A complete medical evaluation is necessary to diagnose the type of diabetes a person has, to determine whether complications of diabetes are already present at diagnosis, and to decide on treatment methods and a plan for ongoing diabetes care. If you have a history of diabetes and are visiting a physician for the first time, you should have a complete physical exam as well as a discussion about your current blood glucose control, the presence of any diabetes complications, and your ongoing diabetes care needs. (For a list of features that should be checked by your health-care provider, see “Monitoring for Control and Complications.”)
The best care for diabetes management involves a team approach. Typical team members include (but aren’t necessarily limited to) physicians (whose coproviders may include nurse practitioners or physician assistants), nurses, dietitians, pharmacists, and mental health professionals, all of whom should have experience working with people with diabetes. It’s best if your team members can work together to offer you the most up-to-date diabetes management plan possible.
Blood glucose control
The primary goal of diabetes management is optimal blood glucose control, since the complications of diabetes are directly linked to high blood glucose levels. Learning how to monitor your blood glucose levels and learning what the results mean are therefore essential parts of your diabetes treatment plan. Self-monitoring of blood glucose helps you and your diabetes care team evaluate your overall blood glucose control and review the trends and patterns of your blood glucose levels during the course of the day.
General recommendations for how often you should monitor may vary with the type of diabetes you have, your treatment plan, and the extent to which your health insurance plan will reimburse you for monitoring supplies. Insulin users, especially those who take insulin multiple times a day, should monitor their blood glucose levels three times or more daily. People with Type 2 diabetes who use insulin less frequently, use other diabetes medicines, or manage their diabetes with meal-planning and physical activity alone should monitor their blood glucose levels as recommended by their diabetes care team to keep tabs on their level of blood glucose control. (To get a sense of what you’re aiming for, see “Blood Glucose Targets.”)
If you are meeting your blood glucose target levels, you should have a glycosylated hemoglobin (HbA1c) test at least twice a year. The HbA1c test is a blood test that gives a measure of your diabetes control over the preceding two to three months. If you have had a recent change in your diabetes treatment plan, or if your blood glucose levels are regularly outside of the recommended ranges, you should have an HbA1c test every three months. (To see how HbA1c test results correlate with blood glucose monitoring results, see “What Does My HbA1c Mean?”)
Tools for management
When it comes to diabetes self-management, knowledge is the best tool you can have. Knowing the steps you can take and the contingencies you should plan for will help keep you healthy and keep the sailing smooth.
Nutrition. When you have diabetes, it is important to understand the relationship between food and blood glucose control. All people with diabetes should see a registered dietitian, preferably one with expertise in diabetes. You and your dietitian should discuss and customize a meal plan for you, taking your health and your personal goals into consideration. Your dietitian can show you how to monitor the effects of the foods you eat on your blood glucose levels.