Traditionally, treatment of type 2 diabetes went something like this:
You're diagnosed and told to "watch your sugar," or you're told to lose weight and come back in a month, or three months. When you do, usually little has changed, because watching your sugar or trying to lose weight when you've been trying to lose weight for decades but haven't succeeded doesn't do much for most people.
Today things have improved a bit, and you're usually prescribed a blood glucose (BG) meter and told to test a few times a day. But you're not told what to do with that data. If your BG levels have been very high, you might be given some medication right away. And then you're told to come back in a month or two. You might be told to go to diabetes education classes and to see a dietician, or you might not.
When you return for the second visit, you're basically told the same things: lose weight, exercise more, and test a couple of times a day, with no real instruction about what to do with the test results.
I'd like to propose a new paradigm for type 2 diabetes treatment, one that emphasizes intensive testing in the early days after diagnosis, then tapering off as you gain understanding of the disease.
Here's how my plan would work:
1. At the first meeting, you would be told your starting A1c, told what it represents, and given the normal range of A1c, which would be your target. Then you would be given a meter and enough strips to test just twice a day and told to test fasting and two hours after your largest meal of the day. All this information would be written down and handed to you as you left, because you might not remember it. Most of us are so shocked by the diagnosis that we're in a sort of fog for a while.
Of course this isn't intensive, but I think most people are in too much shock right away to do much else to begin with. You might be told to stick with your current diet for a couple of days, testing after meals, so you'd see what happens when you eat the way you've been eating. Then you'd be asked to reduce calories, reduce carbs, reduce fats and notice what changes occurred.
2. Month 2. At the second meeting, about a month later (if you felt you were ready for this earlier, that would be scheduled), you'd start the intensive part of the treatment, with the help of a certified diabetes educator (CDE). First you'd be asked if you were willing to do a little work in order to gain control over your diabetes. The CDE would explain that it would involve a lot of record keeping, but if you used the results to modify your diet and exercise patterns in the way that worked best for you, you might be able to avoid taking drugs, or you might have to take fewer drugs than if you didn't do so.
The CDE would provide you with a continuous glucose monitor. Your insurance would pay a small rental fee for the monitor, as well as paying for a month's worth of sensors. The CDE would show you how to insert the sensor for the monitor and would instruct you to write down everything you ate, every bit of exercise you did, and every stressful event or sickness that occurred during the month.