Diabetes Management in Troy, MI

Understanding diabetes

Diabetes develops when the body makes too little insulin or does not use it effectively, allowing glucose (blood sugar) to build up. Over time, it can harm the eyes, kidneys, nerves, heart, and feet. Treatment and regular follow-up reduce these risks.

Possible symptoms include thirst, frequent urination, fatigue, blurred vision, unexplained weight loss, slow-healing sores, or tingling feet. Type 2 diabetes may have no symptoms for years.

The American Diabetes Association recommends screening from age 35, or earlier for adults with overweight or obesity and additional risk factors. Testing is usually repeated at least every 3 years if normal, and sooner when risk is higher. Symptoms warrant assessment at any age.

How diabetes is diagnosed

These laboratory thresholds apply outside pregnancy. Pregnancy uses different testing criteria. Home meters and CGM sensors do not establish a diabetes diagnosis.

On a phone, swipe across the table to see all results.

A random laboratory plasma glucose of 200 mg/dL or higher can diagnose diabetes when accompanied by classic symptoms, such as thirst, frequent urination, and unexplained weight loss, or a hyperglycemic crisis. Without clear symptoms or a crisis, two abnormal results are needed: repeat testing or two different abnormal tests.

Anemia, blood loss or transfusion, some hemoglobin variants, pregnancy, and other conditions can affect A1C accuracy. Your clinician will choose the appropriate test.

Healthy eating with diabetes

Eating well with diabetes does not mean giving up every food you enjoy. Aim for balanced meals that support blood sugar and heart health while fitting your culture, budget, and routine. There is no single diet or carbohydrate target that works for everyone.

Build a balanced plate

Start with a plate about 9 inches across:

• Half: nonstarchy vegetables, such as cucumber-tomato salad, broccoli, green beans, or zucchini.
• One quarter: lean protein, such as fish, skinless chicken, eggs, or tofu.
• One quarter: carbohydrate foods, such as rice, bulgur, whole-grain bread, potatoes, or beans.

Beans and lentils provide both protein and carbohydrates. Fruit, milk, and yogurt also contribute carbohydrates and should be included in your meal plan.

Watch portions, not just sugar

Carbohydrates affect blood sugar even when a food does not taste sweet. Choose fiber-rich foods such as oats, whole-grain bread, beans, lentils, and brown rice more often.

Rice and pita can still fit. If you eat both at one meal, use smaller portions of each instead of a full serving of both. Whole-grain choices offer more fiber, but portions still matter.

On food labels, check the serving size and Total Carbohydrate, not only sugars. Your clinician or dietitian can help set a carbohydrate target based on your medicines, activity, and glucose patterns.

Choose heart-healthy foods and drinks

A Mediterranean-style eating pattern is one option: emphasize vegetables, beans, whole grains, fish, nuts, and olive oil. Choose poultry or plant proteins more often than processed meats and red meat.

Use modest amounts of olive oil instead of butter. Flavor meals with lemon, garlic, herbs, and spices, and limit foods high in sodium or saturated fat.

Choose water, unsweetened sparkling water, or unsweetened tea or coffee. Limit regular soda, sweetened tea, sports drinks, and sugary coffee drinks.

Whole fruit can be part of your meal plan. Choose it more often than juice and include its portion in your carbohydrate plan. Juice used to treat low blood sugar is different from an everyday beverage choice.

Personalize your plan safely

Before fasting, skipping meals, or sharply reducing carbohydrates, review your medicines with your care team. See low blood sugar and medication safety below.

If you have chronic kidney disease, protein, sodium, potassium, phosphorus, and fluid recommendations depend on kidney function and treatment. Avoid starting a high-protein diet without individualized advice.

How diabetes medicines work

The options below mainly treat type 2 diabetes and do not replace insulin in type 1. Choice depends on glucose levels, heart and kidney health, weight, side effects, cost, and your preferences.

This is an overview, not a complete list of medicines or side effects. Follow your prescribed plan, including sick-day instructions. Ask in advance which medicines to pause before surgery or when you cannot eat or drink normally. Do not stop essential insulin on your own.

When is insulin needed?

Insulin replaces or supplements what the pancreas makes. It is essential in clinical type 1 diabetes and may also be needed in type 2 diabetes. Needing insulin is not a personal failure.

• Very high glucose or symptoms: insulin may be considered with A1C above 10%, glucose of 300 mg/dL or higher, marked thirst or urination, or unexplained weight loss. These are clinical decision points, not instructions to start insulin yourself.
• When other treatment is insufficient: insulin can be added if individualized goals are not reached. For many people with type 2 diabetes without severe hyperglycemia, a GLP-1-based treatment is considered before insulin.
• Special situations: illness, surgery, steroid treatment, or pancreatic disease may increase insulin needs. During pregnancy, insulin is the preferred medicine when medication is needed; care is coordinated with the pregnancy team.

We review insulin technique, glucose patterns, and low-glucose episodes during follow-up. Ask about rescue glucagon and a sick-day plan. Some people with type 2 diabetes can later reduce or stop insulin under supervision; people with type 1 need ongoing insulin. Endocrinology referral may be appropriate for complex care.

Continuous glucose monitoring: FreeStyle Libre 3 and Dexcom G7

Our practice uses continuous glucose monitoring (CGM), including FreeStyle Libre 3 and Dexcom G7, when appropriate. A small wearable sensor estimates glucose in the fluid beneath the skin and sends readings to a compatible phone or reader/receiver.

CGM provides a view of glucose patterns throughout the day and night. It can help reveal after-meal rises, overnight changes, and episodes of low glucose that occasional finger-stick checks may miss.

We can review your glucose reports during follow-up to guide treatment decisions. Device choice depends on clinical needs, compatibility, availability, and insurance coverage. Sharing CGM data does not mean that the office monitors it continuously or provides emergency alerts.

Using CGM safely

Keep a blood glucose meter available. If sensor readings do not match how you feel, or the device instructs you to check, use a finger-stick measurement and follow your care plan and the manufacturer’s instructions. CGM measures glucose; it does not deliver insulin by itself.

Follow your agreed insulin plan rather than making unplanned dose changes in response to individual readings. Review alert settings and what to do for low or high glucose with your care team.

Care beyond the glucose number

• Personalized goals: Review A1c and glucose patterns, with attention to avoiding low blood sugar.
• Medication review: Consider effectiveness, side effects, kidney health, cardiovascular risk, and cost.
• Complication prevention: Keep up with kidney blood and urine testing, eye examinations, and foot care as recommended.
• Heart health: Address blood pressure, cholesterol, and tobacco use.
• Daily habits: Review food choices, activity, sleep, and tobacco use. Ask whether diabetes education or a registered dietitian could help.

An A1C below 7% is a common goal for many nonpregnant adults, but targets may be higher or lower depending on health, age, pregnancy, and risk of low glucose.

Prepare for your diabetes visit

Bring your medication and insulin doses, CGM reader or phone, glucose records, and recent lab results. Note any low-glucose episodes and questions about meals, activity, or device use. Ask our team how to make your CGM reports available for review.