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Five Smart Questions to Ask Your Doctor About Diabetes
By: Andrea Zaldivar, MS, ANP, CDE
Often when I discuss diabetes diagnoses with my patients, I am surprised by how calm they seem. True, my patients are adults, and most of them have been confronted with a number of other chronic diseases, such as high blood pressure or hypertension, asthma, or high cholesterol. But the truth is that they are not calm. They are simply numb. These individuals think of diabetes as just one more medical burden. Often, individuals feel fearful and hopeless in the face of a diabetes diagnosis because they are not educated about the disease.
Educating yourself about diabetes will not only make you feel less fearful, it will empower you. Knowledge enables you to be an active participant in your care.
This article explores five questions that all people with diabetes should ask. You do not need to find the answers to all these questions on the first visit with your healthcare provider. Ask them gradually, as you are ready to absorb the answers. Don’t wait too long though. Diabetes control should not be postponed.
What is Diabetes?
You may be surprised to learn that many patients who have had diabetes for many years are unable to answer this question.
You can't expect to make a long-term commitment to diabetes-care without knowing the basics about the disease. When a doctor recommends that you ‘change your diet’, and ‘take your medications’, it is important to understand how and why these recommendations will help you. Getting familiar with the disease itself is the first step to becoming an educated and active participant in your own health care.
Learning with medical language
People learn in different ways. For some, learning about the medical aspects of a disease and how it affects the body is the easiest way to conceptualize it. If you are one of these people, it may be most useful for you to learn about how insulin regulation works. It may help you to learn that diabetes is a disease in which the pancreas doesn’t produce insulin, and the cells in your body are resistant to insulin. With this knowledge, you will then understand that your treatment is assisting in insulin resistance or in insulin production.
Learning with common language
Others prefer to learn about a disease using more common words and concepts. You may be an individual that simply needs to know that your body ‘doesn’t use sugar, the body’s main energy source, the way it should’. This explanation will help you understand why you need to modify your dietary intake, or the ‘sugar’ that you put in your body.
Whatever your learning style, if you are diabetic, it is important that you understand what diabetes is. Get an explanation of diabetes that makes sense to you, so that when you are encouraged to change your eating habits and/or take medicine or insulin, you understand why, and it seems logical based on what you already know.
What Are the Three Most Important Actions I Can Take?
It may seem that there are too many things to do to control your diabetes. Ask your healthcare provider to simplify things. After all, what good is trying to address so many changes that you feel paralyzed to address even one? Ask your doctor to give you his or her top three recommendations. Your healthcare provider may want to individualize your care and add to, or delete some of the points listed below. The top three actions I suggest to control Diabetes are:
Learn how to eat right
What people with diabetes can and cannot eat is one of the main concerns patients express when confronted with diabetes. Learning to eat in a healthy manner may be something you forgot or perhaps never learned. Healthy eating will lower your blood glucose, improve your cholesterol, and decrease your weight. All members of your family, despite whether they have diabetes, can benefit from eating less fat, less sugar, and more vegetables and fiber.
Ask a nutritionist
A nutritionist can assist you in making the dietary changes needed to better control your diabetes and improve your overall health. You will need to learn about the food groups, and learn how the foods in these groups will affect your glucose levels.
Learn to watch your portions
Perhaps one of the most challenging things you will need to concentrate on is portion size. You don’t need to give up food, rather you need learn how much you can safely eat of certain foods without elevating your glucose level.
Take your medicine as prescribed
This requires honesty. You need to be honest with your health care provider as to whether you will take, or are taking the medication he or she is prescribing.
Get your medications straight
Sometimes patients do not take their medications simply because they get confused about how they are supposed to do it. “Do I take the medicine once a day or twice a day?” “ Do I take this new pill with the ones I already have at home or do I stop those?” “How do I get refills of my medications?” You need to make sure you understand when, how often, and which pills to take.
Check your blood sugar daily
Learning how to check your blood glucose at home gives you power over your disease. You will not have to wait until your provider checks your sugar to know how you are doing.
Blood glucose monitoring allows you to ‘play detective’ at home. Can you eat that new pasta dish? You can check your blood glucose before you eat it and then after you eat it. Compare your results and then decide whether you can add this pasta dish to your menu. Through blood glucose monitoring, you will be able to come up with some of your own answers, especially about food intake.
You’ll feel a prick
Patients are often apprehensive about initiating blood glucose monitoring at home because ‘it will hurt’. True, blood glucose monitoring at home may pinch a little when you do it, but living with diabetes-related complications can ‘hurt’ much more. Knowing what your blood glucose levels are at home will help you maintain glucose control, and this control will help you to avoid diabetes-related complications.
What Glucose Levels do I Want to Reach?
Diabetes-care is a lot of work. How do you know if you are heading in the right direction? What should your fasting blood glucose level be? How about your post meal blood glucose level? What should your hemoglobin A1c (a blood test that correlates with a three month
average of blood glucose levels) be?
Blood glucose level goals should be individualized. My initial goals for a patient who had fasting glucose levels in the high 300’s will be different than those for someone who starts out at the low 200’s. Studies have shown however, that your hemoglobin A1c should be at around 7 to prevent complications. This usually translates to an average glucose level of around 150.
What Do I Do if My Blood Sugar Gets Too Low?
Often, healthcare providers become focused on lowering your blood glucose levels, and may forget that when all their interventions ‘kick in’, your glucose may drop too low.
Hypoglycemia, or low blood glucose, is often described as a ‘scary’ feeling. You may feel dizzy, sweaty, and/or confused. Hypoglycemia requires immediate attention as it can lead to coma and death.
Therefore, it is smart for people with diabetes to be familiar with the symptoms of hypoglycemia. People who do not take insulin are less likely to get hypoglycemia than those who take insulin, but it does happen.
What to do
If you begin to feel that you are experiencing the symptoms of hypoglycemia (becoming dizzy, sweaty, confused), you need to check your blood glucose level and see if it is too low. Once you are sure that your glucose is low, you need to quickly raise your sugar.
The general rule is to ingest 15 grams of carbohydrate every 15 minutes. This could be any of the following:
3 glucose tablets
4 oz. of fruit juice
4 oz. of raisins
Continue to ingest this fast glucose until you feel better and you are at your proper glucose level goal (refer to section on glucose levels). You should then have a slower-absorbing meal of carbohydrates to prevent your glucose from dropping again.
Teach your family about hypoglycemia and how to help you if it happens.
If it happens, find out why
Let your provider know if you are experiencing symptoms of hypoglycemia. Together you need to find out the cause of your low glucose level and remedy it. Is your medication too strong? Did you miss a meal? Did exercise cause your glucose to drop too low? Good detective work will help you find the answer and prevent further hypoglycemic episodes.
Who Can I Call if I Have a Question About Diabetes?
You will never know all there is to know about diabetes, and as a person living with diabetes you will be faced with many new questions daily. Not to worry. There are many resources available that can provide the answers to your questions.
First, know how to contact your healthcare provider and other members of the healthcare team (e.g. the nurse or nutritionist) when you need them.
Join a support group with other individuals who have diabetes.
Call the local office of the American Diabetes Association and find out what resources they offer. Read up on diabetes and explore the various sources of information on the Internet. Here are some reputable sources of information on diabetes to start with:
National Diabetes Education Program (NDEP): http://www.niddk.nih.gov
Center for Disease Control Division of Diabetes Translation: 1-877-CDC-DIAB (877-232-3422), or: http://www.cdc.gov/diabetes/ddthome.html
Establish a list of helpful resources so that you know where to go to get the information you need.
The diagnosis of diabetes should not be met with complacency. Rather, let it motivate you to ask questions. The questions that I have presented here are not all that you will need to learn about diabetes, but they are a good start.
As you grow older and your body changes, so will the behavior of your disease. The practice of asking questions will help you to manage the many stages of diabetes as you experience them. A good healthcare provider will not only assist you in finding accurate answers, but will assist you in finding answers that make sense. To you.