by Wesley W. Wilson, MD
NOTE: If you have any questions for “Ask the Doctor,” please send them to the Voice editorial office. The only questions Dr. Wilson will be able to answer are the ones used in this column.
Wesley W. Wilson, MD, has retired as an Internal Medicine practitioner at the Western Montana Clinic in Missoula, Montana. Dr. Wilson was diagnosed with type 1 diabetes in 1956, during his second year of medical school. He remains interested and involved in diabetes education for patients and professionals.
Q: I am presently incarcerated. I have type 2 diabetes, but diet choices and exercise opportunities are of course limited in this place. I want to take care of myself; what is the best way for a prisoner like me to keep my sugar where it should be?
A: Management of diabetes is always a challenge, but, as you point out, your challenges are increased by your limited meal choices and constrained exercise opportunities. You seem to be serious in your desire to control your blood sugar, and thereby reduce your risk of serious complications in the future.
The American Diabetes Association publishes a supplement to their journal Diabetes Care, titled: American Diabetes Association Clinical Practice Recommendations. The latest was published in January 2006, and includes a position statement on diabetes management in correctional institutions. I’d strongly urge you to obtain and review this list of recommendations made by experts and the ADA. They are only recommendations (they are not law), but they may be helpful for you in improving diet and exercise options.
I’ll include the summary and key points for your review:
“People with diabetes should receive care that meets national standards. Being incarcerated does not change these standards. Patients must have access to medication and nutrition needed to manage their disease. In patients who do not meet treatment targets, medical and behavioral plans should be adjusted by health care professionals in collaboration with the prison staff. It is critical for correctional institutions to identify particularly high-risk patients in need of more intensive evaluation and therapy, including pregnant women, patients with advanced complications, a history of repeated severe hypoglycemia, or DKA.
“A comprehensive, multidisciplinary approach to the care of people with diabetes can be an effective mechanism to improve overall health and delay or prevent the acute and chronic complications of this disease.”
I’m not sure how carefully the institution you’re in follows the ADA recommendations, but the majority of the effort needed depends on you. I’m glad you pointed out in your note the two priority items are diet and exercise.
First, can you check your blood sugar regularly? You need to check blood sugar to see how well your efforts are working. Several other questions are important. Do you have high blood pressure? Any heart disease? Any advanced complications? Are you overweight? These have to be considered when planning your exercise and diet plan.
Exercise is difficult to measure or prescribe. Any type of muscular activity improves insulin sensitivity. Isometric exercise can be done in limited space. Lifting weights, walking in place, or walking outside, all improve blood sugars. I feel the exercise should be done several times a day, every day, on a regular schedule, and should be slowly increased in duration as you evaluate your exercise tolerance.
Food is the other part of your treatment program. I expect your food choices are limited, but there are several things you can do to regulate food intake. First, get a booklet or sheet that lists carbohydrate content for each food item, so your breakfast, lunch, and evening meal can be similar in carb content. The other important item to watch is fat in your diet, particularly if your weight is too high.
Remember, you can get help and information from the American Diabetes Association (www.diabetes.org), from local hospitals, or from health care providers.
Check your blood sugars regularly—I’d suggest before and 2 hours after each meal—at least for a week. This will allow you to see how well your program is working. Good control of sugars indicates you can test less frequently, but changes in diet, exercise, or your own situation (such as illness) require more frequent testing.
Monitor your weight, perhaps monthly. If you are overweight, I would expect you to adjust food and exercise so as to achieve slow but steady weight loss.
I hope your prison experience can allow you to achieve and maintain good control
of your diabetes.