choices in diabetes management

How you choose to manage your diabetes may have powerful consequences. What may seem a small thing, such as type of insulin; how you deliver this – by pump, pen or syringe; the blood glucose monitor you use and how often you monitor – can be huge things in your diabetes management, ability to take control and how you feel about yourself and your diabetes.

 what kind of diabetes manager are you?

Looking at what you would like people to say about you at your funeral might sound odd, but it can be a good way to find out what is important to you in life – for example would you want people to say “he was a really good diabetic”? Or “he could stick at things and work them out”; “she managed against the odds”; “she had a great sense of humour!”

This can help to find out what really matters to you in life and these are the things that guide you to take actions in getting and maintaining motivation and control over managing diabetes and other areas of life.

taking control of your diet and food

issues to consider around food include:

• What sort of dietary “management” is needed for your particular situation?
• What type of diabetes you have?
• How old are you?
• Are you are very active or not?
• Are you male or female?
• Do you want to lose, maintain or gain weight?
• What types of foods do you enjoy and want to have in your eating plan?
• Does food factor much in your diabetes management? For example do you want to have a low carbs, and/or low GI carbs eating plan? How about portion sizes? What about built in treats? What will you use for hypo management? What about exercise carbohydrates?
• Are there issues to consider such as your culture or religion, family eating habits and daily routines with work or study that impact on the way you eat, when you eat and so on?
• What is your financial position and are there any restrictions on your weekly food budget?
• Would you benefit from some input from an dietitian? This may be to revisit your understanding of carbohydrate management; find out what is new in terms of diabetes and food if you have had it for a long time – things change rapidly; weight management support; or any other reason why you feel some outside support and input may be helpful.
• What is your history and relationship with food – how do you feel and think about food? Perhaps you don’t think about food – it may be that being conscious about food and how you think about it, can help you to manage better.

These are the kinds of questions you can think about and discuss with your diabetes team, so that you develop a realistic and healthy relationship with food that not only makes diabetes management easier, but makes food just a regular part of life and not something that needs to dominate things. You can read more at our Food and Weight Matters pages here

taking control of your exercise and activity  

issues to consider around exercise include:

• Your age and fitness level
• How much time do you have for formal exercise and how much you can build incidental activity into your day?
• What type of diabetes you have? People with type 1 in particular have hypo management to work out with exercise and this can become frustrating and disheartening; people with type 2 diabetes are often trying to lose weight and may have some physical restrictions for exercise
• Do you have any physical restrictions?
• Think hard about what physical activity you have enjoyed the most in your life? This is the most likely thing you will stick at – do you like solo or group based activity for example? Do you like to be indoors or outdoors? Do you like routine or variation? Do you want to combine aerobic and strength based exercise? How motivated are you?
• With type 1 diabetes, how will you prepare and manage blood glucose? What will you do if you plan exercise which does not happen? How about if you have unplanned activity- how will you deal with the risk of a hypo? How to minimise hypos and increase the weight management aspects of exercise with type 1 diabetes?
• If you have type 2 diabetes and have physical limitations, have not exercise before and/or feel embarrassed due to being obese or overweight when exercising – what can you do to feel better about this, so you can get out and exercise? Would counselling, or other support be helpful? What about specialised groups such as walking groups, Heartmoves and Lift for Life? Look around for resources to support you on this journey.
• What sorts of ideas, thoughts or stories do you have about exercise? We all have them! For example, when the weather is better, then I will go walking; when my knee is better, then I will go to the gym; when work is not so busy, then I will go to the pool” – these “When, Then” stories are something we all have in many areas of life and they are not helpful!
• If you are constantly waiting for the perfect time to exercise – don’t! There is no better time than the present and the barriers to exercise can be broken down when you can consider all of the above elements.

And finally how will exercise assist you in your life?

It is not just about a healthy heart and body, exercise also increased feel good hormones, reduces stress, helps us sleep and makes us feel we are doing something positive for our health – so it is a very important thing to work out how you can stick at it for your whole life.

Maybe you are better off walking to the playground with the kids and playing with them if you have a young family, so you all benefit? Or walking the dog so he also gets a workout! Exercise Physiologists are wonderful support to assist with working out how to build exercise into your life. Hop onto our Diabetes and Exercise page for more.

taking control of blood glucose monitoring (bgm) 

BGM is an unwanted but critical part of diabetes control. However there is no set standard when it comes to choosing a monitor, or deciding how many times a day, week, month, to check your blood glucose. This can make it very confusing!

type 1 diabetes

Generally, you can consider that in type 1 diabetes, you will need to do a minimum of 4 – 6 blood glucose checks a day ( and calling it “checks” and not “tests” can have a big impact on your feelings as checking is a guide, testing is…well a test)

Many people wth type 1 diabetes do more than 6 checks a day. On an insulin pump you may do many more. It is also important to remember that on sick days, at times of high activity or exercise and other unusual situations outside every day routine – more BG checks are needed.

How often you check depends on why you are checking, what you will do with the results and how you will feel about the numbers.

In type 1 it is important to check regularly so that you can monitor for high and low blood glucose; make adjustments to insulin for high readings and catch low ones; manage the dose needed for the carbohydrates you are eating. It also has safety purposes, such as when driving, working or looking after children – it is important to know what your BGL’s are so you can be sure you are in a safe range and not going to lead to a danger for yourself or anyone else.

there are a few reasons to check bgl’s in type 1 that assist your control:

• to keep track of what is happening with your diabetes overall and on a daily basis
• to monitor impact when there are management changes – such as with hormonal changes, pregnancy, growing up, changes from injections to pumps, change of insulin, a new diagnosis of another condition or introduction of a medication that may impact on BGL’s
• to manage sick days and prevent ketones and hospitalisation
• to manage BGL’s when in hospital for surgery or other reason
• to manage exercise
• to prevent low and high BGL’s
• to ensure you and others are safe
• to manage the food you eat
• to make you feel better about how things are travelling on a daily basis and reduce anxiety

and overall, to get some sense of control and ability to make necessary changes.

Type 1 diabetes can present a roller coaster ride within a day, or even from hour to hour, so BGM becomes critical. BGM also becomes very wrapped up in mental health and wellbeing. The results of BGM can seem like a test of what kind of person or what kind of “diabetic” you are, leading to you feeling down on yourself if the results are not what you would like.

It can become a huge stress and a ‘symbol” of your diabetes – so if you are having a hard time, are feeling burnt out and unmotivated, not checking BGL’s can feel like a way of ‘rebelling” against diabetes.

However the background stress of knowing that you actually don’t have any idea what is happening with your diabetes will build up and ultimately have the opposite effect, with you feeling more stressed and more burnt out.

Stopping to check BGL’s can really assist in feeling in control. Sometimes you may need to ease back on this, if you are doing a lot of BGM and feeling burn out, try doing less checks, rather than none and giving yourself some time out whilst still maintaining control. The way you think about results and what goes on in your head can really undermine this one – so try to tune into this and see the thoughts that run through the background around BGM.

type 2 diabetes 

In type 2 diabetes there may be no need to monitor BGL’s at home at all, or you may need to be checking the 4 – 6 times a day and anything in between! This depends on whether you are newly diagnosed, have had type 2 diabetes for a long time, are on diet control, medications and what type, or on insulin. Some of the reasons for BGM at home in type 2 diabetes include:

• Just diagnosed and need to get an idea of what is happening
• Changing management – to medications, different medications or insulin ( the vast majority of people with type 2 will eventually need an insulin injection or more down the track)
• Illness or other medical condition or surgery/hospital admission
• You want to do regular checks as you like to see what is happening from day to day

Often with type 2 diabetes, initially there is no need for checking BGL’s at home, or just to get some idea of what is happening. Your GP and or diabetes educator should discuss this with you at diagnosis.

If the outcome if for dietary management and lifestyle changes at first, then it may not be necessary to do any BGL checks at home for a while. The doctor will use your 3 monthly HbA1c check to see how things are going as it gives an average over the past 8 – 12 weeks.

You should have some say in whether you want to do some checks at home or not. Some people will do a few checks a day, or a few a week and if this is the case, it is helpful to do them at a range of times, to get some overall patterns.

If you are on a medication that can lead to hypos and/or insulin, then checking up to 4 times a day is usually recommended. As with type 1 diabetes, exercise and activity, missed meals and illness can affect your BGL’s and so a closer watch is needed.

Many people with type 2 diabetes get mixed up with all the conflicting information about BGM and it is important to ask questions and also be clear about what you want to do at home when it comes to BGM. It is also true that BGM can become a real stress and lead to people feeling depressed and worried – if this is the case it is also important to work out what is going to be best for you and speak up!

What kind of management choices do you make for your diabetes?

Helen

xx

Helen Edwards 

Founder and Director Diabetes Counselling Online, person with type 1 diabetes for 35 years,mum of 3 and blogger at www.recycledinteriors.org