Five Experts Offer Their Best Advice

Your Tour Guides for the Most Effective Diabetes Self-Care Ever: 

William Tamborlane, M.D.
Trevor Orchard, M.B.B.Ch
Eva Feldman, M.D., Ph.D.
Marian Rewers, M.D., Ph.D.
Francine Kaufman, M.D. 

William Tamborlane, M.D., pioneer in the development of the insulin pump and deputy director, Yale Center for Clinical Investigation; chief, Pediatric Endocrinology, Yale University, New Haven, CT
 

"It’s All About Attitude Adjustments."  

1. Kids and teenagers, listen up: You have to find a way to work with your parents to manage your diabetes. It takes a family, so let your mom and dad look for trends in your glucose levels and help you adjust your insulin doses. Your doses change because you outgrow your old insulin dosage and you have to stay on top of that.
2. If you use a pump—TTFB. Take the Freakin’ Bolus! That’s our motto and we have it emblazoned all over the new pump skin we provide our patients. Nothing is more important for managing your glucose levels with a pump or multiple daily injections.
3. Be a "Diabetes Honor Student" by acing your A1C test:
   less than 7.0%= A+
   7.0 to 7.5% = A
   7.6 to 8.0% = B+ 
4. Stay optimistic. Getting diabetes is like getting dealt a bad hand in poker. You can cry about it or you can accept it and play it the very best you can. You’ll be surprised by how well it can turn out.

Trevor Orchard, M.B.B.Ch., M.Med.Sci., FAHA, professor of epidemiology, pediatrics and medicine at University of Pittsburgh and investigator for the Epidemiology of Diabetes Complications: Phase II and Epidemiology of Diabetes Interventions and Complications 

"Pay Attention to Your ABCs."  

1.  A: We have found that if you can keep good control of your glucose levels—and have A1Cs that are consistently around 7%—it is possible to postpone or avoid diabetes-related health problems. In fact, if you consistently keep your AICs at 7% instead of 11%, you slash your chances of getting complications by an astounding 80%.  
2. B & C: Get your blood pressure and cholesterol levels checked today, and if they are elevated, take steps immediately to bring them down to healthy levels. When it comes to reducing your risk for complications such as kidney and heart disease, it pays to think of more than just glucose control.
3. One extra tip: Ask your doctor if you may be insulin resistant. Though usually seen in type 2 diabetes, some people with type 1, especially those with type 2 in the family or a high waist circumference, maybe insulin resistant. If so, specific therapies such as diet and exercise may make your overall treatment of type 1 more effective.

Eva Feldman, M.D., Ph.D., director, JDRF Center for the Study of Complications in Diabetes, University of Michigan, Ann Arbor

"Join a support group."  

1. Holidays and celebrations are a tough time for people with diabetes. There is a great deal of peer pressure to overeat and over-drink in order to be festive. The best way to regain control of your glucose levels is to join a program where you have positive peer pressure to do what is good for you. We all do better when we are in a group where we get support and encouragement.  

2. Look for a group that helps you with diet and exercise and with emotional support. The components of the program we do here at Michigan—and many other universities offer similar programs at their diabetes centers—has people count calories and carbs, exercise three times a week, and meet with a group of other people striving for the same goals.  

3.  In a group or on your own, aim for 30 minutes of exercise a day walking around your office building or neighborhood. 

Marian Rewers, M.D., Ph.D., MPH, director of clinical division, professor of Pediatrics Preventive Medicine, Clinical Core Director at the Diabetes and Endocrinology Research Center (DERC), Barbara Davis Center for Childhood Diabetes, University of Colorado in Denver.
 

"Create an environment that encourages good habits."  

Parents of children with diabetes can create an environment that makes it easier for children to take good care of their diabetes. Some suggestions:

1. Remember badgering a teenager about diabetes doesn’t work too well. However, providing positive reinforcement and a structure where some things are much easier to do can make a big difference in a child’s life, day to day and in the future. For example, make sure your child goes to bed at a reasonable hour and gets up so that there is time in the morning to test blood sugar levels and eat breakfast, before heading to school. Share family dinners where you can help your child make good food and proper insulin choices.
   
    
2. If your child is not getting regular check ups for his or her diabetes, you need to establish that schedule. If you find it difficult to afford, or don’t know what to do, get help. Contact diabetes organizations such as the local chapter of JDRF, a local college medical center or state health agency to see what services they may provide or refer you to.
   
    
3. If you smoke, your children may also smoke and that would increase their risk of kidney failure five-fold. Also, think about what even secondary smoke does to children with diabetes. They are already at increased risk for heart disease, so quit.

Francine Kaufman, M.D., Chief medical officer and vice president global medical, clinical and health affairs, Medtronic Diabetes; distinguished professor emerita of pediatrics and communications at USC, The Center for Diabetes, Endocrinology & Metabolism, Childrens Hospital, Los Angeles, and author of Diabesity: A Doctor and Her Patients on the Front Lines of the Obesity-Diabetes Epidemic 

"Don’t overwhelm yourself with guilt or "have-tos."
 

1. Think about your diabetes care one hour at a time. If you want to get back on track don’t think that just because you ate waffles for breakfast that you blew the whole day and you might as well continue to blow it. Put boundaries around your "bad" behavior. Compartmentalize it so it doesn’t spill out and lead to more and more problems. That was then. This is now. Get back on track as soon as you can.
    
2. To get back on track it also helps to prioritize, and not try to do everything at once. I think of diabetes self care as four buckets: adherence to your medication routine, glucose monitoring, exercise, and nutrition. If you know you are going to a family dinner where your favorite strudel is being served, maybe you give up on that nutrition bucket for those hours, but you make very sure you test and take your meds.
   
   
3. If you are weary of attending to all the demands of diabetes, sometimes it helps to shake up your routine a bit. Talk with your doctor about making a small alteration in your regular game plan. You may want to start using an insulin pen instead of giving yourself standard injections, or join a support group, or start a new exercise routine. Do whatever it takes to feel that the daily tasks aren’t so all-too-familiar and tedious.