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DR. PONDER: Self-management and diabetes - Odessa American: Dr. Ponder On Diabetes

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DR. PONDER: Self-management and diabetes

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Posted: Sunday, September 30, 2012 6:15 am

A skilled craftsman uses knowledge, experience and tools to build, repair, or maintain a device or system. In very much the same way, a skilled diabetic applies identical strategies in the management of his or her condition.

When first confronted with the diagnosis of diabetes, a cloud of emotions are released. Denial, anger, bargaining; each are present to greater or lesser degrees. But once a state of acceptance is reached, only then can progress be made at tackling the real challenges ahead.

Diabetes can seem like a confusing array of “do this” and “don’t do that” directives. But orders like these only begin to make sense when the reasons behind them are made clear and understandable. Unfortunately, not all patients have access to the diabetes education they need, or the time to absorb it properly. And for those who do get diabetes basic training, any subsequent or ongoing education may be sketchy at best.

Name any discipline where only entry level training prepares you for a lifetime. Ongoing education is necessary to best combat a life threatening chronic disease like diabetes. I consider failure to refer a patient for diabetes education as a form of malpractice. There is just far too much to know about diabetes to get it from a brief in-office encounter with a physician. Ongoing self-study is good, but only after quality face time with an experienced diabetes educator or team.

Once an attitude of lifelong learning is embraced, it becomes the diabetic’s job to seek that out, request it as often as possible, and build a repertoire of skills and tools to manage their diabetes.

Going back to my craftsman analogy, I consider tools to be knowledge and experience with diabetes, not only the physical items we use such as insulin, pills, meters, or food.

What is the skilled diabetic “craftsman” aiming to create? In the simplest of terms, we seek to manage the flux of sugar levels in our bloodstream and attempt to mimic the normal level of flux that occurs in non-diabetics. Every human on Earth has flux in blood sugar levels. It’s only a matter of how much.

The level of sugar in our bloodstream is the end result of what sugar is constantly coming in minus what is constantly going out. It is never static. Imagine pouring water into a cup with a small hole halfway up the side. If the amount of water poured in is balanced correctly, the same amount will flow out the hole and the water level with remain steady. But if too much water is poured into the cup than can leave it, then the cup will overflow.

The knowledge about diabetes we obtain should explain how our actions as well as our omissions will combine with treatments we use to manage the flux in blood sugar levels.

There are forces we learn that act to lower blood sugar levels. Examples include exercise, insulin, and some diabetes pills. Likewise, we learn of things that act to increase blood sugar levels, such as food, stress, and some medications. Excess sugar can also be made inside the body by the liver. The liver also can absorb and store sugar, hence lowering it.

But our blood sugar levels at any given instance are the end result of all these forces combined. And to make things even more interesting, the timing and consistency of our self-care behaviors influences the end results too.

The skilled diabetic learns which of these forces can be manipulated and controlled, and which ones are out of their control and have to simply be reacted to. The skilled craftsman can still makes mistakes, but has the experience and abilities to repair the damage and set things right.

Therefore, quality diabetes self-management is a blend of proactive and reactive strategies with a common end-point: managing the ever present flux in human blood sugar levels.

Dr. Stephen Ponder has had type 1 diabetes for 45 years. He has been a pediatric endocrinologist for 24 years. He can be contacted at swponder@gmail.com , or follow him on twitter at twitter.com/dr_steve_ponder

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