Type 2 Diabetes Management " Carol a 47-year-old woman "

Case study ( 4492 views as of July 21, 2017 )

 Carol, a 47-year-old woman, is generally healthy. She has a history of being athletic, but a long-term knee injury has decreased her ability to exercise. Carol has gained 28 pounds over the last five years. She has been too busy to exercise since having her children and running her own small business.

Carol visits her family physician and complains of fatigue, frequent urination and visual blurring. Her past history includes two prior pregnancies. Her youngest child weighed 9.7 lbs (4.4 kg) at birth. She is not on any prescription medications. Her menstrual cycle has been irregular for the past 4 years since she started gaining weight. There is a family history of type 2 diabetes in both of Carol's parents.

A physical examination reveals Carol's blood pressure is 140/85 mmHg. Her BMI (body mass index) is 29. Carol has increased central body fat with an abdominal circumference of 95 cm. Laboratory investigations reveal a fasting blood glucose of 9.8 mmol/l (176 mg/dl) and a HgA1c of 8.2.

Carol is referred both to a Registered Dietitian and a Nurse working as part of a dedicated diabetes centre. She learns the fundamentals of diabetes management including a balanced meal plan. An exercise prescription is given to her. Her fasting blood sugars are elevated on repeat testing and she is prescribed metformin to reduce high sugars.

Carol could also benefit from regular follow-up with her family doctor and endocrinologist, as well as a personal trainer to help her adapt and progress with her exercise program. Carol could also consider speaking with her local pharmacist to understand the medication she has been prescribed and identify any contraindications.

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Conversation based on: Type 2 Diabetes Management " Carol a 47-year-old woman "

Type 2 Diabetes Management " Carol a 47-year-old woman "

  • K. Michael, Diets that are free of grains (such as the Paleo diet) can be easier to follow than you might think. It would be most helpful to have a holistic nutritionist / nutritionist help you to adjust to such a diet, if recommended. He/she would be able to advise you and simplify the process for you.
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    • Is there supplementation with vitamins, etc that can help people who need to get the required amounts of fibre and B vitamins if they follow grain-free or gluten free diets?
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    • Since whole grains are a very good source of fiber and vitamins, especially the B vitamins, how would you recommend someone on a grain-free diet get their requirements of these nutrients?
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  • Diets free of grains, starchy carbs and sugar, such as The Paleo Diet (with more emphasis on plant-based foods and keeping meat to a minimum), grain-free diet and Ketogenic Diet have shown to be beneficial for managing blood sugar and controlling diabetes type one and two.
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    • It would be difficult for most people to adopt such a drastic change, at the same time as adapting to the other changes necessary with a diabetes diagnosis. Is there a gradual process one can follow to work towards eating a Paleo Diet ?
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  • Type 2 diabetes is an epidemic, largely driven by the epidemic of obesity, and in fact 90 percent of individuals with type 2 diabetes are either overweight or obese.
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  • With circulation, and decrease of circulation specifically with diabetes, comes many problems, including nerve damage and peripheral vascular problems at the bottom of the feet and fingertips.
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  • It differs a little bit depending on your ethnicity, but as it goes up and it gets into the high 20s and definitely beyond the 30s, it starts to carry with it a lot of medical risks. The medical risks of obesity include an increased risk of vascular disease, heart attack, stroke, peripheral vascular disease, an increased risk of cancer of the reproductive organs and colon cancer, amongst others, an increased risk of mortality directly associated with the degree of obesity
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    • The absolute easiest way that we’ve found is the insulin pen delivery. It’s really very simple to use and handle. It actually comes apart, just like a pen. It’s very simple. You can carry it around with you when you’re at work or at home and to the restaurant. So you just take it apart. You just open it up like that.
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  • Having diabetes should not limit your life. She needs to learn how to manage her family life and health to ensure she is feeling the best that she can. Taking the time to exercise and get herself into better shape will assist with managing her diabetes. A diabetic is not limited to what they eat, however they need to know how to control their intake to ensure their blood sugars are kept at a healthy level. This is something that will be present for the rest of their life and they need to understand the day to day management.
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    • In a way it's learning to eat all over again. Not that you can't have your favorite foods but that you have to plan accordingly in order to enjoy them. It's why it's so very important to consult a dietitian after a Diabetes diagnosis
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  • Carol needs to take this diagnosis as a wake up call to prioritize herself and her health. While busy with work and kids she needs to carve out some time to look after herself. She needs to develop a modified exercise plan and take the time needed to plan and prepare healthy meals on a daily basis. Her kids and business may need her but they need her strong and healthy.
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    • She would also be setting a good example of healthy eating for her children.
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    • The reality of a diagnosis like Diabetes is that if you don't take care of it and yourself, you might not be here for your family
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  • There is a misconception that people who have diabetes can never enjoy sweets, but this is not the case. With careful carbohydrate intake monitoring no foods are actually forbidden.
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    • I had gestational diabetes and found that I could eat any sweets I wanted and my blood sugar level would be fine. However, if I had just a nibble of white bread my levels would shoot right up.
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    • @john - great point! This is where a dietitian, nutritionist or naturopathic doctor can be really beneficial in helping individuals with Type 2 diabetes understand how they can incorporate all different types of food into their diet.
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  • Diabetes is a lifelong disease that affects how your body makes or uses insulin. In people who don't have diabetes, insulin is released after eating to regulate blood sugar levels, and allows glucose from the blood to enter the cells. However, in someone with diabetes, this process doesn't work properly and glucose begins to build up in the blood. This build up can have a variety of damaging effects on the body. High glucose levels for example, can damage nerves most commonly in the feet which can resulti in loss of sensation, and can also damage small blood vessels in the eyes causing vision loss. It is therefor essential to learn how to control blood sugar levels in order to maintain good health long term.
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  • For diabetics, it's essential to stay active and fit for an additional reason: effective diabetes management. Some of the benefits of a diabetes exercise program are better regulated blood sugar levels, weight loss, and improved cardiovascular health.
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    • After diagnosis a family member was told to become more active, as they were retired and not getting out and moving as much as before. By changing their food intake and becoming more active their blood sugars are more controlled and they find it easier to function on a day to day basis. Diet and exercise it key.
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  • Referring Carol to a yoga instructor or pilates instructor would also be great ideas as these types of activity have less impact on the joints but are still amazing in terms of their health benefits.
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  • Exercise is another key piece in diabetes management. Although Carol has had a knee injury that has decreased her ability to exercise, a physiotherapist or personal trainer would be able to help suggest activities that are best suited for Carol's situation.
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  • Learning about the glycemic index of foods could really help people with Type 2 Diabetes. It would help them manage blood sugars and likely eat healthier foods and snacks as well.
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  • Taking advantage of allied health professionals can be invaluable in diabetes management. There are dietitians who are Certified Diabetes Educators and can even adjust insulin dosages for a patient, and are often very helpful in complimenting your family physician's treatment plan. A structured exercise program is also suggested to help control blood sugars and improve diabetes risk factors.
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    • Educating the patient is so important. Knowledge is power!
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    • Certified Diabetes educators can not only help with blood sugar control but can also help adjust people's diet to help them lose excess weight. Even losing 10% of ones body weight can have significant benefits on blood sugars for someone who has Type 2 diabetes.
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    • Agreed, support from professionals can empower patients to change and more importantly, maintain these changes for life.
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    • Working with a professional would be helpful for anyone with a diabetes diagnosis. It really is a disease that takes a full lifestyle change
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  • When my mom was diagnosed with Type 2 diabetes she immediately starting following a diabetic diet. She lost 20 pounds in 6 months just by following this diet. It is now no longer a diet but just how she eats.
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  • I think the above article reminds us to slow down and take care of ourselves. A little self care right now, in the form of healthy eating and exercise, can help reduced your changes of developing type 2 diabetes. To be proactive if you have a family health history or are at risk due to obesity you should contact your diabetes educator to see what you can do now to reduce your chances of developing this disease.
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    • @dbutchar - following a healthy eating plan, as recommended for those with type 2 diabetes, usually results in weightloss which will help with her overall health
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  • Metformin for the treatment of Type II diabetes may have certain side effects. Carol is best to take starchy foods in moderation as these can cause abdominal discomfort.
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    • I've heard that Metformin often causes people to lose weight, which is one of it's benefits apart from controlling blood sugars.
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    • @kimberley, yes, for diabetic patients, starchy foods are best in moderation with or without metformin. However, starchy foods with metformin can cause abdominal discomfort.
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    • @yuan lew - aren't starchy foods best eaten in moderation with type 2 diabetes as they can cause blood sugar spikes ?
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