Self-Care Management For Type 2 Diabetes Patients

The Centers for Disease Control and Prevention estimate that 1 in 10¹ Americans has diabetes. Since the condition has no known cure, more than 37.3 million people in the United States live with diabetes.

After the initial diagnosis, people with type 2 diabetes typically develop a self-care management routine with the help of their healthcare providers. Most people with diabetes will only see their health professionals occasionally, so the majority of day-to-day diabetes care is handled by the person living with the condition and their family or care providers. 

Following a type 2 diabetes self-care plan can reduce the likelihood of health complications and improve your quality of life.

What is type 2 diabetes?

Type 2 diabetes is the most common form of this disease. It accounts for about 95% of all diabetes cases, and it's a condition that's becoming even more common. Type 2 diabetes compromises your body's ability to regulate your blood glucose (sugar) levels.

Every cell in the human body needs the energy to function efficiently. Typically, the body obtains this energy by extracting glucose (or sugar) from the energy-rich foods we consume, such as carbohydrates, or from stored fuel called glycogen, which is found in our liver and muscles. 

The glucose is absorbed from the digestive tract, liver, or muscles into the bloodstream. To use this glucose for energy, the body needs a hormone called insulin to transport the glucose inside our cells, where it is metabolized to form energy.

The insulin hormone (along with digestive enzymes) is made and stored in the pancreas, located in the upper abdomen behind the stomach. 

In type 2 diabetes, genetic, environmental, and lifestyle factors can result in damage to the pancreas that then decreases insulin levels in the body. These same factors can also prevent insulin from transporting glucose easily into the cells for energy production. 

This interference with insulin and glucose transport is referred to as insulin resistance. Both the decreased insulin production by the pancreas and the insulin resistance lead to less glucose being transported into cells for essential energy and higher levels of glucose circulating in the bloodstream. 

If left untreated, high levels of blood glucose can cause dysfunction and tissue damage throughout the body. These effects are expressed as different signs and symptoms of type 2 diabetes.

Symptoms

Type 2 diabetes has many signs and symptoms, most of which develop slowly. It can take several years for these to show up. 

The following are the main signs and symptoms of type 2 diabetes: 

• Increased thirst

• Frequent urination

• Increased hunger 

• Unintended weight loss 

• Fatigue/lack of energy

• Blurred vision 

• Slow-healing sores

• Frequent infections

• Tingling, pain, and/or numbness in the hands or feet

• Darkened skin areas around the armpit and neck regions

If you are experiencing any of these symptoms, consult your healthcare professional as soon as possible. 

Who's at risk of developing type 2 diabetes?

Genetics and family history play a very strong role in the development of type 2 diabetes. In fact, there's a stronger link² between family history/lineage and type 2 diabetes than there is between family history and type 1 diabetes.

Environmental and lifestyle factors (such as diet, exercise, stress, pollutants, and climate) also strongly influence the development of type 2 diabetes. Additionally, people above 40 are more likely to develop the disease, although recent studies³ have reported a rise in cases among young people due to the adoption of a more sedentary lifestyle.

The following factors increase your risk of developing type 2 diabetes:

• Obesity or overweight

• Older age

• Type 2 diabetes in family members

• Obesity or overweight in family members

• Being of African American, Alaska Native, American Indian, Asian American, Hispanic/Latino, Native Hawaiian, or Pacific Islander descent

• Lack of regular exercise due to a sedentary lifestyle

• Carrying excess weight around your midsection 

• High blood pressure

• A low level of HDL cholesterol or high level of triglycerides in the blood

• Diabetes in pregnancy (gestational diabetes) or delivery of a baby weighing 9 pounds (4 kg) or more

• Prediabetes

• Polycystic ovary syndrome

Complications of type 2 diabetes

It's important to diagnose and treat type 2 diabetes as early as possible to prevent the many associated complications. If left untreated, elevated blood glucose levels caused by type 2 diabetes can result in: 

• Eye problems, including diabetic retinopathy

• Nerve damage causing loss of feeling and/or nerve pain (diabetic neuropathy)

• Kidney disease

• Heart disease

• Increased risk of heart attack and stroke

• Skin conditions such as slow healing sores and fungal and bacterial infections

• Foot infections and risk of amputation

• Sexual dysfunction

• Hearing problems

• Dementia

Can people with type 2 diabetes use self-care to improve their health?

The terms self-management and self-care describe how a person with type 2 diabetes can take charge of their own daily health care. Both terms refer to your daily routine and the activities you choose to look after your physical, mental, and emotional health. It's important to develop your self-care management routine with the help of your healthcare providers. 

Following a type 2 diabetes self-care plan can reduce the likelihood of diabetes complications and improve your quality of life. Self-care requires knowledge about diabetes, its treatment, and how to adapt to living with a long-term medical condition. 

An efficient diabetes self-care plan combines behavioral changes, enhanced problem-solving skills, and learning how to cope when challenges come up.

Developing a self-care routine allows you to maintain an independent, active, and healthy lifestyle. However, this doesn't mean that you need to do it all alone. Central to your self-care is being able to count on your healthcare professionals, family members, and peers to support your self-management plan. 

Living with diabetes means paying attention to your diet, physical activity, your reactions to certain situations such as stress, and managing your medication. 

An ideal self-care plan includes:

• Access to high-quality information and structured education

• Tailored care strategies that meet your individual needs and way of life

• Supportive people to help you to live well with type 2 diabetes

The American Associations of Clinical Endocrinologists advocates for individuals with type 2 diabetes to become active and knowledgeable participants in their self-care routine.

Likewise, the World Health Organization recognizes the value of teaching people to manage their diabetes. People with extensive diabetes knowledge are better equipped to take effective preventive measures to avoid diabetes-related complications.

People with diabetes should ideally have ready access to helpful information in various formats such as written, electronic, and verbal. Healthcare professionals are trustworthy sources of diabetes self-management information. They can provide context for this information and what it means for you as an individual. 

Self-management support and education are critical for people recently diagnosed with diabetes and those with an established diagnosis. A supported self-care action plan for diabetes management will provide you with the skills and confidence you need to deal with your diabetes.

Benefits of self-care for type 2 diabetes

Following a type 2 diabetes self-care plan has many upsides, including:

• Reducing primary care consultations, outpatient appointments, and diabetes-related emergencies

• Improved communication with your health care providers

• Greater knowledge and understanding of type 2 diabetes

• Reduced admissions to hospitalized and shorter hospital stays

• Less stress, pain, tiredness, depression, and anxiety

• The confidence to adapt to the everyday challenges of living with type 2 diabetes

• Improved blood glucose levels

• Decreased risk of developing diabetes complications 

• A healthier lifestyle and better quality of life 

Type 2 diabetes self-care strategies

Diabetes education is critical, but only if that knowledge translates into beneficial, real-world self-care activities. 

Self-care activities include: 

• Adopting healthier eating habits

• Increasing exercise or activity levels

• Reducing stress or learning how to manage it better

• Decreasing alcohol intake

• Quitting smoking

• Monitoring blood glucose levels

• Regular checks of foot health

• Managing medications

Nutrition and physical activity are core parts of a healthy lifestyle when living with diabetes. Being active and following a healthy meal plan keeps your blood sugar within an optimal range.

Choosing healthy foods

It's only natural for patients with diabetes to worry about eliminating their favorite foods. However, you may still eat the foods you enjoy by reducing the portions or eating them less frequently. Your healthcare team can help you to create a diabetes meal plan.

Typically, your diet should include a variety of healthy foods drawn from all food groups. These include:

• Starchy and non-starchy vegetables: green peas, potatoes, corn, carrots, broccoli, peppers, and leafy greens

• Fruits: melons, apples, bananas, grapes, berries, oranges, and tomatoes

• Grains: whole grains, including 100% whole wheat, oats, brown rice, barley, quinoa, and cornmeal

• Protein: skinless chicken, lean meat, eggs, fish, nuts, beans/legumes/pulses, or meat substitutes such as tofu

• Dairy: yogurt (low sugar or unsweetened varieties), milk, or lactose-free dairy products for the lactose intolerant

Your diet should also include foods with heart-healthy fats such as avocado, salmon, mackerel, tuna, nuts, seeds, and olive or canola oil.

It's a good idea to avoid or limit certain foods and drinks if you have type 2 diabetes. These include:

• Foods high in trans fats or saturated fats (e.g., fatty meats, cream, shortening)

• Processed meats like salami, bacon, sausage, and hotdogs

• Refined baked foods such as cakes, pastries, white bread, and pasta made with white flour

• Highly processed or high-sugar snacks such as packaged cookies and candy

• Drinks or beverages that contain sugar or high fructose corn syrup 

Physical activity

Physical activity is central to your diabetes self-care management. Being active helps to manage your blood glucose levels and keeps you healthy. Combining physical activity with a healthy diet compounds its health benefits. 

Exercise has the following benefits:

• Reduced blood glucose levels

• Less insulin resistance

• Weight loss and weight maintenance

• Lower blood pressure

• Fewer diabetes complications (such as heart attacks and strokes)

• More energy

• Better bone and muscle strength

• Improved mood

• Better quality sleep

The World Health Organization recommends the following activities for people living with type 2 diabetes:

• At least 150–300 minutes per week of moderate-intensity aerobic physical activity

• Or at least 75–150 minutes of vigorous-intensity aerobic physical activity 

• Or an equivalent combination of moderate- and vigorous-intensity activity throughout the week

• Muscle-strengthening activities at a moderate or greater intensity that involve all major muscle groups on two or more days a week

They also recommend that people with diabetes limit the amount of time spent being sedentary - Even light activities such as walking around or standing every thirty minutes have health benefits.

Blood glucose monitoring

Your doctor will advise you on whether or not you need to measure your own blood glucose levels and how to go about this. Self-monitoring allows you to determine the impact of various diabetes self-care activities on your blood glucose levels.  

It also helps you to identify, treat, and prevent hyperglycemia (high blood glucose levels) and hypoglycemia(low blood glucose levels). Self-monitoring enables you to develop the confidence to become independent and feel safe.

Glucose monitoring can be done via finger prick testing with a glucose meter at home. You can keep a record of your measurements and share them with your healthcare team. 

You can also use a continuous glucose monitoring device to record your glucose levels. This device has sensors placed under the skin to monitor your glucose every few minutes. Your information is then transmitted to a mobile device such as your phone and sends alerts when your glucose levels are too high or low. 

Based on your blood glucose readings, you can determine if you need to take action to keep your blood glucose levels within the healthy range set by your doctor. Your diabetes healthcare team members will also be able to review your blood glucose levels over time to determine if you need to make changes to your treatment plan.

Risks of self-care for type 2 diabetes

Self-care for type 2 diabetes mellitus means a lifelong commitment to a care routine to avoid health complications. At times, this responsibility can seem overwhelming, and sometimes it can be difficult to find the resources and support that you need. 

Remember that you can always contact a member of your diabetes healthcare team for help if you're struggling. You may also want to reach out to family members, friends, and other support people. 

Some of the challenges that people trying to self-manage their diabetes face include: 

• Low health literacy: Some people may find it difficult to read or understand medical advice and information. It's important to let your healthcare professionals know if you're finding it difficult to take in the information provided. They can help to make the information easier to understand and implement.  

• Housing challenges: Patients without access to adequate housing might face challenges storing their medication or accessing a kitchen in which to prepare healthy meals. People in some urban areas also lack access to appropriate outdoor or other spaces where they can exercise. 

• Food security: Some people with type 2 diabetes mellitus lack access to fresh, healthy foods that are rich in minerals and vitamins. Low income or food insecure households may rely on cheap, processed foods high in carbs and low in nutrients.

• Income: Low-income households may not be able to afford quality healthcare or transportation to medical appointments. Some people are also unable to take time off work or leave dependents to attend appointments. 

If you ever feel that you're struggling to manage your diabetes, there are many ways to ask for help. You can contact a member of your diabetes healthcare team, reach out to family or friends, or join a type 2 diabetes support group. Or speak with a mental healthcare professional. 

The lowdown

There's currently no cure for type 2 diabetes, but remission (or "reversal") may be possible for some people. By working closely with your doctor and the other members of your diabetes healthcare team, you can help design a treatment and self-care plan that suits your individual needs. 

Lifestyle changes, monitoring, and medication can all help to improve your type 2 diabetes. Following a type 2 diabetes self-care plan can reduce the likelihood of diabetes complications and dramatically improve your quality of life.