The actions of Dawn Prindall’s preschooler brought home to her the importance of diabetes education for people with diabetes and their families.
Prindall, a mother of two small children who lives in Orr’s Island, Maine, has type 2 diabetes and was prone to low blood glucose while she was pregnant and during the postpartum period. One night, after nursing her newborn to sleep, she lay down beside her preschooler, Sam, while her husband stayed with their restless baby in another room.
"I went into [a hypoglycemic episode] so severely, I began convulsing in my sleep," she recalls. "Sam woke up, saw this and tried to wake me. When he couldn’t, he stayed calm, remembered what we’d taught him and pressed the phone button that dials his grandmother’s house up the road."
By the time Sam’s grandmother arrived and his father woke up, the four-year-old had found the glucose gel kept for such emergencies, squirted some into his mother’s mouth and then proceeded to make her a snack, knowing this was something she usually needed.
"He told his grandmother, .Mommy likes peanut butter and crackers. Hope it’s OK that I made some for me, too,’" his mother describes.
Women at Greater Risk
Both type 1 and type 2 diabetes occur more frequently among women. In addition, one-third of women with type 2 are still undiagnosed, according to the Center for Women’s Health Care at Cornell University.
Those who are undiagnosed need to know, says C. Robert Meloni, MD, fellow of the American College of Endocrinology.
In addition to the associated risks of blindness, kidney disease and nerve damage, women with diabetes are up to five times more vulnerable to developing cardiovascular disease.
Type 2 diabetes is growing at an epidemic rate. Data from the Finnish Diabetes Detection and Prevention Trial determined that exercise and attention to diet can reduce the risk of developing type 2 diabetes by about 50 percent in people with impaired glucose tolerance.
Proven preventive measures include reducing fat intake, boosting dietary fiber, opting for complex carbohydrates over processed ones, losing 10 to 20 pounds of excess weight, and increasing exercise, which not only helps to shed pounds but also reduces the visceral fat around internal organs.
The Triple Power of Discipline
"People with diabetes need to have a sense of their own health and recognize that much of the control is in their own hands," says Sandra Hicks of Manchester, New Hampshire.
The 62-year-old Hicks has type 2 diabetes, which she has managed for years through a combination of diet, exercise and the oral medications Glucophage and glyburide. Her family history includes risk elements that tend to be found in higher numbers in African-American families: heart disease, hypertension, kidney disorders and high cholesterol.
"As women, we especially need to take better care of ourselves, since we often feel we need to be there for everyone else," she says.
Meloni describes the challenges faced by a woman with diabetes as a triad of meal planning, time management and exercise.
"Discipline is required to maintain dietary control while making meals for others—resisting the temptation to join in high-carbohydrate snacks prepared for kids, or planning to deal with social events where you should not eat the food offered," Meloni says.
Next it’s a matter of having enough hours in the day. For a woman with diabetes, "it requires making time to check blood glucose, taking time to determine what she can and should eat out of the daily meal plan, scheduling time to exercise in a day with many other demands," Meloni notes.
Christine Bleackley, 25, of Aylmer, Quebec, a mother of two, was diagnosed with type 1 diabetes seven years ago. She says she finds managing diabetes "more of a lifestyle than a chore. I have to be a bit more organized, get the meals on time, keep healthy food in the fridge, run around after everyone else, and still make time for myself."
The third part of the diabetes triad, exercise, helps control elevated blood-glucose levels by using up excess glucose while helping with weight control, Meloni says. But, for many women, it is often the trickiest component to incorporate into their lifestyle.
"We purchased a treadmill, which we keep in the basement," says Jennifer Reno, 30, of Howell, Michigan, the mother of a preschooler. "I began using it at night when everyone was in bed, but that kept me up too late. I can’t take my son into the basement while I am using it because I am afraid he will get hurt. It just never seems to be the right time to exercise."
Bleakley says that she tries to meet the need for exercise through activities she’s doing anyway.
"Walk that mile to the store and carry groceries or push them along with the stroller instead of driving," she suggests. "Use the stairs instead of the elevator, go to the pool when you have time, or take a walk in the park."
The Reproductive Factor
For women, reproductive issues often compound the challenges of managing diabetes. Women with existing diabetes usually need to take more insulin during pregnancy, as changing hormones and the growing fetus place added demands on the body. Those who develop gestational diabetes must alter their diet and may also require insulin.
Reno’s type 2 diagnosis came in the midst of her treatment for polycystic ovary syndrome (PCOS), which can be a precursor to diabetes. She also had gestational diabetes during pregnancy. A surprise benefit of the diabetes medication prescribed after the birth of her son was that it normalized her erratic menstrual cycle.
For mothers, "your kids are part of your team of helpers, too," Prindall notes. In addition to helping children understand the disease in a matter-of-fact way, mothers can enlist their children’s help.
"Let them get juice for you, or ask if you’re okay, or push the button for your blood-glucose test," she suggests.
Most of all, Prindall advises, it helps to remember that no one is perfect. Although the aim is to control diabetes, there’ll be out-of-whack days, with colds, stress or just plain human error, she says.
"You can call your doctor, you can make adjustments. If you follow the plan and have a flexible outlook, you can get back on track. You can manage your diabetes."