You might feel as if your body has betrayed you or that it’s out of control. Some people assume that the worst they’ve heard about diabetes (accurate or not) lies just around the corner, and they jump to panicky conclusions like “I’ll go blind!” or “I can never eat dessert again!” Others are nonchalant, figuring that they’ve managed to get by up to now with diabetes, so “worrying about it won’t get me anywhere.”
You’re probably somewhere in the middle of the spectrum between panic and denial. You may even be relieved to finally know why you’ve been feeling so lousy. All of these emotions are normal. In fact, you can anticipate moving through several emotional stages after being diagnosed. Typically, an I-can’t-believe-it phase gives way to feelings of anger and the realization that there’s a long road ahead, which can sometimes lead to depression. To deal with the dismay a diagnosis can produce:
- View your emotions as progress. The next time you snap at a family member or find yourself in a fog and staring out the window, play the moment out as a mental movie-an emotional scene in an unfolding story that continues to move progressively toward something better. When you accept your feelings as a natural, important part of an ongoing process, it’s an indication you’re actually working through them and going ahead with the rest of your life.
- Talk to someone. Sharing emotions with a loved one, joining a support group, or attending a class about diabetes in which you can meet others with the disease can help put your feelings in perspective and make you feel less alone.
- Think short-term. You may feel overwhelmed by all the changes you have to make in your life, the new self-care skills you have to learn, and the sheer volume of medical information you need to absorb. Rest assured that eventually it will all seem second nature. For now, focus on immediate goals (“Today I’ll meet my dietitian”) that will move you further down the road.
- Forge ahead. The key is not to let your diabetes diagnosis paralyze you. The sooner you take action, the sooner you’ll feel you’ve gotten your life back under control-and the sooner you’ll start to feel better.
What You Can Expect
When you’re diagnosed with diabetes, your doctor will need to cover a lot of ground in a short time. In fact, he’ll want to know virtually everything about you: eating patterns, weight history, blood pressure, medications you’re taking, whether you smoke or drink, how satisfying you find sex, how many kids you’ve had, any family history of heart disease, and any treatment you’ve received for other problems, including endocrine and eating disorders. If you’re a woman, you’ll even be asked about your children’s development. Your doctor isn’t prying. All of this information has a bearing on your condition and the management program you’ll eventually follow. Your doctor will need to know any symptoms of diabetes that you may have been ignoring, and for approximately how long.
Your doctor will also want to do a thorough physical exam, including a cardiac workup that may involve an electrocardiogram (which records the heart’s electrical activity) and a careful look at your mouth, feet, eyes, abdomen, skin, and thyroid gland. You’ll have a battery of tests, including a blood-lipid test for cholesterol (among other things) and at least two different blood-sugar tests-one that shows what your blood sugar is right now and the other, the A1c, what it has averaged for the past two to three months.
It may seem like a lot to begin with, but this initial assessment is arguably the most important phase of your overall care. Other parts of this phase may include questions that determine how much you know about your disease and how motivated you are to do something about it. Eventually, you’ll move on to the next phases, in which you’re in charge from one day to the next and your doctor is a resource for follow-up assessments and treatment of any complications.
Will You Need Insulin?
Insulin generally means needles, and dealing with this one element of care is the single biggest fear for many people with diabetes to overcome. Whether you’ll actually have to confront the business end of a syringe depends first on which type of diabetes you have. All people with type 1 diabetes need insulin (and often find injections to be less daunting than they imagined), but not everybody with type 2 does.
If you have type 2 diabetes, your requirement for insulin will depend on a number of factors, including:
- How much insulin your body makes on its own. If you have type 1 diabetes, your body doesn’t make any insulin; if you have type 2, your body’s insulin-making ability is only partially impaired, and the extent of the impairment is different from one person to the next.
- How well your body uses the insulin it has. If your cells have trouble using the insulin that’s naturally available, you may need supplemental doses.
- Your blood-sugar levels. How high above normal your blood-sugar levels tend to be will help guide your doctor in deciding whether insulin is necessary.
- How effective other forms of treatment have been. As a rule with type 2 diabetes, insulin is not the first treatment used to bring your blood sugar under control.
Where Do You Stand?
Your doctor looks at a lot of variables when deciding how to treat your diabetes, but he’ll pay special attention to two in particular: your blood-sugar readings and your A1c readings. If your blood sugar is sky-high in your initial assessment, you may go straight to drug and insulin therapy until your numbers are brought down. If you have type 2 diabetes, once your blood sugar has stabilized and you begin making lifestyle changes, you may be able to go off insulin and other medications.
One of the numbers your doctor will zero in on is your fasting blood-glucose level, a key test of blood sugar. While other tests also need to be considered and each case must be managed individually, you can roughly anticipate your options depending on what your fasting blood-glucose levels are (numbers are expressed as milligrams per deciliter). As a general guideline:
- If fasting blood glucose is between 110 mg/dl and 125 mg/dl, you have prediabetes (also known as impaired glucose tolerance), a condition in which elevated blood-sugar levels significantly raise the risk of developing diabetes. You’ll be advised to start eating a healthier diet and to get more exercise, but you’re unlikely to get a prescription for drugs or insulin.
- If fasting blood glucose is 126 mg/dl to around 140 or 150 mg/dl, you have full-blown diabetes, but you’ll probably still be able to control your blood sugar with diet and exercise, depending on your condition and results from other tests.
- Once fasting blood glucose exceeds 150 mg/dl and ranges to 200 mg/dl, it’s likely you’ll need drugs in addition to diet and exercise. You may also need occasional doses of insulin for better control at certain times of the day (after meals, for example) when blood sugar tends to be higher.
- When fasting blood glucose goes above 200, you may need drugs or 24-hour insulin coverage-possibly both-along with lifestyle changes.
Check out 3 Healthy Eating Habits to Control Diabetes.