2.3.1.: A Day in the Life of a Diabetic

When it comes to diabetes management, blood sugar control is often the central theme. After all, keeping your blood sugar level within your target range can help you live a long and healthy life. But do you know what makes your blood sugar level rise and fall? The list is sometimes surprising.

Food

Healthy eating is a cornerstone of any diabetes management plan. But it's not just what you eat that affects your blood sugar level. How much you eat and when you eat matters, too.

What to do:

· Keep to a schedule. Your blood sugar level is highest an hour or two after you eat, and then begins to fall. But this predictable pattern can work to your advantage. You can help lessen the amount of change in your blood sugar levels if you eat at the same time every day, eat several small meals a day or eat healthy snacks at regular times between meals.

· Make every meal well-balanced. As much as possible, plan for every meal to have the right mix of starches, fruits and vegetables, proteins, and fats. It's especially important to eat about the same amount of carbohydrates at each meal and snack because they have a big effect on blood sugar levels. Talk to your doctor, nurse or dietitian about the best food choices and appropriate balance.

· Eat the right amount of foods. Learn what portion size is appropriate for each type of food. Simplify your meal planning by writing down portions for the foods you eat often. Use measuring cups or a scale to ensure proper portion size.

· Coordinate your meals and medication. Too little food in comparison to your diabetes medications — especially insulin — may result in dangerously low blood sugar (hypoglycemia). Too much food may cause your blood sugar level to climb too high (hyperglycemia). Talk to your diabetes health care team about how to best coordinate meal and medication schedules.

Exercise

Physical activity is another important part of your diabetes management plan. When you exercise, your muscles use sugar (glucose) for energy. Regular physical activity also improves your body's response to insulin. These factors work together to lower your blood sugar level. The more strenuous your workout, the longer the effect lasts. But even light activities — such as housework, gardening or being on your feet for extended periods — can lower your blood sugar level.

What to do:

· Talk to your doctor about an exercise plan. Ask your doctor about what type of exercise is appropriate for you. If you've been inactive for a long time, your doctor may want to check the condition of your heart and feet before advising you. He or she can recommend the right balance of aerobic and muscle-strengthening exercise.

· Keep an exercise schedule. Talk to your doctor about the best time of day for you to exercise so that your workout routine is coordinated with your meal and medication schedules.

· Know your numbers. Talk to your doctor about what blood sugar levels are appropriate for you before you begin exercise.

· Check your blood sugar level. Check your blood sugar level before, during and after exercise, especially if you take insulin or medications that lower blood sugar. Be aware of warning signs of low blood sugar, such as feeling shaky, weak, confused, lightheaded, irritable, anxious, tired or hungry.

· Stay hydrated. Drink plenty of water while exercising because dehydration can affect blood sugar levels.

· Be prepared. Always have a small snack or glucose pill with you during exercise in case your blood sugar drops too low. Wear a medical identification bracelet when you're exercising.

· Adjust your diabetes treatment plan as needed. If you take insulin, you may need to adjust your insulin dose before exercising or wait a few hours to exercise after injecting insulin. Your doctor can advise you on appropriate changes in your medication. You may need to adjust treatment if you've increased your exercise routine.

Medication

Insulin and other diabetes medications are designed to lower your blood sugar level when diet and exercise alone aren't sufficient for managing diabetes. But the effectiveness of these medications depends on the timing and size of the dose. And any medications you take for conditions other than diabetes can affect your blood sugar level, too.

What to do:

· Store insulin properly. Insulin that's improperly stored or past its expiration date may not be effective.

· Report problems to your doctor. If your diabetes medications cause your blood sugar level to drop too low, the dosage or timing may need to be adjusted.

· Be cautious with new medications. If you're considering an over-the-counter medication or your doctor prescribes a new drug to treat another condition — such as high blood pressure or high cholesterol — ask your doctor or pharmacist if the medication may affect your blood sugar level. Sometimes an alternate medication may be recommended.

Illness

When you're sick, your body produces stress-related hormones that can help your body fight the illness, but they can also raise the level of blood sugar. Changes in your appetite and normal activity may also complicate diabetes management.

What to do:

· Plan ahead. Work with your health care team to create a sick-day plan. Include instructions on what medications to take, how often to measure your blood sugar and urine ketone levels, how to adjust your medication dosages, and when to call your doctor.

· Continue to take your diabetes medication. However, if you're unable to eat because of nausea or vomiting, contact your doctor. In these situations, you may need to temporarily stop taking your medication because of risk of hypoglycemia.

· Stick to your diabetes meal plan. If you can, eating as usual will help you control your blood sugar level. Keep a supply of foods that are easy on your stomach, such as gelatin, crackers, soups and applesauce. Drink lots of water or other fluids that don't add calories, such as tea, to make sure you stay hydrated.

Stress

If you're stressed, it's easy to abandon your usual diabetes management routine. You might exercise less, eat fewer healthy foods or test your blood sugar less often — and lose control of your blood sugar in the process. Additionally, the hormones your body produces in response to prolonged stress may prevent insulin from working properly.

What to do:

· Look for patterns. Log your stress level on a scale of 1 to 10 each time you log your blood sugar level. A pattern may soon emerge.

· Take control. Once you know how stress affects your blood sugar level, fight back. Learn relaxation techniques, prioritize your tasks and set limits. Whenever possible, avoid common stressors.

· Get help. Learn new strategies for coping with stress. You may find that working with a psychologist or clinical social worker can help you identify stressors, solve stressful problems or learn new coping skills.

The more you know about factors that influence your blood sugar level, the more you can anticipate fluctuations — and plan ahead accordingly. If you're having trouble keeping your blood sugar level in your target range, ask your diabetes health care team for help.

General Background On the Biology of Type 1 Diabetes

Both type 1 and type 2 diabetes share one central feature: elevated blood sugar (glucose) levels due to absolute or relative insufficiencies of insulin, a hormone produced by the pancreas. Insulin is a key regulator of the body's metabolism. It normally works in the following way:

During and immediately after a meal, digestion breaks carbohydrates down into sugar molecules (of which glucose is one) and proteins into amino acids.

Right after the meal, glucose and amino acids are absorbed directly into the bloodstream, and blood glucose levels rise sharply. (Glucose levels after a meal are called postprandial levels.)

The rise in blood glucose levels signals important cells in the pancreas, called beta cells, to secrete insulin, which pours into the bloodstream. Within 10 minutes after a meal insulin rises to its peak level.

Insulin then enables glucose to enter cells in the body, particularly muscle and liver cells. Here, insulin and other hormones direct whether glucose will be burned for energy or stored for future use.

When insulin levels are high, the liver stops producing glucose and stores it in other forms until the body needs it again.

As blood glucose levels reach their peak, the pancreas reduces the production of insulin.

About 2 - 4 hours after a meal both blood glucose and insulin are at low levels, with insulin being slightly higher. The blood glucose levels are then referred to as fasting blood glucose concentrations.

In type 1 diabetes, the pancreas does not produce insulin. Onset is usually in childhood or adolescence. Type 1 diabetes is considered an autoimmune disorder.

Blood Glucose Monitoring

By regularly checking and noting your blood glucose levels, you will know if you are meeting your type 1 diabetes treatment goals—the range your blood glucose levels should be in (as explained to you by your doctor). Blood glucose monitoring helps you and your doctor know if your insulin, diet, and exercise plans are working to adequately control your type 1 diabetes.

Your doctor will give you a blood glucose monitoring schedule, but most people with type 1 diabetes check their blood glucose level at least 4 times a day. You will most likely test before every meal and before bed, but testing your blood glucose 1 to 2 hours after you eat (when your blood glucose level is usually highest) is also a good idea.

You check your blood glucose using a glucose meter, which uses a small drop of blood to gauge how much glucose is in your blood. Continuous glucose meters are also available now, and they eliminate the need to prick yourself multiple times a day to get a sample.

Keep a log of your blood glucose numbers so that you can see how well you’re doing controlling your blood glucose levels.

The log will also enable you to see patterns in what affects your blood glucose levels—for example, you’ll be able to keep track of how various types of exercise affect your glucose levels. You can make activity adjustments based on these patterns.

Type 1 Diabetes Treatments . (n .d .). DiabeticLifestyle. Retrieved January 12, 2014, from http ://www .diabeticlifestyle .com /type -1-diabetes /type -1-diabetes -treatments

Podiatrist

A podiatrist is an important part of a team of physicians who manage complications associated with diabetes. Diabetes can affect circulation, nerve sensation (feet go numb or tingly), skin health, and healing wounds and fighting infections. If you have no other complications with your diabetes, an annual foot exam can help detect problems early. Pressure points that turn into calluses can result in foot ulcerations and infections. In growing or fungal toenails can lead to infections as well. Some patients require foot care every 2-3 months to avoid problems with their feet and closely monitor for problems. A podiatrist can assess shoes and even prescribe shoes and orthoses for your feet that will help prevent these complications and accommodate a deformity like hammertoes and bunions. If you have had a wound on your foot of some kind, this can help keep it from recurring. Podiatrists are also trained in surgical correction of many deformities and acquired foot problems.

Nutritionist

One of the most important things that people who have just been diagnosed with diabetes have to pay attention to is their dietary plan. They have to make sure that they have a proper diet. This will help them maintain good health, and well being!

It is a must for people who have diabetes to acquire the assistance of a nutritionist. This is because every individual that has diabetes requires a dietary plan that is customized to suit their needs. A good nutritionist will be able to assess the type of meal that an individual needs depending on what type of health concerns he/she might have.

Those people who need to shed some pounds will benefit greatly from nutritionists. He/she will be able to help them come up with a dietary plan that will help them lose weight, while maintaining the nutrients that their body needs.

Diabetes - Nutritionist . (n .d .). Diabetes - Nutritionist. Retrieved January 12, 2014, from http ://www .diabeticsdigest .com /Nutritionist .

Ophthalmologist

Often, ophthalmologists can detect systemic diseases such as high blood pressure, stroke, and cancer through examination of the eyes. In fact, it is sometimes the ophthalmologist who first discovers that a person has diabetes through changes in the retina.

Major health organizations agree that people with diabetes should get an eye examination that includes dilation of the pupil every year to detect diabetic retinopathy. Unfortunately, many people do not get a yearly eye exam; one recent study reported that less than half of all people with diagnosed diabetes had undergone an eye examination in the past year. Currently, despite medical advances in the treatment of diabetic retinopathy, between 12,000 and 24,000 new cases of blindness related to diabetes are reported every year. Many of these could be prevented if problems were diagnosed and treated early. Routine eye examinations can also uncover other serious eye diseases, including cataracts (which are also more common in people with diabetes), glaucoma, and macular degeneration.