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Self-Management Education: Who's in Charge?

separator Which individual below is likely to have the best blood sugar control and fewer diabetes complications?

Person A: Follows the same diabetes regimen that worked well several years ago. Makes appointments with the doctor and other healthcare providers if problems arise. Doesn't always feel comfortable asking the doctor questions, but figures the doctor is the expert so that's okay. Isn't too interested in finding out about new developments because things have been working well so far. Sometimes worries whether the care plan is still right, but feels a little ashamed about asking.

Person B: Meets with healthcare team on a regular schedule. Had a doctor who was difficult to talk to about care, so found a different doctor. Knows that diabetes changes over time and that adjustments to the care plan are common. Keeps up on new products and other developments, and feels comfortable talking about them with healthcare providers. Realizes that ultimately, it's the person with diabetes who needs to understand the scope of their condition.

Maybe you've guessed the answer is person B

Put together a healthcare team
Certified diabetes educator Mary Frederick explains, "When you think about it, the key diabetes therapies-nutrition, exercise, knowing how and when to take medication, understanding the effects of lifestyle changes and stress-all of these are things people with diabetes have to learn to manage on their own. And it's too much for one person to figure out.

"The key thing here is they have to put together a team of experts whose knowledge they can draw on. They need to meet regularly with their primary care physician, a certified diabetes educator, dietitian, podiatrist, dentist, eye doctor and exercise specialist. They need to feel comfortable asking questions and asking for care.

"When it gets down to it, 90 percent of diabetes management is done by the person with diabetes. They really do have to get that 10 percent from their healthcare providers, so they can be successful with their 90 percent responsibility."

Constant change-what diabetes is all about

"People don't fail. Therapies do," says Frederick. "If something about your treatment plan isn't working, it doesn't mean you've done anything wrong. Diabetes changes over time. Medications need adjusting, the diet may need to change. And the medical community is always finding new treatments. That's why it's so important to meet with your healthcare providers regularly, to catch any changes before they become complications."

An active role: a "need-to-do"
"Taking an active role isn't a nice-to-do, it's a need-to-do," says Frederick. "You've always got to be current on what's available. It can really make life easier. For example, with the most recent dietary guidelines, some people may actually be able to eat in a different way."

Then Mary Frederick says something that would strike a chord for almost anyone with diabetes. "Wouldn't it be a shame to miss the opportunity to normalize your eating?"

If you haven't talked with your healthcare team in a while, consider making an appointment with your diabetes educator now. It's a good way to get yourself going in a good direction.

Mary Frederick, Certified Diabetes Educator, February 2002
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