Managing Your Diabetes

How is diabetes managed?

Before the discovery of insulin in 1921, everyone with type 1 diabetes died within a few years after diagnosis. Although insulin is not considered a cure, its discovery was the first major breakthrough in diabetes treatment.

Today, healthy eating, physical activity, and taking insulin are the basic therapies for type 1 diabetes. The amount of insulin must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose checking. People with diabetes also monitor blood glucose levels several times a year with a laboratory test called the A1C. Results of the A1C test reflect average blood glucose over a 2- to 3-month period.

Healthy eating, physical activity, and blood glucose testing are the basic management tools for type 2 diabetes. In addition, many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels.

Adults with diabetes are at high risk for cardiovascular disease (CVD). In fact, at least 65 percent of those with diabetes die from heart disease or stroke. Managing diabetes is more than keeping blood glucose levels under control—it is also important to manage blood pressure and cholesterol levels through healthy eating, physical activity, and use of medications (if needed). By doing so, those with diabetes can lower their risk. Aspirin therapy, if recommended by the health care team, and smoking cessation can also help lower risk.

People with diabetes must take responsibility for their day-to-day care. Much of the daily care involves keeping blood glucose levels from going too low or too high. When blood glucose levels drop too low—a condition known as hypoglycemia—a person can become nervous, shaky, and confused. Judgment can be impaired, and if blood glucose falls too low, fainting can occur.

A person can also become ill if blood glucose levels rise too high, a condition known as hyperglycemia.

People with diabetes should see a health care provider who will help them learn to manage their diabetes and who will monitor their diabetes control. Most people with diabetes get care from primary care physicians—internists, family practice doctors, or pediatricians. Often, having a team of providers can improve diabetes care. A team can include

• a primary care provider such as an internist, a family practice doctor, or a pediatrician
• an endocrinologist (a specialist in diabetes care)
• a dietitian, a nurse, and other health care providers who are certified diabetes educators—experts in providing information about managing diabetes
• a podiatrist (for foot care)
• an ophthalmologist or an optometrist (for eye care)

and other health care providers, such as cardiologists and other specialists. In addition, the team for a pregnant woman with type 1, type 2, or gestational diabetes should include an obstetrician who specializes in caring for women with diabetes. The team can also include a pediatrician or a neonatologist with experience taking care of babies born to women with diabetes.

 

Things for Your Health Care Provider to Look at Every Checkup (PDF)

Things for Your Health Care Provider to Do Once or Twice a Year (PDF)

 

The goal of diabetes management is to keep levels of blood glucose, blood pressure, and cholesterol as close to the normal range as safely possible. A major study, the Diabetes Control and Complications Trial (DCCT), sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), showed that keeping blood glucose levels close to normal reduces the risk of developing major complications of type 1 diabetes.

This 10-year study, completed in 1993, included 1,441 people with type 1 diabetes. The study compared the effect of two treatment approaches—intensive management and standard management—on the development and progression of eye, kidney, nerve, and cardiovascular complications of diabetes. Intensive treatment aimed to keep A1C levels as close to normal (6 percent) as possible. Researchers found that study participants who maintained lower levels of blood glucose through intensive management had significantly lower rates of these complications. More recently, a follow-up study of DCCT participants showed that the ability of intensive control to lower the complications of diabetes has persisted more than 10 years after the trial ended.

The United Kingdom Prospective Diabetes Study, a European study completed in 1998, showed that intensive control of blood glucose and blood pressure reduced the risk of blindness, kidney disease, stroke, and heart attack in people with type 2 diabetes.

Taking Care of Your Diabetes Every Day

Do these things every day for good diabetes care:

1. Follow your meal plan.
2. Be physically active.
3. Take your diabetes medicine.
4. Check your blood glucose.
5. Check your feet every day for cuts, blisters, sores, swelling, redness, or sore toenails.
6. Brush and floss your teeth every day.
7. Control your blood pressure and cholesterol.
8. Don't smoke.

Experts say most people with diabetes should try to keep their blood glucose level as close as possible to the level of someone who doesn’t have diabetes. The closer to normal your blood glucose is, the lower your chances are of developing serious health problems.

Check with your doctor about the right range for you.

Your health care team will help you learn how to reach your target blood glucose range. Your main health care providers are your doctor, nurse, diabetes educator, and dietitian.

When you see your health care provider, ask many questions. Before you leave, be sure you understand everything you need to know about taking care of your diabetes.

A diabetes educator is a health care worker who teaches people how to manage their diabetes. Your educator may be a nurse, a dietitian, or other kind of health care worker.

A dietitian is someone who’s specially trained to help people plan their meals.

The next sections of this page will tell you more about the four main ways you take care of your diabetes: Follow your meal plan, by physically active, take your diabetes medicine, and check your blood glucose.

Follow Your Meal Plan

People with diabetes should have their own meal plan. Ask your doctor to give you the name of a dietitian who can work with you to develop a meal plan. Your dietitian can help you plan meals that include foods that you and your family like to eat and that are good for you too. Ask your dietitian to include foods that are heart-healthy to reduce your risk of heart disease.

Your diabetes meal plan will include breads, cereals, rice, and grains; fruits and vegetables; meat and meat substitutes; dairy products; and fats. People with diabetes don’t need to eat special foods. The foods on your meal plan are good for everyone in your family! Making wise food choices will help you

• reach and stay at a weight that’s good for your body
• keep your blood glucose, blood pressure, and cholesterol under control
• prevent heart and blood vessel disease

ACTION STEPS...

IF YOU USE INSULIN

• Follow your meal plan.
• Don’t skip meals, especially if you’ve already taken your insulin, because your blood glucose may go too low.

ACTION STEPS...

IF YOU DON’T USE INSULIN

• Follow your meal plan.
• Don’t skip meals, especially if you take diabetes medicine, because your blood glucose may go too low. It may be better to eat several small meals during the day instead of one or two big meals.

Be Physically Active

Physical activity is good for your diabetes. Walking, swimming, dancing, riding a bicycle, playing baseball, and bowling are all good ways to be active. You can even get exercise when you clean house or work in your garden. Physical activity is especially good for people with diabetes because

• physical activity helps keep weight down
• physical activity helps insulin work better to lower blood glucose
• physical activity is good for your heart and lungs
• physical activity gives you more energy

Before you begin exercising, talk with your doctor. Your doctor may check your heart and your feet to be sure you have no special problems. If you have high blood pressure or eye problems, some exercises like weightlifting may not be safe. Your health care team can help you find safe exercises.

Try to be active almost every day for a total of about 30 minutes. If you haven’t been very active lately, begin slowly. Start with 5 to 10 minutes, and then add more time. Or exercise for 10 minutes, three times a day.

If your blood glucose is less than 100 to 120, have a snack before you exercise.

When you exercise, carry glucose tablets or a carbohydrate snack with you in case you get hypoglycemia. Wear or carry an identification tag or card saying that you have diabetes.

ACTION STEPS...

IF YOU USE INSULIN

• See your doctor before starting a physical activity program.
• Check your blood glucose before, during, and after exercising. Don’t exercise when your blood glucose is over 240 or if you have ketones in your urine (see below).
• Don’t exercise right before you go to sleep because it could cause hypoglycemia during the night.

ACTION STEPS...

IF YOU DON’T USE INSULIN

• See your doctor before starting a physical activity program.

Take Your Diabetes Medicine Every Day

Three kinds of diabetes medicine can help you reach your blood glucose targets: pills, insulin, and other injectable medicines.

If you take diabetes pills

If your body makes insulin, but the insulin doesn’t lower your blood glucose, you may need diabetes pills. Some pills are taken once a day, and others are taken more often. Ask your health care team when you should take your pills.

Be sure to tell your doctor if your pills make you feel sick or if you have any other problems. Remember, diabetes pills don’t lower blood glucose by themselves. You’ll still want to follow a meal plan and be active to help lower your blood glucose.

Sometimes, people who take diabetes pills may need insulin for a while. If you get sick or have surgery, the diabetes pills may no longer work to lower your blood glucose.

You may be able to stop taking diabetes pills if you lose weight. (Always check with your doctor before you stop taking your diabetes pills.) Losing 10 or 15 pounds can sometimes help you reach your target blood glucose level.

If you use insulin

You need insulin if your body has stopped making insulin or if it doesn’t make enough. Everyone with type 1 diabetes needs insulin, and many people with type 2 diabetes do too. Some women with gestational diabetes also need to take insulin.

There are five ways to take insulin.

• Taking shots, also called injections. You’ll use a needle attached to a syringe—a hollow tube with a plunger—that you fill with a dose of insulin. Some people use an insulin pen, a pen-like device with a needle and a cartridge of insulin.
• Using an insulin pump. A pump is a small device, worn on a belt or in a pocket, that holds insulin. The pump connects to a small plastic tube and a very small needle. The needle is inserted under the skin and stays in for several days.
• Using an insulin jet injector. This device sends a fine spray of insulin through the skin with high-pressure air instead of a needle.
• Using an insulin infuser. A small tube is inserted just beneath the skin and remains in place for several days. Insulin is injected into the end of the tube instead of through the skin.

If you use other injectable medicines

Some people with diabetes use other injectable medicines to reach their blood glucose targets. These medicines are not substitutes for insulin.

If you don’t use pills, insulin, or other injectable medicines

Many people with type 2 diabetes don’t need diabetes medicines. They can take care of their diabetes by using a meal plan and exercising regularly.

Check Your Blood Glucose as Recommended

You’ll want to know how well you’re taking care of your diabetes. The best way to find out is to check your blood to see how much glucose is in it. If your blood has too much or too little glucose, you may need a change in your meal plan, exercise plan, or medicine.

Ask your doctor how often you should check your blood glucose. Some people check their blood glucose once a day. Others do it three or four times a day. You may check before and after eating, before bed, and sometimes in the middle of the night.

Your doctor or diabetes educator will show you how to check your blood using a blood glucose meter. Your health insurance or Medicare may pay for the supplies and equipment you need.

Take Other Tests for Your Diabetes

Urine tests

You may need to check your urine if you’re sick or if your blood glucose is over 240. A urine test will tell you if you have ketones in your urine. Your body makes ketones when there isn’t enough insulin in your blood. Ketones can make you very sick. Call your doctor right away if you find moderate or large amounts of ketones, along with high blood glucose levels, when you do a urine test. You may have a serious condition called ketoacidosis. If it isn’t treated, it can cause death. Signs of ketoacidosis are vomiting, weakness, fast breathing, and a sweet smell on the breath. Ketoacidosis is more likely to develop in people with type 1 diabetes.

You can buy strips for testing ketones at a drug store. Your doctor or diabetes educator will show you how to use them.

The A1C test

Another test for blood glucose, the A1C, also called the hemoglobin A1C test, shows what your overall blood glucose was for the past 3 months. It shows how much glucose is sticking to your red blood cells. The doctor does this test to see what your blood glucose is most of the time. Have this test done at least twice a year.

Ask your doctor what your A1C test showed. A result of under 7 usually means that your diabetes treatment is working well and your blood glucose is under control. If your A1C is 8 or above, your blood glucose may be too high. You’ll then have a greater risk of having diabetes problems, like kidney damage. You may need a change in your meal plan, physical activity plan, or diabetes medicine.

A1C results

Target for most people - under 7
Time to change my diabetes care plan - 8 or above

My last result_______
My target_______

Talk with your doctor about what your target should be. Even if your A1C is higher than your target, remember that every step toward your goal helps reduce your risk of diabetes problems.

Keep Daily Records

Make copies of the daily diabetes record page. Then write down the results of your blood glucose checks every day. You may also want to write down what you ate, how you felt, and whether you exercised.

By keeping daily records of your blood glucose checks, you can tell how well you’re taking care of your diabetes. Show your blood glucose records to your health care team. They can use your records to see whether you need changes in your diabetes medicines or your meal plan. If you don’t know what your results mean, ask your health care team.

Things to write down every day in your record book are

• results of your blood glucose checks
• your diabetes medicines: times and amounts taken
• if your blood glucose was very low
• if you ate more or less food than you usually do
• if you were sick
• if you found ketones in your urine
• what kind of physical activity you did and for how long

ACTION STEPS...

IF YOU USE INSULIN
Keep a daily record of

• your blood glucose numbers
• the times of the day you took your insulin
• the amount and type of insulin you took
• whether you had ketones in your urine

ACTION STEPS...

IF YOU DON’T USE INSULIN
Keep a daily record of

• your blood glucose numbers
• the times of the day you took your diabetes medicines
• your physical activity

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