The Seven Wonders of Diabetes Management

The American Association of Diabetes Educators (AADE) releases 7 self-care behaviors.

Theresa Garnero By Theresa Garnero, APRN, BC-ADM, MSN, CDE

You don't have to travel the 7 continents of the world to find the 7 keys to diabetes self-management. They are there when you need them and can make all the difference in living successfully with diabetes.

When was the last time you took a close look at your keys? Do you have some that you've carried around for years but cannot identify? Do you constantly lose them? Well, luckily these 7 keys you are about to add to your collection won't weigh you down because they are stored in your mind. Think, and voil, they appear.

Most of diabetes management falls on the person living with the disease. The American Association of Diabetes Educators (AADE) identified 7 self-care behaviors that are key to diabetes management. As a cartoonist and an educator who knows most people are visual learners, I've added an icon for each of these self-care behaviors we will discuss in detail:

• Healthy eating
• Being active
• Taking medication
• Monitoring glucose

• Problem solving
• Reducing risks , and
• Healthy coping
There are four specific diet behaviors that have the most influence on improving glucose control:
1. Being consistent with a meal plan;
2. Treating hypoglycemia appropriately;
3. Responding to hyperglycemia (more insulin and/or less food); and
4. Being consistent with an evening snack, if prescribed.

The payoff? By following a meal plan most of the time, you can see a 1% to 2% decline in A1C, a 15 to 25 mg drop in LDL (the "lousy" or bad cholesterol), a decrease in blood pressure, and a 1- to 2-pound weight loss per week. Easier said than done, especially with temptation around every corner. Now you can pull out that healthy eating key for defense.

Have you seen a dietitian recently to help tailor make a meal plan? Depending on your needs, any of the following could be recommended: regulating carbohydrates, reducing saturated fat and/or overall calories, or increasing fiber.

Exercise is perhaps the most underutilized way to help control diabetes. The two types of exercise are aerobic and anaerobic. Anaerobic exercise does not require oxygen to meet the body's demands and is generally not as beneficial as aerobic exercise.

Unless your physician has advised you not to, exercise is good medicine. The challenge is making it a part of our daily routine. You don't have to go to an expensive gym to get the benefits: improved cardiovascular function, strength, and glucose control. Wear a pedometer and try to work up to 10,000 steps a day—it's just as effective as a 30-minute walk. Start with 3 sessions a week, for 20 to 30 minutes per session, and gradually build up to 60 minutes. Trying to lose weight? The FDA recommends 90 minutes of daily exercise. Many people with diabetes find exercise one of the easiest things to do. It feels good! Remember to wear comfortable shoes.

Self-monitoring of blood glucose (SMBG) has transformed diabetes self-management. You can know your glucose levels by performing a simple blood test, practically anywhere. SMBG reduces diabetes complications! Most insurance companies cover the testing supplies, providing you have a doctor's prescription. If you are interested in learning how to test your glucose, see your diabetes nurse educator.

The other components of monitoring involve blood pressure and lipids (cholesterol) levels. These two very important elements of diabetes management are often overlooked.

Medication therapy is oftentimes needed to achieve glucose control. Did you know that approximately 50% of people do not take prescriptions correctly? To help resolve this dilemma, there are systems that help taking medication more convenient and reliable (for example, insulin pumps and pens, pill boxes, and drug calendars).

You might not need this key for some time, but when you do, it can make the difference between going to the hospital or not. It may take as many as fifteen years to encounter all the common problems associated with diabetes.

This self-care behavior focuses on the "what ifs"—that is, what to do if your glucose is too low or too high, or what if you become sick, what would you do? Unfortunately, if your glucose is too high or too low, it may influence your problem-solving skills. Have a plan, ahead of time, so that you will know what to do.

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Last Modified Date: May 24, 2013

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by Brenda Bell
As I mentioned in an earlier post, one of the benefits that made it cost-effective for me to go with the real healthcare (HSA) plan rather than the phony (HRA) plan is that my company is now covering "preventative" medicines at $0 copay. The formulary for these, as stated by CVS/Caremark (my pharmacy benefits provider), covers all test strips, lancets, and control solutions. I dutifully get my doctor to write up prescriptions for all of my testing needs, submit...
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