Last updated: Oct 20, 2009
to-do-list-diabetes
It's natural to ask yourself—"What did I do?" The important part is to move past this.
(ISTOCKPHOTO/HEALTH)
If you have type 2 diabetes, you may have found out after having a major complication such as a heart attack, stroke, or diabetic coma. About one-quarter of the estimated 24 million Americans with diabetes don't even know they have it.


Or you could have experienced symptoms such as blurry vision or excessive thirst, or just happened to find out from a routine blood test during a checkup.

However you are diagnosed, it's difficult to make instantaneous lifestyle changes. Most people need to gather their wits, talk to the experts and get up to speed on a confusing array of medical terms.

But there are a few things you need to do right way.
  • Don't let the past haunt you. Type 2 diabetes is partly genetic; many people have childhood memories of grandparents or other relatives with diabetes who died after amputations, blindness, heart attacks, or strokes. A lot has changed in recent years. Previous generations had no way to test their blood sugar at home, little or no medication options, and no knowledge about the benefits of diet and exercise. You have tools to control diabetes they could only dream of.
  • Don't go on a crash anything. Moderation and consistency are crucial in type 2 diabetes. You'll learn how to eat at consistent times, limit your total calories, and space your carbohydrate intake out throughout the day. Even exercise needs to be done on a routine, because it can lower blood sugar too. "People who have wild swings in their diet or wild swings on their activity level—that actually makes it more difficult to manage the diabetes," says William Bornstein, MD, an endocrinologist at the Emory Clinic in Atlanta.

  • Don't beat yourself up about it. It's natural to ask yourself—"What did I do?" The important part is to move past this. You could feel bad or guilty, but the more quickly you move on to "What can I do about this?" the better. "You feel that it's your fault, that you did something wrong," says Nancy Janow, 54, of South Orange, N.J. "Maybe you should have lost those few pounds extra that you're carrying. But would it really have made a difference? Or would it have just delayed it?" With more thought and education, Janow realized that, "No, it's not anything I did. It's just who I am. And I've learned to live with it," she says.
  • Don't panic. Many people are horrified when they hear the word diabetes. It could be the idea of using insulin needles, pricking their finger to test blood sugar, or never eating a piece of cake again. There are a lot of myths floating around about type 2 diabetes (such as you can never eat cake). Look to a diabetes educator or other people with diabetes to help fill in the details on what you can eat, whether insulin hurts, or how hard it is to prick your own finger. Most people find these aren't as bad as they expected.
  • Don't be too rigid about treatment options. You may feel that you never want to take oral medication or insulin. Or you may think you could never control diabetes with diet and exercise. The American Diabetes Association recommends that patients initially treat type 2 diabetes with lifestyle changes (improved diet, more exercise, and weight loss) and the oral medication metformin. What works best will depend on your individual circumstances. Sky-high blood sugar at diagnosis? You may have to take insulin before trying to control blood sugar with diet and exercise. The most important thing is to do whatever it takes to lower your blood sugar to safe levels—with diet, exercise and medication, if necessary—so that you can start lowering your risk of complications right away.

    If you need insulin at first, you may not need it permanently. "Insulin is an important tool for controlling type 2 diabetes. It can be used at diagnosis and then, as glucose levels improve, it can be replaced with pills. Insulin is then always available for use when glucose levels get out of hand and extra help is needed," says Katie Weinger of the Joslin Diabetes Center in Boston.

    Overall, 15% of people with type 2 diabetes don't take any medication (controlling blood sugar with diet and exercise alone), and 57% take oral medications alone, without injected drugs like insulin.

    Sixteen percent of people with type 2 diabetes take insulin only, and 12% use a combination of insulin and oral medication.