Starting a New Diabetes Treatment? 12 Essential Questions to Ask Your Doctor

Managing your blood sugar levels is crucial when dealing with diabetes. Your family doctor may recommend medication to balance your sugar, and each option can have side effects. The treatment plan might involve adding a new medication, either in pill form or as an injection in gradually increasing doses. New instructions may also include dietary changes, increased physical activity, and changes in the frequency of blood sugar tests to assess treatment impact. It is crucial to manage your diabetes effectively right from diagnosis. It is wise to set desired balance targets and timelines, striving to achieve them.

If your current treatment is working well or if you have lost weight, your doctor might stop or change your previous treatment. Regardless of what the new treatment involves, there are several questions to consider:

1. What side effects may be associated with my medications?

If you're taking new medications, you might experience new side effects ranging from dizziness to changes in digestive system function. If you notice new symptoms, your doctor can help determine if they are a result of the new medications and advise you on how to address them. Many side effects also subside over time. If you're starting on medications that can cause low blood sugar levels, make sure to ask your clinic team what symptoms to watch for and what actions to take if you experience low blood sugar levels.

2. Will the side effects subside?

In many cases, side effects diminish over time. However, if they remain severe after a reasonable period, ask your family doctor when you can expect improvement or when you should consider alternative treatments.

3. Are my blood sugar levels normal?

Assuming you regularly monitor your blood sugar levels, you should share the results with your doctor. Ask if your blood sugar levels are balanced and within the normal range for you. Check if you've reached the values set as your desired goals. If sugar levels aren't optimal, ask your doctor what additional steps you can take to stabilize them.

4. How often should I check my blood sugar levels?

When starting a new treatment, your doctor may want you to check your blood sugar levels more frequently during the day in the following period. However, if your blood sugar levels aren't well-controlled, you might need to continue checking them often. Frequent glucose monitoring is known to be associated with better glucose control. Patients required to frequently monitor their glucose can benefit from continuous glucose sensors like "Freestyle Libre," allowing them to easily scan their glucose levels using a mobile app at any moment without the need for pricking. The continuous glucose monitoring sensor is attached to the arm and measures interstitial fluid glucose levels, with levels displayed on your screen along with trend arrows and an eight-hour glucose level graph. Continuous monitoring allows the treatment team to understand sugar balance better, detect consistent patterns, and adjust treatment more effectively. It's important to note that recently, the health basket committee approved subsidizing the Freestyle Libre for Type 2 diabetics who inject insulin multiple times a day.

5. What are the signs that my blood sugar levels are too high or too low?

Some diabetes medications can lead to a drop in blood sugar levels, known as "hypoglycemia" (falling below a blood sugar level of 70 mg/dL), which manifests with the following symptoms:

• Heart palpitations
• Anxiety
• Hunger
• Sweating
• Irritability
• Fatigue
• If untreated, hypoglycemia can lead to serious complications such as:
• Clumsiness,
• Confusion
• Seizures
• Loss of consciousness

High blood sugar, known as "hyperglycemia," often goes unnoticed, especially if blood glucose levels are routinely elevated. Symptoms that may appear in cases of hyperglycemia include:

• Frequent urination
• Increased thirst and hunger
• Blurred vision
• Fatigue
• Cuts and wounds that do not heal
• Extended hyperglycemia can lead to chronic complications, such as eye damage, nerve damage, kidney problems, and general damage to both large and small blood vessels.

6. What are my A1c levels and how do they influence my progress?

Your blood A1c level (glycated hemoglobin) is an important measure of how well your sugar levels are balanced. The A1c indicator represents the average blood glucose levels over about three months. Generally, your A1c level should be 7 percent or less. However, your doctor might aim for a lower or higher value depending on your age, overall health, and other factors. It's essential to know your target A1c value. If you aren't informed, ask your doctor. It's recommended to check your A1c level three months after starting new treatment and then every six months after reaching your A1c target.

It's important to note that in certain patient groups, A1c isn't a good representative indicator of sugar balance. This includes patients who suffer from diseases affecting hemoglobin levels like chronic anemia, iron deficiency, hemoglobinopathy disorders, and conditions like kidney failure. Additionally, patients with significant fluctuations in glucose levels (frequent "hypoglycemia" and "hyperglycemia" conditions) may show a relatively normal A1c due to it being an average measure, but in reality, they may not be balanced, suffering from both high and low sugar levels alternately, leading to a potentially wrong conclusion of good balance.

7. Should I change my diet or exercise plan?

Both diet and exercise significantly influence blood sugar levels, making them an essential part of the treatment plan. The family doctor will often refer you to a nutritionist to tailor your nutrition plan to the treatment goals and personal preferences. Changes in diet and lifestyle habits require continuous care and monitoring, so it's important to maintain regular follow-up. Monitoring results after meals can help you and your nutritionist understand how different foods affect your glucose levels and make adjustments to your menu.

8. Can my cholesterol levels and blood pressure be checked?

Maintaining healthy lipid levels and blood pressure is an important part of a good diabetes treatment plan. According to the American Heart Association, diabetes is a risk factor for cardiovascular diseases, and patients with diabetes are required to maintain lower "bad" cholesterol levels, LDL, than people without diabetes. High blood pressure is also a common risk factor for people with diabetes, potentially increasing the risk of certain complications.

9. Can you check my feet?

Diabetes is known to cause silent damage to the feet, especially if your blood sugar levels are not controlled. High blood sugar can hasten foot damage, including:

• Nerve damage
• Foot deformities
• Foot ulcers that won't heal
• Blood vessel damage, leading to poor blood flow in your legs

Ask your doctor to check your feet at each visit and conduct a comprehensive check at the annual mark after starting new treatment to ensure your feet are healthy. If you have any foot problems or injuries, consult your doctor immediately.

10. Will I ever be able to stop the treatment?

Diabetes is a chronic condition that usually requires lifelong treatment. In some cases, diabetes treatment may be temporary. If lifestyle changes such as a healthier diet, regular physical activity, and significant weight loss succeed, you may be able to stop taking or reduce certain medications. Additionally, with the help of innovative treatments, some patients can simultaneously reduce insulin doses and sometimes even stop insulin injections altogether.

11. Should I test my kidney function?

Diabetes can lead to kidney damage, which is often asymptomatic, especially in the early stages. Therefore, after several months of new treatment, it is recommended to request your doctor to order a kidney function test including urine protein.

12. Get more involved: Engage as much as possible in managing the disease. The more you understand the condition and its treatment, the more effectively you can succeed in controlling diabetes, meaning you can live a long and healthy life like anyone else. Today it is certainly possible.

Remember

Diabetes is a chronic disease that can evolve or change over time. Diabetes treatment is personal and unique to each patient. Treatment types may change over the years with changes in disease patterns, according to other medical factors, nutrition, and lifestyle. Therefore, it is essential to maintain continuous and regular contact with your family doctor, monitor sugar levels and balance status, and treat accordingly.

Professor Julio Weinstein, Head of the Diabetes Unit at Wolfson Medical Center and Senior Diabetes Physician at theDMC Diabetes Treatment Center