Diabetes Management and Treatment

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

The plate method allows your diet to be more flexible and allows you to still consume your favorite foods. Imagine a typical 9-inch plate that is divided into 3 sections and the largest section (half of your plate or 50%) should ideally consist of non-starchy vegetables. Example: cabbage, carrots, bok choy, tomatoes.

A quarter of your plate (25%) should consist of lean protein. Example: tuna, salmon, shrimp, chicken breast, ground turkey.

The remaining quarter of your plate (25%) would include grains and starchy vegetables. Example: whole grain bread. High-fiber cereal, oatmeal, rice, pasta.

Here’s an example of what your plate should look like:

Exercise

Most individuals with diabetes can control their blood glucose levels by following a healthy meal plan, 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 the muscles during exercise can increase the uptake of blood glucose and the movement of alternate fuels such as, free fatty acid.

Intensity and duration of exercise are the most important factors that influence fuel use. With increasing exercise intensity, the body relies heavily on carbohydrates as fuel, 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 length of exercise increases.

WHEN?

The best time to exercise is 1 to 1 ½ hours 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 250 mg/dl, wait to exercise. Intense exercise can cause further increase in blood sugar levels. Competition stress may also promote hyperglycemia

HOW MUCH?

Aim for 30-60 minutes a day for 5-6 days a week. Start with 5-10 minutes a day and slowly work towards your goal. 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

If newly diagnosed with diabetes, first line treatment will include lifestyle changes such as, healthy diet options, exercise, and weight loss. Diabetes may also be treated with medications such as 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. Long acting insulin is taken once or twice a day, usually with dinner or at bedtime, and helps to control blood sugar levels throughout the day, for 24 hours.

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.