Diabetes: Knowledge and Interventions

By Lisa E. Cox, PhD, LCSW, MSW
Introduction

Diabetes mellitus is a group of disorders characterized by high levels of glucose (sugar) in the blood. All of them result from problems with insulin, a hormone that removes glucose from the blood and causes it to be stored in body cells. Type I and Type II diabetes are the most common forms, but up to 3 percent of women who did not previously have (or know they had) diabetes may develop it during pregnancy (a condition called gestational diabetes).

Type I

In Type I diabetes (also called juvenile diabetes) the pancreas—a long, soft, irregularly shaped gland located behind the stomach—produces very little or no insulin. All people with Type I diabetes require regular injections of insulin for life. Although girls and boys run an equal risk of developing Type I until about age 12, around the time of puberty the incidence in females begins to decrease in comparison to that in males. Up to age 30, approximately 25 percent more men than women develop Type I, but later on the risk is about the same for men and women.

Type II

Most people who develop diabetes as adults have Type II, a form in which the body requires greater than normal amounts of insulin to maintain normal blood glucose levels, probably because cells throughout the body do not respond appropriately to insulin. Type II (which used to be called adult-onset diabetes) typically begins after the age of 40, although now we have seen Type II diabetes in obese children. Whether men or women get Type II diabetes more often is still unsettled (Carlson, Karen J., Einstat, Stephanie A. & Ziporyn, T., 1996).

Gestational Diabetes

Gestational diabetes is a unique form of the disorder which occurs in pregnancy, probably as a result of hormones made by the placenta which alter the way insulin works. Although glucose levels usually return to normal after the baby is born, women who have gestational diabetes and required insulin during pregnancy do run a higher than average risk of developing Type II diabetes later in life. Gestational diabetes most often occurs in pregnant women who are over the age of 30, who are obese, who have previously given birth to a very large (over 9 pounds) or stillborn baby, or who have a family history of diabetes.

Increased Risks

People with either Type I or Type II diabetes have an increased risk over their lifetime for coronary artery disease, stroke, high levels of blood cholesterol, foot infections, an eye disorder called diabetic retinopathy which can lead to blindness, chronic kidney failure, and nerve damage in the hands and feet. Recent research has shown clearly that normalizing blood glucose levels in Type I and Type II diabetics help prevent these complications.

Controlling Blood Glucose

The strategy for controlling blood glucose for Type I diabetics is to watch one’s diet, maintain a regular exercise program, and adjust insulin dosages carefully by measuring blood glucose levels frequently. A person with diabetes can check his or her own glucose level several times a day at home with a simple device called a glucometer. The patient takes a small lancet, pricks the end of a finger lightly, and puts a drop of blood on a test strip, which is placed into a small machine. After a minute the reading appears , showing a person’s blood glucose level.

For the majority of, weight control is an especially important strategy of controlling the illness. Returning to normal body weight can bring blood glucose to normal levels and delay many of the complications. Maintaining a healthy body weight may even help prevent high blood sugars. If blood glucose cannot be controlled by attention to weight (through exercise and diet), insulin therapy or oral medications—insulin mimetics and insulin sensitizers might be needed (Casares, 2007). In addition, health practices that make sense for everyone, like getting regular exercise, avoiding cigarettes, and preventing ingrown toenails, corns, and calluses on the feet—are particularly important for people with diabetes.

In certain women with diabetes the hormones of the menstrual cycle appear to influence control of glucose levels. Some women may require more insulin during the luteal phase (days 14 to 28) of the menstrual cycle, perhaps because the higher levels of progesterone at this time increase the body’s resistance to insulin. And some women have noticed that they require less insulin at the time of menopause.

Social and Emotional Costs of Diabetes

Diabetes education is essential across the lifespan. Early in life we need to understand what is at stake, before serious consequences related to diabetes occur later in life. We need to understand diabetes so that we can cope with it and manage our condition should we develop it. Some people may be diagnosed only after having had diabetes for many years. In fact, about one-third of the cases of diabetes are picked up on the bases of multiple complications, which have taken years to develop.

While the “diabetes industry” grows, education for health care providers (e.g. physicians, nurses, social workers, etc.) appears to be lessening. For example, one physician has reported that in his medical training, only one week was spent learning about diabetes. Therefore, both and helping professionals must continue to educate themselves and advocate for themselves in different settings—like schools, hospitals and community agencies

According to a 2004 University of Michigan study, diabetes costs the United States at least $7.3 billion per year in lost productivity. Some researchers say that diabetes will likely worsen due to the epidemic numbers of young people being diagnosed with the illness. Such studies remind us of the “huge financial burden diabetes places on patients, their families, and society.” (WebMd article, http://diabetes.webmd.com/news/20041116/diabetes-costs-billions-in-lost-productivity )

Social Workers Can Help

Social workers who are knowledgeable about diabetes can help patients and their families:

  • Explore and understand ways to best manage diabetes:
    • 1) discuss diabetic nerve pain;
    • 2) encourage good foot care;
    • 3) assess existence of blurred vision;
    • 4) be aware of family history related to heart disease; and,
    • 5) suggest early detection of kidney disease).
  • Help people work through health care and insurance mazes
  • Help people understand how lifestyle choices can affect how the disease progresses.
  • “Police” children and educate adults who’ve already been diagnosed.
  • Assess factors related to possible declines in thinking and planning.
  • Understand that depression is about three times more common among persons with diabetes than those without.
  • Explain that if diabetes is not controlled, it can cause many complications that can affect nearly every organ in one’s body (e.g. heart & blood vessels, eyes, kidneys, nerves, gums & teeth).
  • Understand a different approach to managing diabetes, which requires a dramatic limitation on fast acting carbohydrate intake to normalize blood glucose around the clock. (Bernstein, 2007)
  • Find well guided support groups to get support and good information.
  • Locate resources such as the American Diabetes Association.
Web Pages

References

Bernstein, R. K. (2007). Diabetes solution: The complete guide to achieving normal blood sugars. New York: Little, Brown and Company.

Carlson, K. J., Eisenstat, S. A., & Ziporyn, T. (1996). The Harvard guide to women’s health. Cambridge, MA: Harvard University Press, 200-204.

Casares, A. (August 7, 2007). Interview at Stockton College with Assistant Professor who has, for the past ten years, taught a capstone Diabetes course to baccalaureate students.

Rubin, R. L., Biermann, J., & Tooley, B. (1999). Psyching out diabetes: A positive approach to your negative emotions. Chicago: Lowell House (A division of NTC/Contemporary Publishing Group, Inc.).

Song, Y., Manson, J.E., Buring, J.E., & Liu, S. (2004). Dietary magnesium intake in relation to plasma levels and risk of type 2 diabetes. Diabetes Care, 27, 59-65.

WebMD Diabetes Health Center article (2005-2007 WebMD, Inc.). http://diabetes.webmd.com/news/20041116/diabetes-costs-billions-in-lost-productivity

Acknowledgement

The author wishes to thank Dr. Ada Casares, Assistant Professor of Chemistry at The Richard Stockton College of New Jersey, and professor of a capstone Diabetes course, for careful review and editing of this article.

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