Living Well With Diabetes This American Diabetes Month

Amy Hess Fischl, M.S., RDN, LDN, BC-ADM, CDCES

Credit: American Diabetes Association

November is American Diabetes Month, a time to shine a spotlight on the more than 38 million Americans living with diabetes and the millions more at risk. According to Amy Hess Fischl, M.S., RDN, LDN, BC-ADM, CDCES, president-elect for health care and education at the American Diabetes Association (ADA), the month is a reminder to increase awareness, debunk myths, and empower patients and families with the tools and knowledge needed to manage or prevent diabetes. From understanding early warning signs to adopting daily healthy habits and leveraging the latest treatments and technologies, informed action can make a meaningful difference in long-term health.

Why is American Diabetes Month an important time for patients and families to pay attention to diabetes awareness?

Amy Hess Fischl, M.S., RDN, LDN, BC-ADM, CDCES: While the entire year is important to focus on diabetes prevention and management, this month is meant to shine a spotlight on the impact of and to rally around the fight to end diabetes. Today over 38 million people are living with diabetes.

What are the biggest myths or misconceptions about living with diabetes that you’d like to clear up?

AHF:

• Having overweight or obesity does not mean you will always develop type 2 diabetes. Overweight is a risk factor for developing diabetes, but other risk factors such as how much physical activity you get, family history, ethnicity and age also play a role. Unfortunately, many people think that weight is the only risk factor for type 2 diabetes, but many people with type 2 diabetes are at a normal weight or only moderately overweight.
• People with diabetes don’t need special food. A healthy meal plan for people with diabetes is generally the same as healthy eating for anyone. In fact, there are a lot of different eating plans that can help you manage your diabetes. In general, a healthy eating plan for diabetes will include lots of non-starchy vegetables, limit added sugars, swap refined grains for whole grains and prioritize whole foods over highly processed foods when possible. ADA has an excellent resource to help with making small changes to your eating patterns: Try Diabetes Food Hub.
• People with diabetes are no more likely to get a cold or another illness. People with diabetes are advised to get flu shots and other vaccinations because any illness can make diabetes more difficult to manage, and people with diabetes who get the flu are more likely than others to go on to develop serious complications.
• If you have type 2 diabetes and your doctor says you need to start using insulin, it does not mean you're failing to take care of your diabetes properly. Type 2 diabetes is a progressive condition. When first diagnosed, many people with type 2 diabetes can maintain their glucose at a healthy level with a combination of meal planning, physical activity and taking oral medications. But over time, the body gradually produces less and less of its own insulin, and eventually, oral medications may not be enough to keep blood glucose levels in a healthy range. That does not mean healthy eating and activity are no longer working — they still are an important part of overall self-management.

What are some of the early warning signs of type 2 diabetes that people should not ignore?

AHF: Some people with diabetes have symptoms so mild that they go unnoticed. But, there are some common symptoms of diabetes that should not be ignored, such as urinating often, feeling very thirsty, feeling very hungry — even though you are not skipping meals — extreme fatigue, blurry vision, cuts/bruises that are slow to heal, tingling, pain, or numbness in the hands and/or feet, and extreme weight loss, even though you have not changed eating or exercise patterns.

For patients already living with diabetes, what are the most important steps they can take to stay healthy day-to-day?

AHF: First, ask your doctor to refer you to diabetes self-management education and support (DSMES). DSMES services will teach you how to stay healthy and how to make what you learn a regular part of your life. DSMES services will also help you make decisions about your diabetes care, work with your health care team to get the support you need, and learn the skills to take good care of yourself. 

Next, know your diabetes ABCs. Talk to your health care team about how to manage your ABC numbers — A1C, blood pressure and cholesterol — and how to quit smoking. These actions can help lower your chance of having a heart attack, stroke or other serious complications of diabetes. The goal is to know these numbers and keep them close to target levels to lower your risk of long-term health problems.

Another important step is to learn how to live well with diabetes by learning coping skills. Anyone who has or works with someone with diabetes can attest that it can be overwhelming at times. Finding things to do to cope with diabetes and manage stress is essential, such as spending time with friends or doing something you enjoy like gardening, taking a walk, working on a hobby or listening to favorite music. Ask for help if you feel down. Talk with a mental health counselor, support group, clergy member, friend or family member who will listen to your concerns. 

The number one thing that every person with diabetes asks me is “What can I eat?” Making healthy food choices that fit your life is one of the cornerstones of diabetes self-management. You do not have to do it alone, meeting with a registered dietitian nutritionist (RDN) who knows about diabetes is a great start to help you create a personal meal plan to meet your specific needs and help you develop the skills to eat healthfully when eating out or during the holidays. Additional healthy skills include planning ahead. Plan your food each week so you have healthy options at home. When you go out, carry healthy snacks — like baby carrots, sliced apples or nuts — with you.

Being physically active is also important for diabetes self-management. Set a goal to be physically active for 30 minutes most days of the week. Start slow by taking a 10-minute walk three times a day. Twice a week, work to increase your muscle strength. Use stretch bands, do yoga or do heavy gardening like digging and planting with tools.

Additionally, know what to do every day.

• Take your medicines even when you feel good. Tell your doctor if you can't afford your medicine or if you have any side effects.
• Check your feet every day for cuts, blisters, red spots and swelling. Call your health care team right away about any sores.
• Brush your teeth and floss every day to keep your mouth, teeth and gums healthy.
• Ask your health care team how often and when to check your blood sugar.
• Keep track of your blood sugar and keep a record of your numbers.
• Check your blood pressure if your doctor tells you to and keep a record of your numbers.
• Don't smoke. If you already smoke, ask for help to quit. Call 1-800-QUIT-NOW (1-800-784-8669).
• Finally, get regular care to stay healthy.

See your health care team at least twice a year to find and treat any problems early, get lab tests done when your health care team orders them, see a dentist at least every 6 months and an eye specialist annually. If you have Medicare, check to see how your plan covers diabetes care. While these are a lot of things to think about, they all work together to keep you healthy. It is about progress, not perfection.

How has diabetes care changed in recent years — are there new treatments or technologies patients should know about?

AHF: Goodness, this could be an entire article in and of itself! When I started as a diabetes care and education specialist over 25 years ago, we had blood glucose monitors (BGM), two pumps and one burgeoning continuous glucose monitor (CGM), oral meds and insulin. In the past few years, we have quadrupled the products and tech on the market. More pumps, automated insulin delivery, additional CGMs, additional medications. Yet, management goals, outcomes and reduction in long-term complications have not really changed as much as we would hope based on the sheer number of potentially game-changing products. Now we need to figure out how everyone can have access to what will be best for them.

What advice do you have for people who feel overwhelmed by managing their diabetes or supporting a loved one with the condition?

AHF: As I say to my patients all the time, take a breath and let’s just focus on one thing at a time. Diabetes is a marathon, not a sprint. Pick one item from the list we discussed and work on that for a few weeks. Then, make adjustments based on what happens. Nothing will be perfect overnight. I am also a strong proponent of therapy — talking to another human being that has no skin in the game and can give you non-biased advice or just be a set of ears to listen. We have to acknowledge that no person is an island, and it takes more strength than weakness to admit when one needs help.