American Diabetes Association Complete Guide to Diabetes. American Diabetes Association

now, though, let’s talk about some of the basics in managing type 2 diabetes.

      Tips on Managing Type 2 Diabetes

      • Not everyone with type 2 diabetes needs pills or insulin when they are diagnosed.

      • Some people who are newly diagnosed can begin with new meal and physical activity plans. For many, eating healthy food portions and exercising regularly keep blood glucose levels near normal.

      • Your treatment plan is based on your usual blood glucose levels. Ideally, you will want to keep your blood glucose levels as close to normal as possible.

      • For most people, the goal is to keep blood glucose levels between 70 and 130 mg/dl before meals and less than 180 mg/dl after meals. Your doctor may have different goals for you.

      Food and Physical Activity

      For many, treatment for type 2 diabetes means a balance of healthy eating and exercise. Most people with type 2 diabetes are advised to lose weight and improve their physical fitness, which can decrease weight and resistance to insulin. The severity of type 2 diabetes can be greatly reduced by maintaining a healthy body weight.

      Losing a Few Pounds

      Even a modest weight loss of 10–15 pounds can have benefits for your health and diabetes.

      Benefits of Physical Activity and Healthy Eating

      • Physical activity, such as exercise, helps by taking some glucose from the blood and using it for energy during a workout, an effect that lasts well beyond the workout.

      • As your physical fitness improves with regular exercise and activity, so does your body’s sensitivity to insulin.

      • Healthy eating keeps glucose levels lower.

      You’ll find out more about healthy eating, physical activity, and exercise in chapters 10 and 11.

      Medication for Diabetes

      In addition to healthy eating and exercise, some people use pills to help manage their diabetes. These pills are called “oral diabetes medications” or “diabetes pills” because you take them by mouth instead of injecting them like insulin. In addition to pills, people with type 2 diabetes now have the option of taking injectable medications to lower their blood glucose.

      If needed, you and your health care provider will work together to find the best medication for your goals and lifestyle. Only your health care provider can prescribe these medications. You’ll find out more about these medications in chapter 12.

      Tips on Medication for Type 2 Diabetes

      • Generally, diabetes pills are only prescribed for people with type 2 diabetes.

      • At the time of diagnosis, your health care provider may prescribe a diabetes medication, as well as changes to meals and physical activity.

      • Not everyone with type 2 diabetes will be helped by diabetes pills. They are more effective in people who have had high blood glucose levels for less than 10 years.

      • They are more effective in people who eat healthy and who produce some insulin.

      Insulin

      Insulin used to be considered the last resort for people with type 2 diabetes. Now, we know that starting insulin early can help keep you healthier longer.

      For example, in the beginning (before you were even diagnosed) your body was becoming more and more resistant to insulin as your blood glucose levels remained high. Then, once you were diagnosed, and perhaps treated with diet and exercise or diabetes pills, your body became less resistant to insulin. Your meal plan or exercise, alone, may have been enough to keep your blood glucose levels under control.

      However, for many people, the body becomes more resistant to insulin over time. In fact, you are more likely to use insulin the longer you’ve had diabetes.

      It’s Not Failure

      It is a big step, but taking insulin does not mean that you have failed to take care of yourself or that your diabetes is worse. It simply means that your body needs more help to keep your blood glucose levels on track.

      Insulin Is Common for Type 2 Diabetes

      Around 30–40% of people with type 2 diabetes use insulin. If you take insulin, it doesn’t mean your diabetes has changed from type 2 to type 1. You don’t necessarily have type 1 diabetes just because you need insulin. Instead, you are one of many people with type 2 diabetes who uses insulin because it is a helpful treatment option.

      Tips for Getting Started

      • Find a health care provider who can help you with insulin instructions, injection techniques, and schedules.

      • Taking insulin can be intimidating. Find someone you can talk to about getting started. Often people say they wished they’d started taking insulin sooner because it gave them more energy.

      You’ll find more information about insulin and insulin plans in chapter 13. There are several different ways to begin taking insulin. You’ll work with your health care provider to develop an insulin plan that is best for you.

CHAPTER 5

      Gestational Diabetes

      • Early Symptoms and Tests

      • Causes and Risk Factors

      • Prevention and Precautions

      • Management and Treatments

      • Future Considerations

      Pregnancy is a time of possibility and excitement. You try to eat well and rest as much as possible. You may celebrate the baby’s anticipated arrival by decorating a nursery or purchasing new baby clothes. You imagine what kind of mother you’ll be to your son or daughter. The last thing you’ve probably been thinking about is getting diabetes. However, finding out you have gestational diabetes raises a lot of important questions. How will it affect you? How will it affect the baby? Will you have diabetes forever?

      This chapter will attempt to answer some of these initial questions. Women who manage their diabetes well during pregnancy can have healthy, normal babies. But it takes effort and planning. Work closely with your health care providers to come up with a strategy for managing your diabetes to keep you and the baby healthy during pregnancy.

      Gestational diabetes is the technical term for diabetes that develops during pregnancy. It only refers to women who have never had diabetes before and develop high blood glucose during pregnancy. It does not refer to women with preexisting type 1 or type 2 diabetes who become pregnant. Roughly 18% of pregnancies are affected by gestational diabetes, which means about 700,000 American women develop gestational diabetes each year.

Early Symptoms and Tests

      Gestational diabetes usually appears around the 24th week of pregnancy. This is when the hormones of pregnancy naturally begin to cause changes in how your body uses insulin (see more about hormones below). Women with gestational diabetes usually don’t experience any outward symptoms of the disorder. A test is the only way to diagnose gestational diabetes.

      Most women, except those at very low risk for gestational diabetes, will be tested between 24 and 28 weeks of pregnancy. Your health care provider will give you an oral glucose tolerance test to diagnose diabetes.

      Some women who are at very high risk for gestational diabetes