When diagnosed with diabetes, you will have a plethora of questions. Diabetic Nurse Educator, Christine Manga, shares the top 10 frequently asked questions.
A whirlwind of emotions is dealt with when receiving a diabetes diagnosis. Because of this, the first consultation post diagnosis barely touches on treatment per se. This is due to the fact that patients have an overwhelming need to get answers that are pertinent to them. There is definitely a trend to the questions that are asked regularly. I consider the following questions to be frequently asked questions (FAQs).
1. Is my diagnosis correct?
For a diabetes diagnosis to be made, a minimum of two blood glucose tests need to be done. It is recommended that the same test is used, but on two separate days. A fasting blood glucose reading of ≥7 mmol/l, a random blood glucose level of ≥11 mmol/l, or a two hour post glucose ingestion reading of ≥ 11 mmol/l is required for diabetes to be confirmed. One HbA1c level of ≥6,5% would also be sufficient to make the diagnosis of diabetes. If these tests have been done, then the diagnosis is most likely correct.
2. Is Type 2 diabetes reversible or is there a cure?
No and no. It can, however, be managed that it goes into ‘remission’ or gets significantly better. This is more likely to happen in the early stages of the disease. This can be achieved by being physically active and losing excessive amounts of weight by dietary means or bariatric surgery. Even with this weight loss, some people will not go into remission. Unfortunately, aging, the natural progression of Type 2 diabetes, and weight regain will cause the diabetes to return in most people.
3. Did I get diabetes from eating too much sugar?
No. However, a high consumption of fatty and sugary foods can cause weight gain. This extra weight could lead to insulin resistance which usually precedes Type 2 diabetes.
There are some people who do not carry extra weight and yet go on to develop diabetes. In these individuals, genetics may play a significant role. If you have a parent or sibling with Type 2 diabetes, you have an increased risk of developing diabetes yourself.
4. What do I do now that I have been diagnosed with diabetes?
It is important to make positive lifestyle changes. Being active is important. The World Health Organisation recommends 150 minutes of activity a week. Following a balanced, nutritional eating plan is imperative in managing your diabetes. A dietitian can assist you with this, as it is best if it is individualised.
Adhering to the medication regimen, prescribed by your medical practitioner, will also form part of the lifestyle changes. An annual screening by a podiatrist and ophthalmologist are also advised.
5. What should my glucose readings be?
There are international guidelines set out for glucose targets. These targets may need to be adjusted according to your individual needs. Your practitioner would assist you with deciding on a target. By achieving these targets, it may delay the onset of diabetes complications.
The targets set out for the general population with diabetes are:
- fasting blood glucose 4,0-7,0mmol/l
- post prandial (MEAL) blood glucose of <10,0mmol/l
Avoiding hypoglycaemia whilst reaching these targets may be challenging.
6. I don’t want to inject, but do I need to take insulin?
Some patients may live for many years using only oral medication to manage their condition. Research indicates that the earlier diabetes is diagnosed and treated, it may delay the need to use insulin.
On the other hand, some patients experience a much quicker progression of their diabetes. This could result in the need to use insulin early on in the condition. Most people living in excess of fifteen years with diabetes will require insulin.
An indication that you may need insulin is when your glucose readings and HbA1c start to increase. Your medical practitioner will discuss with you – if and when it is necessary to commence insulin.
Once on insulin, you will usually use it for the rest of your life. If the correct injection technique, site rotation and needle replacement is practised, injecting of insulin will not be too uncomfortable.
7. Now that I take insulin, do I have Type 1 diabetes?
No. Type 2 diabetes can’t turn into Type 1 diabetes. They have different causes. Type 1 diabetes is an autoimmune disease – the body completely destroys the insulin producing cells so that no insulin can be produced. People with Type 1 diabetes need to start taking insulin at diagnosis. Type 1 usually occurs in childhood and is much less common than Type 2 diabetes.
With Type 2 diabetes, the body does still produce insulin, however, the body can be resistant to it. Over time the body will produce less insulin, at this stage you will need to start to replace insulin by means of injections. You will still have Type 2 diabetes.
8. Will I gain weight with insulin?
Possibly yes. When you are not using insulin, your levels of glucose in the blood stream are high. Some of this glucose is lost in the urine. Once you commence insulin, the cells in the body absorb this glucose from the blood, to be used as energy. If you are consuming extra glucose, the body will now store it as fat. Portion control and being active are important ways to combat the potential weight gain.
9. Can I share a glucometer with my family/partner?
Preferably not. Firstly, for infection control, it is important that each person who is pricking their finger should use their own needle. This will prevent blood borne diseases spreading.
Secondly, when your practitioner downloads the glucometer to evaluate your control, it will not be a true reflection. Your averages will be skewed and the profile of your readings will be inaccurate. This could lead to incorrect management choices. If you do have to share a meter with someone, let your practitioner know.
10. Can I drink alcohol?
Yes. Taken in moderation it is okay to consume alcohol. One drink a day for women and two drinks a day for men. Taking alcohol with certain medication and/or insulin can increase your risk of hypoglycaemia. Discuss this with your diabetes practitioner.