Dear Ms. Deen:

Now that the dust has settled and the world knows you’ve had type 2 diabetes for a few years I want to offer you (and millions like you new to type 2 diabetes) a dose of support and words of wisdom as a diabetes educator and dietitian who, shall we say, has a few years under her belt. 

First, let me encourage you to close your ears to all the advice (and criticism) you’ve received, free of charge, since coming out about your type 2. These “advisors” clearly don’t know much about YOUR diabetes, YOUR medical situation or, to be downright honest, much about type 2 diabetes and today’s treatments.

Second, let me offer you a virtual hug and pat on the back. Thank you for letting the world know about your type 2 diabetes. Too many people deny they have type 2 and remain in denial during the precious years in which taking action to slow down the disease progression is SO critical (more about that below). 

I know you can do what it takes to control your diabetes. You’ve tackled much bigger mountains in your life! I encourage you to (if you haven’t already) seek out the expertise and support of diabetes educators as you travel this journey. They’ll  offer you plenty of hugs, support and up to date knowledge. Learn about diabetes educators and where to find them.  

For support from others with diabetes who walk in your shoes, tip your toes into the DOC – the Diabetes  Online Community. You’ll get more virtual hugs and a boatload of practical advice to manage your diabetes day to day. For starters check out the folks engaged in Diabetes Advocates.

Third, let me say it’s a changed world out there when it comes to managing diabetes in 2012 and it will continue to change. We’ve learned so much about why and how type 2 develops. We now know that diabetes is not simply a problem of glucose that is too high with not enough insulin to lower it. We know that your blood glucose didn’t just one day become high enough to be diagnosed with type 2 diabetes. No, your body was working at developing type 2 for 5, 10 years before your diagnosis. You likely had prediabetes which went unrecognized. As you know you’re in the company of millions.

At the center of the storm in this progression towards type 2 diabetes (when glucose steadily rises and the insulin you make isn’t able to keep up with the large amounts you need), is insulin resistance and chronic inflammation. Yes, new concepts, new knowledge!  What’s good for you to know is that the earlier after your diagnosis you take action to actively manage your diabetes the healthier you’ll be for years to come.

By the time most people are diagnosed with type 2 their pancreas has been in overdrive for years (5 to 10 as noted) trying to make enough insulin to keep their blood glucose in control. At the point most people are diagnosed with type 2, they’ve lost half or more of their insulin making capacity. That’s why current recommendations from American Diabetes Association suggest that most people with type 2 should start on a glucose lowering medication at diagnosis. Now this isn’t the type of medications your great aunts and grandparents were on. There’s a slew of new meds. For most people the first choice is metformin. It does a good job treating insulin resistance, is easily tolerated (if started and progressed slowly) and is available as a generic, so it’s relatively inexpensive.

You and your healthcare provider chose Victoza, a relatively new medication. Victoza is given as a daily injection (as you well know). (You also know it is not insulin.) Victoza is in the growing category of medications known as GLP-1 analogs.

These medications replace a hormone (glucagon-like peptide 1 [GLP-1]) which is one of a group of hormones released in the small intestine. This hormone has been found to be waning in people with diabetes. Victoza and other drugs in this category, like Byetta and Bydureon (just approved by FDA 1/27/12) work in a few ways. They increase insulin production (so they can only work if you still make insulin), slow the rise of blood glucose after eating because it slows down the pace that foods travel through your gut, decreases hunger and appetite and in many people assists with weight loss (wouldn’t that be nice!). 

You’ve definitely taken heat over taking Victoza (oh yes, and being a Novo Nordisk spokesperson). This is where I suggest closing your ears! What’s great news today is that we have many more ways to help you control your blood glucose and there’s just not ONE cookbook approach (sorry for the analogy, but I knew you could relate) to manage type 2.

Overtime you need to find the mix of healthy eating, physical activity and medication(s) that work best for you to control your glucose, lipids and blood pressure within the ideal target ranges at that time. Doing this is what will keep you healthy for years to come.

We now know that type 2 diabetes will progress over time. You will need to progress your glucose lowering medications over time to continue to keep your numbers in the target zones. This may mean taking more Victoza or adding another glucose lowering type of medication. YOU and YOUR healthcare providers will decide what’s best and when.  

Now to your food choices and eating habits. People have really piled on about what you should and shouldn’t eat and why you haven’t dramatically changed your food choices. Personally I think your idea of implementing moderation is spot on. Making easy changes just like you’ve done substituting unsweetened iced tea for sweetened is a great first step. If you were drinking enough of it, then this substitution can make a big difference in your glucose and weight.

For next steps, take a look at YOUR eating habits now. What’s going to be the easiest change for you to make? Is it eating a bit smaller portions of meats, starches and fats? Do you need to fit in a few more fruits and vegetables into your meals or snacks? There’s no longer a “diabetic diet.” We’re talking about healthier eating. We know that if you lose 5, 10, 15 pounds early on (and keep it off) it can work wonders to lower your glucose and crank back up your body’s sensitivity to the insulin you continue to make. Plus it can slow the progression of type 2. 

And your walks on the treadmill….keep them up. Getting daily exercise does a world of good to help lower your glucose and increase your insulin sensitivity. Plus exercise offers many more benefits. 

Last but not least, take it slow. Make your lifestyle changes one at a time…just like you are doing. Take one day at a time. Don’t beat yourself up for not being perfect. You are human. Keep in mind that knowledge is power (let me candidly recommend two of my books published by ADA Real Life Guide to Diabetes and Diabetes Meal Planning Made Easy – they’re perfect for people with type 2).

Ask questions and keep learning. Diabetes care is rapidly changing. New advances happen daily. Seek and get the support you need. The daily grind of taking care of diabetes is NOT easy, but you of all people can be successful. You’ve got a lot of life in you and ahead of you, that’s for sure. Keep smiling and let those blue eyes sparkle!