Diabetes is a disease currently affecting more than one million people across Australia, with numbers continuing to rise. In fact, diabetes is developing worldwide at epidemic rates. However, although diabetes is so widespread, many of us don’t have a 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 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, check out Diabetes Basics: Understanding the Disease.
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 and support.
Weight control
Type 2 diabetes is two to three times more likely to occur in overweight people – particularly if they’re inactive. Obesity causes the body’s cells to resist insulin, and the resulting 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 losing excess weight, the need for oral anti-diabetic drugs can also be prevented, or mean a lesser dosage is required. Over time, your body’s cells can lose their resistance to insulin, and become sensitive once again to its effects. 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.
Keeping a food and exercise diary is an excellent way to stay on track to meet your recommended diet and activity goals, and help you become more aware of your lifestyle habits.
Balanced diet
Whether you have Type 1 or Type 2 diabetes, a balanced diet is essential for effective management of the disease. Eating a wide variety of whole foods with an emphasis on healthy fats, lean proteins, and high fibre intake, as well as plenty of water, is essential. The quantity of food you’re eating, as well as when you eat, are also vital to blood glucose control. Your dietitian can create an individualised diet plan to suit your food preferences, lifestyle and health status.
Here are a few tips on foods, eating patterns and carbohydrate distribution to keep in mind:
1. Foods:
- Eat foods rich in antioxidant vitamins C, E and beta-carotene (such as non-starchy vegetables and fresh fruits) as well as omega-3 fats (flaxseeds, salmon, avocado, sardines), magnesium (dark green leafy vegetables, whole grains, nuts/seeds, beans) and chromium (wheat germ, liver). These foods may help prevent long-term complications caused by 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 high in sugars, such as soft drinks, cordials and lollies. Small amounts of sugar as part of a meal may be okay occasionally, but you should discuss this with your dietitian.
- To improve your circulation and heart health, limit foods that are high in saturated fat and cholesterol.
2. Eating Patterns
- Don’t skip meals. Particularly if you take insulin or diabetes tablets, sticking to regular meals is important.
- If you’re using insulin medication, eat your meals at the same time each day and aim to eat a similar amount of food at each meal. This allows for the steady release and usage of insulin.
- Eat smaller amounts of food more frequently for steadier, more stable blood glucose levels.
3. Carbohydrate Distribution
- An even carbohydrate distribution is very important in order to make the best use of your available insulin and to prevent extreme fluctuations in blood glucose levels.
- Ask your doctor or dietitian to help you determine the intake of calories and carbohydrates most appropriate for your weight, medication, and activity level. Use regular blood glucose checks to provide feedback.
Regular exercise
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, like walking, is usually recommended for people with Type 1 diabetes, as high impact exercise can be strenuous on the feet and legs, which can lead to circulation problems. It is very important for those with Type 1 diabetes to consult 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 transport glucose into your cells and improves insulin sensitivity. As well as treating diabetes symptoms, exercise also helps to prevent other health risks associated with diabetes. Health and fitness specialists can help you design an exercise program suitable to your fitness level, lifestyle and health needs.
Blood glucose regulation
To properly manage diabetes, it’s essential to monitor your blood glucose levels throughout the day, both at home and at work, and to keep a log of your results. Monitoring your blood glucose daily will help you become familiar with your blood glucose patterns in relation to your diet, exercise and medication. This will also allow you to spot any abnormalities before they becomes extreme or dangerous.
Blood glucose is analysed using a drop of blood from the finger. A blood glucose machine then reads the blood sample. Urine tests can also be used to check for blood glucose, but these 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:
- Stick to a regular daily eating pattern for improved blood glucose control. Eating evenly spaced meals and snacks is ideal.
- Maintain an even carbohydrate distribution.
- Aim to maintain a healthy weight. This doesn’t mean you have to lose a lot of weight – you will experience benefits from even a modest weight loss of just 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 your prescribed insulin or oral medication. If you’re on insulin, know what actions to take if hypoglycemia (low blood glucose) occurs.
- Organise 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 more efficiently.
Insulin therapy depends on many factors, and should be adopted according to your existing health and lifestyle. There are a variety of different injectors and injections available. Your health care team will help you work out an effective insulin routine for your specific needs.
Meal planning to support blood glucose control, weight loss, and exercise is usually the first treatment suggested for people with Type 2 diabetes. In some cases, however, insulin or diabetes tablets are also required to help lower or stabilise blood glucose levels. Diabetes tablets can be divided into three groups: Sulphonylureas, Biguanide, and Acarbose. If you’re 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 from travelling, getting pregnant, or getting sick! However, you do 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 be significantly elevated. When your 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 whenever you fall sick, which includes when to call your doctor, how often to measure your blood sugar, what medicines to take, and how to eat.
In general:
- Drink at least 250 ml of water per 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 go to 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 and soup.
- If you can’t eat, sip on fluids every few minutes so you don’t get dehydrated.
- Do not exercise when you are sick. Exercising when you are sick can cause your blood glucose levels to fluctuate dramatically, and slow your 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 using some simple planning.
- 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’re 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’ll need. If you’re flying, always pack at least half of this in your carry-on luggage.
- Carry a snack pack with you at all times. Pack foods you may not be able to get immediately, including some form of sugar for treating low blood glucose levels.
If you want to get pregnant, it is important to plan ahead and stay very focussed on your overall health. Keeping your 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:
- Strictly monitor your glucose levels. If these aren’t under control, there is a risk of your child suffering from birth defects. During the first six weeks of pregnancy when the baby’s organs are forming, you may not even know you’re 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 to 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 during pregnancy.
- Be aware that your insulin needs may change when you become pregnant.
Where to get help, advice, and information
- See your doctor and ask them for information on diabetes and treatment. Your doctor can also refer you to local diabetes groups that you can get involved in for further support.
- Consult a dietitian for advice on foods and meal plans to meet your individual needs.
- Contact Diabetes Australia or the support group in your state. Diabetes Australia can help you learn more about diabetes, and 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 occur:
- Your blood glucose level is consistently high or low, even if you’re taking your insulin/medications correctly.
- Your symptoms worsen.
- You experience any chest pain, vision problems, sweatiness or numbness.
