Diabetes Management


Diabetes develops when the body cannot properly use the energy provided by food. The ability to utilize food for energy is as important as having air to breathe.
What happens in a normal system?
       • Food breaks down into sugar (the body’s main fuel)
       • Sugar enters the bloodstream and the blood sugar level rises
       • The body sends a signal to the pancreas where the increased blood sugar is sensed
       • The pancreas secretes insulin into the bloodstream
       • Insulin lowers the blood sugar by letting sugar into the cells
       • The blood sugar level falls
       • The body cells use the sugar as fuel
What if this system does not work?
With diabetes, this cycle does not work because the sugar made by the body does not enter the cells, and instead constantly builds up in the bloodstream. This occurs because either there is a lack of insulin (which acts as the key to let sugar into the cells of the body), or the insulin is not working properly.


In Type 2 diabetes, the body may make insulin, but the body either does not make enough or cannot use it. More than 90 percent of people with diabetes have type 2 diabetes. Previously called adult-onset diabetes, it usually appears after the age of 40, although it is starting to show up in children at an alarming rate. Although there may be insulin present, little or no sugar enters the cells, causing it to build up in the bloodstream. This is called insulin resistance. Type 2 diabetes can sometimes be managed by nutrition and lifestyle changes alone, although supplemental insulin or oral medication may also be necessary. About 40 percent of people with type 2 diabetes require insulin injections to achieve blood sugar control.

Symptoms - The symptoms of type 2 diabetes can be easy to overlook and may present themselves over a long period of time. They may include:
       • Weakness and fatigue
       • Dry, itchy skin/numbness, and tingling of hands and feet
       • Frequent infections
       • Blurred eyesight
       • Slow healing cuts and sores
       • Frequent urination (Polyuria)
       • Increased hunger (Polyphagia)
       • Increased thirst (Polydipsia)

Risk Factors - Type 2 diabetes is most likely to occur in people who:
       • are over 40 years in age;
       • are overweight;
       • have a sedentary lifestyle;
       • have a family history of diabetes;
       • have had diabetes during a pregnancy;
       • have a high blood pressure


The best approach to dealing with any complication is preventing it in the first place by adopting healthier habits. If complications have already started, it is not too late to control them and keep them from worsening. Not all people with diabetes develop all the complications mentioned. Easy ways to reduce the risk of complications include the following:
       • maintaining normal blood sugar levels;
       • controlling blood pressure, cholesterol and weight;
       • exercising regularly;
       • quitting smoking;
       • getting regular (at least once/year) checkups of eyes, kidneys and dental;
       • taking nutritional supplements such as essential fatty acids with professional guidance; and
       • maintaining a positive attitude.


A person with diabetes is more likely than other people to have a heart attack, stroke, kidney failure, eye problem, frequent infection, and foot or leg amputation, because of stress on the body organs due to years of uncontrolled high blood sugar. These complications arise when the high levels of blood sugar get deposited in the walls of blood vessels causing them to harden. The various organs of the body suffer when the hardened vessels eventually rupture.
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Decreased ability to fight infection - This is the result of damage to small blood vessels, which causes poor blood flow to the skin and a breakdown of the germ fighting system of the body. These infections can occur in the mouth and bladder. Commonly, infections occur on the feet since injuries often go unnoticed due to the loss of sensation in the damaged nerves.
       • Kidney Damage (Nephropathy) - Nephropathy is kidney damage caused when high blood sugar and high blood pressure damage the tiny blood vessels in the kidney. The ability of the kidneys to filter the blood and dispose of unwanted material is destroyed to the extent that useful products like protein are thrown out of the body and unwanted wastes are retained. When that happens, it is necessary to shift the work of the kidneys to dialysis machines. Timely blood and urine tests can help detect early damage. Many studies have been done that indicate a lower protein diet is beneficial in reducing the amount of protein excretion in the urine and thereby slowing down the progression of kidney failure.
       • Eye Damage (Retinopathy) - Retinopathy, or damage to the retina of the eye, is a serious condition that affects nearly 40 percent of people with diabetes. In addition to inadequate blood sugar control, hypertension and kidney disease contribute to the swelling of numerous tiny vessels that supply blood to the retina causing fluid to leak into the surrounding tissue. If this delicate tissue is damaged, impaired vision leading to blindness may result. Regular eye exams are important to help detect early damage. Strict blood sugar control can help improve treatment results.
       • Large Blood Vessel/Heart Damage (Macroangiopathy) - Damage to the large blood vessels that surround the heart and supply the arms, legs, and head is called macroangiopathy. This complication is more common in type 2 diabetes, but it does occur in type I as well. When the blood sugar level is raised, it tends to form scars on these large blood vessels, trapping the cholesterol and then blocking it. Trying to pump out blood through these clogged vessels overworks the heart and can lead to heart attacks, strokes, and decreased blood flow to the arms, legs, and head. Smoking and high blood pressure can further aggravate this situation. Slow healing of cuts and sores, leg cramps, and dizzy spells may forewarn people with diabetes to the onset of this problem.
       • Nerve Damage (Neuropathy) - Neuropathy is caused when recurring high blood sugar levels cause the nerve cells to swell and scar. As this continues, the nerves lose their ability to transmit signals through the body. This may cause either a tingling of the feet and legs or a numbness or lack of pain from cuts and bruises. When it affects the extremities, nerve damage is called peripheral neuropathy. Nerve damage can also affect the nerve function of various organs such as the stomach causing bloating, nausea, and vomiting. Nerve impulses to the heart can also be damaged, resulting in painless ischemic heart disease and irregular heart rate. Sexual function, especially in men, can be impaired as well.


       • Everyone is different - There is no such thing as a “diabetic diet”. No single eating plan will work the same for everyone. Some people will be able to eat more carbohydrates and still achieve good blood sugar control. Others may require a higher protein intake, with a reasonable balance between plant and animal protein sources. The key is to monitor blood sugar levels carefully to determine which foods work best.
       • Balanced meals – In general, the ideal meal might consist of the following proportions: 1/2 vegetables, 1/4 complex carbohydrate foods, and 1/4 or less of protein foods. A small amount of healthy fat with each meal can also help control blood sugar levels.
       • Small meals every 4-5 hours - The body does not make enough insulin to handle a large meal. A person with diabetes who is dependent on injections may require extra insulin if eating a large meal. In addition, small, frequent meals prevent hypoglycemic episodes.
       • No Starving! - Skipping meals is a set-up for a food binge.
       • Complex carbohydrates - Whole grains, vegetables, and fruits are the most efficient sources. The body not only burns more calories while digesting them, but also gets fiber and more nutrients from these foods than from other food sources.
       • Water - For most individuals, a minimum of six to eight glasses of water per day — preferably spring water — is required. The body becomes dehydrated before one feels thirst. Those with high blood sugars levels require large amounts of water in order to pass the sugar out in the urine.
       • Carbs, Proteins, Fats - Carbohydrates, proteins, and fats are each turned into blood sugar at different rates. Eating a combination of foods will help keep blood sugar levels balanced throughout the day.


Higher fiber foods are good for everyone, especially for people with diabetes. It is best to try to eat between 30—40 grams of fiber a day. There are two types of fiber: soluble and insoluble. Soluble fiber is more important as it helps in slowing or reducing glucose absorption from the intestines. It has also been shown to be beneficial in lowering fats in the blood.
       • Soluble fibers are found mostly in fruits, vegetables, and some seeds. They include pectins, gums, and mucilages that increase the thickness of the food in the intestine.
       • Insoluble fibers are found in brans, husks of whole grains, nuts, and seeds. Their primary role is to act as an intestinal scrubber and clean out the lower gastro-intestinal tract where buildup can occur, contributing to potential cancers, among other things.


The human body needs the right kinds and right amounts of fat to function. All fats are not bad. The key is knowing which fats are the healthiest choice. All fats are basically mixtures of saturated, monounsaturated, and polyunsaturated fatty acids in different proportions.

The prevailing advice from most medical professionals is to avoid all saturated fats and oils. However, some saturated fat such as from butter, fish oil and coconut oil is beneficial. For many people, low fat diets are not an effective strategy for weight loss as low fat foods are nearly always high-carbohydrate foods, which trigger the release of insulin, causing the body to store fat. Many diet plans recommend monounsaturated oils, such as olive oil and canola, as the best oils for weight loss. However, these oils should still be used sparingly because they have a high ratio of omega 6 fatty acids. In the quest to reduce fat consumption, most people do not eat enough of the right kind of fats known as essential fatty acids (EFAs). These fats are termed “essential” because they are critical for good health and cannot be made by the body. Without essential fatty acids in the diet, the brain and body do not develop properly.

Avoid Trans Fat!
Trans fat is made by adding hydrogen to vegetable oil. This improves shelf life and crispiness of foods like crackers and baked goods. These chemically altered fats raise bad cholesterol (LDL) and lower good cholesterol (HDL). To be sure to avoid eating hidden trans fats, do not eat any product that lists hydrogenated or partially hydrogenated oil in the ingredients.


Sugar - The human desire for sweetness in food is a universal one. Having too many sweet foods may not be healthy, but avoiding sweet foods completely is unrealistic. Many people falsely believe that sugar can never be eaten by a person with diabetes and that only artificial sweeteners are allowable. However, natural (unrefined) sugar can be eaten in small amounts as part of a healthy eating plan. Sugars are simply a form of carbohydrate and need to be factored into the total amount of carbohydrates eaten in a day. Since the amount of sugar that can be tolerated will vary between individuals, the best plan is to monitor blood sugar levels frequently.


Though there are many elements that are important for managing diabetes on a daily basis, blood sugar management is the most essential.
Why monitor blood sugar?
If taking insulin, it is important to know the blood sugar level to determine the correct dosage. It is essential for the diabetic health care team to know blood sugar levels so that insulin, other medications, meal plans, and exercise schedules can be adjusted accordingly. It is possible that the need for diabetes medication could decrease or disappear entirely for some people. This cannot be determined without good monitoring.
When to monitor blood sugar?
Most people with well-controlled diabetes who are not taking any medications need to have their blood sugar checked only 2—3 times a week. Monitoring 2—4 times a day is necessary for most individuals with diabetes in order to track the changes that may occur. People with diabetes who are ill, have more than two insulin shots a day, or are pregnant, may need to check blood sugar even more often. The best times to do this are before breakfast, lunch, and dinner, at bedtime, and 1—2 hours after meals.
How to monitor blood sugar?
This can be done with a drop of blood which is obtained by pricking the side of a finger tip with a lancing device. A lancing device is usually a small spring loaded device with a sterile needle, or lancet. Be sure that hands are cleaned with soap and water and well massaged for good blood flow before pricking a finger.

What is the A1C (also called HbA1c) Test?
This blood test shows how blood sugar levels were controlled over the previous two to three months. It should be done by your doctor at least twice a year. Aim for a level below 6.5.


The following special precautions should be made by the person with diabetes while traveling.
       • Extra insulin or oral agents. These should be packed as the particular medicine may not be available in other countries.
       • Insulin protection: keep all insulin in hand-carried bags to avoid temperature changes; divide insulin and other diabetes supplies between at least two different bags in case one is lost; get an insulin carrying case, or pack between layers of clothing; refrigerate upon arrival; insulin can be stored in a cold thermos.
       • Insulin prescriptions: bring prescriptions for insulin, syringes, and a glucagon emergency kit, plus a letter describing the medical condition. Include prescriptions for any other medicines that might be needed.
       • Discuss travel plans with the health care team. This may require changing the timing and amount of insulin doses. Meal times and blood testing may also change.
       • Test blood sugar levels often to judge how the new routine is affecting diabetes control.
       • Find out where and how to obtain medical care. Traveling companions need to know how to help in an emergency.
       • Drink plenty of water, particularly in hot climates. Check ahead on availability of bottled water where needed.
       • Carry glucose tablets and other appropriate snack food.
       • Check with airlines for any special requirements before traveling.


When blood flow is poor or when there is nerve damage in the legs and feet, serious problems can develop. This can lead to a diminished ability of the body to heal itself, often leading to infections that can have consequences as serious as amputations. It is important to take the following points into consideration to prevent infections of the feet.
       • Shoes that fit properly are essential. Feet swell during the day, so a shoe that fits in the morning may be tight by the evening. Leather breathes and is usually better than synthetic materials which can cause sweaty feet that are a breeding ground for bacteria. Orthotics may be needed to ensure a proper fit. Sandals, particularly thong types, can lead to rubbing, making feet vulnerable to cuts. Walking barefoot is not advisable.
       • Foot inspections are crucial to finding anything out of the ordinary. A tiny splinter or callous can be the seed for foot ulcers. Unusual foot odors should also be note as they could be an indication of a festering infection. These problems are not likely to go away on their own.
       • Feet should be washed in warm soapy water and carefully dried, particularly between the toes. Moisturizers are fine for the bottom of the feet, but never between the toes. Toe nails should be clipped straight across.
       • Corn and callous removal should only be done by a podiatrist.
       • Regular testing for levels of neuropathies is advised, and can be done by either the individual or his/her podiatrist.


Exercise is beneficial for everyone but is especially so for people with diabetes. For some people with type 2 diabetes, exercise can make a difference in whether or not medication is needed.

How does exercise help?
       • Assists in lowering blood sugar. The more active person uses more fuel. When muscles are being employed, they use the sugar circulating in the bloodstream.
       • Strengthens joints and muscles. Elevated blood sugar over the years can contribute to glycosylated (sugar-coated) joints, adding to stiffness and arthritic-like conditions. Moving each body part at its joint, daily, can help ease these problems.

How much exercise?
       • To lower blood sugar, exercise for 15—20 minutes at a pace where speaking can be easily accomplished.
       • To burn body fat, a sustained activity at a moderate pace for 35—40 minutes will speed up the process.
       • Doing some type of activity everyday is ideal.
       • Being consistant is important to aid in blood sugar control.

What types of exercise?
       • A medical check-up, especially for those over 35, is necessary. This may include a stress test and possibly a medication adjustment.
       • Activities should be appropriate for a person’s physical condition.
       • It is best to begin exercising slowly and to build up the length and intensity of the activity over time.
       • Aerobic exercise that keeps the body moving continuously is best for lowering blood sugar. For most people with diabetes, particularly if excess body fat is a concern, walking is best and available to almost everyone.

What else is important when exercising?
       • Blood sugar checks are most important. A blood sugar of 240 or greater could signify an insulin insufficiency or too much food intake. Those with insulin requiring diabetes should check for ketones. If blood sugar is below 120, a snack of anywhere from 15—30 grams of carbohydrate is needed to raise the blood sugar level.
       • Exercising in extreme hot or cold weather should be avoided as this can cause blood sugar fluctuations.
       • Wearing white cotton socks and supporting shoes that fit properly.
       • Drinking water before, during, and after exercise.
       • Exercising 30—90 minutes after a meal, when blood sugar is at its peak, will generally satisfy any need for snacking and will guard against hypoglycemic reactions.

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