Start with the Basics
Yes, you can handle a life with diabetes or prediabetes. It’s certainly challenging at times, but it can give you real motivation to take care of your health. The more you know, the more confident you will become and the easier it will be to stay on track. And remember, millions of people are thriving while managing prediabetes and diabetes—you will, too!
The Three Types of Diabetes
There is more than one kind of diabetes. Prediabetes is when blood glucose (also called blood sugar) levels are elevated, but not high enough to be diagosed as type 2 diabetes. Prediabetes is having a fasting blood glucose reading of 100–125 mg/dl.
There are three common types of diabetes:
1. Type 1 diabetes: An autoimmune disorder in which the beta cells in the body stop producing insulin. Insulin is a hormone that allows the body’s cells to receive and use glucose for energy; people with type 1 must take insulin via injections or a pump. Type 1 diabetes is typically diagnosed in children and adolescents, but it can occur at any age in adults.
2. Type 2 diabetes: A condition in which the body doesn’t make enough insulin relative to the amount needed to control blood sugar. The body also can’t effectively use the insulin it still makes. Most people manage type 2 by eating healthfully, being active, and taking medication.
3. Gestational diabetes: A type of diabetes that women can develop during pregnancy. The American Diabetes Association says it occurs in about 18 percent of all pregnancies. Gestational diabetes is managed with healthy eating and activity. It greatly increases the mother’s risk of developing type 2 diabetes later in life and puts the baby at greater risk of obesity and type 2 diabetes later in life. Women who have had gestational diabetes have a 30–60 percent chance of developing type 2 diabetes in the next 10–20 years.
Control Your ABCs—A1C, Blood Pressure, and Cholesterol
A = AIC: An A1C blood test measures the percentage of hemoglobin (the oxygen-carrying protein in your red blood cells) coated with sugar. It measures your average blood glucose (sugar) level over the past two to three months. The A1C test gives you and your health care provider a measure of your progress. Most people with diabetes should have an A1C test every three to six months; people who are meeting their treatment goals may need the test only twice a year.
B = Blood pressure: Blood pressure is the force of blood flow in your blood vessels. A blood pressure test reveals two readings. The top number is the systolic blood pressure, which measures the pressure as your heart beats and pushes blood through your blood vessels. The bottom number is the diastolic blood pressure, which measures the pressure when your blood vessels relax between heartbeats. People with diabetes should have their blood pressure checked at every appointment with their care provider.
C = Cholesterol: There are several types of cholesterol, two of which are important for people with diabetes to monitor. Low-density lipoproteins (LDL) are considered bad cholesterol and can lead to the buildup of plaque on blood vessel walls, which can cause heart attack or stroke. High-density lipoproteins (HDL) are considered good cholesterol and appear to protect against heart disease.
Triglycerides are a form of fat made in the body. People who are overweight or obese, are physically inactive, smoke, or consume large amounts of alcohol or carbohydrate are more likely to have elevated levels of triglycerides, which increases risk for heart disease. A fasting blood test to assess your lipid profile—which measures total cholesterol, LDL and HDL cholesterol, and triglyceride levels—should be done once a year.
There are many factors that affect blood sugar levels, including food and portion size, activity level, medication, sleep, stress, and illness. Carbohydrate found in food increases blood glucose.
To understand the effects these factors have, you’ll need to monitor your blood glucose using a glucose meter. Your doctor may give you one, or you can buy one at a pharmacy. The American Diabetes Association (ADA) recommends people taking multiple insulin injections or using an insulin pump to test their glucose levels three or more times per day; pregnant women taking insulin and people with type 1 diabetes may require more blood glucose checks.
For people with type 2 diabetes, there is no clear answer as to how often or when to perform blood glucose checks. Talk to your health care provider to find the most beneficial plan for your treatment goals and work within your budget or test-strip allotment from your health plan.
Learn How Insulin Works
Get to know insulin, one of the most influential hormones in your body. Insulin acts like a key to open cells, allowing glucose to enter the cells and fuel your body. Having diabetes means your body doesn’t produce any insulin or doesn’t produce enough insulin to keep up with the amount of glucose in the bloodstream; or the cells in the body resist the action of insulin, causing glucose to build up in the bloodstream and go unused.
Taking insulin is a must for people with type 1 diabetes. Some people with type 2 diabetes need insulin when oral medications aren’t doing the job. Remember, taking insulin is not a sign of failure! While it might seem daunting to take insulin shots (it’s not available in pill form), insulin can be the boost your body needs to get your diabetes under control and prevent future diabetes-related health complications.
Insulin pens make taking insulin a bit easier. They hold prefilled cartridges and have a dial that allows you to select the dose you need. Or you can use one of many insulin pumps on the market today. The most common ones used resemble a pager and attach to a belt or slip into your pocket. The pump is programmed to deliver insulin throughout the day (at a low, steady rate with larger amounts given before meals) through a tiny tube that is connected to a catheter inserted in your abdomen or another area on your body. Insulin can be injected just under the skin in the abdomen, legs, arms, and other places.
Use Medication as Directed
Taking medications as directed by your health care provider is essential to living well with diabetes. Many people with type 2 diabetes are able to maintain good blood glucose control by following a healthy lifestyle and taking oral medications as prescribed by a physician. Oral medications work by lowering insulin resistance, increasing insulin output by your pancreas, or lowering blood glucose levels. Some medications perform multiple actions.
As with all prescribed medications, be sure your physician and pharmacist know all of the medications you take (including herbal supplements and vitamins) so they can prevent potentially harmful drug interactions. And make sure to take the medications as directed by your health care team. If you notice unpleasant side effects after starting a new medication, talk to your health care provider or pharmacist right away. There may be an alternate medication available that you will tolerate better.
Medication Tip: If Metformin’s dead-fish smell bothers you, ask about switching to the longer-acting version of metformin.
Plan Your Meals
Planning meals and snacks will help you:
- Stay off the blood sugar roller coaster. Eating irregularly can make your blood sugars bounce back and forth between normal and high levels.
- Fight fatigue and boost energy. Eating meals spaced throughout the day provides a consistent fuel source for your body to perform all the activities you need and want to do.
- Monitor patterns. When you eat consistently and track your blood glucose levels, you can better determine the causes of high and low blood sugars.
- Lose and/or maintain weight. Skipping meals can cause erratic blood sugar levels and lead to overeating later or grabbing unhealthful options when you are overhungry. Well-controlled blood sugar levels help manage appetite, which can help you lose or maintain your weight more effectively.
- Boost nutrition. With planned meals, you’re more likely to include healthful fruits and vegetables, lean protein, and whole grains.
If you do only one thing, exercise, say two experts, both with type 1 diabetes. The sooner you start, the sooner you’ll get blood sugars under control and limit complications, says Sheri Colberg-Ochs, Ph.D., professor of exercise science at Old Dominion University in Norfolk, Virginia.
“Exercise has the ability to make your insulin work better, meaning you can get by with less, and lower your blood sugar and blood fat levels,” she says. “Being regularly active has also been linked to a lower risk for almost every potential diabetes-related health problem.”
“Even if you can only exercise for a few minutes, that’s OK,” adds Gary Scheiner, CDE, clinical director of Integrated Diabetes Services near Philadelphia. “Try to do a little more each day.”
Schedule Regular Exams
Diabetes can influence all aspects of your health. Keeping up-to-date on the following may prevent complications down the road.
- Eyes: Ninety percent of diabetes-related blindness can be prevented by early detection and good control of blood glucose. Visit an ophthalmologist or optometrist once a year to get a dilated-eye exam, which allows the doctor to check for diabetic retinopathy, cateracts, glaucoma, and other eye disorders.
- Teeth: The connection between diabetes and oral health is a two-way street: Diabetes makes mouth problems more likely, and in turn, serious gum disease can make managing diabetes more difficult. Always brush your teeth after every meal and floss twice a day.
- Flu shot: An influenza vaccination is recommended for all people with diabetes at least 6 months of age. A one-time pneumonia shot is recommended for people with diabetes ages 64 and older.
- A1C: Every few months, you should get an A1C test, also known as hemoglobin A1C. The test indicates your average blood glucose reading for the past two to three months, with the goal being under 7 percent for most people. The target will vary depending on your individual lifestyle and medical condition.
- Cholesterol and blood pressure: Heart disease is the leading killer of people with diabetes, so it’s crucial that you check these levels to maintain heart health.
Build a Support Team
Assembling a team of the following experts will help you learn about and monitor your diabetes—it’s essential to managing your health. Just remember, the most important member of your health care team is YOU!
Certified diabetes educator (CDE): CDEs are trained to help people acquire the knowledge, skills, and tools for managing diabetes. They can help you develop an individualized plan to take care of your diabetes and gain confidence in managing your own health. A CDE may also be a registered nurse, registered dietitian, pharmacist, or doctor. Many private insurance companies cover some sessions with a CDE.
Primary care provider: This provider’s job is to oversee all aspects of your diabetes and refer you to specialists as needed. It’s most often a family practice doctor, nurse practitioner, or physician assistant. In some states, it can even be a pharmacist. Make sure all health care providers you see route reports to your primary care provider to ensure thorough and consistent management of your diabetes.
Endocrinologist: This type of doctor specializes in diseases of the endocrine system, including diabetes. Not everyone with diabetes needs to see an endocrinologist—your primary care provider will refer you to one if necessary.
Registered dietitian (RD or RDN): This expert in food and nutrition can help you develop a healthy yet tasty meal plan geared to your specific needs. He or she also can teach you long-term skills to balance diet, medications, and activity. Some CDEs also are RDs or RDNs.
Pharmacist: Having a pharmacist who knows every drug you’re taking can help you avoid dangerous side effects and interactions. Ordering all of your medications from one pharmacy or a mail-order company is a good idea.
Ophthalmologist: Diabetic retinopathy is the most common vision problem in people with diabetes. You can have it and show no symptoms. An eye doctor can diagnose and monitor diabetes-related eye diseases.
Dentist: Diabetes increases your risk of gum disease and mouth infections, which can make your blood glucose levels rise.
Mental health counselor: Diabetes hits many people with an emotional wallop. It’s common to experience depression. Talk with your primary care provider about what type of professional might suit your needs in this area.
Podiatrist: Nerve damage caused by uncontrolled blood glucose can numb your legs and feet, making you unaware of infections. A podiatrist can help you properly care for your feet.