Unit III: Overview of the Cornerstones of Control of Diabetes

Introduction

The professional health care provider must recognize that successful treatment of diabetes depends upon knowledgeable, accurate self-care by the individual with diabetes. All the good intentions and the wealth of knowledge provided by the health care provider are for naught if the individual cannot or will not learn. "Nurses who encourage patients…to play an integral role in planning care 'empower' them by incorporating them into the health care team" (Callaghan & Williams, 1994, p. 138). While the previous quote is taken from a publication that is over twenty years old, it remains true now and, no doubt always will.

Check out this link for opportunities to receive regular e-newsletters about diabetes and diabetes-related topics from the American Diabetes Association: http://main.diabetes.org/site/PageServer?pagename=EM_signup&WTLPromo=PK_enews.


Four Cornerstones of Control of Diabetes

Treatment of diabetes requires the careful balancing of PROPER NUTRITION, EXERCISE, MEDICATION and SELF-MONITORING OF BLOOD GLUCOSE (SMBG) -- the four cornerstones of diabetes control. In the cases of proper nutrition, exercise, and medication, both hyperglycemia and hypoglycemia can occur with relative ease when any one of these is disrupted. Problems ensue, also, if the person experiences severe stress (physical or emotional) which produces an outpouring of epinephrine and glucocorticoids. These are hormones produced in the body that fuel the fight or flight response to a stressor. Glucocorticoids specifically increase the blood glucose. (Review the stress response or the General Adaptation Syndrome in any physiology text to learn more about this, if necessary.)

The ingestion of carbohydrates – sugars and starches – leads to an increase in the blood glucose in the body. (Take a look at the amount of carbohydrate (reported in grams) listed on the Nutrition Facts label included on the packaging of foods). Insulin causes a decrease in blood glucose. Exercise leads to a decrease in blood glucose as the body's cells use it for energy.

To review, for most people, the increase in blood glucose that occurs during and after a meal stimulates the release of precisely the right amount of insulin to make use of the glucose in the blood, and to bring it, eventually, back to normal. In people with diabetes, this does not happen quite as smoothly as that. As a matter of fact, in people with DMT1, there is no production of insulin at all and the blood glucose rises to extremely high levels and eventually metabolic acidosis ensues. Death will result if insulin is not administered. In those with DMT2, while insulin is produced, the body's cells are in varying degrees resistant to it. Consequently, more and more insulin must be produced to metabolize glucose until the body can no longer meet the demand. Blood glucose rises uncontrollably. As noted in previous content of this self-study, the individual with DMT2 typically does not develop metabolic acidosis, but the signs and symptoms associated with hyperglycemia will undoubtedly appear and the individual will feel ill. Exercise leads to a decrease in blood glucose.

Download the Blood Glucose Changes Learner Activity to complete offline.

Four Cornerstones of Diabetes Control

People with diabetes must understand that taking and recording blood glucose values at regular intervals (to include fasting, before meals, two-hours after meals, at bed time and, if necessary, one or two times in the night on occasion to determine changes through the night) are necessary activities to obtain the information needed to determine effectiveness of the treatment regimen. Sharing the documentation of the values (and times obtained) is an important component of every visit with the health care provider, so it is absolutely critical that the individual writes the information on paper and shares it with the health care provider at the time of the visit.

The reason this information is necessary is that decisions relative to the degree of blood glucose control must be made based on patterns of blood glucose changes, not on one or two isolated events. One can make sound decisions about whether the regimen a patient is following is effective in maintaining blood glucose control only on the basis of patterns of blood glucose changes.

Even as the importance of the results of SMBG is emphasized, one must recognize that blood glucose testing requires equipment and materials – a meter, lancets, alcohol swabs, and blood glucose strips – that could represent a financial hardship for some individuals. Failure to comply with SMBG activities may reflect financial constraints more than unwillingness to cooperate. It is important to determine if this is the case in those patients who regularly do not bring results with them to their regular visits. It may be possible for the manufacturing company to provide some remedies for this situation.



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