Expert Advice for People with Diabetes

As a certified diabetes educator, a registered nurse, a registered dietitian and a licensed dietitian nutritionist, Clara Schneider has an expert opinion that you can trust.

Clara is on the advisory board at DiabetesCare.net and writes a weekly blog for the site.

We had the opportunity to interview Clara and find out what advice she has for people with diabetes.

What basic advice would you give to someone who had just been diagnosed with diabetes?

If you are just diagnosed with diabetes, you need to know what kind of diabetes you have and also if you're going to be put on medicine. There are different kinds of diabetes, including pre-diabetes, type 1 diabetes, type 2 diabetes and gestational diabetes.

Young people with type 1 diabetes are sometimes hospitalized when diagnosed. People with type 1 diabetes need to know that they have an autoimmune disease which destroys the beta cells in their pancreas. The beta cells function is to make insulin, and in type 1 diabetes, these cells are destroyed and will no longer make insulin. The only way a patient with type 1 diabetes will live is if that insulin is replaced, so insulin injections need to be started. You hear that there is the inhalable insulin out, but you’re not going to do that for somebody just diagnosed, and most likely you’re not going to do that for type 1, although that might change, depending on advances in research.

If you have type 2 diabetes, you need to know how it is going to be handled. Do you need to go on medication, or will you be able to control it with lifestyle changes?

Is it gestational diabetes? In pregnancy, if tested for diabetes during the first prenatal visit and diabetes is diagnosed, most likely type 2 diabetes will be diagnosed. When tested later in pregnancy (usually at the 24th week) without a history of diabetes, then gestational diabetes will most likely be diagnosed. If you have diabetes in pregnancy, ask to be seen by a diabetes educator as soon as possible.

After you know what kind of diabetes you have, find out if you will need to take medication. How should you take this medicine? How much should you take? What time should you take it? Is the medication in a tablet form or will you inject it? You need to learn the skills to be comfortable taking your medication. If you are a caregiver of a person with diabetes, you also need to be comfortable in giving the medication. Education and care received should be personalized for the patient and their family. All questions need to be answered and learning needs to occur. Use your pharmacist as a good resource to discuss medication questions.

Testing your Blood Sugar

What’s your blood sugar or blood glucose? How are you going to test it? Call your insurance to find out what meter and how many strips your insurance will pay for. If you just go out to the pharmacy and buy a meter, your insurance may not cover what was purchased. Does your insurance company charge you less if you buy your supplies by mail? Ask how that can be done. Most likely you will need a prescription from your physician. Some insurance companies have nurse-navigators who help people with chronic illnesses like diabetes.

Diabetes Education

Ask your insurance company where you can go for diabetes education and how many visits or hours of education will be covered. Ask where you can go for diabetes education. It varies; Medicare is known to pay for 10 hours of diabetes instruction with a certified diabetes program. Other insurance companies may pay for more or less. I had one patient come in and she was approved for 99 visits. You also may be surprised that your insurance company may not cover any visits at all. Find out in your state what you should do if you do not have insurance. I live in North Carolina, and the public health department offers programs based on a sliding scale for people with diabetes. Other states do not provide this service. Call your local health department to see what is available.

Food

Some diabetes medications need to be taken just before eating. Some require you to eat a snack at specific times. One kind of tablet works by encouraging the pancreas to make more insulin. Know how your medication works and how you need to eat so your blood glucose is controlled and you do not have any problems with hypoglycemia or low blood glucose. Some types of insulin work within 15 minutes of injection. With these you need to eat within 15 minutes of taking your medication. Your dietitian needs to know what kind of medication you are on so she/he can help with a meal pattern made especially for you.

Exercise

Ask your doctor and diabetes educator the best ways for you to exercise. Should you exercise before you eat? Should you exercise before you take your medicine? Some people with diabetes need a stress test before they are approved for exercise. Learn how to safely exercise with your type of diabetes. Ask your doctor when you need to test your blood glucose with exercise and if you need to carry carbohydrates with you to potentially treat a low glucose level.

Illness

Ask your diabetes team what you should do when you get sick. Do you need to change your medications or the times you test your blood glucose? At what blood glucose levels should you call the doctor or go to the hospital.

In Part II of our interview, Clara offers more specific advice on dietary choices and how your diabetes care team can help you.