Self Management of Diabetes: Who is Better Than You?

Diabetes needs to be cared for 24 hours a day, and we are the only ones who can control it every minute with our habits and behaviors. Learning to take care of ourselves is essential to control diabetes, avoid complications and thus achieve a good quality of life.

Until relatively recently, the only responsibility for our health rested with health professionals, especially family doctors in the case of chronic diseases such as diabetes. But fortunately this situation has changed and patients are increasingly involved in making decisions about treatment and care.

In fact, it is estimated that 90% of daily decisions regarding diabetes control are made by the patient himself, which shows how important it is for the person with diabetes to learn to take care of themselves and manage the problems derived from the disease.

Diabetes is a complex pathology, since there are many factors that affect it, but that is precisely why the greatest possible involvement is essential, thus being the protagonists of our care. It is more than proven that, the greater the involvement and knowledge of the disease, the greater and better the results of our health and our quality of life will be.

What is Self Management of Diabetes?

Self-control implies that we know how to use the results obtained in self-analysis to make decisions, know how to apply therapeutic modifications and changes in our lifestyle to achieve regulation of blood glucose levels.

Therefore, performing self-tests at home and modifying insulin doses when blood glucose levels are above or below our personal goals is part of self-control; and self-control should also be considered when introducing changes in diet or physical activity in response to laboratory results or the repeated presence of hypoglycemic symptoms.

Other forms of self-control are the modification of certain habits related to free time, especially if you notice that you have gained weight, for example by leading a sedentary life or by the extra calories that you have ingested outside the home by taking tapas at the beach bar during summer. And in a broader sense, self-control is also quitting tobacco use or taking care of your feet.

What are the necessary requirements to carry out self-monitoring?

In order to adequately assume self-control of your diabetes, you must have a series of basic resources:

If you need insulin, you have to know how to measure your capillary blood glucose level on a daily basis. Cleaning the skin, finger pricking technique, handling the strip or reading the results are very important aspects, which are not always given due attention and which, if performed incorrectly, can compromise the validity of the results and cause wrong decisions in insulin dosing.
You must be competent to modify insulin doses in response to self-test results, and to make changes to your diet or physical activity, if necessary.
It is also essential to have available health resources, including access to a therapeutic education program and the continuous support of a team of professionals who supervise the follow-up of the therapeutic plan.
You must know how to deal with special situations such as banquet invitations, field trips, teenage outings, etc.
But in addition, it is necessary that you know how to properly identify, interpret and manage the symptoms of hyperglycemia and hypoglycemia.

Is it really that complicated?

Long-term adherence to a therapeutic regimen that requires so many adjustments to our habits and behaviors will depend, many times, on your being able to perceive the benefits of self-care yourself. We must bear in mind that with a little awareness and discipline the chances of having many diseases and controlling those already diagnosed would be reduced. The normalization of glucose levels, the absence of negative symptoms, as well as the information and support of the medical team can serve to increase our perception of the effectiveness of treatment and self-control and maintain a positive attitude towards them.

The keys to self-care

Everyone has to take care of themselves, even more so when we live with a pathology that, as is the case with diabetes, requires more self-care on the part of the patient himself. Today we have information and good guidelines provided by health professionals, patient associations, as well as magazines and publications on paper or digital and mobile applications that teach us and make our lives easier. We have the necessary knowledge and resources at our disposal, we just have to organize ourselves so that diabetes adapts to our habits.

There are a series of parameters that will help you keep the global state of your diabetes under control:

Healthy nutrition. Controlling what we eat and keeping it healthy is essential for everyone and even more so for people with diabetes. With a good diet we also promote adequate levels of cholesterol, triglycerides, blood pressure and body weight.
Regular blood glucose checks. It is very important to monitor blood glucose frequently, since it allows modifying and adjusting the treatment based on the values obtained, especially in people on insulin treatment. According to the International Diabetes Federation, keeping glycosylated hemoglobin (HbA1C) levels below 6.5% is very beneficial in reducing the long-term complications that diabetes can cause.
Control your body weight, even reduce it if you are overweight, since the accumulation of body fat can cause serious problems in the control of diabetes. This is achieved with a personalized physical activity plan and good eating habits.
Control of blood pressure, since a good control of this value helps to reduce cardiovascular risk. If you need it, your doctor will prescribe a medication to control and maintain your blood pressure at recommended levels, usually below 140/90.
Cholesterol control. In people with diabetes, it is very likely that the levels of lipids in the blood (cholesterol and triglycerides) are altered. Maintaining adequate levels helps prevent possible coronary heart disease. For most people with diabetes, the appropriate levels are:

LDL cholesterol: <100 mg / dl
HDL cholesterol:> 40 mg / dl in men and> 50 mg / dl in women
Triglycerides: <150 mg / dl

Control of microalbuminuria. Microalbuminuria is a marker of early kidney disease and indicates an increased risk of cardiovascular disease and complications. It has been shown that preventive treatment can decisively modify the course of the disease in the patient with diabetes.
Normal values are considered below 30 mg / 24 hours. If it is between 30 and 300 mg / 24 hours, it is recommended to carry out periodic controls to assess the evolution and progression of kidney disease.
Control of ketone bodies. Whenever the level of sugar in the blood exceeds the level of 250 mg / dl, it is important, especially in type 1 diabetes, to perform an analysis of the ketone bodies that appear in the blood or in the urine. Diabetic ketoacidosis, which is more common in type 1 diabetes, can occur when you have not had good control of your diabetes, have forgotten insulin shots, or when you are sick. An infection, especially respiratory or urinary, can cause the appearance of this acute metabolic complication. In many cases, ketoacidosis symptoms are even a first sign to detect the existence of diabetes mellitus.
Check your eyes. The evaluation by the ophthalmologist or optician-optometrist should be every two years if there are no injuries and every year in type 1 diabetes from 5 years after diagnosis. In type 2 diabetes, this assessment will be carried out initially and periodically thereafter, depending on the risk. A complete study should be performed: visual acuity, tonometry (eye strain) and fundus (assessment of retinopathy).
Check your feet every day. Nerve and foot damage can be silent. In the control of the feet, not only vascular alterations are detected but also nerve affectations that produce the so-called diabetic foot (lack of sensitivity that can give rise to lesions that, due to having diabetes, are slow to heal). The foot check should be done by a professional once a year. However, the inspection and care of the feet should be a daily habit that we do at home after showering.

The increasingly influential expert patient

For some years now, the figure of the "expert patient" has been occupying an increasingly relevant place and many initiatives are taking hold in our country, most of them stem from the patient associations themselves.

It is more than proven that when an "expert patient" is the one who addresses other patients, informs them and transmits their experience in the first person, the results are much more effective. Empathy, closeness and being on the same level create a climate conducive to understanding “from you to you”.

More independent children

If self-care is difficult in adults, what about the little ones? Children with diabetes are usually very responsible from a young age with everything related to food and they quickly learn that before taking something they feel like they should ask their parents.

However, the care of the disease is complex, so much so that even parents find it difficult to reach stable levels in their blood glucose.

That said, when can children take on certain responsibilities in treatment? It is clear that this depends on each child. From the age of 3 or 4, children, although they already know how to read the numbers on the glucometers, will not know how to interpret them, so it will be necessary to tell them if the glucose is high or low, but in a short time this will also be controlled.

Managing insulin is already a big word and, in most cases, it assumes a lot of respect for parents in fear of the consequences for misuse. More complicated still is the ability to calculate how much insulin to administer, regulate the pen, or manipulate the continuous infusion pump. So it is advisable to wait until 7 or 8 years for children to start preparing insulin units and, if they have enough courage, even give the injection themselves, but always under the supervision of an adult.

Finding the balance between protecting our child and teaching him to grow up by holding him responsible for his illness and treatment is difficult, but it brings great benefits, since the child will be able to enjoy a life more equal to that of his friends and we will make him more independent.

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