Education is learning what you didn’t even know you didn’t know.
—Daniel J. Boorstin
Diabetes is a chronic disease that requires the person who has it to provide most of his own care. Important parts of that care include following a healthy eating plan, incorporating physical activity into your lifestyle, monitoring your blood glucose on a routine basis, and learning to cope with the ups and downs that often occur. For many people, taking one or more medicines is also necessary to help keep blood glucose levels in target range.
Your diabetes care is a balancing act of all these necessary tasks, and you are the juggler. While it can be challenging, there is help. Diabetes education and training is available that is designed to help you learn more about diabetes and assure that you have up-to-date information, the right tools to manage your disease, and a support system in place for when you need it.
When to learn
Health-care professionals generally agree that for people at high risk of developing Type 2 diabetes, education should start before a person develops the disease. Two common risk factors for Type 2 diabetes are having a close relative with Type 2 diabetes and being overweight; there are other risk factors, as well. The Type 2 Diabetes Risk Test on the Web site of the American Diabetes Association can help a person determine how high his risk is: www.diabetes.org/diabetes-basics/prevention/diabetes-risk-test.
Research has shown that a healthful diet, increased physical activity, and modest weight loss can help prevent or at least delay the development of Type 2 diabetes in people at high risk for it. Those at risk may be referred to a registered dietitian and/or diabetes educator to begin learning about the steps they can take to help them ward off the disease. It is important that those at risk see their health-care provider at regular intervals to monitor their blood glucose levels and be prepared to take the necessary steps — such as starting on medication — should a diagnosis of diabetes occur.
People who are diagnosed with any type of diabetes should receive some diabetes education and training immediately and should be referred for more in-depth training and follow-up, as well. If the health-care provider who diagnoses your diabetes doesn’t tell you what type of diabetes you have, ask; knowing what type you have is a great place to start learning how to care for it.
The most common types of diabetes are Type 1, Type 2, and gestational diabetes. Type 1 diabetes is often diagnosed during childhood or adolescence and requires insulin as treatment. Type 2 is the most common type of diabetes and may be preceded by a diagnosis of prediabetes, meaning that a person’s blood glucose is higher than normal but not high enough to be called diabetes. Gestational diabetes is a type of diabetes that occurs during pregnancy and is more common in women who have risk factors for Type 2 diabetes.
Where to learn
The process of becoming educated about your diabetes should occur over time, starting at diagnosis (or before, if you have prediabetes) and continuing as your needs change. If you have not yet taken diabetes education classes or met with a diabetes educator, start by asking your health-care provider what diabetes self-management education or training services he usually refers his patients to. Some health-care providers have diabetes educators available in the same office or in the same building. Health departments and hospitals often offer diabetes education and training classes, and more and more diabetes education programs are being offered at pharmacies these days. In some areas of the United States, the YMCA or YWCA offers health and wellness classes that may include diabetes-specific education and training. A few individuals and institutions have developed online diabetes courses, in which various topics are covered in segments, or chapters, to be followed sequentially or as the student chooses.
It is always a good idea to learn from the “experts:” health-care professionals with expertise in the area of diabetes education and training. Such experts may include doctors, nurses, dietitians, pharmacists, exercise physiologists, mental health professionals, and others. Many of the professionals who offer diabetes education have become certified to do so, either as a certified diabetes educator (CDE) or a board-certified advanced diabetes manager (BC-ADM) — or in some cases, both. Diabetes educators help people with diabetes learn about their disease, understand how it affects them and their lifestyle, and acquire the skills necessary to take care of their diabetes on a daily basis.
It is important to note that most diabetes education services require a referral by a physician. This is usually necessary for insurance coverage for the services. To avoid any surprises, check up front with your insurance carrier to determine what coverage you have for diabetes education and training. Some questions to ask include the following:
• Is there is a limit to the number of diabetes education classes or one-on-one visits that will be covered?
• Do the education sessions need to be completed within a certain period of time?
• Do the class or visit fees count toward your deductible, if you have one?
• Are you are responsible for any co-payments?
• Does the education program have to meet any accreditation requirements for insurance reimbursement? (Medicare, for example, requires that a diabetes education program be certified.)
• Will the insurance plan pay for a family member to attend diabetes education sessions on behalf of the person with diabetes if, for example, the person with diabetes is a child or an adult with a physical or mental disability?
Examples of accredited programs include the American Association of Diabetes Educators’ Diabetes Education Accreditation Program and the American Diabetes Association’s Education Recognition Program. Some federal health-care services, such as the Indian Health Service and Veterans Health Administration, offer diabetes education services to their beneficiaries. (Click here for information on how to find an accredited diabetes education program.)
Check with the diabetes education program you are thinking about attending and ask what the total cost of the program will be. You may also want to ask how frequently the program is offered and whether you can make up sessions if you miss any. Be sure to ask if the program will bill your health insurance or if some other payment arrangement is preferred. Also, check to see if family members are welcome to attend along with you. Unless there are space restraints, family members are usually encouraged to be there to learn and offer support at no charge.
If you have no health insurance or are unable to afford your plan’s co-payment for diabetes education and training, check with your health-care provider about any free programs that may be available.
What to learn
A number of different topics that affect your diabetes health should be included as part of your diabetes education. Ideally, education and training is an interactive process, in which there is time in each session for the student to ask questions and, in group classes, for members to take part in discussions to learn from one another.
The American Association of Diabetes Educators (AADE) recommends a framework for diabetes education that focuses on seven areas of self-care. The self-care behaviors referred to as the AADE7 include the following:
Healthy eating. When you have diabetes, it is essential to learn how to make healthy food choices and to become familiar with how different types of food affect your blood glucose level. Your diabetes education should also touch on estimating portion sizes, reading nutrition facts labels, food preparation techniques, and timing of meals as it relates to physical activity and certain diabetes medicines, if they are part of your treatment plan. Healthy eating can also help with weight control, which can in turn help control blood glucose levels.
Being active. Engaging in regular physical activity can help you with blood glucose and weight control. Physical activity and exercise can directly lower your blood glucose level and, when performed on a routine basis, help to lower high blood pressure and high triglycerides and raise HDL (“good”) cholesterol. Physical activity can also help lower stress levels, which can also help with blood glucose control.
Monitoring. Self-monitoring of blood glucose is an important part of your diabetes care because your results will help you see the effects of the foods you eat, the activities you perform, and the diabetes medicines you take. A diabetes educator can teach you how to use your blood glucose meter, record your results, and respond to out-of-range results. Other types of monitoring, such as periodic weight and blood pressure measurements, may also be recommended as part of your diabetes care, and your diabetes educator may be able to provide instruction on these types of monitoring as well.
Taking medicines. Many people with diabetes need one or more medicines for optimal blood glucose control. Part of your diabetes education includes learning about how and when the medicine works, what time and how often to take it, how to administer it, what to do if you forget a dose, and how to store it safely. You should also be aware of potential side effects, and which should be brought to your health-care provider’s attention sooner rather than later. If you take a drug that can cause hypoglycemia, or low blood glucose, you need an action plan for treating it.
Problem solving. There will always be problems and challenges that arise when living with diabetes, so it’s important to develop problem-solving skills to deal with them. Among the most important of those skills is being able to recognize and respond to high or low blood glucose levels. Another is learning to manage your diabetes when you’re ill. Traveling and eating out are some other situations that can disrupt your usual routine and make it necessary to employ problem-solving skills.
Reducing risks. An essential part of diabetes self care is learning to prevent long-term complications through effective daily care. It’s also important to schedule regular medical checkups, dental visits, eye exams, and any other specialist care you may need.
Healthy coping. Coping skills are what get you through life’s tough times, including those related to your diabetes. Healthy coping methods include activities such as exercise, meditation, and participating in a support group or seeking support from a partner, friend, or therapist. Diabetes education classes are a good place to talk about what works and to learn from others who may employ skills you could use.
Over time, your diabetes needs will likely change, and you will need to modify some of the things you are doing to stay healthy and keep your blood glucose under control. You can keep your self-care regimen up to date by staying in regular touch with your diabetes care team (all the people who help you care for your diabetes). Check to see if you have insurance coverage for annual visits to a diabetes educator. If something in your diabetes self-care routine is not working quite right or your treatment plan changes, ask your physician to refer you for additional diabetes education.
You may find that printed and electronic resources are great supplements to in-person diabetes education and training. A magazine subscription can keep you informed. Most major diabetes organizations and institutions (and some well-known general medical institutions) publish books on diabetes self-care and update them from time to time. A wealth of knowledge exists on the Internet, as well, and in recent years a number of diabetes-related apps have become available that can help you keep track of your blood glucose levels, food intake, exercise, and other things related to your diabetes. When getting information off the Internet, pay attention to its source: Who is publishing or sponsoring the site? Is their main intent to sell a product or service, or is it to provide information? If you question any of the information you read online or in print, or it is different from what you believe to be true, ask the members of your diabetes care team for clarification.
(Click here for some take-away tips on staying in the know about diabetes.)
In the know
Rarely does anyone ever regret an education. Once you learn something, it can’t be taken away. But knowledge about diabetes — and the best ways to treat it — is forever expanding, so periodically updating what you know is important. And just knowing what to do isn’t enough: Actually doing it is what will help keep you healthy. Keep in mind that no matter how much you learn and put into action, your diabetes care won’t be perfect; nothing in life is. But if you familiarize yourself with your resources for diabetes care and education and seek help when you need it, your care will be the best possible.