When you digest food, your body changes most of the food you eat into glucose (a form of sugar). Insulin allows this glucose to enter all the cells of your body and be used as energy. When you have diabetes, your body doesn’t make enough insulin or can’t use it properly. Because of this, the glucose builds up in your blood instead of moving into the cells. Too much glucose in the blood and not enough in your cells can lead to serious health problems.

All people who have type 1 diabetes and some who have type 2 diabetes need to take insulin. It helps control their blood sugar levels. The goal is to keep your blood sugar level in a normal range as much as possible. Insulin is usually taken by injection (a shot). It can also be taken using an insulin pen or an insulin pump.

Path to improved health

How often will I need to take insulin?

You and your doctor will develop a schedule that is right for you. Most people who have diabetes and take insulin need at least 2 insulin shots a day for good blood sugar control. Some people need 3 or 4 shots a day.

Do I need to monitor my blood sugar level?

Yes. Monitoring and controlling your blood sugar is key to preventing the complications of diabetes. If you don’t already monitor your blood sugar level, you will need to learn how. Checking your blood sugar involves pricking your finger to get a small drop of blood that you put on a test strip. You then insert the strip into a machine called a glucose meter. The results will tell you whether your blood sugar is in a healthy range

There are newer devices that can monitor your blood sugar without pricking your finger. Some of these work by wearing a sensor on your arm or abdomen. The sensor will read your glucose levels from fluids just underneath your skin. The information is then transmitted to a reader or an app on your phone.

Your doctor will help you decide which method is best for you.

When should I take insulin?

You and your doctor should discuss when and how you will take your insulin. Each person’s treatment is different. Some people who use regular insulin take it 30 to 60 minutes before a meal. Some people who use rapid-acting insulin take it just before they eat.

Types of insulin:

• Rapid-acting insulin (such as insulin lispro, insulin aspart, and insulin glulisine) starts working in about 15 minutes. It lasts for 3 to 5 hours.
• Short-acting insulin (such as regular insulin) starts working in 30 to 60 minutes and lasts 5 to 8 hours.
• Intermediate-acting insulin (such as insulin NPH) starts working in 1 to 3 hours and lasts 12 to 16 hours.
• Long-acting insulin (such as insulin glargine and insulin detemir) starts working in about 1 hour and lasts 20 to 26 hours.
• Premixed insulin is a combination of 2 types of insulin (usually a rapid- or short-acting insulin and an intermediate-acting insulin).

What is rapid-acting insulin? How can it help control my blood sugar level?

Rapid-acting insulin starts working more quickly than other types of insulin. It begins working within 15 minutes and leaves your body after 3 to 5 hours.

To keep your blood sugar level steady throughout the day, your doctor may also prescribe a longer-acting insulin. Or they may prescribe another drug for you to take each day in addition to rapid-acting insulin.

When do I take rapid-acting insulin?

You should inject rapid-acting insulin no more than 15 minutes before you eat. Your doctor will tell you how much insulin to inject. Remember, you should not wait more than 15 minutes to eat after you take this insulin shot.

Rapid-acting insulin can be more convenient to take than regular insulin. With regular insulin, you inject the insulin and then wait 30 to 60 minutes before eating. Many people find it hard to time their meals around regular insulin injections. Sometimes they end up eating too soon or too late. Then they don’t achieve the best blood sugar control. Since rapid-acting insulin is taken so close to mealtime, it may help you control your blood sugar more effectively.

Can I mix rapid-acting insulin with other types of insulin?

You can mix a rapid-acting insulin with an intermediate-acting insulin, according to your doctor’s instructions. Rapid-acting insulin should always be drawn into the syringe first. This will keep the intermediate-acting insulin from getting into the rapid-acting insulin bottle. After mixing rapid-acting insulin in the same syringe with an intermediate-acting insulin, you must inject the mixture under your skin within 15 minutes. Remember to eat within 15 minutes after the injection.

How do I prepare the correct dose of insulin?

You may take insulin using a syringe that you fill from a vial or using a dosing pen that contains the insulin. If your rapid-acting insulin comes in a pen, your doctor or their office staff can show you how to use it correctly. Follow the directions carefully.

• Wash your hands.
• Take the plastic cover off the new insulin bottle. Wipe the top of the bottle with a cotton swab that you have dipped in alcohol. It’s best for rapid-acting insulin to be at room temperature before you inject it.
• Pull back the plunger of the syringe. This draws air into the syringe equal to the dose of insulin that you are taking. Then put the syringe needle through the rubber top of the insulin bottle. Inject air into the bottle by pushing the syringe plunger forward. Then turn the bottle upside down.
• Make sure that the tip of the needle is in the insulin. Pull back on the syringe plunger to draw the correct dose of insulin into the syringe. The dose of insulin is measured in units.
• Make sure there are no air bubbles in the syringe before you take the needle out of the insulin bottle. Air bubbles can cut down the amount of insulin that you get in your injection. If air bubbles are present, hold the syringe and the bottle straight up in one hand, tap the syringe with your other hand and let the air bubbles float to the top. Push on the plunger of the syringe to move the air bubbles back into the insulin bottle. Then withdraw the correct insulin dose by pulling back on the plunger.
• Clean your skin with cotton dipped in alcohol. Grab a fold of skin and inject the insulin at a 90-degree angle. (If you’re thin, you may need to pinch the skin and inject the insulin at a 45-degree angle.) When the needle is in your skin, you don’t need to draw back the syringe plunger to check for blood.

Where do I inject the insulin?

Insulin is injected just under the skin. Your doctor or their office staff will show you how and where to give an insulin injection. The usual places to inject insulin are the upper arm, the front and side parts of the thighs, and the abdomen. Don’t inject insulin closer than 2 inches from your belly button.

To keep your skin from thickening, try not to inject the insulin in the same place over and over. Instead, rotate injection places.

Things to consider

If you’re going to use rapid-acting insulin, you need to be aware of insulin reactions and how to treat them. Rapid-acting insulin begins to work very quickly. So while you and your doctor are working to find the right dosage of this insulin, you may have some insulin reactions.

Hypoglycemia is a condition in which the level of sugar in your blood is too low. If you use insulin, your blood sugar level can get too low if you exercise more than usual or if you don’t eat enough. It also can get too low if you don’t eat on time or if you take too much insulin. Most people who take insulin have insulin reactions at some time. Signs of an insulin reaction and hypoglycemia include the following:

• Feeling very tired
• Yawning frequently
• Being unable to speak or think clearly
• Losing muscle coordination
• Sweating
• Twitching
• Having a seizure
• Suddenly feeling like you’re going to pass out
• Becoming very pale
• Losing consciousness

People who have diabetes should carry at least 15 grams of a fast-acting carbohydrate with them at all times in case of hypoglycemia or an insulin reaction. The following are examples of quick sources of energy that can relieve the symptoms of an insulin reaction:

• Non-diet soda: ½ to ¾ cup
• Fruit juice: ½ cup
• Fruit: 2 tablespoons of raisins
• Milk: 1 cup
• Candy: 5 Lifesavers
• Glucose tablets: 3 tablets (5 grams each)

If you don’t feel better 15 minutes after having a fast-acting carbohydrate, or if monitoring shows that your blood sugar level is still too low, have another 15 grams of a fast-acting carbohydrate.

Teach your friends, work colleagues, and family members how to treat hypoglycemia, because sometimes you may need their help. Also, keep a supply of glucagon on hand. Glucagon comes in a kit with a powder and a liquid that you must mix and then inject. It will raise your blood sugar level. If you are unconscious, or you can’t eat or drink, another person can give you a shot of glucagon. Talk to your doctor to learn when and how to use glucagon.

You need to check your blood sugar level regularly using a blood glucose monitor. Your doctor or their office staff can teach you how to use the monitor. You’ll need to write down each measurement and show this record to your doctor. They will use this information to decide how much insulin is right for you.

Blood sugar measurements can vary depending on your lifestyle. Stress levels, how often you exercise, and how fast your body absorbs food can affect measurements. Hormonal changes related to puberty, menstrual cycles, and pregnancy can, too. Illness, traveling, or a change in your routine may mean that you have to monitor your blood sugar level more often.

Questions for your doctor

• Do I need insulin to control my type of diabetes?
• What type of insulin should I take?
• How often do I need to check my blood sugar?
• How can I know how much insulin to take?
• What if insulin doesn’t seem to lower my blood sugar?
• What should I do to keep my insulin from getting too low overnight?

Resources

National Institutes of Health, MedlinePlus: Insulin Injection

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Oral diabetes medicines are medicines that you take by mouth to help control your blood sugar level. They are designed to help people whose bodies still produce some insulin, but not enough insulin.

What medicines could my doctor prescribe?

Many categories of diabetes medicine are available in pill form: metformin (a biguanide), sulfonylureas, thiazolidinediones, meglitinides, dopamine-2 agonists, alpha-glucosidase inhibitors, sodium-glucose transporter 2 (SGLT2), dipeptidyl peptidase-4 (DPP-4) inhibitors, and bile acid sequestrants. Each medicine has good points and bad points. Your doctor will decide which medicine is right for you.

Path to better health

No matter which oral medication your doctor prescribes, you should combine it with a healthier lifestyle. Diet and exercise can do much to improve blood sugar levels.

Biguanide (Metformin)

Metformin is a type of biguanide and it is currently the only biguanide available in the United States. It is often the first oral medicine prescribed for someone newly diagnosed with diabetes. It has the advantage of not causing low blood sugar. Metformin does not cause your pancreas to make insulin, but it helps your body use insulin better. Metformin can cause side effects such as nausea or diarrhea in some people. Your doctor may prescribe metformin in combination with another oral diabetes medicine.

Sulfonylureas

These medicines help your pancreas make insulin. They are inexpensive and have few side effects. There are 3 types of sulfonylureas: glipizide, glimepiride, and glyburide. Side effects may include weight gain and low level of sodium in the blood. Sulfonylureas can be taken alone or with metformin, pioglitazone (a thiazolidinedione), or insulin. If you’re allergic to sulfa, you can’t take a sulfonylurea.

Thiazolidinediones

This class of medicines includes rosiglitazone and pioglitazone. These medicines help your body respond better to insulin. Rosiglitazone and pioglitazone can be used alone or in combination with other diabetes medicines. Side effects may include weight gain, fluid retention, and an increase in LDL (“bad”) cholesterol. People taking rosiglitazone and pioglitazone also need periodic liver tests.

Meglitinides

There are two medicines in this group: repaglinide and nateglinide. Both of these lower your blood glucose by prompting the pancreas to release more insulin. These drugs work quickly and do not stay in your system long. So they are a good option if your meal schedule varies or is unpredictable. They also cause less weight gain than other oral diabetes medicines.

Alpha-glucosidase inhibitors

Alpha-glucosidase inhibitors help control blood sugar levels by preventing the digestion of carbohydrates. Carbohydrates include starchy foods like potatoes and corn. They also include most grains (bread, rice, crackers, cereal) and sugary sweets. The two medicines in this group are acarbose and miglitol. These medicines may cause bloating, nausea, diarrhea, and flatulence (gas).

Sodium-glucose transporter 2 (SGLT2)

A newer class of diabetes medication, SGLT2, includes three medicines: canagliflozin, dapagliflozin, and empagliflozin. These drugs remove extra sugar from your body by sending the sugar out through your kidneys into your urine. They also cause your body to be more sensitive to insulin. The most common side effects caused by SGLT2 are vaginal yeast infections and urinary tract infections.

Dipeptidyl peptidase-4 (DPP-4) inhibitors

There are four medicines in this class of drugs. They are sitagliptin, saxagliptin, linagliptin, and alogliptin. DPP-4 inhibitors help your pancreas release more insulin after you eat. These medicines also tell your liver to release less glucose. Some side effects from taking DPP-4 inhibitors may include nausea and diarrhea.

Bile acid sequestrants

This class of drugs pulls double duty. The medicine in this class, colesevelam, lowers cholesterol and reduces blood sugar levels. So it could be a good choice if you have diabetes and high cholesterol levels. And because these drugs are not absorbed in the blood stream, they may be the best choice for someone who also has liver problems and cannot take some of the other diabetes medicines. Side effects from bile acid sequestrants can include constipation and flatulence (gas).

Things to consider

Managing your blood sugar level is critical to your overall health. Often the focus is on keeping blood sugar levels low. But if they are too low, it can put you at risk, too. Talk to you doctor if you are starting a new exercise program or starting a new diet. He or she may need to adjust your medicine.

Questions for your doctor

• Do I need medicine to control my diabetes?
• What type of medicine would work best to control my blood sugar level?
• When should I take my diabetes medicine?
• What should I do if I miss a dose?
• What side effects might I have?
• Why isn’t my medicine working to lower my blood sugar?

Resources

American Diabetes Association

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It isn’t easy for people to hear that they have diabetes. Diabetes is a disease that cannot be cured. It must be taken care of every day. People who have diabetes must make some important changes in their lives. To stay healthy, they have to learn how to monitor and control their blood sugar levels. People who don’t do this can develop serious health problems, such as blindness, nerve damage, and kidney failure. But there are things you can do to help your loved one who has diabetes.

How can I help my relative who has diabetes?

First, learn all you can about diabetes. The more you know, the more you can help. Encourage your relative to learn about diabetes too. Going to a diabetes education class together may help.

Second, be sympathetic. It can be scary at first for people to find out they have diabetes. Your relative may be frustrated with the changes they have to make. Tell your relative that you understand how they feel. But don’t let your relative use these feelings as an excuse for not taking care of their diabetes.

Path to improved health

In addition to being emotionally supportive, you can also help your relative to make healthy changes. This will help your relative manage their diabetes.

If you eat meals together, eat the same foods your relative eats. Avoid buying foods they aren’t supposed to eat. Healthy-eating rules are the same for everyone, including people who have diabetes. Eat foods that are low in fat, cholesterol, salt, and added sugar. Choose a variety of fresh fruits, vegetables, whole grains, lean meats, and fish.

Encourage exercise. You might even want to exercise together. Walking, jogging, bicycling, swimming, and dancing are all good activities that will help both of you get enough exercise. Your relative should talk to their doctor to find out what kind of exercise to try.

What else can I do?

Learn how to recognize signs of problems. Learn the symptoms of a high blood sugar level (called hyperglycemia). Also learn the symptoms of low blood sugar level (called hypoglycemia). Understand that when your relative is cranky or has a bad temper, their blood sugar level may be too high or too low. Rather than arguing, encourage your relative to check their blood sugar level and take steps to correct the problem.

High blood sugar

This often happens when the person who has diabetes has eaten too much, is sick, has too little insulin in their body, or is under a lot of stress. Symptoms of hyperglycemia include:

• Frequent urination
• Extreme thirst
• Blurry vision
• Feeling very tired

Low blood sugar

This often happens when the person who has diabetes has not eaten very much, has too much insulin in their body, or has exercised beyond their limits. Signs of hypoglycemia include the following:

• Feeling very tired
• Frequent yawning
• Being unable to speak or think clearly
• Loss of muscle coordination
• Sweating
• Twitching
• Seizures
• Suddenly feeling like you’re going to pass out
• Becoming very pale
• Loss of consciousness.

Things to consider

Learning how to live with diabetes takes time. Your relative will have good days and bad days. Times of stress may be the hardest. When people who have diabetes are under stress, they may have more trouble controlling their blood sugar level. When this happens, try to help the person keep things in perspective and get back on track. Provide reminders to eat healthy and to exercise. If the person is feeling frustrated and angry, encourage them to be patient and stick with it. Make sure they also are seeing their doctor regularly.

When to see a doctor

Symptoms of high blood sugar and low blood sugar may be mild and barely noticeable. Other times, they are more severe, especially if sugar levels are at extremes.

Any symptom of high or low blood sugar over several days should alert you that it may be time to call the doctor. It could be that your family member’s medicine should be adjusted.

A sudden drop in blood sugar can be a real health threat for people who have diabetes. If your family member shows signs of having dangerously low blood sugar, offer them some sugary candy. Then, call for emergency medical help.

Signs of dangerously low blood sugar include:

• Dizziness
• Shaking
• Headache
• Blurry vision
• Rapid heartbeat
• Confusion
• Slurring words
• Loss of consciousness

Questions for your doctor

• My family member has diabetes. Does this mean that I am more likely to get diabetes?
• I can’t get my family member to regularly check his or her blood sugar. What should I do?
• How important is diet for someone who has diabetes?
• Can my family member eat some sugar now that they are on diabetes medication?

Resources

American Diabetes Association

National Institute of Diabetes and Digestive and Kidney Diseases: Managing Diabetes

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People who have diabetes are more likely to get heart disease. When you have diabetes, your blood sugar level is often much higher than it should be. Too much sugar in the blood can cause damage to many parts of the body, including blood vessels. Some lifestyle habits may also raise the risk of heart disease.

Diabetes, being overweight, high blood pressure, and heart disease are related. But there are things you can do to reduce the risks of all four conditions. Diet and exercise are good ways to control your blood sugar level, lower your blood pressure, and cut your risk of getting heart disease. When diet and exercise don’t help enough, medicines can help control blood sugar levels, lower cholesterol levels, and control blood pressure.

Controlling diabetes – Path to improved health

There are many things you can do to be proactive about your health. Taking care of yourself is especially important when you have diabetes. Some of the things you would do to control diabetes will also lower your risk for heart disease.

Keep your blood sugar level under control.

Controlling your blood sugar level will lower your risk of heart disease. Many people who have diabetes check their blood sugar level every day. This confirms their medicines and/or insulin, diet, and exercise are working to keep their blood sugar in a normal range.

Lose weight—and keep it off.

Losing weight helps a lot of health problems. For example, if you’ve been told your blood pressure is too high, losing weight can bring it down. If your blood sugar level has been hard to control, losing weight can help.

Weight loss is important if you have a lot of extra weight around your waist and abdominal area. People who tend to carry extra weight around their waist are more at risk for heart disease than people who have extra weight in the hips or thighs. Even losing just 10 pounds can help your blood pressure, sugars, and the risk for heart problems. If you need help losing weight, ask your family doctor for advice. He or she can help figure out a safe and healthy plan for you.

Lower your cholesterol level.

Cholesterol is a waxy substance your body uses to protect nerves, make cell tissues, and produce certain hormones. All the cholesterol your body needs is made by your liver. Cholesterol in the food you eat (such as eggs, meats, and dairy products) is extra. Too much cholesterol in your blood can clog your arteries.

There are two types of cholesterol. LDL (which stands for low-density lipoprotein) is the so-called “bad” cholesterol that can clog your arteries and lead to heart disease. HDL (which stands for high density lipoprotein), is the “good” cholesterol that carries unneeded cholesterol away from body tissues. This lowers your risk of heart disease.

If your doctor says your cholesterol level is too high, what can you do about it? It helps to lose weight and eat a healthy diet.

You should limit the amount of fatty and cholesterol-rich foods you eat. There are many cookbooks available that contain low-fat, low-cholesterol recipes and meal suggestions. If you need help figuring out how to change your diet, your doctor might refer you to a dietitian. A dietitian has special training in planning healthy diets.

If diet alone doesn’t lower your cholesterol, certain medicines can help do that. You and your doctor can talk about these medicines. The medicine that’s best for you depends on your special needs and medical condition.

Increase your physical activity.

Along with diet, exercise is very important for people who have diabetes. Diet and exercise work together to help your body work properly. If you’ve changed your diet to lose weight, exercising can help you lose weight faster. Even if you are not losing weight, do not get discouraged. Adding exercise to your routine will still make a positive impact on your health.

You and your doctor can plan exercises that will work best for you and are safe for you. You don’t need a gym or expensive equipment to get good exercise. Brisk walking is great exercise. Climbing stairs instead of taking an elevator is another good thing to do.

Like eating a healthy diet, exercise will help keep your blood sugar level normal and can lower your risk of heart disease.

Control your blood pressure.

People who have diabetes often also have high blood pressure. High blood pressure is a big risk factor for stroke. It also increases your risk for heart disease and kidney disease.

The same lifestyle changes that control blood sugar levels and lower your risk of heart disease may also keep your blood pressure at safe levels. Weight loss and exercise are important. The more weight you lose, the more you lower your blood pressure. It’s also important not to drink very much alcohol.

If your blood pressure doesn’t come down enough with diet and exercise, your doctor might have you take medicines to help.

If you smoke, stop smoking.

Smoking is bad for everyone, but it’s even worse for people who have diabetes. That’s because it damages the blood vessels. If you have diabetes and smoke, you double your risk of getting heart disease. If you keep smoking while you try to reduce other risks (such as losing weight), you won’t be able to exercise as much. This means you probably won’t lose the weight you need to.

Things to consider

The higher your blood sugar, the higher your risk for developing heart disease. This means if your blood sugar is left uncontrolled, it can really damage your heart. Other factors can increase your risk even more, including smoking or being overweight. Having these risk factors likely means you’ll develop heart problems sooner. And your heart problems will be more severe.

If you have diabetes, talk to your doctor about the best way to manage your blood sugar. Ask the doctor to recommend an exercise program for you. Ask your doctor to refer you to a dietician.

Questions for your doctor

• Do I have risk factors that increase my likelihood for developing heart disease?
• If I have type 2 diabetes, can I manage it with diet and exercise alone?
• If I take medicine to control my blood sugar, do I really need to diet and exercise?
• Should I also see a cardiologist if I have diabetes?

Resources

American Diabetes Association: Nutrition, Eating Doesn’t Have to Be Boring

American Heart Association: Healthy Eating

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Exercise can make a real difference for people who have diabetes. Exercise can help control your weight and lower your blood sugar level. It also lowers your risk of heart disease. Heart disease is a condition that is common in people who have diabetes. Exercise can also help you feel better about yourself and improve your overall health.

Path to improved health

Talk to your doctor about what kind of exercise is right for you. The type of exercise you can do will mainly depend on whether you have any other health problems. Most doctors recommend aerobic exercise. This type of exercise makes you breathe deeply and makes your heart work harder. Examples of aerobic exercise include walking, jogging, aerobic dance, or bicycling. If you have problems with the nerves in your feet or legs, you may need to choose other exercises. Your doctor may want you to do a type of exercise that won’t put too much stress on your feet. These exercises include swimming, bicycling, rowing, or chair exercises.

No matter what kind of exercise you do, you should warm up before you start and cool down when you’re done. To warm up, spend 5 to 10 minutes doing a low-intensity exercise such as walking. Then gently stretch for another 5 to 10 minutes. Repeat these steps after exercising to cool down.

When you start an exercise program, go slowly. Gradually increase the intensity and length of your workout as you get more fit. Talk to your doctor for specific advice.

Should I drink more fluids during exercise?

Yes. When you’re exercising, your body uses more fluid to keep you cool. By the time you feel thirsty, you may already be getting dehydrated. Dehydration (not enough fluid in your body) can affect your blood sugar level. Drink plenty of fluid before, during, and after exercise. Make sure you are drinking water or sugar-free drinks so you aren’t raising your sugar levels.

Exercise checklist for people who have diabetes

• Talk to your doctor about the right exercise for you.
• Check your blood sugar level before and after exercising.
• Check your feet for blisters or sores before and after exercising.
• Wear the proper shoes and socks.
• Drink plenty of fluid before, during, and after exercising.
• Warm up before exercising and cool down afterward.
• Have a snack handy in case your blood sugar level drops too low.

Things to consider

There are risks to exercising for people who have diabetes, but the benefits far outweigh the risks. Exercise changes the way your body reacts to insulin. Regular exercise makes your body more sensitive to insulin. This could cause your blood sugar level to get too low (called hypoglycemia) after exercising.

Your doctor may tell you to check your blood sugar level before and after exercising. There are two ways you can monitor your blood sugar level each day. It can be done through a blood glucose monitor or a continuous glucose monitoring system. Talk with your doctor about which method is best for you.

If your blood sugar level is too low or too high just before you plan to exercise, wait. It’s better to wait until the level improves. Also, be sure to watch your blood sugar level if you exercise in really hot or cold conditions. Temperature changes how your body absorbs insulin.

When to see a doctor

Your blood sugar may be normal when you begin exercising but quickly drop during your workout. Be sensitive to this. Hypoglycemia usually occurs gradually, so you need to pay attention to how you’re feeling during exercise. If you have any of these symptoms, stop exercising:

• A change in your heartbeat
• If you feel shaky or anxious
• If you suddenly begin to sweat more than normal

Follow your doctor’s advice about how to treat hypoglycemia. If you begin to feel worse, call your doctor immediately.

Questions for your doctor

• Am I healthy enough to begin an exercise program?
• What kinds of exercises should I do?
• Are there any exercises I should avoid?
• Do I have any other health conditions that would affect my ability to exercise?
• Am I taking any medication that would interfere with exercise?
• How does exercise affect my blood glucose?
• How does exercise affect my diabetes?

Resources

American Diabetes Association

Centers for Disease Control and Prevention: Get Active!

National Institutes of Health, MedlinePlus: Diabetes and Exercise

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People who have diabetes have too much sugar in their blood. Managing diabetes means managing your blood sugar level. What you eat is closely connected to the amount of sugar in your blood. The right food choices will help you control your blood sugar level.

Path to improved health

Eating well is one of the primary things you can do to help control diabetes.

Do I have to follow a special diet?

There isn’t one specific “diabetes diet.” Your doctor can work with you to design a meal plan. A meal plan is a guide that tells you what kinds of food to eat at meals and for snacks. The plan also tells you how much food to have. For most people who have diabetes (and those without, too), a healthy diet consists of:

• 40% to 60% of calories from carbohydrates
• 20% calories from protein
• 30% or fewer calories from fat

Your diet should also be low in cholesterol, low in salt, and low in added sugar.

Can I eat any sugar?

Yes. In recent years, doctors have learned that eating some sugar doesn’t usually cause problems for most people who have diabetes—as long as it is part of a balanced diet. Just be careful about how much sugar you eat and try not to add sugar to foods.

What kinds of foods can I eat?

In general, at each meal you may have:

• 2 to 5 choices (or up to 60 grams) of carbohydrates
• 1 choice of protein
• A certain amount of fat

Talk to your doctor or dietitian for specific advice.

• Carbohydrates are found in fruits, vegetables, beans, dairy foods, and starchy foods such as breads. Try to have fresh fruits rather than canned fruits, fruit juices, or dried fruit. You may eat fresh vegetables and frozen or canned vegetables. Condiments such as nonfat mayonnaise, ketchup, and mustard are also carbohydrates.
• Protein is found in meat, poultry, fish, dairy products, beans, and some vegetables. Try to eat poultry and fish more often than red meat. Don’t eat poultry skin. Also, trim extra fat from all meat. Choose nonfat or reduced-fat options when you eat dairy, such as cheeses and yogurts.
• Not all fats are bad. It is important to know the differences between fats. Unsaturated fats are the “good” fats (nuts, fish, olive oil, canola oil, seeds, etc.). Saturated fats are less healthy. You should limit these in your diet. They include red meats, butter, lard, full-fat dairy products, dark-meat poultry, etc. Trans fats are the worst fats for you. These fats can be found in processed foods like crackers, snack foods, and most fast foods. To identify trans fats, check food labels for the words “partially hydrogenated.” Your doctor or dietitian will tell you how many grams of fat you may eat each day. When eating fat-free versions of foods (such as mayonnaise and butter), check the label to see how many grams of carbohydrates they contain. Keep in mind that these products often have added sugar.

What is the exchange list?

The exchange list is a tool to help you plan healthy meals and snacks. To add variety to your diet, you can substitute certain foods for other foods in the same group. Some examples are listed here.

Things to consider

If you don’t manage your diabetes, you are putting yourself at risk for many other health problems. The best way to manage diabetes is through diet, exercise, and sometimes medication. Poor diabetes management over time can lead to kidney disease and heart disease. It also can damage your eyes and nerves. It can cause skin tissue problems, especially on your feet and legs.

An important part of managing your diabetes is monitoring your blood sugar level. It’s easy to do this yourself either through a blood glucose monitor or a continuous glucose monitoring system. Your doctor can help you decide which method is best for you.

When to see a doctor

If you are unable to control your blood sugar through diet and exercise, talk to your doctor. It may mean that you need medication to help in your diabetes management. Some signs of uncontrolled high blood sugar include:

• Blurry vision
• Unquenchable thirst
• Unexplained weight loss
• Dizziness or being light-headed
• Nausea
• You are more emotional than normal for no obvious reasons

Questions to ask your doctor

• If I have type 2 diabetes, can I manage it with diet and exercise alone?
• If I take medicine to control my blood sugar, do I really need to diet and exercise?
• Can I still go out to eat when I have diabetes?
• Am I healthy enough to begin an exercise routine?
• What kinds of exercises should I do?
• If I exercise, can I have more high-fat foods?
• Where can I learn more about eating right?

Resources

American Diabetes Association: Nutrition

American Heart Association: Healthy for Good

Centers for Disease Control and Prevention: National Diabetes Education Program

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