6 Features of an Ideal Type 2 Diabetes Treatment Plan

A successful care plan looks different for every person. “Nothing about diabetes is one-size-fits-all,” says Chauntae Reynolds, PharmD, CDCES, a spokesperson for the Association of Diabetes Care & Education Specialists (ADCES) based in Indianapolis. “There are so many different components that go into [designing] a plan for someone, such as their lifestyle, cultural preferences, and financial situation,” Dr. Reynolds says.

Here's how to create a care plan that's right for you.

In shared decision-making, you have a partnership with the healthcare professionals who are seeing you, and you work together to come up with a plan for your care, says Reynolds.

A shared approach requires honesty about what's been working for you and what issues, fears, and concerns you may have with medications and lifestyle recommendations, she says. “Your provider can then recommend options based on your disease and lifestyle, and discuss the pros and cons to determine what will be best for you.”

• A primary care physician (PCP) is responsible for routine care, lab work, prescriptions, and checkups. PCPs may refer you to other specialists for specific aspects of diabetes care.
• An endocrinologist specializes in hormonal health and may be your primary point of contact for diabetes medication management, particularly if you use insulin.
• A nephrologist specializes in kidney health. Long-term, consistently high blood glucose and blood pressure can cause kidney damage. If a PCP or endocrinologist identifies kidney damage during a routine checkup, they may refer you to a nephrologist for kidney care.
• A diabetes care and education specialist provides tailored diabetes self-management education and support (DSMES), collaborating with you to develop a diabetes care plan that fits your lifestyle, culture, and health needs. A certified diabetes care and education specialist (CDCES) may be a nurse, registered dietitian, pharmacist, or other medical professional.
• A registered dietitian (RD) is an expert in nutrition who can help you build a healthy eating pattern that makes body weight and metabolic management goals achievable. This can help you keep complications at bay. An RD who also lists the initials CDCES after their name is certified in diabetes care and education.
• An eye health specialist is needed to diagnose and treat eye complications like diabetic retinopathy. An optometrist can test you for vision problems and treat some diseases; an ophthalmologist is a medical doctor who can prescribe medications, perform eye surgery, and treat all eye conditions.
• A podiatrist is a foot specialist. These providers can identify and treat foot sores or infections, which can be caused by diabetic nerve damage in the legs and feet. They can also assist with routine foot care to prevent diabetes-related foot problems.
• An audiologist is a hearing specialist. Diabetes may harm the inner ear's small blood vessels and nerves, increasing your risk of hearing loss or balance issues. A PCP may refer you to an audiologist if you report hearing loss.
• A pharmacist fills your prescriptions and can advise you on any potential drug interactions or contraindications (reasons you shouldn't take certain medications). They can also help you understand over-the-counter drugs and devices.
• A mental health professional can help you learn ways to cope. The strain of staying on top of your own care can be tough on your mental health. A counselor, psychologist, psychiatrist, or social worker on your care team can help you manage mental health difficulties that arise from living with diabetes, including burnout.
• An exercise specialist, such as a physical or occupational therapist or personal trainer, can help you meet your exercise goals and come up with specific ways to address muscle weakness, pain, or balance problems.
• A dentist can monitor your oral health. High blood sugar raises the risk of gum disease, dry mouth, and thrush, a fungal infection. Regular professional cleanings and checkups can help control these.

You are the expert on you, says Josie Bidwell, DNP, a doctor of nursing practice and a professor at the University of Mississippi School of Medicine in Jackson who specializes in preventive health. “Healthcare providers are experts about the physiology of how medications and other treatments work, but people are the experts on what they feel like they can do or access,” Dr. Bidwell says.

Bidwell might recommend moving toward a whole-food, plant-based diet. If you're currently eating a standard American diet, however, which includes a lot of meat and processed foods, making that change can require a lot of work.

“Instead of a blanket recommendation of eating five servings of fruits and vegetables a day and consuming whole grains, I'll step back and ask what they think about the diet's role in treating diabetes,” she says. When it comes to lifestyle, she might ask a patient to rate themselves on a scale of 0 to 10 in terms of stress management and getting the sleep they need.

“Until we address barriers, sustainable change doesn't happen,” Bidwell adds.

A provider who respects your cultural background is also key. It's a disservice to you if a doctor comes in and tells you that beloved family dishes or food from your culture is “bad” for you, says Reynolds. “We have to meet patients where they are. If rice is a staple in their diet, for example, we have to think about how to keep that food in their diet while making sure it doesn't cause blood sugar spikes.”

The same goes for religion. “Some individuals are focused on the power of prayer to improve their health, and we want to ensure we as providers don't minimize what's important to them. We should add it to the overall treatment plan,” says Reynolds.

But if you've been told to lose weight without any instruction on how to do it, or the sole focus of your interactions with your healthcare provider is on weight loss, you might want to think about whether that's working for you.

“It's quite clear that there is a relationship between overweight, obesity, and metabolic disorders,” says Bidwell. “As you lose weight, blood sugar and blood pressure come down.” But using the number on the scale as the measure of success doesn't often lead to sustainable change, she says.

Instead, having a provider who also engages with you about the benefits of weight loss is crucial. Think ahead six months from now: If you could lose the weight, how would your life be different? Would you be able to interact with family more, have energy to play with your kids or grandkids, or take a vacation and walk to see the sights? That's what's motivating, says Bidwell.

Your diabetes care team can incorporate your triggers and concerns into your wider treatment plan. For example, if you have anxiety about needles and your provider prescribes an injectable medication, they shouldn't dismiss your fears. Instead, they should suggest strategies for making injections less stressful or come up with alternatives if those are available.

What you hear in a doctor's office might not stick with you. You might nod in agreement during the conversation, then leave the office and sit in your car, not knowing what to do next.

“I ask patients to repeat our plan to me before they head out the door,” says Bidwell. If your provider doesn't do this, say, “To be clear, our plan is …” and then repeat back what you heard before you leave. “We want to ensure that we're all working from the same playbook,” says Bidwell.

You should be able to trust your doctor and feel comfortable telling them the truth. “I might talk to someone and acknowledge that it's difficult to test your blood sugar three times daily and ask how often they're able to test,” says Reynolds. She maintains that having a conversation with your doctor about the challenges you're experiencing can make it easier to address where and how to make tweaks in a way that feels comfortable for you.

Your provider should want to understand what's going on behind the scenes before declaring that your plan needs to change or, worse, making you feel like you're in trouble, says Bidwell. For instance, she says, “We may have someone on a certain medication for diabetes, but when we check their A1C [a measure of long-term blood glucose control], it's not improving.” Before intensifying therapy, we should find out if the patient is taking it as prescribed and, if not, why.”

She notes that treatment may not be working due to a patient not taking medication as directed because of side effects or confusion about how to take it correctly. Similarly, if someone is having trouble making lifestyle changes, like struggling to cut back on soda, for example, a doctor should ask the person why that is and figure out how to come up with healthy alternatives.

Daily Tasks

• Check blood glucose and record your numbers at the times your healthcare team recommends.
• Thoroughly check your feet for cuts, sores, blisters, redness, swelling, corns, calluses, or other skin and nail changes, using a mirror or requesting help from a family member if necessary.
• Take your daily prescribed dosage of diabetes medications, even when you feel no symptoms.
• Get around 30 minutes of physical activity on most days, which can include brisk walking.
• Eat healthy foods that provide adequate nutrition without spiking your blood sugar.

Every 3 to 6 Months

• An A1C test — every three months if you've changed medications or are not meeting your treatment goals; every six months if you're maintaining blood glucose goals. A doctor visit — every six months if you're meeting goals; every three months if you're finding it challenging to do so.

Yearly

• A flu shot
• A complete foot check (more often if necessary)
• Cholesterol tests
• A dental exam (more often if necessary)
• Dilated eye exam (more often if necessary)
• A hearing check
• Kidney tests

Just Once or as Needed

• Two pneumonia vaccines, typically a year apart

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• A hepatitis B shot if you're under 60

Be sure to report any new symptoms, health issues, or mental health concerns to a doctor so they can be addressed as soon as possible.

• The ideal type 2 diabetes care plan is individualized, involves a team of specialists, and directly involves you in your treatment planning.
• The care plan should take into account your beliefs, fears, doubts, and motivations in a way that still empowers you to manage blood glucose, make diet changes, and prevent complications.
• If your medications don't seem to improve blood sugar, you're finding sticking to the plan too challenging, or you're experiencing mental health difficulties, raise these with your diabetes care team.