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Diabetes Management

It’s important to work with a health care team and set up healthy goals. Knowing the ABC’s of diabetes management can help with goal setting:

A1c: Hemoglobin A1c test shows what blood glucose has been over the last 3 months. Controlling blood glucose levels will help prevent complications. Get this test at least every 3- 6 months. For most people with diabetes, the A1C goal is below 7%.

Blood pressure: Blood pressure is the force of blood inside the blood vessels. When blood pressure is high, the heart has to work harder. For most people with diabetes, the recommended blood pressure target is blood pressure below 140/80 mm Hg.

Cholesterol: Cholesterol numbers show the amount of fat in the blood. Some kinds, like HDL cholesterol, helps protect the heart. While others, like LDL cholesterol, can block blood vessels and result in heart disease. Triglycerides are another kind of blood fat that increases the risk of heart attack or stroke.

  • LDL (“bad”) cholesterol, under 100 mg/dl
  • Triglycerides, under 150 mg/dl
  • HDL (“good”) cholesterol for men, above 40 mg/dl
  • HDL (“good”) cholesterol for women, above 50 mg/dl


Nutrition

Eating healthy can be a challenge. The best mix of carbohydrates, protein, and fat depends on the goals and preferences of the individual with diabetes. The plate method allows for a more flexible diet and for you to continue eating your favorite foods.

The total amount of carbohydrate consumed has the strongest influence on blood sugar levels. Most individuals with diabetes in the U.S. report eating moderate amounts of carbohydrate (about 45% of total energy intake).

Divide your plate into sections

  • ½ of non-starchy vegetables (spinach, broccoli, carrots, bok choy, tomatoes)
  • ¼ of lean, low-fat protein (tuna, salmon, shrimp, chicken breast, ground turkey)
  • ¼ of carbohydrates (whole grain bread, rice, high-fiber cereal, oatmeal, pasta)

Add

  • Low-calorie drink, such as water, unsweetened tea or coffee
  • A serving of fruits, dairy and/or salad (beware of high-calorie dressings)

Here is an example of what your plate might look like:

plate of carrots, green beans, and chicken

Exercise

Most individuals with diabetes can control their blood glucose levels by following a healthy meal plan and an exercise program and taking oral medication. Exercise can help maintain a healthy weight and blood glucose levels, lowering stress and increasing energy.

Maintaining normal blood sugar at rest and during exercise depends mainly on the body. Contracting muscles increase uptake of blood glucose, even when blood sugar levels are maintained by glucose production by the liver and the movement of alternate fuels, such as free fatty acid.

Intensity and duration of exercise are factors that influence exercise fuel use and are the most important. With increasing exercise intensity, the body relies heavily on carbohydrates as long as there is enough available in the muscle or blood. When glycogen stores are short, muscles increase their uptake and use of circulating blood glucose, along with free fatty acids from fat tissues. Glucose production moves from the liver to improve glycogen production as the length of exercise increases.

WHEN?

The best time to exercise is 1 to 1 ½ hour after a meal. Check your blood sugar before exercising. If your blood sugar is less than 90 mg/dl, have a snack with starch before starting. If your blood sugar is more than 300 mg/dl, wait to exercise. Exercise may cause an increase in blood sugar.

HOW MUCH?

Aim for 30-60 minutes a day for 5-6 days a week. Start with 5-10 minutes and slowly increase the workout minutes. Remember to include a warm-up and cool-down time.

HOW HARD?

You should be able to talk while you exercise. Ask your doctor or diabetes educator before beginning an exercise routine.

Medications

First-line treatment for individuals who are newly diagnosed with diabetes would be to improve their lifestyle by choosing healthier meal options, exercising and losing weight. Diabetes may be treated with insulin and oral medications. Insulin may be required if the blood sugar is too high and diabetes remains uncontrolled.

Insulin is given through shots or can be added into intravenous fluids during hospitalization. Long-acting insulin (basal insulin) works to control blood sugar between meals and during sleep. This type of insulin is usually taken once or twice a day (usually with dinner or at bedtime), which helps controls blood sugar levels throughout the day.

Rapid or fast-acting (bolus) insulin is taken prior to a meal. This type works quickly to control the sudden and rapid spike in blood sugar after a meal.

If you think you have hypoglycemia, check your blood glucose. If your blood sugar reading is 70mg/dl or less, have at least 15 grams of carbohydrates, such as half a cup (4 oz.) of juice or regular soda, 3-5 hard candies, glucose tablets or gel (take as instructed). After 15 minutes, recheck your blood glucose.