How to Control Diabetes

For many, a diabetes diagnosis is a wake-up call. You can get a diagnosis at any age, and it's important to know what you can do to help yourself live a normal life with diabetes. Controlling a case of diabetes is usually a question of managing your blood sugar levels and living an active, health-conscious life. Medications (insulin for type 1 when the body can not make enough insulin, but often other medications for type 2, for when the body does not use its available insulin correctly) are also used to keep your blood sugar under control and to manage your symptoms.

Getting your diabetes under control so you can live a happy and healthy life is the goal. The content in this article refers only to general cases and is not intended to replace the opinion of a doctor or following your medical team's advice.

• Making a Diabetes Treatment Plan (Type 1 Diabetes)

Consult with a doctor to start or adjust your treatment plan. Type 1 diabetes, also called juvenile diabetes, is a chronic disease, which, despite its name, can begin and affect people at any age. This type of diabetes is an autoimmune disease. While it can occur suddenly due to infection, symptoms will usually appear after an illness.[1] Symptoms in type 1 are usually quite noticeable, more severe, and quicker to cause illness. Symptoms for type 1 or advanced type 2 often include:[2]

Increased thirst and frequent urination

Dehydration

Possibly extreme hunger with confused appetite (nothing satisfies you)

Unexplained blurred vision

Unexplained weight loss

Unusual weakness/fatigue

Irritability

Slow-healing sores

Frequent infections (such as gums or skin infections and vaginal infections),

Nausea and/or vomiting

Ketones in the urine, in medical tests -- ketones are a byproduct of the unhealthy breakdown/loss of muscle and fat (wasting away) that happens when there's not enough available insulin to support life.

• Seek medical attention immediately if faced with any of the following severe problems in untreated type 1 or 2 diabetes

These can be life-threatening. They may include:

Weakened immunity to infectious diseases

Poor circulation (including in the eyes and kidneys)

Illnesses, infectious diseases

Numbness, tingling in toes and feet

Infections slow to heal (if at all) especially in toes and feet

Gangrene (dead flesh) in toes, feet, and legs (usually without pain)

• Watch for initial symptoms of Type 1 diabetes being severe, it is not uncommon for you to have to stay in the hospital for a short time after your diagnosis.

 If you suspect that you have diabetes and delay seeing a doctor, you can end up in a coma. Always rely on the advice of a qualified doctor or specialist when deciding on any plans to fight your diabetes.

Neither Type 1 nor Type 2 diabetes can be completely cured, but with a lifelong commitment to your treatment plan, these diseases can be managed to the point that you will be able to live a normal life. Begin your treatment plan immediately after you develop diabetes, for better health. If you think you may have diabetes, do not wait on seeing a doctor. It is highly recommended that you see a doctor.[3]

Take steps to understand diabetes. You're here, so you are in the right mindset. Diabetes educators are highly recommended. These experts help you understand the different tools available to you, and can help you adjust your meals to better control blood glucose levels. For those who are diagnosed with type 1 diabetes at a young age, an appointment with a diabetes trainer/educator is often mandatory, and they will often meet with you while in the hospital.

Take your medications every day. The body of a person with Type 1 diabetes needs insulin because their pancreas is damaged in a way that will not produce enough insulin as needed. Insulin is a chemical compound used to break down sugar (glucose) in the bloodstream. Those with type 1 diabetes must work with their doctor to find their correct dosage of insulin, because different individuals have different reactions to various types of insulin, and because some individuals with this type of diabetes may still be producing insulin at mild levels. Without insulin, the symptoms of Type 1 diabetes will rapidly worsen and eventually cause death. To be clear: Individuals with Type 1 diabetes need to take insulin every day or they will die.[4] Your precise daily insulin dosages will vary based on your size, diet, activity level, and genetics, which is why it is so important to see a doctor get a thorough evaluation before beginning your diabetes treatment plan. Insulin is generally available in several different varieties, each of which is formulated for specific purposes. These are:[5]

Rapid-acting: "Mealtime" (bolus) insulin. Usually taken right before a meal to prevent elevated blood glucose levels after eating.

Short-acting: Basal insulin. Usually taken between meals once or twice a day to control "resting" blood glucose levels.

Long-acting: A combination of bolus and basal insulin. It can be taken before breakfast and dinner in order to keep blood glucose levels low after meals as well as throughout the day.

Intermediate-acting: Combined with rapid-acting insulin. It covers the blood glucose elevations when rapid-acting insulins stop working. This type is typically taken twice a day.[6]

Consider an insulin pump. An insulin pump is a device that continually injects a bolus rate of insulin to mimic the effects of the basal rate insulin. Your blood glucose level is entered into the device at mealtimes and in accordance with your normal testing schedule, and your bolus is calculated for you. In addition a carbohydrate ratio can be set and be added to the bolus calculation as well.

There is the new tubeless (no tubing) insulin pump that is an "all-in-one" unit that typically comes loaded with a three-day supply of insulin with the battery and pump built-in, it is the Omnipod, that is wirelessly controlled by a Personal Diabetes Manager (PDM). It takes ideally about ten pumps per month that come in a box holding a 30-day supply.[7]

The old, standard injection set consisted of a plastic cap attached to a catheter that injects the insulin (subcutaneous delivery of insulin). It was inserted into your chosen injection site brought from the pump by tubing called the cannula. The pump set might be attached to a belt or near the delivery site with an adhesive pad. On the other end, the tubing connects to a cartridge that you fill with insulin and insert it into the pump unit. Some pumps have a compatible glucose monitor that measures glucose levels just below the dermis. While not as effective as a glucose meter, this device will allow early detection and compensation for sugar spikes and drops.

Pump users typically monitor their blood sugars more frequently to evaluate the effectiveness of insulin delivery by the pump, to be aware of the pump malfunctions. Some malfunctions of the insulin pump include:

Pump battery is discharged

Insulin is inactivated by heat exposure

Insulin reservoir runs empty

Tubing loosens and insulin leaks rather than being injected

The cannula becomes bent or kinked, preventing the delivery of insulin.

Exercise. In general, people with diabetes should strive to be physically fit. Physical exercise has the effect of lowering the body's glucose levels - sometimes for as long as 24 hours.[8] Because the most harmful effects of diabetes are caused by elevated glucose levels (blood sugar "spikes"), exercise after eating is a valuable tool that uses sugar naturally and allows people with diabetes to keep glucose at manageable levels. In addition, exercise also provides the same benefits to those with diabetes that it does to those without it - namely, greater overall fitness, weight loss (but rapid weight loss is a bad symptom indicating food and sugar is not used properly by your system). You can gain higher strength and endurance, higher energy levels, elevated mood, and more benefits of exercise as well.

Diabetes resources generally recommend exercising at least several times per week. Most resources recommend a healthy mix of cardio, strength training, and balance/flexibility exercises. See How to Exercise for more information.

Though low, manageable glucose levels are generally a good thing for the moderate activity for people who have diabetes. Exercising vigorously while you have low blood sugar levels can lead to a condition called hypoglycemia, in which the body doesn't have enough blood sugar to fuel its vital processes and the exercising muscles. Hypoglycemia can lead to dizziness, weakness, and fainting. To counter hypoglycemia, carry a sugary, quick-acting carbohydrate with you while you exercise, such as sweet, ripe orange, or a soda, a sports drink, or such as recommended by your health team.[9]

Minimize stress. Whether the cause is physical or mental, stress is known to cause blood sugar levels to fluctuate.[10] Constant or prolonged stress can cause blood sugar levels to rise in the long term, which means you may need to use more medication or exercise more frequently to stay healthy. Generally, the best cure for stress is a preventative one - avoid stress in the first place by exercising frequently, getting enough sleep, avoiding stressful situations when possible, and talking about your problems before they become serious.

Other stress management techniques include seeing a therapist, practicing meditation techniques, eliminating caffeine from your diet, and pursuing healthy hobbies. See How to Deal With Stress for more information.

Avoid getting sick. As both an actual physical ailment and as an indirect source of stress, illness can cause your blood sugars to fluctuate. Prolonged or serious illness can even necessitate changes in the way you take your diabetes medication or the diet and exercise routines you'll need to keep. Though the best policy when it comes to illnesses, is to avoid them by living a life that is as healthy, happy, and stress-free as possible. If and when you do come down with an illness, be sure to give yourself the rest and medicine that you need to get better as quickly as possible.

If you have a common cold, try drinking plenty of fluids, taking over-the-counter cold medications (but avoid sugary cough syrups), and getting plenty of rest. Since having a cold can ruin your appetite, you'll want to be sure to eat roughly 15 grams of carbohydrates every hour or so.[11] Though having a cold usually elevates your blood sugar levels, refraining from eating as may feel natural can cause your blood sugar to fall dangerously low.

Serious illnesses always require the advice of a doctor, but managing serious diseases in patients with diabetes can require special medicines and techniques. If you are a person with diabetes and you think you may have a disease that is more serious than an ordinary cold, see your doctor right away.

Modify your diabetes plans to account for menstruation and menopause. Women with diabetes have unique challenges when it comes to managing blood sugar during their periods and menopause. Though diabetes affects every woman differently, many women report having elevated blood sugar levels in the days before their periods, which can require using more insulin or changing your diet and exercise habits to compensate.[12] However, your blood sugar levels during your menstrual cycle may be different, so talk to your doctor or gynecologist for specific guidance.

Additionally, menopause can change the way that the body's blood sugar level fluctuates. Many women report that their glucose levels become more unpredictable during menopause.[13] Menopause can also lead to weight gain, sleep loss, and temporary vaginal ailments, which can increase the body's levels of stress hormones and elevate glucose levels.[14] If you have diabetes and are going through menopause, talk to your doctor to find a treatment plan that's right for you.