Effective Strategies for Diabetes Management and Overall Wellness

Wellness in Diabetes Management?

As an owner of a diabetes practice, I am frequently judged by the way I handle “wellness”; in that I separate it from the “diabetes” conversation.   Though I believe that it is important for us as humans to eat right and be active; why should that same conversation come up on how to control diabetes as the main focus?  Are they one in the same, as people think?  Not to me.  To me how I control a patient’s glucoses COULD be with a component of lifestyle, but let’s not forget the genetics that got them there.   There are people who can eat what they want, be couch potatoes, and have zero health deficiencies.  But then there are people who eat super strict and work out probably WAY too much and still have issues losing weight or end up with a heart attack or high blood pressure.  Why?  Genes.  Plain and simple.

So, if genes are why we have diabetes, why would I focus more on the food and activity and not the cause of the diagnosis in the first place?   With my type 1 patients, sure I want them to eat healthy and be active, because if we are working so hard on controlling glucoses to reduce risk of complications later in life; why would we not do so when talking about issues like complications of being overweight?  But they are not one in the same.   I cannot control glucose alone in patients with Type 1 with food.  I do that with insulin.   I don’t need to food shame them when they already have plenty of literal critiquing of their own food day in and day out.   The average person wouldn’t spend 1/8 of their time thinking in detail about food the way someone with diabetes has to.  We have to be careful how much attention we have on food as it relates to controlling glucoses, otherwise, the wrong mental connection happens and the right focus (insulin) is missed. 

So what about my type 2 patients?  Surely food is a conversation with all of them too right?  Half yes and half no.   I still do not believe that food and activity is what got them to where they are.  The fact that their body likes to store glucose and insulin in fat cells rather than using it is going to happen until we control the cause.  Now, if they eat excessive carbs, more excessive insulin will be made, and more fat cells will be needed to store all of this excess.  So, yes, food is a conversation along with activity.  But again, the cause must be addressed.  I have had far too many very frustrated patients living with diabetes coming into my practice wanting reprieve from the monotonous “just stop eating carbs, just start exercise more” mantra that is not getting them anywhere.  

Instead, lets all agree that genes are horrible.  We can blame our parents, grandparents, great grands, ancestors, etc.  But we have them and they predispose us.  Once they become active in our body it is important to address not just how we live but how we medically need to take care of ourselves.  For some people, healthy eating (NOT dieting) and exercise is enough.  For some, we need that plus other medical intervention to stop excessive weight gain (caused by their insulin resistance).

So do I address wellness in every diabetes visit?  No.  Do I think it is important.  Sure.  But I also believe I need to meet each patient where they are.   If they barely remember to take their insulin at meals, or are brand new at carb counting, is it ok to push further and add complex meal planning to their instruction?  What will be missed the food or the medication?  Yep, you got it!  The medication 100% of the time.   It’s just too much.   It is time to realize that people with diabetes (type 1 AND type 2) did not do something to get themselves here.  They were born with genes that predisposed them.  

So as healthcare professionals, our job is to control the disease and SEE the person.   If you feel wellness is needed, address it.  But do so at the right time, in the right mindset, with the right words.   Patients and caregivers will appreciate the time and attention given to the individual rather than the number.