Diabetes Forecast

Your Blueprint for a Diabetes Treatment Plan

By Tracey Neithercott ,

Trying to manage diabetes without a treatment plan is a lot like building a house without a blueprint. That plan is the key to designing an aesthetically pleasing house that won't crumble when you flush the toilet. Forget the blueprint and you could end up with something messy and potentially dangerous. The same goes for your diabetes.

Routine lab tests and checks can help protect your body and alert you to any developing complications. Click HERE for a chart of the tests you'll need, what they determine, and how often to get them.

"I didn't get an honest-to-goodness treatment plan until 10 years into being diagnosed," says Pam Tuggle, 64, of College Park, Ga., who has type 2 diabetes. "The doctor I was going to just said, 'Here's your medication and you have diabetes.' " Without a complete blueprint for diabetes management, Tuggle's then-uncontrolled diabetes led to eye complications and she was pronounced legally blind. She found a new doctor who created a diabetes management plan with her. "I was able to start to get my blood sugar under control," says Tuggle.

The goal of your treatment plan is to help you understand your disease and manage it to the best of your abilities. Your needs may change over time, which is why even the best diabetes management plan, like a home, may benefit from some remodeling.

Here's the Plan
Everyone's diabetes management plan will be different, but most include the same elements. Medication, food, exercise, and monitoring are critical aspects for any type of diabetes. Also important are mental health assessment and the use of problem-solving skills. And because to treat diabetes you need to treat the whole body, disease prevention is a major factor in a treatment plan. Part of prevention is regular testing (think: A1C, blood pressure, and cholesterol management). Your health care providers will help you set and keep track of goals and how often you should be screened for common conditions. Click here for a "Health Report" you can print out to help keep track of the tests you'll need.

Because your diabetes care is mostly in your hands on a daily basis, your plan should reflect how you live. Your health care provider will take into account activities such as school, work, and exercise and help you develop a plan for when you're sick.

Manageable Steps
Goal setting is another big part of any treatment plan. You and your health care provider should discuss long- and short-term goals and the steps needed to reach them. "In order to make all this manageable, set goals and work toward those goals all the time," says Jane K. Dickinson, RN, PhD, CDE, program coordinator and adjunct faculty member for the Diabetes Education and Management Program at Teachers College at Columbia University. One goal at a time is fine. "Have in the back of your head that you're working toward something, that there's meaning to it all."

If you become overwhelmed, keep in mind that no one has perfect blood glucose control overnight or every single day. "It is one step at a time," Dickinson says.

Other Checks
Weight: Your provider will weigh you at each visit and, if needed, advise you on how to drop a few pounds. Aside from the stress it puts on your organs and joints, obesity increases insulin resistance and heart disease risk. Losing weight helps you become more sensitive to insulin.
Physical activity: Because exercise improves your overall health and lowers your blood glucose, your health care team will want to help you get or stay active. Knowing how to manage blood glucose is a key part of your exercise plan.
Dental care: People with uncontrolled diabetes are more likely to have gum disease. Visiting your dentist twice a year for cleanings can help you spot and treat gum problems before they get serious.
Smoking cessation: Smoking with diabetes increases your chances of complications, including heart attacks and strokes. Your health care team can help you design a quitting strategy.
Healthy eating: Your dietitian and other providers will encourage you to eat more fruits and vegetables, whole grains, lean protein, and low-fat dairy, while reducing salt, fat, and added sugars.

One of the first things your doctor will discuss with you is the medications that can help you to keep your blood glucose, cholesterol, and blood pressure in control. Before you leave the doctor's office, it's important to know what each med is for, when to take it, and what to do if you miss a dose.

For insulin users and people taking certain blood glucose–lowering pills, learning the signs of hypoglycemia (low blood glucose) and how to treat it are essential skills.

For people new to taking insulin and/or counting carbs, finding the right insulin-to-carb ratio can take a few visits. "It's an educated guess," says Debbie Manchester, RN, MSN, CDE, a diabetes nurse educator at the Washington University Diabetes Center at Barnes-Jewish Hospital. "We will want to make changes as frequently as you give us your [blood glucose] information."

Managing your diabetes medication is an ongoing process, one that benefits from regular communication with your diabetes care team. "We rely on feedback from the patients," says Mark Schutta, MD, medical director of the Penn Rodebaugh Diabetes Center at the Hospital of the University of Pennsylvania. "If they're having any [blood glucose] problems, we want them to call us. That kind of one-on-one interaction is really valuable."

Your medication needs are likely to change over time, depending on life stages and other factors. Say, for instance, that you start exercising after lunch and find yourself going low. You can work with your doctor or diabetes educator to modify your medication. Losing weight may mean you can reduce the amount or types of medication you take. If you're unable to meet A1C goals, not unusual given the progressive nature of type 2 diabetes, you may need more than one type of blood glucose–lowering medication.

Food and Nutrition
Much of diabetes management centers on what you put into your mouth. How many carbs does it have? Calories? How much sodium? Medical nutrition therapy, learning with the help of a dietitian to carb count and manage daily calories, is a key element of your plan. Your food choices can help you manage blood glucose, blood pressure, cholesterol, and weight to keep you feeling your best.

The good news: Having an eating plan makes dining easier than staring into your pantry and deciding there's nothing to eat. You might even discover a new fondness for healthful foods you previously rejected. "I do more whole foods now, and I don't do processed foods," says Tuggle. "I tell people vegetables are my best friends and other foods are acquaintances. I had to learn to eat foods I hadn't eaten before."

A dietitian can help you set goals (such as eating 2 1/2 cups of vegetables a day), understand your calorie target, and count carbohydrate grams. For example, a woman who wants to lose weight may be advised to aim for 45 grams of carbohydrate per meal; a high school athlete may need far more.

You and your dietitian may discuss how to enjoy variety in what you eat. People with diabetes can vary what they eat, as long as their meals are balanced and healthy, says Schutta: "So what we advocate is three square meals a day with fairly consistent portions of protein, fat, and carbohydrate." Should you have complications of diabetes, such as heart or kidney disease, a dietitian can modify your food plan to keep blood glucose in check and maintain heart health and kidney function.

One of the biggest questions in diabetes management concerns blood glucose control: Are you achieving (and maintaining) your target blood glucose levels? Your diabetes management team will focus on your A1C levels along with your daily self-monitored blood glucose results.

A helpful form of communication is your blood glucose log, whether on paper or using meter software, to show your doctor or diabetes educator at each visit. Once your health care provider has seen your most recent readings, he or she can suggest appropriate changes, maybe a little more insulin here or fewer carbs there. "My sugars were all over the place, for no reason at all—even if I were to eat something with no carbs or sugar," says Caitlin Drouin, a 14-year-old student with type 1 from Ontario, Canada. "They decided to change my [treatment plan], and it is working amazingly now. I'm feeling better because my sugars are so well controlled [that] I feel like I have more energy."

Setting an A1C target and defining action steps (such as adding 30 minutes of physical activity daily) put you on the path to control. By keeping track of your blood glucose levels and modifying treatment as needed, you'll fine-tune your plan to get the results you and your doctor want.

Physical Activity
Exercise plays a major role in lowering blood glucose and improving other health measures, too. Many people with type 2 diabetes learn about the significance of exercise when they're diagnosed because it is an important aspect of weight loss, which improves insulin resistance. But even people with diabetes at an ideal weight benefit from exercise; it naturally lowers blood glucose levels and improves heart health in most cases. Your providers will help you incorporate exercise into your treatment plan, determining how many calories you need based on how much exercise you get and making sure your blood glucose doesn't go too low during or after a workout.

Problem Solving
Another aspect of the diabetes treatment plan that many people overlook is problem solving. It's an essential skill for adjusting medication, treating hypoglycemia, and counting carbs, as well as obtaining needed supplies such as strips and communicating with loved ones who may be acting like the "diabetes police." Drouin says "changes in life are unpredictable, especially since I am a teenager. So I usually have a backup plan. For example," she adds, "if my [meal] needs to be delayed for whatever reason and I didn't know, I eat a little 15- to 20-gram carb snack. I always have one on me."

Finally, your diabetes treatment plan should consider your mental health, whether you and your provider talk about the stress and frustration that come with a chronic illness or you see a counselor, social worker, or psychologist who can help you deal with your disease. Don't overlook this aspect of your health. Depression is more common in people with diabetes, and untreated depression makes you less able to control your blood glucose.

Getting support is important, and it tends to be helpful to know other people living with diabetes. Your doctor or diabetes educator should be able to point you to a support group in your area. "I got involved with a diabetes support group that was held at the hospital that my doctor is [part of]," says Olivia Logan, 25, who has type 2 diabetes. "That was very, very helpful. And that was free." And there's support available online. The American Diabetes Association message boards, DiabetesDaily.com, and TuDiabetes.org are places to meet other people dealing with diabetes.

A Team Effort
You're in charge of your treatment plan. That means you can decide how involved you want to be in its creation, though most doctors and diabetes educators agree that collaboration is key.

Having a frank discussion with your care provider about your treatment plan can ensure you're getting the best treatment possible. Jennifer Lovett, RN, a nurse from Oak Hill, Ohio, was diagnosed with type 2 diabetes six years ago but couldn't bring her blood glucose down despite taking medication, exercising often, and eating healthfully. When her doctor urged her to see an endocrinologist, she balked, determined to control her diabetes by herself. "[My primary care doctor] begged me to go see an endocrinologist, but I was too stubborn," says Lovett, 38. "I wish I would have listened." Once she gave in, Lovett learned that she had latent autoimmune diabetes in adults (LADA) and could keep her blood glucose in a normal range by using insulin, which she takes using a pump.

When you're working together to ensure good diabetes control, you can discuss problems and brainstorm solutions that fit your doctor's recommendations and your lifestyle. Your treatment plan puts you in charge. The goal is for someone with diabetes to become empowered to make decisions, to go out and do the different tasks that are part of diabetes management, and to seek the answers to questions, says Dickinson: "The most important thing is that the person with diabetes is at the center of all of it."



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