First Steps and How to Cope When the Doctor Says You Are Diabetic

My husband was recently diagnosed with Type II Diabetes. He's always had the risk factors for it, and we were, perhaps, in denial about those risks until one day when the doctor said, "I think we'd better test your blood sugar." The glucose meter spat out a number way too high for fasting blood sugar.

"You're diabetic."

The doctor took perhaps five minutes to explain to him that he needed to take some pills for it, and that he needed to change what he eats. This left us rather in the dark. We'd always heard that diabetics must take insulin, but that is not always the case. We'd also heard that diabetics could not eat sugar in any form. It turned out that was a myth, too! We also thought that Type I and Type II diabetes were the same thing, but the onset later in life determined the type. Wrong again! Type I diabetes is often caused by an autoimmune disease where the body does not produce insulin, while Type II tends to be an insulin resistance - the body makes normal amounts of insulin, but those amounts are not enough to work effectively.

Insulin injections can be used, but often doctors will try the patient on a combination of pills, diet, and exercise (only your doctor can determine how to best treat your diabetes). The first pills my husband took made him very ill, so the doctor gave him a different drug. So far, this new medicine has done well in keeping his blood sugar down without many side effects.

There are several things that we've discovered that all new diabetics should do.

#1 - Get a doctor that you can trust and communicate with well.

After our doctor allotted five minutes to explain things initially, and another five on a follow-up visit, and we STILL had no answers, we fired him - even though we'd been with him for over ten years. We found an excellent endocrinologist (a specialist in diabetes, thyroid disorders, and similar conditions). The new doctor has spent an enormous amount of time answering our questions, referring us to additional information, and making sure that we were comfortable with what he was telling us.

Depending on how advanced your diabetes is, you may need a specialist. Many people can remain in the care of a good internist or family practice doctor. If your doctor is answering all your questions, taking the time to run the appropriate tests, and you feel comfortable with this doctor, then stay! If, however, you feel put off or the doctor says, "Just take these pills and you'll be fine", then it's time to find a new doctor.

#2 - See a Diabetes Educator.

A diabetes educator is often a nurse or other health professional who has special training in diabetes and diabetic's special needs. The DE can assist you with medication questions, answer questions about your particular type of diabetes, and help you develop coping skills so that you can best combat this disease. It helps to come prepared with a list of questions and a notepad for taking down answers.

#3 - If your insurance will pay for it, see a nutritionist as soon as possible.

One of our biggest stumbling blocks at first was, "What on earth can he eat?" The next question was, "What can we eat together?" I quickly determined that it didn't make sense to cook separate meals for each person - so, for the most part, the whole family eats healthy now. I do occasionally buy separate snacks - some made specifically for diabetics, and some which simply have no carbs, like pork skins. I bag them in individual portions and send them with my husband for lunch.

Seeing a nutritionist can help you sort out what can be eaten, what's an "absolutely never", and what foods can be eaten occasionally (like chocolate cake!). The nutritionist can also work with you to develop a new eating plan that covers social situations, restaurants, snacks while at work, and holiday meals. Be sure that both you AND your spouse attend the meeting with the nutritionist.

We started out with a very, very low carb diet - our own take on the Atkins diet - but as a practical measure, it failed. I began to research online and discovered that diabetics can eat most foods in moderation, and that some foods cause a bigger rise in blood sugar than others. We started eating whole wheat bread made with minimal sweetener, basmati or brown rice instead of white rice, and a smaller serving of potato than before. We've cut back on fried and fatty foods, because fats in combination with carbs cause the blood sugar to go up. They also increase the risk for heart disease, which diabetics are more likely to develop than the general population. For most people, a change to a diabetic diet will prompt weight loss. If you were overweight to begin with, this is a good thing! If you weren't, ask your nutritionist or doctor about weight maintenance programs.

Be sure that you get enough to drink! While many diabetics reach for the diet sodas, they're still not good for you - even without the sugar and calories. (In fact, there are many questions still unanswered regarding the health risks of sugar substitutes). Water with a wedge of lemon or lime or no-sugar-added juices (in moderation) are both excellent choices.

There are several diabetic diets available today. One of the most popular uses an exchange scheme - you get a pre-set number of fats, carbs, and "free" foods per day (or per meal). Using this diet, you can "budget" for a piece of chocolate cake at dessert by forgoing other carbs during dinner. Other popular diets, like South Beach and Nutrisystem, are based on the glycemic index. Certain foods cause your blood sugar to rise more than others. By simply replacing many "white" foods with whole-grain alternatives and watching portion sizes, many problem foods are elimated. Be sure to discuss your diet choices with the nutritionist and your doctor.

#4 - Check your blood sugar often, and take your medication(s) as directed by your doctor.

Your doctor should prescribe a blood glucose meter. Most operate on the same premise: get a pinprick of blood and apply it to a special test strip. The meter reads the strip and tells you what your blood sugar is right at that moment. Normal fasting blood sugar runs between 70-99, and normal blood sugar two hours after eating should be between 70-145. Your doctor may give you slightly higher numbers as a target for the first few months - ours said a fasting blood sugar of below 120 was fine to start with. Your doctor should tell you how often to check your blood sugar. Usually they'll want you to do it more often in the beginning, so you can get a feel for how the blood sugar rises and falls with eating. Later, you may be able to check it just once a day, or even every few days.

If you have questions about your medication, ask - and confirm the answer with your pharmacist. It's now more important than ever to tell your doctor what other medications you take, including vitamins, supplements, and herbal medicines. It's also important to use only one pharmacy, so that any potential drug interactions can be easily found. As we discovered with the first drug my husband took, these medications can have serious side effects... some of which are life-threatening. Be sure to report anything unusual to your doctor immediately - don't just "put up with it".

If the doctor prescribes insulin, rather than pills, be sure to find out exactly how to take it, when to take it, and how to store it. Insulin usually must be kept cold, so if you will be travelling you need to make a plan for carrying it safely. You also need a plan for disposing of used needles and lancets.

Whether you are on pills or insulin for your diabetes, you need to know and understand two things: What to do if your blood sugar gets too high, and what to do if it drops too low. If it gets high enough or low enough, you could die. Diabetes is not something to be taken lightly. Certain medications can cause wild swings in your blood sugar, especially if you make a mistake in dosing or timing. You may need to carry glucose tablets or wear a medical alert bracelet. Your doctor can tell you what to watch out for.

#5 - Start exercising.

If you were previously sedentary, it's time to change! Diabetics MUST exercise! Talk to your doctor about the best way to start exercising. Depending on your overall health, walking or swimming may be excellent ways to start. Or, the doctor might recommend that you join a gym or attend a fitness class just for diabetics.

If you don't like to exercise, there are some easy ways to add exercise to your life. Start by parking further away from the entrance - those extra steps add up! Take the stairs instead of the elevator. If you have ten flights to go, try walking up just one and take the elevator from there. In two weeks, start taking two flights of stairs at a time. Take your kids or your dogs for a walk around the block a couple of times a week. Soon you'll find that you enjoy the extra activity, and look for more ways to add it to your life.

#6 - Practice good self-care and check out your body every single day.

People diagnosed with diabetes are at high risk for developing sores, especially on their feet and fingers. If your diabetes was caught early and your blood sugar is well-controlled, you may not have to worry - but be careful and check yourself anyway. When you clip your nails, do it straight across and be very cautious that you do not nick the skin. Do not walk barefoot, even in your house. If you go swimming at the beach, you may need to wear water shoes.Check your hands, feet, and lower legs daily for sores. You might not be able to feel them (diabetics tend to lose feeling in their extremities over time). If you develop a sore that does not show signs of healing in a day or two, or looks infected when you spot it, call your doctor for instructions.

#7 - Be sure to make your three-month checkup with your doctor.

Your doctor will want to run some specialized blood tests on you, about three months after you start taking medicine for your diabetes. This test will show how well-controlled your blood sugar is over time. The results of this test may bring praise from your doctor, and may prompt a change in your diet, exercise regimen, or medications. Bring a list of questions for the doctor, too.

There is no cure for diabetes - but many people can reverse it completely or greatly reduce its affects on their lives by following these seven steps and taking an active role in their own health care.