Every person with diabetes is unique, so each treatment plan is individualized — what’s best for one person may not be ideal for another. “Nothing about diabetes is one size fits all,” says Chauntae Reynolds, PharmD, CDCES, a spokesperson for the Association of Diabetes Care & Education Specialists based in Indianapolis. “There are so many different components that go into selecting a plan that’s appropriate for one person, such as lifestyle, culture, and financial situation,” she says. That said, knowing where you stand and how your overall plan stacks up can be an important predictor of success. People with diabetes who honed their self-management skills — the ability to carry out day-to-day lifestyle habits that help control blood sugar, as well as being informed and part of the decision-making process — had a more marked decrease in A1C levels compared with control groups, according to a review of 118 interventions published in June 2016 in the journal Patient Education and Counseling. It helps to look at the big picture and consider how you and your healthcare team are ensuring your plan works for you and changing it when needed. Here’s how to assess your current plan and what to look for in a future one.
1. You should feel like you’re part of a team.
Shared decision-making isn’t just a buzzword; it’s essential in a good diabetes plan. “Shared decision-making is where 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. It’s a less authoritative way of interacting with your doctors and helps empower you as a patient. “Your provider can then say, ‘These are the medications we have, based on your disease and lifestyle, and let’s talk about the pros and cons to determine what will be best for you,’” adds Reynolds.
2. Your plan should honor your background.
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. “We have to meet patients where they are,” says Reynolds. “If rice is a staple in their diet, for example, we have to think about how we can keep that food in their diet while making sure it doesn’t cause as high of blood sugar spikes.” Same goes for religion. For instance, she notes, “Some patients are focused on the power of prayer to improve their health, and we want to make sure we as providers don’t minimize what’s important to them. We should add it into the overall treatment plan.”
3. Your plan should be individualized.
You are the expert on you, says Josie Bidwell, DNP, an associate professor at The University of Mississippi School of Medicine in Jackson. “Healthcare providers are experts about the physiology of how medications work, but people are the experts on what they feel like they can do or have access or the means to acquire and do,” she explains. For example, Bidwell might recommend moving toward a whole-food, plant-based diet. If a patient is currently eating a standard American diet, which includes a lot of meat and processed foods, then there is a lot of work that has to be done to get there. “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 about what they think about 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 regards to stress management and getting the sleep they need. “Until we address barriers, sustainable change doesn’t happen,” Bidwell adds.
4. Your plan shouldn’t focus only on the number on the scale.
Weight loss can be an important part of a type 2 diabetes management plan, but if you’ve heard a blanket recommendation to lose weight without any instruction on how to get there or a sole focus on weight loss, then you should think about if that’s working for you. “It’s quite clear that there is a relationship between [being] overweight or obese and metabolic disorders,” says Bidwell. “As you lose weight, blood sugar and blood pressure comes down.” But using the number on the scale as the measure of success doesn’t often lead to sustainable change, she says. Instead, what’s important is a provider who will engage with you about non–weight related goals. Think out 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? Take a vacation and walk to see the sights? That’s what’s motivating, says Bidwell.
5. Your fears and worries should be addressed.
What if you have anxiety about needles and your provider prescribes an injectable medication? Rather than dismissing that fear, your provider should take it seriously, dig into it more, and help you come up with a plan that accommodates your needs. The ideal plan should allow for adjustments, made by working with your doctor, that incorporate changes that make it okay for you, says Reynolds.
6. The plan should be clear and easy to understand.
The funny thing about doctor’s offices is that you might go in, they might talk to you, you might nod your head in agreement, and then you leave and sit in your car, not knowing what to do next. “I ask patients to repeat our plan back to me before they head out the door,” says Bidwell. If your provider doesn’t do this, then before you go, say, “To be clear, our plan is …” and repeat back what you heard. “We want to make sure that we’re all working from the same playbook,” says Bidwell. Last but not least, you should be able to trust your doctor and feel comfortable telling them the truth, such as finding it tough to stick with your type 2 diabetes treatment plan. “I might talk to someone and say, ‘I know it’s difficult to test your blood sugar three times per day. How often are you able to test?’” says Reynolds. Being able to have a conversation with your doctor about challenges you are experiencing can make it easier to address where tweaks need to be made 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, 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 the reason treatment may not be working may have to do with 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 — the underlying reasons should be examined. Having a doctor you can trust and talk to, as well as a type 2 diabetes treatment plan that follows the ideal strategies mentioned above, can be a winning combination for you.
