Diabetes Education

New Diabetes Diagnosis

You may be feeling overwhelmed with your diagnosis. Feelings of anger, fear or guilt are normal. The first steps to successful management of your diabetes are to learn about your health condition and understand your treatment plan.

Consider sharing your feelings with friends and loved ones. Health care professionals and diabetes support groups offer assistance with working through negative emotions. People with diabetes are no different than anyone else: everyone has "low" or "blue" days, so remember to talk to someone if your emotions are getting in the way of taking care of yourself.

Diabetes has no cure, but together with your healthcare team, you can successfully treat diabetes and live your life fully. Diabetes is mostly a "self-management" condition, and with proper knowledge you can take charge and manage your diabetes.

Share the knowledge you have learned from your diabetes healthcare team with family and friends so they can better understand diabetes management.

Q. What is Diabetes?

A. Diabetes is an insulin deficiency. Insulin is a hormone, made in an organ located behind the stomach called the pancreas. When you have diabetes, your body cannot use the food you eat for energy, because insulin is not working the way it should. Or, your pancreas is not making enough insulin hormone.

Q. How does insulin normally work?

A. During food digestion, most foods we eat are broken down to glucose. Glucose is a form of sugar, and glucose is the body's main source of energy. Glucose enters the bloodstream during food digestion, and the amount of glucose in the blood increases.

The body reacts to this rise/increase in blood glucose by signaling the pancreas to release insulin into the bloodstream. The function of insulin is to take glucose from the bloodstream to the body cells to be used properly for energy. Insulin hormone is the "key" that "unlocks the door" of the cell wall, and allows glucose to enter the cell to be used for energy by our body.

Q. What happens with insulin function in diabetes?

A. In diabetes, glucose is not properly entering the cell to be used for energy. This is because the pancreas is not making enough insulin or the insulin hormone is not working as it should to allow glucose to enter the cells (insulin resistance). The result is glucose levels in the bloodstream rise, and the blood glucose levels rise to abnormally high levels. The kidneys will rid the body of some of the excessive glucose by filtering it from the blood, then remove the glucose from the body through urination. However, the body's blood sugar levels still remain high/elevated.

Q. What are symptoms of diabetes?

A. Signs of diabetes occur because the body cells are not getting the glucose they need for energy. It is common to feel tired, urinate more frequently, and feel very thirsty. Weight loss may occur, even if you are eating as you do normally. Other symptoms may include: dry skin, increased hunger, blurred vision, frequent infections, slow wound healing, impotence, and numbness or tingling in hands and feet.

Q. What are risk factors for developing diabetes?

A. Anyone can get diabetes at any time, but some people have more risk than others. These are risk factors for diabetes:

  • Age: over age 40
  • Family history: having a close relative (mother, father, brother, sister) with diabetes.
  • Being overweight: A body mass index (BMI) greater than 25. The risk for developing diabetes is higher in persons who have body fat deposited in the waist and chest areas, as this may be associated with increased insulin resistance.
  • Physical inactivity: There is a greater insulin resistance in persons who seldom exercise.
  • Ethnicity: There is a greater risk of developing diabetes among persons of certain ethnic backgrounds including: African American, Hispanic American, Native American, and Asain American.

Q. What are the treatments for diabetes?

A. Begin with proper goal setting. The main goal for persons with diabetes is long-term blood glucose control. To help achieve glucose control, master these basics of diabetes management:

  • Healthy eating
  • Regular physical activity
  • Medications: As prescribed and directed
  • Regular blood glucose monitoring/testing blood sugar
  • Keep regular appointments with your health care team

Q. What are complications of diabetes?

A. Many health problems can be caused by long-term uncontrolled diabetes:

  • Damage to nerves: impotence, stomach problems, numbness and tingling.
  • Damage to small blood vessels: kidney disease, eye disease.
  • Damage to large blood vessels: stroke, heart attack, blood circulation problems.

You could delay or prevent these complications with your diabetes management care plan, which has been developed by you and your health care team.

Q. What can I do to prevent diabetes complications?

A. Having diabetes is a long-term health concern. There are diabetes complications you can delay or prevent by proper diabetes self-management and continuous monitoring of your health. Do not try to make too many lifestyle changes at once. Start small, take one step at a time. It is important to choose one goal for physical activity or healthy eating, and then change it gradually over time.

Your goal progress can be tracked by home testing of blood glucose. This is called "self monitoring of blood glucose" or "SMBG" using a blood glucose meter. Ask your physician or health care team member which is the best glucose meter for you to use to monitor your blood glucose levels.

The American Diabetes Association (ADA) has set target blood glucose levels:

90-130 mg/dl before meals
Less than 180 mg/dl after meals (2 hours after eating)
Between 110-150 mg/dl at bedtime

A1C: Less than 7% (A1C measures average blood sugar levels for 2-3 months)
(Adapted from American Diabetes Association Guidelines, 2003)

Q. Who are my diabetes healthcare team members?

A. Treatment for diabetes management include: meal plans, stress management, medications, and an exercise plan. You will work with a team to manage your diabetes. Some of the members on your team may include:

  • Physician
  • Certified Diabetes Educator
  • Registered Dietitian
  • Registered Nurse
  • Registered Pharmacist
  • Eye Doctor: Opthalmologist
  • Foot Doctor: Podiatrist
  • Licensed Clinical Social Worker
  • Exercise Physiologist

Q. What is a diabetes meal plan?

A. To keep your blood glucose levels in the proper range, the most important aspect of diabetes management is eating a well-balanced food plan. See a registered dietitian and/or a certified diabetes educator to develop a proper diet. Weight control will be an important concern, so the calories in your meal plan may be limited. Work together with your dietitian to individualize your meal plan. You can still eat most of your favorite foods, but in smaller portions. Your dietitian can help you plan meals that taste good and are nutritious.

Try these tips for improving your nutritional intake:

    Pay attention to serving sizes. Eat smaller portions.
  • Eat foods that are prepared with a low fat cooking method: baked, boiled, broiled, stewed, grilled and roasted.
  • Eat foods that are high in fiber: whole grains, fresh vegetables, fresh fruits.
  • Eat slowly. Eat small bites and chew foods well.
  • Read food labels carefully.
  • Learn about carbohydrate gram counting from your dietitian.

Q. Which foods contain carbohydrates? How much carbohydrate should I have in my meal plan?

Carbohydrate foods are found in these food groups: grains and starchy vegetables, fruits, milk and sweets.

Using the Plate Method for diabetes meal planning will help you eat a well-balanced meal with a variety of foods. The Plate Method will help you to consume the proper amount of carbohydrates each day.

Generally at one meal you will have a single plate (not too large) consisting of: salads, steamed vegetables, whole grain starches or breads in small portions, and lean proteins: fish, chicken, lean beef or pork (loin cuts), as well as a cup of low fat milk and a fresh fruit. The vegetables should fill half (50%) of your plate.

On average you will try to keep your carbohydrate intake to no more than 60 grams carbohydrate per meal. In each USDA food group listed in the diabetes food guide pyramid, a specific amount of food contains a carbohydrate gram value.

Here are some carbohydrate gram values for common food groups:

  • FRUIT GROUP: 15 grams carbohydrate from one common portion: Include 2-4 portions daily.
    • Small apple (1)
    • 100% Pure Fruit Juice, ½ cup (4 ounces)
    • Fresh grapes (17 small)
  • GRAIN and STARCH GROUP: 15 grams carbohydrate from one common portion: Include 6 or more servings daily
    • Whole Grain Bread, 1 slice
    • Cooked Rice, ⅓ cup
    • Cooked Potato, ½ medium
  • MILK GROUP: 12-15 grams carbohydrate from one common portion: Include 2-3 portions daily.
    • Low fat (1%) Milk, 1 cup ( 8 ozs.)
    • Light or Low Carb Yogurt, 1 cup ( 8 ozs.)
    • Plain Yogurt, 1 cup ( 8 ozs.)

Other general meal planning guidelines:

  • Eat high fiber, low fat foods without added salt and sugar.
  • Consume 3 healthy meals each day and snacks if recommended.
  • Eat meals at approximately the same times each day.
  • Consume meals approximately 4-5 hours apart.

Don’t know what to cook? Try our diabetes recipes and cooking tips.

Q. What do I need to know about exercise, glucose monitoring and medications?

A. Try to be active for at least 30 minutes each day. Start with just 5-10 minutes per day for 3 days per week. Then gradually increase the time and frequency you exercise to a more active lifestyle.

Check your blood glucose levels as directed by your physician. Your healthcare team will show you how to check your blood sugar. Ask the physician how often you should test your blood glucose levels. Write your blood glucose results in your logbook each time you test. Discuss the results of your blood glucose readings at your regular appointments with health care team members.

Ask your physician the names of the medications you take, and ask how the medications work. Over time, people with diabetes may require increased amounts of medications, or different types of medications. This may be considered to be a natural progression of diabetes, and does not mean that you have not been managing your diabetes properly. Keep a list of medications that you are taking, and bring the list and your medication bottles to all doctor visits.

Q. Besides daily SMBG, what other types of monitoring will be necessary to meet my treatment needs?

A. Stay healthy by monitoring these health factors according to the following schedule:

  • Testing to be done at every physician visit:
    • Weight
    • Blood Pressure
    • Foot Health (Check feet to identify loss of sensation)
  • Testing to be done every 3-6 months:
    • A1c (Average blood glucose for 2-3 months)
    • Dental Health (Teeth should be cleaned and gums checked)
  • Testing to be done every 12 months:
    • Dilated Eye Exam
    • Cholesterol Profile (Lipid Level Testing)
    • Kidney Disease Tests (Serum Creatinine: can estimate)
    • Glomerular Filtration Rate (GFR) and Microalbuminuria (tests kidney function)

NOTE: Your individual diabetes care plan may be modified by your diabetes health care team to meet your specific needs, including differences in the frequency or type of monitoring.

Q. Where can I obtain further information on diabetes management?

A. Here are some websites which provide useful tips for living a healthy lifestyle with diabetes:

American Heart Association: www.americanheart.org
American Diabetes Association: www.diabetes.org
American Association of Diabetes Educators: www.diabeteseducator.org
American Dietetic Association: www.eatright.org
Let's Move!: http://www.letsmove.gov/get-active
Diabetes Self Management Periodical: www.diabetesselfmanagement.com
Children with Diabetes Periodical: www.childrenwithdiabetes.com
Information on Smoking Cessation: www.healthmonitor.com

Remember: There is no cure for diabetes, but with the proper diabetes self-management plan and appropriate treatments, diabetes can be controlled, and complications can be prevented or delayed.

Jeanna Rhoulhac, RD, LD/N, CDE, has been dedicated to helping people with diabetes for almost 20 years. Jeanna’s interest in diabetes began at an early age as her maternal grandmother had type 2 diabetes. Providing her clients with an individualized plan of care is very important to Jeanna, who strives to motivate and support her clients in every way. More about Jeanna

The goal of Destination Diabetes® is to be a useful and credible resource for the more than 20 million children and adults who have diabetes in the U.S. and their families. Destination Diabetes® provides information on a wide range of diabetes health and wellness topics. Articles are written or reviewed by diabetes advisors who have experience in diabetes education.