Managing Diabetes

People with diabetes can manage it with meal planning, physical activity, and, if needed, medications. Detailed advice to treat your condition is outlined below.

Management Schedule

Adults with diabetes should receive medical care from a physician-coordinated team of health care professionals. Referrals to team members should be made as appropriate.

At each regular diabetes visit:

• Measure weight and blood pressure.
• Inspect feet if one or more high-risk foot conditions are present.
• Review self-monitoring glucose record.
• Review/adjust medications to control glucose, blood pressure, and lipids. Consider regular use of low-dose aspirin for CVD prevention as appropriate.
• Review self-management skills, dietary needs, and physical activity.
• Assess for depression or other mood disorder.
• Counsel on smoking cessation and alcohol use.

Quarterly:

• Obtain A1C in patients whose therapy has changed or who are not meeting glycemic goals (twice a year if at goal with stable glycemia).

Annually:

• Obtain fasting lipid profile (every 2 years if patient has low-risk lipid values).
• Obtain serum creatinine to estimate glomerular filtration rate and stage the level of chronic kidney disease.
• Perform urine test for albumin-to-creatinine ratio in patients with type 1 diabetes > 5 years and in all patients with type 2 diabetes.
• Refer for dilated eye exam (if normal, an eye care specialist may advise an exam every 2–3 years).
• Perform comprehensive foot exam.
• Refer for dental/oral exam at least once a year.
• Administer influenza vaccination.
• Review need for other preventive care or treatment.

Lifetime:

• Administer pneumococcal vaccination (repeat if over 64 or immunocompromised and last vaccination was more than 5 years ago)

Managing Diabetes Daily

Eat healthily

The belief that if you have diabetes you will have to eat special foods is untrue. Your diet should be the same as that of anyone else - high in fibre, fruit and vegetables and low in fat, salt and sugar.

However, different foods will affect you in different ways, so it is important to know what to eat so you get the right amount of glucose for the insulin that you are taking. A diabetes dietician can help you to work out a diet plan that can be fitted to your specific needs.

Please see the 'lifestyle' section for more information on diet and recipe ideas.

Exercise regularly

Physical activity lowers your blood glucose level, so it is particularly important to exercise regularly if you have diabetes.

Like anyone else, you should aim to do at least 30 minutes of moderate exercise, at least five times a week. This can be any activity that gets you slightly out of breath and raises your heart rate. However, you should not start a new activity without consulting your GP or diabetes care team first.

As exercise will affect your blood glucose level, you and your care team may have to adjust your insulin treatment, or diet plan, in order to keep your glucose level steady.

Do not smoke

If you have diabetes, you have an increased risk of developing a cardiovascular disease, such as a heart attack or stroke. If you also smoke, you are increasing this risk even further, as well as increasing your risk of many other serious smoking-related conditions, including lung cancer.

If you smoke and you would like to give up, your GP will be able to provide you with advice, support, and treatment to help you quit.

Drink alcohol in moderation

If you have diabetes, you should only drink alcohol in moderation, and you should never drink alcohol on an empty stomach. Depending on the amount that you drink, alcohol can cause either high, or low, blood glucose levels (hyperglycaemia or hypoglycaemia).

Drinking alcohol may also affect your ability to carry out insulin treatment, or blood glucose monitoring, so always be careful not to drink too much. For men, the recommended daily amount of alcohol is between 3-4 units and, for women, the recommended daily amount is between 2-3 units.

Let others know about your condition

If you have type 2 diabetes, you should wear an identity bracelet in order to let others know that you have the condition. This will ensure that if you blackout or collapse, emergency healthcare professionals will quickly know that you have diabetes.

You should also carry a glucagon kit with you in case of hypoglycaemia (low blood glucose). Your diabetes care team should train you, plus several of your family members, and close friends, in how to use it.

Look after your feet

Having diabetes means that you are more likely to develop problems with your feet, including foot ulcers and infections from minor cuts and grazes. This is due to the possibility of high blood glucose damaging the nerves in your feet (see the Complications section above).

To prevent problems with your feet, you should keep your nails short and wash your feet daily using warm water. Wear shoes that fit properly and see a podiatrist or chiropodist (a specialist in foot care) regularly so that any problems are detected early.

You should also regularly check your feet for any cuts, blisters or grazes because you may not be able to feel them if there is damage to the nerves in your feet. See your GP if you have a minor injury to your foot that does not start to heal within a few days.

Have regular eye tests

If you have type 2 diabetes, you should have your eyes tested at least once a year to check for retinopathy.

Retinopathy is an eye condition where the small blood vessels in your eye become damaged. It can occur if your blood glucose level is too high for a long period of time (hyperglycaemia). If left untreated, retinopathy can eventually cause blindness.

Regular eye tests should help to ensure that any signs of retinopathy are picked up as soon as they appear.

Managing Your Diabetes at Work, School, and During Travel

Main Article: Diabetes at Work, School and Traveling

Staying in charge of your diabetes no matter what your day holds—work, school, travel, or special events—takes planning ahead.