Your first month with a new diagnosis
The appointment was twenty minutes and the list felt endless. Most of it does not have to happen this week.
The appointment took about twenty minutes. You came out with a piece of paper, possibly a prescription, and the clear impression that your life is supposed to look different by Monday.
Nobody handed you a plan for the next four weeks. A lot of information arrived at once, some of it frightening, and the parts you remember are probably not the parts that matter most.
So here is the thing that rarely gets said in the room. Almost nothing has to change this week. The first month is for getting your footing.
Nothing you did last week caused this
Type 2 diabetes means sugar stays higher in your blood than it should, because your body is not making enough insulin or is not responding to it as well as it used to. Prediabetes is the same story, earlier and milder.
It is not a punishment for dessert. Family history, age, ancestry, sleep, long stretches of stress, some medications and where your body tends to store fat all feed into it, and none of those are a decision you made on a Tuesday.
That matters practically, not just emotionally. People who believe they caused this tend to either overhaul everything for three weeks and quit, or avoid the whole subject. Neither one helps your numbers.
A diagnosis is information about your body. It is not a verdict on your character.
The short list for the first month
Genuinely short.
- Fill the prescription, if you were given one, and take it the way it was written.
- Find out what your numbers actually were. Your A1C, your blood pressure, and whether kidney and cholesterol tests were done. Ask for a copy of the results, or find them in your health record. You will be comparing everything to these for years.
- Book the follow-up. Most people are seen again within a few months to see how things are moving.
- Ask how, and whether, you should be checking at home. Some people are given a meter, some a sensor, some neither. What is right depends on your medication, not on how motivated you are.
- Make one change to how you eat. One.
That is the month. Everything else on the internet can wait for you.
What can wait
Eye screening and a foot exam belong on your list, and both are usually arranged in the months after a diagnosis rather than the week of it. Your care team will tell you when.
The gym membership can wait. So can emptying the pantry, deciding your permanent position on bread, buying a scale that talks to your phone, and reading a forum at one in the morning. None of those is the reason anyone’s numbers improve.
The change that works is the one still running in November. A ten minute walk after supper, a different drink, a breakfast with some protein in it: pick something you would still do on a bad week, and let it be boring.
If you were given a prescription
Metformin is the usual first medication for type 2 diabetes in Canada. The stomach upset it can cause in the first couple of weeks is common, usually settles, and is often better with food or with the slow release form. If it is bad enough that you are thinking about stopping, tell your prescriber or pharmacist first. There is nearly always something to adjust, and stopping quietly means nobody knows.
Some people start on insulin or a sulfonylurea such as gliclazide, glyburide or glimepiride. Those can bring your blood sugar too low, so ask directly what a low feels like, what to carry, and what to do about alcohol and skipped meals.
Whatever you were given, the dose is a decision for the person who prescribed it. Bring your readings and your side effects to that conversation instead of adjusting anything on your own.
The part nobody schedules
Most people feel something in the first month, and it is rarely one clean feeling. Relief that there is finally a name. Anger. Embarrassment. A sort of low grade dread about the future that is hard to say out loud to family who are being encouraging.
All of that is ordinary, and it is worth saying to your care team, because it changes what help is useful to you. A person who is frightened needs different support than a person who is bored.
Worth a word with your care team
Message your team, or call, if you are drinking and urinating far more than usual, losing weight without trying, seeing blurry, or feeling exhausted in a way that is new. Those can mean your blood sugar is running high enough to need attention now rather than at the follow up.
Go to emergency, or call 911, for nausea and vomiting with stomach pain, breathing that is fast and deep, drowsiness that is hard to shake, or breath with a fruity smell. That combination can mean diabetic ketoacidosis, which is uncommon in type 2 diabetes but does happen, and it can occur even when readings are not very high in people taking an SGLT2 inhibitor such as empagliflozin, dapagliflozin or canagliflozin. Chest pain or pressure, sudden weakness on one side, or trouble speaking are also 911, diagnosis or not.
If you take insulin or a sulfonylurea and you have shakiness, sweating, confusion or sudden hunger, treat the low first, then tell your team. Repeated lows are a reason for your prescriber to look at the dose.
One small place to start
Write down three things on the back of the paper you were given: your A1C, your blood pressure, and the date of your next appointment. If you do not know one of them, that is your first question.
If you are a 360Care member, message your care team in the app with those three things and one sentence about what you are most worried about. We will start there rather than at the beginning of a textbook.