In This Chapter

Teaching friends and loved ones about hypoglycemia

Making sure your primary physician is following the standards of care

Finding an exercise partner

Enlisting other types of help

Diabetes is a social disease. No, I don’t mean that you catch it like herpes. I mean that you can’t continue very long with diabetes without calling on the help and expertise of others. Asking for help is not such a bad thing. People who regularly interact with others seem to live longer and have a higher quality of life.

Diabetes has become so pervasive in the United States that practically everyone either knows someone who has diabetes or has it himself. There is a huge, growing body of knowledge about all aspects of diabetes, but you have to be willing to share your diagnosis with others so they can help you. These days I even get new patients when people who know they have diabetes share their diagnosis and symptoms with someone else and that person realizes that he has diabetes as well.

In this chapter, you discover how to make use of the great resources that are available to people with diabetes. So many knowledgeable people are out there — it would be a shame not to utilize their information. (Why, even I use my colleagues’ knowledge on very rare occasions!)

Explain Hypoglycemia

If you take either insulin or one of the sulfonylurea medications (see Chapter 11), you may become hypoglycemic. Occasionally, hypoglycemia can be so severe that you’re unaware of the problem. At that point, someone in your environment needs to know the symptoms of hypoglycemia and how to treat it. Chapter 4 contains all that information.

You may want to make a list of the signs and symptoms of hypoglycemia and pass it around to your family and friends. You should keep that list and an emergency kit to treat hypoglycemia at home and at work. You may even want to wear a medical alert bracelet so someone can identify your problem when none of these people are around.

Follow the Standards of Care

Decades of following diabetes patients, along with increasing scientific knowledge, has led to the establishment of “standards of care” for people with diabetes. These recommendations usually appear in a supplement to the January issue of Diabetes Care, a journal of the American Diabetes Association. I outline these standards in Chapter 7 and on the cheat sheet for this book, which you can find online. By following the standards of care, you have a good chance of avoiding the short- and long-term complications of diabetes. If these complications have already occurred, you have a good chance of having them diagnosed while they are still treatable.

You are the one who needs to make sure that you get an annual eye examination, get your urine tested for microalbumin and your nerves tested for sensation, and get all the other tests that must be done regularly and routinely. (See Chapter 7 for more on these tests.) You can’t do these tests alone, however. You need your physician to order the tests and send you to the eye doctor. Don’t expect your physician to remember all these details. Just as you have trouble keeping to a program of care over a lifetime, your physician does much better with acute illnesses than chronic ones.

Find an Exercise Partner

Few people continue a regular exercise program completely on their own; I also have trouble doing so. However, when you know that someone is waiting for you, you tend to perform the exercise much more regularly. I have many patients who are regular exercisers because I emphasize exercise so much. All of them exercise with a partner.

If you belong to a club, finding an exercise partner is easy. First, you select the sport, and then you hang out in the place where the sport is played. If the sport is a racket sport, you will soon find others at about your level. If the sport is something like running, you have to be a little forward and ask whether you can join someone or a group about to run. The people you can keep up with are your natural exercise partners.

If you’re not a member of a club, finding an exercise partner is a little more difficult. You may have to approach people with whom you work, or you may need your significant other to commit to exercising with you. Most people are happy to walk with you, and some will run and bike with you. Cyclists seem to like group activity, and you can check out listings at a local bike shop or the Sunday newspaper in the activities section to find a group. If you can’t seem to find an exercise partner, try a personal trainer.

Use Your Foot Doctor

Your foot doctor is your first line of defense against lesions of the foot. He or she knows what the foot should look like and will notice problems very early, when they’re still reversible. Your doctor probably has a foot doctor that he likes to work with.

One of the most useful things the foot doctor can do is to cut your nails. It is too easy to accidentally cut your skin when you try to cut your own nails. If you have diabetes, the consequences can be serious.

Should you notice an abnormality, you must get to the foot doctor immediately. In this situation, you are much better off erring on the side of too much rather than too little medical care. In my practice, I ask the patients about their feet at every visit and examine the feet of those who have been found to have neuropathy (see Chapter 5) in the past. If I discover a foot problem, the foot doctor sees it that day.

Doctors have performed the first hand transplantation, which seems to be going well, but as far as I know, no plans exist to do a foot transplantation. Take good care of your feet because they have to last a lifetime. Your foot doctor can be your major ally in this endeavor.

Enlist Help to Fight Food Temptation

Ever since Adam and Eve, the problem of temptation has been on the front burner. For a diabetic, the constant temptation is to eat foods that do not further your major diabetic goal, which is to control your blood glucose. The opportunities for screwing up your diet are boundless. Just like your exercise partner, your “food partner” — your significant other — can make staying on your diet a lot easier for you.

If your partner cooks most of the meals in your household, he or she has a responsibility to prepare the right kinds of foods. To do so, your partner must know what to make and what to avoid (see Chapter 8). If you go to the dietitian, take your partner along.

Numerous books of recipes and meals are written specifically for people with diabetes. The first cookbook you should look at is Diabetes Cookbook For Dummies (John Wiley & Sons, Inc.), which I wrote with Cait James. That book would not have been written if it didn’t offer a special feature — the recipes of some of the finest chefs in the United States and Canada. I include a number of good recipes in Appendix A of this book. You can also go to www.dummies.com/extras/diabetes for a list of great websites.

I believe that one big problem in diabetes (as well as the nondiabetic obese population) is large portions of food. One of the simplest of diets is to eat the same foods but half as much. As I worked with the chefs in the various restaurants represented in Appendix A, again and again they remarked to me that Americans eat much more food in a portion than Europeans. Americans have learned to avoid fat, but they eat too much carbohydrate.

When it comes to eating out, your loved one can steer you to restaurants where you can choose foods that work for you. When you’re in the restaurant, he or she can point out the healthy choices. The best way to direct you is to set an example of appropriate eating for you.

If you’re asked to dinner in someone’s home, your partner can help by telling your host in advance that you have diabetes and need to avoid eating certain foods. It is unwise, however, to turn your loved one into a nag. Asking to be reminded each time you stray from your diet will lead to hostility.

Expand Your Diabetes Knowledge

The person who serves as your diabetes educator is the source of a huge amount of necessary and sometimes critical information. Every person with diabetes ought to go through a program of education after the initial shock of the diagnosis is past (see Chapter 1). Never hesitate to ask a question, no matter how basic you think it may be. You will be surprised by how many others want the same information. Insurance will generally pay for yearly education, but check your insurance to be sure.

Of course, every caregiver should be a diabetes educator as well. When you are past the formal diabetes education program, don’t hesitate to ask questions of your physician, your dietitian, or any of the other people in your team (see Chapter 12).

Knowledge about diabetes is expanding so fast that great advances are arriving almost daily. Some of these advances may be just what you need.

Fit Your Favorite Foods into Your Diet with a Dietitian

Years ago, a diagnosis of diabetes meant that you had to make enormous changes in your diet. This adjustment was hard enough for people who ate the usual American diet but much harder for people who came from another culture and had an entirely different diet. Fortunately, this situation has changed dramatically.

The dietitian’s job is to come up with a diabetic diet plan based on your food choices, not those of the dietitian. If you have special dietary needs because of your culture, a dietitian must be able to accommodate those needs if they are reasonable.

Members of your culture ate the foods that you like for generations without developing diabetes in large numbers. The main reasons they didn’t develop diabetes in large numbers are that they did not eat the large portions you eat and they were much more physically active than you are. If you want to keep enjoying “your” foods, eat and exercise like your great-grandparents.

Don’t be satisfied with a printed sheet of paper with the heading “Diabetic Diet.” The key word in diabetic diets is individualization. You probably won’t stay on a diet that you do not enjoy.

Seek Out Appropriate Specialists

The specialist who knows the most about diabetes is the diabetologist (or endocrinologist), a physician with advanced training in diabetes care who maintains his or her edge by attending diabetes meetings regularly and keeping up with the literature by reading the most important clinical diabetes journals. In addition, these days an up-to-date specialist has to be aware of what is on the Internet and how to differentiate reality from hype. This person can explain the latest advances in diabetes to you.

Not only do you want to find a diabetes specialist, but should you develop a complication of diabetes, you also want to use a specialist in that area. At the first sign of kidney disease associated with diabetes, ask your doctor to refer you to a nephrologist. Have an eye doctor examine your eyes every two years or more often if necessary. If there is any question of loss of sensation or abnormal muscle movements, see a neurologist. If there is any indication of heart trouble, get a referral to a cardiologist.

The pace of advances in diabetes is amazing. A general physician cannot keep up with it. The diabetes specialist concentrates on diabetes and the other specialists concentrate on their fields, and that is to your benefit.

Discuss Your Meds with the Pharmacist

One of your most valuable and least utilized resources is your pharmacist. He or she is loaded with information about drug actions, interactions, side effects, proper dosage and administration, and contraindications, as well as what to do in case of an overdose. Every time you get a new medication, you can have your pharmacist run it against the medications you’re already taking and see whether any problems might occur. Thanks to computers, this comparison should take only a few minutes. If you work with one drug store, you should be able to get a printout of your entire list of medications, which you can carry with you in case you ever need medical care.

The pharmacist can also save you money by recommending generic equivalents to the brands that your doctor prescribes. The doctor may have good reason to prescribe them, so the pharmacist will check with him before giving you a different medication.

The information in the computer tends to be all-inclusive. If a drug has ever had a side effect, no matter how rare, it will probably be in the computer. The drug manufacturer wants to be able to say that it warned you about every possibility. If a side effect or drug interaction is serious, discuss it with your physician before you start the new medication.

Share This Book with Everyone

If you really want your friends and loved ones to understand what you’re going through, why not give them a copy of this book and ask them to read it? You can select the chapters that are most important to you. Your family and friends will probably be delighted to have a resource they can understand, and you can expect a lot more help from them.

When I began writing this book, I did so because I saw a need for information that could be understood by most people without the benefit of a medical-school education. At the same time, I wanted you to have a little fun because “a spoonful of sugar helps the medicine go down.” But I did not want to trivialize diabetes, and hope I have not done so. If you believe I have succeeded in what I set out to do, share this book with others.