Are you managing your diabetes properly? A new survey by Diabetes Ireland and Janssen Pharmaceutical of people with type two diabetes revealed that while 70pc of patients felt in control of their diabetes, only half had significantly changed their diet; just over one-third had significantly improved their exercise habits; and almost a quarter had forgotten to take their medication at some stage.
"The failure of people to take their medications really questions their ability to follow the other essential behaviours of healthy eating and taking regular activity, which are more difficult," warns Dr Anna Clarke, health promotion manager with Diabetes Ireland. "This suggests that although people think they are looking after themselves, many may not be taking the proper precautions to control their diabetes".
1 Glucose control
Glucose is the sugar in your blood which comes from foods such as breads, pasta, potatoes, fruit and milk products. Know your average glucose levels and get a check-up every three or four months to ensure they are on track. This requires you to attend your doctor or other health professional and have a specimen of blood sent to a laboratory for analysis. The recommended result is an average of 40 to 50 mmol-l, which means you have good glucose control and are managing your diabetes well. A result over 50 needs to be reviewed with the doctor, and an action plan needed.
2 Care about your cholesterol
Cholesterol is the amount of fat in your bloods and it can have a major impact on your heart and health. Know your cholesterol levels. For people with diabetes, cholesterol results need to be checked annually and should ideally be less than 4.5mmol-l. Control your cholesterol by monitoring your intake of saturated fats and by not smoking.
3 Watch your blood pressure
Blood pressure is a measure of the elasticity of your arteries and an indication of general health. Readings should be below 140/90. All adults with diabetes are put on anti-hypertensive medication to protect the kidneys. It is essential that you take this medication as directed.
To maintain good blood pressure, reduce salt intake and exercise regularly. Processed and convenience foods usually have high levels of salt.
4 Eat well
A healthy, well-balanced diet, low in saturated fats and processed sugars, is required to manage diabetes or prevent type 2 diabetes. Eat unprocessed or unrefined sugar such as those found in fruit, milk and high-fibre foods, such as vegetables and wholegrains. Have three high-fibre meals a day, and only occasional treats. "Remember, shop well and you will eat well," says Dr Clarke. Know the ingredients that might affect your blood glucose levels. Know how much is a portion.
Enjoy a minimum of 30 minutes of exercise a day, and 60 minutes for weight loss. Exercise, for the majority of people, is a physical activity which leaves them feeling slightly breathless and in need of a shower afterwards. Dr Clarke says: "However, you should be able to carry on a conversation during the activity."
If you are physically unable to move from your chair, there are exercises you can do whilst sitting.
In the Diabetes Ireland/Janssen Pharmaceutical survey, just 35pc of patients with type two diabetes significantly improved their exercise habits after being diagnosed.
6 Take your medicine
Anyone with type one diabetes - an autoimmune condition which requires insulin injections/pump to sustain life - needs to take insulin regularly. Type two diabetes is a chronic condition, which can be treated by limiting sugar intake and having regular activity - it will often require medication and insulin injections. It is vital that all medication is taken as prescribed. If you do not do this, your doctor needs to be informed. According to a recent survey of 300 people with type two diabetes, 23pc of people with the condition forget to take their medication at some stage in the previous month. One in 20 forget at least once a week. If you regularly miss medication, take action: use an alarm, an app or written record of medication use. People with diabetes are entitled to all diabetic and cardiac medication free of charge under the Long Term Illnesses (LTI) Scheme.
7 Check in on your health
Regular check-ups are essential to protect your health. Monitoring your heart, for example, ensures that any health problems are picked up early, and treatment commences. You need an annual retina screen. Check that you are on the Diabetic Retina Screen database and attend all appointments. You will also need to have a heart and kidney check-up and a full physical examination, including a foot assessment, on an annual basis.
8 Focus on feet
The foot is the furthest part of the body from the heart and brain. The length of the blood vessels between the heart and the feet means there's more potential for blood vessel damage as a result of high glucose levels, high blood pressure or high cholesterol. Any change to the blood vessels can affect the feet, and as the nerve supply can be compromised, you may feel nothing and be unaware of potential limb-threatening conditions. Daily foot care includes regular washing, thorough drying, inspection for redness or cuts, and the application of cream to the back and front of the feet (not between the toes), and wearing shoes and socks that do not have internal seams. If you suspect any difficulty, such as skin redness or calluses on your foot, contact your healthcare team.
9 Team up
Living with diabetes is not easy and you may need the support of family and friends. Talk about the condition and make sure to attend every medical appointment. Don't be afraid to say you have diabetes. Let other people help you by joining them in practicing a healthy lifestyle which to prevent them getting type two diabetes too.
10 Be organised
Life with diabetes requires forward planning to ensure you maintain a healthy lifestyle. "It's easier to eat healthily if you plan your meals, and easier to exercise if you dedicate part of the day, early in the day, to exercise - and easier to take your medication if you establish a routine of when you take it," says Dr Clarke.
11 Investigate your insurance
While members of the Insurance Federation have agreed that they will not load their car insurance premiums for diabetes, it's important to know that most travel insurance policies will have a general exclusion in respect of claims arising out of a pre-existing condition. This means that someone with diabetes who experiences health complications abroad would have to pay their own hospital bills, unless they had disclosed their condition in advance to their insurer and received confirmation in writing that they would be covered. Even if they were hospitalised for another reason, say a car accident, and their treatment was complicated by their diabetes, they would be refused cover. The good news is that cover is available for people with diabetes.
12 Think before you travel
The key to successful travel is planning ahead. "You can travel anywhere in the world, but talk to your diabetes team to plan how to manage your diabetes during a trip," says Dr Clarke. You may need to bring extra medication and always check what foods may be available to you during the journey.
13 Common illnesses
Minor health upsets can disrupt diabetes management. Be aware of how to manage your diabetes during common colds and flu. If you are on medication, review your Sick Day Management with your diabetes team - for example, says Dr Clarke, you may need to take extra insulin and you should never stop taking insulin even if you are not eating. "All people with chronic conditions should have their annual flu vaccination and their five-yearly pneumonia vaccine," she says. Be prepared for check-ups by listing questions you may like to ask in your blood glucose monitoring booklet or notebook.
14 Plan your pregnancy and ask about sexual health
A woman with diabetes must plan a pregnancy carefully. Blood sugar must be controlled before conception, which means the woman and her partner must use contraception until good blood sugar control is achieved. Planned pregnancies must be discussed with your diabetes team. If you have sexual health issues (such as erectile dysfunction which can result from poor glucose control), poor circulation or damaged nerve endings, don't be afraid to raise the issue with your team; they're used to talking about this.
15 Mind your mental health
If you feel you are depressed, consult your GP for the most effective means of treatment. A diagnosis of diabetes may cause difficult emotions that are a natural part of adjusting to life with diabetes. Discuss it with people you are comfortable with: friends, a GP or nurse. Mood swings are linked to uncontrolled diabetes, regardless of the type. It's important to monitor blood glucose control and changes in mood. It may be helpful to keep a mood diary to bring to your next check-up.
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