Introduction
So, you’ve just been newly diagnosed with diabetes and you’re not sure how to cope with it. I can help with that! It’s very common to be given a diagnosis and not be told what to do next except maybe take a pill or a shot without much of an explanation or guidance! There’s more to controlling diabetes than taking medications that you should know about. I’ll review what gets missed!
November is National Diabetes Awareness Month, however, due to the number of people undiagnosed or under-diagnosed, it’s worth emphasizing during heart health month—February. This is one disease that can be managed and treated when identified as early as possible.
Understanding how to manage this disease begins with education. Knowledge is the first step in identifying what to do next. The more you know and put into action the better you’ll feel. I’ve taught many diabetes education classes and helped hundreds of people either decrease their medications or completely come off their meds for diabetes by tweaking their diet and finding ways to incorporate physical activity. Not everyone will respond to lifestyle behaviors alone and may need medication to help control blood sugar levels. That said, anyone taking medications will still benefit by monitoring their diet and moving more. Diabetes is a chronic disease that affects your blood sugar. In my last blog post 5 Heart Health Habits-Checklist I talked about how blood affects the heart. Diabetes is a contributing factor to the number one disease, heart disease. In this blog, my attention is on newly diagnosed Type 2 diabetes, bringing me to my first point.
Know Your Type of Diagnosis
According to the Centers for Disease Control and Prevention (CDC), more than 100 million adults in the United States exist with diabetes or prediabetes, and that number continues to rise. The number of adults who’ve been diagnosed has more than doubled in the past 20 years. There are people walking around with diabetes or prediabetes who don’t know it. Either they’ve never been tested, or their doctor gives a weak report about the results, without seriously addressing it, as in—”your levels are OK!” People with numbers out of range (i.e., on the higher end) are at a greater risk for significant health complications, such as heart disease, blurred or loss of vision, kidney failure, amputation of limbs, and premature death.
If you haven’t been told which type of diabetes you have, ask your doctor. There is a huge difference between Types 1, 2, and 3.
Type 1: an autoimmune disorder (creates very little to no insulin) – not curable.
Type 2: insulin is created in the body but not used efficiently – can be reversed.
Type 3: Type 2 diabetes and Alzheimer’s disease (highly controversial and not widely accepted by the medical community)
Type 3c: pancreatogenic diabetes (secondary insult to the pancreas)
More on Type 2 Diabetes
Type 2 diabetes is the most common form and fastest-growing type. Your body doesn’t make enough insulin or becomes resistant to insulin. Insulin is produced in your pancreas and helps to balance blood glucose levels. When the pancreas isn’t producing enough insulin there’s a buildup of glucose in the blood, raising glucose levels. If left untreated you may begin to experience complications with your eyes, stomach, feet, hands, mouth, heart, liver, skin, and urinary issues.
Organs affected
Eyes – blurry vision that can’t be corrected with glasses, can go blind if left untreated.
Stomach – digestive problems, partial paralysis of the stomach.
Feet/hands – due to poor circulation at high risk to develop sores, blisters, and nerve damage over time.
Mouth – gum disease, bleeding gums.
Heart – fatty deposit buildup narrowing in your heart’s blood vessels.
Liver – unable to filter blood.
Skin – rashes, blisters, and poor wound healing.
Urinary system – UTI (urinary tract infection), and bladder infections.
Questions to Consider
Upon diagnosis did your doctor advise you to take a Diabetes Self-Management Education class or refer you to a dietitian when you were diagnosed?
Whether newly diagnosed or have had diabetes for years, you may not have received any education on how to manage it with diet and physical activity. This education is essential to help you understand and handle your diabetes and should not be overlooked. Most insurance plans will pay or reimburse you for diabetes education whether it’s class or with a dietitian. If your doctor hasn’t recommended this instruction, ask for it.
Are you seeing an endocrinologist (a specialist who treats hormone imbalances such as diabetes and thyroid disorders) or does your Primary Care Physician (PCP) manage your medications?
Many PCPs manage diabetes, and that’s perfectly acceptable, but it’s important that you’re informed of other options. Equally significant is that you feel comfortable with your doctor, developing a relationship of trust (i.e., Do they deal with a lot of cases to understand all the aspects of the condition, including current diet, exercise, and medication treatments?) These are important questions to ask your doctor if you’re not seeing an endocrinologist.
When is the next time you’re scheduled to have blood work done, and is HbA1c included?
People who’ve been diagnosed with diabetes should be tested every 3-6 months for their HbA1c (test to measure the average blood sugar level over the past 3 months) to determine how well their body is controlling their blood glucose. To all the diabetics reading this, if your doctor is not testing for HbA1c, ask for the lab test. I’ve seen some doctors not test HbA1c when managing their patient’s blood glucose levels. The result is dependent upon medications adjustments. The HbA1c test is also used to diagnose prediabetes, a condition where blood sugar is higher than normal but not at a level to be diagnosed with diabetes.
It’s also underdiagnosed because there are no clear symptoms. In other words, you may have either prediabetes or diabetes and not know it, and this is regardless of family history. It’s a good idea to have it checked, especially if you’re over 45 years old.
Are your medications adjusted according to the levels of your blood sugar report?
As mentioned above, it’s important to have bloodwork tests done to either adjust or change your medications. If you experience any of the following: unexplained increase in blood sugar, blurry vision, excessive thirst, frequent urination, or poor wound healing, alert your doctor immediately. Know that illness and stress can raise your blood sugar levels. Some surprisingly other causes of an increase in glucose: artificial sweeteners, coffee (those sensitive to caffeine), overeating, dehydration, loss of sleep, and sunburn.
As you begin to regulate your blood sugar through diet and physical activity over time, your medications may need to be decreased.
Oral Medications vs Injections
There are two main types of medications for Type 2 diabetes (T2DM), pills and injections (insulin and non-insulin) not to be confused with Type 1 diabetes which requires insulin injections only. Many people are puzzled when they’ve been prescribed an injectable form of medication for Type 2 diabetes, thinking that type doesn’t require it.
I’m not going to review all the medications available for T2DM, but you should understand what kind of medication you’ve been prescribed, how and when to take it, and why—the purpose of that medication. Also, ask how it’s stored. All medications have side effects, and you should know the signs and symptoms to report to your healthcare provider if you’re experiencing any of them immediately.
Injections
Insulin injections
When oral pills are not enough to control your blood sugar, you may be prescribed insulin. There are several different types: long-acting, intermediate-acting, regular (short-acting), and rapid-acting. Again, be sure to understand all the details if you’re prescribed any of these medications. Don’t be afraid to ask questions.
Non-insulin injections
These medications help stimulate insulin from your pancreas by keeping food in your stomach longer to help prevent a spike in your glucose, lowering the amount of sugar released in your bloodstream. Lastly, they’re designed to help you eat less so you feel full sooner.
Both types of injectables have different delivery devices such as syringes, pens, pumps, and jets. All the devices have needles except the jet form. Thanks to technology there’s now a smart insulin pen! I know, it’s complicated at first, but you’ll learn to cope and succeed over time.
Blood Glucose Meters
Blood glucose meters are a self-care tool to help you monitor your blood sugar daily. There are many meters to choose from. They range in cost, use of ease, and accuracy. Be sure to learn and understand how to test with the meter you select or prescribed. Ideally, your healthcare provider should demonstrate how it’s used or direct you to a professional such as a diabetic nurse educator or dietitian who specializes in diabetes. More on blood glucose monitoring.
Blood Sugar levels
Your healthcare provider should give you a range of numbers to look for once you start using your meter. Know your numbers and what to do when they fall out of range. Both low and high out-of-range are critical to your immediate health.
High blood glucose (hyperglycemia) – some common causes are eating too much, unplanned snacking in between meals, lack of physical activity, missed medication or incorrect dose, dehydration, stress, illness, and other medications such as some types of antidepressants and corticosteroids. Any of these could be a high read on your meter.
Low blood glucose (hypoglycemia) – could be caused by too much insulin, more physical activity than what you normally do, and not eating enough to align with your recommended dose. It’s important to understand what to do when you have low blood sugar and how to raise it slowly. The number on the meter will be different for each person when experiencing low blood sugar but the method of how to raise it slowly will be the same.
Caution: Alcohol can raise or lower blood glucose to dangerous levels.
Ask your doctor the following upon diagnosis:
- The type of diabetes you’ve been diagnosed with.
- The side effects (signs & symptoms) of the medication you’ve been prescribed.
- What to expect and for how long you’ll experience a change in your body.
- To show you how and where to inject yourself with the meter and any injectable devices.
- Your range of numbers when you take a reading from the meter.
- The signs & symptoms for out-of-range glucose readings and what the plan is for both hyperglycemia and hypoglycemia.
- How to store medications and discard any devices safely.
- How to manage low blood sugar.
- Your lab results and what the numbers mean. OK, is not a number!
- How often you should test with your glucose meter and how to safely discard the strips and needles.
- Most importantly, ask to be referred to a diabetes class or educator (Registered Nurse or Registered Dietitian) if not already recommended.
Meal Plan
Don’t let food fool you!
We all know that donuts are not the healthiest choice especially if you’re trying to control your blood sugar levels, but did you know neither are bagels? You might think swapping out your breakfast donut for a bagel is a healthier choice and understandably so. After all, bagels don’t have sugar like donuts. Turns out, the bagel has a larger amount of carbohydrates than the donut leading to a higher release of glucose in the bloodstream. This is not to suggest you can’t have a donut or bagel but rather to understand the importance of an individualized meal plan and how carbohydrates affect your glucose.
A designed meal plan specific to your needs is vitally important when you’re monitoring blood sugar. Meal plans are personalized and can’t be taught in a blog. Hence, the reason your healthcare provider should recommend a diabetes program, class, or dietitian to help you. (worth repeating ) During this, you’ll learn all of the above in greater detail and will be taught a meal plan tailored to your specific needs.
Conclusion
Those with Type 2 diabetes, who implement diet changes, increase their physical activity and lose some weight have the possibility of managing or even reversing their diabetes—without the use of medication. If this approach fails, you and your doctor may decide to start on medication(s). Additionally, there may be an immediate need to start medication(s) to get your glucose under control. Remember, medication is not a replacement for poor food choices.
You and your healthcare provider should have a plan in place after your diagnosis and before leaving their office. Learning all you can about your new diagnosis and how to manage it is your best health option.
In optimal health,
Lisa