Ask the experts - self care, having good control over diabetes, healthy weight, dietitians and staying motivated

Christopher D. Saudek, MD, is professor of medicine and director of the Johns Hopkins Diabetes Center and a former president of the American Diabetes Association.

Q: If you have diabetes, why is it important to learn self-care?

A: We call having diabetes an “experiment in self-government,” meaning there are many decisions you make every day that govern your self-care. What you eat, whether you check your blood sugar, what medications you take, how active you are physically—these all affect your diabetes control. It’s not possible for any healthcare professional to be with you all the time, so you have to understand your own diabetes and how your self-care is going to affect you in the long run.

Q: How do you know if you have good control of your diabetes?

A: Hemoglobin A1C (a test of your average blood sugar control for the past two to three months) is the universal test of whether you’re doing well, and the general guideline is that it should be under 7%. However, there are some circumstances in which this is not really necessary, for example, in the very elderly and in people with other major health conditions that make it less important to follow
this guideline.

Q: How important is it for people with diabetes to reach and maintain a healthy weight?

A: For most overweight people with type 2 diabetes, losing 5% to 7% of their body weight is very effective in controlling the disease. The challenge is keeping off the weight that’s lost, which requires changing eating and activity habits.

Q: If you have diabetes, do you need to meet with a registered dietitian?

A: I think you should. People may have misconceptions about a diabetic diet, thinking that they can’t eat any carbohydrates or fats, for example. In fact, the best nutrition plans are skillfully worked out by a professional who will find out what you like and don’t like, what you’re doing now, and what you could do that’s acceptable to you. That’s all-important, because the surest way to have somebody not follow a nutrition plan is to make it impossible to stick to. I recommend meeting with a nutritionist periodically because it’s often hard for him or her to tell you everything you should know in one meeting.

Q: How does getting exercise help control diabetes?

A: Regular exercise helps with weight loss, cardiovascular health, and blood pressure control, and it gives you a sense of well-being. Talk to your doctor before you start exercising if you’re at high risk for heart disease or you haven’t exercised at all. Start slowly and build up. Four to five times a week is a good goal, but one size doesn’t fit all. What’s most important is to get
out there and break a sweat, and
do it regularly.

Q: If you have type 2 diabetes, do you need to check your blood glucose levels with a glucose meter?

A: Everyone with diabetes should check their blood sugar with a glucose monitor on a regular basis—how frequently will depend on how much your blood sugar varies. It will help you identify what symptoms are caused by blood sugars that are either high or low. You’ll also learn the effects of your self-care behavior. If you eat a big slice of pizza and two hours later your blood sugar is 250, for example, you might think again before eating that in the future.

Q: How can people with diabetes stay motivated to take care of themselves?

A: Ask for family support, or talk to your diabetes educator or even a counselor. Keep in mind that you can’t expect perfection. Everybody gets off track sometimes. The question is, do you get yourself back on? Having realistic goals and trying to meet them is important. There are also books that can help provide motivation, including 101 Tips for Coping with Diabetes by Richard L. Rubin (American Diabetes Association, 2003).

Q: Where can people get more information about self-care for diabetes?

A: The American Diabetes Association Web site (www.diabetes.org) is a reliable source of information, and there’s a helpline you can call. The National Diabetes Education Program (http://ndep.nih.gov) also has very good information.