by Elizabeth Close, MD
It is very important for everyone with diabetes to understand the tools they have to manage their blood sugars well. You would never trust your car to a mechanic who could not tell you how to use a wrench, so why would you leave your diabetes to inexperienced hands? To your hands without KNOWLEDGE!
Of course, it goes without saying that taking the medications your Doctor prescribes is the very first step. If you are not taking your medicine, it cannot work. I know there are many frightening side effects and warnings for every medication . . . on the internet, on print outs from your pharmacy, in television commercials, and even passed by word of mouth. But if you have concerns about any of these, please ask your doctor or pharmacist to clarify your concerns instead of stopping your medication. Most diabetes medications have very few significant side effects, and using them is much safer than leaving diabetes untreated!
Knowing how your medication works to control your diabetes is essential. For instance, pills cannot be used to treat dangerously high blood glucose levels or ketoacidosis in the same way that rapid or short-acting insulin can. And high blood sugar levels while taking only pills means that adjustment needs to be made to your medication or that insulin may need to be added.
Your doctor should become your partner in managing your diabetes, and to do so, they need to know what medications you are taking. When medication adjustments are made, under the assumption that you are taking them exactly as they are prescribed, your dosages could be raised or lowered based on false information. . . So it is very important to tell your doctor exactly how, when, and if you are able to take your medications. Not telling your Doctor what you are taking could result in overtreatment, and be especially harmful to you during times of hospitalization. Honest communication is essential to successful management of your diabetes!
It is important to tell your Doctor about all the medications and treatments you are taking, because there are many medications and conditions that can affect your blood glucose control. Some medications, such as steroids, can cause your blood sugar to rise very rapidly. Infections or serious illness can also cause blood sugar levels to rise. Decreases in your food intake, or increased activity can lead to very low blood glucose levels, if medication and insulin dosages are not adjusted . . . which brings up a most relevant point. . . Lifestyle changes are truly "medication" with few if any negative side effects! Particularly for people who have Type 2 Diabetes, who are often able to eliminate their need for "pills" altogether through use of diet, exercise, and other Healthy Choices.
As you age with diabetes, however, you are likely to find that your blood glucose levels are not as easy to manage. . . Even for those who were very successful in the beginning because they chose to make Healthy Choices, and take their medication as directed. When this happens for you, please know that it is NOT a failure on your part. Diabetes is a progressive disease, and the need to take insulin or additional medication should never be considered a reason to believe you have failed, or a reason to give up on previous efforts! Age, coexisting conditions, use of multiple medications, and numerous other factors change how your body metabolizes medication. Your pancreas simply wears out and loses its ability to secrete insulin, and insulin replacement becomes necessary. What matters more than anything is keeping your blood glucose levels under the best control that is possible for you, because UNCONTROLLED diabetes is your enemy . . . Not Insulin!
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Diana Guthrie PhD, ARNP, FAAN, CDE, BD-ADM, AHN-BS, CHTP