Newly Diagnosed Diabetes: What Should Happen Next?

“I have been reading a lot about diabetes and I am so confused and overwhelmed.”

Yes. When you are new to diabetes it is a verbal onslaught. We spend about an hour with a new diabetes consultation, and even with that much time people leave a little glazed over, because there is so much to learn. So let me tell you what I tell every patient with newly diagnosed diabetes on day one.

Key takeaways

It takes three to six months to understand diabetes and feel in control of it, and nobody absorbs it in one appointment.
A new diabetes consultation at my practice is about an hour long and covers weight, waist and neck circumference, blood pressure, a full medication history, what you eat and how you move.
Nobody should leave a diagnosis with only a prescription: diabetes education, nutritional counseling and sensor training are the foundation, and nobody leaves my office without that process started.
A continuous glucose monitor alone, even with no new medication, lets patients change their own behavior and improve A1C by up to two percent, a range otherwise matched only by insulin.
A1C is a three month average that hides variability; a sensor’s GMI predicts your A1C over seven or fourteen days and shows the swings that damage eyes, kidneys and nerves.

How long does it take to understand your diabetes?

Realistically, three to six months from a new diabetes diagnosis. That is how long it takes to understand the disease, the way it progresses, what to do about it, and to feel comfortable and in control enough to adapt as your needs change.

That is okay. It takes time, it takes repetition, and it takes a team that is willing to work together on your behalf. Nobody absorbs this in one appointment, and nobody should be expected to.

If this is the question you came in with, it is the one we answer in your first hour here. New patients are seen within two weeks and you do not need a referral. Call or text (817) 380-4880.

I was diagnosed and given nothing except a prescription. Is that normal?

Being diagnosed with diabetes and handed only a prescription is incredibly common, and it should not be. I ask every new patient three questions. When were you diagnosed? Have you ever needed insulin? And did anyone give you diabetes education when they diagnosed you? My anecdotal estimate is that ninety percent or more answer no to that third question.

That is the most fundamental thing you were not given. Understanding how the disease works, why it progresses, and how to work around it is the crux of your success, and that is not something a prescription gives you.

Nobody leaves my office without either having had diabetes education or having the process started to get it. That covers understanding the condition, nutritional counseling, learning to use a continuous glucose monitor, and insulin pump training if that is what you need. There are now programs that arrange this education across the country and work with insurance, so lack of access is no longer a reason to skip it.

What is the single most useful tool for newly diagnosed diabetes?

The single most useful tool after a new diabetes diagnosis is a continuous glucose monitor. If we did nothing else, no new medication, no formal education, and simply let you see what is happening to your blood sugar in real time as it happens, you can modify your own behavior and improve the A1C by up to two percent!

What else is that good? Insulin. Insulin is that powerful, and a sensor gets into the same range by showing you what your own choices do.

So we send almost everyone home with a sensor at least once. It is your chance to run experiments. Test the foods you love and see what they do. Test a different way of eating the same food. Test the foods you believe are healthy, because some of them are not actually good for your blood sugar, and now you will know.

What should happen at a first diabetes appointment?

A first diabetes appointment with us is an hour of your time, and this is what the hour contains. We measure weight, waist circumference, neck circumference and blood pressure. We go through every medication you have used before, whether it caused problems, and exactly what happened. We talk about what you actually eat, and about exercise.

What does breakfast look like? What does dinner look like? What exercise do you enjoy, what have you been doing, and what limits you? If we do not know these things, we cannot hope to improve them.

And I tell every new patient the same thing. The more you do for you, the less I will ever have to do to you. Fewer medications, fewer complications, fewer hospital visits, less money spent. That is a good deal.

Then we talk about comprehensive care, because diabetes is not an exercise in lowering sugar or fixing an A1C or restricting carbohydrates. It touches a lot of systems. Controlling blood pressure, cholesterol and vascular risk is as much my job as the glucose. So is protecting bone. So is treating weight, primarily as a way to improve insulin sensitivity when weight is part of the problem.

What questions should I ask at the diabetes clinic?

Ask these four questions at any diabetes clinic, whatever type you have.

Where can I get diabetes education?
What is the best route for me to a dietitian and a diabetes educator?
Can I have a sensor, so I can see what is happening in real time?
And which medications are right for me, given everything else in my history?

That last one matters because this is not one size fits all. Chronic kidney disease, for example, rules certain drugs out. We have a whole closet of diabetes medications to choose from, and the right one depends on you.

What is the difference between my A1C and my daily readings?

Your A1C is a three month average of overall control. Daily readings show variability, which A1C hides and which matters a great deal. People whose blood sugar rides a roller coaster are at far higher risk of damage to the eyes, kidneys and nerves than people with the same average and stable numbers.

A sensor such as a Dexcom or a Libre gives you a figure called the GMI, which is its best prediction of what your A1C would be over the period you are looking at, seven days, fourteen days, whichever you choose. So you always have context. Seventy five percent of the time in range, stable, predicted A1C of 6.2. That is a good report, and you can see it the day it happens rather than three months later.

What should be checked besides blood sugar?

Besides blood sugar, everything diabetes touches should be checked, and that is head to toe, from mental health to the nerves in your feet. The American Diabetes Association issues new standards of care every January, and it is a book, pages and pages of what to check and why.

Mental health and burnout.
Eye health.
Dental health.
Heart health.
Waistline, blood pressure and cholesterol.
Bone mass, because diabetes impairs normal bone metabolism.
Nerves, which means you are entitled to a diabetic foot examination at least once a year and more often if needed.

If I neglect any one of those, I am not providing comprehensive diabetes care. And comprehensive care is what every patient with diabetes deserves.

Where this leaves you

Three to six months to understand this, and that is normal. Education first, because the understanding is the crux of your success. A sensor as early as possible, because seeing your own blood sugar in real time does as much as insulin. And comprehensive care, head to toe, because diabetes touches far more than the number on the meter.

If you were handed a prescription and nothing else, you are not getting that yet.

See your own numbers, not a guess. Your first diabetes visit here is an hour, and you leave with a sensor plan and an education plan, not just a prescription. $400, first follow up included, no referral. To book your consultation, call or text (817) 380-4880.

Frequently asked questions

How long does it take to get diabetes under control after diagnosis?

Three to six months to understand the disease, how it progresses, what to do about it, and to feel in control of it. That is normal. It takes repetition and a team willing to work together on your behalf, not a single appointment.

What should I expect at my first diabetes appointment?

About an hour. Weight, waist and neck circumference and blood pressure, a full medication history, a conversation about what you actually eat and how you move, a plan for diabetes education, and usually a glucose sensor to take home.

What is the first thing to do with newly diagnosed diabetes?

Get a continuous glucose monitor and diabetes education. Seeing your blood sugar in real time lets you change your own behavior, and that alone can improve A1C by up to two percent. Understanding how the disease works and why it progresses is the crux of your success.

What is the difference between A1C and GMI?

A1C is a lab test averaging three months of control. GMI is the sensor’s prediction of your A1C over the period you select, seven days, fourteen days, whichever you choose, available immediately, and it shows variability that A1C hides.

What should be checked besides blood sugar in diabetes?

Blood pressure, cholesterol, kidneys, eyes, teeth, bone density, nerves including an annual foot examination, weight and waist, and mental health. All of it is part of comprehensive diabetes care, and the American Diabetes Association updates its standards of care every January.

Do I need an endocrinologist for type 2 diabetes?

Not always, but if you were diagnosed and handed a prescription with no education, no sensor and no plan, you are not receiving comprehensive care, and a direct care endocrinology practice does not require a referral.