Where to start when you learn you have diabetes

Focusing on the most important steps can help you manage the disease

Published: November 2009

A diagnosis of type 2 diabetes can seem overwhelming. The sheer volume of information is intimidating, and even reputable health organizations sometimes offer conflicting advice. Plus, many outdated notions about the disease and diabetes treatment persist. (See our 10 diabetes myths to set the record straight.) But recent evidence and our own large survey of people living with the disease underscore the effectiveness of simple approaches to control.

To succeed in managing your diabetes you need to make a commitment to losing excess weight through proper diet and exercise. You also should adhere to your drug regimen and follow up with your doctors as necessary so that they can monitor your progress and adjust your diabetes treatment. Here are our three steps for creating a personalized treatment plan:

Health-care team

Our survey respondents told us which health-care providers were most helpful in four important areas: diabetes education, symptom recognition, diet and nutrition, and controlling pain and disability. Results underscored the importance of building a comprehensive health-care team, as no single provider topped every category. It also identified the ones who seemed most helpful. Below is a list of the professionals to consider, along with a summary of our respondents' experience.

Primary-care physician. You need this doctor, usually an internist or family practitioner, to manage your overall health, refer you to other health-care providers, and coordinate your care. And for diabetes, you'll probably need such referrals because our survey found that general-practice doctors were less helpful than specialists when it came to giving detailed advice.

Endocrinologist. These doctors, who specialize in diabetes and other diseases of the endocrine system, scored near the top in helping patients understand and manage the disease, recognize symptoms, and control pain and disability. People with severe diabetes almost always need one, and others can probably benefit, too.

Certified diabetes educator. These are usually registered nurses, nurse practitioners, physician's assistants, or registered dietitians with special training in diabetes and could be the most valuable member of your health-care team. Our survey respondents rated them at or near the top in every area, perhaps because they're more likely to have the time it takes to provide detailed advice on self-care, such as how to use your medications, check your blood sugar, watch for symptoms, and improve your health habits.

Registered dietitian. Dietary changes were important to our successful respondents, and not surprisingly, registered dietitians ranked well above other providers in offering nutritional advice. Look for one who is also a certified diabetes educator who has had special training and experience in diabetes.

Podiatrist. Because diabetes can interfere with blood flow and cause nerve damage in the feet, people with the disease run a high risk of infection even from seemingly harmless calluses or sores. Our survey confirmed the wisdom of placing a podiatrist, a specialist in foot care, on your health-care team, as respondents rated them among the most helpful in managing pain and disability.

Eye doctor. Diabetes can damage the blood vessels of the eye, but early treatment can be effective. So everyone with diabetes needs to see an ophthalmologist or an optometrist at least once a year, preferably a provider who often treats diabetes patients. Referral to a retinologist, an ophthalmologist who specializes just in the retina, may also be necessary.

Pharmacist. Almost all of our respondents told us that they take multiple medications, which increases the likelihood of dangerous drug interactions. Your pharmacist can catch potential problems, counsel you on side effects, and recommend safe over-the-counter products. Try to have all of your prescriptions filled at the same pharmacy so that the pharmacist has a complete record of your medications. Also let your pharmacists know what over-the-counter drugs and dietary supplements you take.

Dentist. Excess blood sugar creates a hospitable oral environment for bacteria, making people with diabetes prone to infection. So be sure to tell your dentist that you have diabetes and go for checkups twice yearly.

Mental-health professional. This may be an often-overlooked team member, but our survey found that the disease can exact a heavy emotional toll. One in five respondents reported symptoms of depression and anxiety; that number jumped to one in three for people who were unsuccessful at managing their disease. Depending on your issues, you may want to see a:

  • Social worker, who can lead you to resources for medical and financial needs and may be able to help you cope with family or workplace issues related to your condition. Social workers have training in individual, group, and family therapy.
  • Clinical psychologist, who can provide short-term counseling during a time of stress or longer-term help with longer-lasting issues.
  • Psychiatrist, a medical doctor who can prescribe drugs and also provide counseling.

How to cope

People with diabetes sometimes get overwhelmed by all the things they "should do"—change their diet, join a gym, take drugs, and check their blood sugar. No wonder up to 20 percent of patients say they would give up eight to 10 healthy years in exchange for a life without diabetes treatment, according to a recent report in the Archives of Internal Medicine.

The truth is that although you need to take steps necessary to get your blood sugar under control, you have latitude in the goals you set and the paths you choose. Many people think that a diabetes diagnosis condemns them to a life without desserts, for example, but our survey showed that other dietary strategies trumped giving up sugar.

Similarly, you don't necessarily need to heft weights or pay for an expensive trainer to add more physical activity to your life: Most of our successful respondents reported walking as part of their daily routine. And although people newly diagnosed with the disease often worry about insulin injections or frequent blood-sugar checks, many people can control their condition without either.

To avoid frustration, tackle your to-do list one item at a time, working with the appropriate member of your health-care team. If possible, start with an endocrinologist or primary-care doctor to get up to speed on your condition and figure out what medications will work for you with the fewest side effects.

Then ask for a referral to a diabetes educator (who can provide the detailed advice you may need) and a dietitian (who will help you design an eating plan that suits your tastes and lifestyle, both at home and when dining out). When it comes to exercise, don't think in terms of what you should do, but what you enjoy. Like dancing or taking the dog for a walk? Try to work those activities into your day.

Tests and drugs

Talk to your primary-care physician or endocrinologist about the specifics of your diabetes treatment plan: how often you need to be seen, the tests you need, your medications, and your goals for blood-sugar, blood-pressure, and cholesterol levels. Although your plan may vary, depending on your individual needs, here's a summary of what to expect:

Blood-sugar tests. Your physician should monitor your diabetes treatment every four to six months using the hemoglobin A1c (HbA1c) blood test or glycohemoglobin, which reflects the average blood sugar level over the prior three months. Unless you use insulin or have been newly diagnosed, frequent home monitoring of blood sugar is generally not necessary. In our survey, successful respondents were no more likely to check their blood sugar at home than those who had more trouble managing their disease. (To learn more about the latest research on home monitoring, see What you should know.)

But even if you don't monitor your blood sugar at home, your physician or nurse educator should teach you to recognize signs of when it shoots up very high (hyperglycemia) or drops very low (hypoglycemia). If that happens, see your doctor or get to a hospital right away.

Blood-pressure and cholesterol tests. In addition to high blood sugar, more than half of our respondents reported having high blood pressure; more than 40 percent had problems with cholesterol or triglycerides. That helps explain why people with diabetes have an increased risk of heart attack and stroke—and why they should have their blood pressure checked at every doctor visit and their cholesterol at least yearly. Aim for the targets listed in our table below.

Medications. The vast majority of our successful respondents took an oral medication such as metformin, and more people rated that as "very helpful" than any other strategy. But successful medication use doesn't mean taking a lot of drugs--it means taking the right ones and adjusting the dosages if necessary. For details, see our Best Buy Drug Report on diabetes.

People who are unable to normalize their blood sugar with pills should talk to their doctor about adding an injection of long-acting insulin to their regimen. People with diabetes may also require medication to control high blood pressure and cholesterol levels and should talk with their doctor about low-dose aspirin to reduce their risk of heart attack.

Know your numbers

If you have diabetes, keep your blood chemistry levels close to these targets.

Hemoglobin A1c (HbA1c) Below 7% (below 6.5% for some)
Blood pressure Below 130/80 mmHg
LDL (bad) cholesterol Below 100 mg/dL (below 70 mg/dL is better)
HDL (good) cholesterol Above 40 mg/dL for men; 50 mg/dL for women
Triglycerides Below 150 mg/dL

Choose your provider

Guide to the tool

This tool is designed to help you clarify your treatment concerns and objectives so that you can make informed decisions about what might work for you based on the experiences of our survey respondents. Here's more information about our survey sample and methods. Whether you will achieve the same results depends on a number of factors, including the severity of your condition and your overall health, and they can be determined only by a clinical examination.

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