How to Adjust to Life With Diabetes

Managing diabetes can be frustrating, challenging, and -- yes -- rewarding. Diabetes impacts every aspect of life -- from food preparation and eating to family planning and intimacy, from friendships to interactions in the workplace.

Fitting diabetes into a life full of other responsibilities requires the ability to adapt. It takes a lot of energy to balance your control of blood glucose levels with other physical, emotional, and social priorities. Indeed, the word "control" smacks of full-time effort. But you can adjust to diabetes without completely disrupting your life. In this article, we will show you exactly how to adjust to life with diabetes. Here are the topics we will cover:

  • How to Commit to a Diabetes LifestyleA diagnosis of diabetes will naturally require many changes in your lifestyle. Changes in diet and your monthly financial budget are two examples. The first hurdle for many new diabetes patients is an acceptance of this new reality. From there, they can develop the resolve to dedicate themselves to the new tasks that must be accomplished. On this page, we will show you how to recommit your life to a diabetes lifestyle.
  • How to Take Control of Your DiabetesA patient with diabetes may grow despondent or at least frustrated that this new complication has been introduced. Some patients may just passively move through the treatments that their doctor prescribes for them, but this approach will most likely not result into a fully integrated life plan. Once diabetes has been diagnosed, it is important for the patient to take an active role in his or her treatment. On this page, we will show you how to become informed about your treatment options and how to select the ones that will be best for you.
  • How to Involve Your Friends and Family in Your Diabetes CareDiabetes care begins with you and your doctor, but proper management of the disease involves everyone who is close to you. In this section, we will teach how to involve your friends and your family in your diabetes care. Because diabetes will require so many changes to your diet -- and, in turn, the food you have in your house -- your family will naturally have to play a big part in a diabetes plan. As a means of support, friends and family can be invaluable.
  • How to Chart Your Diabetes TreatmentA treatment plan for diabetes can seem fairly abstract on a day-to-day level. You may make the right diet and exercise choices, as well as check your glucose levels, but how do you know that any of your efforts are really having a positive effect? Diabetes is a strange condition because it might not affect your health in the short term, but it may have devastating long-term consequences. On this page, we will help you learn how to track your diabetes progress daily so that you can see the actual positive effects of your painstaking efforts.
  • Insurance for DiabeticsThe medical costs of diabetes can be staggering. With glucose-testing equipment, syringes, and insulin, the bills can really pile up -- and that doesn't even take into consideration the many doctor visits that are necessary. Of course, all medical treatment is expensive in this day and age, and that's why many people need health insurance to help cover the costs. In this section, we will investigate exactly how much you can expect your health insurance to cover in your diabetes care.
  • Diabetes Support GroupsDiabetes support groups can enhance the efforts of your friends and family in the management of your diabetes care. If nothing else, a diabetes support group can be a place for you to meet people who are struggling with the same burden; it can give you the opportunity to talk openly about your challenges among people who truly understand. In this section, we'll cover all the benefits of diabetes support groups.
  • Travel Tips for DiabeticsThough diabetes will certainly complicate your life, it shouldn't rob you of your everyday pleasures. Traveling, for instance, will take extra preparation, but it is far from impossible. On this page, we will provide valuabe travel tips. We also will tell you what types of precautions you should take when traveling internationally.
  • How to Maintain a Positive Outlook With DiabetesThe ultimate goal of just about any medical treatment plan should be a better quality of life for the patient. That's why, regardless of how you choose to deal with diabetes, it is important that you feel positive about the treatment decisions you have made. In this section, we will offer some simple tips for maintaining a bright outlook while dealing with the day-to-day frustrations of diabetes.

This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

How to Commit to a Diabetes Lifestyle

©2006 Publications International, Ltd. It is important to keep healthy snacks on hand  to avoid resorting to harmful foods.

Most of the time, we have a pretty good idea what we should do to maintain our health and well-being. The hard part is actually doing it. We're familiar with the drill: Brush and floss our teeth, exercise regularly, reduce fat and cholesterol, reduce stress, limit alcohol intake, see the doctor for checkups. But how many of us consistently perform these healthy habits? The answer is, very few! So it's no surprise that it is equally -- if not more -- difficult to manage diabetes consistently.

Fit Diabetes Into Your LifeLet's be honest. It's not easy to fit diabetes into your life without making it the center of your existence. The people who accomplish this seem to perform their diabetes tasks quietly, not making a big deal about them. They test their blood glucose routinely, adjusting their meals, activity, or diabetes medication according to their schedule. They have learned to work diabetes into their lifestyle. To them, diabetes care comes as naturally as brushing their teeth each morning. If you're having trouble getting on track with diabetes management, try these tips:

  • Stock the proper tools. Keep plenty of diabetes supplies, such as lancets, testing strips, diabetes medication, syringes, and glucose tablets or juice, on hand. Make sure you have replacement batteries for your glucose meter and an extra pen for recording your blood glucose results. A travel or cosmetics case can keep supplies together, organized, and portable. Consider having two meters, one at home and one at work for easy access.
  • Purchase appropriate foods to make diabetes care easy for you. If you must buy desserts and other temptations for your family, store them out of sight. Temptation that stares you in the face is hard to resist.
  • If you find yourself in a slump with your care, enlist the support of family and friends to remind you to keep up with your testing and medication. Bear in mind your testing does not become their responsibility; it is yours.
  • Devise ways to remind yourself. Leave your meter in an obvious location so you remember to test. Leave yourself notes in conspicuous places. Synchronize the testing and/or medication to coincide with other activities in your daily routine; for example, when the coffee is brewing in the morning, test your blood glucose.
  • Establish a routine. It sounds so obvious, but if you establish a routine for your care, diabetes management becomes an automatic response, even when you feel stressed or pressured by other events in your life.
  • Don't let diabetes care keep you from doing something you really want to do. With frequent testing and a good understanding of your diabetes care, you can participate in most activities you enjoy. 

People who are successful at diabetes control have learned to be good problem solvers. This is a skill that takes practice. It's important that you work at developing your problem-solving skills. Start by defining the problem and identifying the barriers to solving it. Be as specific as you can. Perhaps you fall off your program in the hectic hours of dinner time. You and your spouse have just arrived home from work; you've picked the kids up from various points: child care, soccer practice, the library. Everyone's hungry and a little tired; you had a bad day at work, and you're tired and cranky yourself. You want to hear about everyone's day, but they're all talking at once. You need to eat but dinner won't be ready for a while yet, so you grab the first item you see in the refrigerator. Then you realize you forgot to take your diabetes medication or check your blood glucose level. In this scenario, the problem is staying in good control around dinner time. The barriers to overcoming the problem are everyone's different, hectic schedules. Once you identify the problems and barriers, you find resources to deal with them. Keep healthy snack foods on hand -- cut-up carrots and celery, apples, granola bars -- to tide everyone over until dinner is on the table. Arrange for younger children to get a snack before you pick them up from child care. Older kids can pack a snack to take with them to school, and you can pack a snack to eat before you leave work. You and your spouse might prepare and freeze some meals ahead of time for quick preparation. Perhaps you need to work on some stress busters so you don't come home from work so wound up. Take a walk with your kids before or after dinner to hear about their day.

Do you see how this works? When you confront problems, you realize you have options to solve them. You will feel less manipulated and more in control of yourself and your future. If you find the solutions to your problems are not as simple as those outlined here, you may need to get help from books, classes, a counselor, or a diabetes educator. Do whatever it takes!

Do What It Takes

It's easy to be complacent with diabetes care, pushing it on the back burner as other concerns -- house, kids, family, school, friends, work, and so on -- take priority. But diabetes care needs to be important enough in your life so you continue to do the very best you can to care for yourself. Why settle for less?

What's more, your diabetes program should be dynamic, changing with your individual needs and the progress new technology and new research bring. Consequently, you probably will not follow the same management program for the rest of your life. Gone are the days when a person took one unchanging dose of insulin for 30 years. And unless you are in perfect control right now (not many people fall into that category), most assuredly you can take steps to improve your level of control.

If what you are doing currently does not give you optimal diabetes control, with your doctor's direction, move to the next level of control:

  • If you are on a diet and exercise program, consider taking an oral agent.
  • If you take an oral agent, your doctor may want to change your dose or try another agent.
  • If you have reached the maximum dose with oral agents and blood glucose levels remain higher than your target range, you may need to take insulin.
  • If your blood glucose control is not adequate, do whatever it takes to improve it -- such as taking multiple daily injections or using an insulin pump.

The biggest part of adjusting to life with diabetes is learning not to be a passive participant in your medical treatment. In the next section, you will learn how to take control of your care.This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

How to Take Control of Your Diabetes

©2006 Publications International, Ltd.Obviously, the first step when planning your diabetes care is finding a health care provider that you are comfortable with.

When receiving treatment for diabetes there will be many decisions to make about your care. While you could leave these choices up to your doctor, the only way to be sure that your treatment plan fits with your lifestyle is to become an active participant.

Assemble a Winning Team

One of the most important elements of a successful diabetes care program is a health care provider. Whether you work with one professional or a team of professionals, you should feel your health care provider is willing to listen to your concerns and take the time to make sure you understand how best to manage diabetes. Your doctor may be an endocrinologist, a doctor who specializes in dealing with hormonal problems. (Insulin is a hormone.) A child or adolescent with diabetes may be cared for by a pediatric endocrinologist who has special knowledge about diabetes in children. If an endocrinologist is not available in your area, choose a doctor who has experience in diabetes care. Ultimately, a physician's most important qualification is that you feel comfortable with him or her. Ideally, a multidisciplinary team is available to you. The team may include a doctor, nurse educator, registered dietitian, social worker, psychologist or psychiatrist, and exercise physiologist. But all of these specialists may not be available in the area in which you live or the health care setting you use. You and your doctor may need to put together your own team:

  • Ask your doctor to refer you to a diabetes educator or dietitian. The American Association of Diabetes Educators can also provide you with names; phone them at 1-800-338-3633, or visit their Web site at www.aadenet.org and click on "Find an Educator."
  • Look for professionals with the credential C.D.E, which stands for Certified Diabetes Educator. This abbreviation assures you this licensed provider has met certain education requirements and has passed an examination that verifies knowledge and expertise in diabetes.

Finding a health care professional who is sensitive to your needs and able to provide the support you need is critical to your diabetes care. Communication is vital: Are you comfortable talking with this person? Is he or she readily available and willing to take time to answer questions or help with medication adjustments? You may need to talk with a few health care professionals before you find one who is right for you.

Take the HelmThe formation of diabetes care teams marks a shift in diabetes care. Traditionally, a doctor would tell you what to do, and you were expected to go home and do it. But with health care systems changing, people must learn to be advocates for themselves. The doctor is no longer the center of the team. You're in the driver's seat; it is up to you to steer the direction of your care. If you're unsure how to be an advocate for yourself, here are a few suggestions:

  • Don't settle for someone who will not work with you to keep diabetes under optimal control. If a health care provider is too busy to spend time with you or seems unaware of how best to help you, find someone else. Even if you've been seeing one physician for a long time, do not feel compelled to stick with him or her. Place your needs first. A physician who is unable to help you because of patient load or lack of experience with diabetes is not the best physician for you, no matter how long you've known him or her.
  • Ask your physician to refer you to a diabetes educator, registered dietitian, and/or psychologist if you have difficulty in areas where these professionals can help. And don't feel put out or dismissed if your physician refers you to one of these professionals without your asking. A physician who recognizes that others can help where he or she cannot is putting your needs first.
  • Tell your health care provider what part of your management program you can do easily and where you have difficulty. Together you can come up with ideas to smooth the rocky areas and reinforce the already-strong areas.
  • Stay abreast of new research and developments in diabetes care. Ask your health care provider if new products might benefit you.
  • Demand frequent communication with your health care provider so he or she can carefully monitor your blood glucose levels.

Be a SpongeSoak up as much diabetes information as you can hold! The more you know about diabetes, the better prepared you will be to handle problems if they crop up. Some people attempt to cope by denying their diabetes and its harmful effects. But this head-in-the-sand approach leaves them unable to deal with the trials and frustrations of diabetes management. In most cases, you are the only one who can make decisions about your care on a daily basis. Your doctor, diabetes educator, or registered dietitian cannot be with you 24 hours a day. The more you know, the better the decisions you will make.

  • Read as much as you can about diabetes. Ask your educator for materials and sources. Many publications about diabetes are available at your local library. You can also subscribe to newsletters published by manufacturers of glucose meters.
  • Join the American Diabetes Association (ADA) and/or the Juvenile Diabetes Research Foundation International (JDRFI). For information about joining the ADA, call 1-800-DIABETES, or visit the Web site at www.diabetes.org. For information about joining the JDRFI, call 1-800-533-CURE, or visit the Web site at www.jdrf.org.
  • Stay abreast of new research technologies through publications and your diabetes educator.
  • Understand the importance of controlling diabetes. If you are unclear about any aspect, talk to your health care professional.
  • Attend classes or seminars on diabetes given by a local hospital or the ADA or JDRFI.
  • Talk to others about how they care for their diabetes. Find out what works for them. You can do this by joining a support group run by the ADA, JDRFI, or a local hospital.
  • Ask questions of knowledgeable people: doctors, nurses, pharmacists, registered dietitians, and so on.

Be PreparedDiabetes care is one area of your life where you really don't want surprises. So use a bit of forethought to help you stay in control.

©2006 Publications International, Ltd.Make sure you have the equipment you need at all times so you're not caught short-handed after the pharmacies close.
  • Inventory necessary supplies regularly, perhaps on the first of each month. Don't let supplies get too low. You don't want to run out when pharmacies are closed or find that your pharmacy must special order your prescription.
  • If you take insulin, keep at least one extra bottle of each kind of insulin on hand. If you break a bottle or something else happens to it, your backup will save you an urgent trip to the pharmacy.
  • Check your meter case regularly to make sure you have enough strips and lancets. Make sure the meter's code matches the code on the bottle of strips. Keep an extra supply of batteries on hand if your meter is battery-operated. Don't forget to check your second meter, too, if you have one that you keep at work or carry with you!
  • When you travel, pack twice as many supplies as you think you will use.
  • If you are hiking, boating, or are otherwise away from people and food, pack far more food and glucose tablets than you think you will need, especially if you take insulin. Also pack your Glucagon kit and show someone how to use it.
  • Always have some readily available form of sugar with you. Keep extra crackers and juice boxes in the car to treat hypoglycemia, in addition to water or a sugar-free beverage.
  • Always wear a medical ID.
  • If you use an insulin pump, always be prepared to give yourself an injection of long-acting insulin in case of a problem with the pump.

While taking charge of diabetes care is vitally important, you must also realize that you cannot handle this enormous responsibility all on your own. In the next section, you will learn how to get your friends and family involved in your diabetes care. This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

How to Involve Your Friends and Family in Your Diabetes Care

©2006 Publications International, Ltd.Because diabetes will affect so many areas of your life, it is important to have your family supporting you.

To really ensure a successful diabetes treatment plan, it's important to have the support of the people in your life. While your diabetes care will ultimately start and depend on you, we all need a helping hand. As a patient, you cannot rely on your doctor for everything. Eventually, you will need the people who love you to carry some of the burden.

Make It a a Family Affair

Diabetes is called a family disease because it affects every family member. Food selection and preparation as well as the timing of meals are important aspects of family life. The need for medication and avoidance of hypoglycemia (low blood glucose) can take away some spontaneity from meals. Dining out presents a whole new challenge. Your diabetes management affects your family in other ways, too. They undoubtedly have feelings about your health, ranging from concern and sympathy to guilt and resentment. They may also worry about their own susceptibility to diabetes. Perhaps your treatment affects your family financially. Perhaps you require your family's help to pick up (or even administer) your medication or drive you to appointments with your doctor or diabetes educator. Recognize that the more your family members know about diabetes control, the more you all benefit. To get your family involved:

  • Ask family members to attend diabetes education classes with you. Their direct participation involves them more effectively than your simply explaining what was taught, and they have the opportunity to ask questions of the instructor. Discuss what each of you learned, and ask your educator to clarify any discrepancies.
  • Provide your family with reading materials. Encourage them to join the American Diabetes Association.
  • Practice skills at home with your family: Perform finger sticks for blood glucose, inject saline into an orange or doll, and review the treatment for hypoglycemia so family members can understand what you go through and also carry out these acts in case of emergency.
  • Make sure family members know your meal and medication schedule. Tell them how you plan to handle any schedule changes so they're prepared in the event of complications.
  • Encourage any family member who is having trouble coping with your having diabetes to seek counseling to discuss his or her feelings and/or anxieties.

Teach Your FriendsSome people are reluctant to tell others about their diabetes care needs. But friends who care can help you stay on top of your program. Friends will take their attitude about diabetes from you. If you see it as a stigma, they may be reluctant to help you. On the other hand, if they see you taking charge of your condition and talking about it openly and honestly, they will feel more confident about helping you remain in control.

Friends won't know how they can support you unless you tell them. Here are ways to help your friends understand the role of diabetes in your life:

  • Let others know how they can help you: "It really helps me when I see you order healthy foods off the menu first..." Let them know how you feel about them eating sweet foods and desserts in front of you. Some people find it difficult to not eat what everyone else has; others don't mind at all when their friends have sweet foods. Clear the air with your friends, and cast off everyone's uncertainty about what to do.
  • Encourage your friends to jump on the bandwagon. Everyone can -- and should -- eat a low-fat, well-balanced diet. Explain that just because you have diabetes, you needn't eat foods that are "different" from what everyone else is eating. The healthful behaviors you adopt to control diabetes and your weight are elements of a healthy lifestyle everyone can participate in.
  • Prompt a friend to join you in an exercise or weight control program.
  • Describe the signs and symptoms of hypoglycemia (low blood glucose) and how to treat it. Show friends where you keep treatment supplies, such as glucose tablets, juice, candy, or a Glucagon emergency kit, and explain how much of each you should receive in the event you do not recognize the signs yourself.
  • Show friends where you carry your emergency phone numbers. Keep a list posted near your phone so visitors can find the numbers easily.
  • Engage your friends in diabetes-related activities through the ADA or JDRFI. Ask your friends to participate in a fund-raiser walk with you.

Once you have your diabetes support group in place, there are other steps you can take to make sure your plan for care succeeds. On the next page, we will learn how to track the progress you've made. This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

How to Chart Your Diabetes Treatment

©2006 Publications International, Ltd.Documenting your successes will help you stay positive about your diabetes plan.

Treating your diabetes can be a slow, long-term process. It might be hard to see the positive effects of limiting your diet while everyone else around you is indulging in sweets. The best way to feel that you are making positive progress on a day-to-day basis is to track your progress. Once you see the results in front of you, you'll know your treatment plan is working.

Look for Patterns Learning to identify diabetes patterns is a valuable tool. It takes practice and it takes diligence, but the results are well worth it. Your doctor and diabetes educator will want to see your daily medication, blood glucose, and food records, and they'll help you learn to evaluate them yourself. If you control diabetes by means of diet and exercise, watching for patterns is less critical but still useful. It allows you to see how your blood glucose responds to certain foods and different types of exercise.To detect patterns of control, you must first have a good understanding of your medication. If you require an oral agent or insulin, know the name of the medication, when it begins to work, when it works the hardest (when the action peaks), and how long it works. Record periods of activity, exercise, or stress as well as foods and eating patterns. If you had extra food one day or a special treat, write it down. Likewise, it's important to know if you missed a meal, ate lightly, or were sick. Here are some other ideas to help you study your patterns.

  • Recognize that two heads are better than one. Study your records with a family member or friend. He or she can help you remember that a particular entry coincides with the night you went to the mall or went bike riding.
  • Use color to help you keep track. Purchase two different-colored highlighter markers. Highlight low numbers (less than your target range) in, say, yellow and high numbers (greater than your target range) in pink. After a couple of weeks, study the pattern. When are the highs and lows occurring? Why do you think they occur when they do? If your page looks very "pink" at supper, can you determine why you consistently run over your target range then? Have you been snacking too much in the afternoon? Are certain foods to blame? Are you eating a large midday meal? Or are you eating appropriately, which means you may need an adjustment in your medications or exercise schedule?
  • Compare bedtime readings with your dinner menu. Can you track high bedtime readings to certain foods? For example, do you notice that blood glucose levels are particularly high when you eat pizza, Mexican food, or mashed potatoes? If you take pills, you might want to experiment by eating less of the foods you suspect cause glucose levels to rise, or exercise longer before or after that meal. If you take insulin, ask your doctor or educator if he or she suggests you take extra insulin on nights you eat these foods.
  • Recognize that all foods are not created equal. Some are more refined and as a result more easily absorbed than others. Some have more fat, resulting in a slower rate of absorption. (The effects of a particular food may even vary greatly from one person to the next.) Figure these facts into your control. If you notice a raisin bran cereal causes a greater rise than oatmeal, choose the raisin bran cereal on an active morning and choose the oatmeal on a less hectic morning.
  • Look for a pattern of low blood glucose after exercise. If such a pattern occurs, how long after exercise does it occur? Are blood glucose levels too low in the morning when you exercise the evening before? If so, consider eating a little extra at bedtime, or talk to your educator or doctor about changing your diet, medication dose, or medication timing.
  • Look for a pattern of high blood glucose after low results. This effect is commonly called a rebound, and it occurs when hormones kick in to raise blood glucose when it is too low. Because the hormones continue to work for a while after blood glucose returns to normal, a high blood glucose level often follows. On the other hand, high blood glucose levels that occur after low ones may also be due to overeating or anxiety eating. Evaluating patterns helps you identify the difference.
  • Keep a record of where you inject insulin. Some people notice differences in their glucose levels when they inject insulin in their arm compared with days they use their leg or abdomen.
  • Look for bumps or lumps of thickened tissue at your injection sites. These raised areas may appear if you give your injections in the same places for a long time. They are fat and scar tissue, which prevent good absorption of insulin.

Measure Success

One of the ways you and your doctor will evaluate the success of your diabetes control is to review the results you obtain when you test your blood on your meter. Discuss with your doctor your target range for blood glucose levels. If your results generally run outside this target range, your doctor, diabetes educator, or registered dietitian can help you adjust your food, exercise, or medication. Another way to assess diabetes control is with a blood test called hemoglobin A1C (HbA1C). Hemoglobin is a part of your red blood cells. Researchers discovered that glucose sticks to hemoglobin. The HbA1C test measures the amount of glucose that stuck to the hemoglobin; this is an excellent reflection of average blood glucose control over the past two to three months. Most people with diabetes undergo an HbA1C test every three months. In general, the closer the result is to normal -- so long as you don't also experience hypoglycemia -- the better. Every little bit you can decrease HbA1C levels helps reduce complications of diabetes. Keep track of your HbA1C results just as you do your other tests:

  • Ask your doctor what your goal is for HbA1C results.
  • Don't be too upset if your HbA1C result doesn't improve very quickly. It takes at least two months to see significant changes.
  • Evaluate your HbA1C results in conjunction with your meter test results. If the HbA1C value is high, indicating a high average blood glucose, and your meter numbers are normal, something is amiss. It could be a problem with your meter accuracy, or you may be testing blood glucose only at times your blood glucose is within normal range.

Another major concern when planning your diabetes strategy should be what role your insurance company can play in your treatment. We'll examine this question in the next section. This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Insurance for Diabetics

©2006 Publications International, Ltd,Diabetes is a condition that requires a lot of medical care and the bills can be intimidating.

There is no question that diabetes is an expensive disease. And negotiating the insurance scene can be complicated and confusing. In fact, do you really understand your health benefits? Obviously, the purpose of health insurance is to save out-of-pocket expenses for health care. But to ensure you receive all the benefits you're entitled to so you don't spend more than you should, you must understand the finer points of your insurance coverage.

  • Does the plan allow referral to an endocrinologist, or must you be treated by your primary care physician?
  • How many physician and education visits does the plan cover?
  • Do you have coverage for diabetes education, including nutrition education? In some states, insurance companies provide coverage for diabetes education if the program has been recognized by the American Diabetes Association or the State Department of Health as meeting certain standards of care and education.
  • Does your plan specify what type of meter or brand of insulin you can purchase?
  • If your insurance does not cover expenses for preventive diabetes care, consider submitting a letter of medical necessity for services and supplies to encourage the insurance company to cover these costs. Sometimes a physician's letter or support of the cost-effectiveness of diabetes education from your educator can supply insurance companies with rationale for providing the coverage you need. A copy of this letter should also be given to your employee benefits personnel so your employer can also encourage the insurance company to supply coverage of diabetes care.
  • To reduce costs, consider mail ordering three-month supplies of insulin or other equipment you need to manage your diabetes. It may be much less expensive.

Talk with your insurance agent or employee benefits representative if you have any questions. And follow this advice for coping with the paperwork:

  • Make sure you file your claims to the proper portion of your benefit plan; most plans have basic and supplemental portions.
  • Try not to file a claim until your expenses exceed your yearly deductible, but don't delay filing. Generally, claims must be filed by the end of the calendar year following the year the charges were incurred.
  • Submit itemized bills. Balance due, paid on account, and cash register receipts may not be acceptable. Bills should include the name and address of the provider, patient's full name, date of service, description of services performed, amount charged for each service, and the diagnosis.
  • Keep copies of your submissions for your files.
  • If your coverage includes a prescription plan, learn how prescriptions should be written. For example, some plans cover a three-month supply of medication, and prescriptions must be written that way. Other plans request that all medications be written on one prescription. Know what your plan requires, and ask your doctor's office to place this information in your records so you will not endure a delay when you need supplies.

If you're considering switching to a new plan or policy, be sure to find out if any new plan contains a preexisting illness clause that either excludes coverage of diabetes care completely or excludes care for a certain waiting period (such as six months to a year). Be truthful when you fill out insurance applications. Misrepresentation can lead to cancellation of your policy and denial of benefits. If you apply for coverage and are denied, provide evidence that diabetes is well controlled and that you are either free of complications or they are stabilized. Your doctor can help by submitting a letter with laboratory results confirming good control. You should also inquire about state services for people with diabetes. Many states now have "pooled risk" insurance plans for people who have difficulty getting group coverage. The premiums for these plans may be a bit higher than others, but you can purchase comprehensive health insurance at an affordable cost. Contact the Office of the Insurance Commissioner in your state. Consider reducing your premium costs by choosing higher deductibles.Another outlet that can help you manage your diabetes care is the many support groups that are available for diabetes patients. We'll learn about these groups in the next section.This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Diabetes Support Groups

©2006 Publications International, Ltd.A support group can help introduce you to other people who are going through the same struggle you are.

One way to help yourself is to get involved in diabetes organizations. Your participation in these groups helps in a couple of ways. First, you meet others with some of the same problems and concerns you have. You learn from each other's experiences. You problem-solve together. You learn that you are not the only one who feels as you do or has been through what you've been through. You may even make lifelong friendships.

Diabetes AdvocacyHave you ever felt discriminated against in the workplace because you have diabetes? If an employer has ever refused to allow you time to take insulin or test your blood, to eat meals or snacks, or to store necessary diabetes supplies in your work area, you know what it's like to be made to feel different as a result of a medical condition or made to feel as if your condition makes you somehow less competent in the workplace. People with diabetes and other medical conditions have support. Diabetes is considered a disability under the Americans with Disabilities Act of 1990. The purpose of the Act is to eliminate discrimination against people with disabilities; it became effective in July 1992 for employers with 25 or more employees and July 1994 for employers with 15 or more employees. The Act ensures equal employment opportunities for people with disabilities.

In addition, it states that "reasonable accommodation" must be made for persons with disabilities. Reasonable accommodation includes making existing facilities accessible to employees with disabilities; restructuring a job; modifying the work schedule; acquiring new or modifying existing equipment or devices; and modifying examinations, training materials, or policies to make them appropriate for individuals with disabilities. The employer, however, need not provide accommodation if doing so would be significantly difficult or expensive (it would incur "undue hardship"). The Equal Employment Opportunity Commission (EEOC) investigates complaints of violations of the Act.

The Act protects your rights in the workplace. You can help by observing these tips for managing diabetes in the workplace.

  • Make sure someone knows you have diabetes. Your condition does not need to be public information, but someone -- a supervisor or coworker -- should know you have diabetes, how you treat it, and where you keep your supplies.
  • Tell your employer what you need to manage diabetes. If you need to eat a snack or take your lunch at a certain time, for example, let your employer know this. Most employers try to be accommodating.
  • If altering a work schedule proves difficult or problematic, you may be able to change your diabetes management schedule. For example, if taking lunch at noon is not possible or desirable (maybe the lunch hour is the busiest time of day at your job), you may be able to adjust your insulin or add a snack in the morning.
  • If possible, keep your diabetes supplies in a desk drawer or somewhere close to your work site. If you need to test during the day, you may be able to test quickly and inconspicuously at your desk and get on with your work.
  • If you believe you are being discriminated against because you have diabetes, call the Equal Employment Opportunity Commission office at 1-800-669-4000.

Of course, it's important to stress that living with diabetes means living a full life and enjoying all that is has to offer. In the next section, we learn how to travel safely with diabetes.This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

Travel Tips for Diabetics

©2006 Publications International, Ltd.Travel is not one of the luxuries you need to forgo because you have diabetes.

Just because you have diabetes doesn't mean you can't enjoy the full range of joys that life has to offer -- including traveling. Whether embarking on a roadtrip or heading overseas, there are some precautions you should take if you are traveling and you have diabetes.

Drive Safe

When hypoglycemia (low blood glucose) occurs, the brain, deprived of glucose, cannot function properly. Clouded judgment, impaired reaction time, confusion, and disorientation can result. Obviously, this is not a good state to be in while driving, for you or for anyone else on the road.

Take precautions before you get behind the wheel:

  • Always test your blood glucose level before you drive. Carry testing equipment with you.
  • Always carry a form of fast-acting sugar as well as a follow-up snack containing protein! Keep extras handy for unexpected events such as when you're caught in rush hour traffic or the car breaks down. Store peanut butter crackers, juice boxes, and glucose tablets in the glove compartment. And don't forget to replace any food supplies you use!
  • If you experience hypoglycemia symptoms, pull off the road and wait until your blood glucose level returns to normal range and your symptoms have ended before continuing.
  • Drive with a companion when possible.
  • Stop to test your blood glucose at 3- to 4-hour intervals and/or any time you suspect hypoglycemia.

Pack SmartClutching your plane ticket and itinerary, you smile when you think about how much you're going to enjoy this trip. But the smile fades when you realize that for all your careful planning, you've forgotten to plan how to fit diabetes control into this vacation. How will you handle the change in time zones? Will you be able to find appropriate foods at your destination? You place a call to your diabetes educator, who confirms that travel can present some challenges but assures you that diabetes care is generally available worldwide. Your educator points out that if you follow some commonsense tips for travel, you should be able to hit the road without hitting too many snags. Start with what you pack:

  • Take plenty of supplies. Double the amount you anticipate you'll need in the event of any problems. Insulin bottles can break, and replacing them may not be easy. If you do break a bottle of insulin, go to a local pharmacy or emergency room for insulin. Some countries may have another strength of insulin (U-40 or U-80) and syringes to match, so be careful and accurate when measuring the dose.
  • Keep your supplies with you at all times. If you're flying, place your meter, strips, insulin, syringes, and snacks or glucose tablets in carry-on luggage, not in your check-in baggage. If you need them during the flight, it's usually a good idea to explain briefly to the person sitting next to you what you're doing with that needle. In general, people are supportive and will probably tell you about their friends and family members with diabetes. Pack enough food in carry-on bags to replace the carbohydrates you might normally consume at a meal. Crackers and raisins are easy to transport.
  • Keep insulin in an insulated container, especially if you're traveling to a warm climate. A wide-mouth thermos works well for this. Travel packs designed for this purpose are available.
  • If you're hiking, biking, mountain climbing, or boating, carry plenty of food and a fast-acting source of sugar. If you take insulin, carry a Glucagon kit along, and teach someone how and when to use it. Keep your meter with you, too.
  • Travel with a buddy, if possible, and ask him or her to carry extra supplies for you as well. If you're traveling alone, make sure your carry-on bag or briefcase is well stocked.
  • Take sugar-free powdered drink mix if you're traveling to a country where diet drinks are not readily available. Mix it with bottled water.
  • When traveling outside the United States, obtain a prescription from your doctor, stating that you have diabetes and that you are required to carry syringes. Wear your medical ID to show customs personnel in case you are questioned.
  • Crossing time zones can really throw your management schedule off. Depending on the distance you travel, you could lose or gain as much as a day. Your diabetes educator can help you plot out your home schedule and that of your destination to see how the time differences will affect your usual eating and medication times.
  • If you're flying and you are not on a flexible insulin regimen, call the airlines to ask when food is usually served. Airlines prepare special meals if you request them 24 hours ahead of time.
  • Keep your watch on home time until you arrive at your destination. This allows you to adjust your schedule correctly in the new time zone. Or purchase a traveler's watch with two faces.

Ask your registered dietitian for advice on adjusting to different types of foods. In some countries, meats, fresh fruits, or vegetables may be a rarity; diets may consist of a lot of complex carbohydrates, such as beans, corn, bread, and rice. You'll need to adjust your medication accordingly. Also, if beer or wine is the culture's beverage of choice at mealtimes, you'll need to calculate these extra calories into your plan. The evening meal in Spanish-speaking countries is typically quite late. Consider reversing your bedtime snack and evening meal to accommodate this habit.If you travel frequently, you might consider a more flexible regimen such as an insulin pump or multiple daily injections. Finally, we will look at what might be the most important aspect of living with diabetes -- staying positive. We will give you some tips to keep your spirits up on the next page.This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.

How to Maintain a Positive Outlook With Diabetes

Successful diabetes control requires a positive outlook. That's a simple statement, but it's a significant point. You must think that controlling diabetes is a worthwhile endeavor, or you won't do it. And if you don't believe you will ever succeed, you probably won't. How do you forge a positive attitude? Start by recognizing that you can take steps to alter your health.

  • Decide to make the best of it. You can't change the fact you have diabetes, so your choices are either to deny and ignore it or accept it and deal with it.
  • Find something bigger than yourself to believe in. Free yourself from focusing on and constantly worrying about your own problems and concerns. Join a charitable organization, church group, or advocacy group. Become a hospital volunteer or a Big Brother or Sister.
  • Practice visualization. Close your eyes and see yourself as healthy, active, and in good control of diabetes.
  • Make an effort to find the positives both in life and in diabetes. Managing diabetes may give you more of a sense of control of your fate. Quitting smoking can help you feel more disciplined. Weight loss can boost your self-esteem. Joining an exercise program can lead to new friends. Make a list of positive elements, and review it on down days.
  • Enlist the help of family and friends to keep you motivated. Avoid negative people who make you feel sad or bad about yourself. Surround yourself with people who care about you and will help you with the many tasks that are part of diabetes control.
  • Reward yourself for jobs well done, such as when you lose five pounds or keep excellent records for a week.
  • Understand that you will experience ups and downs. You will follow your regimen better at some times than you will at others. Don't be too hard on yourself or make excuses when you fall off your program. Admit you slipped, then try to determine why so you can prevent another fall.

Jean Betschart Roemer, MN., MSN., CRNP., CPNP., CDE., is a pediatric nurse practitioner and diabetes educator in the Department of Endocrinology, Diabetes and Metabolism at Children's Hospital of Pittsburgh. She is a past president of the American Association of Diabetes Educators and a recipient of the American Diabetes Association Outstanding Health Professional Educator Award. She has worked with children with diabetes and their families since 1980.  Ms. Roemer, mother of three, and now a Grandma, was diagnosed with type 1 diabetes in 1968. http://www.learningdiabetes.com/This information is solely for informational purposes. IT IS NOT INTENDED TO PROVIDE MEDICAL ADVICE. Neither the Editors of Consumer Guide (R), Publications International, Ltd., the author nor publisher take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, action or application of medication which results from reading or following the information contained in this information. The publication of this information does not constitute the practice of medicine, and this information does not replace the advice of your physician or other health care provider. Before undertaking any course of treatment, the reader must seek the advice of their physician or other health care provider.