Are you newly diagnosed with type 2 diabetes and not sure what to do? Don’t panic. This step-by-step guide will walk you through exactly what you need to do after a type 2 diabetes diagnosis so you can manage your blood sugar easily and effectively.
Did you know that 10.5% of the population has diabetes, and 90-95% of those have type 2 diabetes? I want you to know that you are not alone. Being newly diagnosed with type 2 diabetes can be overwhelming and quite scary… There are steps you can take to properly manage the disease, but oftentimes these diet and lifestyle changes can compound the stress you’re already feeling from the diagnosis.
You might be thinking back on your life and wondering what led you here. Instead of ruminating on the past and the things out of your control, this blog will help you to look forward and focus on the next steps in a practical way. I will outline your next steps to help reduce any potential stress surrounding your diagnosis, in order for you to still live your best life with type 2 diabetes.
What is type 2 diabetes?
Type 2 diabetes is a chronic condition marked by high blood sugar levels due to problems with your body’s ability to use that sugar – glucose – as fuel.
As your blood sugar levels increase, the pancreas produces more and more insulin in an attempt to shuttle the sugar into your cells. Your cells eventually stop responding as well to insulin’s signal to bring sugar into the cell for energy, maintaining the high blood sugar levels. This is referred to as insulin resistance because your cells are resistant to insulin’s signal. For some, this can be coupled with reduced insulin production.
Chronic high blood sugar can lead to complications including organ damage, cardiovascular damage, and issues with nerves, eyes, feet, kidneys, and gums. Being diagnosed with type 2 diabetes and learning how to control your blood sugar is the first step to preventing these outcomes.
There are many things that are considered risk factors for type 2 diabetes including chronic stress, limited physical activity, and body composition. However, there are also things that are completely out of your control that can give you a higher risk of developing the disease. These things include your family history, your race/ethnicity, polycystic ovary syndrome (PCOS), your age, and more.
If you’ve been newly diagnosed with type 2 diabetes, just know that it is not your fault. Although weight is a risk factor, it is not the only cause of the disease. Rather, it is your genes in combination with your environment that determines whether or not you develop diabetes. So, don’t blame yourself for developing this disease. Instead, focus on what you can control in order to manage it and live your best life.
How can you best manage type 2 diabetes?
While there is no cure for type 2 diabetes, there are areas that you can focus on to manage the disease and stay healthy and achieve improved blood sugar control and even remission.
The five most important things to focus on when you’ve been newly diagnosed with type 2 diabetes are:
- Testing blood sugar and understanding the results
- Understanding the diabetes diet and meal planning
- Physical activity
- Having a diabetes care team
Let’s dive into these topics one-by-one to outline how each of these things should be utilized to help you manage your diabetes.
#1 Should I test my blood sugar?
If you’ve been newly diagnosed with type 2 diabetes, you are probably aware that your blood sugar levels are important and need to be monitored. Checking your blood sugar levels is essential for understanding whether or not your diabetes care plan is working, and whether or not you need to make any changes.
You’re probably new to testing… here’s how to do it
You will be using either a blood glucose meter or a continuous glucose monitor (CGM) in order to keep track of your blood sugar. Please be sure to refer to your meter’s specific instructions, as they can be slightly different.
Here are the general steps involved in testing your blood sugar with a blood glucose meter:
- Wash your hands and insert test strip into meter
- Lance side of fingertip to get a blood droplet (avoid main fingertip area which is used throughout your day to avoid additional discomfort)
- Hold the edge of the test strip on the blood droplet
- The display will show your current blood glucose level
Once you’ve obtained your results, be sure to jot them down in a journal. Also include some notes about what is going on around the time of testing (i.e., food, stress, exercise) since diet and lifestyle factors contribute to blood sugar levels.
What the blood sugar testing results mean
Keeping a log of your results can help determine if your diabetes management plan is successful or if it needs some tweaking. This can be done the old-fashioned way with pen and paper, or you can use a tracking app on your smartphone. You want your levels to be within your goal range; not too high and not too low.
Sometimes your blood sugar levels will be out of range. This is bound to happen, especially when you’ve been newly diagnosed with type 2 diabetes, so don’t be too hard on yourself. Tracking your blood glucose is a means to help figure out what works best for you as an individual. It can take a bit of time to figure out your personal care plan, so expect a bit of trial and error in the beginning.
Make sure to speak with your doctor to see if they suggest immediate contact when blood sugar results are outside of a certain range. Communication is key in this situation, as your healthcare provider can help you tweak things to get you back inside your goal range.
Blood sugar goal ranges
Your blood glucose goal is highly individualized and depends on your age, whether you are pregnant, other health conditions, and how long you’ve had diabetes.
Speak with your doctor to determine what your personal target levels are, but in general, you can refer to these ranges:
- Blood glucose pre-meal: 80-130 mg/dL
- Blood glucose 1-2 hours post-beginning of meal: less than 180 mg/dL
- A1C: less than 7% (also referred to as eAG: less than 154 mg/dL)
What is A1C and what does it mean?
An A1C test (aka hemoglobin A1C or HbA1c test) is a blood test that reveals your average blood sugar levels over a 3-month period. The results from an A1C test can help diagnose diabetes, but also help your healthcare provider analyze how well your diabetes care plan is working over time.
So, how exactly does this test work? Blood sugar attaches onto a protein in your red blood cells called hemoglobin, and an A1C test measures the percentage of red blood cells containing sugar. Higher A1C levels means higher chronic blood sugar, which can lead to diabetes complications. This is why it’s so important to test A1C in addition to daily blood sugar measurements.
For people without diabetes, a normal A1C level is below 5.7%. However, when you have diabetes, the general goal is to have your A1C level be less than 7%. Keep in mind that your personal target may be different based on a variety of factors.
Sometimes you may see estimated average glucose (eAG) reported instead of A1C, but just know that these are two ways to measure the same thing.
|A1C (%)||eAG (mg/dL)|
Usually, you should receive an A1C test twice per year. If you need to change your treatment or if your numbers aren’t in your goal range, you may be asked to get tested more often.
#2 Understanding the diabetes diet
There is a lot of misinformation out there when you are looking for help with your diet for diabetes. You’ve probably seen conflicting messages and have been left feeling confused or frustrated, not knowing who to trust. I want to help dispel the notion that your diet has to be super complicated or that you have to remove entire food groups. Why add more stress onto your life? Here are the facts:
What foods impact blood sugar the most?
Simple vs complex carbs
First things first: you do not have to avoid all sugar and carbs. However, it is important to note that not all carbs are created equal, so you should focus on consuming mostly complex carbohydrates and limiting simple carbs and added sugars.
Complex carbs (whole grains, legumes, vegetables) are made up of complicated chains of sugars. This type of carbohydrate is more slowly digestible and also contains vitamins, minerals, and fiber to support your overall health. Diets rich in these complex carbs can help you lose weight and reduce the risk of cardiovascular disease.
Simple carbohydrates (refined carbs and added sugars) are rapidly digestible, leading to a spike in both blood sugar and insulin levels. It is more important to limit added sugars because they rarely come with any nutritional benefit and can lead to spikes in your blood sugar. No more than 10% of your daily calories should be from added sugars since these are considered empty calories.
Benefits of fiber
Naturally occurring sugars and complex carbohydrates are bound with other beneficial nutrients, including fiber. Fiber slows down the absorption of sugar, so consuming fiber-rich foods doesn’t lead to the same type of blood sugar spike as consuming added sugars or simple carbs does. Not only does fiber slow down the absorption of sugar, it also can help to reduce blood sugar both pre- and post-meals, lower insulin levels, and lower cholesterol.
Food sources of fiber include plant-based foods like vegetables, whole grains, legumes, and nuts. Women and men should be consuming 25 g and 38 g minimum, respectively, and up to 50 grams daily. The easiest way to consume sufficient amounts is to ensure a variety of whole plant foods in your diet, and minimize processed foods. Focus on dietary sources of fiber rather than supplements, since these can often lead to unnecessary gastrointestinal distress. Lastly, be sure to slowly increase your daily fiber intake and drink plenty of water to avoid uncomfortable bloating, gas, and constipation.
The importance of protein and fats
Carbs aren’t the only macronutrient that matters in your diet for diabetes – protein and fat intake also matters. While consuming proteins and fats doesn’t directly lead to blood sugar increases, these macronutrients are also important to consider when planning your meals for blood sugar control.
If you are vigilant about your carb intake but aren’t tracking the amount of calories you consume from protein or fat, then it may result in an increase in body fat as the excess calories are stored as fat. Any increase in fat can make your body more insulin-resistant, and lead to more diabetes complications over time.
The type of protein and fat also matters. Diets higher in saturated fats (butter, cheese, cream) and high-fat animal proteins can also lead to more insulin resistance and poor management of blood glucose levels. Opt for more plant-based options (tofu, legumes, nuts and seeds, olive oil) and lean animal proteins (fish, chicken breast) to reduce your intake of saturated fats.
How to balance meals to manage blood sugar
Since your diet impacts your blood sugar, you can adopt a strategy to keep your blood sugar balanced by focusing on meal planning or counting carbs, if that approach is right for you.
Should you count carbs?
Working closely with your diabetes care team can help you determine the proper amount of carbs you should be consuming throughout each day. Spacing your carbs over the course of the day is important, because consuming too many carbs at once can lead to blood sugar spikes.
Start by looking at the Nutrition Facts panel of the foods and beverages you consume at each meal and look for the total grams of carbohydrates. Total carbs include sugars, starch, and fiber. Since fiber doesn’t raise blood sugar, you can deduct the grams of fiber from the total carbs to obtain your net carb count. Pay attention to the proper serving size for the food to be sure you are consuming the amount
Carb counting is especially beneficial for those who need to take mealtime insulin. This allows you to better manage your blood sugar by matching your insulin dose to the amount of carbs you consume in that meal. If you don’t need to take mealtime insulin, carb counting is not necessary, but you may still choose to do so if you wish.
Simple diabetes meal planning
Meal planning is very important for diabetes, especially when planning your carbohydrate intake. The amount (and type) of carbs you consume determines how quickly your blood sugar will rise after a meal. Although complex carbs are more slowly digested, consuming too many complex carbs at once can also lead to a blood sugar spike. This is why spacing out your carb intake is key in diabetes management.
For those who don’t take insulin and don’t necessarily need to count carbs, you can instead focus on the Diabetes Plate Method to determine how to easily structure your meals to ensure you’re getting the proper balance of macronutrients at every meal.
Stick to a plate less than 9 inches in diameter to prevent overeating and break it into 3 sections at each meal:
- Fill half your plate with non-starchy veggies (for example vegetables like broccoli, carrots, cucumber, green beans, peppers, greens, and tomatoes)
- Fill a quarter of the plate with lean protein (chicken, turkey, eggs, fish, lean cuts of meat, tofu)
- Fill the remaining quarter with carbs (whole grains, potato, beans/legumes, fruits, dairy products)
- Opt for water or low calorie options for your beverages, avoiding added sugars
Sometimes foods are combinations of sections of the plate, including things like soups, sandwiches, and pasta dishes. When this happens, just do your best to consume them in the same proportions as you would if they were organized neatly onto your Diabetes Plate.
If the Diabetes Plate feels like a big adjustment compared to how you’ve eaten in the past, meeting with a registered dietitian can help make this process easier. Your dietitian can explain how to make the best food choices for your needs, how to understand Nutrition Facts labels, how to count carbs, and simplify navigating how to eat for blood sugar balance. There is no single best diabetes diet that works for each and every person. Working with your dietitian allows you to customize a diet plan based on your individual preferences and needs.
Balance is key when it comes to diabetes management. You want something sustainable – something that you can be consistent with in order to effectively manage your blood sugar for life.
#3 Understanding medications for type 2 diabetes
Since your body is unable to use insulin as effectively when you have type 2 Diabetes, you may need to take medication to help reduce your blood sugar levels. There are several categories of medications for type 2 diabetes, all which work to reduce blood sugar in various ways. You should speak with your doctor to find your best fit based on your medical history and personal needs.
Biguanides are one common category of medication for type 2 diabetes. These decrease blood sugar by lowering sugar production in the liver and reducing how much sugar you absorb after eating. Another effect of this medication includes increasing insulin sensitivity (aka reducing insulin resistance). Metformin is the most common type of biguanide.
Alpha-glucosidase inhibitors slow down digestion of complex carbs to keep blood sugar lower after meals.
Bile acid sequestrants help lower blood glucose along with blood cholesterol.
Dopamine agonists help to prevent insulin resistance, and include bromocriptine (Cycloset).
Dipeptidyl peptidase-4 (DPP-4) inhibitors improve insulin production and help prevent hypoglycemia (low blood sugar).
Glucagon-like peptide-1 (GLP-1) receptor agonists reduce appetite and slow stomach emptying to help prevent blood sugar spikes. These also reduce glucagon use, meaning that less glycogen is broken down into glucose by the liver. This type of medication is recommended for those who also have kidney or heart disease.
Meglitinides and sulfonylureas help your pancreas release more insulin. For some, this can lower blood sugar too much and put you in a hypoglycemic state.
Sodium-glucose transporter (SGLT) 2 inhibitors help your kidneys expel more glucose via urine. This medication type is recommended for those with kidney and heart disease.
Thiazolidinediones help increase the insulin sensitivity of your fat cells and decrease glucose levels in your liver. This medication may increase the risk of heart disease, so it is not for everybody.
#4 What type of exercise is best for type 2 diabetes
Another major aspect for diabetes management is exercise. This is because working out can help lower your blood sugar in a couple of ways. Exercising leads to higher insulin sensitivity and reduced insulin resistance. This allows insulin to work more effectively to bring glucose into your body’s cells for energy. Also, during exercise, your contracting muscles can actually take in glucose without the help of insulin.
Staying active allows you to better manage your diabetes by keeping your blood sugar levels within range. Exercise also improves your cardiovascular fitness, reducing the risk of heart disease, heart attack, and stroke. If you need to lose weight, regular exercise along with a balanced diet can also help to improve body composition and reduce waist circumference which may help to improve diabetes outcomes.
The best forms of exercise for diabetes include:
- Riding a bike/stationary bike
- Strength training (weights or resistance bands)
- Tai chi
The recommendation for general health is to be physically active for 150 minutes of moderate-intensity physical activity per week, including both cardio and strength training. However, remember this is a general recommendation. Any increase in physical activity will benefit health. So if you are inactive now and can add in 30 minutes per week, that’s a great start. Slowly over time you can continue to build up as your fitness level improves.
In the same way that you do not want your blood sugar levels to be too high, you also don’t want them to plummet too low. If you are taking insulin, make sure to adjust your insulin dose and carb intake accordingly. Always measure your blood sugar before exercise to help prevent hypoglycemia as well as after exercise, as blood sugar can be impacted by exercise for up to 24 hours.
Understanding how your blood sugar levels respond to exercise can take some time. Measuring your blood sugar before and after exercise can enlighten you to how your body responds to various forms and lengths of exercise.
Be sure to speak with your doctor before starting any kind of workout regimen to ensure there are no precautions or restrictions necessary.
#5 Creating your diabetes care team
Managing your diabetes can feel like a massive adjustment to your life as a whole. You now have to consider so many different aspects of your life, adjusting your diet, your habits, and your behavior. It can be overwhelming if you feel like you’re in this all by yourself. That is why creating your diabetes care team is so essential. You don’t have to feel alone in this process.
So who should be part of your care team?
- Your primary care physician to assist with overall health
- A Certified Diabetes Care and Education Specialist to assist with education about managing your diabetes
- An endocrinologist to ensure proper medication and diabetes management
- A registered dietitian (RD) to assist you with meal planning to keep your blood sugar balanced
- A mental health professional to help with stress reduction strategies and promote effective coping strategies for living with a chronic condition
- A podiatrist for your foot health
- An ophthalmologist for your eye health
- A loved one who will support your efforts to manage your diabetes
Each of these medical providers fulfills a specific health need when you have been newly diagnosed with diabetes. You may be surprised that you need so many teammates, but think about it this way… You can’t play baseball with only a pitcher. You also need a catcher, players on each base, and players in the outfield.
Every player on your team offers support in their specific role, which contributes to the team’s overall success. With each of these healthcare players contributing their expertise, you can more easily claim victory when it comes to improving and maintaining your health.
Why you need a dietitian on your diabetes care team
In the same way that an endocrinologist is a specialist when it comes to your hormones, dietitians are specialists when it comes to nutrition and food. When you’ve been newly diagnosed with type 2 diabetes, your diet has to be adjusted in order to balance your blood glucose levels. A dietitian who specializes in diabetes is your absolute best bet when it comes to designing your personal game plan for blood sugar control.
There is no single best one-size-fits-all diet for diabetes management. Your dietitian will help you determine what style of eating would work best for you based on your lifestyle, food preferences, health goals, and individual medical needs.
If you weren’t immediately given a referral to a dietitian upon diagnosis, you can use the Academy of Nutrition and Dietetics website to find one that specializes in diabetes. You can also contact your insurance provider to give you options for in-network RDs who specialize in diabetes and are covered by your insurance policy.
You also want to make sure that you and your dietitian are compatible. Meeting with an RD isn’t something that should only happen once. It should be a continuous relationship, especially as your health and personal goals may change over time.
Your checklist of what to do after a diagnosis of type 2 diabetes
Being newly diagnosed with type 2 diabetes can feel overwhelming. But remember, just like type 2 diabetes didn’t occur overnight, managing it won’t happen overnight either. Just take it day by day, one step at a time and you will find your blood sugar levels improving and your confidence at being able to manage diabetes increasing. Start by following these five steps and you will be well on your way to managing type 2 diabetes effectively:
- Test your blood sugar accordingly, understand what your results mean, and communicate with your doctor when needed.
- Understand how your diet impacts your blood sugar, count carbs if you are taking insulin, and make the Diabetes Plate your template for each meal.
- Use medication to assist with blood sugar management if recommended by your doctor.
- Exercise regularly and adjust carb and insulin dosage as necessary.
- Create your diabetes care team so you have the support you need to not feel overwhelmed or alone.
You can see that with the support from your diabetes care team, some careful planning, and general knowledge about your disease – diabetes management doesn’t have to be so stressful. Strive for progress over perfection, and try to remember you are not alone when it comes to your diabetes management. Make small, sustainable changes to your lifestyle over time rather than aggressively changing your entire life. Be realistic, communicate with your diabetes care team, and you will be on the road to blood sugar control and better health in no time.