YOU CAN DO IT!
Dissolving Common Barriers to Diabetes Control

SIGNIFICANT ADVANCES in the past few years have expanded the number of tools health care professionals have to assist in reducing complications associated with diabetes. Prior to 2000, the focus was on lowering blood sugar levels to lessen complications of the heart, nerves, kidneys, eyes and organs. Now, attention suddenly has also been placed on lowering blood pressure, lowering cholesterol and other blood fats, and lowering weight. It seems like overnight, people with diabetes now have to concentrate not only on lowering blood sugar levels, but also on removing saturated fat from their dietary choices; increasing the consumption of foods high in monounsaturated fats and increasing exercise to a minimum of 150 minutes each week.

But the fact remains that we are falling quite short of achieving optimum reduction in blood sugar and blood fat levels. The average blood sugar levels for persons with diabetes as measured by Hemoglobin A1C in the US is now 9%, much higher than recommended by the American College of Endocrinologists (ACE) and the American Diabetes Association (ADA). We know for sure, the higher the A1C value the higher the risk for developing a preventable complication. Despite all the tools we have at our fingertips, we are not winning the fight against complications.

MONITORING blood sugar is important for achieving good blood sugar control. One barrier to achieving control has now been eliminated with newer, faster "alternative site" monitors. Besides traditional fingertip testing, these monitors allow testing on hands, forearm, leg, calf and fingers. After a year of using alternative site testing, a very important discovery was made. There is approximately a 40 mg/dL difference in blood sugar levels obtained in the forearm and fingertip during times of rapidly fluctuating blood sugar levels, like after a meal or when blood sugar is dropping rapidly. If you have an alternative site monitoring system, be sure to read the owner's manual and operating instructions carefully to understand where to test during these times, or call the toll free customer service number on the back of the monitor to ask for assistance.

Non-invasive blood glucose testing is also slowly coming into use with one "wrist-watch" system now available and several others expected in the next 12-18 months. Instead of pricking the fingers for a blood sample, blood sugar levels are continuously monitored during the active period of the glucose sensor. Although more expensive, if the barrier for testing is the need to prick a finger or body part, your testing solution may well be here.

DIETARY recommendations have changed significantly over the past 10 years. Many people believe that they cannot eat sugar once they have diabetes. A common therapy recommendation 20 years ago, this "rule" was dissolved in 1993 with newer dietary recommendations. Today, there is no single "ADA diet" that applies to everyone with diabetes. Emerging research strongly suggests that a healthy diet is one based on food patterns and not on elimination of single nutrients. It is well known that dietary changes can lower hemoglobin A1C levels by as much as 1-2 points! That means that if you were able to follow an individually designed meal plan and your Hemoglobin A1C level is currently 9%, you could LOWER that value to 7-8% over the next 90 days. Sadly, most individuals with diabetes have never seen a certified diabetes educator or dietitian to learn how to eat well, and avoid the "fad" diets being followed that may lead to dangerous long-term health complications. Many people dismiss the need for this type of appointment because of the myth that the food they enjoy will be "taken away" from them, or that the dietitian will remove all the "fun" of eating. It is true that if you are currently consuming too many calories each day, your meal plan could well disappoint you. The reality is most people in the US consume 30-50% more calories each day than they need.

Over consumption of food, particularly carbohydrates, is the leading cause of high blood sugar levels in people with poorly controlled diabetes. Sugar-free products are commonly consumed in large quantities, with the belief that they have no impact on blood sugar control. Consider this: a carbohydrate is a carbohydrate. It does not matter the source of the carbohydrate, because once digested 100% of all carbohydrates turn into blood sugar in your bloodstream. Specifically what this means is that if the "sugar-free" product you are eating contains carbohydrate, more than likely it is negatively affecting your blood sugar control! Become a savvy label reader and you will begin to see that you may have been unintentionally hurting your blood sugar control by consuming foods that effect your blood sugar control. Common foods that fall into this category include sugar-free brownies, pies, cookies and candy. Remember: the total amount of carbohydrates in meals and snacks is more important than the source of carbohydrate in regard to the effect on blood glucose levels.

INSULIN therapy has long been considered by doctors and patients alike to be a "last resort" in treating blood sugar levels that remain too high. For many people, the suggestion of beginning insulin therapy seems like a "failure" or "punishment." Some have even been assured that if they will follow a diet, exercise daily and lose weight, they can avoid the use of insulin all together. As difficult as it is to hear and accept, the majority of people with Type 2 diabetes will ultimately have to use insulin in order to adequately treat high blood sugars. This is based on research and clinical practice that shows that diabetes is progressive and the progressive destruction of the cells that make insulin in the body leads to the need to supplement and replace insulin in order to lower blood sugar levels. Each year, thousands of people with diabetes ignore medical advice to start insulin. This decision can lead to progression of complications that rob people of healthy, vital lives.

Many myths surround the use of insulin and serve as additional obstacles to adequate diabetes control. The reality: Insulin does not make you fat. Insulin does not cause blindness or kidney failure or heart attacks. Insulin use does not necessarily mean a lifetime of use. Oral pills are not insulin.

You cannot live a healthy life without adequate insulin levels in your body. It is difficult to let go of a fear or a failed expectation when insulin is the right answer. If you have done everything you can with diet, exercise, stress reduction and medication and your Hemoglobin A1C remains higher than 7%, insulin can not only save your life, it can preserve your quality of life.

Diabetes self-management can at times seem daunting. Ideas you have commonly held may well be the things that are hindering you from achieving the type of control you need or want. Information regarding diabetes therapy changes and advances occur rapidly. It is important to recognize that self-management is a lifetime of learning. There are numerous books, periodicals and web sites that can help keep you up to date with these changes.

You are the key to your success. It has been suggested that 85-90% of the outcome of diabetes rests in the hands of the person with the disease. Health care providers can assist you in achieving your goals, but you are key to help you live a life free of complications. Keep trying. Keep doing the best you can do. If you struggle, lose ground or interest, start again. Each day is another opportunity to try. You can do it!

About the author: Kimberley Krapek, RN, MS, CDE has been a nurse educator and clinical nurse specialist helping people learn to control diabetes for over 20 years. She is president of Diabetes Solution, Inc. of Aurora, Colorado.