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diagnosed with type 2 diabetes: managing treatments, support and resources
9 minute read
according to diabetes canada, people with diabetes are more than three times more likely to be hospitalized with cardiovascular disease than the general population.
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you’ve been diagnosed with type 2 diabetes and you’re a little stunned, not to mention stressed. what do you do? who do you see? what medications will you need? how will this change your life? it can all be overwhelming but it may also be small comfort to know that more than 11 million of your fellow canadians asked the same questions when they were diagnosed with either diabetes or prediabetes.
there are three types of diabetes: type 1, which mostly develops in children and adolescents; type 2, which affects adults; and gestational diabetes, which can come on during pregnancy and usually resolves itself after birth.
type 2 is the most common, making up about 90 per cent of cases. it occurs when your body isn’t able to produce enough insulin, or properly use the insulin it does produce, according to diabetes canada. common symptoms of type 2 diabetes include unusual thirst, frequent urination, weight fluctuations, extreme fatigue, blurred vision and numbness in the hands and feet. complications can lead to high blood pressure, kidney failure, heart disease and stroke, eye damage, nerve damage and limb amputation. more reason to be stunned and stressed.
people who are inactive, obese or overweight are at higher risk, as are those over the age of 45, have a parent or sibling with the disease, or are descended from countries in africa, latin america, asia or first nations.
type 2 diabetes can sometimes be managed (or prevented) through a healthy diet and exercise, but it may also require insulin or other medication, such as metformin, ozempic or mounjaro.
fortunately, proper disease management can help you avoid any major complications and have a good quality of life. knowing what lies ahead, understanding your treatment options, and being aware of the supports available can help ease your unease.
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here’s how to manage a type 2 diabetes diagnosis.
build a type 2 diabetes care team
you’ll likely get the news you’ve got diabetes when your family physician, nurse practitioner or walk-in clinic orders a simple blood test that measures the amount of sugar in your blood. once confirmed, she or he may take on your care themselves or refer you to either an endocrinologist or a diabetes education centre (dec), where you may be assigned to a case manager who will help guide you through the system.
“the referral pathway depends on lots of factors, including a person’s age, diagnosis type, health history, any complications experienced, the availability of services [in their area], et cetera,” says ann besner, senior manager of people affected by diabetes, knowledge & connection team, at diabetes canada. “those who have access to a diabetes education centre or diabetes education program are often able to access specialized care from a multidisciplinary team with a focus on diabetes.”
she says such a team could comprise of:
- registered nurse
- registered dietician
- pharmacist
- exercise specialist
- chiropodist
- podiatrist
- social worker
- other mental health providers.
dr. tom elliott, endocrinologist and medical director for bc diabetes, says, “in our clinic, we make an assessment, [suggest] lifestyle recommendations, which are typically eat less, specifically fewer carbs and low glycemic index carbs, exercise more, and reduce stress.”
elliott says almost all complications are avoidable if you understand the disease, know how to manage it, and what to watch for. “if your sugars run high for 10 years or more, then your body gets damaged. the back of your eye gets damaged, leading to blindness. the nerves in the feet get damaged, leading to numbness, ulceration of the feet and amputations. the kidneys get damaged, leading to dialysis, and the blood vessels get damaged, leading to heart attack and stroke.
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“if you have diabetes that’s well controlled with medication, your risk of getting those things is no greater than the next person. control the sugar from the word go and the chances of those complications are extremely low.”
he says his clinic offers detailed handouts on everything from drug treatment options, pharmacare guidelines for coverage, diet, carb counting, diabetes reversal, and mindfulness to reduce stress and anxiety, which in themselves can lead to other health issues.
one of the more serious complications is diabetic nephropathy, also called diabetic kidney disease, according to the mayo clinic. it occurs when the kidneys’ work of removing waste products and extra fluid from the body is disrupted. over time, diabetic nephropathy damages the kidneys’ filtering system, leading to life-threatening kidney failure.
“a nephrology referral could be made if a person has pre-existing kidney issues or is experiencing kidney complications resulting from diabetes,” says besner.
according to diabetes canada, people with diabetes are more than three times more likely to be hospitalized with cardiovascular disease than the general population, 12 times more likely to be hospitalized with end-stage renal disease, 20 times more likely to have a lower limb amputation, and have a reduced lifespan by five to 15 years.
since keeping active is a crucial part of managing diabetes, a physiotherapist can help design a safe and effective exercise program tailored to your specific situation. exercise can also help you shed some pounds, if you need to. according to endocrine web, nine out of 10 people with type 2 diabetes are overweight, and that added fat tissue, especially around the belly, can increase insulin resistance. weight loss can also ward off diabetes-related complications.
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this is also where a registered dietician can help by creating a personalized meal plan. dieticians can also offer nutrition counselling to help you learn about reduced caloric intake, glycemic control, spacing and regularity in meals, and specific foods that will benefit you, according to diabetes canada, as well as those that will not: a recent study published in the american journal of clinical nutrition has shown people who regularly eat red or processed meat have a higher risk of developing type 2 diabetes.
a diabetes coach can also help you stick with your diet and exercise program and suggest other behavioural modifications in a non-judgmental way. he or she can also act as a sounding board if you’re struggling with the challenges of living with diabetes.
diana sherifali, assistant professor, school of nursing at mcmaster university, focuses part of her research program on self-management in conjunction with a diabetes coach. in a diabetes canada webinar, she has said coaching can be as effective as medication at managing glucose levels, among other psychosocial benefits. of her studies into coaching, she said, “we were successful in demonstrating that there was not only clinical improvement but that patients felt that it was important in terms of improving their quality of life . . . and that they valued non-judgmental support.”
understand type 2 diabetes supports and coverage
all these supports and specialists are ideal, but if you live in an area where there are none, have long wait lists where there are specialists, or you can’t afford them, what do you do? diabetes is an expensive illness — treating it costs the health-care system $30 billion a year — and out-of-pocket expenses range anywhere from $76 all the way to $10,000, depending on your province, medication type, and severity of the disease. in some areas, public funding covers all or most medications, devices and supplies, in others coverage is less than 20 per cent.
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“some specialists’ services are [also] covered through public health insurance, such as a referral to a cardiologist or neurologist, or may be available through the clinic or practice where the primary care provider works,” says besner. “there are different medications, monitoring devices, pumps and supplies that are reimbursed through provincial, territorial or federal health plans for those who are eligible. however, coverage is not exhaustive in any one jurisdiction and is inequitable across the country.”
she says that, for those who have private insurance, “there is often partial or full coverage for a variety of providers, like dietitians, chiropodists, et cetera. many people incur some out-of-pocket costs associated with healthcare services when they don’t have access through a public or private insurance plan. sometimes these costs can be prohibitive for people and are ultimately [a barrier to] accessing certain treatments.”
because of this disparity in public coverage, organizations like diabetes canada continue to advocate to various levels of government to help people with diabetes access the medications, devices, supplies, services and supports they need.
for information on other provincial and territorial benefits, people can contact their nearest government service centre. those living with severe diabetes may also qualify for disability benefits or the cpp disability benefit.
besner says apart from the inequitable access to treatments, other barriers for people with diabetes navigating the system is a shortage of family doctors. “there is no quick fix to these problems and a coordinated effort is required to begin to address the problems people face when it comes to diabetes care,” she says.
coping with a diagnosis of diabetes can also come at a cost to your mental health and that of your family, according to the canadian journal of diabetes. some people may have a constant fear of their blood sugar levels dropping; some may be afraid of developing severe complications; some may be coping with stigma and stereotyping around the disease, which can even come from their interactions with health care professionals. there’s a common misconception that people have brought the disease on themselves, when diabetes is in fact caused by many complex factors, and not all are within a person’s control.
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also, 33 to 50 per cent of people living with diabetes can develop a condition called diabetes distress, which can cause them to become undisciplined in checking their blood sugar levels or keeping medical appointments.
a good health care team will recommend regular screening for mental health issues.
learn self-management strategies for type 2 diabetes
there are many strategies people living with diabetes can adopt to prevent or delay complications and live a full and productive life. these include healthy behaviours such as regular physical activity, managing stress, having a healthy diet, not smoking, and keeping blood sugars in check. it’s also important to keep learning about your condition to recognize any issues that might arise, and keeping on top of any research into new treatment options.
diabetes canada offers a video series called deep dives, which offer more in-depth information on diabetes management. a variety of experts offer tips and tools on everything from carb counting to insulin delivery to a range of exercises and sports training to the latest research and how people can participate. the more you learn about the disease, the less daunting it seems and the more confident you become about living with it.
contact patient resources for type 2 diabetes
there are many helpful resources available, including diabetes canada, which offers strategies for stress management, information about foods with low glycemic index, medication management, podcasts, and other virtual learning options.
the diabetes hope foundation offers emotional, social and financial supports directed specifically at young people transitioning from pediatric to adult diabetes care, including a scholarship program and peer mentorship to inspire youth to achieve not only their academic goals but to work toward independent diabetes management.
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there are also lots of social media platforms that offer online forums and chat groups specifically for those living with diabetes, including on facebook.
the public health agency of canada also notes that supports and services are available through public health and municipal government offices, community centres, hospitals, provincial diabetes associations, diabetes education centres, and online and in-person support groups. resources specific to indigenous populations, who have a diabetes rate three to five times higher than that of other canadians, are also available through the aboriginal diabetes initiative and the national indigenous diabetes association.
to perhaps back up from going down that road, those with prediabetes can assess their risk of developing diabetes by taking the public health agency of canada’s canrisk questionnaire.
diabetes is a life-long, chronic condition that requires constant vigilance that can become exhausting. knowing where to turn and who to turn to can make the journey a lot more manageable.
robin roberts is a vancouver-based writer.
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