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Better blood glucose control has gained significant attention since the release of the landmark Diabetes Control and Complications Trials (DCCT). The study emphasized the importance of good control in helping patients feel better, and ultimately enjoy a better lifestyle. Here are seven steps that will help you gain greater control of your diabetes management.
Blood Glucose and Hemoglobin A1C Testing
Blood glucose testing gives you important feedback for making immediate and day-to-day adjustments in your diabetes management. The hemoglobin A1C (HbA1c) test shows you your average blood glucose over the last 60 to 90 days. Both types of testing are necessary with insulin pump therapy.
Treating Hypoglycemia (Low Blood Glucose)
Hypoglycemia, or low blood glucose (BG) levels, cannot be completely avoided on insulin pump therapy, however, most people find that they occur less often and are less severe than with insulin injections. In fact, clinical studies show that BG lows can be reduced by as much as 75%1 when using insulin pump therapy.
It is important to establish a routine for when your blood glucose is low. Have something available to treat a low and you are less likely to overtreat and raise your glucose levels too much.
Treating Hyperglycemia (High Blood Glucose)
High blood glucose can occur while using the pump for the same reasons it did when you were not on the pump, including some situations that are unique to insulin pump therapy:
The goal of treating hyperglycemia is to prevent Diabetic Ketoacidosis (DKA) and delay or prevent diabetes complications due to high blood glucose over an extended period of time.
Sick Day Management
Managing diabetes during an illness or infection requires frequent blood glucose and urine ketone testing. Illness and infection put extra stress on the body and often raise blood glucose. An insulin pump allows you to make adjustments to quickly and easily respond to illness and infection.
When you are sick, it is difficult to take care of your diabetes, but, unfortunately, you must. If you are too sick to monitor your diabetes carefully, ask a friend or family member to help. If there is no one to help you, ask your healthcare provider for assistance.
Nutrition and Carbohydrate Counting
Insulin pump therapy allows you to be flexible with your food choices. Since there is no long-acting insulin dictating when, what or how much you eat, there is no reason to be rigid concerning your diet. By understanding the nutritional content of the food you eat, you will be able to take insulin accordingly to maintain blood glucose control.
Carbohydrates have the greatest effect on blood glucose, especially within a few hours of being eaten. Counting carbohydrates allows you to match your insulin dose to the food you are eating. Although fat and protein can affect your blood glucose when eaten in large amounts, it is the carbohydrates that affect blood glucose the most.
Using an insulin pump during exercise allows you to reduce your basal rate instead of eating carbohydrates to compensate for the lowering effect exercise often has on blood glucose. Your body needs insulin and carbohydrates to use glucose for energy during exercise. How much you need to reduce your insulin and how many carbohydrates you need to eat varies with different types of exercise and with how often you exercise. It takes trial and error to get the balance right.
It is important to keep in mind that the body needs insulin during exercise; therefore, it is not recommended that you discontinue using the pump unless the exercise is of short duration (1 hour or less).
Managing Infusion Sites
It is important to be proactive about keeping your infusion set healthy and your insulin, reservoir, and infusion set fresh. With a little care, you can take full advantage of the benefits of insulin pump therapy and avoid serious problems.
A few simple principles can significantly improve your results: