Type 2 diabetes is the inability to effectively use glucose and to move that glucose into the cells to be burned as energy. In type 2 diabetes the cells become insulin resistant. Insulin is the vehicle that moves glucose through the blood and into the cells. If the cells don’t recognize insulin, the glucose can’t get into the cells to be used and more and more glucose circulates in the blood. The variability and the progressive nature of type 2 diabetes are remarkably different from person to person. For this reason, the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) are both advocating an individualized patient-centered approach to diabetes care.
Patient-centered care is responsive to what the patient wants, their values, and to some degree what medications they are willing to use. This approach may seem like you are providing less than effective treatment, but the best instructions that are not followed are useless. Treatment options that the patient agrees to and is willing to adhere to, even when not optimum, will result in more compliance and more effective care.
Not everyone with type 2 diabetes benefits from aggressive blood glucose management. The ADA recommends an A1C of lower than 7 for most patients. A1C is a blood test that measures a compound in the blood called glycosylated hemoglobin. The amount of this compound reveals the average blood sugar levels over the last 6 to 12 weeks. The higher the number the higher the average blood sugar. In patient-centered care the A1C target would be individualized based on each person’s circumstances.
For younger patients (less than 65 years old), or for those who are newly diagnosed, have a long life expectancy, and no heart disease, an A1C target of 6 to 6.5 would be beneficial and should be encouraged. For some patients, less stringent A1C targets may be more appropriate. Goals of 7.5 to 8 may be more realistic for an older patient (more than 65 years old) who has more complications and additional health factors. Glucose control is totally in the hands of the patient. Setting goals that cannot be met or that create additional health concerns will never be achieved.
Stringent control of blood sugar can cause more episodes of hypoglycemia -- low blood sugar. Though the overall goal of treatment is to keep blood sugar down, if it goes too low this is problem as well. For a long time hypoglycemia in type 2 diabetes was not given much attention because it is not a common problem. As blood sugar targets are lowered it can become a problem, especially for older individuals. Hypoglycemia can lead to heart rhythm problems, dizziness which may increase the risk of falling, confusion, and infection. These problems can erode the patient’s confidence to care for themselves and remain independent.
For some patients, lifestyle changes may be more effective in managing type 2 diabetes than an intense focus on blood sugar levels. Reducing blood pressure, modest weight loss (5% of bodyweight), more exercise, a healthier diet, and smoking cessation may do more to slow down the progression of type 2 diabetes.
Patient-centered care is time consuming and often does not fit the model of our current health care system. The health professional needs to get to know the patient and understand their needs, culture, values and ability to cooperate. The health care provider needs to be nonjudgmental while at the same time remaining gently persistent to achieve change. The need to continually revisit and encourage lifestyle changes and medication needs, all the while appreciating that not every patient will achieve these goals, is the most effective approach.
The more a person learns about type 2 diabetes, the better they can care for themselves and ultimately the healthier they will be. Diet, exercise, blood sugar levels, and medication all play a part in the management of type 2 diabetes, but the most important member of the health care team is always the patient. The rest of the team actually depends on them because the patient sets the pace for what they can and are willing to do. It truly is all about YOU.
© NRH Nutrition Consultants, Inc.
Jo-Ann Heslin, MA, RD, CDN is a registered dietitian and the author of the nutrition counter series for Pocket Books with sales of more than 8.5 million books.
The Complete Food Counter, 4th ed., 2012
The Diabetes Counter, 4th Ed., 2011
The Protein Counter, 3rd Ed., 2011
The Calorie Counter, 5th Ed., 2010
The Ultimate Carbohydrate Counter, 3rd Ed., 2010
The Fat Counter, 7th ed., 2009
The Healthy Wholefoods Counter, 2008
The Cholesterol Counter, 7th Ed., 2008
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For more information on Jo-Ann and her books, go to: TheNutritionExperts
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