Top 10 Tips for People Newly Diagnosed with Type 2

Diabetes
by Adam Brown, diaTribe and dLife.com

1. Know that developing type 2 diabetes does not represent a personal failing.

It develops through a combination of factors that are still being uncovered and better understood. Lifestyle
(food, exercise, stress, sleep) certainly plays a major role, but genetics play a significant role as well. Type 2
diabetes is often described in the media as a result of being overweight, but the relationship is not that simple.
Many overweight individuals never get type 2, and some people with type 2 were never overweight. At its core,
type 2 involves two physiological issues: resistance to the insulin made by the person's beta cells and too little
insulin production relative to the amount one needs. These problems can lead to high blood sugar, which over
time can cause various complications like heart disease and stroke, retinopathy, and neuropathy (you can read
more about diabetes complications here). Treatments for type 2 diabetes – a healthy eating plan, regular
exercise, and blood glucose lowering drugs - involve addressing both insulin resistance and the relative lack of
insulin to control blood glucose levels. The progression from normal glucose levels through prediabetes, and
then to type 2, can often take five to 10 years.

2. Taking care of your diabetes soon after diagnosis (and before) will pay off now and in the long term.

Type 2 diabetes is not a death sentence by any stretch, but it is a serious disease that demands your attention
immediately. Ignoring it may not seem to have significant short-term consequences (chronic high blood glucose
levels are not painful), but over time, the elevated glucose levels can damage your nervous system, blood
vessels, eyes, heart, and kidneys. In the landmark Diabetes Prevention Program study, even a small percent of
people with prediabetes were found to have evidence of eye disease (retinopathy). Managing your blood
glucose levels now, along with other health risk factors (e.g., cholesterol, blood pressure, weight), is necessary
for preventing these complications. Losing even a small amount of weight and keeping it off can also improve
glucose control as well as have other clinical benefits (read more tips on managing diet and exercise below for
more on weight loss). Keep in mind that better diabetes management will also benefit you in the here and now –
your mood and energy levels are adversely affected when your glucose levels are high.

What's the evidence? In the landmark UKPDS study, 5,102 patients newly diagnosed with type 2 diabetes
were followed for an average of 10 years to determine whether intensive use of blood glucose-lowering drugs
would result in health benefits. Tighter average glucose control (an A1c of 7.0% vs. an A1c of 7.9%) reduced
the rate of microvascular complications (which affect the eyes, kidneys, and nervous system) by 25%. For every
percentage point decrease in A1c (e.g., from 9% to 8%), there was a 25% reduction in diabetes-related deaths, a
7% reduction in mortality, and an 18% reduction in combined fatal and nonfatal heart attacks.

3. Recognize that type 2 diabetes is a progressive disease.

When people are diagnosed with type 2 diabetes, they have already lost up to 50% or more of their beta cell
function (the cells in the pancreas that make insulin) and are typically also insulin resistant, meaning they can't
use the insulin they make effectively. A few patients can initially manage their diabetes with a healthy eating
plan and exercise. But over time, beta cell function decreases, which makes blood glucose harder to manage. To
continue achieving blood glucose control, people typically need to add one or more different types of
medications. The good news today is that there are many more choices available, and a number of these
medications don't cause as much hypoglycemia, hunger and/or weight gain as in the past (e.g., metformin,
pioglitazone, DPP-4 inhibitors, GLP-1 agonists, SGLT-2 inhibitors, and better insulin). The need to use more
and different types of medications does not mean that you have failed. Diligent management early on can help
preserve remaining beta cell function and slow progression – another reason why acting early and
aggressively is so important.

4. Food has a major impact on blood glucose – optimizing your mealtime choices, especially
carbohydrates, can improve your diabetes management and overall health.

In my experience, carbohydrates can raise blood sugar much more than protein and fat and thus, require extra
monitoring and management with available insulin. Here are a few tips that may help you manage blood sugars,
and you can read here for more suggestions:

 I try to reduce the amount of carbohydrates I eat at one time, or I choose carbohydrates lower on the
glycemic index – see Adam's Corner on Why All Carbohydrates are Not Created Equal.
 Avoid drinks with lots of added sugars and carbohydrates (unless you have low blood sugar, also called
hypoglycemia). Staying away from regular soda and large amounts of fruit juice is usually wise.
 Impose portion control. For instance, use the "½ plate rule" – fill half your plate with veggies or salad.
Also, avoid directly eating out of food packages, a convenience trap that encourages overeating. At sit-
down restaurants, tell the waiter you don't want the free bread – sometime the temptation is too hard to
resist!
 As a general rule, I try to eat foods that are as natural and minimally processed as possible – the fewer
ingredients on the label, the better. Fruits and vegetables are always a good way to go. By contrast, try to
avoid highly processed foods (e.g., chips, candy) that I find can be less filling and raise my blood
glucose more substantially.
 Try substituting almond and coconut flour in recipes – in my experience, these have a significantly
smaller impact on my blood glucose, contain lots of healthy fat and fiber, and help make baked goods
much more diabetes-friendly.

5. Exercise is a free drug – use it as much as possible!

Regular physical activity done for about 30 minutes most days each week can lower blood glucose, help your
body better use the insulin your body continues to make, and improve your cholesterol levels. If you already
have an activity you love, keep doing it! If you're not very active right now, it's critical not to be intimidated by
the thought of getting started. Even something as simple as walking (see here for more details) can lower blood
glucose and improve your heart. Here are some simple ways to incorporate more activity into your life:

 Find some friends or coworkers that share your interests. Accountability to someone else is a huge factor
in sticking with something. Check out Insulindependence to connect with others in the active diabetes
community.
 Find ways to include exercise in your daily life – go for a walk during your lunch break, try walking
meetings, take the stairs instead of the elevator, or park in the farthest spot in the parking lot.
 Try an app: Moves, GymPact, Seven Minute Workout, Strava, Sworkit, Power 20, and so many more
out there are great to get you moving.
 Give an activity tracker a shot – these little devices are incredibly motivational and the data is
completely addicting. The most popular option is Fitbit, but there are many others.
 Set goals and hold yourself accountable – read here for a few pointers.

6. Use blood glucose testing to identify patterns.

When it comes to managing blood sugar, think of your glucose meter as a compass. By testing before and after
certain events like meals and exercise, these data can point the way toward factors that affect your blood
glucose. I make this fun by approaching it like a scientist: How much does walking lower my blood glucose?
How does a dinner of chicken and vegetables compare to a pasta meal? To make your glucose results more
useful, you can try structured testing, a more strategic approach to checking your blood sugar – Accu-Chek has
developed two free tools to help identify blood sugar patterns that you can download here and here. Remember
that the purpose of collecting glucose readings is to give you information to optimize your therapy. Are you
running consistently high after breakfast? Is your blood sugar dropping low in the middle of the night?
Recognizing such patterns in your glucose readings can answer these types of questions and help you and your
healthcare provider make changes to your diabetes management.

7. Needing to take insulin is NOT YOUR failure.

Type 2 diabetes is a progressive disease, and your body's ability to make insulin is likely to decline over time.
Indeed, about 30-40% of type 2 patients end up needing to take insulin to manage their blood glucose,
particularly those who have had diabetes for a long time. As you start to take insulin, remember that you are not
alone! Injections can be a hassle for everyone, but there are now devices designed to ease the burden – insulin
pens that are increasingly patient friendly, Valeritas' V-Go insulin delivery device, Medtronic's i-Port Advance,
and full-featured insulin pumps.

8. Keep learning and find support!

The more you learn about type 2 diabetes – from organizations and other people – the more you will realize
how much there is to know. Here are some resources that we enjoy (although there are many more).

 Websites: American Diabetes Association, CDC, NIH/NIDDK, The Mayo Clinic, The Joslin Diabetes
Center
 Books: Diabetes Burnout by Dr. William H. Polonsky, Diabesity by Dr. Fran Kaufman, Your First Year
with Diabetes: What To Do, Month by Month by Theresa Gamero, The First Year: Type 2 Diabetes: An
Essential Guide for the Newly Diagnosed by Gretchen Becker, Diabetes Meal Planning Made Easy by
Hope S. Warshaw
 Conferences: TCOYD (for all patients) and Diabetes Sisters (for women)
 Support: TuDiabetes, Diabetes Daily, Diabetic Connect

9. Seek out a Diabetes Educator.

Diabetes educators are certified health care professionals with specialized knowledge in diabetes self-
management and education. They provide real-life guidance, coaching, and support. To receive diabetes
education, you can ask for a referral from your primary health care provider. Going to a diabetes educator is
covered by Medicare Part B as well as many health insurance plans. You can learn more by using this resource
from the American Association of Diabetes Educators.

10. Review our Patient's Guide to Individualizing Therapy at www.diaTribe.org/patientguide.

This short list of questions is intended to help you and your healthcare provider discuss what therapies and goals
are right for you.

NOTE: This information is not intended to be a replacement or substitute for consultation with a qualified
medical professional or for professional advice related to diabetes or another medical condition. Please contact
your physician or medical professional with any questions and concerns about your medical condition.