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Diabetes Mellitus Type 2

Progress and Monitoring

When Alvin and his wife returned for their second class in two weeks, Alvin reviewed his blood sugar testing records with Nurse Ireland. His records showed that he had been testing 3 -- 4 times daily and that greater than 75% of the results were in target range. At class, Alvin's test result was 93 mg/dl, and his technique was good.

Since the first class, Alvin had had an appointment with Dr. Emmett. Based on his blood sugar records, Dr. Emmett had decreased the dose of Amaryl® from 4 mg. to 2 mg. daily. Alvin had also noticed that the burning in his feet was gone and the numbness and tingling in his fingers was much better. He stated that Dr. Emmett had said this was because his diabetes was better. Nurse Ireland praised Alvin for his success and encouraged him to keep up the good work. She also pointed out that his weight had stabilized another sign that his diabetes was better controlled. His wife smiled broadly.

The class learned about low blood sugar and high blood sugar, the causes of both and what actions to take if either occurred. Alvin learned that he should carry some form of fast-acting carbohydrate on him at all times, to treat a low blood sugar, and should wear some type of medical identification.

The class reviewed their food and activity records with Ms. May. They asked questions about various foods and the effects that they noticed on blood sugars. Alvin was surprised to learn that the sugar-free cookies he had at lunch one day still contained a significant amount of carbohydrate, and were the reason his blood sugar was high before dinner. Ms. May reviewed food label reading, and told the class to be especially watchful on foods labeled low-fat or sugar-free, since these foods may still contain carbohydrates.

She then moved on to discuss other nutrition issues, such as the recommendation to eat 6 oz. protein daily, and to try to limit fat intake to 30% or less of total daily calories.

Ms. May also discussed alcohol consumption in diabetes. She told the class that persons with controlled diabetes could drink alcohol, but men should limit themselves to two drinks per day, and women to one. Persons with diabetes should never drink on an empty stomach, since alcohol can lower blood sugar levels, leading to hypoglycemia. She also reminded the class to be sure and "count" any carbohydrate in the drink itself (like beer), or in the mixer, such as fruit juice or milk.

Ms. May and Nurse Ireland talked with the class about setting personal goals for their own management of their diabetes. Alvin was happy to report that he and his wife had taken a walk after dinner several times in the past week, and that he had enjoyed the time to talk. He set a goal to walk at least 5 times per week, and to purchase a medical identification medallion.

The class was instructed to continue their blood glucose testing schedule, and to bring their record books to the next class in 2.5 months.

By the time Alvin returned for his 3 month class, 100% of his tests were in target range, and his average blood sugar, calculated by his glucose monitor, was 111. He had lost 4.4 lbs. He had seen Dr. Emmett again, who again cut his dose of Amaryl®, down to 0.5 mg qd.

He had also seen the eye doctor. His blurry vision was resolved, and his eye exam was normal.

Alvin was most proud to report that his HbA1c was down to 8.3%. At the third class, he and his wife learned about the necessity for maintaining normal blood pressure, what to do on sick days, and how to check and care for his feet.

They also learned how to estimate portion sizes, like a piece of meat the size of a deck of cards is about 3 oz. and a serving of potatoes about the size of a tennis ball is one carbohydrate choice or 15 grams. The class discussed strategies for dining out and reviewed how they were doing on their goals.

The fourth and final class was six months after Alvin started at the Diabetes Center. His weight had stabilized at 199 lbs. And he had taken in his belt by an inch. He was no longer taking Amaryl®, and his blood glucose tests remained 100% in range. He was walking/jogging 5 -- 6 times per week for at least 30 minutes. Most impressively, his HbA1c was down to 6.8%.

In class, pattern control of blood glucose readings was discussed, and what to do if more than 50% of tests were out of target range. The role of stress and stress management were emphasized. The natural progression of diabetes was discussed, along with the need to maintain blood glucose testing for a lifetime.

Necessary routine medical care such as frequent blood pressure checks, an annual eye exam, an annual foot exam, periodic laboratory tests, and an annual flu shot were outlined. The session included a review of the food pyramid and healthy eating habits. Goal setting and community resources for ongoing education and support topped off the class.

A complete report of Alvin's progress in class was sent to Dr. Emmett. A few months later, Dr. Emmett shared back with the Diabetes Center that Alvin's nine-month HbA1c was 6.9% and his weight remained stable. He continued off of medication, and his glucose control was excellent.