Dustin: I was wondering if you could tell me about the things that you do to stay healthy and keep your diabetes under control so I can check on mom and see if she is doing the things that she is supposed to. I always see you writing stuff down when you are testing your blood sugar on that little machine. What are you writing down?
Grandma: Oh, I'm keeping records. It is one thing that I do to help control my diabetes. When I found out that I had diabetes, I had to start to test myself at home. The two main things that I record are my blood glucose level and the things that I eat every day. I also keep track of my weight and when I exercise. When I first started testing myself two to four times a day, the records helped me understand more about how food, exercise, and the medications that I was taking affected my blood sugar level. Keeping records of all these things also told me what I was doing wrong in the times that my blood glucose was high.
Blood Glucose- The main sugar that the body makes from the food we eat. Glucose is carried through the bloodstream to provide energy to all of the body's living cells. The cells cannot use glucose without the help of insulin.
Dustin: Why do you keep all of those records?
Grandma: It really helps out when I go to the doctor on my check-ups. The doctor can see what I've been doing and how my blood glucose has reacted. Then he can modify my diet, exercise, or medications based on the records I am keeping.
Dustin: Do you have to make changes in your diet?
Grandma: Yes I do. I have to have a good balance between what I eat and drink, the exercise that I do, and the medicine that I take. I have to eat regular meals, and I can't skip meals. Also I need to eat a variety of foods, and I need to eat less fat, sugars, and salt.
Dustin: I know that you walk to the store to get groceries, but what other kinds of exercise do you do?
Grandma: Exercise is also an important part of my diabetes control. Exercise helps me keep my blood sugar down, control my weight, and also helps with preventing heart and circulation problems. I had to ask my doctor what kind of exercise was right for me. Since I am an older woman, walking is probably that best type of exercise for me but I also go picking berries and I pull weeds in my garden all of the time. Long ago the doctor told me about the things that I had to remember when I first started to exercise. I remember him telling me to start with a little exercise at a time. I tried to do some exercise every day since it was better for me than to exercise once a week really hard. I also picked an exercise that I liked. This way I would be having fun and not thinking that I had to do it, causing me not to. He also told me that as I felt stronger I could increase the minutes that I exercised.
Dustin: I heard from a classmate that diabetes could make you go blind. Is that true Grandma?
Retinopathy- A disease of the small blood vessels of the retina of the eye in people with diabetes. In this disease, the vessels swell and leak liquid into the retina, blurring the vision and sometimes leading to blindness.
Grandma: Yes, that is true, diabetes can make you go blind, but I found out that people with diabetes who keep their blood sugar down or close to normal are less likely to get retinopathy, and if they do get this eye disease they don't get it as bad. I have to go to the eye doctor every year to get a special eye exam. The doctor puts drops in my eyes so he can see the blood vessels better, to find out if I have the early signs of retinopathy.
Dustin: Can you help stop retinopathy?
Did you know?
The American Diabetes Association says that smoking damages and constricts the blood vessels and that this damage can worsen foot ulcers and lead to blood vessel disease and leg and foot infections. They also say that of the people with diabetes who need amputations, 95 percent are smokers.
Grandma: Yes, good eye care can help prevent this and other eye diseases. I keep my blood sugar down. I also keep my blood pressure down because high blood pressure can make problems worse. One big change was that I had to quit smoking. I found out that besides increasing your chances of getting cancer, smoking causes a lot more problems when you have diabetes. Smoking increases the blood sugar so it is harder to control the blood sugar level. It also increases the blood pressure. In some studies, it has also increased the chances to get retinopathy.
Dustin: Do you know what to watch out for?
Grandma: Yes, I have to watch out for things like: if my vision goes blurry, or if I have trouble reading signs or books. I also have to look out for things like: if my eyes hurt, if I feel pressure in my eye, or if my eyes get red and stay that way for a while. There are some other warning signs, too, like: if I see spots or flashing lights, if straight lines don't look straight, and if I can't see stuff from the side like I used to.
Dustin: What happens if you get retinopathy?
Grandma: There are treatments for diabetic retinopathy. The doctor may do laser surgery to stop the bleeding in the blood vessels in the eyes.
Dustin: Why do you have to check your feet all the time?
Grandma: When I was first diagnosed with diabetes, the doctor asked to look at my feet. I did not know what he was doing until I found out that I really need good foot care. He told me that I have to have my feet checked at least four times a year. I learned how to take care of my feet at home, checking my feet daily, looking for scratches, cracks, cuts, or blisters. I also have to check between my toes and on the bottoms of my feet. As I got older, I had to have someone check my feet for me because I couldn't see them as well.
Dustin: What do you do if you find a cut or a blister?
Grandma: Well, I wash the wound with soap and water. I don't put on a band-aid or any kind of tape because it may irritate the skin. Then I watch it daily and if it doesn't get better in three days, I go to the doctor.
Dustin: Is that one of the reasons you are always washing your feet, too?
Grandma: Yes, it is.
Dustin: Wouldn't it just be easier to just soak your feet and chill out in front of the T.V.?
Grandma: I can't soak my feet because soaking them will make them dry and can lead to additional infections. If I did have dry feet, I could put lotion on them, but not in between my toes because it could cause germs to grow that could lead to infections because of the moisture.
Dustin: Do you have to cut your toenails different?
Grandma: A nurse showed me how to cut my toenails. She said not to cut into the corners of my toes. She also said that she could cut my toenails if I couldn't do it myself. She also told me to never cut corns or calluses and not to use razor blades, corn plasters, liquid corn, or callus removers because they may irritate the skin on my feet.
Dustin: Why do you wear socks all of the time? Even in the summer when it is really hot.
Grandma: I need to wear socks and shoes all the time to protect my feet. I have to make sure that my shoes fit well and are comfortable, and that my socks aren't too tight. I also have to check the water that I put my feet into. I test the water with my elbow first. This is because when you are a diabetic your feet may get numb, and you will burn or freeze your feet if you don't test the water first. When my feet are cold at night, I just wear socks to bed to keep them warm. I also check my shoes for sharp objects that might be in them that may hurt my feet.
Dustin: What can you do to help your feet from getting numb?
Diabetic neuropathy- Damage to the nerves of a person with diabetes. Nerve Damage may affect the feet and hands, as well as major organs.
Grandma: To help prevent nerve damage or diabetic neuropathy, I have to do some of the same preventive measures as for the other complications. For example, I have to keep my blood pressure under control because high blood sugar can damage nerves over time. I also have to check my feet for changes, to be active, and to exercise because this is good for the nerves in the feet. I also learned that there are tests for nerve damage and that I have my feet checked each visit because I may be unaware of the nerve damage.
Dustin: Does diabetes make you have heart problems, too?
Grandma: To help to prevent the problems of the heart and blood vessels, the doctor told me to eat right and to get exercise. He also told me to quit smoking. He also told me to check my blood pressure and cholesterol.
Dustin: Are there any other problems that diabetes does to your body?
Grandma: Other organs that uncontrolled diabetes can damage are the kidneys. When the kidneys become damaged, they cannot filter blood anymore, causing waste products to build up in the blood. When the kidneys become damaged there are treatments that people can get to help them. They may need to go on dialysis like your Aunt Ruth or they may need to have a kidney transplant. The doctor told me that diabetes causes problems with my kidneys, but there are ways to prevent and control kidney problems.
Dustin: What are they?
Blood pressure- The force of the blood against the artery walls. Two levels of blood pressure are measured: the highest, or systolic, occurs when the heart pumps blood into the blood vessels, and the lowest, or diastolic, occurs when the heart rests.
Grandma: Well, I need to keep my blood sugar under control because high blood sugar levels can damage the kidneys over time. I also have to keep my blood pressure under control. The doctor said if my blood pressure was too high I may have to start monitoring my blood pressure at home to make sure it is under 140/90. If my blood pressure is too high, then he may have to give me blood pressure pills to help keep my blood pressure down. I also have to choose healthy foods. I have to cut back on foods high in protein and eat less salt so that I can keep away problems that may damage my kidneys. I drink lots and lots of water. It helps dilute the blood that passes through the kidneys. You know, Dustin, there is one other problem that I never thought of when I got diabetes. Can you guess what it is?
Dustin: No, but you can tell me.
Grandma: One thing that I didn't think about when I was diagnosed with diabetes was the problems with gum disease. The people that I talked to on how to care for myself told me that I have to have proper teeth and gum care to help prevent gum disease. They told me to keep my blood sugar in control, and to brush and floss my teeth often. They also told me to get regular care and to have my teeth cleaned at least every six months. There were things that I had to watch out for.
Dustin: Like not being able to chew your dry meat?
Grandma: Yes, and other things like bad breath, a bad taste in the mouth, bleeding or sore gums, and sore or loose teeth.
Dustin: Do you have to do things different when you get sick?
Grandma: Yes, sick days can be very stressful times. When I get sick, my body is under a lot of stress. When my body is under stress my blood sugar may rise. Being sick can make my diabetes go out of control. Your mom should have a sick day plan with her doctor before she becomes sick, like I do.
Dustin: What kind of plan do you have?
Grandma: I have to be sure to keep taking my diabetes medications. I need to keep taking them even though I can't eat. Sometimes my doctor may even have me take more of my medications when I get sick. I need to try to eat my regular diet. If I can't do that, I try to eat the same amount of fruits and breads as I usually do. If I can't do either of these, I use what is called food exchanges.
Dustin: What are food exchanges?
Grandma: Food exchanges are measured portions of foods that can be eaten in exchange for another type of foods. I try to eat enough soft food and liquid food exchanges that take place of the fruits and breads that I usually eat.
Dustin: What else do you do?
Grandma: I drink a lot of liquids. More that usual. These liquids that I drink should have no calories. I try to drink at least 1/2 cup to a 3/4 cup every half-hour to hour. Some good choices on what to drink are water, diet soda, and tea without any sugar. I also need to check for changes in my blood sugar, ketones, weight, temperature, and how I am breathing and how alert I feel. I test my blood sugar for changes at least every four hours. If my blood sugar level is 240 mg/dL or higher it is a good idea to check my urine for ketones. I weigh myself every day to find out if I am losing weight while I am sick. Losing weight without trying is a sign of high blood sugar. I also check my temperature every morning and evening because a fever may be a sign of infection.
Ketones- Chemical substances that the body makes when it doesn't have enough insulin in the blood. When ketones build up in the body for a long time, serious illness or coma can result.
Dustin: Are there ways to help you prevent getting sick?
Grandma: Yes, there are ways. One way is to keep up to date with my vaccinations to help prevent some sickness like the flu.
Dustin: There are probably things that you should watch out for when you are sick too.
Grandma: Yep, the doctor told me I should call the clinic or go to the emergency room if any of these things happened: if I couldn't keep food or liquids down for more than six hours or if I felt so sick that I couldn't eat normally. Also, if I had severe diarrhea, if I lost five pounds or more without trying, if my temperature is over 101 F, or if my blood sugar level is lower than 60 mg/dL or stays over 300 mg/dL.
Dustin: Boy, grandma, that is a lot of stuff to remember. How do you remember all of that information?
Grandma: Well, after doing these things to help with my diabetes for 20 years, it becomes a habit, but I do have pamphlets that I can look at to remind myself.
Dustin: What kinds of pamphlets do you have?
Grandma: I have ones on, all of the topics that you and I just talked about.
Dustin: Do you have one on exercise?
Grandma: No, but on the way to the hospital we can stop at the tribal fitness center to see if they have some pamphlets on exercise.
Dustin: Yeah, I would sure like something on exercise so I can know what I can do with mom to help her start to exercise.
Grandma: Well shall we be going?
Dustin: Yeah, can I drive?