The National Institute of Diabetes and Digestive and Kidney Diseases lays out the basics: Diabetes is “a disease that occurs when your blood glucose, also called blood sugar, is too high.” Your body converts the foods you eat into energy and this energy — glucose — is circulated by your bloodstream to your cells. A hormone called insulin produced by the pancreas helps your cells extract the sugar they need from your blood, but sometimes your body doesn’t make enough or any insulin. When you don’t have enough insulin, glucose gets stranded in your blood, which can lead to high blood sugars.
Symptoms of diabetes include increased thirst and urination, an increase in feeling hungry, fatigue and blurred vision, numbness or tingling in the hands or feet, unexplained weight loss and sores that don’t heal properly. If left untreated, diabetes can be deadly, but there are many things you can do to manage the condition to lessen its impact on your health.
According to the Centers for Disease Control and Prevention, 30.3 million Americans (9.4 percent of the population) have diabetes, and new cases are being diagnosed every day. If you’ve recently been diagnosed with diabetes, be sure to ask your doctor the following questions to be sure you’re doing all you can to maintain your health in the face of this potentially fatal disease.
[See: 10 Myths About Diabetes.]
1. Which type of diabetes do I have?
There are a few different kinds of diabetes, the two primary forms being Type 1 and Type 2. Type 1 diabetes is an autoimmune disorder in which the pancreas fails to manufacture enough (or any) insulin. Sometimes referred to as juvenile diabetes, it often afflicts children (but can occur at any age) and tends to come on rapidly. “The majority of patients will tell you that suddenly, over one to two weeks, they became very thirsty, they dropped 10 pounds in a week, and they’re dizzy,” says Dr. Kathleen Wyne, associate professor in endocrinology at The Ohio State University Wexner Medical Center. Type 1 diabetes is relatively rare, accounting for about 5 to 10 percent of all cases of diabetes.
Type 2 diabetes, on the other hand, is the most common form, accounting for 90 to 95 percent of all cases. Wyne says Type 2 diabetes develops slowly, typically over several months. Your body develops a resistance to insulin and “you’re not able to make enough insulin to overcome the resistance,” she says. Type 2 can occur in people of all ages, but tends to happen more often in older, overweight individuals.
It’s important to get tested right away to determine which type of diabetes you have, because the diseases are different and have different treatment protocols. With both diseases, starting treatment early can reduce the severity of the disease and delay its progression.
2. What medications do I need to take?
These days, there are several medications available to diabetic patients that can help control blood sugars. Metformin is a common oral medication that many patients with Type 2 diabetes start with. Patients with Type 1 diabetes usually need injectable insulin. There are also new technologies, such as inhaled insulin, continuous glucose monitoring devices and insulin pumps, that you may be offered depending on the type and stage of your disease.
Most newly diagnosed diabetics have a lot to learn quickly about how to manage their disease. Your doctor will set you up with a glucose meter and you’ll be instructed to check your blood sugars several times daily. You may also be referred to a diabetes education specialist to learn how best to manage the disease. “Patients need to learn a lot of actual skills like injecting insulin, checking their sugars, checking for ketones and some basic dietary things,” says Dr. Elizabeth Halprin, clinical director of adult diabetes at the Joslin Diabetes Center in Boston. (Ketones are a blood acid released by the breakdown of fat in the body. The body does this when there’s not enough glucose to supply the body’s energy needs. In diabetics with uncontrolled blood sugars, these ketones can turn glucose into acid, Halprin says, a “very dangerous” condition called ketoacidosis.) Keeping tabs on blood sugars and ketone levels can be a lot of work, but controlling these levels will help help you feel better and may slow the progression of the disease.
3. What lifestyle changes will I need to make?
Because diabetes relates to how your body uses the foods you eat, making some dietary and exercise changes may be a critical component of your treatment regimen. “Food becomes a different entity for people with diabetes,” Halprin says. This tends to be truer for people with Type 2 diabetes than people with Type 1, but people with both diseases need to be mindful of what they’re eating, when they’re eating and how food can change how medications and insulin work. “You have to establish a new relationship with food,” she says
Your doctor should talk to you about your diet and may recommend removing simple carbohydrates or high-sugar content foods, such as soda, cookies, candy, bread, rice and potatoes. “There are some people, their main offender is soda,” Halprin says. “They drink liters of it a day, and if all they do is get rid of that, it makes a huge difference.”
In addition, Halprin says diabetes patients need to learn how physical activity can help them regulate their blood sugars. “Exercise improves insulin efficiency and therefore acts like a dose of insulin. Just walking around the block will lower your blood sugar even if you didn’t take any medication,” she says. Talk with your doctor about how much exercise you should get daily and what form of exercise is best for your situation.
[Read: How Do I Know if I Have Diabetes?]
4. Who can help me manage this condition?
Your primary care doctor should be the “gatekeeper” when dealing with a new diabetes diagnosis, Wyne says. She says it’s very important to make an appointment with your primary care doctor if you have symptoms that seem to indicate diabetes, “because the symptoms might be something else. The primary care doctor’s job is to evaluate the symptoms and determine the diagnosis.”
If the diagnosis is Type 1 diabetes, Wyne says you should schedule an appointment with an endocrinologist right away to make sure that the disease is controlled appropriately from the outset. If you’ve been diagnosed with Type 2, your primary care doctor should be able to manage the condition for you. If you need confirmation of your diagnosis, an endocrinologist can make that determination.
5. How will the disease progress?
“Diabetes progresses over time,” Wyne says. “It’s just what diabetes does, and everyone with Type 2 diabetes needs to be told that eventually you will take insulin.” Despite your best efforts, over time, you’ll likely end up on additional medications as your body loses its ability to produce insulin. It’s a progressive chronic illness, and one that’s going to require management from the time of diagnosis for the rest of your life.
Wyne says that although many patients know about metformin, many “don’t understand that they’re going to be taking it for the rest of their life. Somehow there’s this message that if you lose five or 10 pounds you can stop the metformin and the diabetes will go away. We don’t have a way to cure diabetes. We may be able to put it in remission, but it never goes away.” Wyne says that once you start taking metformin, you’ll be on it for life or until another treatment supersedes it.
That said, Wyne says you do have a lot of control of how quickly the disease progresses. “When you’re first diagnosed with [Type 2] diabetes, if you can lose even just 15 pounds, that’s going to make a world of difference in how your diabetes behaves for the rest of your life. The more weight you can lose at diagnosis and keep off, that determines how many medications you’re taking three years later or five years, even 20 years later. I’ve seen people with Type 2 lose 50 pounds at diagnosis, keep it off, and 20 years later they’re only taking one or two pills for their sugar. But the person who doesn’t lose the weight or continues to gain weight and doesn’t take their medicine, in 5 to 7 years, the pills aren’t able to work and we’re needing to add insulin and progressing to more complicated insulin because their body has lost the ability to make insulin.”
The bottom line, Wyne says, is early intervention can change the trajectory of the disease, therefore it’s critical to follow your doctor’s advice on weight management and medications right from the start. “At the time of diagnosis, patients have the power to determine how it’s going to progress.”
6. What else should I be aware of?
Some patients feel a stigma around their diagnosis, particularly with Type 2 diabetes, which often occurs as a result of obesity and perhaps some unhealthy lifestyle habits. This can be harmful, Halprin says. “Mental health is a huge part of diabetes. Here at Joslin, we have a whole behavioral health department to help people cope.” She also recommends finding a support group that can help you feel less alone in the day-to-day struggles that diabetes imposes.
She also recommends looping in close friends or family members to your diagnosis. “It’s generally a disease where at some point you may need help, and it’s better if people in your life know you have diabetes.” Halprin says some patients are reluctant to take care of themselves appropriately because they fear how others will react when they find out, noting that sometimes you might have to check your blood sugar or administer insulin while at a restaurant, which can be tricky to do discreetly. “Some people feel very self-conscious and their own health suffers because they don’t want to reveal their diagnosis to anybody. So they don’t take their insulin because there isn’t an adequate environment or they have to go to the bathroom to do it. There are all sorts of things that can interfere with your ability to take care of yourself if you don’t want people to know about it,” she says. But talking this through with your doctor or a mental health provider can help you cope better with the situation and prioritize your health.
[See: Got Diabetes? Why You Must Protect Your Feet.]
Halprin also notes that you should be prepared for big changes in how your body looks, feels and works once you begin treatment. “It’s most likely that you’ve lost weight if your blood sugars were very high. That’s not a good way to lose weight, and when you start treatment you will gain weight. For some patients, that will be very difficult.”
She says the reason why patients often gain weight once your blood sugars stabilize is because your body wasn’t able to process the sugar appropriately, so that glucose was passing out of your body via increased urination. “All the sugar signifies calories going into the toilet. Therefore, you’re losing weight because you’re not hanging onto those calories. But as soon as we give you medication, then you’ll hold onto that sugar, and you will gain back the weight that you lost and maybe gain more than you lost.” Doing your best to keep that weight gain to a minimum or even losing more weight can go a long way to delaying the progression of the disease.
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6 Questions to Ask Your Doctor When You?re Diagnosed With Diabetes originally appeared on usnews.com
