Patient Guidelines: Diabetes Self-Management

According to the Cleveland Clinic and a large body of research, lifestyle is the key to diabetes self-management. I see many posts on social media and in patient groups that mention diet or exercise as a solution to reverse diabetes. While both diet and exercise are important parts to the solution, it’s important to understand that scientific research confirms that while you can manage diabetes, it can not be reversed.

To successfully manage your diabetes you’ll need to develop, execute, track, and refine a diabetes management plan (DMP). This should be done with leadership and partnership from your primary care physician (PCP), and coordinated with any specialists and clinicians that you are working with; such as an endocrinologist.

Your plan should include nutrition, physical activity, stress, and medication management. The nutrition part of your plan should be developed and managed with input from a dietitian.

In order to be successful your DMP must be realistic. It must fit with your current lifestyle and your circumstances. Your DMP should also be documented in your medical record so you can stay on plan even if you change physicians, relocate, or find yourself with out insurance.

There are 8 behaviors that you should include in your DMP. They are;

1. Physician Guidance
2. Healthy Nutrition
3. Physical Activity
4. Blood Sugar Monitoring
5. Medication Management
6. Problem-Solving
7. Coping Skills
8. Risk Reduction

Physician Guidance

You physician and his/her staff should be experienced and comfortable helping you develop a diabetes management plan (DMP) and discussing it with you during and in-between appointments. Follow up with your PCP and/or the practice staff should be frequent and agreed to by you and your physician. If you are at a high risk for non-compliance your physician’s staff should help by directing you to local support services.

Tip: Medicare pays for 10 hours of diabetes education. An additional 3 hours of medical nutrition therapy is also available to patients. After the first year, 2 hours of additional training are available each year.

Healthy Nutrition

Start by working with your PCP and a registered dietitian to create a weekly meal plan. This should include eating a balanced diet with a variety of foods, including fruits, vegetables, whole grain foods, low-fat dairy products, and lean meat, poultry, fish, or meat alternatives.

Your meal plan should include a focus on the right amount of carbohydrates to control your blood sugar. This should be done in collaboration with a dietitian. Your meal plan should offer lower fat options and limit saturated fats, and it should emphasize using sugar in moderation. Other inclusions in your meal plan are 20-35 grams of fiber per day. Vegetables, beans, and whole grain foods are good sources. Drinking water throughout each day, avoiding high fat foods, and using less salt are also part of a good meal plan.

If you have type 1 diabetes your insulin dose can be adjusted based on level of carbohydrates in your meal.

Physical Activity

You can help control your blood sugar, slow the progression of your diabetes, improve your overall health, manage your weight, boost your brain activity, and help manage stress through physical activity. The type of physical activity that’s right for you should be discussed with your PCP, added to your DMP, and tracked for your use.

Tip: Life will get in the way on some days. It’s OK to miss a planned exercise or skip a day or two when you’re not feeling up to it. The keys to success are to;

1. Get back on your physical activity plan when you do fall off.
2. Track your activity every day no matter what.
3. Discuss your plan regularly with your physician.
4. Change your plan as needed to fit your life and health.

Blood Sugar Monitoring

How often you should test your blood sugar level depends on the type of diabetes you have and your diabetes management plan (DMP). According to the Mayo Clinic If you have type 1 diabetes it’s common to test before snacks, meals, and bet time, before and after exercise, and sometimes during the night.[i]   Some people treated with insulin may use a continuous glucose monitor (CGM). CGMs rely on a sensor placed under your skin to read your blood sugar levels. Some work automatically, and others require you to run a receiver over the sensor.

If you have type 2 diabetes, you will likely be testing less. The actual amount will depend on if you are taking insulin, and the type and amount of insulin you’re taking. If you’re taking multiple injections each day, testing is often recommended before meals and at bedtime. If you’re using a long-lasting insulin you may only test a few times daily before meals. If you are managing your diabetes without any insulin, you may not need to test your blood sugar every day.

In all cases, you should work with your doctor to identify what’s best for you, and set targets based on your personal circumstances. The factors your doctor use will usually include;

1. The type of diabetes you have.
2. Your age and life expectancy.
3. How long you’ve had diabetes.
4. Any diabetes complications.
5. Your overall health, and other conditions.
6. If you are pregnant.
7. Personal considerations.

Tip: Medicare pays for monitors, test strips, lancets, testing supplies, and glucose control solution. Consult with your physician for limitations.

Taking Medication

If you have type 1 diabetes you are likely to take medication for the rest of your life. Yet, it is estimated that 20% to 30% of patients do not take their medications as advised by their doctors. If you experience negative side effects from your medication tell you doctor. In most cases there are other options.

Problem-Solving

Diabetes is both chronic and progressive. Since managing diabetes requires daily attention, you are solving problems related to your activity, diet, and stress. Learning how to respond to changes in your blood sugar and different situations requires you to find solutions that work for you. It’s important to note that over time this can also take a mental and emotional toll on you.

Coping Skills

Having skills to maneuver difficult or potentially embarrassing situations will help you to stay positive and engaged with your DBM. If you feel like you are failing, you are much more likely to let your disease dictate your life.

Risk Reduction

You can take preventive actions to minimize your risk of letting your disease make you feel lousy or incapacitate you. Following your DMP, having regular exams with you doctor(s), checking your blood pressure, and checking things like your feet, eyes, teeth, cholesterol, and other lab tests are all parts of your DMP that should be discussed with your doctors.

Barriers to Success

Many patients are not comfortable making decision about their care because they have relied on their clinicians to tell them what to do. The problem with that strategy if you are trying to manage your diabetes is that your daily decisions often have even a bigger impact on your success managing your disease than anything that happens in your doctor’s office. If you do not have affordable access to drugs, you are not satisfied with your clinicians, or you are unsure about any aspect of your care you should seek help from your doctors, insurers, community services, local area providers, and online support groups. Connections to resources and help with every aspect of your diabetes management plan can be found at https://atomic-temporary-114370344.wpcomstaging.com.

[i] Mayo Clinic. Blood sugar testing: Why, when and how. https://www.mayoclinic.org/diseases-conditions/diabetes/in-depth/blood-sugar/art-20046628