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You're over 50 and taking time to smell the roses when suddenly you get stung. The doctor says you have type II diabetes and must alter your lifestyle. Forget those maple bars at the office every morning. Dust off your running shoes in the back of the closet. That midlife crisis has arrived, and it's nothing you expected.
Sixty-five year old Martin MacArthur of Winterhaven, Florida, went through a long period of denial after he was diagnosed. "For a long time I ate whatever I wanted and didn't exercise. I was angry and blamed myself for contracting the disease. I think a lot of people with diabetes do that."
After a long cycle of guilt and unhealthy eating habits, MacArthur still struggles with changing his lifestyle for the better. Lately, his wife has been working to come up with new healthy recipes, and whenever he's feeling up to it, he takes walks. So far he has reduced his weight from 275 pounds to 265 pounds. "I know what I shouldn't eat. It's just a question of doing it," says MacArthur.
Guy Scharf, of Mountain View, California, experienced similar feelings of denial when his doctor diagnosed diabetes at age 52. Two years later, he is on the right track. "I've started Dr. Sears' Zone Diet and lost 20 pounds, and I've begun walking every other day for 40 minutes."
What Should I Eat?
People with diabetes can still have their cake and eat it too. However, it needs to be an occasional addition to a solid nutritional plan.
"In my house gravy is a beverage," says retiree Walter Gretzler, age 76. Despite the fact that he is a self-proclaimed "meat and potatoes man" Gretzler has managed to lose 30 pounds and cut his Glucotrol XL intake in half.
At the retirement community where Gretzler lives, he eats breakfast at home. Later he goes to the cafeteria once a day for lunch, which he splits into two meals - half for lunch and the other half for dinner. "It's a question of quality, not quantity," says Gretzler about his diet plan.
As Gretzler has learned, one of the most effective weapons against diabetes can be a balanced low-fat diet.
In a recent study published in the March/April issue of The Diabetes Educator, researchers found that 100 percent of the people surveyed believed that it was important to follow a meal plan in order to control their diabetes. However, only 27 percent of these people actually followed their diet plans daily.
Cindy Onufer, RN, CDE, from the Oregon Health Sciences University, suggests meeting with a registered dietitian. A dietitian can individualize meal plans and make the transition to a low-fat diet easier to swallow.
In addition to this, Onufer recommends the ADA's A Month of Meals program which comes in six volumes. A Month of Meals gives recipes incorporating everything from easy-to-cook frozen foods to tips on how to order at restaurants. To order A Month of Meals contact the ADA at (800) 232-6733. The price of one volume is $12.50 plus $3.00 shipping/handling.
Whom Can You Call?
Understanding the meaning of diabetes can be daunting to those who are newly diagnosed. Those who have had the condition for years without realizing it often develop serious complications as well. These are some of the reasons why diabetes education is so vital.
Iva Durham of Proctorville, Ohio, had begun to drop weight and develop symptoms such as excessive thirst and urination over the course of two years. Convinced that she had terminal cancer, she finally got the courage up to see a doctor. By then she had lost feeling in both her calves, was sleeping 20 hours a day and was having difficulty with her eyesight. Her doctor told her she had diabetes, but did little else to prepare her for the disease.
"He handed me a short pamphlet, then wrote me a prescription for insulin," she explains. "He didn't even show me how to inject it or where. He said, 'Don't shake the insulin bottle,' then he sent me on my way."
Frustrated, Durham, with the help of her daughter, found a certified diabetes educator in Marion, Illinois, where she was living at the time. "I called her in a panic. I had no idea what I was doing or where I should inject the insulin. She came to my house on Christmas day and showed me what to do. We've been friends ever since."
A good physician will put his or her patient in touch with a diabetes educator. The educator can then explain the process of diabetes management which includes diet, exercise and glucose monitoring. To find an educator in your area call the Diabetes Educator Hotline at (800) Team Up4 or (800) 832-6874.
Myths and Misconceptions
When it comes to diabetes care, stereotypes flourish. William Polonsky, a psychologist and diabetes educator, has conducted studies on doctors' views of their patients. "We asked primary care doctors why they thought their patients weren't maintaining their diabetes very well. Some said they weren't scared enough, weren't bright enough, or they were set in their ways."
These attitudes, coupled with a patient's lack of education about diabetes, can lead to serious repercussions such as blindness, amputation and even death.
Doctors can be rushed with their diagnosis and uninformed about diabetes, leading the patient to underestimate the severity of his or her condition.
At the time of diagnosis, the only thing that Gary Scharf knew about diabetes was that people with the condition had to take insulin. Plus, his doctor made him feel like having diabetes was no big deal. "He had this laissez faire attitude - I had no idea of the urgency or of the importance in caring for my diabetes," says Scharf.
Fortunately, he soon found a new doctor who took his condition seriously.
Cindy Onufer agrees that diabetes should not be taken lightly. "Sometimes type IIs are told that they have 'a little diabetes,' so they don't take it seriously. But there is no such thing as 'a little diabetes.' You either have it or you don't."
Changing to Insulin
Pills will fail for approximately 30 percent of the people with diabetes taking oral medications. That means at least three out of ten people diagnosed with type II will eventually need to take insulin.
People with type II diabetes on oral medications who have to switch to insulin often blame themselves, thinking they haven't taken good enough care of themselves.
"When people hear it's time to switch to insulin, they think their life is over," says Polonsky. "It suddenly hits them - and they're thinking, 'My God this is real. This is serious.'"
Polonsky has seen many of his patients plummet into deep depression over the idea of changing from oral medications to insulin.
"Many people with type II have grown up with relatives who have had diabetes and had to inject insulin. They've heard stories of the horrible complications that occurred and equate them with insulin, but it's not insulin's fault - it's poor control of diabetes," he says.
In his practice, Polonsky has helped his patients conquer a multitude of fears about injecting insulin, including patients who believed insulin would make them blind. "The most important thing is to get the care you need, and don't be too hard on yourself," he says.
Ways of managing type II diabetes are changing and being treated differently by physicians.
"Many people are started on the wrong kind of pills, and not given the right diet and exercise information to keep them off of insulin," says Alan Marcus, MD.
Currently, a revolution in oral medications is underway.
"The emphasis now is on insulin sensitizers like Glucophage and Rezulin. People with type II are being told to take these instead of sulfonylureas," explains Marcus.
With new therapies, the future looks bright for many people with type II who hope to avoid painful insulin injections.
With age, the chances of developing diabetes grows. Statistics show as many as 20 percent of people over 70 have the condition.
In addition, elderly people may have other chronic conditions such as arthritis or high blood pressure. As a result, their diabetes may take a backseat while they try to cope with other illnesses.
Walter Gretzler is an exception. After undergoing several surgeries for prostate cancer and a hip replacement, Gretzler didn't let his diabetes get swept under the rug. He gives a lot of credit to the staff of nurses working at the Florida retirement community where he lives for helping him control his diabetes. "They gave intensive courses on diabetes management and they made me realize the seriousness of it. Now diabetes has become my number one priority," says Gretzler.
Seniors often live on fixed incomes or have limited access to transportation. Because of this they may not test their blood sugars as often to save on the cost of test strips, or they may be unable to get to the store often enough to stock up on fresh foods such as vegetables and fruit for a healthier diet.
In addition, people living in retirement communities often have little control over their menu, as many eat planned meals in a central cafeteria. As a diabetes educator, Onufer has often dealt with the special concerns facing people living in retirement communities. "If someone feels that their diet needs are not being met, they should talk with the administration. Many changes can be made that are minor and inexpensive, like sugar-free jello instead of regular for dessert."
Many type IIs feel overwhelmed by the regimen they must follow to keep their diabetes under control.
"When I was first diagnosed, I didn't think I could handle it," says Walter Gretzler. "I loved to snack and I never exercised. But now I read nutrition labels avidly and I'm doing aquatic exercises at the local YMCA. I'm keeping my diabetes under pretty tight control."
Sometimes it is also hard to face the truth - diabetes is a very serious and debilitating disease. People with diabetes may have a host of reasons for not taking their diabetes seriously. Maybe they have never been educated about the importance of diabetes management or they have no network of support.
Russell Glasgow, PhD, has done extensive research on type IIs at the Oregon Research Institute. "In our research we've found that a strong family support network makes all the difference in successful diabetes management," he says.
Many people with diabetes just don't know where to begin. Cindy Onufer deals with a good deal of patients in this category.
"My advice is to take things in small steps," she says. "For instance, walking is the best exercise and just about anyone can do it. Walk for 10 minutes a day, four or five times a week, then in a couple of weeks make it 15 minutes long and six days a week," she suggests.
Onufer also suggests volunteering time at a local organization or joining an exercise class. "Being involved in something you enjoy has wonderful side-effects."
Polonsky agrees that it's often easy to be overwhelmed, and difficult to make positive changes in lifestyle.
"I always tell my patients to start with something simple. Any action they take will be helpful, and it will snowball."
0 comments - Jun 1, 1997