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You, Yourself and Diabetes: Overcoming the Challenges of Living Alone


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by Gary Scheiner MS, CDE

Living with and managing diabetes isn't easy for anyone, least of all those who live alone. Lacking the support and protection of family, friends and partners in your home presents a host of new challenges. But hey, what would life be without a few challenges? Let's get right to the business of overcoming them.

Challenge 1: Hypoglycemia (Low blood glucose)

You are at increased risk for hypoglycemia if you take insulin or a diabetes pill such as a sulfonylurea or meglitinide that causes the pancreas to secrete extra insulin. Sometimes, low blood glucose can put your brain on the fritz. As a result, you may not be able to properly treat the low, and loss of consciousness could result. Without someone at home to help you detect and treat your lows, special precautions should be taken.

First, ask your doctor about setting your target blood glucose at a level slightly above normal. This provides you with a "safety margin" in case you go below your target. Check your blood glucose often; this allows you to snack in case you are approaching a low level. Your doctor might even consider prescribing a continuous glucose monitoring sensor (CGMS), or switching you to a different medical treatment that is not likely to cause low blood glucose. Be careful when drinking alcohol, as it can make blood glucose drop unexpectedly – sometimes a few hours later. Also, try to have your meals on schedule. When engaging in any form of physical activity check your blood glucose and take a carbohydrate-containing snack if necessary.

Also, know your early warning signs of low blood glucose. Not everyone becomes shaky and sweaty at the first signs of a low. Sometimes the symptoms are subtle: yawning, tingling, or reading the same sentence repeatedly. Try to learn what your specific symptoms are, and check your blood glucose the moment any symptoms appear.

Challenge 2: Taking Medication

Remembering to take your diabetes medication in the proper amounts and at the proper times is essential to long-term disease management. If you sometimes forget to take your insulin or diabetes pills, try using a programmable alarm clock, or have a friend call to remind you. And be sure to ask your doctor for specific instructions on what to do if you miss or delay a dose.

Challenge 3: Meal Preparation

If you live alone, resist the urge to eat out (or get take-out) too often. Restaurant food, particularly fast food, is notoriously high in fat, sodium and calories. Most supermarkets now have salad bars and deli counters where you can purchase single-serve food items to take home. When preparing your own meals, make enough for several servings and freeze or refrigerate the extras in single-serve containers. If you prefer to prepare single servings from recipes, simply check the number of total servings and divide the ingredients accordingly. For example, for a recipe that "serves 4"; divide all the ingredients by 4 in order to prepare a single serving. If you're interested in learning more about cooking for one, magazines that specialize in cooking for diabetes run excellent recipes several times each year.

Challenge 4: Illness

With no one to take care of you during an illness, it is very important that you stay in close contact with your physician. Call at the first sign of fever, vomiting, ketones, or other unusual symptoms. Have your doctor or nurse write a sick-day management plan that you can follow at home. And keep a sick-day "tool kit" at home with items such as a thermometer, blood glucose testing kit, ketone test strips, low-sugar beverages, and appropriate over-the-counter medications.

Challenge 5: Visual Impairment

When you cannot see well enough to perform daily rituals such as drawing up insulin, taking medications, reading food labels and exercising, diabetes control can suffer greatly. When the going gets tough, the tough don't give up. They ADAPT! A variety of visual aids, adaptive devices and audio accessories are available for people with diabetes and visual impairment. Assistive products are available from Lighthouse International (www.lighthouse.org), the National Federation of the Blind (www.nfb.org), and several online stores. There is also an excellent newspaper, Voice of the Diabetic, published by the Diabetes Action Network of the National Federation of the Blind. To subscribe, call 410-659-9314 or visit http://www.nfb.org/nfb/Voice_of_the_Diabetic.asp.

Challenge 6: Foot Care

A daily foot inspection is very important for detecting problems early and keeping your feet healthy. If you live alone and have difficulty reaching or seeing any part of your feet, a carefully positioned mirror can be very helpful. If you have limited nerve sensation in your feet, burns are a potential problem. Keep a thermometer in your bath/shower, and never put your feet in water above 105° F.

Challenge 7: Reaching Out

Living with diabetes can be a lonely experience – especially for those who live alone. If you have ever felt the need to reach out to someone who understands how you feel, support networks may be just the answer. Even if you don't feel the need to receive support yourself, the act of giving support to others is worth its weight in gold.

Most hospitals offer diabetes support groups on a regular basis. Your local American Diabetes Association may have a list of support programs in your area. If face-to-face groups are not your cup of tea because of travel or personal issues, consider participating in a diabetes chat room on the internet. Although information derived from chat rooms may not always be accurate, you can still gain an emotional lift from conversing with other people facing similar challenges. Some diabetes web sites offer weekly or monthly chat rooms as well as a wealth of information about diabetes. These include:

American Diabetes Association (ADA): www.diabetes.org

Diabetes Exercise and Sports Association (DESA): www.diabetes-exercise.org

Juvenile Diabetes Research Foundation (JDRF): www.jdrf.org

Insulin Pumpers: www.insulin-pumpers.org

National Diabetes Information Clearinghouse: www.niddk.nih.gov/health/diabetes/ndc.htmm

About Gary Scheiner:

Gary Scheiner is a Certified Diabetes Educator and exercise physiologist with diabetes training from the Joslin Diabetes Center. He operates Integrated Diabetes Services (www.integrateddiabetes.com), a private practice near Philadelphia, specializing in intensive diabetes management and lifestyle intervention for insulin users and providing consultations via phone and Internet. Gary has had type 1 diabetes since 1985. Questions about this article can be sent to Gary@integrateddiabetes.com.

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