Purpose: Teach behavior modification for successful management of diabetes.

About 7.5 million people suffer from diabetes in the United States. While diabetes occurs in people of all ages and races, it is more prevalent amongst the African Americans, Latinos, Native Americans, and Asian Americans/Pacific Islanders.In type 2 diabetes the body either does not produce enough insulin or the cells just cannot use it efficiently. The food we eat is converted into glucose. Glucose is the basic fuel for the cells in the body. Insulin transports the glucose from the blood into the cells so they can use it for energy. In diabetes the glucose cannot be transported into the cells because of lack of, or insufficient insulin- so glucose levels rise in the blood. The high blood sugar levels give rise to multiple Complications of the heart (coronary artery disease), kidneys, nervous system (neuropathy), and eyes (retinopathy); and the cells get starved because their fuel is not getting transported into the cells.

There are several studies that show that proper management of diabetes can reduce cardiovascular risk factors and delay diabetes related morbidity. According to the American Diabetes Association (ADA) goal for glycemic control is glycosylated hemoglobin (A1C) less than 7%. A 1% reduction in A1C has been shown to decrease microvascular and diabetes related complications.

The management guidelines for type 2 diabetes suggest:

1) glucose control with diet and medications,

2) lifestyle modification, such as low starch and low fat diet, and

3) modest weight loss with exercise, up to 5 to 7% of initial body weight

Overweight is defined as Body mass index (BMI) of 25 to 29.9 kg/m2

Obesity is defined as a BMI of equal to or greater than 30.0 kg/m2.

In addition waist circumference is helps in evaluating the diabetes risk amongst the diabetics.

Self management behaviors:

The American Association of Diabetes Educators (AADE) have identified seven behaviors that are essential for self management of diabetes. These are:

1) eating healthy- making healthy food choices, understanding portion sizes and learning the best times to eat are key to diabetes management. The ADA recommends the following food pyramid guidelines and servings per day for healthy eating:

- grains and starches (6 to 11 servings)-------one serving is the approximately less than the size of palm of your hand

- vegetables (3 to 5 servings)

- fruits (2 to 4 servings of fresh fruits)

- milk and dairy (2 to 3 servings)

- meat (4 to 6 ounces)

- fats, sweets, and alcohol (use sparingly)

2) Exercise or being active-Modest regular activity improves insulin sensitivity and glucose control, Frequency and duration of exercises can be increased gradually to an hour a day for at least 3 alternate days a week.

3) Monitoring- Daily self-monitoring of blood glucose helps to assess how food, physical activity and medications affect your blood glucose levels. People with diabetes also need to regularly check their blood pressure, urine ketones and weight.

4) Medication compliance-Effective drug therapy can lower blood glucose levels as well as  reduce the risk for diabetes complications.Diabetics should be knowledgeable about each medication, including its action, side effects, efficacy, toxicity, prescribed dosage, appropriate timing and frequency of administration, effect of missed and delayed doses and instructions for storage, travel and safety. Goal is to achieve a fine balance between achieving optimal glucose control, and preventing and managing hypoglycemia (low blood sugar). Ask your doctor or Ask the Pharmacist for more help.

5) Problem solving: Diabetics should keep their problem-solving skills sharp because even after decades of living with the disease, stability is never fully attained. Diabetes is a progressive disease, and with aging and changing life situations -different chronic complications continue to emerge. Different complications bring different challenges with them.

6) Risk reduction: Diabetics must target towards smoking cessation, and regular eye, foot and dental examinations in order to reduce diabetes complications and to maximize health as well as quality of life. Make Your Body's Well Being a priority. The time you spent on eye care, foot care and skin care, as well as your heart health and oral health, will delay or prevent the onset of dangerous complications of diabetes later in life.

7) Healthy coping: Psychological distress dampens one's motivation to keep diabetes under control, and the commitments required for effective self-care are difficult to maintain. So seek support from your family or support groups around you to help address your Common Concerns and fears. They can help you learn what you can control and offer ways for you to cope with what you cannot.

More Health Information For Men and Women and Diabetes are available at the ADA website.