Your diabetes care team can help you adjust your treatment plan and manage your blood sugar levels. If a change is needed, your doctor may adjust your current medication, add new diabetes medications, or suggest starting an insulin regimen.
Why Your Diabetes Treatment Plan May Change
There are a number of factors that can contribute to a decline in blood sugar control, says Margaret Powers, PhD, RD, CDE, who has served as president of healthcare and education for the American Diabetes Association and is a registered dietitian, certified diabetes instructor, and research scientist at the Park Nicollet Health Clinic in Minneapolis. When type 2 diabetes first develops, you may be insulin resistant, which means you make a lot of insulin, but your body can’t use it effectively, Dr. Powers says. Then, over time, you make less insulin and become insulin deficient. “This is seen a lot, but it doesn’t happen overnight; it’s a gradual process,” says Powers. Other factors can also affect blood sugar, including a significant change in weight, activity level, or diet or starting a new medication, she says. Stress can also impact your treatment. When you’re chronically stressed, your body produces hormones that might cause your blood sugar to rise. An additional illness or a major change like a divorce, job loss, or loved one’s death can cause prolonged stress, which can raise blood sugar. Stressful life changes may also affect how well people take their medication, adds Susan Weiner, RDN, a certified diabetes educator in New York and the American Association of Diabetes Educators’ 2015 Educator of the Year. “Before, there may have been someone who helped motivate and support the person with diabetes. And daily diabetes self-management can be challenging even under the best of circumstances,” she says. If you need to change things up, it doesn’t necessarily mean you’ll need to adjust your medication regimen. It may just be a matter of refocusing on your food and activity plan, as well as reducing stress. Consider taking these steps to get your type 2 diabetes treatment back on track.
Monitor your blood sugar and A1C levels to gauge treatment success
An A1C test measures your average blood glucose (sugar) levels over the past three months. It’s the test that’s used to diagnose prediabetes and diabetes and also to help track and manage the condition. Your results are reported with a percentage. Generally speaking, a reading of less than 7 percent is usually optimal to prevent type 2 diabetes complications. Your target may be higher or lower, so be sure to talk to your diabetes care team about your personal A1C goal. While A1C tests are a good indicator of how well treatment is working overall, Powers explains that the A1C reflects an average. That means you could actually be experiencing many highs and lows, depending on what you eat and whether you exercise, even if your A1C result seems normal. That’s why at-home blood sugar testing as prescribed by your doctor is also important. Regular monitoring shows your blood sugar levels on a day-to-day basis. If your numbers aren’t consistently within your target range, you may need a change in treatment. Most people with diabetes should see their doctors about every three to four months to get their A1C, blood pressure, blood sugar, and cholesterol levels checked and to reevaluate their treatment plan as necessary. You may need to see your doctor more or less frequently, depending on your treatment plan and blood sugar control. According to Powers, there are four critical times to have your diabetes self-management plan assessed:
When you are newly diagnosedAnnuallyWhen complicating factors occurWhen you have transitions in care
There are many factors that can affect your A1C, so it’s important to review your diabetes management plan regularly so you don’t miss the opportunity to do what’s best for you.
Keep up with healthy lifestyle changes
Anyone who’s started a new diet or exercise program knows sticking to it for the long haul is often the most challenging part. But it’s essential to maintain lifestyle changes to get the best diabetes control, says Powers. Even diabetes medications, she says, won’t work on their own. Important lifestyle changes to manage your diabetes include:
Eating a healthy diet to keep your blood sugar levels stable, with the help of your diabetes educator or a registered dietitian. While there is no one-size-fits-all diet, for most people it means cutting back on calories and saturated fats; reducing carbohydrates and distributing them evenly throughout the day; and bumping up your intake of vegetables, fruits, and other high-fiber foods.Getting more physical activity, which helps lower blood sugar. Aim for 30 to 60 minutes most days of the week — everything from walking and gardening to swimming and biking — and combine that with two days of resistance training, such as weight lifting or yoga, for the best results.Losing weight, which also helps lower blood sugar levels. Even 5 to 10 pounds can make a difference.
Work with your doctor to adjust treatment as needed
While some people with diabetes can manage their blood sugar with lifestyle changes, including losing weight, eating a healthy diet, and exercising regularly, many others require diabetes medications. Metformin is a typical first medication for people with type 2 diabetes, says Powers. It works by decreasing the amount of sugar the liver produces and making muscle cells more sensitive to insulin so sugar can be absorbed. If metformin no longer works for you, your doctor may add another drug to your treatment plan. “But there’s no magical second drug; the secondary options will depend on the individual,” she says. Your doctor may prescribe other oral medications or noninsulin injectables. There are several different classes of diabetes medications that work to lower blood sugar in different ways. For instance, some trigger the pancreas to release more insulin, while others work in the intestines to block the breakdown of some carbohydrates or in the kidneys to increase the amount of sugar excreted in urine. Your doctor may suggest adding one or more of these to your medication plan. You’ll know your new medication is working if your A1C numbers shift down toward your goal. If you’ve had type 2 diabetes for many years, there may come a time when the medications you’ve been taking and lifestyle changes you’ve made might not work anymore. As a result, insulin injections may be needed in people whose A1C numbers are very high, Powers says. Keep in mind that although insulin therapy used to be added only when other medications weren’t working, it’s sometimes started earlier these days for people with type 2 diabetes. “Work with your healthcare provider, who will be able to recommend the best way to adjust your medications and insulin dosage so you can continue to properly manage your type 2 diabetes,” she says.
Stay positive when your type 2 diabetes changes
“Don’t feel like you’re in this alone,” Weiner says. Reach out to a friend, family member, healthcare provider, or certified diabetes educator for support. Additionally, take measures to manage stress. “Recharge and do something you enjoy: Take a walk, cuddle a pet, listen to music, or treat yourself to a massage,” she says. Additional reporting by Colleen de Bellefonds
