| Managing Diabetes-Intro |
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Diabetes is one of the most manageable chronic diseases. When blood sugar and the other risk factors for complications (blood pressure, blood fats, weight, and tobacco use) are well controlled, potential outcomes such as blindness or kidney disease can be prevented. Or, at the least, the onset of complications may be significantly delayed. No matter what age a person is when diabetes is diagnosed, delaying blood vessel problems that lead to complications is always the goal. People who have diabetes must take charge of their own disease by assembling a team of health professionals. Selecting a physician or nurse practitioner who is experienced and motivated to control the risk factors for complications is the first step. There are several categories of health professionals who may be certified diabetes educators. It is wise for people with diabetes to seek the help of a diabetes nurse educator as well as a registered dietician who have achieved professional certification known as C.D.E. (Certified Diabetes Educator). Doctors, exercise physiologists, and pharmacists may also be C.D.E.’s. Certification is based on passing a standardized examination approved by the National Certification Board of Diabetes Educators (NCBDE) after accumulating a minimum number of years of professional diabetes education prior to certification. C.D.E.’s around the country must pass the same test and retake the examination every five years. No matter what the professional background of the diabetes educator is, the concept of shared management of diabetes based on accepted national standards of care is the right practice. People with diabetes are able to participate in their own management decisions due to the ability to monitor their own blood sugar. They also learn to know what the health care professionals taking part in their care are responsible for monitoring and which diagnostic tests should be routinely performed, as well as the frequency and expected outcomes of those tests. It is important that family members and close friends share in diabetes management for support of the person and the program. One nice side effect of this is that, since the diabetes lifestyle is so healthy for everyone, people who share in that lifestyle receive the same benefits that the patient does. The basic and essential parts of diabetes care include physical activity, nutrition, stress management, monitoring, foot care, medications (in many cases, but not all), and control of the risk factors that lead to complications. Everyone who has diabetes needs to learn about all of these things as well as be encouraged to succeed at them. This is why education and motivation underlie any successful plan. Each of the components of diabetes care falls under one of three categories: medical management, lifestyle adjustments, and social and cultural adjustments. Later in this series, each will be discussed in the context of those categories. The healthy lifestyle associated with diabetes management offers many more benefits than control of blood sugar. Weight control, immunity against colds and flu, improvements in digestive function, protection of joints and strengthening of muscles and bones, improved healing of wounds and skin disorders, control of blood pressure, control of cholesterol and other blood fats, protection against heart disease and strokes, and even protection against cell changes that lead to cancer are among the many benefits of a healthy diabetes lifestyle. An increased level of energy and well-being are also frequent results of the adjustments that help manage diabetes. And last, yet certainly not least, many people feel that the self-esteem and sense of achievement that come from taking charge of one’s own health are important and satisfying rewards on their own. Prevention of complications is a primary treatment goal of diabetes management. Today, more than ever, it is possible for patients, through shared management to be able to prevent diabetes complications. Some of the reasons for this brighter outlook compared to the past include improvements in just about every aspect of treatment that include a variety of nutrition options, more and better oral medications that target specific aspects of type 2 diabetes, refined and specially engineered insulins using human sources and advanced lab techniques, knowledge about the effects of exercise on glucose levels, self-monitoring, and continuous exciting research findings that improve the outlook for diabetes practically daily. Unfortunately not all people with diabetes are taking advantage of these improvements in care. Sometimes they refuse to do so, and sometimes they have not received up-to-date information from their health care providers. (Remember, in today’s health care setting, the term providers means doctor, physician assistant, or nurse practitioner.) It is easier to understand the complications of diabetes if we first separate them into groups. When they are sorted like this, they make more sense. All complications can be divided into two basic types. These are short-term and long-term. Short-term complications are sometimes called acute or metabolic, and long-term complications are often called chronic or vascular (meaning related to the blood vessels). Short-term complications can then be divided further into two groups: hypoglycemia and hyperglycemia, which mean low blood sugar and high blood sugar. The brain and body need to have normal blood sugar, also known as normoglycemia and euglycemia. As a result of treatment, in combination with too little food or excessive exercise or alcohol, sometimes blood sugar can go dangerously low. And with inadequate treatment or with an accompanying illness or infection, blood sugar may go far too high. Each of these short-term complications are discussed in detail in other sections of this series. Long-term complications are also divided into two main groups. They are called microvascular and macrovascular. Micro means very small and, as noted, vascular means blood vessel. Microvascular complications result from structural damage to the walls of very small blood vessels throughout the body. They become injured to the point that they no longer supply enough oxygen and nutrients to the tissues, and can leak blood and blood components such as fats and proteins. Tissues starve or are damaged as a result. Macro means large. Macrovascular complications are those that result from plaque building up inside the larger blood vessels that can result in partial or complete blockages. Plaque is a combination of fats, sugars, proteins, white blood cells, and, in the later stages, minerals that turn it into hard and dangerous obstructions. These obstructions can slow down or stop the flow of blood and can tear arteries, causing hemorrhage, if they suddenly break off. Microvascular complications can be divided into three main types. These are retinopathy (disease of the lining of the back of the eye), nephropathy (disease of the kidney also called renal disease), and neuropathy (disease of the nerves). The word ending “pathy” is from Greek and means disease. Macrovascular complications can also be divided into three types. These are coronary artery disease or disease of the vessels that provide blood to the heart, cerebrovascular disease or disease of the blood vessels leading to and throughout the brain, and peripheral artery disease or disease that results in blood flow problems most frequently occurring in the lower legs and feet. Sometimes the blood vessel blockages of the heart and brain are grouped together into one category. Their initials CAD or CVD more or less describe the same condition, and if one is diseased, it is very likely that there are problems with the other. In spite of all this, there is a bright side. In most cases, those with diabetes can learn to prevent and manage the short-term complications. And, with proper education and diabetes management, long-term complications can often be prevented, diagnosed early, treated effectively, and sometimes even reversed. Each one of these complications is individually explored in terms of prevention as well as early and late treatment in other sections of this series. |
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