So You Have Diabetes - Now What?

Hearing the words “You have diabetes” can feel overwhelming. Don't panic! Take a deep breath and read on. Diabetes is manageable, and understanding what’s happening inside your body is the first step toward taking control.

What’s Going On Inside Your Body?

When we eat, food is broken down into three main macronutrients: carbohydrates, proteins, and fats (for more on this, check out my article on Nutrition 101: The Basics of Macros). Of these, carbohydrates are the body’s primary energy source. They’re broken down into glucose, a simple sugar that fuels our cells.

But glucose can’t enter your cells on its own — it needs help. That’s where insulin comes in. Think of insulin as the key that unlocks the door to your cells, allowing glucose to enter and be used for energy.

What Is Insulin Resistance?

Sometimes, our cells are exposed to too much insulin for too long. This can be as a result of a diet high in carbohydrates and processed sugars and being sedentary and overweight. Just like someone who stops responding to constant background noise, our cells begin to ignore insulin’s signal. This is called insulin resistance. It will now require a larger quantity of insulin to respond to the same carb load. When that happens, your pancreas has to make more and more insulin to get glucose into your cells.

Over time, the pancreas simply can’t keep up and blood sugar levels start to rise. This can be detected first as prediabetes, then, if no lifestyle intervention is made, can progress to diabetes. Elevated blood sugar doesn’t just float around harmlessly; it can damage blood vessels, leading to blockages and poor circulation.

Why Uncontrolled Diabetes Matters

Chronically high blood sugar can affect nearly every organ system, all having to do with damage to small blood vessels throughout the body. Some of the major complications of uncontrolled diabetes include:

• Retinopathy – damage to the eyes that can lead to vision loss

• Nephropathy – kidney damage that can progress to kidney failure

• Neuropathy – nerve damage causing numbness, tingling, or burning pain (often in the feet)

• Cardiovascular disease – plaque in the coronary (heart) arteries which can lead to angina and heart attack (Myocardial Infarction)

• Cerebrovascular disease – plaque in the cerebral (brain) arteries which can lead to stroke (Cerebrovascular accident)

• Peripheral vascular disease – poor circulation to the limbs leading to pain (claudication) when walking and non-healing wounds or ulcers – especially in the feet, sometimes leading to bone infection or amputation

Managing Diabetes and Preventing Complications

The key to preventing complications is keeping your blood sugar under control.

You can monitor your glucose levels at home using fingerstick checks or a wearable continuous glucose monitor (CGM). Your healthcare provider will also check your HbA1c, a blood test that reflects your average glucose over the past 3 months. A normal HbA1c is below 5.7%, prediabetes is 5.7%-6.4%, and 6.5% and higher is diagnostic of diabetes. For most diabetics, the goal is an HbA1c below 7%.

Treatment Options:

• Metformin is usually the first-line oral medication.

• If that’s not enough, other oral or injectable medications can be added.

• Some people eventually require insulin therapy.

But medication is only one part of the plan — what you eat matters enormously. Focus on whole, nutrient-dense foods: plenty of vegetables, lean proteins like fish and chicken/turkey, healthy plant fats from nuts and olive oil, and high-fiber carbohydrates such as whole grains, beans, and fruits in moderation. Limit refined carbs such as white bread, pasta, sugary snacks, soda, juice and desserts and processed foods, which cause sharp spikes in blood sugar. Regular physical activity is also very important and helps your body use insulin more effectively as well as use up the sugar you do eat.

In addition, keeping up with yearly diabetic screenings can help us detect complications early.

• All diabetics are advised to adhere to the following routine screenings

  • Annual dilated eye exam

  • Annual foot exam (with monofilament testing for nerve damage)

  • Annual urine microalbumin test (to detect early kidney disease)

Your doctor will likely also recommend you start a cholesterol lowering statin and a baby aspirin daily for heart disease and stroke prevention

The Bottom Line

Diabetes is a lifelong condition, but you are in the driver’s seat. With the right combination of medication, lifestyle choices, and regular checkups, you can prevent or delay complications and live a full, healthy life.

Your daily choices, especially what you eat and how active you are, have a powerful impact. Don’t rely on medications alone. Take charge, stay informed, and remember: You’ve got this.

Stay well,

Sandra Koehn, DO