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Going on the Offensive with Diabetes

Going on the Offensive with Diabetes

The causes, symptoms, and treatment of diabetes

By Cindy Parlett, R.N., B.S.N, C.D.E., C.W.O.N

While it is true that diabetes is a serious chronic condition, it is also true that many people with diabetes live relatively normal lives. What often makes the positive difference for people is a proactive attitude and a commitment to actively managing this difficult disease.

The challenges

Under normal circumstances the pancreas produces insulin, which is a hormone that allows the body's cells to absorb sugar (or glucose) from the bloodstream. In a person with diabetes, the pancreas has either stopped producing insulin (type 1 diabetes), or it no longer produces insulin in sufficient amounts (type 2 diabetes).

This lack of insulin results in abnormally high levels of sugar in the bloodstream. High blood sugar (known as hyperglycemia) typically causes a number of distressing symptoms, among them fatigue, constant thirst, and excessive urination. Over the long term, hyperglycemia can cause serious complications including damage to the retina of the eye, nerve damage, high blood pressure, and kidney disease. Thus, both the immediate and ongoing challenge for people with diabetes is keeping their blood sugar within an acceptable range.

Some people (most typically those with type 2 or adult-onset diabetes) can keep their diabetes under control through weight loss, exercise, smoking cessation, other lifestyle changes, and in some cases, oral medication. On the other hand, some people with type 2 diabetes, and all people with type 1 diabetes, require insulin injections to control the level of glucose in their bloodstreams.

Staying on top of change

There are very effective approaches to self-management of diabetes, and new information is emerging all the time. One of the important developments in diabetes management is a blood glucose test called HbA1c which indicates a person's blood glucose level over the previous two to three months. Because blood sugar levels vary so much over a 24-hour period, daily readings can be misleading, and sometimes discouraging. The HbA1c provides a blood sugar average over time, making it possible for a doctor and patient to evaluate the long-term effectiveness of their diabetes management plan. In addition, regular HbA1c tests serve to encourage people to stay on track with their plan if the test results are positive, and to talk with their doctor if adjustments are indicated.

There are also some new oral medications on the market now that target different parts of the body. Some patients find that a combination of medications works well in helping them gain control of their blood sugar. Staying on top of new medications and discussing them with your doctor or nurse educator is always a good idea.

Many people with type 1 diabetes are opting for insulin pumps. By establishing a basal rate of insulin and mimicking the body's insulin production, these tiny computerized pumps eliminate the need for insulin injections. People who are committed to following a regimen of meal planning and carbohydrate counting- people who are conscientious and motivated-do quite well using an insulin pump. By avoiding large swings in blood sugar over time, they are able to hold the diabetes in check and they stay well longer.

If you are living with this chronic disease, it's wise to stay abreast of new developments and talk them over with your doctor. Don't be reluctant to engage your caregiver in conversation about new drugs, tests, technology, or recommendations for treatment. As a nurse and health educator, I encourage patients to help their doctors help them in pursuing the best long-term management approach. This will ensure that everything that can be done to hold the diabetes in check is being done.

Cindy Parlett, R.N., B.S.N., C.D.E., C.W.O.N. is a certified diabetes nurse educator. She teaches a class for people with diabetes and their families at the Cayuga Center for Healthy Living to help them understand and manage their illness. For more information, call (607) 252-3590.

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