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The Four Pillars of Diabetes Care

Source: Angel Ponce, RD, CDE

Type 2 Diabetes has become a world wide pandemic that is affecting men, women, adults, adolescents, and even children. The outcomes are devastating to the individual as well as to his/her loved ones. It is one of the leading causes of preventable death and disability. Yes, preventable, meaning that all the complications of diabetes can be prevented or minimized. The challenge in controlling this chronic disease is that it is very complicated to treat and manage. The patient is usually overwhelmed with information, treatment regimens and appointments.

Self-management education is the key to controlling Type 2 Diabetes, meaning that most of the management is done at the home and not at the doctor’s office. One very effective way to manage the disease at home is by establishing routines around the four pillars of diabetes care - meal planning, physical activity, medications/insulin, and self-management of blood glucose (checking blood sugars).

Pillar #1
The patient must eat his/her meals at about the same times every day, eat approximately the same amounts of food per meal and limit or count carbohydrates.

Pillar #2
Establishing a physical activity plan, as recommended by a physician.

Pillar #3
The patient must take his/her medications and insulin as recommended every day. It is important to not skip them or self adjust.

Pillar #4
Checking blood sugars as indicated to assess how nutrition, physical activity, and meds/insulin are helping to attain appropriate diabetes control.

Through checking blood sugars, the patient can learn how certain foods and physical activity affect blood sugars on a daily basis. A Registered Dietitian, Nurse, Certified Diabetes Educator, or Health Educator can help in developing a proper individualize plan.

The four pillars of diabetes care are like a car with four wheels. In order for the car to run well all four wheels must be properly aired up. If one wheel is flat, the car will not run. If one tire is a bit low, the car will run but not as effectively as it normally would. What this means in terms of diabetes is that the patient must establish a routine around the four pillars of care; if he/she does not follow any one of the four pillars the person will not feel very well (fatigued, head ache, blurry vision, hungry, increased thirst and urination-signs and symptoms of high blood sugars). This is equivalent to having a flat tire. If the patient does follow the pillars but does not follow them as recommended, than one or more of the tires will be low. The car will run, however, not as efficiently as it should. The patient will be able to function with minimal signs and symptoms of high blood sugars. However, the slightly elevated blood sugar levels will cause complications in the long run. Please remember that our bodies are our main mode of transportation and we must always assure to keep our four wheels properly aired up.


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