Successfully Manage Type 2 Diabetes
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Know the Basics
Knowledge can go a long way toward easing the stress of a type 2 diabetes diagnosis. Learning how to eat, exercise, and monitor your blood sugar levels are among the first steps in understanding what having type 2 diabetes means for you. Sticking to the basics can help you take control of your diabetes.
Take comfort in the fact that you’re among millions. Type 2 diabetes is the most common form of diabetes, accounting for 90-95 percent of people living with diabetes (PWDs). If you consider the family members and friends of everyone you know who has diabetes, you may have a wealth of support available to you. Plus, ongoing research continues to find new ways to improve the lives of those with diabetes.
How You Control Type 2
Eating healthfully, getting regular exercise, checking blood sugar levels, and taking blood glucose-lowering medications as prescribed (if you need one or more) can help you control type 2 diabetes. Several of these actions in turn may contribute to a small amount of weight loss, improved cholesterol (blood lipids), and lower blood pressure. Treatment options -- including lifestyle strategies and blood glucose-lowering medications -- will likely change over time as the disease progresses. Type 2 diabetes is a progressive disease.
What You Need to Know to Manage Diabetes
There are several steps to successfully managing diabetes, including:
• Healthy eating and regular meal planning
• Understanding carb counting
• Monitoring blood glucose (blood sugar)
• Identifying your target goals for glucose, cholesterol, and blood pressure
• Learning about the blood glucose-lowering medication you take
• Including physical activity
• Gathering your support team
• Telling others about your diagnosis (when you are ready and want to)
Balanced Meal Planning
Here's some good news: There's no reason to run out and buy "diabetic foods." Developing a healthy eating plan that reflects your individual calorie and nutrition needs and food preferences is key because it’s most likely what you’ll be most successful following. Work with a dietitian to help you create an eating plan. Following your plan as close as possible can help keep your blood sugar under control while allowing you to enjoy healthful, delicious meals and snacks. Establishing a regular routine will help you settle into your lifestyle with diabetes and keep your blood sugar at a healthy, consistent level.
• Eat about the same amount of food each day.
• Eat meals and snacks about the same times each day.
• Don't skip meals (particularly if you take a glucose-lowering medication that can cause hypoglycemia or low blood sugar).
• Take your blood glucose-lowering medications at the same time each day.
• Work in regular physical activity that you enjoy, such as gardening, walking the dog, Zumba, biking, or nature hikes.
• A well-balanced meal plan incorporates carbohydrate, protein, fat, vitamins, minerals, and fiber. As with any healthful eating plan, lowering your saturated fat and cholesterol as well as salt/sodium intake will help you meet your nutritional goals. The good news is you can enjoy desserts and sweets in moderation.
Create Your Plate
The American Diabetes Association (ADA) recommends a Create Your Plate method of meal planning, similar to the U.S. Department of Agriculture's Choose My Plate (choosemyplate.gov), which replaced the Food Pyramid. The ADA's Create Your Plate encourages you to put six easy steps into action:
• Use a 9-inch dinner plate and create three sections: one half and two quarters.
• Fill the largest section (1/2 of the plate) with nonstarchy vegetables, such as spinach, carrots, lettuce, greens, cabbage, bok choy, green beans, broccoli, cauliflower, tomatoes, salsa, onions, cucumbers, beets, okra, mushrooms, peppers, or turnips.
• In one of the small sections (1/4 of the plate) place starchy foods, such as whole grains, whole wheat bread or rolls, brown rice, pasta, tortillas, cooked beans, peas, potatoes, corn, lima beans, sweet potatoes, or winter squash.
• Finally, in the remaining small section (1/4 of the plate) place a small portion of meat or protein choice, such as chicken, turkey, fish, seafood, lean beef or pork, tofu, eggs, or low-fat cheese.
• Add a serving of fat-free milk or another dairy option, such as fat-free yogurt. Depending on your meal plan and carb-count budget, you can omit the extra dairy and add a piece of fruit.
Accurately keeping track of the amount of carbs you eat and adhering to your individual guidelines are keys to controlling your blood sugar levels. Counting carbohydrate grams, or carb counting for short, is a common approach to diabetes meal planning today. The reason for focusing on carbohydrate is because research shows carbs have the greatest impact on blood sugar, especially after eating.
Think of foods as packages of nutrients -- combinations of carbohydrate, protein, and/or fat. No one food has all the nutrients your body needs, which is why eating a wide variety of foods helps you meet your nutrition needs. Work with a dietitian or diabetes educator to determine the right amount of daily carbs and calories for you.
The three main calorie-containing nutrients are carbohydrate, fat, and protein. (Alcohol also contains calories.) Most of the calories in the following foods are from carbohydrate.
Starches: bread, cereal, pasta, whole grains
Starchy vegetables: potatoes, corn, legumes (beans)
Fruits: Apples, berries, melon, fruit juice
Nonstarchy vegetables: green beans, tomatoes, broccoli
Dairy: milk, yogurt, cheese
Sweets and sugary foods: ice cream, chocolate, regular soda, candy
Most people tend to eat the same foods from day to day, so an easy first step is to learn the carb counts of the foods you usually eat:
• List the foods, meals, and snacks you regularly eat.
• Note how many grams of carb are in each portion.
On food packaging, the Nutrition Facts label should be your first source for total carbohydrate content. The listing of nutrients is detailed, consistent, and easy to find.
Monitoring Blood Sugar Levels
Checking your blood sugar helps you monitor how well your diabetes plan is working. It helps you and your health care providers figure out if your current plan is effective or what actions you both need to take to progress your therapy for better control.
Ask your health care provider if you should be checking your blood sugar levels with a glucose monitor. If so, ask how and where to get a meter and strips. Ask how often you should check your glucose. Ask what levels are too high or too low and what actions you should take if your results reach these levels.
"In the beginning, there is a learning curve," says Sue Freeman, R.N., BSN, CDE, coordinator of the Diabetes Education Center at Iowa Methodist Medical Center/Lutheran Hospital in Des Moines.
You and your provider might want to check your blood sugar more often, perhaps a couple times a day. You might try checking your blood sugar at different times on different days. This can give you more information with fewer tests. If your glucose is in good control and you don’t observe too many ups and downs, you may be able to check less often.
If your health care provider makes a change in a glucose-lowering medication you take, then you may want to check more often for a period of time. It’s best to talk to your provider about the amount of monitoring that’s good for you. Also, find out your health plan’s coverage for diabetes supplies, which could impact how often you test. Most health plans cover some glucose monitoring supplies.
Possible times to test:
• In the morning, before breakfast.
• Before a main meal, such as dinner, about 6 p.m.
• Two hours after a main meal, such as dinner, about 8 p.m.
Your Goal Numbers
Tight diabetes control means keeping your blood sugar level as close to normal as possible.
Diabetes experts rely on the target goals for blood glucose and A1C set by either of two organizations -- the American Diabetes Association (ADA) and the American Association of Clinical Endocrinologists (AACE). Individual results and goals vary, so talk with your health care provider about what targets are best for you.
Testing your AIC determines your average blood glucose level from the past two to three months based on how much glucose sticks to the red blood cells, or hemoglobin. This is proportional to the amount of glucose in the blood.
Monitoring Supplies and Definitions
Lancet: A special small needle used to prick the finger to extract a very small drop of blood used for monitoring blood sugar levels; usually spring-loaded for a faster, less painful stick.
Meter: A machine that calculates your blood glucose and, depending on the machine, can keep a log of readings. There are at least 25 commercial meters on the market, according to the U.S. Food and Drug Administration, so talk with your doctor or certified diabetes educator about which options are right for your needs and how to properly use the meter. Check with your health plan about what meters they cover. Also find out if there are rebates on the meter you’d like to purchase.
Test strips: Chemically coated strips that combine with the glucose in your blood to determine a blood sugar level when inserted into a glucose meter.
Blood Glucose-Lowering Medications
Today's guidelines suggest that most people with type 2 diabetes should start on a blood glucose-lowering medication when they’re diagnosed. The medication suggested and prescribed most often is called metformin. This medication decreases insulin resistance, which is one of the common underlying problem in type 2. You will likely need other blood glucose-lowering medications over time. There are several categories of blood glucose-lowering medications:
Blood glucose-lowering medications in the following categories can cause hypoglycemia or low blood sugar:
• Sulfonylureas: glimepiride (Amaryl), glipizide (Glucotrol), glyburide (Diabeta, Micronase), others
• Meglitinide (Prandin)
• Nateglinide (Starlix)
• Insulin (all types)
If one or more of your blood glucose-lowering medications can cause hypoglycemia, pay close attention to the directions for when to take it in relation to eating. Always carry your blood glucose meter and a source of pure glucose, such as glucose tablets or candies.
Drugs that Don't Cause Hypoglycemia
Blood glucose-lowering medications in the following categories generally do not cause hypoglycemia (unless they are taken with a medication that can cause low blood sugar):
• Metformin (Glucophage, Glumetza)
• Glitazone (Actos, Avandia)
• Alpha-glucosidase inhibitor: acarbose (Precose)
• DPP-4 inhibitors: sitagliptin (Januvia), saxagliptin (Onglyza), linagliptin (Tradjenta)
• SGLT-2 inhibitors: canagliflozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance)
• Injectable exenatide (Byetta [twice daily], Bydueron [weekly])
• Injectable liraglutide (Victoza [once daily])
• Injectable pramlintide (Symlin) -- intended for use with rapid-acting insulin; when pramlintide is prescribed, insulin doses need to be lowered to prevent hypoglycemia
Again, pay close attention to the directions for when to take your diabetes medications in relation to eating. Always carry your blood glucose meter and a source of pure glucose, such as glucose tablets or candies.
Note: There are combination medications, and more are on the way. These combinations may contain medications that can cause hypoglycemia and medications that do not. Ask your health care providers or pharmacist about the possible side effects of the combination drug(s) you take and the risk for low blood sugar.
Adapting to taking insulin can be scary, most often because of the required injections. Some people wonder why insulin can't be taken orally. Unfortunately, insulin would be broken down by the enzymes that break down protein in the stomach because insulin is protein. The only way to ensure its effectiveness is delivery by injection.
Giving yourself shots every day may feel like a loss of freedom or a constant reminder of your diagnosis. This is where a positive attitude can play an important role in your diabetes management. It may sound simple, but staying positive can go a long way in combating depression or denial. Fortunately, there are some tips to making insulin therapy less difficult.
Create balance in your treatment. What you eat and how much you exercise affects your insulin use. If your eating plan or physical activities change, be sure to adjust your insulin dosage with the help of your health care provider or diabetes educator.
Where you inject insulin also matters. Consistency gives you a better idea about how long it will take to bring your blood glucose to your desired level.
When you take insulin also affects your blood sugar levels. Try to take insulin at the same time each day to achieve balance and avoid crashing and spiking.
Help take the pain out of insulin shots. The needles people use today to take insulin are very thin and very short. Needle technology has come a long way. Whether you take insulin by syringe or you use an insulin pen, make sure you work with your health care provider and pharmacist to use the thinnest, shortest needle that is right for you.
The Importance of Physical Activity
If exercise is already a part of your daily routine, congratulations! You are in luck. Daily physical activity helps improve your diabetes management by:
• burning calories
• aiding weight loss and weight management
• boosting metabolism
• helping your body use insulin more efficiently
• controlling blood glucose
• reducing the risk of heart attacks and strokes
• balancing emotional and mental health
• building strength
• increasing energy
How Much Exercise Is Enough?
You certainly don't have to start training for a marathon to get the exercise you need. The American Diabetes Association recommends 150 minutes per week of moderate-intensity aerobic activity, as well as resistance training two or three times per week.
If you haven't been active and plan to start adding exercise to your routine, ease into it. Just a 10-minute walk several times a day can build stamina, getting you ready for longer stretches. Always talk to your health care provider before starting a new exercise routine.
Simple Ways to Get Moving
Don't like to run? Not into the gym scene? Don't worry. It's easier than you may think to get moving. Boost your activity level by expanding your everyday chores or hobbies into workouts. Even small things can make a difference. Try one of these ways to include extra movement in your day:
• Do yard work such as gardening and raking leaves.
• Vacuum and mop your floors, making several trips up and down the stairs.
• Take the stairs instead of the elevator or escalator.
• Park farther away at the grocery store or shopping mall to get in a few extra steps whilerunning errands.
• Walk or bike instead of driving when possible.
Or mix and match these 30- to 60-minute activities on different days of the week or adopt a regular exercise routine -- whatever works for you.
• Take a brisk walk, walk the dog, or hop on the treadmill.
• Take a bike ride or try a stationary bike.
• Take a dance class or go out dancing.
• Play tennis or other sports such as basketball.
• Sign up for yoga classes or do yoga at home.
• Swim laps at your local YMCA or take a water aerobics class.
Your Support Team
You will be the team leader of a very important group of people to help establish and support your goals, answer your questions, and cheer you on.
Your doctor supervises overall care and, when necessary, refers you to other health care providers, such as specialists. Look for a primary care provider who regularly treats patients with diabetes. A physician's assistant or nurse practitioner can also provide appropriate care, and you might find that they have more time available to you. You may want to get a referral to an endocrinologist who specializes in diabetes.
If you are new to the world of medications, finding a trusted pharmacist is a must to monitor medications and possible drug interactions. If you use dietary supplements, make sure your care providers know what and how much you take. A pharmacist can answer questions about which ones can elevate blood sugar.
A diabetes educator, who will most likely be a registered nurse (R.N.) or registered dietitian (R.D.), can help you learn how to monitor blood sugar, take your medication, figure out a healthy eating plan, and much more related to your diabetes management.
Other helpful specialists:
• exercise specialist
• registered dietitian
• ophthalmologist or optometrist
• mental health counselor
Telling Others About Your New Diagnosis
Telling someone about your type 2 diabetes diagnosis is a personal choice. Consider the person or people you are telling, the timing of your news, and the reasons behind your decision.
Telling family or those close to you is a good idea, especially to educate them and have a plan in place in case you have a health emergency.
If you take a medication that can cause hypoglycemia, such as insulin, explain the symptoms you might experience during a low blood sugar and how they can help you if you need it.
That doesn't mean you have to tell everyone or talk about it all the time. It's a choice that can change as time goes on. If your privacy is important to you, you may only confide in your closest relatives or friends and not talk about it beyond informing them of your news. If you tend to be more open, you might find that talking about it often with different people makes you feel better.
All the people you tell will likely have different reactions based on their personal experiences with diabetes. If your coworker has a family member dealing with complications from diabetes, they might be more sympathetic or worrisome about your news. However, if you share your diagnosis with a friend who has a connection with someone who has an excellent A1C, her reaction and outlook might be more positive and supportive.
Reliable resources to use and share: