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The International Diabetes Center in Minneapolis has
launched an initiative to promote the importance of
achieving an A1c of less than 7 percent. Hente was able
to keep his A1c levels fairly low with lifestyle changes
such as increased exercise and lower calorie meals.
But after several years, these lifestyle changes alone
couldn't keep his levels low. His A1c crept up to 8
percent and eventually 10 percent. Hente said he was
resistant to taking insulin, but the consequences of
uncontrolled blood sugars hit him hard when a friend
was forced to have one leg amputated because of untreated
diabetes.
Diabetes is the leading cause of lower limb amputations,
according to the American Diabetes Association. It's
also the No.1 reason why adults aged 20 to 74 are diagnosed
with new cases of blindness in the United States. Adults
with diabetes are two to four times more likely than
adults without diabetes to have a stroke or die of heart
disease.
These statistics are why Hente decided to start giving
himself insulin injections once a day, in addition to
taking two insulin-producing tablets daily.
"I'm a photographer, and I don't want eyesight
problems," he said. "If I can keep my A1c
below 7, my risk of complications goes way down."
Like Hente, many diabetics need to have their treatments
tweaked at different times. Ellie Strock, ANP, CS, RN,
CDE, a nurse with the International Diabetes Center,
said that health care providers are often slow to make
changes when patients aren't responding to initial therapies.
"A lot of these [patients] feel they have failed,
and it really isn't that they've failed," Strock
said. "It's that the therapy isn't working."
But finding the ideal treatment requires nurses and
doctors to understand myriad new drugs and treatments
that are evolving, Strock said. The new combination
pills, for example, allow diabetics to take one medication
to treat both insulin resistance and insulin deficiency.
There are long-acting insulins and rapid-acting ones.
Strock is also adamant that nurses should keep experimenting
with treatments until a patient's diabetes is successfully
controlled.
She recently saw a woman in her 30s, overweight and
taking metformin to make her body more sensitive to
insulin. The woman also was using glyburide to increase
the insulin release in her pancreas. She was taking
the maximum dosages, but still had an A1c of 9.5 percent.
She'd tried exercising and eating healthier, but it
wasn't working. Strock knew that lifestyle changes alone
couldn't reduce her levels to less than 7 percent.
After talking with the woman, they both agreed that
she was a good candidate for insulin therapy. Although
this wasn't the patient's first choice, lowering her
levels was a high priority.
For Strock, interactions like this one reveal one of
the perks of her job. "There are things we can
do to help people," she said. "The most difficult
thing is that there are a lot of excellent ways to manage
diabetes, but there are a lot of people who donhave
it under control. We have the tools available to do
it, but we have to educate people how to use these tools."
For M.J. Wainwright, RN, a diabetes educator for Type
1 patients, the challenge is teaching children how to
control their disease. Wainwright, who works at Fountain
Valley (Calif.) Regional Hospital, said children sometimes
are faster learners than adult patients.
"Overall, the kids with diabetes do better than
the adults because you can teach them that there's nothing
wrong with them," she said. "They learn that
there's nothing they can't do."
Wainwright's daughter was diagnosed with diabetes when
she was 2. Wainwright said her nursing background forced
her to confront the potential complications of untreated
diabetes, and she responded by introducing healthy cooking
habits to her family.
Her daughter, now 11, tests her blood sugar about five
times a day, takes three insulin shots daily and pays
close attention to what she eats. Although her daughter
has the freedom to eat anything in moderation, she cannot
afford to "just pig out," Wainwright said.
Her daughter's condition hasn't stopped her from pursuing
competitive gymnastics, and for Wainwright, this is
an example of the lifestyle that's possible if patients
confront the disease head-on.
"It shows that diabetes certainly doesn't have
to devastate you," Wainwright said. "I like
letting families know that they can control it. You
don't have to let it control you, and it doesn't have
to change the quality of your life."
Contact Heather Stringer at heathers@nurseweek.com
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