How to Make a Treatment Plan for Type 2 Diabetes

From verywellhealth.com

Getting a diagnosis of type 2 diabetes can be a jarring experience, but learning about the condition and setting realistic treatment goals with your healthcare provider can brighten your outlook. Ultimately the goal of treatment is blood glucose control, symptom management, and reducing your risk of medical complications.

Managing type 2 diabetes requires a commitment to a well-designed treatment plan. This article discusses how to work with a healthcare provider to develop a treatment plan. It covers what you should include in your plan, how to know when you need to adjust your plan, and how to stay on track.

FatCamera

Making a Plan With Your Healthcare Provider

If you are diagnosed with type 2 diabetes, you’ll likely have many questions about the condition. Questions about your treatment plan, the lifestyle changes you’ll have to make, and ways to prevent serious medical complications are natural.

Enlisting the help of a healthcare provider and a diabetes care team is a great way to form a plan that works best for you and meets your needs. For starters, your healthcare provider will discuss changes to your diet to help regulate your blood sugar and promote weight loss (if needed).

Next, they will likely formulate a diabetes care schedule that includes daily monitoring of your blood sugar levels and a review of the medications you need to take. During this time, the diabetes care team will teach you how to measure your blood sugar levels and administer insulin (if necessary).

You may also discuss the importance of an exercise plan, attending your healthcare provider appointments, and periodic tests, such as kidney functioning tests, a dilated eye exam, and checking your blood sugar using a haemoglobin A1C lab test (a measure of your average blood glucose control over the previous three months).

What to Include

Elements of a diabetes treatment plan include blood glucose monitoring, nutrition, exercise, medications, healthcare appointments, addressing costs, and access to resources and diabetes education.

At-Home Testing

Glucose monitoring is very important because it helps you determine the foods you can eat, your physical activity level, and the amount or type of medication you need.

Some people perform daily finger sticks to determine their blood glucose level with a blood glucose meter (glucometer). Alternatively, continuous glucose monitoring—constant measures of your blood sugar levels throughout the day via a tiny sensor inserted under your skin—has become increasingly popular. Blood sugar is typically checked four times a day:

• When you first wake up, before you eat or drink anything
• Before a meal
• Two hours after a meal
• At bedtime

For most people living with diabetes, the aim is to keep blood glucose at these levels:

• Before a meal: 80 to 130 milligrams per decilitre (mg/dL)
• About two hours after a meal starts: Less than 180 mg/dL

These goals may be lower if you are pregnant or thinking about getting pregnant.

Insulin and oral diabetes medication are often used to manage blood glucose levels, especially if you struggle to keep your blood sugar levels within a normal range with lifestyle modifications.  

Nutrition Guidelines

Though there are no hard and fast nutrition guidelines for diabetes management, you will inevitably have to make some changes to your diet if you are living with diabetes. Nutritional plans are not crafted with a one-size-fits-all approach. Suggested changes and goals will be individualized, flexible, and realistic for you to implement.

Your diabetes care team, including your primary healthcare provider, nurses, and a registered dietitian nutritionist, will help you craft a plan to meet your collective goals.

Your nutritional plan will likely include the following:

• Limiting high carbohydrate foods such as junk food, highly processed foods, candy, sugary drinks, white bread, and pasta that cause your blood sugar levels to spike quickly
• Increasing your intake of high-fibre foods
• Counting your carbs and emphasizing eating healthy carbs, including non-starchy vegetables (such as broccoli, spinach, and green beans), low-carb fruits (such as raspberries and blueberries), and lean protein (such as chicken, turkey, beans, tofu, or eggs).
• Substituting water or unsweetened iced tea for fruit juices and sodas

Cooking your own meals, exhibiting portion control, and using a meal plan or the plate method can help you to stay on track. Checking your blood sugar before and after meals can also help give you an idea of which foods cause your blood sugar to increase to unsafe levels.

Remember, the goal is not to just eliminate food groups—that may cause more harm than good. Instead, you want to find the right balance of healthy carbohydrates and protein. The combination of some trial and error plus following your healthcare provider's guidance will help you find the best meal plan for you.

Exercise Guidelines

Physical activity and exercise can help a person with diabetes manage blood sugar levels, reduce heart disease risk, and promote weight loss. Aim for 150 minutes a week of sweat-breaking cardiovascular exercise (like cycling, jogging, brisk walking, or dancing). Also, add activities two or more days a week that work your muscles.

If you are taking insulin or another diabetes medication, check your blood sugar before exercise to ensure you do not develop low blood sugar (hypoglycaemia). Checking can also alert you to high blood sugar levels and the need to take your insulin or medication to lower your blood sugar to a level that is appropriate for exercise.

Proper hydration and a post-exercise blood sugar check are also components of a diabetes-friendly exercise plan.

Your exercise plan may also include wearing appropriate socks and footwear to prevent blisters, monitoring your feet for any signs of irritation or sores, and knowing when to contact your healthcare provider if any develop and do not begin to heal.

Medications

Oral medications or insulin injections may be necessary if changing your eating habits and exercise do not control your blood sugar levels. Your need for medication is usually determined by the severity of your diabetes and how your body responds to lifestyle changes that lower blood sugar.

Your treatment plan will include which medications to take and the dosing schedule. It will also include monitoring your blood glucose and how to adjust dosages based on the readings. The plan will include information as to when to notify your healthcare provider.

Oral diabetes pills help your body lower blood sugar levels. Diabetes pills aid glucose metabolism in different ways based on the class of drugs.

Here is a list of oral medications based on how they work (drug class in bold):

• Drugs that increase the amount of insulin the body produces: Sulfonylureas such as Glucotrol (glipizide), Amaryl (glimepiride), DiaBeta (glyburide), meglitinides such as Prandin (repaglinide) and Starlix (nateglinide) and DPP-4 inhibitors such as Januvia (sitagliptin), Onglyza (saxagliptin), and Tradjenta (linagliptin)
• Drugs that improve the way insulin works in the body: Biguanides such as Glucophage (metformin) and thiazolidinediones (which also improve the way your cells respond to insulin), such as Actos (pioglitazone) and Avandia (rosiglitazone)
• Drugs that lower the amount of glucose released by the liver: the dopamine agonist Cycloset (bromocriptine) and DPP-4 inhibitors

Insulin injections may be necessary. These are available in a variety of forms. Your treatment plan will detail when and how to use them.

Follow-Ups With Healthcare Providers

Meeting frequently with your diabetes team is an integral part of any diabetes plan. Typically, a person living with diabetes will meet with their primary healthcare provider and an endocrinologist (a specialist in hormonal conditions) every three to six months to:

• Check your blood sugar levels with a haemoglobin A1C lab test
• Check blood pressure and waist circumference
• Review medications
• Review labs
• Perform a focused physical exam to check for signs of worsening diabetes: This may include a fundoscopic eye exam, diabetes foot check, cranial nerve exam, reflex checks, and a visual exam looking for dry skin, poor wound healing, and skin darkening (acanthosis nigrican). 
• Monitor weight loss and quitting smoking progress
• Make adjustments to your plan (based on your overall health and activity level)

Even if your diabetes is well managed, you probably will periodically meet with several specialists, including an eye doctor (ophthalmologist), a heart doctor (cardiologist), and a kidney doctor (nephrologist), to ensure that these organs are working properly.

You may meet with these specialists more often if you develop symptoms such as blurry vision, chest pain, or frequent urination. 

Insurance and Out-of-Pocket Costs

Diabetes management can be fairly expensive, with the average U.S. adult living with diabetes incurring an average expense of nearly $17,000 per year. Some of this cost can be offset by health insurance.

How much your health insurance pays will depend on the extent of your treatment needs and the services your health insurance plan covers. When possible, people living with diabetes may choose a plan that provides maximum coverage to limit out-of-pocket costs, especially for medications, procedural care, and office visits.

Most private and public insurance plans cover preventative services such as diabetes screenings and weight management counselling, and many cover a large portion of your diagnostic testing and the cost of generic medications.

Generally, Medicaid and Medicare provide broad diabetes coverage, but your specific plan will determine exactly how much is covered. You’ll want to know your coverage so you are not hit with a surprise bill at the end of the month, which may discourage you from continuing care.

Most out-of-pocket costs are due to one or more of the following:

• Hospital inpatient care
• Prescription medications to treat complications of diabetes
• Anti-diabetic agents (such as metformin and insulin) and diabetes supplies (such as an insulin pump and glucose strips)
• Office visits to healthcare providers (co-payments and deductibles)

Finances should never be a reason to compromise care. Unfortunately, that is the case for some, hence why it is important for healthcare providers to be transparent about the cost of care and formulate a plan to meet the person's needs. 

Resources and Self-Education

The Centers for Disease Control and Prevention's Diabetes Self-Management Education and Support (DSMES) services can help you understand diabetes and diabetes treatment. Your healthcare provider can help you find this program in your area. These are also listed by the Association of Diabetes Care & Education Specialists.

Your healthcare providers can answer whatever questions you might have, but they may not be available at every moment. Family and friends, as well as outside resources, including peer support groups and social media, can help you get answers while also limiting stress and anxiety.

For example, if you are concerned about the rising cost of your diabetes care, social media apps or members of your support groups can share tools, resources, and general insights, such as which insurance plans are the most diabetes-friendly and ways to reduce your prescription costs. 

Reasons to Change Your Treatment Plan

Your treatment plan should be reviewed and updated regularly. You should also schedule a visit with your healthcare provider for this purpose when you have the following issues.

Loss of Blood Sugar Control

If you are feeling more sluggish than usual or your symptoms are worsening, your blood sugar levels are likely too high or too low. You can confirm your suspicion by checking your blood sugar. Sometimes small changes to your diet, medications, or activity level can cause your blood sugar level to change unexpectedly.

Reviewing your treatment regimen with your healthcare provider is a great way to troubleshoot the problem, reiterate some of the key principles of your plan, and discuss ways to bring your levels back toward your target goal. Remember, treatment plans are fluid and change over time based on your body's needs. 

For example, if your blood sugar is too high or too low, you may have to change the dose or frequency of your insulin or diabetes medication. You may need to start insulin if you have difficulty keeping your blood sugars within a healthy range with oral diabetes medication and lifestyle modifications.

Portion control and routine exercise can help reduce unexpected blood sugar spikes after meals. Blood glucose levels can change if you don't get enough sleep, drink enough water, and limit your alcohol intake. Therefore, living a healthy lifestyle is often as important as being compliant with your medication. 

Pregnancy

If you have type 2 diabetes and are pregnant or seeking to get pregnant, it is important to monitor your blood sugar levels and eat a healthy diet. You can set diet and exercise goals in consultation with your pregnancy healthcare provider.

Meeting regularly with a healthcare provider can ensure that you are checking your blood sugar frequently and addressing any issues.

Lifestyle Changes

Your blood glucose levels can change when your lifestyle changes. If you have a change of schedule, living situation, employment, activity level, or diet, you may need modifications to your treatment plan. Sometimes an illness or injury can lead to changes in your lifestyle habits.

Discussing your treatment plan with your healthcare provider can help you find ways to incorporate positive lifestyle behaviours that can make your blood sugars more predictable.

This underscores the importance of eating a healthy diet, controlling your portion sizes, exercising, getting enough sleep, drinking enough water, and limiting your alcohol intake.

Getting Support

Family and friends are often the go-to support systems for a person living with a chronic health condition. Discussing your worries, fears, and needs in this new world of living with diabetes can help you relieve stress and anxiety over your diagnosis.

Checking with your healthcare team and discussing the changes that you will have to make moving forward can help you reimagine your life as a person living with a chronic illness.

Online and in-person peer support groups are a great way to discuss your concerns about diabetes. It’s also a way to share resources, stories, tips, and advice about what has worked and hasn’t worked for you.

Every person’s diabetes journey is different, but hearing various perspectives may be helpful and eye-opening. 

The following national (USA) organizations and social media apps offer peer support:

• Centers for Disease Control and Prevention
• Association of Diabetes Care & Education Specialists (ADCES)
• College Diabetes Network
• Endocrine Society
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
• My Fitness Pal (app)
• Carenity (app)
• Glucose Buddy (app)
• Medical ID (app)

Local diabetes support groups may be convenient and add a more personal touch. Defeat Diabetes Foundation has a state-specific database that allows you to find support groups in your community.

Managing Other Health Needs

No diabetes plan is complete without a conversation about managing other health conditions that may exacerbate your diabetes. Discuss any new or existing condition with your diabetes healthcare team.

Review the medications and treatments you need for these conditions. They may interact with or affect your diabetes medications, leading to side effects or affecting blood sugar control. You may require changes to your diabetes treatment plan as other conditions progress or resolve.

Generally, the better you manage your other health conditions, the better your diabetes outlook.

Summary

Creating a diabetes treatment plan will help you manage the condition for the best outcomes. Elements of a diabetes treatment plan include monitoring your blood glucose levels, nutrition, exercise, medications, follow-up appointments, addressing costs, and accessing resources and diabetes education.

You should review the plan with your healthcare provider regularly and know when to make an appointment for a special review, such as when your blood sugars are not well controlled, you are pregnant or plan to become pregnant, you have a new condition or a change in an existing condition, or you have a change in lifestyle.

A Word From Verywell 

There is no one-size-fits-all treatment plan for type 2 diabetes. Your health history, underlying health conditions, and the severity of your condition will likely determine your treatment goals. Therefore, it is imperative to talk to your healthcare provider and formulate a treatment plan that is best for you.

Still, no plan is perfect, and you will likely have good days and bad there. During those times, don’t be afraid to lean on your family, friends, and peer support groups for much-needed guidance and support.

https://www.verywellhealth.com/treatment-plan-diabetes-6740653