By Laura Hieronymus, MSEd, RN, BC-ADM, CDE, and Pamela Rickerson, RN, MSN, CDE | August 14, 2012 4:23 pm
There are no secrets to success. It is the result of preparation, hard work, learning from failure.
–General Dwight D. Eisenhower
Serving in the US military requires a certain level of physical fitness and freedom from any disability “that may require excessive time lost from duty for necessary treatment.” When civilians apply to join the military, therefore, they are required to pass a medical exam and to disclose information about their medical history. While not all medical conditions disqualify a person from joining the military, many do, and any type of diabetes generally does.
Developing diabetes while already serving in the military, however, is not automatic grounds for separation (retirement) from the military. Several hundred service members (out of more than 1.4 million currently serving) are diagnosed with diabetes each year. Between 1997 and 2007, fewer than 6% of diabetes diagnoses were Type 1 diabetes, 80% were Type 2 diabetes, and the remaining 14% were not consistently reported as either Type 1 or Type 2 diabetes. Because active service members have mandatory medical examinations and free access to health care, it is thought that there are few undiagnosed cases of diabetes among military personnel. Service members who develop diabetes and cannot maintain an HbA1c level below 7% without medication are referred to a medical evaluation board, which assesses their medical fitness and makes recommendations about follow-up care.
As is the case for civilians, being overweight or obese puts a service member at higher risk of developing Type 2 diabetes. In 2011, the Armed Forces Health Surveillance Center reported that between January 1998 and December 2010, nearly 400,000 of its active members had at least one overweight-related medical diagnosis. Factors that are most commonly correlated with obesity in enlisted personnel are older age, African-American or Hispanic ethnicity, and being married with the spouse in the household. Furthermore, the average duration of active military service after an overweight-related diagnosis was 15 months shorter than those active members without an overweight-related medical diagnosis. Service members who fail to meet weight standards through reconditioning programs may be ineligible for reenlistment, promotions, career advancement, and professional training.
Military service members with Type 2 diabetes generally have the following characteristics: they are older, have a higher body-mass index, and are less likely to be Caucasian and more likely of African-American or Hispanic American descent. Also, having a history of post-traumatic stress disorder (PTSD), a type of anxiety disorder that can occur as the result of experiencing a life-threatening event, is associated with a higher risk for diabetes.
Affiliation with the military typically brings about frequent moves, often with little advance notice. It may also involve long separations of the service member from his (or her) family, when he is deployed to active duty. Both of these situations are stressful and may contribute to unhealthful lifestyle patterns as all parties adjust to a new living or family environment.
To help its members stay as healthy as possible, the U.S. military has established a variety of benefits for its service members and their families that support healthy eating behaviors and being physically active. One of these is the system of commissaries, or military grocery stores, that provide grocery shopping in a safe and secure environment in locations around the world. Military shoppers can save an average of 30% or more on food and related items, compared to prices at regular, commercial grocery stores. To help shoppers make healthy choices, the Defense Commissary Agency has initiated the “Eat Healthy and Be Active Your Way!” program, which includes posting nutritional tips throughout its commissaries.
More information on healthy eating and a healthy lifestyle is available on the Commissary Agency website, www.commissaries.com, including information on making healthy food choices for children. Home cooking is encouraged and supported by a section entitled “Healthy Living,” which has recipes, cooking tips, and nutrition information.
In support of healthy activity levels, most military bases have a gym and often other facilities for recreation and outdoor activities. In addition, the “Fitness Center” of the website www.military.com has seemingly endless articles, videos, and guidelines for service members and their families to get fit. Some are aimed at meeting the fitness requirements of the various branches of the military, while others are focused on building and maintaining general fitness.
The Armed Services YMCA offers recreational programs, child and youth programs, educational programs, and spouse and parenting support at facilities on or near military installations worldwide. Its services are free or offered at a reduced cost to junior active-duty service members and their families. (Higher-ranking service members and their families are also eligible to use many of the services offered.) In addition, certain “regular” YMCAs are offering free memberships and respite child care services to eligible military families and personnel. (See “Resources for Healthful Eating and Exercise” for more details.)
Taking advantage of fitness and other healthy lifestyle programs can go a long way toward lowering stress, as well as preventing or helping to control diabetes, high blood pressure, and high cholesterol and triglycerides. Regular exercise may also help to elevate a depressed mood in some cases and help with symptoms of post-traumatic stress disorder. If an organized fitness program isn’t available or doesn’t meet your needs, exercising on your own can have the same benefits.
Uniformed service members, retirees, and their families receive health benefits through TRICARE. For all of its beneficiaries, TRICARE covers outpatient visits, hospitalization, preventive services, and prescription drugs. For beneficiaries with diabetes, TRICARE also covers diabetes supplies (such as blood glucose meters and strips) and outpatient diabetes self-management and training programs.
Information about TRICARE coverage can be found online at www.tricare.mil. Service members with diabetes can also contact their TRICARE benefits administrator to discuss the availability and location of medical professionals who have expertise in treating diabetes.
Taking advantage of covered diabetes self-management education and services is well worth your while. You may have coverage for one-on-one visits with a diabetes educator and/or coverage for group diabetes education classes. Group diabetes classes are not only helpful for learning the facts about diabetes and its care, but also for sharing ideas, recipes, and healthy tips with other class members.
When you have (or are at risk for) diabetes, it is a good idea to get expert advice on how to eat healthfully, control your weight, and keep your blood glucose in target range. A registered dietitian (RD) can help you understand how various foods affect your health and work with you to develop a meal plan that meets your needs.
In addition to healthy eating, other topics that will help you manage your diabetes include how to stay physically active, how to monitor your blood glucose level, how to develop coping techniques, and how to lower your risk of diabetes complications. If your diabetes care provider prescribes medicines to help you control your diabetes, you will need to learn how they work, how to properly take them, and what side effects they might have. You will also need to know what to do if your blood glucose levels go too high or too low.
The Veterans Health Administration (VHA) houses the largest integrated health-care system in the United States. The VHA consists of 152 medical centers and almost 1,400 community-based outpatient clinics. Other resources such as community living centers, centers for veterans and residential living are within the VHA. Among the employees, the VHA employs licensed health-care professionals to help provide expert care to veterans across the United States. Veterans who qualify for VHA services and medical coverage can search the Veterans Affairs website using a tool that lists physicians, nurse practitioners, dentists, and psychologists to help them find a health-care team to work with to determine an individualized plan of care, including care for diabetes-related needs.
The Veterans Health Administration (VHA) has developed programs for preventive nutrition and wellness, as well as various illness-focused nutrition training at the Veterans Administration (VA) medical centers and health-care facilities throughout the nation. Many VA medical centers and outpatient clinics offer a full range of diabetes services. In addition, veterans can work with the diabetes program staff to establish the necessary resources to assist with optimal diabetes care (such as blood glucose monitoring supplies and medicines).
More than 800,000 people with diabetes receive care through the VHA. To help you find a VA facility in your state, use the online VA locator tools listed in “Veterans Health Administration Resources”.
Staying healthy can often be a battle in itself when you have diabetes. For military personnel, veterans, and their families that qualify for such programs, resources exist to promote health and well-being. Diabetes and health services are of utmost quality and reasonably available. Take advantage of such services to be in the best possible health. You deserve it.
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