First Steps to Control: Dealing with a Diabetes Diagnosis

Whether you have just been diagnosed with diabetes or are changing doctors, your first appointment will entail a complete physical and comprehensive health history. Your doctor will need to learn about your health background and establish a baseline for you. The doctor will need to know:

• Whether you have symptoms, and if so, when was the onset
• Whether you have any diabetes-related complications such as heart disease or vision changes or kidney damage
• What your current diet is like, if you have a history of being overweight, or whether you’ve suddenly lost a lot of weight
• How physically active you are in your daily routine and whether you exercise
• Whether you have any cardiovascular risk factors—tests may be prescribed to determine this
• What medications you are currently taking
• Your family medical history, especially regarding diabetes and heart disease

Should You see an Endocrinologist?

Type 2 diabetes is considered an epidemic in the United States, and with good reason. More than 37 million Americans–roughly 1 in 10–have diabetes. Of that 37 million, 90-95% have type 2 diabetes. As a result, primary care physicians (PCPs) are used to treating people with type 2 diabetes. If you are newly diagnosed with type 2 and your A1C is below 9, your PCP has the expertise to care for you but you still have the choice to seek care with an endocrinologist. However, if you have type 2 diabetes and an A1C of 9 or higher, or you are newly diagnosed with type 1 you should see an endocrinologist.

Good control makes all the difference. There are two prongs to controlling diabetes: medication and lifestyle changes:

Medication

If you have type 1 diabetes, you are insulin dependent. Barring any future scientific breakthroughs, you will need to take insulin for the rest of your life. Your endocrinologist will work with you to arrive at the dose, delivery system (including continuous glucose monitors and insulin pumps), and type of insulin that’s right for you. In addition, your needs may change over time based on your diet, weight changes, health status, activity level, pregnancy, and other factors.

If you have type 2 diabetes, you may be able to lower your blood sugar through weight loss, exercise, and dietary changes, depending on your A1C and general health. If medication is needed, there are a variety of drugs your doctor may prescribe. Your physician will monitor your progress to see how well your prescription is working for you and how well you are tolerating it. Dosage may need adjusting, and some people need more than one medication.

Regardless of what type of diabetes you have, you are at an elevated risk for complications related to diabetes, especially for uncontrolled diabetics. Your doctor will go over the risk assessment for diabetes associated complications, address any current complications you might have related to diabetes, evaluate and optimize medications to help manage and reduce your future risk.

Lifestyle changes

Whether you are diagnosed with type one or type two diabetes, lifestyle changes will be an essential part of your treatment. You will need to learn what to eat—and what not eat—and how to count carbs. Don’t worry about making separate meals for yourself and your family: there are many easy, tasty, diabetes-friendly recipes the whole family can enjoy. There are also lots of creative ways to make family favorites healthier. For example, on pizza night, make a big salad and have a slice and a salad instead of two slices.

If your doctor advises you to lose weight, ask about safe, healthy weight loss methods as the latest fad diets may not be indicated for a person with diabetes. The same goes for exercise—talk to your doctor before you jump into a new workout plan. You may need to start slowly and gradually increase the intensity and duration of your workouts. The American Diabetes Association recommends striving for 10,000 steps a day, or 150 minutes of aerobic exercise a week.

Can Diabetes be Reversed?

If you have type 2 diabetes, lifestyle changes could do more for you than only controlling your blood sugar. It takes will power and determination, but some people are able to manage their diabetes through diet and exercise by itself without requiring any medications. If they are currently on medication, they may eventually be able to stop taking it—with their doctor’s approval, of course! This may be a possibility for you if you are newly diagnosed and have not had type 2 diabetes very long. However, if you have been living with uncontrolled type 2 diabetes for a number of years, your pancreas is overworked, and your glucose tolerance is likely impaired. In that scenario there is a possibility that you will likely have to keep taking medication indefinitely. Even then, intensive lifestyle changes can slow the progression of the disease and possibly spare you from having to add insulin to your regimen. Your doctor can check your pancreatic function through a fasting C-peptide blood test and order comprehensive autoimmune workup. The results determine whether you need to start taking insulin.

A Diabetes Education

The right doctor and medication are essential, but ultimately, your health is in your hands. The most important thing you can do after your diagnosis is learn everything you can about diabetes and how to manage it. MarinHealth’s Braden Diabetes Center was founded to help you do just that.

The Braden Diabetes Center provides comprehensive education, services, and support for people with diabetes. The Center offers education and training in both one-on-one and group settings to help patients understand diabetes, make healthy choices, and learn to confidently manage their blood sugar in any situation. Braden Diabetes Center also provides care for gestational diabetes and pediatric diabetes. If you were diagnosed during a recent hospitalization at MarinHealth Medical Center, you were likely referred to the Braden Diabetes Center, which also serves as a bridge to help hospitalized patients manage their diabetes after discharge until they can get in to see a doctor. To learn more, visit: www.mymarinhealth.org/bdc.

Watch Out for Dr. Google

Even as you become an old hand at managing your blood sugar, it’s a good idea to take an occasional refresher course and keep up with new developments. Medical science is constantly coming up with new research, drugs, technologies, and treatment guidelines. However, be sure to consider the source. The Internet has made everyone an expert on everything—or so they think. If you’re looking for trustworthy, vetted information online, the American Diabetes Association’s website is the best place to start.

Sharleen Sidhu, MD, MPH, is a board-certified endocrinologist at MarinHealth Endocrine & Diabetes Care | A UCSF Health Clinic, and the Medical Director of the MarinHealth Braden Diabetes Center.