Читать книгу Transitions in Care - Howard A. Wolpert - Страница 20

Pros:

• Greater lifestyle flexibility and freedom

• Greater sense of control over diabetes

• Greater sense of well-being from a reduction in glucose fluctuations

• Promise of a healthier future

• Help with the dawn phenomenon (increased release of glucose by the liver during the early morning [“dawn”] period)

• Improved ability to recognize low blood glucose reactions (see Bumps in the Journey: Intensive Therapy and Hypoglycemia on page 24)

• Improved control during physical activity

• Easier weight control (see More Bumps in the Journey: Intensive Therapy and Weight Gain on page 32)

Cons:

• Pumps are a visible sign of diabetes

• Extra time and effort required to get started and use the pump

• Inconvenient to wear

• Increased risk for diabetic ketoacidosis

• Must monitor blood glucose at least four times a day

• Added responsibility of taking care of the catheter sites and pump

• Extra troubleshooting skills required

• Catheter site infection

• Cost

For more information to help you decide whether the pump is right for you, see Smart Pumping for People with Diabetes: A Practical Approach to Mastering the Insulin Pump (Wolpert 2002).

Using blood glucose monitoring to decide about insulin doses and using the numbers from your logbooks to identify glucose patterns.

Learning how to troubleshoot and treat hypoglycemia (low blood glucose reactions).

Learning how physical activity affects glucose control and how to regulate your glucose levels during and after exercise (see Getting Physical on page 54).

Learning how to manage your diabetes during illness and sick-days.

Learning how alcohol affects your glucose control and how to manage your diabetes when you drink (see page 52).

This learning will be an ongoing lifelong process, and as you progress further, you will find that that there will always be some additional information or insights that can be important to you. For example, the fat in your diet (sometimes hidden in muffins, pizza, and fries) can make your body less responsive (sensitive) to insulin and can also have a big impact on your blood glucose after meals. So this may be something you will also need to pay attention to as you progress in optimizing your glucose control. Figure 4 illustrates some of the factors that affect the delicate balance between high and low glucose levels.

For more information on intensive insulin and pump therapy, see the Complete Guide to Diabetes (American Diabetes Association 2005). Your state chapter of the American Diabetes Association (ADA) can put you in touch with ADA-recognized education programs that offer guidance and instruction in diabetes self-management.

FIGURE 4 The balance between high and low glucose levels.