If you have read the first articles in this series, you are now familiar with the nature of diabetes and the problems it can cause. It is time to look at treatment. How can diabetes be kept in control so that the serious outcomes of heart disease, strokes, kidney disease, blindness, and amputations can be avoided? Step one requires the willingness to “get with the program.” Unfortunately, far too many people experience denial about having diabetes. Since in its early years, type 2 diabetes can be a somewhat invisible disease, it is hard to imagine the damage that is occurring throughout the blood vessels and nerves. Every day diabetes educators hear people say how much they wished they had been serious about diabetes in its early stages, before the processes that lead to complications occurred. Every one of us should try to follow the worthy motto about “today being the first day of the rest of our lives.” And we all should accept the fact that none of us have behaved perfectly in the past. So leaving that all behind, much can be done from this day forward. In many cases, diabetes complications can be prevented. And even if they have already occurred, very often they can be kept from getting worse and sometimes, at least to some extent, they may be may reversed.

The risk factors that cause blood vessel and nerve related diabetes complications include a long duration of high blood sugar, high blood pressure, abnormal blood fats, and/or tobacco use. Science has shown us how to control these risks, but we must respond to that knowledge. So many people in our area and across the country are living typically unhealthy lifestyles that include over-indulgence in food and under-indulgence in physical activity. These habits are serious enough on their own, but in the presence of diabetes, they are the fast track to complications. With willingness to participate in a good program based on up-to-date medical advice from health care providers, goals for prevention and treatment that keep the risk factors in control can be achieved. Getting past denial and getting into a good healthy program will include the following guidelines for treatment.

Glucose levels must be controlled by careful attention to meals, exercise, and when necessary, medications. In addition, self blood glucose testing should be performed by every person with diabetes. Many practitioners also believe that those people in the early stages of diabetes development of impaired glucose tolerance and impaired fasting glucose should also be testing their own blood sugars at least occasionally. For those with diabetes, regular physician checkups that include a glycated hemoglobin test (a1c) every three to six months must also be part of controlling glucose. This test indicates whether the present program is adequate or not. And if not, adjustments can be made. Similar to glucose management, blood pressure and blood fats can be well controlled through nutritional and exercise improvements, as well as with medications when needed. A tobacco habit can be stopped through behavior management training, often enhanced by various medications that help relieve the anxiety associated with quitting and that reduce nicotine withdrawal.

Of course education must always be the fundamental part of all diabetes management programs. This is the only way to have excellent communication and shared planning with the health care team that will lead to success in managing diabetes and preventing its complications. In the next article we’ll take a look at all the components that make up a good diabetes care plan.