More and more health plans realize that covering the cost of diabetes education and/or nutrition counseling (known as medical nutrition therapy) is beneficial. Medicare does cover both under Part B (outpatient services) and many other health plans do as well. The best advice is to contact your health plan to determine what Diabetes Self-Management Education and Support (DSMES) services they pay for. Put up a fuss if they say they don't!!

Here’s how to find a diabetes educator or diabetes education program in your area: 

• The American Diabetes Association (ADA) approves diabetes education programs around the US through an application and recognition process. Going to an ADA “Recognized Program” ensures that you receive quality diabetes education. You can find ADA Recognized Education Programs in your area online or by calling ADA at 1-800-DIABETES (1-800-342-2383). 
• The American Association of Diabetes Educators (AADE): Many diabetes educators belong to this professional organization. Diabetes educators may be nurses, nurse practitioners, dietitians, exercise physiologists, pharmacists, social workers, behavioral counselors, or psychologists. You’ll find diabetes educators working at the ADA Recognized Education Programs (mentioned above). AADE also has a process for accrediting diabetes education programs. Going to an AADE accredited program ensures that you receive quality diabetes education. To find an AADE accredited program go to AADE's website and then search for diabetes educators by your city and zip code.

As the saying goes, knowledge is power! The best way for you to learn about diabetes and take care of yourself now and for the long run is to get to know a diabetes educator or a group of educators at a diabetes education program. You'll find diabetes education programs at many large and small hospitals. Today there are also more and more independent diabetes educators in private practice and education programs are showing up in supermarkets, pharmacies and even online. This will become more common as technology provides us with virtual solutions to deliver diabetes education and support.

Ask your healthcare provider for a referral to a diabetes educator or diabetes education program (Alert: yes, you may need to ask.)

There are two excellent routes to finding a diabetes education program that is either recognized through the American Diabetes Association or accredited through the American Association of Diabetes Educators (AADE). This service is referred to by Medicare and some healthcare plans as Diabetes Self-Management Education and Support (DSMES) or Diabetes Self- Management Training (DSMT). The DSMES services you are eligible to receive will depend on what your health plan covers. Medicare covers DSMES as a Medicare benefit under Part B.

Here’s how to find a diabetes educator or diabetes education program in your area: 

• The American Diabetes Association (ADA) approves diabetes education programs around the US through an application and recognition process. Going to an ADA “Recognized Program” ensures that you receive quality diabetes education. You can find ADA Recognized Education Programs in your area online or by calling ADA at 1-800-DIABETES (1-800-342-2383). 
• The American Association of Diabetes Educators (AADE): Many diabetes educators belong to this professional organization. Diabetes educators may be nurses, nurse practitioners, dietitians, exercise physiologists, pharmacists, social workers, behavioral counselors, or psychologists. You’ll find diabetes educators working at the ADA Recognized Education Programs (mentioned above). AADE also has a process for accrediting diabetes education programs. Going to an AADE accredited program ensures that you receive quality diabetes education. To find an AADE accredited program go to AADE's website and then search for diabetes educators by your city and zip code.

If you can’t find a program through one of the routes above, contact your local hospital, ask your healthcare provider or ask other people with diabetes you know to recommend a nearby diabetes education program. 

Don't think about diabetes education as a one-time visit. Read what this says again, Diabetes Self-Management Education and Support. Yes, getting ongoing support is a very important aspect of taking care of your diabetes and yourself. 

You'll need both education and support as you strive to manage your diabetes.

To stay healthy and complications-free with diabetes for years to come you need to control your blood glucose levels day to day and over the years. Yes, easier said than done. To accomplish this requires careful attention to eating, physical activity and management of your glucose lowering medication. That means if your blood glucose levels aren't under control, work with your health care provider and diabetes educator to get and keep them under control.

Yes, over the years people with type 2 diabetes must progress their diabetes medications to match the progression of diabetes (translated that’s their dwindling supply of insulin). Learn more about this progression and what to do about it in my book Diabetes Meal Planning Made Easy.

Today we know that it takes more than managing glucose levels to stay healthy and complications-free over the years. Studies show that taking early action and being aggressive with your care to keep not just your glucose levels but also your blood lipids (fats) and blood pressure in target ranges over time is what’s critically important. Check out the glucose, lipid and blood pressure goals below. 

Target Ranges for Glucose, Lipids and Blood Pressure*

 *The American Diabetes Association recommends these  targets for most people with diabetes, however, there are exceptions. You and your health care providers should decide on which goals are right for you based on your individual situation, age and health.

** Hemoglobin A1C is a measure of blood glucose control over the past 2 to 3 months. Think of the A1C blood test as a video recording of all the ups and downs of your blood glucose during that time. 

If you are diagnosed with diabetes, get serious NOW! Don’t delay and don’t deny! Too many people don't realize that it is so important to take care of diabetes from day one to prevent and/or delay the complications of diabetes. 

Today we know from studies that taking early action and being aggressive with your care to keep your glucose, blood lipids (fats) and blood pressure in target ranges over time is what’s critically important to get and keep you healthy. Learn more about the large National Institutes of Health study in type 2 diabetes, called the Look AHEAD study that showed some benefits of early action and weight control over time. 

Target Ranges for Glucose, Lipids and Blood Pressure*

*The American Diabetes Association recommends these  targets for most people with diabetes, however, there are exceptions. You and your health care providers should decide on which goals are right for you based on your individual situation, age and health.

Most people with diabetes have type 2 diabetes (about 90%). Many people with type 2 diabetes are overweight (at least 80%). Therefore early on the most important thing to do is loose a few pounds and keep as many of those lost pounds off as you can. Learn more about what it takes: The Truths about Keeping Pounds at Bay.

Today there is no such thing as a diabetic diet. Eating to control diabetes is simply healthy eating. What’s not so simple is doing it!

Learn more about why there’s no longer one specific Diabetic Diet in Got Diabetes? Needless or Necessary to Follow a Diabetic Diet?.

For easy to follow advice to eat healthier, check out my book Diabetes Meal Planning Made Easy.

Another key to getting and keeping blood glucose under control is to become more physically active. This burns glucose and calories and helps you reduce diabetes symptoms. It also helps decrease insulin resistance, a common thread in type 2 diabetes. Learn more in Insulin Resistance, Weight Gain and Type 2 Diabetes: Connect the Dots.  

Current guidelines recommend that most people with type 2 diabetes need to take at least one glucose lowering medication. Most recommendations suggest starting with the medication metformin which helps decrease insulin resistance. Remember, what's most important is that you keep your blood glucose, lipids and blood pressure in control over the years (see these goals in the table above).  

If you have type 1 diabetes, you need to become knowledgeable about how food affects your blood glucose levels. Most people with type 1 and those with type 2 diabetes who take insulin use a method of meal planning called carbohydrate counting. To learn more about carbohydrate counting check out my book Complete Guide to Carb Counting.

Whether you have type 1 or type 2 diabetes consider partnering up with a diabetes educator to learn how to balance food, insulin and physical activity. Learn how to find a diabetes educator or diabetes education program. Contact me if you'd like to schedule a consultation.

Diabetes, whether type 1, type 2 is actually quite easy to diagnose. A diagnosis can generally be made based on one or more blood tests for glucose (blood from a vein, not a finger) and/or an A1C test (see definition below). 

If you have risk factors for diabetes (type 2) (see below) or think you have diabetes get your numbers checked by a healthcare provider. According to the American Diabetes Association, if you’re over 45, regardless of any risk factors, you should get your A1c or glucose level tested annually. If you’re younger than 45, overweight and have other risk factors (see below), get your A1c or glucose tested annually. If you’re at high risk (see risk factors below), follow up with your healthcare provider. Get tested and know for sure. 

Hemoglobin A1C is a measure of blood glucose control over the past 2 to 3 months. Think of the A1C blood test as a video recording of all the ups and downs of your blood glucose during that time. Since 2010 the American Diabetes Association and other diabetes organizations around the globe consider the A1C test the preferred measure to diagnose diabetes because it provides a better picture of glucose ups and downs over time. A1C is also used to monitor how diabetes is being managed.   

Type 2 Diabetes and Prediabetes Risk Factors: 

• Above 45 years old
• Family history of type 2 diabetes (parent, brother or sister)
• Member of an ethnic group with increased risk: African American,  Hispanic/Latino, Asian American or Pacific Islanders, American Indian or Alaska Native
• Diagnosed with gestational diabetes or given birth to a baby weighing more than 9 pounds
• Diagnosed with high blood pressure (hypertension)
• Live a sedentary lifestyle
• Overweight or obese (BMI > 25 or > 23 in Asian Americans)
• Smoke cigarettes
• Snore loudly, brief pauses in breathing during sleep, poor quality sleep and/or been told you have sleep apnea

Blood Glucose and A1C Numbers Used to Diagnose Diabetes and Prediabetes (see notes below)

Notes: These numbers do not apply to pregnant women and for the diagnosis of gestational diabetes. If the results from one test are not convincingly indicative of the diagnosis, then a repeat test should be done on a different day. 

*Hemoglobin A1C is a measure of blood glucose control over the past 2 to 3 months. Think of the A1C blood test as a video recording of all the ups and downs of blood glucose during that time. Since 2010 the American Diabetes Association and other diabetes organizations around the globe consider the A1C test the preferred measure to diagnose diabetes because it provides a better picture of glucose ups and downs over time. A1C is also used to monitor how diabetes is being managed.

Reference: American Diabetes Association, Standards of Medical Care for Diabetes – 2015. 

Keep in mind there is no such thing as "borderline diabetes" or a "touch of sugar"- either you have diabetes or you don't. Get tested, know for sure. You may have prediabetes. Learn more about prediabetes.

People diagnosed with type 1 diabetes most often develop symptoms of diabetes prior being diagnosed and their blood glucose levels can get quite high prior to being diagnosed. The common diabetes symptoms are: thirst, frequent urinating, hunger, weight loss and tiredness. 

For people diagnosed with type 2 diabetes it is quite common to not have any symptoms of diabetes at diagnosis. It’s important to note that a person diagnosed with type 2 diabetes has likely had progressively elevated blood glucose levels (in the range for prediabetes – see chart above) for many years prior to being diagnosed. Learn more in Insulin Resistance, Weight Gain and Type 2 Diabetes: Connect the Dots . If you need assistance with weight loss and knowing what and what not to eat with diabetes check out my book Diabetes Meal Planning Made Easy.

If you think you’re at risk for or have diabetes get tested as soon as possible. 

If you have diabetes, take it seriously! Take action now!