The total management package for people with diabetes requires a team effort. Like any management package, diabetes management requires all parts to function. Most of all, it requires you to follow directions, think through your program, and have input into that program. Nothing can happen without interaction between you and your physician (and other health-team members). Some of the additional team members are the nurse in the hospital or clinic, the nurse educator, the dietitian, the counselor or psychologist, the social worker, the podiatrist, and the exercise specialist.

Program Management

The physician is the manager of your program. The nurses in the hospital or clinic see that you get the right medication at the right time and that you are monitoring yourself to the best of your ability.

The nurse educator works closely with the physician to coordinate resources in the hospital or office and to assist you in carrying out your program. The dietitian makes sure that you know what your food choices are and why and when you should eat certain foods. The counselor or psychologist (or psychiatrist, if medication, psycho analysis, or neuropsychiatric assistance is needed) is on the team to assist you in your adjustment to having a chronic illness and in thinking through the impact it will have not only on your life but also on the lives of your family and friends. The social worker’s job is to assist you in the financial realm and in developing or mobilizing community support. This person might also be involved in some counseling, especially for rehabilitation services, if needed. The podiatrist is included to be sure that one of the most vulnerable areas of your body your feet are kept in good condition. The exercise specialist helps you to develop your individual exercise prescription, which includes the type of exercise and its frequency, timing, and intensity.

Other key specialists, if they are needed, might include a cardiologist, a nephrologist, a neurologist, an ophthalmologist (or retinologist), a gastroenterologist, and an orthopedist.

All care must, of course, be kept in balance. To do this, you must test your blood sugar regularly and monitor your food intake, your activity, and your medicine. You must take note of the way you feel and of whether you have had a reaction. You also need to be aware of any other factors that can help you to personalize your program.

The information must be correct and complete. Accurate input from you, even though it may seem embarrassing at times to give this, will allow your physician and other health professionals to design the most useful and safe program to meet your needs.

Record Keeping

To help the health team help you, you should be sure that your records are as accurate and complete as possible . These records also act as a teaching tool for you: Accurately obtained and kept, such data can give you assurance concerning how food and insulin or other diabetes medication result in changes in your blood-glucose levels.

To best accomplish the feat of record keeping, look to some of the various companies that offer free blood-glucose monitoring booklets or develop your own on paper or through the use of a computer. Be sure to have your name and some identifying data in place, such as an address or phone number; in case you lose your papers, this information will help in the return of the records.

The next two important items are dates and times. There should be places to record variations in information about certain foods, different times, type of low-blood-glucose response, and so on. In recording, the columns should be set up so that you could see a pattern, if one exists. For example, you might find that at 11:45 A.M. every day you have an insulin reaction or that you have a blood-sugar level greater than 200 at 3:00 every afternoon. This would give you guidance as to the need for a change in food or insulin or an oral hypoglycemia agent prior to that time.

In some programs you will be given guidance, within set limits, to alter your food, medication, or activity prior to the time a pattern occurs. If you saw that each day, at about the same time, you were having a higher blood sugar (e.g., 204 mg/dl [11 mmol]), you would learn to increase insulin, decrease food, or increase activity prior to the time of day the elevated sugar had been noted. The increased number of tests done increases the ability of the physician to help you. It has been shown that the more one conducts tests and then contacts the health professionals or makes educated changes, the more normal the blood-glucose levels are.

In any case, be sure to have at least three days of what we’ll call “profiles.” A “profile” means performing a minimum of four blood-glucose tests per day at the requested times (for example, fasting and two hours after each meal, or premeal and bedtime). These records, along with other information such as the glycosylated hemoglobin test and glycosylated protein or fructosamine levels, will aid in the decision making process of whether to change or maintain your present program.

One woman who had attended a diabetes education program went in to her appointment with her physician with her well kept record booklet. Her physician looked briefly at the booklet and then tOld her that she didn’t need to bring in so much information. As the woman was walking out of the office, she saw the physician dropping the record book into a wastebasket. She was so shocked that she turned around, picked up the record book, and promptly changed physicians. The physician probably did not know how to interpret the data, and the woman was wise to find a physician who could interpret the data and support her in achieving good control.

Reporting

Other ways you can help are by promptly reporting the occurrence of any severe insulin reactions. Most of the time, you will be able to recognize why a severe reaction has occurred. If not, a change in management is needed right away. If a change has occurred in your lifestyle, if you plan to travel (especially for the first time), or if you are experiencing a lot of stress and find that, even though you have followed through with your program, the desired glycemic response is not occurring most of the time, you need to report to your management team so that they can assist you in making changes in your program. Tell them the problem, and, as needed, give them the last two to three days of blood-sugar readings and urine ketone results if a blood-sugar reading has been greater than 250 mg/dl (14 mmol). Also tell them of any changes in your food intake or activity.

No matter how insignificant a particular piece of information may seem to you, it may be the most helpful in assisting your diabetes team to help you. Remember: (1) test/monitor; (2) record; (3) report.

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This entry was posted on Wednesday, March 5th, 2008 at 4:54 am and is filed under Health Flash. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.