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Help for Patients & Caregivers
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Help for Patients and Caregivers : Diabetes
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What is type 2 diabetes?
How can type 2 diabetes be prevented?
Signs and symptoms
of type 2 diabetes?
Types of Diabetes
Should I be tested for diabetes?
What does it mean to have pre-diabetes?
Other factors that may increase
my risk for type 2 diabetes
Doing My Part: Getting Started
Hope Through Research
Staying Healthy from Head to Toe
What is type 2 diabetes?
Diabetes is a disease in which blood glucose levels are above normal.
People with diabetes have problems converting food to energy.
After a meal, food is broken down into a sugar called glucose,
which is carried by the blood to cells throughout the body. Cells
use the hormone insulin, made in the pancreas, to help them
process blood glucose into energy.
People develop type 2 diabetes because the cells in the muscles,
liver, and fat do not use insulin properly. Eventually, the pancreas
cannot make enough insulin for the body’s needs. As a result, the
amount of glucose in the blood increases while the cells are starved
of energy. Over the years, high blood glucose damages nerves and
blood vessels, leading to complications such as heart disease, stroke,
blindness, kidney disease, nerve problems, gum infections, and
amputation.
How can type 2 diabetes be prevented?
Although people with diabetes can prevent or delay complications
by keeping blood glucose levels close to normal, preventing or
delaying the development of type 2 diabetes in the first place is
even better. The results of a major federally
funded study, the Diabetes Prevention
Program (DPP), show how to do so.
This study of 3,234 people at high risk
for diabetes showed that moderate diet
and exercise resulting in a 5- to 7-percent
weight loss can delay and possibly prevent
type 2 diabetes.
Study participants were overweight and had
higher than normal levels of blood glucose,
a condition called pre-diabetes (impaired glucose
tolerance). Both pre-diabetes and obesity
are strong risk factors for type 2 diabetes.
Am I at Risk for Type 2 Diabetes?
Because of the high risk among some minority groups, about half
of the DPP participants were African American, American Indian,
Asian American, Pacific Islander, or Hispanic American/Latino.
The DPP tested two approaches to preventing diabetes: a healthy
eating and exercise program (lifestyle changes), and the diabetes
drug metformin. People in the lifestyle modification group exercised
about 30 minutes a day 5 days a week (usually by walking)
and lowered their intake of fat and calories. Those who took the
diabetes drug metformin received standard information on exercise
and diet. A third group received only standard information on
exercise and diet.
The results showed that people in the lifestyle modification group
reduced their risk of getting type 2 diabetes by 58 percent. Average
weight loss in the first year of the study was 15 pounds. Lifestyle
modification was even more effective in those 60 and older. They
reduced their risk by 71 percent. People receiving metformin
reduced their risk by 31 percent.
What are the signs and symptoms
of type 2 diabetes?
Many people have no signs or symptoms. Symptoms can also be so
mild that you might not even notice them. Nearly six million people
in the United States have type 2 diabetes and do not know it.
Here is what to look for:
- increased thirst
- increased hunger
- fatigue
- increased urination, especially at night
- weight loss
- blurred vision
- sores that do not heal
Types of Diabetes
The three main kinds of diabetes are type 1, type 2, and
gestational diabetes.
Type 1 Diabetes
Type 1 diabetes, formerly called juvenile diabetes or insulindependent
diabetes, is usually first diagnosed in children,
teenagers, or young adults. In this form of diabetes, the
beta cells of the pancreas no longer make insulin because
the body’s immune system has attacked and destroyed them.
Treatment for type 1 diabetes includes taking insulin shots or
using an insulin pump, making wise food choices, exercising
regularly, taking aspirin daily (for some), and controlling
blood pressure and cholesterol.
Type 2 Diabetes
Type 2 diabetes, formerly called adult-onset or noninsulindependent
diabetes, is the most common form of diabetes.
People can develop type 2 diabetes at any age, even during
childhood. This form of diabetes usually begins with insulin
resistance, a condition in which fat, muscle, and liver cells do
not use insulin properly. At first, the pancreas keeps up with
the added demand by producing more insulin. In time, however,
it loses the ability to secrete enough insulin in response
to meals. Being overweight and inactive increases the
chances of developing type 2 diabetes. Treatment includes
taking diabetes medicines, making wise food choices, exercising
regularly, taking aspirin daily, and controlling blood
pressure and cholesterol.
Gestational Diabetes
Some women develop gestational diabetes during the late
stages of pregnancy. Although this form of diabetes usually
goes away after the baby is born, a woman who has had
it is more likely to develop type 2 diabetes later in life.
Gestational diabetes is caused by the hormones of
pregnancy or a shortage of insulin.
Am I at Risk for Type 2 Diabetes?
Sometimes people have symptoms but do not suspect diabetes.
They delay scheduling a checkup because they do not feel sick.
Many people do not find out they have the disease until they have
diabetes complications, such as blurry vision or heart trouble. It is
important to find out early if you have diabetes because treatment
can prevent damage to the body from diabetes.
Should I be tested for diabetes?
Anyone 45 years old or older should consider getting tested for
diabetes. If you are 45 or older and overweight (see BMI chart on
pages 10 and 11), it is strongly recommended that you get tested.
If you are younger than 45, overweight, and have one or more of
the risk factors on page 5, you should consider testing. Ask your
doctor for a fasting blood glucose test or an oral glucose tolerance
test. Your doctor will tell you if you have normal blood glucose,
pre-diabetes, or diabetes.
What does it mean to have pre-diabetes?
It means you are at risk for getting type 2 diabetes and heart disease.
The good news is if you have pre-diabetes you can reduce the
risk of getting diabetes and even return to normal blood glucose
levels. With modest weight loss and moderate physical activity,
you can delay or prevent type 2 diabetes. If your blood
glucose is higher than normal but lower than the diabetes range
(what we now call pre-diabetes), have your blood glucose checked
in 1 to 2 years.
Doing My Part: Getting Started
Making big changes in your life is hard, especially if you are faced
with more than one change. You can make it easier by taking these
steps:
- Make a plan to change behavior.
- Decide exactly what you will do and when you will do it.
- Plan what you need to get ready.
- Think about what might prevent you from reaching your
goals.
- Find family and friends who will support and encourage you.
- Decide how you will reward yourself when you do what you
have planned.
Your doctor, a dietitian, or a counselor can help you make a plan.
Here are some of the areas you may wish to change to reduce your
risk of diabetes.
Reach and Maintain a Reasonable Body Weight
Your weight affects your health in many ways. Being overweight
can keep your body from making and using insulin properly. It can
also cause high blood pressure. The DPP showed that losing even a
few pounds can help reduce your risk of developing type 2 diabetes
because it helps your body use insulin more effectively. In the DPP,
people who lost between 5 and 7 percent of their body weight significantly
reduced their risk of type 2 diabetes. For example, if you
weigh 200 pounds, losing only 10 pounds could make a difference.
Body mass index (BMI) is a measure of body weight relative to
height. You can use BMI to see whether you are underweight,
normal weight, overweight, or obese. Click here to view the BMI table.
- Find your height in the left-hand column.
- Move across in the same row to the number closest to your
weight.
- The number at the top of that column is your BMI. Check
the word above your BMI to see whether you are normal
weight, overweight, or obese.
If you are overweight or obese, choose sensible ways to get in
shape:
- Avoid crash diets. Instead, eat less of the foods you usually
have. Limit the amount of fat you eat.
- Increase your physical activity. Aim for at least 30 minutes
of exercise most days of the week.
- Set a reasonable weight-loss goal, such as losing 1 pound a
week. Aim for a long-term goal of losing 5 to 7 percent of
your total body weight.
Make Wise Food Choices Most of the Time
What you eat has a big impact on your health. By making wise food
choices, you can help control your body weight, blood pressure, and
cholesterol.
- Take a hard look at the serving sizes of the foods you eat.
Reduce serving sizes of main courses (such as meat), desserts,
and foods high in fat. Increase the amount of fruits and
vegetables.
- Limit your fat intake to about 25 percent of your total calories.
For example, if your food choices add up to about 2,000 calories
a day, try to eat no more than 56 grams of fat. Your doctor or a
dietitian can help you figure out how much fat to have. You can
check food labels for fat content too.
- You may also wish to reduce the number of calories you have
each day. People in the DPP lifestyle modification group lowered
their daily calorie total by an average of about 450 calories.
Your doctor or dietitian can help you with a meal plan that
emphasizes weight loss.
- Keep a food and exercise log. Write down what you eat, how
much you exercise—anything that helps keep you on track.
- When you meet your goal, reward yourself with a nonfood item
or activity, like watching a movie.
Be Physically Active Every Day
Regular exercise tackles several risk factors at once. It helps you
lose weight, keeps your cholesterol and blood pressure under
control, and helps your body use insulin. People in the DPP who
were physically active for 30 minutes a day 5 days a week reduced
their risk of type 2 diabetes. Many chose brisk walking for exercise.
If you are not very active, you should start slowly, talking with your
doctor first about what kinds of exercise would be safe for you.
Make a plan to increase your activity level toward the goal of being
active at least 30 minutes a day most days of the week. Choose activities you enjoy. Here are some ways to work extra
activity into your daily routine:
- Take the stairs rather than an elevator or escalator.
- Park at the far end of the lot and walk.
- Get off the bus a few stops early and walk the rest of the way.
- Walk or bicycle instead of drive whenever you can.
Take Your Prescribed Medications
Some people need medication to help control their blood pressure
or cholesterol levels. If you do, take your medicines as directed.
Ask your doctor whether there are any medicines you can take to
prevent type 2 diabetes.
Hope Through Research
We now know that many people can prevent type 2 diabetes
through weight loss, regular exercise, and lowering their intake of
fat and calories. Researchers are intensively studying the genetic
and environmental factors that underlie the susceptibility to obesity,
pre-diabetes, and diabetes. As they learn more about the molecular
events that lead to diabetes, they will develop ways to prevent and
cure the different stages of this disease. People with diabetes and
those at risk for it now have easier access to clinical trials that test
promising new approaches to treatment and prevention. For information
about current studies, see http://ClinicalTrials.gov.
Diabetes - Staying
healthy from
head to toe
If you have diabetes, controlling your
sugar is always the first priority. A healthy
diet, regular exercise and good medical
care can help.
When your blood sugar is under
control you’re also at lower risk for
complications from diabetes. High
blood sugar levels can damage your
nerves and blood vessels.
When levels are too high it can cause
damage and disease in your eyes, teeth
and feet. That’s why these parts of your
body need special care, according to
the American Diabetes Association.
Eyes. To keep your eyes healthy,
get an eye exam every year. You
should also go to the doctor if:
- Your vision gets blurry.
- You see double.
- Your eyes hurt.
- You see spots.
Teeth and gums. Have your teeth
cleaned and checked every 6 months.
Brush your teeth, front and back,
twice daily with a soft brush. Floss
once a day. See your dentist if you
notice any problems with your
gums or teeth.
Feet. Wash and dry your feet
every day. Use lotion to keep the
skin from drying out.
Check every day for sores, blisters,
calluses or swelling. Don’t try to treat
calluses or corns at home. See your
doctor.
Cut toenails straight across. Look
for sharp edges—they can cut your
Check shoes inside and out for
sharp objects before you put them
on. Pebbles, nails or even a torn
shoe lining could cause problems.
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10 Tips for Family Caregivers.
1. Caregiving is a job and respite is your earned right. Reward yourself with respite breaks often.
2. Watch out for signs of depression, and don’t delay in getting professional help when you need it.
3. When people offer to help, accept the offer and suggest specific things that they can do.
4. Educate yourself about your loved one’s condition and how to communicate effectively with doctors.
5. There’s a difference between caring and doing. Be open to technologies and ideas that promote your loved one’s independence.
6.Trust your instincts. Most of the time they’ll lead you in the right direction.
7. Caregivers often do a lot of lifting, pushing, and pulling. Be good to your back.
8. Grieve for your losses, and then allow yourself to dream new dreams.
9. Seek support from other caregivers. There is great strength in knowing you are not alone.
10. Stand up for your rights as a caregiver and a citizen.
Tips for Family Caregivers from Doctors
- Write questions down so you won’t forget them
- Be clear about what you want to say to the doctor. Try not to ramble.
- If you have lots of things to talk about, make a consultation appointment, so the doctor can allow enough time to meet with you in an unhurried way.
- Educate yourself about your loved one’s disease or disability. With all the information on the Internet it is easier than ever before.
- Learn the routine at your doctor’s office and/or the hospital so you can make the system work for you, not against you.
- Recognize that not all questions have answers—especially those beginning with “why.”
- Separate your anger and sense of impotence about not being able to help your loved one as much as you would like from your feeling about the doctor. Remember, you are both on the same side.
- Appreciate what the doctor is doing to help and say thank you from time to time.
Care Management Techniques You Can Use
Did you ever wish you could just pick up the phone and call someone who would take stock of your situation, help you access the right services, counsel you and your family to help resolve some of your differences, then monitor your progress with an eye toward channeling your energy and abilities as effectively as possible? If your answer is “yes,” you’re not alone. Having the help of a care coordinator (often called a care manager) could make all of our lives easier and less lonesome, and help us be more capable family caregivers. While most of us may not have access to a care coordinator, we can all learn how to think and act like one, thereby reaping numerous benefits for our loved ones and ourselves.
What Is Care Coordination?
Although every case is different, the care coordination approach usually involves:
- Gathering information from healthcare providers;
- An assessment of your care recipient and the home environment;
- Research into available public and/or private services and resources to meet your loved one’s needs; and
- Ongoing communication between all parties to keep information up-to-date and services appropriate and effective.
Unfortunately, an assessment of your abilities and needs is not necessarily a standard part of the process, but it should be. A complete view of the situation cannot be gained without one. An objective analysis of your health, emotional state, other commitments, etc., are key elements in determining how much you can and cannot do yourself, and what type of outside support is needed to ensure your loved one’s health and safety.
Become Your Own Care Coordinator
By learning and applying at least some of the care coordination techniques and ideas that follow, you’ll be in a much better position to develop an organized course of action that will, hopefully, make you feel more confident and in control — a goal well worth working toward.
Educate yourself on the nature of the disease or disability with which you’re dealing. Reliable information is available from the health agency that deals with your loved one’s condition and the National Institutes of Health. When using the Internet, stick with well-known medical sites. Understanding what is happening to your care recipient will provide you with the core knowledge you need to go forward. It will also make you a better advocate when talking with healthcare professionals.
Write down your observations of the present situation including:
- Your loved one’s ability to function independently, both physically and mentally.
- The availability of family and/or friends to form a support network to share the care.
- The physical environment: Is it accessible or can it be adapted at reasonable cost?
- Your other responsibilities — at work, at home, and in the community.
- Your own health and physical abilities.
- Your financial resources, available insurance, and existence of healthcare or end-of-life documents.
This assessment will help you come to a realistic view of the situation. It will let you know the questions to which you need answers. It can be a handy baseline for charting your caregiving journey and reminding you just how much you’ve learned along the way.
Hold a family conference. At least everyone in the immediate family should be told what’s going on. A meeting can set the stage for divvying up responsibilities so that there are fewer misunderstandings down the road when lots of help may be needed. A member of the clergy, a professional care coordinator, or even a trusted friend can serve as an impartial moderator. A family meeting is a good way to let everyone know they can play a role, even if they are a thousand miles away. It can help you, the primary family caregiver, from bearing the brunt of all the work all of the time.
Keep good records of emergency numbers, doctors, daily medications, special diets, back-up people, and other pertinent information relating to your loved one’s care. Update as necessary. This record will be invaluable if something happens to you, or if you need to make a trip to the ER. If you can maintain a computer-based record, that will make updating all that much easier and it might even allow you to provide the medical team with direct access to the information.
Join a support group, or find another caregiver with whom to converse. In addition to emotional support, you’ll likely pick up practical tips as well. Professionals network with each other all the time to get emotional support and find answers to problems or situations they face. Why shouldn’t family caregivers?
Start advance planning for difficult decisions that may lie ahead. It’s never too early to discuss wills, advance directives, and powers of attorney, but there comes a time when it is too late. It is also vital that you and your loved one think through what to do if you should be incapacitated, or, worse, die first. It can happen.
Develop a care team to help out during emergencies, or over time if your situation is very difficult. In an ideal world there will be lots of people who want to help. More likely you’ll be able to find one or two people to call on in an emergency or to help with small chores. The critical thing is to be willing to tell others what you need and to accept their help.
Establish a family regimen. When things are difficult to begin with, keeping a straightforward daily routine can be a stabilizer, especially for people who find change upsetting and confusing.
Approach some of your hardest caregiving duties like a professional. It’s extraordinarily difficult to separate your family role from your caregiving role, to lock your emotions up in a box while you focus on practical chores and decisions. But it is not impossible to gain some distance some of the time. It requires an almost single-minded approach to getting the job at hand done as efficiently and effectively as possible. It takes practice, but is definitely worth the effort.
©National Family Caregivers Association | www.nfcacares.org | Phone: 800/896-3650
Seating & Mobility - As a caregiver, you need to be very understanding to the individual's needs. This is a very hard time as they are being told they need to start living their life in a different manor than they had done so previously. It will be most beneficial to educate them, either with a professional, or through a support group. By becoming involved in different activities with others in the same condition, the individual will be able to make the transition much easier. As far as the actual device, you will want to make sure that the individual is fully capable of performing all the operations of the mobility device and can do so in a comfortable manner. Areas to pay close attention to include an adjustable backrest, a suspension system, a fore-and-aft track adjustment, an up-and-down seat adjustment, an armrest and/or footrest, and lumbar region support.
How do you care for your mobility device?
The most important areas that you need to pay attention to are referred to as the 3 B’s…Bad batteries, bent wheel rims and failed bearings. If you notice something that doesn’t seem right, but it isn’t all too annoying, you should still get it looked at right away. This could prevent a more severe accident from happening. So as the saying goes “it’s better to be safe than sorry”.
When a wheelchair is purchased, you will want to make sure that all the correct adjustments and modifications are made. This needs to be done by a professional and should take up to a couple of hours if done correctly. As long as the proper measures are taken initially, the work of maintaining the device will be substantially easier.
Additional Resources
It's always wise to find out what your county and state have to offer in the way of services, even if you think you won't qualify for them. Check the blue pages of your phone book for the numbers, or go on line. Counties and states all have web sites. Type the name of your state or county and state into any major search engine i.e. Iowa, or Montgomery County, PA. Navigate from there to locate the Department of Health and Human Services and the specific office most relevant to your needs, such as office on disabilities, elder affairs, or maternal and child health.
Other good sources of information include your local hospital or clinic (social work department), area adult day centers, social service and faith-based agencies, and/or the local chapter of the health agency that focuses on your loved one's condition. It is by no means certain that any of these will offer caregiver support services, but they are good places to check, and they are good sources for information about services to directly support your loved one.
National Family Caregivers Association
10400 Connecticut Avenue, Suite 500
Kensington, MD 20895
800-896-3650
Web site: http://www.thefamilycaregiver.org
e-mail: info@thefamilycaregiver.org
The National Family Caregivers Association (NFCA) is a grassroots organization created to educate, support, empower, and advocate for the millions of Americans who care for chronically ill, aged, or disabled loved ones. NFCA is the only constituency organization that reaches across the boundaries of different diagnoses, different relationships, and different life stages to address the common needs and concerns of all family caregivers. NFCA serves as a public voice for family caregivers to the press, to Congress and the general public. NFCA offers publications, information, referral services, caregiver support, and advocacy.
Caregiver-Specific Web Sites
There are a variety of Web sites that offer information and support for family caregivers, in addition to those from specific organizations.
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