Receiving the diagnosis of diabetes can be daunting. However, having the correct information and guidance will make the transition and acceptance less intimidating. Diabetes nurse educator, Christine Manga, suggests the best questions to ask to make it a smooth transition.

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Asking your healthcare professional the following questions will assist in receiving clarity about what is necessary to manage your diabetes to the best of your ability.

1. What type of diabetes do I have?

Knowing what type of diabetes you have will determine your treatment plan. There are three main types: Type 1, Type 2 and gestational diabetes.

Type 1 is an auto-immune condition. This is caused by the body destroying its own insulin producing beta cells. The reason isn’t clearly understood but is often preceded by a viral infection. Type 1 makes up 5-10% of people with diabetes.

Type 2 is a progressive condition with ongoing loss of beta cell function. It’s also characterised by insulin resistance which is where the body still has sufficient insulin, but the body is unable to utilise it. Type 2 accounts for 90-95% of diabetes cases.

Gestational diabetes presents and is diagnosed for the first time during pregnancy. It usually develops at about the 24^th week of pregnancy. Hormones produced by the placenta cause insulin resistance and an increase in blood glucose levels. These elevated glucose levels pass through the placenta to the foetus. Gestational diabetes tends to resolve after the birth.

2. What treatment will I have to take?

The type of diabetes you have will determine the treatment that you’re prescribed.

Type 1

Type 1 will be treated solely with insulin, initiated at the get-go. Treatment will be lifelong. This will be administered as multiple daily injections or through a continuous subcutaneous insulin infusion from an insulin pump.

Some patients with Type 1 will also receive metformin if they become insulin resistant. Unfortunately, Type 1 is currently irreversible.

Type 2

People who are diagnosed with Type 2 can go into remission with a drastic change in lifestyle including diet, weight loss and an increase in activity. It’s vital to continue testing your blood glucose levels to ascertain if you’re still in remission.

For most of the population, treatment initiation is usually metformin. As time and condition progress, increased doses of oral medication may be indicated. There is a full plethora of oral medication available to people with Type 2. These medications will be introduced and removed in response to your diabetes progression.

Eventually insulin may be required to manage your blood glucose levels. This is not due to failure on your part but rather the natural progression of Type 2. Adding insulin to your medication regimen doesn’t change your diagnosis. You would be known as having insulin-dependent Type 2 diabetes.

Gestational diabetes

Treatment consists of metformin and/or insulin. Gestational diabetes usually resolves after the birth and medication would be discontinued. Testing your blood glucose levels by means of an oral glucose tolerance test at six to 12 weeks post-delivery is recommended. You should continue to test one to three years thereafter. There is an increased risk of developing Type 2 after having gestational diabetes. 

3. Will the medication cause side effects?

Enquiring about potential side effects of new medication is useful, as knowing what to expect makes adherence easier, gives you peace of mind as well as knowing when to report a side effect to your healthcare practitioner.

Certain medications have common side effects experienced by many people. Being prepared for these and knowing how to manage them and how long to expect them to persist for will instil confidence in your treatment.

4. What are the symptoms of uncontrolled blood glucose levels?

People tend to experience similar symptoms to each other when their glucose is either high or low however it’s possible to experience different symptoms. It’s beneficial to learn to recognise these symptoms to afford yourself time to take appropriate corrective action.

Typical symptoms of high glucose readings:

• Increased thirst
• Increased urination
• Blurry vision
• Nausea and vomiting
• Fatigue
• Dry mouth
• Over a longer time, weight loss and delayed wound healing are also symptoms.

Typical symptoms of low blood glucose levels:

• Sweating
• Hunger
• Shaking
• Anxiety
• Palpitations
• Irritability

5. Will these symptoms go away?

Once you’re diagnosed, commence medication and improve your lifestyle, your symptoms will almost definitely improve. They may not subside fully until your glucose levels are in target range or much improved. An exacerbation in the control of your diabetes may cause symptoms to recur. This may be a sign that medication needs to be reviewed.

6. How often should I see my doctor and who else should I see?

Once you’re diagnosed you should see your doctor at least every six months, more regularly if you’re struggling to manage your diabetes. At these visits you should discuss your glucose control as seen on your blood glucose meter, or continuous glucose monitoring (CGM) and Hba1c. Medication should be reviewed and blood pressure and weight checked. Any concerns could be brought to the table here.

Blood tests for cholesterol and kidney functions should be done annually unless more frequent testing is required. Over and above monitoring these parameters, an annual visit to a podiatrist and ophthalmologist are recommended even if you’re not aware of any problems currently.

These initial visits will allow for a baseline from which deviations can be assessed. Getting assistance from a dietitian will be invaluable. Diabetes nurse educators, like myself, make understanding your diabetes much simpler. We are fortunate to be able to spend more time with you than the average doctor can. All the above-mentioned services will complement each other, hopefully making your diabetes journey a smooth one.

7. What are realistic goals and targets?

Glucose:

Fasting readings of between 4-7mmol/L.

Two hours after a meal the reading should be below 7,8mmol/L.

Time in range (TIR) is a relatively new concept. This focuses on having above 70% of glucose readings within the range of 4-10mmol/L instead of focusing on specific numbers. There is a strong correlation between TIR and HbA1c.

HbA1c:

The usual target is 7,0%. These targets may be individualised between you and your practitioner.

BMI:

Maintaining a healthy weight with a BMI of between 18,5-24,9 is advised.

Exercise:

The World Health Organisation recommends 150 minutes of moderate exercise per week. This will be broken down to shorter sessions spaced out over the week.

8. How often should I test my blood glucose levels?

People with Type 1, 2 and gestational diabetes using insulin need to test more often than people using oral medication only. People with T1 should be testing at least four times a day, pre meals and at bedtime. Before and after exercise may also be necessary. A 2am test is useful to rule out overnight hypoglycaemia.

For people not on insulin, less testing is required. Testing a fasting reading twice a week would be sufficient. It’s also useful testing two hours after meals from time to time, to establish the effects of your meal on your blood glucose levels. Try to aim for no more than 2mmol/L increase after meals.

When medication is being altered, more regular testing may be required, up to seven tests a day for three days. CGM is a convenient way to track blood glucose levels 24 hours a day. Unfortunately, it’s an expensive tool.

9. Why should I make all these changes?

Unfortunately, uncontrolled diabetes can result in many long-term complications including eye, feet and kidney damage. There is also an increased risk of cardiovascular disease.

Having good communication and support from your diabetes team will lighten your burden, and managing diabetes will hopefully not weigh you down.

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