Diabetes is a disease that currently affects over one million people across Australia, and the numbers are on the rise: in fact, diabetes is developing worldwide at epidemic rates. However, although diabetes is so widespread, many of us don’t have a good basic understanding of the disease or how to manage it.
Even if you don’t have diabetes yourself, you are likely to know someone who does, and it is good to be familiar with the basics. This two-part guide explains the basics of diabetes and diabetes management in easy-to-understand terms.
In this second part of the guide we look at how to manage diabetes, including issues like diet, exercise, medications, blood glucose regulation, and managing diabetes in special circumstances. For the first part of this guide, click on the link for ‘Diabetes Basics: Understanding the disease’ at the bottom of the page.
When managing diabetes, remember you don’t need to do it alone. Establish a good relationship with your doctor, dietitian, and other medical professionals, as they can provide you with sound advice for your situation.
Type 2 diabetes occurs two to three times more often in overweight persons – particularly if they are inactive. Obesity causes the body cells to resist insulin and the resultant build up of glucose leads to diabetic symptoms. Weight loss, coupled with a healthy diet and regular exercise, often corrects this condition in Type 2 diabetes. By reducing weight, the need for oral anti-diabetic drugs can also be prevented or their dosage lessened. Over time, your body cells can lose their resistance and become sensitive once again to the effects of insulin. Insulin and blood glucose levels may normalise, and diabetes symptoms may disappear.
Weight control is also important for people with Type 1 diabetes as it contributes to a healthy lifestyle and longevity.
Using a food and exercise diary is an excellent way to keep on target with recommended diet and activity goals.
Whether you have Type 1 or Type 2 diabetes, good diet is essential for effective management. Eating a wide variety of foods with an emphasis on a balance of healthy fats, moderate protein, and high fibre, as well as plenty of water is recommended. Actual food quantities, as well as when you eat, are also vital to blood glucose control. Your dietitian can individualise a diet plan to suit your food preferences, lifestyle and health status.
Here are a few hints on foods, eating patterns and carbohydrate distribution to keep in mind:
- Eat foods rich in antioxidant vitamins C, E and beta-carotene (such as non-starchy vegetables and fresh fruit) as well as omega-3 fats (flaxseeds (linseeds), salmon, tuna, sardines), magnesium (dark green leafy vegetables, whole grains, nuts/seeds, beans) and chromium (wheat germ, liver). These foods may help to prevent long-term complications of diabetes, such as damage to small blood vessels and nerves.
- Choose wholegrain breads, cereals and pasta, and eat plenty of fresh fruits, vegetables, nuts, seeds, and legumes. These foods contain fibre and slow the release of glucose into your blood after a meal.
- Limit foods that are very high in sugars, such as soft drinks, cordials, lollies. Small amounts of sugar as part of a meal may occasionally be okay, but you should discuss this with your dietitian. You may like to use artificial sweetners.
- For circulation and heart health, limit foods that are high in saturated fat and cholesterol.
- Don’t skip meals. If you take insulin or diabetes tablets, regular meals are important.
- If on insulin, eat meals at the same time each day and eat a similar amount of food at each meal. This allows for a steady release and usage of insulin.
- Eat smaller amounts of food more frequently for steadier, more even blood glucose levels.
- An even carbohydrate distribution is very important in order to make best use of available insulin and to prevent extreme fluctuations in blood glucose levels.
- Ask your doctor or dietitian to help you determine the level of calories and carbohydrate most appropriate to your weight, medication, and activity. Use regular blood glucose checks to provide feedback.
For people with Type 1 diabetes, exercise can help to both stabilise blood glucose over a long period of time and to prevent diseases that people with diabetes are more prone to, such as heart disease. Low impact exercise, such as walking, is usually recommended for people with Type 1 diabetes as high impact exercise can be strenuous on the feet and legs, which can cause circulation problems. It is very important for those with Type 1 diabetes to consult with a health professional and monitor their blood glucose levels carefully when embarking on an exercise program.
Exercise is a highly important and effective form of treatment for Type 2 diabetes. Muscular contraction as a result of exercise helps to transport glucose into the cells and improve insulin sensitivity. As well as treating symptoms, exercise also helps to prevent other health risks associated with diabetes. Health and fitness specialists can help you to design an exercise program suitable to your fitness level, lifestyle, and health needs.
Blood glucose regulation
To properly manage diabetes, it is essential to monitor blood glucose throughout the day, both at home and at work, and to keep a log of results. Daily monitoring of your blood glucose will help you become familiar with your blood glucose patterns in relation to diet, exercise and medication. It will also allow you to spot an abnormal level before it becomes extreme.
Blood glucose is checked using a drop of blood from the finger. This is then read by a blood glucose machine. Urine tests can also be used to check for blood glucose, but they are not as effective and should only be used when blood testing is not possible. To help stabilise blood glucose, keep the following tips in mind:
- Keep to a regular daily eating pattern for good blood glucose control. Evenly spaced meals and snacks is best.
- Maintain an even carbohydrate distribution. For more information click on the article link to ‘Carbohydrates and Diabetes: Breaking it down” at the bottom of the page.
- Keep a healthy weight. This does not mean you have to lose a lot of weight – you will begin to benefit with even a modest weight loss of only 5-10% of your body mass, combined with regular exercise.
- Control your diet. Know what and when you will eat. Seek a referral to a dietitian for expert advice.
- Don’t skip prescribed insulin or oral medication. If on insulin, know what action to take if hypoglycemia (low blood glucose) occurs.
- Have regular checkups with your doctor.
Insulin and medications
Insulin is used to keep blood glucose as close to a normal level as possible. People with Type 1 diabetes must take insulin as their bodies do not produce it naturally. Some people with Type 2 diabetes also take insulin to help their bodies use glucose.
Insulin therapy depends on many factors and should be worked out according to your existing health and lifestyle. There are a variety of different injectors and injections available. Your health care team will help you to work out an effective insulin routine.
Meal planning for blood glucose control, weight loss, and exercise are always the first treatments used for people with Type 2 diabetes. In some cases, however, insulin or diabetes tablets are also used to help lower blood glucose levels. Diabetes tablets can be divided into three groups: Sulphonylureas, Biguanide, and Acarbose. If you are diagnosed with Type 2 diabetes, your doctor will advise you about these medications if you need them.
For more information on insulin and medications, see your doctor.
Managing diabetes when sick, travelling, or pregnant
Having diabetes doesn’t stop you going travelling, getting pregnant, or getting sick! However, you need to be aware of how to handle your diabetes in relation to these special circumstances.
When you get sick and you have diabetes, your blood glucose levels can get very high. When the body releases hormones to fight diseases, these hormones also raise blood sugar levels and interfere with the blood sugar-lowering effects of insulin. Make sure you have a prepared plan for sick days that includes when to call your doctor, how often to measure blood sugar, what medicines to take, and how to eat.
- Drink at least 250 ml of water an hour to prevent dehydration.
- Always continue to take your medications. You often need more insulin when you are sick.
- Check your blood glucose levels every two to four hours. If you have Type 1 diabetes, test your urine for ketones each time you use the toilet.
- Stick to your normal meal plan if you can. Have regular low-fat snacks if you can’t face normal meals. Suggestions include: toast, crackers, boiled rice, soup, low-fat custard.
- If you can’t eat, sip fluids every few minutes so you don’t get dehydrated.
- Do not exercise when you are sick. Exercising when you are sick can make blood glucose levels fluctuate dramatically and slow healing down.
- Always check with your pharmacist to see if over-the-counter medicines, such as cough medicine, are suitable for you.
- Get a yearly flu shot.
If you go traveling you can make your trip safer and more enjoyable by some simple planning ahead.
- Before a long trip, take a medical exam to assess how well your diabetes is under control.
- Take a letter from your doctor with you explaining your condition and how it is treated. Also take a prescription for insulin or diabetes pills in case of emergency. Make sure the prescription is valid where you are traveling.
- Wear a medical ID bracelet or necklace that shows you have diabetes.
- Pack at least twice as much medication and blood-testing supplies as you think you will need. If you are flying, always take at least half of this as carry-on luggage.
- Take a snack pack with you at all times. Pack it with foods you may not be able to get immediately including some form of sugar for treating low blood glucose.
If you want to get pregnant it is important to plan ahead and stay very focused on your overall health. Keeping blood glucose under control is essential to the good health of you and your baby, both before and during pregnancy.
If you plan to have a baby:
- Keep a very strict watch on glucose levels. If these are not under control there is a risk of birth defects. During the first six weeks of pregnancy when the baby’s organs are forming, you may not even know you are pregnant. For this reason, good blood sugar control before you get pregnant is crucial. Plan for your pregnancy and try to have your blood sugar under control for 3-6 months before getting pregnant.
- Make sure you see a doctor who knows how to take care of pregnant women with diabetes.
- Have your eyes and kidneys checked as pregnancy can lead to complications in these areas.
- As with any woman who is pregnant, do not smoke, drink alcohol, or use harmful drugs. These directly affect your baby.
- Continue to work with your health care team to maintain good blood glucose levels, regular exercise, and a healthy diet.
- Be aware that your insulin needs may change when you become pregnant.
Where to get help, advice, and information
- See your doctor and ask him or her for information on diabetes and treatment. Your doctor can also refer you to local diabetes groups that you can get involved in.
- Contact a dietitian to advise you on foods and meal plans.
- Contact Diabetes Australia or the support group in your state. Click on the links below. Diabetes Australia can help you learn more about diabetes, find resources, learn prevention strategies, and put you in touch with other diabetics.
This article is for informational purposes only and is not intended to replace professional medical advice. Please see your doctor immediately if any of the following occurs:
- Your blood glucose level is consistently high or low even though you are taking your insulin/medications correctly.
- Your symptoms worsen.
- You get any chest pain, vision problems, sweatiness or numbness.