10 Most Common Questions Answered After a Type 2 Diagnosis

Facing a new diagnosis of type 2 diabetes can be a difficult and confusing time. Many ask “why me?”,  some may feel shame due to the stigma surrounding type 2,  while others want to know what they can proactively do to better their health. I asked people living with type 2 diabetes what their initial questions were at diagnosis. Hopefully, this can help some of you who are learning how to live with this new condition.

1. What is type 2 diabetes?

Type 2 diabetes is the presence of excess sugar that occurs due to the body’s resistance to insulin.

Insulin resistance — a condition in which the body’s cells do not respond properly to the hormone insulin — is at the heart of type 2 diabetes. At first, the pancreatic beta cells release large amounts of insulin to compensate for insulin resistance and elevated blood glucose levels. Type 2 diabetes ultimately occurs when these cells that secrete insulin become dysfunctional, and cannot release enough insulin to keep blood sugars at a healthy level.

Type 2 diabetes is considered a progressive disease — for most patients, it will get more severe over time.

2. Why did this happen to me?

We know that there are both environmental and genetic factors associated with a type 2 diagnosis. We also know that obesity can lead to diabetes, but not everyone who is obese winds up with type 2 diabetes, and some people with type 2 diabetes aren’t even overweight. Age, ethnicity, and numerous other factors also come into play.

Try not to be discouraged by your diagnosis. Instead, use it as an opportunity to start or maintain a healthy lifestyle. This will help you to avoid issues down the road, and can help turn the diagnosis into a positive change in your life.

3. What should my blood sugars be?

The American Diabetes Association (ADA) generally recommends a fasting blood glucose level of 80-130 mg/dL. One to two hours after a meal, your blood sugar should be lower than 180 mg/dL.

These goals, however, may be adjusted based on several other factors. Making this adjustment can be more art than science, and is something best decided with the help of your clinician. Older patients, or those that already have more serious health issues, may be advised to target less stringent glucose control, for example.

Many factors affect your blood sugar level. Not just what you’ve eaten, but exercise, sleep, stress, illness, and many other smaller factors besides.

4. Are there alternative treatments?

Many of our readers are skeptical about mainstream medicine. We understand.

Even the experts agree that type 2 diabetes is best treated with a commitment to healthy lifestyle habits. It would be a mistake to rely on a drug — even the newest and most powerful diabetes drugs — to manage your diabetes. Good diet and exercise decisions should play a critical role in any type 2 diabetes management strategy.

Eating healthy — making sure you get plenty of protein and focus on unprocessed and nutritious foods, like plenty of vegetables — and making sure to stay active can help you to stay maintain optimal shape and blood sugars.

While there are certainly alternative treatment options for diabetes, they should not claim to “cure” diabetes. Be wary of any treatments that sound too good to be true. But many members of the Diabetes Daily community believe that complementary treatments, including supplements, acupuncture, or meditation, have had positive effects on their health.

5. Will I have to go on insulin?

If you haven’t already been prescribed a drug, you can probably expect to start using metformin. Metformin is an inexpensive and reliable drug for lowering blood sugar. The side effects can be unpleasant, but most people tolerate metformin well.

Some people — especially those with cardiovascular health issues or a serious need to lose weight — will be prescribed stronger drugs, particularly GLP-1 receptor agonists (such as Ozempic) or SGLT2 inhibitors (such as Jardiance).

If you still cannot keep your blood sugar at a safe level, you may finally be prescribed insulin. For many patients, it takes years to reach this point.

6. What doctors should I see annually?

Diabetes has the potential to cause a dizzying number of health complications. As a result, you might end up seeing a variety of specialists.

You should visit your eye doctor annually, such as an optometrist or ophthalmologist, to check for potentially serious conditions, such as glaucoma, cataracts, diabetic retinopathy, and diabetic macular edema.

Patients who have been living with type 2 diabetes for a long time are at a greater risk for kidney disease and may also need to be under a nephrologist’s care. They can also administer dialysis, for those patients undergoing dialysis treatment.

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Eventually, you may need to see a podiatrist regularly. People with diabetes can also be more susceptible to wounds not healing properly, especially in the feet and legs.

Other specialists to consider are a dietician and personal trainer, if you feel you need help with reaching your diet and fitness goals.

7. How much should I expect this disease to cost me?

Living with type two diabetes can place a significant economic burden on the individual. Costs vary widely depending on what country you live in and your insurance details.

The American Diabetes Association has estimated that Americans with diabetes “incur average medical expenditures of $16,752 per year, of which about $9,601 is attributed to diabetes.” This number, of course, includes the contribution of patients with more advanced and expensive medical needs, such as dialysis.

Your out-of-pocket cost is impossible to estimate, because insurance coverage varies so profoundly.

8. Can I manage it just through diet and exercise? Can it be reversed?

Diabetes experts avoid the word “reverse,” but there is agreement that the condition can be put into remission.

Some people with diabetes have been able to achieve and maintain healthy glucose levels without the use of glucose-lowering medication. Generally, this improvement is the result of significant weight loss from diet and exercise changes (sometimes with the use of bariatric surgery). Dramatic weight loss reverses the progression of type 2 diabetes and can restimulate insulin sensitivity and beta cell activity.

Remission is not always possible. Some patients, even if they do everything right, cannot defeat their diabetes. For many, remission is likely an unrealistic goal. It may be better to focus on managing diabetes — getting blood sugar levels (and other metabolic parameters, such as blood pressure) down to a healthier level so as to reduce the risk of long-term complications.

9. Does having diabetes lower my life expectancy?

Type 2 diabetes can shorten your life. It’s one of the scariest things about the disease, and it’s not an easy one to talk about.

On average, people with type 2 diabetes die somewhat earlier due to their condition. We can’t put a reliable number on the difference: maybe it’s a few years earlier, or maybe it’s a handful. The true risks will vary based on individual circumstances.

Diabetes can also accelerate the development of disabilities, cognitive impairment, and other hazards that reduce the quality of life associated with aging.

Improved blood sugar management and weight loss are the two most powerful health changes that most people with diabetes can make to reduce the risk of premature health declines and death. And the younger a patient is diagnosed, the more years they have to gain by improving their health.

10. Are my children at risk?

Maybe. There is a strong genetic component to type 2 diabetes, and if you’ve been diagnosed, it means that your children are somewhat more likely to develop the same condition. Many other factors come into play, and while diabetes runs in families, developing healthy habits, maintaining a healthy weight, and keeping active can help stave off a diagnosis as well.

A diagnosis of type 2 diabetes shouldn’t feel like a death sentence. With a little determination and support from your medical team and loved ones, you can manage this condition. Asking questions and staying on top of your diabetes care is key to maintaining long-term success.

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