Successfully Manage Type 2 Diabetes
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Know the Basics
Knowledge can go a long way toward easing the stress of the diagnosis of type 2 diabetes. Knowing how to eat, exercise, and monitor your blood glucose levels are the first steps in understanding what 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 are not alone. 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 and friends of everyone diagnosed, you have a wealth of support available. Plus, ongoing research continues to find new ways to improve the lives of those with diabetes.
How You Control Type 2
Eating healthy, getting regular exercise, checking blood sugar levels, and taking blood glucose-lowering medications as prescribed can help control type 2 diabetes. Several of these actions in turn may contribute to a small amount of weight loss, improved cholesterol (lipids), and lower blood pressure. Treatment options -- including lifestyle strategies and blood glucose-lowering medications -- will likely change over time as the disease progresses.
What You Need to Know to Manage Diabetes
There are several steps to successfully managing diabetes, including:
- Healthy eating and meal planning
- Understanding carb counting
- Monitoring blood glucose
- Identifying your target goals for glucose, lipids, and blood pressure
- Learning about the blood glucose-lowering medication you take
- Including physical activity
- Gathering your support team
- Telling others about your diagnosis
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 needs and preferences is key. Work with a dietitian to create your plan. Sticking to your plan will help keep your blood glucose under control while allowing you to enjoy healthful, delicious meals and snacks. Establishing a routine will help you settle into your new lifestyle, but more importantly can help keep your blood glucose at a healthy, consistent level.
- Eat about the same amount of food each day.
- Eat meals and snacks about the same time each day.
- Don't skip meals.
- Take blood glucose-lowering medications at the same time each day.
- Do physical activity about the same time each day.
A well-balanced meal plan incorporates carbohydrate, protein, fat, vitamins, minerals, and fiber. As with any healthful meal plan, lowering your saturated fat and cholesterol as well as salt/sodium intake will help you meet your nutritional goals. The good news is desserts and sweets can be enjoyed on occasion when they fit into your diabetes meal plan.
Create Your Plate
The American Diabetes Association (ADA) recommends a Create Your Plate method, 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 offers six easy steps:
- 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) add starchy foods, such as whole grains breads, brown rice, pasta, tortillas, cooked beans, peas, potatoes, corn, lima beans, sweet potatoes, or winter squash.
- Finally, to the remaining small section (1/4 of the plate) add your 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.
Basic carb counting relies on eating similar amounts of carbohydrate at the same times each day to keep blood glucose levels in your target range. The general guideline for women is 45-60 grams of carb at each meal, and for men it's 60-75 grams of carb. For weight loss, women should aim for 30-45 grams of carb at each meal; for men, 45-60 grams. Check with a registered dietitian to determine how many carbs per day is right for you.
This meal contains 45 grams of carb, or 3 carb choices (1 carb choice = 15 grams of carb)
One 3-4 ounce piece of grilled chicken
1/2 cup of corn
1/2-1 cup of spinach
1 slice of bread
1 cup of milk
A note about carbohydrate:
The good carb/bad carb craze has been replaced by other diet-of-the-day fads, but the belief that there are good carbs and bad carbs still sticks in people's minds. Remember: Your body treats all carbohydrate the same -- as energy. However, whole grains, which contain carbs, have more nutritional value and more fiber than refined or processed carbs. No matter what carb source you choose, always consider portion sizes.
Monitoring Blood Glucose Levels
Checking your blood sugar helps you figure out what actions to take for your overall health. Monitoring and logging your results will help you and your diabetes health care team determine the best treatment and lifestyle goals for you.
Ask your health care provider if you should be checking your glucose. If so, ask how and where to get a meter and strips. Ask how often you should check your glucose. Ask what actions you should take if your glucose is too high or too low.
"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. Freeman advises three glucose tests a day for someone who has been newly diagnosed:
- 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.
Freeman notes that when her patients meet target blood glucose goals 75 percent of the time, testing can be cut down if desired, and that monitoring standards can vary from person to person.
Your Goal Numbers
Tight diabetes control means keeping your blood glucose 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 check with your health care provider.
Testing your AIC determines your average blood glucose level from the past 2-3 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 needle used to prick the finger to check a drop of blood for monitoring blood glucose 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. Also, check with your health plan about meter coverage or rebates.
Test strips: Chemically coated strips that combine with the glucose in your blood to determine a blood glucose level when inserted into a glucose meter.
Blood Glucose-Lowering Medications
Today's guidelines suggest that most people with type 2 diabetes get started on a blood glucose-lowering medication called metformin. This medication decreases insulin resistance, which is 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:
- sulfonylureas (glipizide, glyburide)
- meglitinides (Prandin, Starlix)
- glitazones (Actos, Avandia)
- alpha-glucosidase inhibitors
- exenatide (Byetta), liraglutide (Victoza)
- DPP-4 inhibitors (Januvia, Onglyza, Tradjenta)
Drugs, such as those in the sulfonylurea family, work by stimulating the beta cells in the pancreas to release more insulin. Others, such as metformin, reduce the amount of glucose produced and released by the liver. Often, glucose-lowering medications are combined to help you hit your target glucose levels. Generally, pregnant women cannot take oral medications.
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 destroyed in the stomach when digested. 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 diet or physical activities change, be sure to adjust your insulin dosage with the help of your physician 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 -- advancements in ultra-thin needles, insulin pens, and specially coated needles offer more ease at the injection site.
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 maintenance
- boosting metabolism
- helping your body use insulin more efficiently
- controlling blood glucose
- reducing the risk of heart attack and stroke
- balancing emotional and mental health
- building strength
- increasing energy
How Much Exercise Is Enough?
You 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 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 while running 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 general practitioner who regularly treats patients with diabetes. A physician's assistant or nurse practitioner can also provide appropriate care. You may want to see 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 choose to use health supplements, a pharmacist can answer questions about which ones can elevate blood glucose.
A certified diabetes educator (CDE), who will most likely be a registered nurse (R.N.) or registered dietitian (R.D.), can help with monitoring, medication, and diabetes management. Having a CDE as part of your team is important to patient care.
Other helpful specialists:
- personal trainer or 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.
"You need to take the next step and tell people around you what they'll need to do if you develop hypoglycemia -- 'This is what you'll see, and this is what I need you to do,' " says John Zrebiec, M.S.W., CDE, associate director of Behavioral Health Sciences at the Joslin Diabetes Center in Boston and a member of the Diabetic Living editorial advisory board.
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 to different people makes you feel better.
Every person 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.