How Serious is Diabetes ?

Protecting Type 2 Diabetics With Multi-Level Care

Diabetes is a problem often more complicated than single solutions or interventions can resolve. For instance, it can take a team effort, plus judicious use of the newest generation of insulin, to bring the blood sugar levels of many of these patients under control. Active patient participation and counseling and education programs are key to bringing blood sugar levels to 7% or less.

Patients with type 1 diabetes are 2.5 times as likely to develop an eating disorder as the general public. Also, women may skip necessary insulin injections to manage weight. Women with diabetes and eating disorders get severe diabetes complications earlier. They also have higher mortality rates.

Eating disorders rates may be higher in women with type 2 diabetes as well. For some, the lifelong struggle with weight may relate to binge eating problems, although it is unclear whether the binge eating drives the overweight that leads to type 2, or if events occur in another order. Depression may also play a role in this cycle.

People with diabetes must always balance food, exercise, and insulin to control blood sugar levels. When this balance is disrupted, certain emergency conditions, including low blood sugar (hypoglycemia) or high blood sugar (hyperglycemia) may result. Most patients do not have access to specialized referral centers, and the care of these complex patients is most often the job of the primary care physician.

The patient empowerment movement at the University of Michigan and research at Joslin, using motivational interviewing (a technique by which you and your healthcare team identify and prioritize healthcare goals together and build supports to achieve these goals), has proven to be more successful in reaching diabetes management goals than the more traditional approach of being told by healthcare providers what to do.

Chronic disease is frequently linked with depression, and research from Washington University in St. Louis and elsewhere suggests that people with type 1 and type 2 diabetes have higher rates of depression. The good news is that research also shows that successfully treating depression improves diabetes management.

For anyone, stress can wreak havoc with blood sugars — some will have routinely higher blood sugars when stressed, others will experience low blood sugars. This may occur simply because people under stress may be less focused on complex tasks required for diabetes self-care. Research at Duke University shows that learning stress management techniques can improve long-term blood sugar control in type 2 diabetes.

Diabetes is never easy. But by keeping a hopeful outlook, managing stress, getting help for depression, burnout or other mental health issues and setting realistic goals, it can be managed successfully and people with diabetes can live long and productive, healthy lives.

People with diabetes are more likely to develop heart and blood vessel disease than non-diabetics. Much can be done to reduce the risk of developing these problems, and prevention involves more than just treating the sugar levels. Blood pressure and cholesterol (lipid) target levels for people with diabetes are lower than for those who don’t have diabetes because of the risk of cardiovascular complications.

Unless there is a reason that it would be unsafe for individual patients, doctors recommend taking blood pressure - lowering medications and an aspirin a day to keep blood vessels healthy and prevent cardiac disease. Feet should be examined at every office visit for signs of circulation and nerve problems or unhealed sores that could lead to serious complications. Patients with diabetes need yearly-dilated eye exams as well. These are just some of the vital basics of diabetes care - make sure you are getting them!