Diabetes Education

Diabetes is a horrible disease. It often leads to heart disease, kidney disease, amputations, eye problems. I find a major flaw in how we educate our new diabetics. Diabetic education usually consists of meeting with the diabetic educator/dietician for approximately 8 hours, and a two hour follow up annually if your doctor remembers to order this. We teach the patient what their goal blood sugar measurement should be, how to recognize the signs and symptoms, the ideal diet recommendations for them. What we don’t teach well, and often only give a short lecture format is the implications of activity and exercise on blood sugars.  

In cardiac rehabilitation we measure blood sugar on entry, and after exercise. It is amazing how many patients do not understand that it isn’t safe to exercise when blood sugars are in the 400 range. Never have I had a patient who uses urine dip sticks to check to see if they are in ketoacidosis even though their blood sugars are high. I have had patients appear completely normal in conversation and ability and yet their blood sugars are in the low 30′s. Usually I would catch these when I noted a little more sweaty than normal. Had these patients left and drove home, there would surely be an accident.

I would propose that diabetic education get changed to incorporate exercise classes similar to a cardiac rehabilitation format.  What better way to educate a patient then to teach them how their exercise can effect their blood sugar. Does a 30 minute work out typically drop them 20 points, or 100 points. How does their eating prior to the activity effect their blood sugar? Do they need to eat mid way through an exercise session. I would often find this was necessary with my patients with insulin pumps. This is an optimal time to teach exercise safety warming up, cooling down, signs and symptoms, assessing feet afterwards. Remember  long term diabetics often don’t feel traditional chest discomfort and have silent ischemia. Does the patient turn pale when exercising, are they breathing harder than they should, are they experiencing nausea? Look at the feet pre and post exercise, are their hot spots, blisters, toe nail issues that will become a problem if not addressed. It always irks me when my diabetic patients see their primary care physicians and they never look at their feet. My counselling to patients is to have your socks and shoes off on every visit, every time.

If we want to reduce health care costs of diabetes I believe we should change our diabetic education to include a month of exercise classes.