Diabetes: The Basics – Problem Solving
Problem solving is an essential skill in diabetes self-management. Your diabetes needs can change from day to day. What works for you most of the time may not work on a particular day. For example, on a day with high stress your blood sugar may be higher than usual or lower than usual. Or, on a day that you are traveling you may cross several time zones and need to change your medication schedule. On a vacation day, you might have a lot more or a lot less physical activity than usual. All of these situations will require some adjustment.
To complicate things even further, your diabetes needs can change gradually over time. What used to work for you may no longer work as your life situation changes and your body changes over time. For example, if you change jobs or retire, your schedule may change, and you might need to make changes in your diabetes management. Or, if you develop arthritis in your hands, you may have less ability to handle small strips for your blood glucose meter. And if you have Type 2 diabetes, your pancreas may gradually lose its ability to make insulin, and you may need to make changes in your eating, physical activity, or medications.
Most diabetes situations have possible solutions. Good solutions need to fit the individual people who have the problem, and that may require some creativity. Fortunately, effective problem-solving is a skill that can be learned. The most effective learning happens when people work together to solve real problems. This recording will give you a few basic ideas to help you get started.
You need flexible, positive thinking
When you approach a diabetes problem, the situation usually does not respond to methods you used before. You will need to be willing to try something different, perhaps something brand-new to you. You need to believe that the problem can be solved somehow, or at least improved. A positive attitude will help you explore possibilities, think of creative solutions, and be willing to try new ways of doing things.
Finding information about diabetes self-management
Many diabetes problems can be helped by having more information about diabetes self-management, or how people can manage their own diabetes. There are many sources of information to help you solve diabetes problems.
If you have Internet access, you might want to begin looking for information there. You can find reliable information about diabetes management by searching out the following web sites:
- The National Diabetes Education Program
- Large health care organizations such as the Cleveland Clinic, the Joslin Diabetes Center, or Mayo Clinic
- The 3 major national diabetes patient magazines —Diabetes Forecast, Diabetes Health, and Diabetes Self-Management.
- The large companies that manufacture diabetes medications, blood glucose meters, and other products also have a lot of good diabetes self-management information. Check the web sites for the companies that make any medication or diabetes equipment that you use.
If you do not have Internet access, you can still find a lot of information the old-fashioned way —in a library. Many local public libraries have a section of books devoted to diabetes, and also carry copies of diabetes magazines. Do be cautious about the books you choose! Many diabetes books have reliable information, and others do not. See the section below about how to consider suggestions from other people.
Finally, local diabetes associations, and local chapters of national diabetes organizations, can be good sources of information. These recordings were produced by a local diabetes organization, the Diabetes Association of Greater Cleveland. Similar organizations exist in many other major cities.
Problem-solving with other people who have diabetes
Other people with diabetes can also help you find ways to solve problems. If you explain your problem to a group of people with diabetes, it is very likely that someone else will have had to deal with something similar. Support groups, either face-to-face or on the Internet, can often help people solve diabetes problems. Ask your diabetes educator or your local diabetes association about support groups near you, or search for diabetes discussion groups, listservs, and discussion boards on the Internet.
You need to be thoughtful about considering suggestions from other people with diabetes. Something may work very well for someone else, but not work well for you. And some people use unproven remedies that don't do much, or can even be harmful. If someone gives you a suggestion, try following these steps:
- Think about whether it makes sense according to what you know about diabetes and your own self-management.
- Read other reliable sources, and see if you can find that suggestion somewhere where you can trust the information.
- Ask a trusted health care professional if the suggestion makes sense for you.
Problem-solving with your health care professionals
Your doctor, your diabetes educator, your dietitian, and any other members of your health care team can help you solve diabetes problems. They can share information with you that is tailored to your needs, and can guide you through a process of thinking of possible solutions and choosing what will work for you. If you have a problem that is getting in the way of your diabetes care, make an appointment to see one of them to discuss it.
When you try something new
When you decide to try a new way of solving a problem, consider it an experiment. Try it for a short period of time, and then re-evaluate. Is it working for you? Are there any new problems? Have there been any unexpected benefits? Do the benefits outweigh the problems, or do the problems outweigh the benefits? Ultimately, you are the one who lives with your diabetes. Only you can decide how to solve your diabetes problems.
Examples of Problem Solving: Low and High Blood Sugar
Everyone who has diabetes eventually has some problems with low or high blood sugar. Consider the following situations faced by real people with diabetes:
Carol has Type 1 diabetes and uses an insulin pump. Usually, her blood glucose is in fairly good control. However, she sometimes has problems with low blood sugar. For example, she recently went on a weekend trip with friends. While she was away, her blood sugar went so low that she lost consciousness and could not be roused. Her friends called an ambulance. After this episode was over, Carol thought through what she had done earlier in the day that could have led to this severe low blood sugar. What do you think might have happened?
Tom has Type 2 diabetes, treated with oral medications. He has changed jobs recently. In his new job, he feels self-conscious about checking his blood glucose. When he gets home, his blood glucose is often higher than he wants it to be. He is trying to figure out a way to control his blood glucose during the day at work. What would you suggest to him?
Virginia has Type 2 diabetes, treated with a combination of oral medications and insulin. Her daughter is getting married next month. Her blood sugar has been gradually increasing in the afternoon and evenings over the last several weeks. She believes this is from the stress of planning the wedding, and wants to find a way to control it without changing her medication. What do you think she should try?
Record-Keeping: a Key to Solving Blood Sugar Problems
There are many possible causes of high and low blood sugar. When you are trying to figure out which cause applies to you, it helps to have good records of your monitoring results and of the common factors that affect blood sugar. These are:
- What, when, and how much you ate and drank, especially carbohydrates and alcohol
- What kind, when, and how much medication you have taken
- What type of exercise or other physical activity you have done, when and how long
- Notes about times of high stress, and stress management techniques you try
- Notes about any illness you have
There are many ways to keep diabetes records. Here are some common ones:
- All of the large blood glucose meter companies have log books available that make it easy to record these factors in pencil-and-paper format.
- Many meters allow you to program notes with you blood sugar readings, and all the information can be downloaded to a computer.
- There are some record-keeping systems online that keep your records on a secure site under password.
- Applications, or programs, for keeping diabetes records are available for certain smart phones.
Whatever system you use, when you are trying to solve a blood glucose problem, it is important to have information that is as complete and accurate as possible.
Let's go back to Carol, Tom, and Virginia. What did they learn by looking at their blood glucose records?
The day after Carol's hypoglycemia event, she thought about what had happened. Carol knows that she has high stress when she travels, and that often raises her blood glucose so gave herself a little extra insulin. Then she had gone sightseeing with her friends, and walked more than usual. She had a glass of wine with supper, which can lower blood sugar. And she had eaten very little carbohydrate with her supper. Any one of these alone might have caused mild hypoglycemia for her. But the combination of all of these caused severe hypoglycemia.
Tom did not have lunch time blood sugar readings to help him know when his blood sugar was actually rising. But he did keep records of his food, physical activity, and stress. He saw that his lunch was about the same lunch he had been eating for many years, so he decided that was probably not responsible for his higher blood sugar. He noticed that the high stress of learning a new job did seem to affect him, especially on days when his records showed his stress was highest. He also realized that he was walking less on his new job. In his old job, he had to walk farther from the parking lot, and he also climbed stairs several times a day to use the copy machine on a different floor. Tom realized looking at this information that he needed to have the results from lunch time and afternoon blood sugar tests to find out what was affecting his results the most, and what worked to correct it. He asked his diabetes educator for information about a smaller, faster meter, so he could check his blood sugar without other people noticing. And he decided to check it in the bathroom, where he could have privacy.
Virginia could tell from her blood sugar records that she was right about stress causing her high blood sugar. On days that she had high stress about her daughter's wedding, her readings were higher, even when she ate her usual meals. She decided to try an experiment. She added a 1/2-hour brisk walk right after lunch. That helped her blood sugar levels some, but she was still not back to her target range. So she kept walking, and she tried one more thing: she began using a guided imagery recording for stress management that was recommended by her diabetes educator. She listened to it every morning when she first woke up. On days that she felt highly stressed, she also listened to it in the evening. To her surprise, that helped her get her blood sugar closer to a normal level.
Each of these people used their own diabetes records to identify the source of their blood sugar problems, and to develop solutions they could live with. You can do the same.