10 Things to Do When You Find Out You Have Diabetes
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So You Have Diabetes -- Now What?
Before you were diagnosed with diabetes, chances are your schedule was filled with work and family, leaving little time for taking care of yourself. Now your health care provider is encouraging you to make lifestyle changes, such as choosing healthier foods, becoming more physically active, and testing your blood glucose (blood sugar). This new diabetes regimen might seem daunting, but with a one-step-at-a-time approach, you can successfully achieve a healthy and active lifestyle and manage your diabetes care.
Find the top actions to take when you are diagnosed with type 2 diabetes.
Inspect Your Health Plan
Diabetes can be expensive, so it's important to find the best possible and affordable health insurance coverage.
Cover your care
Group and individual health plans vary in the amounts of monthly premiums, deductibles, and copayments, as well as which health care providers' services are covered and where. Ask questions. It can be frustrating to learn that the cost of your diabetes self-management education program is covered only after you've met a deductible, but some options for education are more affordable than others, says Sue Freeman, R.N., B.S.N., CDE, coordinator of the Diabetes Education Center at Iowa Health Des Moines.
Does your insurance cover diabetes education?
Ask your health care provider to refer you to an accredited diabetes education program or to a certified diabetes educator (CDE) or registered dietitian (RD) for Medical Nutrition Therapy (MNT).
Diabetes education obtained in an accredited program is covered by Medicare Part B and many private health plans. Two associations accredit programs: the American Association of Diabetes Educators (AADE) and the American Diabetes Association (ADA). At least one member of the program staff needs to be a CDE, among other requirements. Dietitians who provide MNT must be registered by the Academy of Nutrition and Dietetics.
Important questions to ask about your health plan:
- How much is the monthly premium (fee)?
- Is there a preexisting-condition exclusion that would make you pay before obtaining coverage for diabetes services? Effective January 14, 2014, insurance companies will be prohibited from refusing coverage based on preexisting conditions per the Affordable Care Act of 2010.
- What are the copayments for health care provider visits, medications (different ones have different copays), and diabetes supplies?
- Are there restrictions on the amounts of diabetes supplies you can get at one time and where you can purchase them (a pharmacy or durable medical equipment provider)?
- Does the plan cover the services of specialists, such as endocrinologists, eye doctors, podiatrists, dentists, mental health providers, and exercise physiologists?
- What medications are covered? Is there a prescription plan? How often can prescriptions be refilled and where (a local pharmacy or mail order)?
Note: If you have been uninsured for more than six months because of a preexisting condition, such as having diabetes, check to see if your state offers a Pre-Existing Condition Insurance Plan (PCIP). This coverage option was established in 2010 until the 2014 provision goes into effect.
Consider Medications to Lower Glucose and More
Will you need medicine to control your blood sugar? Not necessarily. Some people need medication right away, while others don't (the American Diabetes Association now recommends starting metformin at diagnosis). Type 2 diabetes is a progressive disease, which means your ability to make and use insulin will decrease over time due to changes in your body. The amount of blood glucose-lowering medication you take may need to increase, or new medications may need to be added over time. Regular monitoring will tell you and your health care provider when a change is warranted.
There are six main types of diabetes pills, a variety of insulins, and a few injectable drugs that help lower blood glucose. These numbers change frequently as new medications become available on the market.
Important questions to ask a pharmacist or certified diabetes educator about your medications:
- How does the medication lower my blood sugar?
- How do I take the medicine (orally or injection)?
- How much (dosage), when (before or with meals), and how often (frequency) do I take the medicine?
- Should I take a dose if I miss it?
- What side effects, if any, might I expect?
- What can I do to minimize side effects?
- Does this medication interact with any of my other medications?
- What nonprescription medicines (over-the-counter, supplements, or herbals) interact with the medication?
- How and where should I store the medication and any extra amounts?
- When should I call my health care provider about a side effect or high or low blood glucose?
- When is the best time to test my blood glucose to assess how my medications, food, and activity are working to manage it?
Create Your Diabetes Eating Plan
Although diabetes treatment plans vary, each includes nutrition therapy, physical activity, monitoring, support, and medications. Your food and activity plans are the heart and soul of your treatment plan.
Food? Activity? Testing? "First try to relax," says Teresa Peiffer, R.N., B.S.N., CDE, of Iowa Health Des Moines. "Most people find they don't need to make dramatic changes in their lifestyle. Get started by simply keeping track of what you're doing. Write down what, when, and how much you eat. Make notes about the physical activity you do. Then test your blood glucose to see the impact of these factors on your blood glucose."
Consider Working with a Registered Dietitian
Your registered dietitian or certified diabetes educator (CDE) can help outline a plan and guidelines so you can make smart and healthy choices. Strategies they might use include:
- Identify your food preferences and healthful foods you like.
- Accommodate your unique daily schedule and activities.
- Budget and distribute carbohydrate-containing foods (starches, fruit, fruit juice, milk, yogurt, sweets) to achieve target after-meal blood glucose levels.
- Choose healthful fats to achieve target blood cholesterol and triglyceride (lipid) levels.
- Determine appropriate portion sizes for weight loss and maintenance.
- Determine a sodium budget to help you achieve target blood pressure.
Tip: Donna Starck, R.D., CDE, of Iowa Health Des Moines underscores the importance of keeping written food records. "Written records can help you identify your healthy habits and areas where small changes might be helpful," she says.
Develop a Plan for Physical Activity
Physical activity is the perfect partner to your eating plan: Food gives you energy, and activity can help to burn it up! The American Diabetes Association recommends accumulating 30 minutes of aerobic activity such as walking on most days, with the addition of resistance training (pushing, pulling, lifting) three times a week.
Every step you take can improve your overall health by:
- Improving blood sugar levels.
- Helping your body better use the insulin you still make.
- Decreasing total cholesterol and triglycerides (blood lipids) and increasing HDL (good) cholesterol.
- Decreasing blood pressure.
- Fostering weight loss and maintenance.
- Increasing strength, endurance, and flexibility.
- Increasing energy and feelings of well-being.
Your activity plan should eventually include three types of activity:
- Aerobic or cardiovascular (working heart and lungs, such as walking, biking, swimming, dancing, and stair-climbing).
- Resistance or strength training (lifting, pulling, and pushing).
- Stretching and flexibility.
What to consider when developing a physical activity plan:
- What activities do you enjoy?
- How can you build activity into your already-busy day?
- How active are you now?
- Do you have an all-or-nothing mentality? If yes, try to reshape your thinking. Some activity is better than none when it comes to lowering your blood sugar. Snatch 10 minutes here and 10 minutes there, and you'll soon accumulate your daily 30
- Assess your steps for a few days by wearing a pedometer (a small device that fits on your waistband). One mile is about 2,000 steps.
- Set small, realistic goals, go at your own pace, and reward yourself when you reach them. For instance, if you start with 1,500 steps, try adding a couple hundred steps each day until you reach your goal.
Incorporate Activity into Your Routine
Staying active is important, but you don't have to hit the gym to stay in shape. Every step, push, pull, lift, and stretch counts!
- Lift: carry sand bags, groceries, trash
- Push: mow the lawn, push a stroller
- Pull: weed the garden
- Stretch: take a stretch break at work
Try these simple ways to incorporate physical activity into your day:
- Walk with your pet, baby, or grandchild
- Bike or walk to do neighborhood errands
- Climb a couple flights of stairs instead of taking the elevator
- Avoid sitting (at a screen, on a couch) for more than 30 minutes at a time
How to limit hypoglycemia
If you take a blood glucose-lowering medication that can cause hypoglycemia (low blood sugar), ask your diabetes educator about how to prevent and treat hypoglycemia during exercise. And check your blood glucose before and after the activity to see the effects.
Connect with Others
Initial and ongoing support is crucial when you have diabetes. Connecting with others recharges your battery and motivates you to take care of yourself. Talking with someone you trust can ease anxiety about having diabetes.
Ask yourself these questions:
- Where do I get support?
- What do I need to take care of my diabetes?
- Am I comfortable asking for support/help?
- What motivates me?
Sources of support to get questions answered, compare diabetes experiences, or vent frustration:
- Support groups in person or online
- Community programs
- Group diabetes classes
- Friends and family
- Your health care team
Shop for Diabetes Supplies
What supplies do you need to manage your diabetes? Here's a quick rundown of frequently used tools.
Common diabetes supplies:
- Blood glucose meter: Ask if a complimentary meter is provided at your first appointment with your health care provider, by rebate from a manufacturer, or from your health insurance company.
- Blood glucose test strips: These are expensive; get a prescription from your health care provider. Depending on the health plan, a certain number of strips may be covered.
- Lancing device: Used to obtain a blood sample for a test strip.
- Lancet: A needle used in the lancing device.
- Medicine: Oral or injectable drugs prescribed by your physician.
- Syringes: For insulin or other injectable drugs.
- Sharps container: To contain used lancets and needles. You can use a hard plastic container with a lid, such as a laundry detergent bottle.
- Medical identification: A card, bracelet, or necklace.
- Food, activity, and blood glucose record book: To help you be aware of the effects of what you eat, activity, stress, and medication on your blood glucose levels and to help your health care provider make recommendations for your diabetes management.
Pick Your Primary Care Provider
When choosing a primary care physician to help you manage your diabetes, it's important that your physician:
- Respects your individuality.
- Listens and responds to your questions and concerns.
- Recommends the best treatment plan possible.
- Reviews your treatment plan regularly.
- Adjusts your plan as needed based on your A1C, self blood glucose tests, lipids (blood fats), blood pressure, and other lab work.
- Refers to others on your health care team as needed.
Consider a Diabetes Self-Management Training Program
If your primary health care provider isn't part of a diabetes center or clinic, he or she may refer you to a diabetes education center. Your options include meeting individually with a certified diabetes educator (CDE) or participating in a group diabetes education program.
Where are diabetes educators and education programs?
You’ll find diabetes educators in diabetes education programs, which are often housed in a hospital or medical center. You might find two educators, a nurse and dietitian, or a nurse and pharmacists working as a team. In large programs you may also see an exercise physiologist or psychologist. These programs are often called a diabetes self-management education (or training) program, abbreviated DSME or DSMT.
The location of diabetes educators and their programs is changing. Programs and educators are becoming more accessible to where you live and work. You’ll now find educators in primary care provider offices, pharmacies, supermarkets, and offices in strip malls. This is great news!
Find Programs in Your Area
Create a Diabetes Care Schedule
When you're newly diagnosed with diabetes, many questions arise: What tests and checks should I have? When should I have them? What is normal?
There are some checks and tests you'll need, both when you are first diagnosed and ongoing, to take care of your diabetes. Early detection, prevention, and treatment are keys to minimizing diabetes complications. Work with your primary care provider to customize your diabetes care schedule, including personal goals and targets. Schedule these preventive tests and checks in advance, and mark your calendar!