Diabetes Journey

Diabetes can be looked at as a journey. As with all journeys, it can be difficult to live with day to day. But you can choose to view your diabetes journey as a way to live a healthier life. Here is a story about one person who made this choice.

DENISE’S JOURNEY BEGINS

Denise is a teacher at a local college who was interested in learning more about her diabetes. She was diagnosed during a visit with her primary care physician several years ago and was advised to lose some weight. But she hadn’t taken it seriously until her most recent visit, when she discovered that the levels of her A1C and lipids (fats in the blood) had increased.

One year ago, Denise took a positive first step by calling her health care provider’s office. She asked for a diet to help her lose some weight. Her hope was that with an over-the-phone consultation and an outline of a weight loss plan, she would not need to go on diabetes medication. As you can guess, it was not that easy. An outline of a diet is helpful, but if it is not tailored for you and doesn’t include the foods that you like to cook and eat, it probably won’t work for the long term.

THE NEXT STEPS

Denise then visited with a diabetes educator. Together, they talked about her history of overeating, weight gain and lack of activity. The diabetes educator helped by asking Denise her thoughts about diabetes and how it was affecting her life. She asked Denise about what she thought would work for her and offered information and resources. As they talked, Denise began to come up with a plan. She felt sure that she could actually use this plan. One of the reasons she felt this way was that she was coming up with her own goals. She was taking charge instead of waiting for someone else to do it for her.

Her goals were to lose weight and get more exercise, while still being able to eat out—an activity she and her husband enjoyed. She had lost weight in the past and found that writing down what she ate was helpful. Her short-term plan included:

• Keeping a food diary
• Keeping a blood glucose log book (several tests per day, including before breakfast and two hours after her biggest meal of the day)
• Attending a diabetes education program, with tips for healthy eating and increasing activity

Her long-term plan included committing to becoming more active. Denise felt sure this plan was realistic and doable for her. Her educator told her that making a plan works better if it is RUMBA: Realistic, Understandable, Measurable, Behavioral and Achievable.

STAYING ON TRACK

In time, Denise attended a series of diabetes classes, including a class about medications for diabetes. She began to keep records of the food she ate and the time she spent walking or doing other physical activities. She also tried to eat about the same amount of carbohydrates at breakfast, lunch and dinner each day.

Over the next several months, Denise had begun to lose some weight, yet not as much as she wanted. In fact, her A1C increased to 7.7 percent (goal of under 7); her blood pressure was still high (162/80—goal of 130/80), and her weight was still more than 200 pounds on her 5’4″ frame.

One of the reasons for Denise’s lack of progress was that she had decided not to join a gym, because she didn’t know when she would find the time to exercise. She found it very hard to use her meal plan, especially when she was visiting friends and family and during the holidays. So, instead of giving up she decided to use the concept of “maintaining” at those times—choosing to maintain rather than lose weight.

EYES ON THE PRIZE

It is now one year later and Denise has made good progress. She has lost 31 pounds. In addition, her blood glucose is 112-140 and her blood pressure is 128/80 (both in target range).

Denise has not yet reached her final goals, but continues to work toward them. Because these changes were not enough to lower her blood glucose and blood pressure into her target range, she has started taking a pill for her diabetes. Her educator helped her to understand that taking medication doesn’t mean that she failed—it just means that her body needs more help to keep her blood glucose where she wants it.

Denise has become more active on the “10,000 Steps” program (see page 44 for more information). This is easier for Denise than joining a gym, given her work and family schedule. She now walks more often, adding extra steps into her day whenever possible.

REACH YOUR GOALS

Here are some things you can do to stay on track even if, like Denise, you face ongoing challenges reaching your goals:

• Attend classes or support groups to get the most up-to-date information on diabetes care. You can also get this information from web sites, local community organizations and your health care team.
• Build a strong diabetes education and medical care team (nurse and nutrition educators, pharmacist, physicians and others). Ask for recommendations from others who have diabetes.
• Make a plan that fits into your life and offers choices, and know how to adjust it.
• Keep trying. Even when the plan doesn’t work, you have the chance to learn about diabetes and yourself.

Education, effort and ownership were Denise’s strengths. Her diabetes team was always ready to help at any point. Your pharmacist is part of your diabetes team and can help you reach your diabetes care goals. The most important thing Denise learned is to look at diabetes as a journey and not as a destination. You can do the very same.

Reviewed by Robert Ehrman, MD