Self-care each day may help determine how you feel and how you stay healthy in the long term. Monitoring your blood sugar is one of the most important things you can do to manage diabetes.

Some people may need to check a couple of times a day, while others may choose to check their blood sugars more frequently. You may choose to poke your finger for a small blood drop to check your blood sugar on a small handheld meter, or you may opt for a continuous glucose monitor that provides a more complete picture of how your glucose levels are fluctuating throughout the day.

People who need to check their blood sugar more often include those who:. You can read more about how blood sugars or glucose levels play a part in your diabetes management and understand what glucose goals may be best for you to discuss with a healthcare team.

Your healthcare team may suggest one or more medications to help you manage T2D. These medications may include:. A healthcare team may also prescribe other common medications for T2D. Lifestyle changes are an essential way to manage diabetes.

These changes may include exercise, maintaining a moderate weight, and eating a healthy and nutritious diet. You may work with a doctor who specializes in diabetes and a dietitian who can help you plan your meals. At the end of the day, you may spend a lot of time buying healthy foods, planning meals, and cooking.

Because of the work that goes into meal planning , getting support and guidance can be helpful. Some general recommendations for healthy eating with diabetes include:. Managing diabetes and making lifestyle changes can come with a learning curve.

Working with diabetes educators can help you make better choices that may help you better manage T2D. Some of the skills diabetes educators can help you learn may include :. A doctor may refer you to a diabetes self-management education and support service, or you can find one with the American Diabetes Association tool.

You may need to work with a healthcare team to figure out a diabetes care plan that works best for you. A care plan will likely include different items such as blood sugar management, medications that may help you manage your diabetes, food choices, exercise plans, and mental health considerations.

Diabetes may worsen mental health, and untreated mental health issues may make your diabetes management more difficult.

People who have diabetes are times more likely to have depression , and only one-quarter to one-half of the population seek help. Getting help and support can help you cope with the stress that can come with self-care.

Research from points to the benefits of receiving emotional and psychological help, including improvement in diabetes management in the short term as well as preventing diabetes complications in the long term.

A healthcare team can help you manage T2D through office visits, routine medical testing, lifestyle education, nutritional advice, or counseling. You have the most power concerning your diabetes management. Learning and using T2D self-care is the best way to stay healthy.

Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. Type 2 diabetes is a serious condition, but you can manage it with treatment.

Is it possible for it to be reversed? Learn the facts. People 45 years and older have a higher risk of developing type 2 diabetes, but more and more young people are being diagnosed with diabetes.

If you know someone living with type 2 diabetes, you can offer support, comfort, and kindness in a number of ways. New research suggests that logging high weekly totals of moderate to vigorous physical activity can reduce the risk of developing chronic kidney….

Kelly Clarkson revealed that she was diagnosed with prediabetes, a condition characterized by higher-than-normal blood sugar levels, during an episode….

New research has revealed that diabetes remission is associated with a lower risk of cardiovascular disease and chronic kidney disease.

Type 2…. A Quiz for Teens Are You a Workaholic? How Well Do You Sleep? Health Conditions Discover Plan Connect. When our to-do list seems endless, our excuses help us brush it off. After all, many household tasks can wait, but this tactic is dangerous if you have diabetes.

When unmanaged, diabetes can lead to blindness, heart disease , kidney failure, limb amputation and premature death. You can reduce your risk for complications and improve your health with these seven self-care tips.

Be realistic with your goals and how to achieve them. Look to family members, friends and your diabetes care team for support. Balance your diet with fruits, lean proteins, low-fat dairy, nonstarchy vegetables and whole grains. Get regular checks of your blood pressure , blood sugar, cholesterol, eyes, feet and weight.

Follow healthy behaviors, see your doctor regularly for needed tests, quit smoking or vaping, and brush and floss daily.

Each week, get at least minutes of moderate aerobic activity and reduce sedentary behaviors.

Learn More. When our to-do list seems endless, our excuses help us brush it off. After all, many household tasks can wait, but this tactic is dangerous if you have diabetes. When unmanaged, diabetes can lead to blindness, heart disease , kidney failure, limb amputation and premature death.

You can reduce your risk for complications and improve your health with these seven self-care tips. Be realistic with your goals and how to achieve them. Look to family members, friends and your diabetes care team for support.

The health care team and others support the adoption and maintenance of daily self-management tasks 8 , 40 , as many people with diabetes find sustaining these behaviors difficult.

They need to identify education and other needs expeditiously in order to address the nuances of self-management and highlight the value of ongoing education. Table 6 provides details of DSMES at this critical time. Annual assessment of knowledge, skills, and behaviors is necessary for those who achieve diabetes treatment targets and personal goals as well as for those who do not.

Primary care visits for people with diabetes typically occur every 3—6 months These visits are opportunities to assess all areas of self-management, including laboratory results, and a review of behavioral changes and coping strategies, problem-solving skills, strengths and challenges of living with diabetes, use of technology, questions about medication therapy and lifestyle changes, and other environmental factors that might impact self-management It is challenging for primary care providers to address all assessments during a visit, which points to the need to utilize established DSMES resources and champion new ones to meet these needs, ensuring personal goals are met.

See Table 5 for indications for referral. Possible barriers to achieving treatment goals, such as financial and psychosocial issues, life stresses, diabetes-related distress, fears, side effects of medications, misinformation, cultural barriers, or misperceptions, should be assessed and addressed.

People with diabetes are sometimes unwilling or embarrassed to discuss these problems unless specifically asked 62 , Frequent DSMES visits may be needed when the individual is starting a new diabetes medication such as insulin 64 , is experiencing unexplained hypoglycemia or hyperglycemia, has worsening clinical indicators, or has unmet goals.

Importantly, diabetes care and education specialists are charged with communicating the revised plan to the referring provider and assisting the person with diabetes in implementing the new treatment plan.

The identification of diabetes-related complications or other individual factors that may influence self-management should be considered a critical indicator of the need for DSMES that requires immediate attention and adequate resources.

The diagnosis of other health conditions often makes management more complex and adds additional tasks onto daily management. DSMES addresses the integration of multiple medical conditions into overall care with a focus on maintaining or appropriately adjusting medication, meal plans, and physical activity levels to maximize outcomes and quality of life.

In addition to the need to adjust or learn new self-management skills, effective coping, defined as a positive attitude toward diabetes and self-management, positive relationships with others, and enhanced quality of life are addressed in DSMES services 16 , The progression of diabetes can increase the emotional and treatment burden of diabetes and distress 65 , It has a greater impact on behavioral and metabolic outcomes than does depression Diabetes-related distress is responsive to intervention, including DSMES-focused interventions 68 and family support However, additional mental health resources are generally required to address severe diabetes-related distress, clinical depression, and anxiety It is important to recognize the psychological issues related to diabetes and prescribe treatment as appropriate.

Throughout the life span many factors such as aging, living situation, schedule changes, or health insurance coverage may require a re-evaluation of diabetes treatment and self-management needs see Tables 5 and 6.

They may also include life milestones: marriage, divorce, becoming a parent, moving, death of a loved one, starting or completing college, loss of employment, starting a new job, retirement, and other life circumstances.

Changing health care providers can also be a time at which additional support is needed. DSMES affords important benefits to people with diabetes during transitions in life and care. Providing input into the development of practical and realistic self-management and treatment plans can be an effective asset for successful navigation of changing situations.

The health care provider can make a referral to a diabetes care and education specialist to add input to the transition plan, provide education and problem solving, and support successful transitions. The goal is to minimize disruptions in therapy during any transition, while addressing clinical, psychosocial, and behavioral needs.

Additionally, MNT helps prevent, delay, or treat other complications commonly found with diabetes such as hypertension, cardiovascular disease, renal disease, celiac disease, and gastroparesis. MNT is integral to quality diabetes care and should be incorporated into the overall care plan, medication plan, and DSMES plan on an ongoing basis 1 , 40 , 69 — 72 Table 8.

Although basic nutrition content is covered as part of DSMES, people with diabetes need both initial and ongoing MNT and DSMES; referrals to both can be made through many electronic health records as well as through hard copy or faxed referral methods see Supplementary Table 1 for specific resources.

Everyday decisions about what to eat must be driven by evidence and personal, cultural, religious, economic, and other preferences and needs 69 — The entire health care team should provide consistent messages and recommendations regarding nutrition therapy and its importance as a foundation for quality diabetes care based on national recommendations Despite the proven value and effectiveness of DSMES, a looming threat to its success is low utilization due to a variety of barriers.

In order to reduce barriers, a focus on processes that streamline referral practices must be implemented and supported system wide. Once this major barrier is addressed, the diabetes care and education specialist can be invaluable in addressing other barriers that the person may have.

Without this, it will be increasingly difficult to access DSMES services, particularly in rural and underserved communities. With focus and effort, the challenges can be addressed and benefits realized.

The Centers for Disease Control and Prevention reported that only 6. This low initial participation in DSMES was also reported in a recent AADE practice survey, with most people engaging in a diabetes program diagnosed for more than a year These low numbers are seen even in areas where cost is less of a barrier because of national health insurance.

Analysis of National Health Service data in the U. This highlights the need to identify and utilize resources that address all barriers including those related to health systems, health care providers, participants, and the environment. In addition, efforts are being made by national organizations to correct the identified access and utilization barriers.

Health system or programmatic barriers include lack of administrative leadership support, limited numbers of diabetes care and education specialists, geographic location, limited or lack of access to services, referral to DSMES services not effectively embedded in the health system service structure, limited resources for marketing, and limited or low reimbursement rates DSMES services should be designed and delivered with input from the target population and critically evaluated to ensure they are patient-centered.

Despite the value and proven benefits of these services, barriers within the benefit design of Medicare and other insurance programs limit access. Using Medicare as an example, some of these barriers include the following: hours allowed in the first year the benefit is used and subsequent years are predefined and not based on individual needs; a referral is required and must be made by the primary provider managing diabetes; there is a requirement of diabetes diagnosis using methods other than A1C; and costly copays and deductibles apply.

A person cannot have Medicare DSMES and MNT visits either face to face or through telehealth on the same day, thus requiring separate days to receive both of these valuable services and possibly delaying questions, education, and support.

Referrals may also be limited by unconscious or implicit bias, which perpetuates health care disparities and leads to therapeutic inertia.

To address these barriers, providers can meet with those currently providing DSMES services in their area to better understand the benefits, access, and referral processes and to develop collaborative partnerships.

Participant-related barriers include logistical factors such as cost, timing, transportation, and medical status 34 , 77 , 78 , For those who avail themselves of DSMES services, few complete their planned education due to such factors.

Underutilization of services may be because of a lack of understanding or knowledge of the benefits, cultural factors, a desire to keep diabetes private due to perceived stigma and shame, lack of family support, and perceptions that the standard program did not meet their needs and is not relevant for their life, and the referring providers may not emphasize the value and benefits of initial and ongoing DSMES 34 , 79 , 80 , Health systems, clinical practices, people with diabetes, and those providing DSMES services can collaborate to identify solutions to the barriers to utilization of DSMES for the population they serve.

Creative and innovative solutions include offering a variety of DSMES options that meet individual needs within a population such as telehealth formats, coaching programs, just-in-time services, online resources, discussion groups, and intense programs for select groups, while maximizing community resources related to supporting healthy behaviors.

Credentialed DSMES programs as well as individual diabetes care and education specialists perform a comprehensive assessment of needs for each participant, including factors contributing to social determinants of health such as food access, financial means, health literacy and numeracy, social support systems, and health beliefs and attitudes.

This allows the diabetes care and education specialist to individualize a plan that meets the needs of the person with diabetes and provide referrals to resources that address those factors that may not be directly addressed in DSMES. It is best that all potential participants are not funneled into a set program; classes based on a person-centered curriculum designed to address social determinants of health and self-determined goal setting can meet the varied needs of each person.

Environment-related barriers include limited transportation services and inadequate offerings to meet the various cultural, language, and ethnic needs of the population.

Additionally, these types of barriers include those related to social determinants of health—the economic, environmental, political, and social conditions in which one lives The health system may be limited in changing some of these conditions but needs to help each person navigate their situation to maximize their choices that affect their health.

It is important to recognize that some individuals are less likely to attend DSMES services, including those who are older, male, nonwhite, less educated, of lower socioeconomic status, and with clinically greater disease severity 84 , Further, studies support the importance of cultural considerations in achieving successful outcomes 84 — Solutions include exploring community resources to address factors that affect health behaviors, providing seamless referral and access to such programs, and offering flexible programing that is affordable and engages persons from many backgrounds and living situations.

The key is creating community-clinic partnerships that provide the right interventions, at the right time, in the right place, and using the right workforces Several common payment models and newer emerging models that reimburse for DSMES services are described below.

For a list of diabetes education codes that can be submitted for reimbursement, see Supplementary Table 2 Billing codes to maximize return on investment ROI in diabetes care and education.

CMS has reimbursed diabetes education services billed as diabetes self-management training since 40 , In order to meet the requirements, DSMES services must adhere to National Standards for Diabetes Self-Management Education and Support and meet the billing provider requirements 40 , Ten hours are available for the first year of receiving this benefit and 2 h in subsequent years.

Any provider physician, nurse practitioner, PA who is the primary provider of diabetes treatment can make a referral; there is a copay to use these services. CMS also reimburses for diabetes MNT, which expands access to needed education and support.

Three hours are available the first year of receiving this benefit and 2 h are available in subsequent years. A physician can request additional MNT hours through an MNT referral that describes why more hours are needed, such as a change in diagnosis, medical condition, or treatment plan.

There are no specific limits set for additional hours. There is no copay or need to meet a Part B deductible in order to use these services. Many other payers also provide reimbursement for diabetes MNT Reimbursement by private payers is highly variable.

Many will match CMS guidelines, and those who recognize the immediate and longer-term cost savings associated with DSMES will expand coverage, sometimes with no copay. With the transition to value-based health care, organizations may receive financial returns if they meet specified quality performance measures.

Diabetes is typically part of a set of contracted quality measures impacting the payment model. Health systems should maximize the benefits of DSMES and factor them into the potential financial structure. There are reimbursable billing codes available for remote monitoring of blood glucose and other health parameters that are related to diabetes.

The use of devices that can monitor glucose, blood pressure, weight, and sleep allow the health care team to review the data, provide intervention, and recommend treatment changes remotely. Sample referral forms that provide the information required by CMS and other payers for referral to DSMES and MNT are available along with reimbursement resources see Supplementary Tables 1 and 2.

These or similar forms can be embedded into an electronic health record for easy referral. Health systems and clinical organizations can maximize billing potential by facilitating the reimbursement process, ensuring all applicable codes are being utilized and submitted appropriately.

This usually requires support from those who frequently work with health care codes such as staff in billing and compliance departments.

Shared medical appointments can be performed with DSMES and they are reimbursable medical visits. This Consensus Report is a resource for the entire health care team and describes the four critical times to refer to DSMES services with very specific recommendations for ensuring that all adults with diabetes receive these benefits.

Diabetes is a complex condition that requires the person with diabetes to make numerous daily decisions regarding their self-management. DSMES delivered by qualified personnel using best practice methods has a profound effect on the ability to effectively undertake these responsibilities and is supported by strong evidence presented in this report.

DSMES has a positive effect on clinical, psychosocial, and behavioral aspects of diabetes. DSMES provides the foundation with ongoing support to promote achievement of personal goals and influence optimal outcomes.

Despite proven benefits and demonstrated value of DSMES, the number of people with diabetes who are referred to and receive DSMES is significantly low 73 — Barriers will not disappear without intentional, holistic interventions recognizing the roles of the entire health care team, individuals with diabetes, and systems in overcoming issues of therapeutic inertia The increasing prevalence of type 2 diabetes requires accountability by all stakeholders to ensure these important services are available and utilized.

health care system has changed with increased attention on primary care, technology, and quality measures DSMES services that directly connect with primary care are effective in improving clinical, psychosocial, and behavioral outcomes 92 — A variety of culturally appropriate services need to be offered in a variety of settings, utilizing technology to facilitate access to DSMES services, support self-management decisions, and decrease therapeutic inertia.

This article is being published simultaneously in Diabetes Care DOI: The authors would like to acknowledge Mindy Saraco Managing Director, Scientific and Medical Affairs from the ADA for her help with the development of the Consensus Report and related meetings and presentations, as well as the ADA Professional Practice Committee for providing valuable review and feedback.

The authors acknowledge the invited peer reviewers who provided comments on an earlier draft of this report: Christine Beebe Quantumed Consulting, San Diego, CA , Anne L.

Burns American Pharmacists Association, Alexandria, VA , Amy Butts Wheeling Hospital at the Wellsburg Clinic, Wellsburg, PA , Susan Chiarito Mission Primary Care Clinic, Vicksburg, MS , Maria Duarte-Gardea The University of Texas at El Paso, El Paso, TX , Joy A.

Dugan Touro University California, Vallejo, CA , Paulina N. Duker Health Solutions Consultant, King of Prussia, PA , Lisa Hodgson Saratoga Hospital, Saratoga Springs, NY , Wahida Karmally Columbia University, New York, NY , Darlene Lawrence MedStar Health, Washington, DC , Anne Norman American Association of Nurse Practitioners, Austin, TX , Jim Owen American Pharmacists Association, Alexandria, VA , Diane Padden American Association of Nurse Practitioners, Austin, TX , Teresa Pearson Innovative Health Care Designs, LLC, Minneapolis, MN , Barb Schreiner Capella University, Pearland, TX , Eva M.

Vivian University of Wisconsin, Madison, WI , and Gretchen Youssef MedStar Health, Washington, DC. Duality of Interest. is on an advisory board of Eli Lilly. is the treasurer for the American Academy of Nurse Practitioners Certification Board of Commissioners and Vice President of the American Nurse Practitioner Foundation.

reports receiving an honorarium from ADA as an Education Recognition Program auditor and is a participant in a speakers bureau sponsored by Abbott Diabetes Care and Xeris.

reports being a paid consultant of Diabetes — What to Know, Arkray, and DayTwo. reports being a participant in speakers bureaus sponsored by Boehringer Ingelheim, Novo Nordisk, and Xeris. reports research grant funding from Becton Dickinson.

has received honoraria from ADA. No other potential conflicts of interest relevant to this article were reported. Author Contributions.

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Medical Nutrition Therapy as a Core Component of Quality Diabetes Care. Identifying and Addressing Barriers. Article Information. Article Navigation. Consensus Reports June 11 Powers ; Margaret A. Corresponding author: Margaret A.

Powers, margaret. powers parknicollet. This Site. Google Scholar. Joan K. Bardsley ; Joan K. Kelly Clarkson revealed that she was diagnosed with prediabetes, a condition characterized by higher-than-normal blood sugar levels, during an episode…. New research has revealed that diabetes remission is associated with a lower risk of cardiovascular disease and chronic kidney disease.

Type 2…. A Quiz for Teens Are You a Workaholic? How Well Do You Sleep? Health Conditions Discover Plan Connect.

Type 2 Diabetes. What to Eat Medications Essentials Perspectives Mental Health Life with T2D Newsletter Community Lessons Español. Type 2 Diabetes Self-Care: Blood Sugar, Mental Health, Medications, and Meals.

Medically reviewed by Kelly Wood, MD — By Jennifer M. Edwards on September 7, Importance of T2D self-care Blood sugar Most common medications Food choices Getting diabetes education Mental health Takeaway The focus in managing type 2 diabetes includes blood sugar monitoring, taking your prescribed medications as needed, and working with a healthcare team on food choices, exercise planning, and mental health.

Why is type 2 diabetes management important? How often should you check your blood sugar with type 2 diabetes? What should your blood sugar levels be?

Was this helpful? Most common type 2 diabetes medications. What foods should you eat with type 2 diabetes? Do I need diabetes education?

Developing a diabetes care plan You may need to work with a healthcare team to figure out a diabetes care plan that works best for you. What kind of mental health and psychosocial support is available? How we reviewed this article: Sources. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations.

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Learn about the basics of diabetes, and get tips on how meal planning, exercise, proper medication and coping strategies can help you live well.

Learn More. When our to-do list seems endless, our excuses help us brush it off. After all, many household tasks can wait, but this tactic is dangerous if you have diabetes.

When unmanaged, diabetes can lead to blindness, heart disease , kidney failure, limb amputation and premature death. You can reduce your risk for complications and improve your health with these seven self-care tips.

Be realistic with your goals and how to achieve them. DSMES programs provide both education and ongoing support to control and manage diabetes. These programs help people learn self-management skills and provide support to sustain self-management behaviors.

DSMES programs have helped people with diabetes lower blood sugar glucose levels, prevent complications, improve quality of life, and reduce healthcare costs.

The Stanford Diabetes Self-Management program is an evidence-based approach designed to improve diabetes self-management practices, and delivered by certified educators.

While it is important for people with diabetes to develop and engage in self-management practices, self-management can also involve family members, friends, or other caregivers. These individuals can offer emotional support, model healthy behaviors, participate in exercise activities, help monitor blood sugar glucose levels, administer insulin or other medications, and open communication around effective self-management practices.

Enhanced social support from family and friends can help build self-efficacy for diabetes self-management. Self-efficacy, related to diabetes self-management, is an individual's belief in their ability to successfully manage their own health needs.

Self-efficacy is important for effective diabetes self-management. It is important that patients understand the benefit of diabetes self-management activities.

Programs can encourage healthcare providers to speak openly with patients about self-management and refer patients to self-management programs. Patients with diabetes should be encouraged to ask questions and be reminded that these activities can help them to achieve successful disease management.

Diabetes Self-Management Education and Support in Rural America Website An overview of the benefits of diabetes self-management programs. Describes different types of diabetes self-management education and support programs available to communities.

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Type 2 diabetes mellitus adult. Mayo Clinic; Wexler DJ. Initial management of hyperglycemia in adults with type 2 diabetes mellitus. Diabetes and women. Planning for sick days. Diabetes: Managing sick days. Castro MR expert opinion. Mayo Clinic.

Hypoglycemia low blood glucose. Blood glucose and exercise. Riddell MC. Exercise guidance in adults with diabetes mellitus. Colberg SR, et al. Palermi S, et al.

The complex relationship between physical activity and diabetes: An overview. Journal of Basic and Clinical Physiology and Pharmacology. Take charge of your diabetes: Your medicines.

Sick day management for adults with type 1 diabetes. Association of Diabetes Care and Education Specialists. Alcohol and diabetes. Diabetes and nerve damage. Roe AH, et al. Combined estrogen-progestin contraception: Side effects and health concerns. Products and Services The Mayo Clinic Diet Online A Book: The Essential Diabetes Book.

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