BEING ill with a chronic disease is a lonely, individual experience. No one can really understand what the sick person is going through, as on-lookers, we can only empathize, and help as best we can.

Diabetes is one such disease with a chronic course, requiring a long-term, lifestyle change with no prospect, as yet, for a cure. Since no man is an island, the patient, to have a good quality of life, will need all the help he can get from professional caregivers, family and friends and co-workers.

The three most important factors for success are: patient education and empowerment, regular and competent health care, and the love and support of family and friends.

The patient
You are the most important member of the team. You are living the life of a person with diabetes. It is important to learn as much as you can about diabetes, it is an enormous responsibility to take care of yourself. The quality of your life rests in your hands, for as much as people around you want to help, they can only help as much as you will allow them. By educating yourself, you arm yourself with essential tools that will allow you to take charge of your disease. Cooperation comes from understanding.

The health care team
Contrary to a common misconception, the health care team, made up of your diabetes specialist (endocrinologist, diabetologist), diabetes specialist nurse (DSN), dietitian, ophthalmologist, podiatrist or chiropodist, psychologist or social worker, other medical specialists and pharmacist are not persecuting or punishing you, they are rooting for you. They are on your side!

Patients may feel the pressure for their blood sugars to behave for the wrong reasons. Some may feel that they need to keep the team happy, performing magic on their numbers (automatically subtracting 50 mg percent from every result above 200 mg percent), or fasting for days before a follow up so that they pass the consult with flying colors. Other patients may resent the team; feel the team is too demanding, or that the goals set are too high. The key is to set realistic, attainable goals for yourself and not for anyone else. Otherwise, whom are you kidding? The only one you’re hurting is yourself.

Many hospitals now have diabetes centers set up all over the Philippines. These centers are set up with trained and certified diabetes educators. The Philippine Center for the Study of Diabetes at the Makati Medical Center has an intensive training course.

If your physician is not directly involved with a center, he may refer you directly to a center, or attempt to educate you himself with every visit. More often than not, the team exists loosely in a network of referrals within the hospital or medical arts building, rather than being based in one single location.

WHAT TO LOOK FOR IN YOUR TEAM
Diabetes specialist
Find a doctor with interest and experience in diabetes management, either a board certified endocrinologist or diabetologist, to assess your health status, offer treatment choices, and supervise your total diabetes care program. Your doctor should be professional, affable, approachable and available to you at all times. Do not hesitate to ask questions regarding your care. Involve yourself in treatment decisions. If you are unhappy about your current physician, feel free to find someone with whom you are comfortable. On the other hand, don’t simply shop around for someone who will tell you want YOU want to hear (i.e., you don’t have to go on insulin if you don’t want too).

Nurse educator
See a registered nurse (RN) who specializes in diabetes education for individualized care and support. These nurses usually frontline diabetes centers in the hospital and outpatient setting.

Registered dietitian
See a registered dietitian who specializes in diabetes for a personalized meal plan that fits your lifestyle and your diabetes care needs. They will walk you through how to use an exchange system for your calorie and food choices.

Social worker or psychologist
A social worker, psychologist, or counselor can help you learn to manage the stress of daily life and to make lifestyle changes that will help you control your diabetes.

Pharmacist
A pharmacist can inform you about the actions and interactions of medications that affect your diabetes control. This communication is especially important if more than one physician prescribes medications for your health.

OTHER PLAYERS:
Opthalmologist
An eye specialist will perform routine retinal examinations to screen for and treat diabetic eye manifestations on a regular basis.

Chiropodist or podiatrist
A foot specialist treats foot problems, including calluses, sores, or ulcers. They help you prevent future foot injury. They also can fashion special shoes or inserts and padding to relieve pressure on your feet.

Other specialists
At one time or another, other specialists like cardiologists, nephrologists, neurologists, pulmonologists, gastroenterologists, obstetrician-gynecologists, urologists or surgeons may be consulted for new problems or complications you might have. Your physician will explain the reason for the referral to you, and can expect feedback, either an opinion or suggestion from the other specialist. You may see some members of your diabetes care team more often than others.

WHAT TO EXPECT FROM YOUR TEAM:
• When you have just been diagnosed, your diabetes care team should:

Give you a full medical examination.

• Work with you to make a program of care which suits you and includes diabetes management goals—this may take the form of a record for you to keep

• Arrange for you to talk with a diabetes specialist nurse (or practice nurse) who will explain what diabetes is and discuss your individual treatment and the equipment you will need to use.

• Arrange for you to talk with a dietitian, who will want to know what you usually eat, and will give you advice on how to fit your usual diet in with your diabetes—a follow-up meeting should be arranged for more detailed advice.

• Tell you about your diabetes and the beneficial effects of a healthy diet, exercise and good diabetes control.

• Provide you with regular and appropriate information and education, on food and footcare for example.

Once your diabetes is reasonably controlled, you should:

• Have access to your entire diabetes care team at least once a year—in this session, take the opportunity to discuss how your diabetes affects you as well as your diabetes control.

• Be able to contact any member of your diabetes care team for specialist advice, in person or by phone.

• Have further education sessions when you are ready for them.

• Have a formal medical annual review once a year with a doctor experienced in diabetes.

Family and friends
The lifestyle change and stresses, both emotional and economic, will impact on the people closest to the patient. Major adjustments will have to be made to the diabetic’s food and food preparation that will affect the entire family. It is impractical and expensive to prepare two sets of food for every meal. Besides, a diabetic diet is a healthy diet to follow, whether you are diabetic or not.

Family members can sometimes sabotage a patient’s diet by eating a bowl of ice cream in plain sight. Or they can dispense well meant advice, which is often based on hearsay and not sound medical fact. The education, understanding and cooperation of the entire family is essential to the success of a lifestyle program. The doctor may need to emphasize that the shared genetic and environmental milieu may mean that other family members are at risk for diabetes in the future. Early lifestyle prevention will benefit themselves as well as their patient.

Getting by
The team approach in diabetes, as in life, helps a person with diabetes feel they are not in it alone. The professional and competent support of the health care team, the loving support of family and friends, and the empowered patient will spell long term success and a good quality of life.

The diabetic patient will more than just get by with a little help from his friends.