Northwest Health Fall 2010


The Diabetes Challenge

This chronic disease can be daunting, but there are many tools and strategies to help you take control.

Go to: Northwest Health Index

Everyone needs to eat to stay alive, and for many of us, eating is also one of our greatest pleasures. For someone with diabetes, though, that simple act can be fraught with worry. "Every time a patient with diabetes puts something in his mouth, he has to ask — is my blood glucose too high or too low? When did I last eat and when do I need to eat again?" says David McCulloch, MD, a diabetes expert with Group Health Physicians and author of "The Diabetes Answerbook."

More and more Group Health members are asking these questions as the national incidence of type 2 diabetes — which is closely tied with rising obesity rates — continues to soar. In 2009, 9 percent of adults aged 18 and older had diabetes compared with 5 percent in 1997, according to the Centers for Disease Control and Prevention.

Despite the challenges of diabetes, many patients find that with the support of Group Health clinicians and resources, they can manage their disease.

For some patients, taking a Living Well With Chronic Conditions workshop is helpful. These workshops, taught by peers who have a chronic condition, cover a wide variety of topics, from dealing with emotions to improving communication with your health care team and understanding self-management techniques. You can register for a workshop by calling the Group Health Resource Line at 206-326-2800 or toll-free, 1-800-992-2279, or sign up for online workshops.

For other patients, a support group or a group medical visit is a powerful tool. Jeff Gelgisser, MD, who practices family medicine at our Redmond Medical Center at Riverpark, meets with a group of 10 to 15 patients quarterly for visits that last an hour and a half.

"The most extraordinary thing about the group," says participant David Baum, "is that you get to see that other people have the same problems, the same fears, and the same deficiencies in their self-care as you do. Everybody wants to eat too much, not exercise enough, and finds the scheduling and monitoring of medication hard — at least at first. But people have devised a huge variety of solutions." The group makes it easy to share these solutions, he says.

Drs. Gelgisser and McCulloch, and Meredith Cotton, RN, a diabetes team nurse consultant, say that the issues highlighted here are common challenges faced by their patients with diabetes. Check out the strategies they offer.

Take the Challenge

Challenge: Making lifestyle changes that will make a difference

Strategy: Big changes can seem overwhelming, so take small steps. If you want to start exercising, begin by walking around the block instead of training for a marathon. Take the stairs instead of the elevator. Set a daily goal of steps, and use a pedometer to count them. For weight loss, control portion size by using a smaller plate. Rather than serving "family style" at the table, plate food in the kitchen. Make incremental diet changes such as drinking 2 percent instead of whole milk, substituting brown rice for white, or cutting out soda pop.

Challenge: Dealing with unsolicited advice on what you should eat

Strategy: Many popularly held beliefs are out-of-date (for instance, the incorrect belief that people with diabetes cannot eat any sugar). Make an appointment with a dietitian who can arm you with information that will help you make good decisions about eating and counter myths and unsolicited advice about what to eat.

Challenge: Figuring out the impact of exercise on your diabetes

Strategy: There is no reason to stop exercising, or reduce the level of exercise. But you should become well acquainted with how exercise changes your blood glucose level. Take readings before and after you exercise to help determine when you need to eat: before or after exercise, or in the middle of a workout.

Challenge: Consuming any amount of alcohol

Strategy: Alcohol is OK in moderate amounts: generally, two drinks in a day for men, and one for women. A drink is 12 ounces of beer, 5 to 6 ounces of wine, and 1 to 1.5 ounces of hard liquor. Steer clear of drinks when you don't know their alcohol content.

Challenge: Continuing to eat foods that you really enjoy

Strategy: While you need to be conscious of what you eat, it doesn't mean you can't eat things you've always enjoyed. Understand what foods are healthy, and which ones help control your blood sugar. Initially, you may need to avoid sugary foods and drinks. But as you monitor your blood glucose, you'll begin to understand how your body responds to food and exercise, and will be able to tailor your eating accordingly.

Challenge: Eating at social events when you have no control over what's served

Strategy: Eat something before you go to the event, so you don't arrive hungry. That will help you make the best possible food choices from what's available. Bring along a non-caloric beverage — water or iced tea for example.

Challenge: Managing your disease without taking insulin

Strategy: Making diet and lifestyle changes does help many patients successfully manage their disease without taking insulin or other medication — for awhile. But diabetes is a progressive disease and most patients eventually need to take insulin. "In many cases, it feels like a failure to go on insulin," Cotton says. "But the need for insulin isn't a reflection of them or their behavior; it's simply a progression of the disease." Once on insulin, exercise and attention to diet will help keep you in the best possible health.

Challenge: Disease management fatigue

Strategy: Because diabetes is a chronic disease, it requires lifelong management. The best strategy is to look at the self-care that you need to do — such as exercising, getting enough sleep, and taking part in an activity you enjoy — as things you do to keep yourself healthy, rather than things you "must" do.

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