When you go to a new doctor for the first time, you need to be prepared to learn as much as you can in the typically short office visit. Some people recommend that you go to your first appointment with a list of 19 or 20 questions to ask the doctor. Because getting answers to that many questions would take hours, be sure to ask your most important ones first.
A typical appointment with a doctor in the U.S. is 20.5 minutes, according to a 2015 study. But consider yourself lucky if your appointment is even that long.
In February 1994, a VA Clinic doctor told me that I had type 2 diabetes. I didn’t know a thing about it and started to ask questions. But he cut me off after I asked my first or second one. He told me that my 14 minutes were up.
Furthermore, don’t be surprised if your doctor takes five or 10 minutes to answer your questions. In my experience, doctors have shared details that I wasn’t yet ready to deal with or understand.
So you must take an active role in the conversation. Make it a dialogue, not a monologue.
This makes your first question by far the most important one. If you want to avoid taking drugs as much as possible, your first priority has to be finding out whether your doctor will support your low-carb diet.
Not all doctors have given up their fear of fat, but we need to eat plenty of it for energy when we follow a low-carb diet of little starch or sugar. Too much starch and sugar will raise your blood glucose so high that you will probably get some serious diabetes complications.
But at first, a low-carb diet usually isn’t enough. So the second point that you and your doctor will need to discuss is what diabetes medication to take.
If you have type 1 diabetes, taking insulin will always be essential. If you have type 2 diabetes, at first you also will probably need to take insulin. Or maybe another diabetes drug.
Above normal is dangerous
You need the help of one of these drugs because quickly managing your blood glucose is crucial. Every day that your glucose is above normal, you increase your risks of complications. Two large studies, the Diabetes Control and Complications Trial and the United Kingdom Prospective Diabetes Study, demonstrated this.
Generally, our doctors will first prescribe metformin to people with type 2 diabetes. This is the most common diabetes drug because it works, has one of the best safety profiles, and is inexpensive.
Insulin works fastest
But insulin works much faster than any other diabetes drug. Some doctors and clinics prescribe insulin first to people with type 2 diabetes. The result has been a powerful effect in a short time.
I told William Polonsky, Ph.D., about the fear some people have of being hooked on diabetes drugs when I interviewed him recently. He seemed surprised at my statement.
A fire is burning
A long-term goal of managing type 2 diabetes without drugs may be great, Dr. Polonsky told me. “But whatever you can do now, do it because there’s a fire burning when you are in an unsafe place. You need to do something about that.”
Only after you bring your glucose level down to normal do you have the luxury of managing diabetes without drugs. But the key ways to do this — getting down to a normal weight, eating fewer carbohydrates, and becoming more active — all take time. As much as I wanted to manage diabetes without drugs, it took me 13 or 14 years to get there.
You also need to make sure that you have enough time during your first appointment to discuss the third question: which blood glucose meter do you recommend?
This is the only gadget that you need to help you manage diabetes. You can buy it over-the-counter, but you can usually save money when you get a prescription for it and for test strips. You will likely have a choice of two or more systems, so ask your doctor which one he or she recommends.
How to use it
These three questions are your crucial first steps in managing diabetes. But if your doctor hasn’t told you yet that your time is up, the next most important question is how to use the meter. This includes asking your doctor when you should check your blood glucose level and what to do if it’s too high or low.
Your doctor probably won’t have enough time to tell you all you need to know about how to use your meter. So to answer this question and others that you have about glucose testing, be sure to read my previous articles, especially the ones linked below.
After the visit
Finally, scheduling a follow-up appointment is important to discuss any questions that come up during your treatment. Make sure to have additional questions ready for your next visit, too.
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David Mendosa is a journalist who learned in 1994 that he has type 2 diabetes, which he now writes about exclusively. He has written thousands of diabetes articles, two books about it, created one of the first diabetes websites, and publishes the monthly newsletter, “Diabetes Update.” His very low-carbohydrate diet, current A1C level of 5.1, and BMI of 19.8 keep his diabetes in remission without any drugs. He can be found on Twitter @davidmendosa and on Facebook at David Mendosa.
David Mendosa was a journalist who learned in 1994 that he had type 2 diabetes, which he wrote about exclusively. He died in May 2017 after a short illness unrelated to diabetes. He wrote thousands of diabetes articles, two books about it, created one of the first diabetes websites, and published a monthly newsletter, “Diabetes Update.” His very low-carbohydrate diet, A1C level of 5.3, and BMI of 19.8 kept his diabetes in remission without any drugs until his death.