The Game Plan: Blood Sugar Basics

How would you like an online interactive resource for type 2 diabetes that teaches you blood sugar basics? The American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) have come together to develop “the Game Plan” diabetes management program. By going to the website at, you can get everyday tips, watch a video, take a quiz that tests your understanding of high and low blood sugar, and find advice on how to approach your healthcare team.

Three coaches walk you through this process: endocrinologist Dr.Farhad Zangeneh, MD,  registered dietitian/exercise physiologist Samantha Heller, MS, RD, CDN, and a former professional athlete and ESPN personality, Mike Golic (see our interview with Mike at

“The Game Plan,” which is sponsored by Merck, is available to all type 2s at no charge. Family members and healthcare providers who want to learn more about managing blood sugar can also take advantage of this resource.

Last week, I interviewed Dr. Moghissi, an endocrinologist who worked on developing “the Game Plan,” and Samantha Heller, the program nutritionist.

Nadia: Dr. Moghissi, can you give us a brief history of the “The Game Plan” and “Blood Sugar Basics” and explain the purpose of this online educational tool?

Dr. Moghissi: I’ve been involved with this program from the beginning. “Blood Sugar Basics” was created in 2010 with patients with type 2 diabetes in mind. The goal of the program from the beginning has been to help individuals with type 2 diabetes with easy-to-understand information, approachable tools, and the knowledge to manage their diabetes. Not only high blood sugar which, as you know, is the hallmark of type 2 diabetes, but also to make them aware of the problem of low blood sugar.

Many people may not be aware that patients with type 2 diabetes can develop low blood sugar. Even though it can be risky, I think the good news is that it’s avoidable. As you know, causes of low blood sugar include skipping meals or suddenly increasing physical activity.Taking certain diabetes medications can also cause low blood sugars. So on, we provide a quiz to help patients understand whether they know what they need to know about diabetes and also how to recognize low blood sugar and how to speak to their healthcare professionals.

Nadia:  You have added a new component to “Blood Sugar Basics”: “The Game Plan.”

Dr. Moghissi: Yes. We have tried to break down the complicated question of diabetes management into four simple goals, so that patients can set individual goals and identify what they need to do for their physical activity and nutrition and keep track of their progress. We are very, very excited about this program because the information that is provided is easy to understand and approachable.

Samantha Heller, the expert nutritionist and physical fitness coach, has helped us learn how to make lifestyle changes that sometimes seem daunting. The four-step approach is simple to understand.  Patients can visit to set goals and go through these four steps to manage their diabetes.

Nadia: What are the four steps in this program?

Dr. Moghissi: Well, the first step is “Huddle,” which is sort of the theme of the whole program. “Huddle” means to get together with your healthcare professionals and talk about your condition and learn about the ABCs of diabetes. “A” is for knowing your A1C.  “B” is for blood pressure, and “C” is for cholesterol. So that’s the first step, to set individual goals. The second step is “Enter The Nutrition Zone.” It involves talking about setting up meal plans that are appropriate for individual patients, how to make sure that meals are nutritious, on time, not skipped, and so on. The third step is “Get into The Game” by becoming more active.  Check your exercise goals with your healthcare professional. The fourth step is “Check the Score Board” to see how your new healthy habits have affected your blood sugars.

Samantha Heller: One of the things that’s so exciting about the “The Game Plan” is its interactive component. When people with type 2 diabetes feel overwhelmed, they get scared, they don’t know what to eat, they don’t know whether they should have an exercise program.  “The Game Plan,” as well as, is interactive, which draws people in as they are making a personal and individualized plan for themselves. It’s the closest we can get to seeing our own registered dietitian or physician without actually seeing them.

One of the things that I like in the “Nutrition Zone” is that there’s a food planner. It’s like a calendar, where you can write down your meals and your snacks and keep track of your blood sugars. This is a great way for people to learn to be very conscious and mindful of what they’re choosing to eat. What they choose to eat affects their energy level and their blood sugars.  I love the interactive component of it. It’s also fun to track when you start exercising. Even if you are an experienced exerciser, it’s really fun to track how long you’ve walked, how far, how many Zumba classes you took. It makes it simple and fun and do-able and actionable for each person, and so I think the interactive component of “The Game Plan” on is such a valuable tool for patients.

Dr. Moghissi: People with type 2 diabetes sometimes think it’s a milder form of disease. It’s a myth, but you will hear them say, “I have a touch of diabetes.”

Patients try to underestimate the significance of type 2 diabetes and are, therefore, less likely to take it seriously. Type 2 diabetes patients think their diagnosis is less serious than type 1 diabetes.  It’s for this reason that we need to increase awareness for everyone to try to do their best to control the risk factors and prevent diabetes complications.

Nadia: I have had type 2 patients say, “I have borderline diabetes” or “Mine is not that bad.”

Samantha Heller: You know, Nadia, I have patients who just try to ignore it. They get a diagnosis of type 2 diabetes, and they just try to pretend that it never happened. We really want patients to understand that ignoring it is serious. Paying attention to it can change everything. You can live well with diabetes by making simple easy changes one step at a time, and I think in this way we take out the guesswork and it’s less overwhelming for patients.

Nadia: How do people become motivated when they don’t feel that their diagnosis is serious?  

Dr. Moghissi: I think that it is important to talk about the good news about diabetes. Patients have heard horror stories, have seen their family members or people they know going blind or going on kidney dialysis, or losing a limb. That’s the bad news about diabetes, but there is also good news about diabetes.

First of all, over the past decade, we have learned a lot more about the pathophysiology of diabetes, what causes diabetes, how we can prevent it, and how to manage it. I think that the tools, the knowledge, the research have grown by leaps and bounds over the past decade to help us understand why it’s important to manage blood sugar.

We also have many more tools and many more new medications to help patients with diabetes manage their blood sugar and really live a normal life. It’s not a death sentence. When my patients are newly diagnosed and they’re devastated, I say “Look, you know, 20 years ago we didn’t know as much about diabetes. We didn’t have tools. We had maybe a couple of medications. Now we can do a lot more.” I think that empowering patients to take charge is important. We want them to say “You know, maybe I am from an ethnic background that puts me at higher risk, maybe genetically I’m more prone. Perhaps it’s not my fault because I didn’t choose my parents or my genes, but I can choose the way I live moving forward.”

I think that is the message that helps patients. “Yes, I can do something about it!” Really empowering them with information, with knowledge, to take charge and not allow diabetes to take charge and control their lives. We want the patients themselves controlling their lives, and that’s why we created

Nadia: I really like that approach. People with diabetes are used to being reprimanded on some level and blamed for bringing diabetes on themselves. But the blame game does not motivate people to take charge moving forward. Do you have diabetes patients who have benefited from your philosophical approach?

Dr. Moghissi:  I can give you several examples. When patients come to me, I tell them, “This may be the best thing that has happened to you because now you really can take charge and not take your health for granted!” Especially at the beginning when their diabetes is newly diagnosed, many times it can be managed by just lifestyle changes and maybe one medication.

So now all of a sudden they’re trying to manage their blood sugar. They’re managing their blood pressure, they’re managing their cholesterol, they’re eating better, they’re more active. I’ve seen many of my patients take the bull by the horns and say “Okay, I’m going to change the way I eat. I am going to take small steps, making a small change in my daily schedule to fit in maybe a half hour of walking or taking the stairs instead of taking the elevator.” Those small changes all of a sudden will really change their risk profile for heart disease. I’ve seen it many times in patients who have come in crying, saying “Oh I’ve been diagnosed with type 2 diabetes,” and then they begin to understand that “Okay, I can do really something about it and live a healthier life.” They can go do it, and the results can be amazing.

“The Game Plan” is all about really helping individuals with type 2 diabetes and their loved ones to make small changes, take small steps for a healthier life, one step at a time. At the beginning, when their diabetes is diagnosed, they are overwhelmed. They feel that it’s the end of the world. “The Game Plan” is an easy-to-understand and approachable way we help them to really understand what they need to do to take charge of their life.

Nadia: Do you find that the people who log their food and exercise are more successful than people who don’t?

Dr. Moghissi: Absolutely. Keeping track is always important because sometimes we underestimate what we eat and overestimate our physical activity and exercise. We human beings may not be completely cognizant of everything that is happening in our busy lives every day. But when you keep track, you can look back and see, “Okay, I walked 30 minutes on Tuesday. I increased it to 40 minutes the next day. Last week I walked three days. Now I’m increasing it to four days and gradually, hopefully, every day.” So keeping track is helpful. And, in fact, we know from research that individuals who write down their blood sugar in a logbook, for example, do better than the ones who test and don’t log.

I think that if you take it seriously and make it part of your routine, then you can’t leave your diabetes at home. So you take it with you wherever you go. You think “What am I doing? What am I putting in my mouth? What am I doing as far as physical activity?” Keeping track of it will help you realize what you actually did.

Nadia:  Thank you for taking time out to illuminate us on the “The Game Plan: Blood Sugar Basics.”  People with type 2 and their family members will benefit from this new, easy-to-use online resource.

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