10 Things to Do When You Find Out You Have Diabetes
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So You Have Diabetes -- Now What?
Now that you have diabetes, your health care provider is likely encouraging you to make lifestyle changes, such as choosing healthier foods and becoming more physically active. You might be encouraged to monitor your blood glucose (blood sugar) by regularly checking your glucose levels. Your health care provider might also recommend getting tests and checks during the year and doing certain things, like flossing and brushing your teeth more often.
It can feel overwhelming wondering how you’ll fit these added to-dos into your day. Take a deep breath, and then approach making changes one step at a time. Over time, you can successfully achieve a healthy and active lifestyle and manage your diabetes care.
Inspect Your Health Plan
Diabetes can be expensive, so it's important to find the best possible and affordable health plan that will cover your diabetes-related medications (if you need them) and supplies, like a glucose meter and test strips.
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. Be prepared to ask questions.
Does your insurance cover diabetes self-management education and support (DSMES)? Ask your primary care provider to refer you to an accredited or recognized DSMES or to a certified diabetes educator (CDE) or registered dietitian (RD)/registered dietitian nutritionist (RDN) for medical nutrition therapy (MNT).
Note: Be sure to ask if you have to meet a deductible to get coverage for diabetes management classes.
Diabetes education obtained from one of the accredited or recognized programs is covered by Medicare Part B and many private health plans. The American Association of Diabetes Educators (AADE) and the American Diabetes Association (ADA) recognize programs.
More important questions to ask about your health plan:
• How much is the monthly premium (fee)?
• What are the copayments for health care provider visits, medications (different ones have different copays), and diabetes supplies?
• Are there restrictions on the types of diabetes supplies you can get, the amount you can order at one time, or 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 prescribed medications are covered? Is there a prescription plan? How often can prescriptions be refilled and where (a local pharmacy or mail order)?
Note: Effective January 14, 2014, insurance companies are prohibited from refusing coverage based on preexisting conditions per the Affordable Care Act of 2010.
Consider Medications to Lower Blood Sugar and More
Will you need medicine to control your blood sugar with type 2 diabetes? Most people need at least one blood glucose-lowering medication as soon as they are diagnosed. A small number don't. The American Diabetes Association and other expert organizations now recommend that most people diagnosed with type 2 diabetes start taking metformin at the time of diagnosis.
Type 2 diabetes is a progressive disease, which means your ability to make and use the insulin your body produces will decrease over time due to changes in your body. The amount of blood glucose-lowering medication you take might increase, or new medications may need to be added over time. However, if blood sugar levels fall back into a normal range and you lose weight through healthy eating and physical activity, you may be able to take less or take no medication for a while. Regular monitoring will tell you and your health care provider when changes are warranted.
There are at least seven main types of blood glucose-lowering pills, a variety of insulins, and a few injectable drugs that help lower blood sugar. More will become available in the future.
Important questions to ask your health care provider, pharmacist, or diabetes educator about your medications:
• How does the medication lower my blood sugar?
• How quickly will it start to lower my blood sugar in the short- and long-term?
• How do I take the medicine (orally or by 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?
• When should I call my health care provider about a side effect or high or low blood sugar?
• 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 is the best time to test my blood sugar 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 a healthy eating plan, physical activity, monitoring, and support, and most include 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 UnityPoint 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 diabetes educator can help develop a plan and guidelines that will work for your lifestyle. Strategies they might use include:
• Identify your food preferences and healthful foods you like.
• Accommodate your unique daily schedule and activities.
• Advise and budget 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 (blood 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 UnityPoint 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 healthy 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) two or 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, which means the same as improving insulin sensitivity.
• 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 physical activity plan should, over time, include three types of activity:
• Aerobic or cardiovascular activity that benefits the heart and lungs (walking, biking, swimming, dancing, stair-climbing).
• Resistance or strength training (lifting, pulling, 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. Any 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 minutes.
• 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, child, or grandchild.
• Bike or walk to do neighborhood errands if you live a reasonable distance away.
• Climb a couple flights of stairs instead of taking the elevator or escalator.
• 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. If you are regularly exercising and experiencing low blood sugar, it’s likely your glucose-lowering medication(s) need to be changed. Talk to your health care provider.
Connect with Others
Initial and ongoing support is crucial when you have diabetes. Connecting with others can recharge and motivate 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 providers
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 or if your health care provider suggests a monitor. If not, ask about rebates and check your health plan coverage for these supplies.
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. (One of these usually comes with your meter.)
Lancet: A needle used in the lancing device.
Medicine: Oral or injectable drugs prescribed by your health care provider.
Syringes: For insulin or other injectable drugs. Or pen needles for insulin pens and other injectable pens.
Sharps container: To contain used lancets and needles. You can use a hard plastic container with a lid, such as a laundry detergent or bleach bottle.
Medical identification: A card, bracelet, or necklace.
Food, activity, and blood glucose journal, record book, or mobile app: To help you track what you eat, activity, stress, and medications and the effects they have on your blood sugar levels. This will also 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 they:
Listen and respond to questions and concerns.
Recommend the best treatment plan possible.
Review treatment plans regularly.
Adjust plans as needed based on A1C, self blood glucose tests, cholesterol, blood pressure, and other lab work.
Refer patients to other specialists based on health needs.
Consider a Diabetes Self-Management Education and Support Program
If your primary health care provider isn't part of a diabetes center or clinic, ask him or her to refer you to a DSMES program. Most likely the program will be a class or series of classes with other people who also have diabetes.
Find Programs in Your Area:
Create a Diabetes Care Schedule
When you're newly diagnosed with diabetes, you’ll likely have loads of questions, such as: What tests and checks should I have? When should I have them? What is normal?
There are some checks and tests you'll need -- some when you are first diagnosed and some on a recurring basis -- 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!