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Living with diabetes

Being diagnosed with a chronic disease like diabetes can be challenging. After you get over the initial shock of learning you have diabetes, you will likely have dozens of questions about how diabetes will affect your life and the actions you’ll need to take to take care of yourself.

Over the past couple decades, important advances have been made in the ability to manage both type 1 and type 2 diabetes (the two major forms of the disease). Nowadays, there are more tools than ever before to help you monitor and control your blood glucose. In fact, even though you will always have to be careful about controlling your blood sugar, blood pressure, and lipids, most people with diabetes can1,2:

  • Continue to lead full and active lives
  • Enjoy the foods and activities they have always enjoyed
  • Take part in almost any form of physical activity

Other important tools that you have in your corner to help you lead a healthy and active life, include your healthcare provider (doctor, nurse practitioner [NP], or physician assistant [PA]), your diabetes educator, and various specialists you will see (eg, optometrist or ophthamologist, registered dietitian/dietitian nutritionist, podiatrist, exercise physiologist)

Take advantage of Diabetes Self-Management Education and Support (DSMES)!
Medicare and by most private health insurance plans will cover DSMES services if you have type 2 diabetes. These service cover diabetes education and support provided by a American Association of Diabetes Educators (AADE)-certified diabetes educator. A diabetes educator is a healthcare professional who specializes in helping people with and at risk for diabetes and related complications to make behavioral changes designed to help them better manage their condition and lead a healthier life. DSMES services focus on seven important self-care behaviors that are keys to living a healthy life with type 2 diabetes:

  • Healthy eating
  • Being active
  • Monitoring blood glucose
  • Taking medication
  • Problem solving
  • Healthy coping
  • Reducing risks for health complications

Ask your doctor, PA, or NP to refer you to a local DSMES provider. If your provider is not familiar with DSMES services or the referral process, you can direct them to the AADE website or download and print DSMES information and a referral form and give it to your provider yourself.

More resources at
There are also resources, such as the discussion forums, where you can connect online with other people with diabetes and get both support and useful information on a wide range of topics relevant to living with diabetes. One of the wonders of the Internet is that you can reach out to and connect with a wider group of people than ever before. This can be a powerful way of sharing both information and experience.

Getting your diagnosis… an emotional roller coaster

If you’ve been diagnosed with diabetes, the first thing you may find yourself doing is dealing with the powerful feelings that surface, including anxiety, uncertainty, and fear. Living with the challenges of a chronic disease such as diabetes can be emotionally challenging. It’s no wonder that risk of developing depression and anxiety is greater in people with diabetes compared to those without the disease.3-5

Learn more about psychiatric complications associated with diabetes.

Reacting to a diagnosis of diabetes

No two people will react the same to being diagnosed with diabetes. However, there are some common feelings that you may encounter when you learn that you have the disease. These include shock, denial, confusion, anxiety, anger, and relief. Understanding these feelings and knowing what to expect can help you get through the initial difficult period after your diagnosis. Remember, once you’ve gotten over the shock, you’ll be able to start living a healthy life with diabetes.

Learn more about how you might react to your diagnosis.

Managing diabetes

An important first step in managing diabetes is to make sure that you take advantage of the expertise of your healthcare provider and other professionals have in helping your learn to manage your diabetes.

Your healthcare provider (doctor, nurse practitioner [NP], or physician assistant [PA]) and your diabetes educator and registered dietitian/dietitian nutritionist can work with you to put together a comprehensive plan for managing your diabetes. Your diabetes care plan will typically involve monitoring your blood glucose level, lifestyle modifications (healthy eating plan and physical activity), and medication to improve glycemic (blood glucose) control and other parameters associated with diabetes risk (eg, weight, blood pressure, lipids), and approaches to decrease risk for cardiovascular complications (eg, quitting smoking, management of high blood pressure, and, in certain people, taking a daily low-dose of aspirin).

While lifestyle modifications (healthy eating, weight control, and physical activity) are the core of any type 2 diabetes care plan, many healthcare providers will suggest that you start on the oral diabetes medication metformin when you are diagnosed or shortly thereafter. If a single medication is not sufficient for glycemic control, then your provider may suggested adding another oral or injectable medication or insulin.6,7

Blood glucose control.. Your blood glucose treatment goal or target will depend to some degree on individual factors, including your age and health status. However, keeping A1C around or under 7% has been shown to decrease the risk of microvascular complications (these include complications where small blood vessels are affected, such as retinopathy and kidney disease). Keeping A1C levels under 7% is a reasonable goal for many non-pregnant adults. However, your healthcare provider may suggest an even lower A1C target of 6.5% or under, if you can achieve this goal without developing hypoglycemia or having side effects due to medication. Younger people who are diagnosed with type 2 diabetes sometimes use this lower A1C target. A higher A1C target of 8% or less may be appropriate for people who are affected by severe hypoglycemia, older people, or people with advanced cardiovascular disease, kidney disease, or other complications6

Learn more about blood glucose monitoring.

Blood pressure control. People with diabetes (who do not have kidney complications) should maintain blood pressure below 140/80 mmHg. Blood pressure below 130/80 mmHg may be appropriate for certain patient groups. Talk to your doctor about what your blood pressure target should be.6

Lipids. If you have type 2 diabetes, you are at increased risk for heart disease. Therefore, your low-density lipoprotein (LDL) cholesterol level should generally be below 100 mg/dL, your triglycerides should be be below 150 mg/dL, and your high-density lipoprotein (HDL) cholesterol should be greater than 40 mg/dL (for men) and greater than 50 mg/dL (for women). If you have heart disease and diabetes, you should aim to keep your LDL cholesterol lower—below 70 mg/dL.6

Blood glucose monitoring. Ongoing monitoring of blood glucose is an important and necessary part of managing diabetes. If you have type 2 diabetes, your healthcare provider will monitor your glycemic control using hemoglobin A1C testing on a regular schedule during office visits. The frequency of monitoring will be determined by how well your blood sugar is being controlled and other factors. Your provider may want to test you more frequently after a change in medication. If you use insulin therapy, your provider will have you do self-monitoring of blood glucose using a blood glucose meter.6,7
Learn more about blood glucose monitoring devices.

Lifestyle modifications. If you have type 2 diabetes, lifestyle modifications will be the core of your diabetes care plan. It can be a challenge to make fundamental changes to the way you live. However, healthy changes, including losing weight and keeping it off, getting regular physical activity, controlling your blood pressure and lipids, quitting smoking, and healthy eating will make a big difference when it comes to protecting yourself from complications associated with diabetes. Reach out to your healthcare provider and your AADE-certified diabetes educator to help you make the behavioral changes that you’ll need for successful diabetes self-management. 6

Medications and insulin. At the time you are diagnosed with type 2 diabetes or shortly thereafter, your healthcare provider may recommend that you start on an oral diabetes medication in combination with lifestyle modifications for control of blood glucose. If your blood glucose is extremely high (A1C of 10% to 12%), your provider may start you on insulin alone or in combination with another diabetes medication.

Many people who are diagnosed with type 2 diabetes will be started on an oral medication (take as a pill) called metformin (brand names: Glucophage, Gumetza, Riomet, Fortamet). Metformin is an insulin sensitizer. This means it helps the liver and the muscle use excess glucose. By sensitizing your tissues, metformin helps your body make better use of the insulin you continue to make. If the maximal dose of a single medication is not sufficient to lower blood glucose, your healthcare provider may suggest you add another medication to metformin. There are many different kinds of medications, both oral and injectable, to help you control blood glucose.

When it comes to medications to control type 2 diabetes, the ADA recommends using an approach of adding medications (including insulin) in a stepwise fashion as needed to achieve blood glucose control. As mentioned, most people will start with the drug metformin. If this drug is insufficient for blood glucose control after a 3-month period, another oral or injectable diabetes medication or insulin is added to treatment. If this combination is insufficient for blood glucose control after a 3-month period, then another medication or insulin is added. Finally, if a three-drug combination is not sufficient, your provider may recommend a more intensive program of insulin treatment, with or without other diabetes medications.6,7

Learn more about diabetes medications and insulin.

Decreasing risk for diabetes complications. Diabetes is associated with a range of serious health complications, including cardiovascular disease (heart attack and stroke), kidney disease, vision problems, and problems affecting the feet. Therefore, strategies for preventing diabetes complications are an important part of every person’s diabetes care plan. Keeping blood glucose under control is an important key to reducing risk complications. Additionally, there are a range of other preventative strategies that you can use to protect yourself from diabetes complications.

Learn more about diabetes complications and how I can prevent them.

Other considerations in living with diabetes

A diagnosis of diabetes can have a far-reaching impact, affecting many aspects of life, from your work to planning for travel to considerations involving health and other types of insurance, caregiving, and family life. As daunting as this sounds, remember, you are not alone. We can offer you valuable information on a range of topics to help you meet the challenges of living with diabetes.

Written by: Jonathan Simmons | Last reviewed: May 2014.
1. McCulloch DK. Patient information: Diabetes mellitus type 2: Overview (Beyond the Basics). Nathan DM, Mulder JE, eds. UptoDate. Wolters Kluwer Health. Accessed at: 2013.-- 2. McCulloch DK. Patient information: Diabetes mellitus type 1: Overview (Beyond the Basics). Nathan DM, Mulder JE, eds. UptoDate. Wolters Kluwer Health. Accessed at: 2013. -- 3. Nouwen A, Lloyd CE, Pouwer F. Depression and type 2 diabetes over the lifespan: a meta-analysis. Response to Mezuk et al. Diabetes Care 2009;32:e56. -- 4. Smith KJ, Beland M, Clyde M, et al. Association of diabetes with anxiety: a systematic review and meta-analysis. J Psychosom Res 2013;74:89-99. -- 5. Surwit RS, Schneider MS, Feinglos MN. Stress and Diabetes Mellitus. Diabetes Care 1992;15:1413-22. -- 6. American Diabetes Association. Standards of Medical Care in Diabetes—2014. Diabetes Care 2014;37:S14-S80. -- 7. Inzucchi SE, Bergenstal RM, Buse JB, et al. Management of hyperglycemia in type 2 diabetes: a patient-centered approach: position statement of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2012;35:1364-79.