Steps to Take When Your Diabetes Treatment No Longer Seems to Be Working


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It’s likely you’ve gotten into a rhythm when it comes to managing your type 2 diabetes (T2D). Yet, between your medication and lifestyle habits, treatment isn’t always a “set it and forget it” type of approach. While some people may be fine on a management plan for years or even decades, others may need to readjust from time to time.

Catching issues early so you can make a pivot in your treatment is particularly important for older adults. “For those over age 50, having uncontrolled blood sugar can be more dangerous than for younger adults,” says Pouya Shafipour, M.D., a family and obesity medicine specialist at Providence Saint John’s Health Center in Santa Monica, California. “That’s because it can cause more damage in the kidneys and other organs for these patients, and that’s hard to reverse. Because of that, it’s important to stay aware of how treatment is affecting you, rather than assuming that because it’s worked in the past, it will always work.”

Signs you need a switch

Larger blood-sugar fluctuations would be the biggest sign that you need to change your type 2 diabetes treatment, says Dr. Shafipour. But it’s not the only one. He adds that these should also be on your radar:

  • Numbness in the hands and feet
  • Changes in vision
  • Swelling in the legs, ankles, and feet
  • Frequent headaches
  • Slower wound healing than usual
  • Fatigue that doesn’t improve with rest
  • Dry mouth and skin
  • Increased thirst
  • Frequent urination
  • Feeling hungry even though you’ve just eaten

One aspect of less-managed treatment can be gastrointestinal (GI) difficulties, which may seem unrelated to your T2D but could actually be a sign that treatment needs to be changed, according to Mark Tanchel, M.D., a gastroenterologist at Gastroenterology Associates of New Jersey in Hackensack.

“Gastroparesis is the most common GI issue with diabetes,” he says. “This involves delay of emptying the stomach, which can result in feeling overly full after eating. You may also have nausea, bloating, and abdominal pain.” Other GI difficulties encountered may include frequent diarrhea or acid reflux, each of which would require looking at different treatment options to alleviate.

What to do about them

When you start noticing signs that your treatment needs to be changed, begin tracking those symptoms as soon as possible, suggests Dr. Shafipour. Be specific about what symptoms you’re seeing, even if you feel they’re not connected to your type 2 diabetes. Write down any other aspects of your day that may be influencing those symptoms. That could include feeling bloated right after eating, for instance, or having numbness in your hands only when you lie down for a nap.

Along with logging those symptoms, make an appointment with your healthcare provider, and be clear about the purpose of your visit from the start. For example, instead of asking for a checkup, tell the scheduler that you’d like to be seen in order to talk about changing your treatment. That way, the physician will know in advance what type of conversation you’ll be having, Dr. Shafipour says. “This will make the appointment more efficient, because the doctor will have a heads-up about what to cover. In some cases, it will allow the provider, and in some cases, allow the provider to go into the appointment with some other treatment options in mind,” he adds.

Ultimately, you are the most important member of your diabetes care team. You’re the one who lives with the condition every day and only you know how you feel.

If your healthcare provider has a system that allows you to download documentation, ask the office if they’d like a copy of your symptoms in advance. This might help your provider decide if you need a referral as part of your appointment. For example, Dr. Shafipour says signs like blurred vision may prompt a visit to an ophthalmologist.

Before the appointment, prioritize your symptoms if you have several, he adds. It’s helpful for a provider to know what seems to be the biggest concern, especially if it’s interfering with your everyday activities.

Start the conversation

Even when you’ve provided information in advance and made the appointment based on changing your treatment option, be clear and straightforward. Consider phrases like:

  • “I’ve been noticing new symptoms over the past couple of weeks, and wanted to talk about whether my treatment is no longer working effectively.”
  • “I feel like my diabetes was managed well in the past, but recently it hasn’t felt like that, so I wanted to discuss possible changes in my treatment plan.”
  • “Even though I’ve followed my treatment as usual, I’m beginning to be concerned about certain symptoms and wanted to hear if changing my treatment would resolve those.”

Ultimately, you are the most important member of your diabetes care team. You’re the one who lives with the condition every day and only you know how you feel. You should be the one making decisions about what might work best to help you manage your type 2 diabetes.

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