Reprinted from the fall issue of The Ohio Family Physician
By: Kate Szymanski, DO; Luisa Corpuz, MD; and Megan Sizemore, PharmD, University of Toledo Medical Center, Family Medicine
Myth 1: It is more important to avoid “lows” than “highs.”
Reality: While there is some truth to this myth, because of the critical nature of hypoglycemia, it is helpful to educate the patient on striking a balance and not over-treating their lows. Even patients with long-term diabetes can benefit from reviewing how they currently treat hypoglycemia and the “rule of 15,” which is eating 15 grams of quick-acting carbohydrates (e.g. four glucose tabs, 4oz of juice or regular soda) and then rechecking blood sugar in 15 minutes. Some patients also benefit from their physicians reviewing their medications and informing them of which medications cause hypoglycemia. Since many classes of diabetic medications do not pose an intrinsic risk of hypoglycemia, some patients are unnecessarily worried about the risk.
Myth 2: People with diabetes need to cut out all sweets and carbohydrates.
Reality: Diet and lifestyle modifications play a large role in improving outcomes and minimizing the need for medications, but it does not need to be a strict no-carb diet. The American Diabetes Association (ADA) recommends the Healthy Plate method1 which recommends splitting each plate into ½ for non-starchy vegetables, ¼ for protein, and ¼ for carbohydrates. Examples for carbohydrates include oatmeal, brown rice, starchy vegetables, fruit, and beans. The ADA has a website with detailed information about the Healthy Plate method, along with a tool to help with meal planning and creating a grocery list. A referral for a pharmacist or dietitian to dedicate time to helping patients understand the dietary guidelines is recommended.
Myth 3: Taking medications replaces the need for dietary changes.
Reality: Taking medications is only part of the puzzle when it comes to diabetes. When patients are resistant to lifestyle changes, it can be helpful to discuss the progression of treatment. Many patients want to avoid insulin and informing them of where they are in the progression of treatment can be beneficial and motivating for them to work on lifestyle changes. The patient’s current diet and lifestyle, along with their ability to modify, should also be taken into consideration.
Myth 4: Insulin is a punishment for poor diabetic control.
Reality: Typically, patients can be placed on three maximally tolerated doses of non-insulin diabetic treatment before considering insulin.2 In addition, there are several medical conditions in which the use of insulin is due to a change in production and utilization of insulin in the patient’s body such as Type I, Type 1.5, and gestational diabetes. As in Myth 3, providing education to patients about where they are in the progression of treatment may help them to see insulin as the next logical step rather than a punishment.
Myth 5: Exercise alone will make medication or dietary change unnecessary.
Reality: While exercise can be helpful with reducing hyperglycemia, exercise alone is not likely to create the necessary reduction in hemoglobin A1C. In a meta-analysis3 of trials, exercise for more than 150 minutes per week showed a 0.89% reduction, while exercise routines with a duration of less than 150 minutes per week showed a 0.36% reduction. Depending on the patient’s current diet and exercise regimen, it may be possible to achieve a goal hemoglobin A1C with lifestyle changes alone; however, while this may delay medication, over time most patients will require additional treatment. Exercise is a valuable part of the management of diabetes, but patients will benefit from a realistic expectations.
References available on the Ohio Academy of Family Physicians website.