In This Chapter

Understanding the importance of monitoring, dieting, testing, and exercising

Solidifying prevention with medication, the right attitude, and planning

When I originally wrote this chapter, I came up with 20 things you had to do in order to prevent or reverse the effects of diabetes. I decided that was too much to ask of you, so I reduced the list to ten essentials. Surely you can do everything in this chapter when you consider that it is only half as difficult!

Can you pick and choose what you will do? No. Everything here is essential to living a long and high quality life with diabetes. You wouldn’t want to save your sight and lose your kidneys. So read this chapter very carefully and practice every recommendation. And if you think I should have left any of the other ten behaviors in, let me know.

Major Monitoring

You have this incredibly compact and accurate glucose meter. Now you want to use it to find out how your blood glucose is doing at any time of day or night under any circumstances. You don’t feel well. Is it low blood glucose or the beginning of a cold? Test! You just ate a large portion of pasta. Did it raise your blood glucose too much? Test! You can monitor your glucose in so many ways, almost without pain, that you have no excuse for not doing so. And you don’t have to do it with a finger stick every time. Most meters allow you to do it in other parts of your body — your arm, leg, or abdomen for example — especially when the blood glucose would not be expected to change rapidly as it would during or after exercise or after a meal. At those times, you should only use your finger.

People with type 1 diabetes need to test at least before meals and at bedtime because their blood glucose level determines their dose of insulin. People who have stable type 2 diabetes may test once a day at different times or twice a day. If you’re sick or about to start a long drive, you may want to test more often because you don’t want to become hypoglycemic — or hyperglycemic for that matter. The beauty of the meter is that you can check your blood glucose in less than ten seconds any time you feel it’s necessary.

Devout Dieting

If you are what you eat, then you have the choice of being controlled or uncontrolled depending on what you put into your mouth. If you gain weight, you gain insulin resistance, but a small amount of weight loss can reverse the situation. The main point you should understand about a “diabetic diet” is that it’s a healthy diet for everyone, whether they have diabetes or not. You should not feel like a social outcast because you’re eating the right foods. You don’t need special supplements; the diet is balanced and contains all the vitamins and minerals you require (although you want to be sure you’re getting enough calcium and vitamin D).

You can follow a diabetic diet wherever you are, not just at home. Every menu has something on it that’s appropriate for you. If you’re invited to someone’s home, let them know you have diabetes and that the amount of carbohydrate and fat that you can eat is limited. If that fails, limit the amount that you eat. (See Chapter 8 for more on your diet.)

A person with T2DM who follows a careful diet can reduce his hemoglobin A1c by 1 percent or more. This translates into a reduction in the occurrence of complications like eye disease, kidney disease, and nerve disease of more than 25 percent. Is that benefit worth your effort?

Tenacious Testing

The people who make smoke detectors recommend that you change the battery without fail each time you have a birthday. You should use the same simple device to remember your “complication detectors.” Make sure that your doctor checks your urine for tiny amounts of protein and your feet for loss of sensation every year around the time of your birthday. It takes five to ten years to develop complications of diabetes. When you know the problem is present, you can do a lot to slow it down or even reverse it. Never has it been truer that “an ounce of prevention is worth a pound of cure.” (For more on complications that may develop, see Chapters 4 and 5.)

I make it very easy for you to get the tests you need at the time you need them. The online cheat sheet for this book at www.dummies.com/cheatsheet/diabetes gives you the current testing recommendations. Make a copy for your doctor if he or she does not already have such a list. Demand that you get the tests when they are due. A doctor with a busy medical practice may forget whether you have had the tests you need, but you don’t have an excuse for forgetting. Make sure she tests your hemoglobin A1c, your blood pressure, and your cholesterol among other things.

Enthusiastic Exercising

When you take insulin (as opposed to pills), controlling your diabetes is a little harder because you have to coordinate your food intake and the activity of the insulin. But I have patients who have had diabetes for decades and have little trouble balancing their food and insulin. They are the enthusiastic exercisers. They use exercise to burn up glucose in place of insulin. The result is a much more narrow range of blood glucose levels than is true of the insulin takers who do not exercise. They also have more leeway in their diet because the exercise makes up for slight excesses.

I am not talking about an hour of running each day or 50 miles on the bike. Moderate exercise like brisk walking can accomplish the same thing. The key is to exercise faithfully. (For more on exercise, see Chapter 10.) Thirty minutes of moderate exercise every day will not just improve your diabetes. It will also reduce the possibility of a stroke, a heart attack, and many cancers, and just keep you feeling generally good. Exercise can reduce your hemoglobin A1c by 1 percent or more, just like diet.

Lifelong Learning

When I see a patient new to me who has had diabetes for some time, I am amazed at the lack of knowledge of many fundamental areas of their disease. You would think that they would want to know anything that might help them to live more comfortably and avoid complications.

So much is going on in the field of diabetes that I have trouble keeping up with it, and it’s my specialty. How can you expect to know when doctors come up with the major advances that will cure your diabetes? The answer is lifelong learning. After you get past the shock of the diagnosis, you are ready to learn. This book contains a lot of basic stuff that you need to know. You can even take a good course in diabetes. Then you need to keep learning. Go to meetings of the local diabetes association. Become a member of the American Diabetes Association and get its terrific magazine called Diabetes Forecast, which usually contains the state-of-the-art developments.

Remember that a lot of misinformation is available on the web, so you must be careful to check out a recommendation before you start to follow it. Even information on reliable sites may not be right for your particular problem.

Above all, never stop learning! The next thing you learn may be the one that will cure you.

Meticulous Medicating

Compliance, which means treating your disease in accordance with your doctor’s instructions, is a term that has special relevance for the patient with a chronic disease like diabetes who must take medications day in and day out. Sure, it’s a pain (even if you could take insulin by mouth and not by injection). But the basic assumption is that you’re taking your medication. Your doctor bases all his or her decisions on that assumption. Some very serious mistakes can be made if that assumption is false.

Check with your pharmacist to make sure that your pills don’t interfere with one another. Some pills are taken with food; others are taken with no food for a period before and after that medication. Taking them correctly is just as important as taking them at all.

Every time a study is done on why patients’ health conditions do not improve, compliance is high up or leads the list of reasons. Do you make a conscious decision to skip your pills, or do you forget? Whatever the reason, the best thing to do is to set up a system so that you’re forced to remember. Keeping your pills in a dated container quickly shows you if you have taken them or not. You can even divide the pills by time of day.

Appropriate Attitude

Your approach to your disease can go a long way toward determining whether you will live in diabetes heaven or diabetes hell. If you have a positive attitude, treating diabetes as a challenge and an opportunity, managing your disease is easier and your body actually produces chemicals that make it happen. A negative attitude, on the other hand, results in the kind of pessimism that leads to failure to diet, failure to exercise, and failure to take your medications. Plus, your body makes chemicals that are bad for you when you are depressed.

Diabetes is a challenge because you have to think about doing certain things that others never have to worry about. It brings out the quality of organization, which can then be transferred to other parts of your life. When you’re organized, you accomplish much more in less time.

Diabetes is an opportunity because it forces you to make healthy choices for your diet as well as your exercise. You may end up a lot healthier than your neighbor without diabetes. As you make more and more healthy choices, you feel and test less and less like a person with diabetes.

Preventive Planning

Life is full of surprises (like the sign on a display of “I Love You Only” Valentine cards: Available in Multipacks). You never know when you will get more than you bargained for. That is why having a plan to deal with the unexpected is so important. Say you’re invited to someone’s home, and she serves something that you know will raise your blood glucose significantly. What do you do? Or you go out to eat and are given a menu of incredible choices, many of which are just not for you. How do you handle that? You run into great stress at work or at home. Do you allow it to throw off your diet, your exercise, and your compliance with your doctor’s orders?

A little advance planning can overcome any eating challenge. Discuss good foods with the people who regularly cook for you. Check out the calorie breakdown of the foods you eat at fast food places, usually available on the Internet. Many restaurants provide the nutritional breakdown on their websites. Make a diet for yourself and follow it.

The key to these situations is the realization that it’s not possible for everything to go right all the time. In the case of the friend who cooked the wrong thing for you, you can at least eat a small portion to limit the damage. At the restaurant, you should come prepared with the food choices you know will keep you on your diet. It may be better not to look at the menu and simply discuss with your waiter what is available from your list of correct foods.

Fastidious Foot Care

A recent headline read: “Hospital sued by seven foot doctors.” I would certainly not like to treat any doctor with seven feet or even a doctor who is seven feet tall. Whether you have two feet or seven feet, you must take good care of them. The problem occurs when you can’t feel with your feet because of neuropathy (see Chapter 5). You can easily know when this problem exists just by checking with a 10-gram filament. If your feet cannot feel the filament, they will not feel burning hot water, a stone, a nail in your shoe, or an infected ulcer of your foot.

When you lose sensation in your feet, your eyes must replace the pain fibers that would otherwise tell you there is a problem. You need to carefully examine your feet every day, keep your toenails trimmed, and wear comfortable shoes. Your doctor should inspect your feet at every visit.

Diabetes is the primary cause of foot amputations, but this drastic situation is entirely preventable if you pay attention to your feet. Test bath water by hand, shake your shoes out before you put them on, wear new shoes only a short while before checking for pressure spots, and get a 10-gram filament and see whether you can feel it. If you smoke, you are especially at a high risk for an amputation of your toes or foot. The future of your feet is in your hands.

The other aspect of fastidious foot care is making sure the circulation in the blood vessels of your feet remains open. This test is done by your doctor performing an ankle-brachial index on all patients with diabetes older than age 50 and younger patients who have risk factors for arterial disease such as smoking and high blood pressure (see Chapter 5). It quickly tells you and your doctor if you’re experiencing a problem with your circulation.

Essential Eye Care

You’re reading this book, which means you are seeing this book. So far, there are no plans to put out a Braille edition, so you had better take care of your eyes or you will miss out on the wonderful gems of information that brighten every page.

Caring for your eyes starts with a careful examination by an ophthalmologist or optometrist. You need to have an exam at least once every two years (or more often if necessary). If you have controlled your diabetes meticulously, the doctor will find two normal eyes. If not, signs of diabetic eye disease may show up (see Chapter 5). At that point, you need to control your diabetes, which means controlling your blood glucose. You also want to control your blood pressure because high blood pressure contributes to worsening eye disease, as does high cholesterol.

Although the final word is not in on the effects of excess alcohol on eye disease in diabetes, is it worth risking your sight for another glass of wine? Smoking has definitely been shown to raise the blood glucose in diabetes. Even at a late stage, you can stop the progression of the eye disease or reverse some of the damage if you stop smoking now.