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Diabetes: A Guide to Living Well—A Program of Individualized Self-careThomas-Littleton, Colorado
Diabetes: A Guide to Living Well—A Program of Individualized
Self-care
Gary Arsham, MD, PhD, and Ernest Lowe. Publisher: American Diabetes
Association, Alexandria, Virginia. Date of Publication: 2004. Price:
$14.95
"We accept diabetes... as one more building block of life." "We are not simply managing diabetes, we are balancing our lives." "We have firsthand knowledge of the gifts of diabetes." The above quotes from the book Diabetes: A Guide to Living Well—A Program of Individualized Self-care are examples of the positive approach that is the hallmark of this book. Written by Gary Arsham, MD, PhD, a physician/educator who has had diabetes for more than 50 years, and Ernest Lowe, a counselor, educator, and television writer/producer who also has had diabetes for more than 50 years, it also includes a chapter written by Cathy Feste, a motivational specialist, also a person with diabetes. Diabetes: A Guide to Living Well is intended for anyone with diabetes. The book may be helpful for any newly diagnosed person with type 1 or type 2 diabetes or established diabetes. Individuals who are also struggling with the challenges of diabetes may find it most valuable. Likewise, individuals who are burned out, dispirited, discouraged, and hopeless may also find the messages very supportive. As a program of individualized self-care, it includes thorough explorations of the basics of eating well, physical activity, medications, and stress reduction. As a helpful tool for diabetes educators, Diabetes: A Guide to Living Well provides great ideas for helping people with diabetes deal with negative feelings, as well as ideas for jump starting their resolve to do better self-management. The thesis of this book is to offer a program of individualized self-care. The person with diabetes can select a moderate program, an intensive program, or no program at all. On a continuum from no care to best care, the authors spell out a moderate program with its benefits and downside. This moderate program has less self-care behaviors (less blood sugar monitoring and a set dose of medication) and will not reduce the risk of complications as much as the intensive program will. The intensive program is similar to the intensified insulin program familiar to diabetes educators. It includes more frequent blood sugar monitoring and the components of knowledge that must be mastered to allow adjusting medication based on activity, carbohydrate counting, and patterns. The person may choose "no program," or choose not to participate in self-care behaviors. In a very respectful and helpful manner, the book gives a framework to help the person understand why he or she may have chosen this program. The authors give ideas of selfcare basics that will help move one from the no program to the moderate program and from the moderate program to the intensive program. The chapter on the no program in my opinion is well worth the cost of the book. The authors state in the beginning of the book that it is designed so that any chapter can be read as needed. Chapters do not need to be read in order. The first half of the book deals with the behaviors in each of the different programs (moderate, intensive). Although the chapter titled "Eating Well" is well written and inclusive, the book could have mentioned behaviors such as measuring and recording food portion sizes earlier in describing moderate versus intensive programs. The authors could have been stronger in mentioning 2-hour postprandial blood sugars in the discussion of each program. These behaviors seem to have gotten short shrift. As an example, the Daily Diabetes Log gives as much space for an entire day of food recording as it does for time/date. This leads me to think that food records are not really encouraged. The "Eating Well" chapter could have benefited from more discussion on the effect of high-fat meals on blood sugars and what to do with late-night dinners or snacks. It could also have benefited from mentioning restaurant eating and fast foods, as they are such a component of our society. One excellent vignette gives an example of how cutting down on snacks and portion sizes and adding exercise can help cut down on high blood sugar. The book could benefit from more such vignettes. Putting a positive light on physical activity, the book gives great guidance for developing a program and understanding the effects of exercise on blood sugars. The chapter on stress reduction gives a very comprehensive list of activities that help deal with emotions, negative feelings, and negative people. Excellent advice is given in the chapter on complications. How do you help a patient who is refusing dialysis based on his wife's negative reaction? This book gives great guidelines and help. Diabetes: A Guide to Living Well would be a helpful addition to a class for people with new-onset diabetes. I also found myself recommending this book frequently to those who were trying to refocus on self-management behaviors. The authors help with some of the most vexing problems that diabetes educators face: negativism and lack of self-care. Perhaps my behavior of recommending this book frequently speaks for how valuable this book is to diabetes educators.
The Diabetes Educator, Vol. 32, No. 1,
65-66 (2006)
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