Professional medical service of Diabetes
Diabetes can affect many parts of your body. So you’ll want to have various types of doctors who specialize in different areas on your diabetes health care team. Knowing which doctor to see and when to see them can help you manage diabetes and prevent complications.
The human body is a delicate and complex system. A breakdown in one part of the body can affect how other parts of your body perform. This is no different with diabetes. Managing diabetes means managing the health of the whole body. This is why you’ll want to have a diabetes care team that includes specialists from different fields. Your diabetes care team will help you develop a diabetes management plan to help you stay healthy and prevent any diabetes-related complications.
Like any important relationship in your life, you’ll want to find members for your diabetes care team who will listen, support, and respect you (also known as person-centered care). This means having a team that makes sure your preferences, needs, and values are used to help guide clinical decisions. Remember, you are the most important member of your diabetes care team. The other specialists will depend on you to tell them your needs, priorities, and feelings. Having the right diabetes care team can set you up for diabetes management success.
The “Who’s Who” of Your Person-Centered Care Team
People living with diabetes should work with a team that combines long-term treatment approaches and maintains communication and goal setting among all team members. “So, who should be on my team?” Glad you asked! Below is a list of health care professionals you might need and the roles they’ll play in managing your diabetes.
Primary Care Provider (PCP)
This doctor is usually your general or family doctor who gives you routine medical care. You will typically see your PCP for general care, such as yearly checkups, physical exams, and lab tests, and to write prescriptions. When you have diabetes, you’ll want to see this doctor at least once a year, or more often, if recommended.
This is a doctor who specializes in the body’s hormones. Because diabetes affects how your body produces and uses insulin (a hormone), your primary care provider may want you to see an endocrinologist. It’s not unusual for an endocrinologist to become the primary doctor to manage your diabetes.
Diabetes Care and Education Specialist
This health care professional is trained to provide personalized diabetes self-management education and support (DSMES). DSMES helps people with diabetes gain the knowledge and decision-making skills needed for diabetes self-care. Diabetes education is a recognized part of your diabetes care. And it’s covered by Medicare and most health insurance plans when it’s offered through an accredited diabetes education program. As a member of your care team, a diabetes care and education specialist makes managing your diabetes easier. You’ll work together to create a diabetes management plan that’s specific to your health needs, lifestyle, and culture.
Health Tips & Info
Diabetes prevention: 5 tips for taking control
Changing your lifestyle could be a big step toward diabetes prevention — and it’s never too late to start. Consider these tips.
Lifestyle changes can help prevent the onset of type 2 diabetes, the most common form of the disease. Prevention is especially important if you’re currently at an increased risk of type 2 diabetes because of excess weight or obesity, high cholesterol, or a family history of diabetes.
If you have been diagnosed with prediabetes — high blood sugar that doesn’t reach the threshold of a diabetes diagnosis — lifestyle changes can prevent or delay the onset of disease.
Making a few changes in your lifestyle now may help you avoid the serious health complications of diabetes in the future, such as nerve, kidney and heart damage. It’s never too late to start.
1. Lose extra weight
Losing weight reduces the risk of diabetes. People in one large study reduced their risk of developing diabetes by almost 60% after losing approximately 7% of their body weight with changes in exercise and diet.
The American Diabetes Association recommends that people with prediabetes lose at least 7% to 10% of their body weight to prevent disease progression. More weight loss will translate into even greater benefits.
Set a weight-loss goal based on your current body weight. Talk to your doctor about reasonable short-term goals and expectations, such as a losing 1 to 2 pounds a week.
2. Be more physically active
There are many benefits to regular physical activity. Exercise can help you:
- Lose weight
- Lower your blood sugar
- Boost your sensitivity to insulin — which helps keep your blood sugar within a normal range
Goals for most adults to promote weight loss and maintain a healthy weight include:
- Aerobic exercise. Aim for 30 minutes or more of moderate to vigorous aerobic exercise — such as brisk walking, swimming, biking or running — on most days for a total of at least 150 minutes a week.
- Resistance exercise. Resistance exercise — at least 2 to 3 times a week — increases your strength, balance and ability to maintain an active life. Resistance training includes weightlifting, yoga and calisthenics.
- Limited inactivity. Breaking up long bouts of inactivity, such as sitting at the computer, can help control blood sugar levels. Take a few minutes to stand, walk around or do some light activity every 30 minutes.
3. Eat healthy plant foods
Plants provide vitamins, minerals and carbohydrates in your diet. Carbohydrates include sugars and starches — the energy sources for your body — and fiber. Dietary fiber, also known as roughage or bulk, is the part of plant foods your body can’t digest or absorb.
Fiber-rich foods promote weight loss and lower the risk of diabetes. Eat a variety of healthy, fiber-rich foods, which include:
- Fruits, such as tomatoes, peppers and fruit from trees
- Nonstarchy vegetables, such as leafy greens, broccoli and cauliflower
- Legumes, such as beans, chickpeas and lentils
- Whole grains, such as whole-wheat pasta and bread, whole-grain rice, whole oats, and quinoa
The benefits of fiber include:
- Slowing the absorption of sugars and lowering blood sugar levels
- Interfering with the absorption of dietary fat and cholesterol
- Managing other risk factors that affect heart health, such as blood pressure and inflammation
- Helping you eat less because fiber-rich foods are more filling and energy rich
Avoid foods that are “bad carbohydrates” — high in sugar with little fiber or nutrients: white bread and pastries, pasta from white flour, fruit juices, and processed foods with sugar or high-fructose corn syrup.
4. Eat healthy fats
Fatty foods are high in calories and should be eaten in moderation. To help lose and manage weight, your diet should include a variety of foods with unsaturated fats, sometimes called “good fats.”
Unsaturated fats — both monounsaturated and polyunsaturated fats — promote healthy blood cholesterol levels and good heart and vascular health. Sources of good fats include:
- Olive, sunflower, safflower, cottonseed and canola oils
- Nuts and seeds, such as almonds, peanuts, flaxseed and pumpkin seeds
- Fatty fish, such as salmon, mackerel, sardines, tuna and cod
Saturated fats, the “bad fats,” are found in dairy products and meats. These should be a small part of your diet. You can limit saturated fats by eating low-fat dairy products and lean chicken and pork.
5. Skip fad diets and make healthier choices
Many fad diets — such as the glycemic index, paleo or keto diets — may help you lose weight. There is little research, however, about the long-term benefits of these diets or their benefit in preventing diabetes.
Your dietary goal should be to lose weight and then maintain a healthier weight moving forward. Healthy dietary decisions, therefore, need to include a strategy that you can maintain as a lifelong habit. Making healthy decisions that reflect some of your own preferences for food and traditions may be beneficial for you over time.
One simple strategy to help you make good food choices and eat appropriate portions sizes is to divide up your plate. These three divisions on your plate promote healthy eating:
- One-half: fruit and nonstarchy vegetables
- One-quarter: whole grains
- One-quarter: protein-rich foods, such as legumes, fish or lean meats
When to see your doctor
The American Diabetes Association recommends routine screening with diagnostic tests for type 2 diabetes for all adults age 45 or older and for the following groups:
- People younger than 45 who are overweight or obese and have one or more risk factors associated with diabetes
- Women who have had gestational diabetes
- People who have been diagnosed with prediabetes
- Children who are overweight or obese and who have a family history of type 2 diabetes or other risk factors
Share your concerns about diabetes prevention with your doctor. He or she will appreciate your efforts to prevent diabetes and may offer additional suggestions based on your medical history or other factors.
Anyone who has symptoms of diabetes should be tested for the disease. Some people will not have any symptoms but may have risk factors for type 2 diabetes and need to be tested. Most pregnant women should also be tested for gestational diabetes. Testing helps doctors find diabetes sooner, so they can work with their patients to manage the disease and prevent health problems. Type 1 diabetes Doctors often diagnose type 1 diabetes in children and young adults when they have diabetes symptoms, such as feeling thirsty and having to urinate more often, or if they may have diabetic ketoacidosis . Symptoms in adults may be less specific. Type 1 diabetes can run in families. A study called TrialNet offers free testing to relatives of people with type 1 diabetes, even if the relatives don’t have symptoms. Type 2 diabetes Experts recommend routine testing for type 2 diabetes if you have certain risk factors. You may have a higher risk of developing type 2 diabetes if you are 1) age 35 or older 2) American Indian, Black or African American, Asian American, Hispanic/Latino, or Pacific Islander 3) overweight or have obesity and have at least one other risk factor 4) a woman who had gestational diabetes. Take the American Diabetes Association Diabetes Risk Test to see if you are at risk for type 2 diabetes. Children can also develop type 2 diabetes. Experts recommend testing children and teens between the ages of 10 and 18 who are overweight or have obesity and have at least one more risk factor, such as a low birth weight, a parent who had diabetes while pregnant, or another factor.1 Adults and children with normal diabetes test results should be retested every 3 years. If your blood glucose levels are higher than the target range, but not high enough to be diagnosed with diabetes, doctors will diagnose you with prediabetes. Having prediabetes is serious because it raises the chance of developing type 2 diabetes. But developing type 2 diabetes can be prevented. Adults and children diagnosed with prediabetes should be tested for type 2 diabetes every year. Testing for type 2 diabetes before and during pregnancy All women who are planning to get pregnant should be tested for type 2 diabetes, especially if they have risk factors. If you are already pregnant, you should be tested for type 2 diabetes at the first prenatal appointment, or in the first 15 weeks of pregnancy. If you have diabetes, you should receive special care during your pregnancy to avoid problems for you and the baby. Gestational diabetes All pregnant women who do not have a previous diagnosis of diabetes should be tested for gestational diabetes between 24 and 28 weeks of pregnancy. If you have gestational diabetes, you should get tested after your baby is born to see if you have type 2 diabetes, usually within 12 weeks after delivery.
Doctors use a variety of tests to diagnose diabetes and prediabetes. Your doctor may recommend different tests depending on whether you have symptoms or not, or whether you are pregnant. Fasting plasma glucose test: The fasting plasma glucose (FPG) test measures your blood glucose level at a single point in time. For the most reliable results, your doctor will give you the test in the morning after you have fasted for at least 8 hours. Fasting means having nothing to eat or drink except sips of water. A1C test: The A1C test is a blood test that provides your average levels of blood glucose over the last 3 months. Other names for the A1C test are hemoglobin A1C, HbA1C, glycated hemoglobin, and glycosylated hemoglobin test. You can eat and drink before this test. Before using the A1C test to diagnose diabetes, your doctor will consider factors, such as whether you are in your second or third trimester of pregnancy or whether you have certain types of anemia NIH external link or another problem with your blood.1 The A1C test might not be accurate in those cases. Certain types of hemoglobin, called hemoglobin variants, can interfere with measuring A1C levels. Most A1C tests used in the United States are not affected by the most common variants. If your A1C test results and blood glucose levels do not match, your doctor should consider that the A1C test may not be a reliable test for you. Your doctor will report your A1C test result as a percentage, such as an A1C of 7%. The higher the percentage is, the higher your average blood glucose levels are. Random plasma glucose test Sometimes doctors use the random plasma glucose test to diagnose diabetes when you have symptoms of diabetes and they do not want to wait until you have fasted for 8 hours. You may have this blood test at any time. Glucose challenge test If you are pregnant, your doctor might test you for gestational diabetes with the glucose challenge test. Another name for this test is the glucose screening test. In this test, a health care professional will take a sample of your blood 1 hour after you drink a sweet liquid containing glucose. You do not need to fast for this test. If your blood glucose level is too high—135 mg/dL to 140 mg/dL or higher—you may need to return for an oral glucose tolerance test while fasting. Oral glucose tolerance test The oral glucose tolerance test (OGTT) helps doctors detect type 2 diabetes, prediabetes, and gestational diabetes. However, the OGTT is a more expensive test than the FPG test and the glucose challenge test, and it is not as easy to give. Before the test, you will need to fast for at least 8 hours. A health care professional will take a blood sample to measure your glucose level after fasting. Next, you will drink a liquid that is high in sugar. Another blood sample is taken 2 hours later to check your blood glucose level. If your blood glucose level is high, you may have diabetes. If you are pregnant, your blood will be drawn every hour for 2 to 3 hours. If your blood glucose levels are high two or more times during the OGTT, you may have gestational diabetes.
Each test to detect diabetes and prediabetes uses a different measurement. Usually, your doctor will use a second test to confirm you have diabetes. Diabetes: A1C Test: 6.5% or above FBS: 126 mg/dL or above Glucose Tolerance Test: 200 mg/dL or above RBS: 200 mg/dL or above Prediabetes: A1C Test: 5.7 – 6.4% FBS: 100 – 125 mg/dL Glucose Tolerance Test: 140 – 199 mg/dL N/A Normal A1C Test: Below 5.7% FBS: 99 mg/dL or below Glucose Tolerance Test: 140 mg/dL or below The table below helps you understand what your test results mean if you are not pregnant. If you are pregnant, some tests use different cutoffs. Ask your doctor what your test results mean.
estational diabetes is diagnosed using blood tests. You’ll probably be tested between 24 and 28 weeks of pregnancy. If your risk is higher for getting gestational diabetes (due to having more risk factors), your doctor may test you earlier. Blood sugar that’s higher than normal early in your pregnancy may indicate you have type 1 or type 2 diabetes rather than gestational diabetes