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Diabetes Mellitus: Principles of self-management

DIABETES MELLITUS

Diabetes Mellitus: Principles of self-management

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Diabetes Mellitus Principles of self-management

Diabetes management is largely the responsibility of the person with diabetes. The role of professionals would not work otherwise

Let me first state that the term self-management does imply going it alone. You are part of a team. This team includes a doctor, a nutritionist, a diabetes educator, and other specialists such as podiatrists. The most important part of it is yourself. All the others are there to guide you on the important things to do, the many don’ts and to assess your progress over time. You must be willing to take their advice and recommendation and implement them. You must consider yourself the critical determinant in the success of this team. This is why we call it a self-management journey.

The constitution of this team is crucial. In Kenya, as in most of Africa, most people with diabetes will only have access to a doctor. Even that is extremely limited. Most people only see their doctor during scheduled quarterly visits, and the consultation may only take a few minutes. This contributes to the feeling by most diabetes that they are on their own, fighting a disease intent on taking them down.

This feeling of isolation may be heightened by the demands of diabetes management. You have to deal with a barrage of information regarding your diet, physical exercise, use of medicines, and general self-care. Multiple tests and the cost of frequent self-testing can be overwhelming. Self-management requires self-acceptance, and a great deal of self-discipline to deal with the multiple challenges that come with diabetes. The important aspects of self-management include:

Taking medicines 

As in every other chronic disease, medications become a part of your daily life. For those living with diabetes, this may consist of either insulin, oral medicines, or both. You may also have other diseases such as hypertension or heart disease, which require you to use other drugs. This is especially the case for middle-aged and older adults with type 2 diabetes.

All medicines have particular recommendations. It is essential to know when and how to use them. The precautions necessary depend on your age, other comorbidities, the presence of complications, and the latest test results. The doctor should guide you in tailoring your medicine schedule to your daily routine to make it easy to remember. Reminders on your phone are also helpful. The key is NEVER EVER to SKIP YOUR MEDICINES or change the prescribed routine or dosage without consulting your doctor. Dealing with the side-effects should be something between you and the doctor.

For details on diabetic medicines see Different types of drugs for Diabetes Mellitus 

Blood sugar self-monitoring 

This is the backbone of effective self-management. It is what guides your diet and use of insulin. The body’s metabolic status changes continuously depending on your feeding, physical exercise, psychological stress, and use of medicines. Testing allows you to know how these factors influence your blood sugar level and guide you on the appropriate response.

Self-monitoring means checking your blood glucose levels using a glucometer. This can be done both as a structured exercise as well as when needed. The structured self-monitoring is based on the recommendation of the doctor and diabetes educator (most times, the doctor acts as both). It is done to guide your daily decisions as well as generate information to tailor your doctor’s management plan. It, therefore, must be done as recommended and recorded correctly for use. Mostly, structured testing is done first thing after waking up, before meals and before an insulin injection.

But you may also need to test your blood sugar any time you feel abnormally lethargic, excessively hungry or thirst or frequent urge to relieve yourself. These are indicators of fluctuations in blood glucose level in the blood. The symptoms are a body’s way of communicating to you. You must not ignore them. Test your blood sugar to know the appropriate response.

For specific details read Blood Glucose monitoring 

Healthy Diet 

A universal concern for people living with diabetes is the diet. The right medicine use and frequent testing cannot work unless you follow the strict nutritional guidelines. This does not mean you must give up your favorite foods. The most significant problem with diabetes is that people feel it restrict your diet to a level where you always have to watch what you eat. Over time, you learn how to choose the foods you eat. This comes with your understanding of how your eating habits and the food contents affect your blood glucose levels. It is recommended that you eat regular meals and avoid those with high sugar content. The goal is to keep your blood sugar predictable and avoid wide fluctuations. Developing a balanced diet should take into consideration your age, work, and glucose monitoring targets. This should be done as a team with your doctor, diabetes educator, and a dietician. For more details, see a practical guide to the diabetic diet.

Physical activity

Most people with diabetes mellitus also have other chronic diseases such as hypertension or heart disease. This is especially so for those with type 2 diabetes mellitus. Physical exercise helps with the management of many chronic diseases just as it has benefits for those without any disease. It will improve blood glucose control and prevent the early onset of diabetes complications. It especially helps to keep your weight and cholesterol levels under control and thus reducing the risk for cardiovascular diseases. The key is to make it a part of your daily routine so that it does not feel like you are forcing yourself into it. You should also be customized to your body’s metabolic needs as indicated by blood glucose monitoring.

Self-management for those with diabetes is the determinant of their quality of life and the success of any treatment plan. Everything revolves around daily living and should be integrated into one’s work routine, family life, and any future aspirations. Remember also not to beat yourself up because the journey has many pitfalls. If you find yourself struggling, it is most likely that you are doing it wrong. This may indicate that you have not fully accepted your reality as a person living with diabetes mellitus.

 

 

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