... about type II diabetes

By Julia Cyboran

Nearly two million Canadians have diabetes and almost 90% of those cases are type II. It's one of the most common diseases that GPs have to address so a lot of your patients will be looking to you for support. As a primary care physician, you can help deliver the right message and keep patients on track — but it's not an easy task. Here are some tips on how you can help patients make these adjustments and better manage their diabetes.

IT'S ALL ABOUT CONTROL
Precaution is the best cure Dr Harris explains that taking precautions early on is one of the best ways to delay the onset of diabetes. "We're looking to identify people with pre-diabetes. Folks who have high blood sugar," he explains. "There's an opportunity to intervene [at that early stage]. Early on, lifestyle changes — like diet and exercise — have the most bang for their buck." Dr Harris also stresses that you have to explain to patients who are at high risk what their diagnosis means and the health problems that may accompany this condition. "One of the key messages to get out to patients," he says, "is the increased risk for heart attack and stroke."

Lifestyles of the insulin challenged Let patients who've just found out they have diabetes know that there's hope — they can control it. "I do recommend to my patients that they see a dietician and a diabetes educator," says Dr Harris. "The core of any successful strategy is the patient taking control of their diabetes." He suggests that you talk to patients about some of the changes they can make right away — tactics like portion control, cutting down on high fat foods, and reducing high carb loaded foods like pop. "I really avoid the word diet," he says, "that implies temporary — we're looking for a permanent shift in lifestyle."

Diet fad or fiction The fad diets out there — and there are many — may have your patients wondering which ones work. "I get a lot of questions about the Atkins and South Beach diets," says Dr Harris, "one problem is that these diets are hard to sustain." He adds that the one thing about diets is that they all work in the short term but fail in the long term. Another popular diet among diabetics might be the Glycemic Index (GI) diet. "It's very popular in some countries," explains Dr Harris, "I don't promote it but there's some evidence that it may be helpful."

Time to work out Dr Harris says that you need to reinforce the need for patients to exercise. "The goal is 150 minutes of physical activity a week," he says. Break that down for patients and tell them that means about 30 minutes of activity five days a week. "I really like to focus on walking," says Dr Harris, "It's excellent exercise. Patients should know that they don't have to join a gym." One gadget that Dr Harris recommends to his patients is the pedometer. It helps his patients gauge how much activity they've done by counting their steps. "It's a good reminder system."

Reach for the Rx You need to explain to patients that because diabetes is a progressive disease they will need drugs, says Dr Harris. It will get worse "but you can tell patients that it's not anyone's fault. We need to get away from the blame game," he adds. Dr Harris explains that the goal for patients is to try to get as close to blood glucose, lipid profile and blood pressure targets as possible (see the table below for the numbers). "In order to [hit] these targets tell patients that they need to go on drugs," says Dr Harris. "I make a point of telling my patients that they can expect to need more and more meds and eventually insulin." Before they go on insulin, Dr Harris recommends that you address the issue of needles with patients: "If you present it right and address the fears, you can help them overcome their anxiety."

Agony of the feet Many people know that with diabetes comes an increased risk of foot problems. "Diabetes is the leading cause for non-traumatic amputations," explains Dr Harris. So it's important that you stress how important it is for patients to take care of their feet. "If a patient has poor diabetes control, they're putting themselves at risk," says Dr Harris. Simply put, patients need to follow the steps above to keep their condition in check. You can also suggest that they pay special attention to their feet; wear shoes outdoors, slippers indoors; and practise good foot care and hygiene.