Quality of Life with Diabetes

More than 34 million Americans have diabetes and require a lifetime of treatment. You are not alone. Diabetes requires daily self-management. At times, this can be challenging. But the benefits are very real.

• Knowledge and awareness are at the heart of good diabetes self-management
• Self-empowerment is the key to success. A positive approach can help you feel better and reduce your risk for complications.

Diabetes educators can provide you with the support you need. They are healthcare professionals who specialize in the care and education of people with diabetes. Diabetes educators include nurses, dietitians, doctors, exercise psychologists, and social workers.

Yes. How you took care of your diabetes ten years ago is different from how you should be taking care of it today. Diabetes care has changed over the past ten years. The dose of medicine you were taking in the past may not be correct today. Also, as you age and grow older, your health needs will change, too.

You are not on one therapy forever. Having regular screenings, checkups, and education is important. It helps you and your healthcare team know which therapy is most helpful for you.

• When diabetes is not well controlled, the level of sugar in your blood goes up. High blood sugar can cause damage to many parts of your body, including your eyes, heart, feet, nerves, and kidneys.
• Diabetes can also cause high blood pressure and hardening of the arteries.

• Your kidneys contain filters that are filled with tiny blood vessels. High sugar levels in the blood can cause these blood vessels to become narrow and clogged. When the filters do not get enough blood, less waste and fluid is removed from your body.
• Diabetes can also cause damage to nerves in your body, making it hard to empty your bladder. The pressure caused by this may injure the kidneys or cause infection.

If you have kidney disease, it means your kidneys are damaged. Kidneys can become damaged from a physical injury or a disease like diabetes or high blood pressure. Healthy kidneys do many important jobs. Among other things, they filter your blood of waste and extra water, and help your body make red blood cells. But once the kidneys are damaged, they cannot do these jobs well enough to keep you healthy. Over time, this loss of kidney function can become life-threatening. It can lead to kidney failure. If you have kidney failure, you will need lifetime treatment with dialysis or a kidney transplant.

The best way to find it is to be tested for it. People with diabetes should be tested for kidney disease at least once a year with two simple tests:

• A simple urine test checks to see if you have protein in your urine. Your body needs protein. But it should be in the blood, not the urine. Having a small amount of protein in your urine may mean that your kidneys are not filtering your blood well enough. Having protein in your urine is called "albuminuria." This can be a sign of early kidney disease.
• A simple blood test to estimate GFR (glomerular filtration rate). Your GFR number tells you how well your kidneys are working. Your GFR is estimated from a simple blood test for a waste product called creatinine. Your creatinine number is used in a math formula along with your age, race, and gender to find your GFR.

About one-third of people with diabetes will get kidney disease. Diabetes is the leading cause of kidney disease and kidney failure. Some groups of people, such as African Americans/Blacks, Hispanics, and Native Americans have a higher risk of developing kidney disease and kidney failure from diabetes. But there are steps you can take to lessen your risk. Not everyone with diabetes will get kidney disease.

• Getting treatment for your diabetes and doing all you can to self-manage your diabetes may help keep you from developing kidney disease.
• Keeping your blood sugar in control can help keep you from getting kidney disease. Having high blood sugar is a major risk factor for diabetes.
• High blood pressure is one of the major factors that puts people with diabetes at risk for kidney disease. Keeping your blood pressure at the level your doctor suggests can help stop you from getting kidney disease.
• Getting tested regularly for kidney disease is important because early detection and treatment of kidney disease may help slow or even stop it from getting worse.

Yes. If you have diabetes, you will need to manage your diabetes on a daily basis. To do so, you should learn self-management skills and practice self-care behaviors. In fact, the American Association of Diabetes Educators (AADE) recommends seven self-care behaviors for people with diabetes.

• Healthy-eating. Making healthy food choices, understanding portion sizes, and learning the best times to eat are central to managing diabetes.
• Being active. Getting regular physical activity is very important. With the right amount of exercise, people with diabetes can improve blood sugar control, blood pressure, and maintain a healthy weight.
• Monitoring. Daily self-monitoring of blood sugar levels helps you and your healthcare team know how your diet, physical activity, and medications are affecting your blood sugar levels. You also need to check your blood pressure and weight as often as your doctor recommends.
• Taking medication. Some people with diabetes will need to take special diabetes medicine in the form of pills or insulin injections. Your healthcare team will be able to determine whether you need to or not. They will help you understand how your medications work. They can teach you how to inject insulin or explain how diabetes pills work and when to take them. Not everyone with diabetes will need to take diabetes medicine.
• Problem solving. A person with diabetes must have good problem-solving skills. On any given day, a high or low blood sugar episode or a sick day will require you to make fast, informed decisions about food, activity and medications.
• Reducing risks. Having regular exams for your eyes, feet, heart, and kidneys, can help you reduce your risk for other health problems caused by diabetes. An important part of your self-care is learning to understand, seek, and regularly obtain preventive health services.
• Healthy coping. It's important to understand that your emotions and your physical health are connected. This means that having a healthy emotional life and good coping skills will help you to live longer, and feel better.

To learn more about these self-care behaviors, go to www.diabeteseducator.org

People with diabetes should see a diabetes educator for monitoring, education, and support at least once a year. Ongoing checkups and follow-ups with a diabetes educator are important. They can help you learn how to avoid kidney disease. If you already have kidney disease, they can help you keep it from getting worse. They can also help you find and get early treatment for other health problems that can be caused by diabetes or kidney disease.

If you are over 65, your Medicare benefit provides for an initial visit of three hours with a dietitian, two hours with a diabetes educator, and ten hours of diabetes self-management training (DSMT). Be aware that you must ask for a referral from your doctor for every yearly visit.

To find a diabetes educator in your area, go to http://www.diabeteseducator.org.

The National Kidney Foundation has free booklets that provide more information about diabetes. Call the national toll-free number 855.653.2273 and ask for free booklets on diabetes, kidney disease, or kidney failure. You can see these and other titles at www.kidney.org/store.

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