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If you're diagnosed with type 2 diabetes, it can take a while to understand all you need to do to manage this complex disease.
"It takes more than a visit or two to settle in and get the information you need," explains Carole Mensing, R.N., M.A., CDE, president of health care and education for the American Diabetes Association and a diabetes clinical nurse specialist at the University of Connecticut in Farmington. "Many first-time patients will say to me, 'Give me a pill and get me out of here.' Often, I think they don't understand the depth and complexity of their condition."
Blood sugar and your health
Soon after a diagnosis of diabetes, your health care provider is likely to tell you about the importance of healthful lifestyle changes, personal self-care and medical tests -- everything from skin and foot care to smoking cessation, weight control and regular eye exams.
Following your provider's recommendations can help you prevent or delay the serious complications of uncontrolled diabetes: blindness, kidney failure, heart attack, stroke and amputation of one or both legs below the knee.
To keep it simple, it's helpful to know one common theme runs through nearly every aspect of managing diabetes: blood sugar (blood glucose) control.
"Blood glucose levels have everything to do with your health," says Ms. Mensing. With type 2 diabetes, the body is unable to produce enough insulin or properly use the hormone insulin, which the body depends on to get glucose into the cells where it can be used as fuel.
Glucose levels in the blood increase when insulin is absent or insufficient, or not used effectively and glucose cannot be transported into cells. Subsequently, your body doesn't get the fuel it needs. What's more, when blood levels stay high over time, blood vessels become thickened and lose their elasticity. This decreases blood flow in the smallest vessels, the capillaries, and can lead to serious damage to major organs.
To help prevent or delay these complications, you must keep your blood glucose levels as normal as possible. You do this through glucose monitoring, lifestyle changes and medications, if necessary.
Your team of health care providers -- such as your primary care physician, a nurse educator and a dietitian -- can support you through all the steps needed to help control your blood sugar levels.
Glucose testing
In the first days or weeks after diagnosis, you may be asked to closely monitor your blood glucose levels. These glucose tests can show how your body responds to diet, exercise and other treatments and reveal any need for medication.
"One blood sugar test a day does not provide enough information," stresses Ms. Mensing. "A single test only gives a snapshot of your blood sugar level at a given moment. If you get a high or low reading, repeat it soon afterward so you know if your blood sugar is rising or falling."
Keep a record of each test and time of day it was done, and share this information with your physician. Timing has a bearing on how your doctor might alter your treatment.
Weight control
Controlling your weight is a leading prescription both for managing type 2 diabetes. It also helps prevent diabetes in the first place.
"If you're predisposed to diabetes, then being overweight makes the insulin your body produces much less effective," says Ms. Mensing.
Losing 7 to 10 percent of your body weight can lower your insulin resistance and help your blood glucose levels come down naturally.
Meal planning
A person with diabetes needs to pay close attention to meal planning. You must be consistent with caloric intake throughout the day, eating small portions frequently -- and consistently. A balanced diet should include protein (10 to 13 percent of your daily calories), carbohydrates (57 to 65 percent of your daily calories) and fat (25 to 30 percent of your daily calories). Carbohydrates should be mostly "complex" (starches), instead of "simple" (sugars). Fresh or frozen vegetables are an important part of your diet.
"One of the most common misconceptions patients have is that they must cut all the 'white foods' from their diets -- like potatoes, rice, bread and sugar," says Ms. Mensing.
But eating complex carbohydrates as part of a healthful diet can help the body maintain its energy, provide fiber that may actually help control blood sugar and keep you healthier overall.
Physical activity
Getting your body moving not only helps you lose weight by burning calories, but also can help your body use blood glucose. Active muscles can remove glucose from the blood without the presence of insulin. Inactive muscles require insulin to take glucose from the blood. You don't have to run a marathon or work out at the gym every day, Ms. Mensing says. Just taking a brisk walk for 60 minutes a day, most days of the week, can make a real difference to your health. You can break up your activity into several shorter segments through the day.
Oral medications
Diabetes pills don't contain insulin, which can be delivered only by shots, by an insulin pump or by inhalation. However, they can help control your blood sugar by stimulating the body's own insulin production or increasing the body's ability to utilize the insulin being produced.
Insulin
In years past, insulin was prescribed only for people whose bodies could produce little or no insulin (primarily people with type 1 diabetes). Today, however, insulin sometimes is part of the standard type 2 treatment plan to get blood sugar back to more normal levels.
"Every person is evaluated individually," says Ms. Mensing. "Medicines are chosen based on the blood glucose levels, health and abilities of each person."
If all these steps are too much to contemplate all at once, realize you don't have to do them alone.
"Education is the key to success," says Ms. Mensing. "Know that your health care team is right there, ready to help when questions arise. Use your experts -- that's what we're here for."