This is a new column, which will appear regularly in the VOICE OF THE DIABETIC. I have chosen "Your Diabetes Care Should Fit You" as its title because this is my general philosophy as a Diabetes Educator. I try to help each individual person find how to make their own diabetes care fit well with their own needs and the life they lead.
I picture diabetes care as something like clothing. We all know what it feels
like to have clothes that fit well. They're comfortable for the things that
we have to do in them. When we think of diabetes care now, in 2002, with all
the advances we've had, with the multitude of new medications, and new tools
available to help us manage our diabetes—we now have so many choices, so
much flexibility! I believe we should use this flexibility to make our diabetes
care fit each of us, just as we all like to have clothing that fits us.
This was not always possible. Before we had so many choices for diabetes management, there was much less flexibility. Back then, if you wanted good diabetes control, you did what you needed for your diabetes, and your whole life had to fit into that. That's sort of like buying clothes that don't fit you—and then trying to squeeze your body into them. Now we can fit your diabetes care to you—if you're getting up-to-date diabetes care.
Let's look at an example. Consider two women, Cindy and Marilyn, who both have type 2 diabetes. Both of them need insulin to control their diabetes well, but the similarities end there.
Cindy leads a very predictable life. She works as a medical secretary, and her schedule is almost the same every day. She wakes up at the same time daily, eats very similar meals, at the same time every day, and exercises every day by walking ½ hour after she gets off work. She likes her job, and although there are some stresses associated with it, on the whole she is content with her life. She is willing to put some effort into managing her diabetes, but would prefer to keep her number of injections to a minimum.
Marilyn, on the other hand, is a high school teacher. Her schedule is anything but predictable. If she has a lot of papers to grade, she might stay up late and get up early. She is able to eat breakfast at the same time most days; but her lunch schedule is different on Tuesday and Thursday from Monday, Wednesday and Friday. She loves teaching, but her classes are very large, and her work is stressful. Her appetite varies a great deal, depending on her stress and activity levels. On some days she exercises after work, but on other days she is too exhausted after work to do anything but go home and read. She would like to have good diabetes control, and is willing to work at it, but she finds it very difficult to change her erratic eating habits.
Twenty years ago, most doctors would have prescribed the same insulin regimen for both Cindy and Marilyn—a mixture of R and NPH inulin, injected twice a day, ½ hour before breakfast and ½ hour before supper. Ths regimen is designed to have the peak action of the R cover the insulin need for breakfast and supper. The longer action of the NPH covers the background need for a basal insulin, and NPH's peak mid-day covers the insulin need for lunch. Once the insulin is injected, it has a predictable action time, and for a person with a consistent schedule, the action times can be matched to the schedule, with good diabetes control as a result.
That regimen would have suited Cindy well. Her predictable eating and exercise
habits would have allowed her to attain good diabetes control with the action
times of the insulin. But for Marilyn it would have been a disaster. Her irregular
lunch schedule, and her irregular eating habits and exercise would have combined
to produce high blood sugar some days, and low blood sugar others. And having
low blood sugar in front of a class of rowdy high school students wold be a
high-stress event for anyone!
We now have some choices for an insulin regimen that will fit Marilyn's irregular and unpredictable life. One of the new insulins, Lantus, provides a flat action for 24 hours, so she can use it to meet her need for a background, basal insulin without having to worry about getting hypoglycemia when she eats. She is willing to inject herself more frequently, if it helps her get good diabetes control, so she could use one of the new rapid-acting insulins—Humalog or Novolog—to cover her meals. To use such an insulin effectively, she would have to check her blood sugar before each meal, and then calculate how much insulin to give herself, based on how much she planned to eat and whether she needs to bring her blood sugar down. Since she is much more willing and able to do this extra blood glucose testing, calculations, and injections than she is to change her irregular schedule and eating habits, this regimen suits her well.
This is just one small example. In coming columns, I will cover more about the many choices available in modern diabetes care, in the areas of meal planning, oral medications, insulin delivery, and exercise. I invite your questions, to help make this column meet YOUR diabetes needs!
About myself:
I am a Registered Nurse and a Certified Diabetes Educator (CDE). I have worked with blind people who have diabetes, for about 15 years, and I have diabetes myself. I was already a Diabetes Educator when I diagnosed my own type 2 diabetes. That I developed diabetes came as no surprise to me, since I come from a large family that has lots of people with it, and I had gestational diabetes with my third child.
When I developed diabetes, the only oral medications we had
were the sulfonylureas, and that kind of medication gave me intolerable side
effects; so I've been using insulin since very soon after diagnosis, for almost
10 years. I have used an insulin pump for about two years, and the pump suits
me well.