Top 10 Tips for People Newly Diagnosed with Type 2 Diabetes

by Adam Brown

twitter summary: Ten tips for newly diagnosed T2 #diabetes: act NOW for long-term benefits, use healthy eating, exercise, meds + structured blood glucose testing

short summary: This article offers ten tips for people newly diagnosed with type 2 diabetes: 1) Know that developing type 2 diabetes does not represent a personal failing; 2) Start to take care of your diabetes as soon as you’re diagnosed (and even better, before, if you know you have prediabetes); 3) Recognize that type 2 diabetes is a progressive disease; 4) Keep in mind that food has a major impact on blood glucose; work to optimize your mealtime choices; 5) Exercise is a powerful and underutilized tool which can increase insulin sensitivity and improve health – use it as much as possible; 6) Use blood glucose testing to identify patterns; 7) Don’t forget that needing to take insulin doesn’t mean you failed; 8) Keep learning and find support; 9) Seek out the services of a Diabetes Educator; and 10) Review our Patient's Guide to Individualizing Therapy at www.diaTribe.org/patientguide.

1. Know that developing type 2 diabetes does not represent a personal failing. It develops through a combination of factors that are still being uncovered and better understood. Lifestyle (food, exercise, stress, sleep) certainly plays a major role, but genetics play a significant role as well. Type 2 diabetes is often described in the media as a result of being overweight, but the relationship is not that simple. Many overweight individuals never get type 2, and some people with type 2 were never overweight. At its core, type 2 involves two physiological issues: resistance to the insulin made by the person’s beta cells and too little insulin production relative to the amount one needs. These problems can lead to high blood sugar, which over time can cause various complications like heart disease and stroke, retinopathy, and neuropathy (you can read more about diabetes complications here). Treatments for type 2 diabetes – a healthy eating plan, regular exercise, and blood glucose lowering drugs - involve addressing both insulin resistance and the relative lack of insulin to control blood glucose levels. The progression from normal glucose levels through prediabetes, and then to type 2, can often take five to 10 years.

2. Taking care of your diabetes soon after diagnosis (and before) will pay off now and in the long term. Type 2 diabetes is not a death sentence by any stretch, but it is a serious disease that demands your attention immediately. Ignoring it may not seem to have significant short-term consequences (chronic high blood glucose levels are not painful), but over time, the elevated glucose levels can damage your nervous system, blood vessels, eyes, heart, and kidneys. In the landmark Diabetes Prevention Program study, even a small percent of people with prediabetes were found to have evidence of eye disease (retinopathy). Managing your blood glucose levels now, along with other health risk factors (e.g., cholesterol, blood pressure, weight), is necessary for preventing these complications. Losing even a small amount of weight and keeping it off can also improve glucose control as well as have other clinical benefits (read more tips on managing diet and exercise below for more on weight loss). Keep in mind that better diabetes management will also benefit you in the here and now – your mood and energy levels are adversely affected when your glucose levels are high.
   
   What’s the evidence? In the landmark UKPDS study, 5,102 patients newly diagnosed with type 2 diabetes were followed for an average of 10 years to determine whether intensive use of blood glucose-lowering drugs would result in health benefits. Tighter average glucose control (an A1c of 7.0% vs. an A1c of 7.9%) reduced the rate of microvascular complications (which affect the eyes, kidneys, and nervous system) by 25%. For every percentage point decrease in A1c (e.g., from 9% to 8%), there was a 25% reduction in diabetes-related deaths, a 7% reduction in mortality, and an 18% reduction in combined fatal and nonfatal heart attacks.

3. Recognize that type 2 diabetes is a progressive disease. When people are diagnosed with type 2 diabetes, they have already lost up to 50% or more of their beta cell function (the cells in the pancreas that make insulin) and are typically also insulin resistant, meaning they can’t use the insulin they make effectively. A few patients can initially manage their diabetes with a healthy eating plan and exercise. But over time, beta cell function decreases, which makes blood glucose harder to manage. To continue achieving blood glucose control, people typically need to add one or more different types of medications. The good news today is that there are many more choices available, and a number of these medications don’t cause as much hypoglycemia, hunger and/or weight gain as in the past (e.g., metformin, pioglitazone, DPP-4 inhibitors, GLP-1 agonists, SGLT-2 inhibitors, and better insulin). The need to use more and different types of medications does not mean that you have failed. Diligent management early on can help preserve remaining beta cell function and slow progression – another reason why acting early and aggressively is so important.

4. Food has a major impact on blood glucose – optimizing your mealtime choices, especially carbohydrates, can improve your diabetes management and overall health. In my experience, carbohydrates can raise blood sugar much more than protein and fat and thus, require extra monitoring and management with available insulin. Here are a few tips that may help you manage blood sugars, and you can read here for more suggestions: 

• ​I try to reduce the amount of carbohydrates I eat at one time, or I choose carbohydrates lower on the glycemic index – see Adam’s Corner on Why All Carbohydrates are Not Created Equal.

• Avoid drinks with lots of added sugars and carbohydrates (unless you have low blood sugar, also called hypoglycemia). Staying away from regular soda and large amounts of fruit juice is usually wise.  

• Impose portion control. For instance, use the “½ plate rule” – fill half your plate with veggies or salad. Also, avoid directly eating out of food packages, a convenience trap that encourages overeating. At sit-down restaurants, tell the waiter you don’t want the free bread – sometime the temptation is too hard to resist!

• As a general rule, I try to eat foods that are as natural and minimally processed as possible – the fewer ingredients on the label, the better. Fruits and vegetables are always a good way to go. By contrast, try to avoid highly processed foods (e.g., chips, candy) that I find can be less filling and raise my blood glucose more substantially.

• Try substituting almond and coconut flour in recipes – in my experience, these have a significantly smaller impact on my blood glucose, contain lots of healthy fat and fiber, and help make baked goods much more diabetes-friendly. 

5. Exercise is a free drug – use it as much as possible! Regular physical activity done for about 30 minutes most days each week can lower blood glucose, help your body better use the insulin your body continues to make, and improve your cholesterol levels. If you already have an activity you love, keep doing it! If you’re not very active right now, it’s critical not to be intimidated by the thought of getting started. Even something as simple as walking (see here for more details) can lower blood glucose and improve your heart. Here are some simple ways to incorporate more activity into your life: 

• Find some friends or coworkers that share your interests. Accountability to someone else is a huge factor in sticking with something. Check out Insulindependence to connect with others in the active diabetes community.

• Find ways to include exercise in your daily life – go for a walk during your lunch break, try walking meetings, take the stairs instead of the elevator, or park in the farthest spot in the parking lot. 

• Try an app: Moves, GymPact, Seven Minute Workout, Strava, Sworkit, and so many more out there are great to get you moving.

• Give an activity tracker a shot – these little devices are incredibly motivational and the data is completely addicting. The most popular option is Fitbit, but there are many others. 

• Set goals and hold yourself accountable – read here for a few pointers.

6. Use blood glucose testing to identify patterns. When it comes to managing blood sugar, think of your glucose meter as a compass. By testing before and after certain events like meals and exercise, these data can point the way toward factors that affect your blood glucose. I make this fun by approaching it like a scientist:  How much does walking lower my blood glucose? How does a dinner of chicken and vegetables compare to a pasta meal?
   
   To make your glucose results more useful, you can try structured testing, a more strategic approach to checking your blood sugar – Accu-Chek has developed two free tools to help identify blood sugar patterns that you can download here and here. Remember that the purpose of collecting glucose readings is to give you information to optimize your therapy. Are you running consistently high after breakfast? Is your blood sugar dropping low in the middle of the night? Recognizing such patterns in your glucose readings can answer these types of questions and help you and your healthcare provider make changes to your diabetes management.

7. Needing to take insulin is NOT YOUR failure. Type 2 diabetes is a progressive disease, and your body’s ability to make insulin is likely to decline over time. Indeed, about 30-40% of type 2 patients end up needing to take insulin to manage their blood glucose, particularly those who have had diabetes for a long time. As you start to take insulin, remember that you are not alone! Injections can be a hassle for everyone, but there are now devices designed to ease the burden – insulin pens that are increasingly patient friendly, Valeritas’ V-Go insulin delivery device, Medtronic’s i-Port Advance, and full-featured insulin pumps.

8. Keep learning and find support! The more you learn about type 2 diabetes – from organizations and other people – the more you will realize how much there is to know. Here are some resources that we enjoy (although there are many more).

• Websites: American Diabetes Association, CDC, NIH/NIDDK, The Mayo Clinic, The Joslin Diabetes Center

• Books: Diabetes Burnout by Dr. William H. Polonsky, Diabesity by Dr. Fran Kaufman, Your First Year with Diabetes: What To Do, Month by Month by Theresa Gamero, The First Year: Type 2 Diabetes: An Essential Guide for the Newly Diagnosed by Gretchen Becker, Diabetes Meal Planning Made Easy by Hope S. Warshaw

• Conferences: TCOYD (for all patients) and Diabetes Sisters (for women)

• Support: TuDiabetes, Diabetes Daily, Diabetic Connect

9. Seek out a Diabetes Educator. Diabetes educators are certified health care professionals with specialized knowledge in diabetes self-management and education. They provide real-life guidance, coaching, and support. To receive diabetes education, you can ask for a referral from your primary health care provider. Going to a diabetes educator is covered by Medicare Part B as well as many health insurance plans. You can learn more by using this resource from the American Association of Diabetes Educators.

10.  Review our Patient's Guide to Individualizing Therapy at www.diaTribe.org/patientguide. This short list of questions is intended to help you and your healthcare provider discuss what therapies and goals are right for you.

Interested in learning more about tips for people with diabetes? Please read our top ten tips for people newly diagnosed with type 1, for parents of children with type 1.

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