control blood sugar better than syringes. Unfortunately, pens can be expensive and aren’t always covered by insurance plans. Some drug companies have patient assistance plans that provide pens for free; check www.needymeds.org for more information.
• Find ways to move your body. For Al, this means walking for a short errand instead of taking his car and using the stairs instead of the escalator. Kellie recommends walking around the room while watching TV and lifting heavy cans or bags of rice while sitting in a chair, as well as going for walks with a friend or neighbor.
• Take care of your eyes (by getting eye exams annually) and feet (which are at increased risk of infection and poor circulation). Avoid going to the beach barefoot and check your feet each night.
• Find a buddy who can provide you with emotional support. Al was able to talk with a woman in his church who also had diabetes. “I could call her up and say, ‘I’m feeling miserable,’” he said. “A lot of people don’t understand how when your sugar levels are high you can become cranky. I appreciated having her around to share.”
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