Close-ups

A Patient's Perspective

Diabetes: Taking Control of My Health



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Am Fam Physician. 2013 Jun 1;87(11):758.

When I was diagnosed with diabetes in 2008, I was really upset. I went home and cried the whole day. Finally, I sat down and, looking at my grandchildren's pictures, said, “This is it. I cannot cry. I just have to do this.” I knew that I could either control my diabetes, or I could die young.

First, I worked on changing my diet by eating smaller portions. It was hard to resist big servings of foods I loved like corn, potatoes, and gravy. Next, I gave up pop, which I drank often. I quit “cold turkey,” and now only drink water or diet green tea. After three and a half years, I still don't miss it. I further cut down on sugar by switching to sugar-free snacks and artificial sweetener. Overall, I watch carbs and sodium, stay away from sweets, and eat plenty of fiber. Right after my diagnosis, I also started exercising. I walk to or from work, which totals about a mile and a half.

The first month of making changes was the hardest, but when I noticed weight coming off, I started to feel better. It gave me willpower and confidence. I still get motivation from thinking about my grandchildren. I want to live longer and be there for my kids and still be able to travel and work. I've worked as a lunchroom monitor for the past 20 years, and I love my job. Last week the principal called me to say that I'm a good role model for the kids.

My doctor couldn't make me do what I needed to—I had to do it myself. I've received good advice and encouragement about my weight loss and help with my eating habits from my family physician. The nurses at the office are great, and they always tell me I'm an inspiration!—b.a.

COMMENTARY

When B.A. came in to see me for follow-up after the initial diabetes diagnosis, I was impressed with her motivation to change. She made changes in both her eating and physical activity patterns, and within two years had lost 10 pounds. In late 2011, she became concerned about possible metformin side effects. Given her successful weight loss, we elected to try taking her off of the medication.

After one month off of metformin, she had lost seven more pounds and her A1C level was 6.2. During the next three months, her home fasting blood glucose levels were always less than 120. She continued her walking and mindful eating, and her three-month repeat A1C level remained 6.2 off medications. Additionally, her blood pressure was 128/72. We agreed to stop her hypertension medication (diuretic), and she has maintained her goal blood pressure and continues to lose weight. Her example of internal motivation and perseverance with the long-term project of weight loss has inspired me and several of the nurses in my practice and has assisted us in caring for others with similar chronic health conditions.

RESOURCES

Improving Chronic Illness Care: Self-management support

http://www.improvingchroniccare.org/downloads/selfmanagement_support_presentation_template_with_citations.ppt

University of California, San Francisco, Office of Developmental Primary Care: Patient action plan

http://developmentalmedicine.ucsf.edu/pdf/actionPlan/EnglishActionPlan.pdf

Close-ups is coordinated by Caroline Wellbery, MD, Associate Deputy Editor, with assistance from Amy Crawford-Faucher, MD; Jo Marie Reilly, MD; and Sanaz Sara Majd, MD. Questions about this department may be sent to Dr. Wellbery at afpjournal@aafp.org.

A collection of Close-ups published in AFP is available at http://www.aafp.org/afp/closeups.

The editors of AFP welcome submissions for Close-ups. Guidelines for contributing to this feature can be found in the Authors' Guide at http://www.aafp.org/afp/authors.


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