Type 2 Diabetes Management Overview

From Diabetes Educator Veronica Brady, here is the 3-prong approach to managing type 2 diabetes. 

So this is it. You have heard the words that you have been dreading/fearing for years. YOU have type 2 diabetes. How did this happen to you? You thought that for the last several months-to-years that you were doing all of the right things. Ok, some of the right things. You cut back on the number of sweets. You tried to get some extra steps in and well, you lost 2-3 pounds. You tried, but now you feel like you “failed”.

What happened? All the provider told you was that you have type 2 diabetes and now you need to take this pill, meet with the dietician… After the word diabetes, you stopped listening. Now you have questions. Let’s see if I can provide you with some much-needed answers.

The Diagnosis

You didn’t fail.

Let’s start with what type 2 diabetes means.

Type 2 diabetes occurs when your body can not make enough insulin to meet your needs or when the insulin that you are producing is not being used appropriately. Currently, there are more than 30 million people in the United States living with diabetes and of those, at least 90% have type 2 diabetes.

Type 2 diabetes is diagnosed using blood. There are two tests that are commonly used. The first is fasting blood glucose. When the fasting blood glucose (by either finger stick or lab draw) is greater than 125mg/dL (after 8 hours of fasting) on more than one occasion, type 2 diabetes is diagnosed. If the random blood sugar (meaning a blood test is done either by fingerstick or lab draw at “any” time of the day) and the reading is >200mg/dL this too is diagnostic of type 2 diabetes. 

The second blood test that can be done is a hemoglobin A1c. This blood test measures the amount of sugar attached to your red blood cells and estimates what your blood sugar levels have been for the last 3 months. If the A1c is greater than 6.4% this indicates type 2 diabetes.

It is recommended that two tests be done to confirm the diagnosis.

So now you know—your fasting blood sugar was high, your random blood sugar was high and your A1c was above 6.5%. It’s true!-- you have type 2 diabetes. Now what do you do?

Well, let’s talk more. The 3-prong approach to managing type 2 diabetes includes: diet, exercise and if needed medication.

Diet

What you eat has a significant bearing on your blood sugars.

Check out previous articles about starches, fats and proteins for a deeper dive into focusing on food. But, for now, how about we keep it simple. If it tastes good—spit it out! Just kidding! However, you may need to adjust what you are eating.

For example—cakes, pies, cookies, ice cream, regular soda are all things can cause blood sugar to become or remain elevated. It has been recommended that these “empty” calories be avoided except for “special occasions” and we will agree that every day is not a special occasion.

The best way to think about food moving forward is not so much that you have to “diet”, but you may have to modify your food intake. For some of us, this means eating smaller portions. For others, this will mean avoiding fast foods. Overall, the simplest way to improve dietary intake is to stick to a plant-based diet, avoid excessive amounts of red meat, and limit alcoholic beverages.

Exercise

I once heard someone say “less fork more foot”. That is how some of us may need to visualize our plan to keep our blood sugars stable. Consider walking after each meal. Many of us have those wonderful inventions called ‘Fitbits, Health Monitors, Step Counters…” that keep track of how much you move and often send you inspirational messages if you are not keeping on task. These can be useful tools to assess how much you move in the course of your day.

It has been recommended that 10,000 daily steps should be the goal. 

The recommended amount of exercise is 150 minutes of moderate (brisk walking, mowing the lawn, rowing, dancing) or 75 minutes of vigorous (running, stair climbing, swimming laps, jumping rope) activity per week along with 2-3 days of strength training per week.

Medications

Let’s face it. Nobody wants to take another pill but, sometimes it is unavoidable.

The most common medication that is prescribed after the diagnosis of type 2 diabetes is metformin. Metformin is designed to be taken 1-3 times daily. It does not lower blood sugar rapidly, but it does help to bring blood sugars back into normal ranges by helping the body to use its naturally-produced insulin more effectively and helping muscles to use excess sugar for energy. It is usually easily tolerated with very few side-effects.

Other than metformin there are a number of medications that can be used to help manage blood sugars. Your primary care provider will assist you in determining the medication that is right for you.

Blood Sugar Testing

Now we move on to a subject that is a bit controversial, yet is one of the most basic staples in diabetes management—blood sugar testing.

You may ask - Do I need to test my blood sugar? Who cares about the numbers? Why would anyone want to voluntarily test their blood sugar? It means poking your finger, and frankly, that can hurt. Why can’t I just base what I do on how I feel?

Well, here’s the thing. Blood sugar readings can tell you a lot. Checking your blood sugar 1 to 2 hours after a meal can tell you if that pizza, pasta or any other food had a negative impact on your reading. Checking first thing in the morning can tell you if your blood sugar is at a healthy level before you eat. Testing at bedtime can tell you how your diet and exercise efforts affected you today.

While testing blood sugar is not always mandatory for people with type 2 diabetes managing with diet or pills, it is advised to test once a day at alternating times—especially when starting a new regimen, or at least a couple times per week. Seeing the blood sugar reading on the meter is often a great motivator to change behavior if needed.

Living Well with Type 2 Diabetes

What does all of this mean for your future? Let’s start here. 

Life is for living and there needs to be some “joy in the journey”. It is entirely possible to modify your diet, find an exercise that you enjoy and even take medications if necessary and still live a happy, healthy and fulfilled life. The goal is to know your blood sugar numbers (home readings and A1c) and make changes if indicated to avoid any possible complications related to type 2 diabetes.

Be well!