Type 2 diabetes no insulin

After diabetes diagnosis, many type 1 and type 2 diabetics worry about their life expectancy.

Death is never a pleasant subject but it’s human nature to want to know ‘how long can I expect to live’.

There is no hard and fast answer to the question of ‘how long can I expect to live’ as a number of factors influence one’s life expectancy.

How soon diabetes was diagnosed, the progress of diabetic complications and whether one has other existing conditions will all contribute to one’s life expectancy – regardless of whether the person in question has type 1 or type 2 diabetes

How long can people with diabetes expect to live?

Diabetes UK estimates in its report, Diabetes in the UK 2010: Key Statistics on Diabetes , that the life expectancy of someone with type 2 diabetes is likely to be reduced, as a result of the condition, by up to 10 years.

People with type 1 diabetes have traditionally lived shorter lives, with life expectancy having been quoted as being reduced by over 20 years.

However, improvement in diabetes care in recent decades indicates that people with type 1 diabetes are now living significantly longer.

Results of a 30 year study by the University of Pittsburgh, published in 2012, noted that people with type 1 diabetes born after 1965 had a life expectancy of 69 years.

How does diabetic life expectancy compare with people in general?

The Office for National Statistics estimates life expectancy amongst new births to be:

  • 77 years for males
  • 81 years for females.

Amongst those who are currently 65 years old, the average man can expect to live until 83 years old and the average woman to live until 85 years old.

What causes a shorter life expectancy in diabetics?

Higher blood sugars over a period of time allow diabetic complications to set in, such as:

  • Diabetic retinopathy
  • Kidney disease
  • Cardiovascular disease (heart disease)

Higher blood sugars can often be accompanied by associated conditions such as

  • Higher blood pressure
  • High cholesterol

Both help to contribute to poor circulation and further the damage to organs such as the heart, kidneys, eyes and nerves in particular.

In some cases, short term complications such as hypoglycemia and diabetic ketoacidosis can also be fatal.

Transcript

Statistically diabetes results in lower life expectancy than people without diabetes. However, it is not all doom and gloom and there are steps you can take which can help to increase your likelihood of living longer.

The bad news is that average life expectancy for people with diabetes is shorter than people without diabetes. Diabetes UK’s annual report on diabetes in the UK states:

  • People with type 1 diabetes, on average, have shorter life expectancy by about 20 years
  • People with type 2 diabetes, on average, have shorter life expectancy by about 10 years

That sounds very depressing but there are some factors that also need to be considered. The statistics are based on historical figures from times when people with type 1 diabetes

lacked access to blood glucose monitoring. With the much better access to self monitoring these days, life expectancy of current generations may well improve. These days, people with type 2 diabetes are getting diagnosed earlier in the development of diabetes which, with good diabetes control, may also help to improve long term life expectancy.

The following factors can be a significant help towards keeping healthy and living longer:

  • Attaining good blood glucose control
  • Keeping blood pressure and cholesterol levels within target levels
  • Maintaining a healthy body weight

Your health team should check your progress on each of these at least once each year.

There are other guidelines provided by the NHS that contribute to living a longer and healthier life, including:

  • Eating a balanced diet with a high proportion of vegetables
  • Including physical activity into each day
  • Not smoking
  • Keeping any alcohol intake low

What can I do as a diabetic to help increase my life expectancy?

Maintaining good blood glucose control is a key way to prolong the length of your life.

Keeping blood sugar levels within the recommended blood glucose level ranges will help to offset the likelihood of the complications and therefore increase life expectancy.

It is highly recommended to enjoy a healthy lifestyle, of a well balanced diet and regular activity, in order to help keep blood pressure and cholesterol at healthy levels and promote good blood circulation.

Why has life expectancy been lower for people with type 1 diabetes?

People with type 1 diabetes will, in the majority of cases, develop diabetes at a younger age than those with type 2 diabetes, therefore they will usually spend a longer period of their life living with the condition.

However, there is good news – people with type 1 diabetes have been known to live for as long as over 85 years with the condition. As noted above, recent studies into life expectancy are showing significant improvement in life expectancy rates for people with type 1 diabetes born later in the 20th century.

As noted above, recent studies into life expectancy are showing significant improvement in life expectancy rates for people with type 1 diabetes born later in the twentieth century.

  • Diabetic for over 75 years
  • Living with diabetes for 85 years

Is type 2 diabetes less serious than type 1 diabetes?

Generally type 2 diabetes develops more slowly than type 1 diabetes.

As a result, some people can be diagnosed with type 2 diabetes (and some other diabetes types) years after they first developed the condition. In some cases diabetes may only be diagnosed after noticing the signs of diabetic complications which is a serious position.

It is not fair to judge which condition is more serious, all types of diabetes have a serious impact on people’s health and it is a difficult condition which takes a lot of time, persistence and care to manage.

How long can I, a diabetic, live without insulin while traveling?

When your technology fails you

My biggest fear while traveling has always been and will always be the destruction of my insulin by heat. One day your stash can be fully functional and the next it could be ineffective. This has never happened to me, and I work very hard to never let it happen. I just don’t know how long a Type 1 diabetic such as myself can be conscious without insulin.

I do know that when I’ve had a pump failure which has not alarmed me – trust me, that can happen – I’ve gone from 150 to over 450 in a matter of 4 hours. 4 hours? In some of the places I visit, I wonder how many hours it would take to get new insulin?

Perhaps I’m exaggerating, but the fear is present and real. But I can’t let fear drive me, I have to make confidence drive me.

My worse fear, in Agua Calientes, Peru

In Agua Calientes, Peru, the town at the foot of Machu Piccu, I experienced my worst fear and luckily was able to bring it all under control by the end of the day. This occurred in 2015. I had recently switched from my Medtronic pump which I had had for at least 10 years to the Animas Vibe. Well, that is to say, I’d had several different models of pumps during those ten years, but always stayed with Medtronic. I had chosen the Animas Vibe because it was recommended by my endocrinologist for being waterproof, and I wanted to stop worrying about getting the pump wet during travel.

Along with a new pump comes new accessories – new-style infusion sets and reservoirs. The infusion set for my new Vibe was quite different from the Medtronic – it was a circular plastic cup-like structure with a retractable needle and tape in the center, ready for a spring-loaded mechanism to boink it into you. How’s that for a technical description? It was really easy to use.

Animas Infusion Set – actually upside down – the needle is covered by the removable blue sheath, and gets quickly inserted into your skin and popped out, leaving a tube in your skin. The white tape you might see there automatically adheres to your skill. The spring mechanism is in the bottom half of what you see above.

So that morning in Agua Calientes I had to refill my insulin reservoir, and change my infusion set. I did so competently. We went off for a morning walk down the road to a butterfly farm and then down to a museum. It was at the museum I realized I was very thirsty. I checked my blood sugar and it was in the mid-300s! That NEVER happens to me! This wasn’t just a matter of some hidden sugar in the buffet breakfast, this was a problem.

So we hiked back up the hill to town, arrived back at our hotel. We had already checked out of the hotel that morning, leaving our luggage in their storage. I dug through my carry-on to find my supplies and then begged, yes begged, for a private location which was NOT a rest-room to fix a medical equipment problem. They finally let me use a room that had not yet been cleaned. I swapped out everything – new insulin in the reservoir, new set, everything.

By now my sugar was above 400. I also took several units of insulin via a needle, just to make sure it was in me. But what was in me? Was good-acting potent insulin in me? Or had my insulin somehow been fried by, who knows how? I hadn’t done anything wrong and couldn’t figure it out.

We had lunch, and hung around town, waiting for our train to Cusco which would leave mid-afternoon. Such stress! I didn’t realize back then how relatively slowly insulin acts in me. I now know that it takes about 40 minutes to start kicking in. That’s 40 minutes while my sugars are continuing to go up, so that’s a higher blood sugar that the insulin must counteract, once it does start working.

I was checking and checking, wondering if the insulin would work. There was a pharmacy in town, which I was ready to bolt to, but I did have just a little time before the train before making that final decision.

All the while I felt OK. I was thirsty and continuing to drink a lot of water, and not about to take another hike, but I was ambulatory and able to make decisions. I’d max’d out the blood glucose meter. All it would say is “HI”.

Finally, at least an hour and a half hour later I finally saw my blood sugars register on the meter. Oh! 425! how exciting. I’ve never been so happy about a blood sugar like that!

That meant my insulin was good!!!!!!!

But it didn’t mean my pump was working. I had taken a large dose by needle in the hotel, and that was most probably what was hitting me now. Would I continue to drop or would I start to climb again?

As long as I had my bottle of good insulin, and a needle, I was good to take the train. It wasn’t until part-way back in the train that I began to have the confidence that my pump was actually pumping INTO me. (Visually I could see insulin emerge if I unclipped the set from my abdomen, but was there a problem with this infusion set as well? Was my whole batch plugged or something?)

Such trauma!

Something continued to fail, even at home!

What actually happened? I learned about a month later what had happened, when it happened AGAIN! This time I was not traveling and it was easier and less traumatic to address. No worries this time about the potency of my insulin as it had been in the refrigerator, had not frozen and had not fried. So it must be the pump or set itself.

As soon as I could I returned to my house and removed the set from my abdomen. Oh my goodness! I could see that the little tube which was supposed to be fully inserted into my flesh by the needle was just laying on top of my skin like a little twist-tie. It had not penetrated! If it had not penetrated, that meant the needle had not actually penetrated.

I quickly and easily inserted a new one. But not knowing why the needle had not penetrated, and with the painlessness of the procedure not being able to detect the needle myself, it left me still in that hours-long quandary of watching and waiting for my sugar to drop. You can’t actually check unless you remove the set and then you can see if it actually was inserted, at which time it is too late because you’ve already removed it.

This happened at least four more times over the next nine months. The subsequent times were less traumatic because by then I was using the Dexcom Continuous Glucose Monitoring system integrated into the pump. The pump would alarm me as my sugar popped over 200, and I could see it climbing unabatedly. I would realize by the time it max 270 that something was wrong, and I would change out the infusion set.

I learned to never change my insulin at the same time as I changed my set. I felt at risk each change and wanted to be able to much more easily diagnose the issue. I change my insulin reservoir and insulin, but leave in the same working set. I swap the infusion set but keep the same reservoir, knowing that the insulin is good. I always check my blood sugar via meter at the time of swap. I never swap later than 7pm. Those are good practices but I really needed to do them, feeling so at risk each time.

I was very frustrated with the manufacturer and thought to myself, “This never happened with Medtronic!” I complained to my doctor who had never heard of this happening. Then I noticed on the Animas website that they sell sets with 6mm long needles and 9mm long needles. I’d been using the 6 because I don’t have tough skin and am relatively thin.

The ultimate solution – choose 9mm instead of 6mm

I thought, “Maybe a longer needle will pack a bigger punch and actually penetrate my skin.” I switched over to the 9mm needles. When they go snapping in, I generally feel it! And I feel happy it hurts! The little tube introduced by the needle is also longer but I don’t feel that. Ever since switching to the 9mm sets, I have not had a single episode of mis-introduction!

Then Animas announced they are leaving the insulin pump market and I am switching back to my Medtronic, and so happy I am to be doing so. Welcome back Medtronic!

Non-insulin drugs for treating type 2 diabetes

A wide variety of non-insulin medications are available for people with type 2 diabetes, and new drugs emerge every year.

Some of the most common oral treatment options include:

Metformin

Share on PinterestMetformin is taken orally and helps control blood sugar levels.

For people with type 2 diabetes, doctors usually prescribe metformin (Glucophage) first.

Metformin helps control blood sugar levels by reducing the amount of sugar that the liver produces and improving how the body uses the sugar.

Metformin is available in the following forms:

  • Tablets: A person usually takes these two or three times a day with meals.
  • Extended-release tablets: These are long-lasting, and a person usually takes one pill with their evening meal.
  • A liquid: A person typically takes this once or twice a day with meals.

Initially, a doctor usually recommends a low dosage of metformin. Depending on how the individual’s blood sugar levels respond to the medication, the doctor may gradually increase the dosage.

In more severe cases, the doctor may prescribe a combination of metformin and other diabetes medications, which can include insulin.

When taking metformin, or any other medication, carefully follow the doctor or pharmacist’s instructions.

Although drinking alcohol in moderation with metformin is generally safe, too much can increase the risk of serious side effects, such as hypoglycemia and lactic acidosis, which is a potentially life-threating condition.

Hypoglycemia, when a person’s blood sugar levels become too low, can cause symptoms such as:

  • confusion
  • dizziness
  • tiredness
  • hunger
  • nervousness

Severe hypoglycemia is dangerous and requires immediate medical attention.

Common side effects of metformin include:

  • nausea
  • vomiting
  • diarrhea
  • stomach pain
  • a loss of appetite
  • flatulence
  • a rash
  • a metallic taste in the mouth
  • a headache
  • a runny nose
  • muscle soreness

If a person experiences severe side effects, they may need to stop taking metformin temporarily.

Sodium-glucose cotransporter-2 (SGLT2) inhibitors

SGLT2 inhibitors are a relatively new group of oral medications for type 2 diabetes.

They work by increasing the amount of sugar that the kidneys absorb from the bloodstream and pass out through the urine. This helps to lower a person’s blood sugar levels.

Doctors usually prescribe SGLT2 inhibitors in combination with metformin when metformin alone cannot sufficiently lower blood sugar levels. However, a doctor may prescribe an SGLT2 inhibitor alone, especially if a person cannot take metformin.

A person typically takes an SGLT2 inhibitor once a day. Drugs available in this group include:

  • canagliflozin (Invokana)
  • dapagliflozin (Forxiga)
  • empagliflozin (Jardiance)

Because of their effect on the kidneys, SGLT2 inhibitors increase a person’s risk of contracting genital and urinary tract infections. Doctors do not recommend these drugs for people with kidney diseases.

Dipeptidyl peptidase-4 (DPP-4) inhibitors

DPP-4 inhibitors, or gliptins, are a new class of oral drug for type 2 diabetes.

They increase the production of insulin in the body and decrease the amount of sugar that the liver releases into the bloodstream. These effects help to lower a person’s blood sugar levels.

Doctors usually prescribe DPP-4 inhibitors in combination with metformin, when metformin alone cannot lower blood sugar levels sufficiently. Under certain circumstances, a doctor may prescribe a DPP-4 inhibitor alone as a first-line treatment for type 2 diabetes.

A doctor may be more likely to prescribe these drugs for people who:

  • have chronic kidney disease
  • are older
  • are of African-American descent

A person typically takes a DPP-4 inhibitor once daily. Available drugs in this class include:

  • alogliptin (Nesina)
  • linagliptin (Tradjenta)
  • saxagliptin (Onglyza)
  • sitagliptin (Januvia)

Alpha-glucosidase inhibitors (AGIs)

AGIs work by slowing digestion and reducing the absorption of sugar into the bloodstream. A person usually takes an AGI three times a day with the first bite of each meal.

Available AGIs include acarbose (Glucobay, Precose) and miglitol (Glyset). Doctors usually prescribe them in combination with other diabetes medications, such as metformin.

Sides effects of AGIs can include diarrhea, stomach upset, and gas.

Insulin secretagogues

These oral medications cause the pancreas to produce more insulin, which helps to regulate blood sugar levels.

There are two main types of insulin secretagogues:

  • those in the sulfonylurea class, such as glimepiride, glipizide, glyburide, chlorpropamide, tolbutamide, and tolazamide
  • those in the meglitinide class, such as repaglinide and nateglinide

A person usually takes sulfonylureas once or twice a day and meglitinides two to four times a day with meals.

Doctors usually prescribe insulin secretagogues in combination with other diabetes medications, such as metformin. These drugs may increase a person’s risk of hypoglycemia and cause slight weight gain.

Thiazolidinediones (TZDs)

TZDs are sometimes called glitazones. They increase the body’s sensitivity to insulin, which allows the hormone to regulate blood sugar levels more effectively.

Doctors usually only prescribe TZDs if other first-line treatments, such as metformin, have not achieved the desired effect.

TZDs are oral tablets, and a person usually takes them once or twice a day, with or without food. Taking these medications at the same times each day is important.

Available TZDs include rosiglitazone (Avandia) and pioglitazone (Actos). Some medications include a combination of a TZD and another diabetes drug, such as one in the sulfonylurea class or metformin.

Side effects of TZDs can include:

  • body fluid retention, which can lead to swelling
  • weight gain
  • vision difficulties
  • skin reactions
  • chest infections

In recent years, doctors have been less likely to prescribe TZDs, due to concerns that they may increase the risks of heart failure and bladder cancer.

Tips for keeping your AC1 under 7 percent:

  • Make a plan and stick to it
  • Build a support system network
  • Read food labels – look for serving size, and total carbohydrates
  • Shop for whole foods (lean meats, whole grains, fresh fruits and vegetables, and low-fat dairy products)
  • shop and prep meals in advance
  • Eat small frequent meals, instead of larger meals
  • Get out and get moving. Turn off the TV, or watch and work out
  • Decrease stress by trying relaxation techniques, meditation, yoga, or other relaxing activities

Diabetes is a balancing act

It can be a bit troublesome to try to get your diet, exercise, and medications straight. All of this effort is to have your A1C stay under 7 percent, so that you are living healthy with diabetes. However, if your A1C starts creeping up, and you have tried many other diabetes medicines in order to try to get your A1C down to no avail, don’t balk at starting insulin.

Should I start insulin?

If your healthcare provider decides that it is time for you to start insulin, then it probably is. In order to avoid long term complications when your beta cells have just given out, and are not making enough insulin anymore, you should start insulin if advised to do so. It would be better to take an insulin injection to get your A1C down below 7 percent, than it would be to end up with a non-healing ulcer, on the dialysis unit, or experience going blind.

For most people with diabetes, the goal is to keep the A1C below 7 percent, and to live healthy with diabetes. This can be achieved by using an individualized and patient-centered approach. Some important factors that should be taken into consideration when picking a diabetes medication are:

  • the costs
  • patient preference
  • side effects (including weight gain)
  • and the risk of a low blood sugar.

Over to you

Have you ever been told you had to go on insulin? How did it make you feel, and how did you overcome your fear?

If you have never had to go on insulin, share your success stories and difficulties of managing your diabetes with diet, exercise, and/or oral medications, or other non-insulin injections. We would love to hear from you.

TheDiabetesCouncil Article | Reviewed by Dr. Christine Traxler MD on September 19, 2018

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Last Updated: Wednesday, September 26, 2018 Last Reviewed: Wednesday, September 26, 2018

Last year, we reported on a study in which a nine-year-old boy with type 1 diabetes was able to come off insulin injections for 19 months by following a Paleolithic ketogenic diet.

Before beginning the diet – a modified version of the ketogenic diet, which consisted only of animal meat, fat, offal and eggs with a fat:protein ratio of 2:1 – the boy had been on insulin therapy for six weeks, alongside a high-carbohydrate diet.

Some members of the diabetes community attributed the success of the diet to the honeymoon period, which is when people with type 1 diabetes can still produce some insulin following their diagnosis.

Are these findings attributable to a honeymoon period?

Not according to Hungarian physician Dr. Csaba Tóth.

“This should by no means be regarded as a honeymoon period”, Dr. Tóth, the medical leader of Paleomedicina Hungary, told Diabetes.co.uk

“Besides this method, we are not aware of any clinical data from literature indicating an increase in C-peptide following diagnosis onset while being safe and without side effects.

“Typically, C-peptide tends to zero already at one year after diagnosis onset on the standard diabetes diet. The present case is not the only one in our practice. We are following others and experiencing the same.”

Furthermore, Dr. Tóth believes that adopting the diet could lead to autoimmune changes within type 1 diabetes.

“It seems that if one strictly adheres to the diet, the autoimmune process may halt. From ex vivo human studies four routes are known to recover pancreatic beta cells. Thus it seems possible to recover the lost function of the pancreas. Of course, this is possible in those cases without insulin receptor dysfunction only.”

The boy went 24 months without insulin after following the Paleo diet. Photo: IJCRI

The boy in the study went without insulin for 24 months. The success is undoubtedly remarkable, even if he moved on to insulin injections afterwards.

Not only did the boy go two years without insulin, but his blood sugar levels were significantly lower on the Paleolithic ketogenic diet compared to his six weeks of insulin therapy. He didn’t have any complications or episodes of hypoglycemia, and the study authors stressed that the diet can be sustainable in the long-term.

They noted, though, that patients with long-standing type 1 diabetes are likely to have exhausted beta cells, and the need for insulin replacement could be unavoidable. “In these cases, however, the Paleolithic ketogenic diet may be used as an adjunct in an attempt to likely prevent diabetic complications,” said the researchers.

What significance do these findings have for type 1 diabetes?

“Our findings indicate that patients diagnosed with type 1 diabetes may have another option to choose,” said Dr. Tóth.

The boy in the study went without insulin for 24 months. The success is undoubtedly remarkable, even if he moved on to insulin injections afterwards.

“This is a treatment requiring much more from the patient and his/her environment in terms of motivation, cooking techniques, personal burden of resisting against the mainstream etc. However, once realised, the method may offer a much better outcome of the disease.”

It should be noted, though, that when Dr. Tóth says the Paleolithic ketogenic diet could be a treatment option for type 1 diabetes, he doesn’t mean as a replacement for insulin injections.

The diet could help newly diagnosed type 1 patients with residual insulin secretion be without insulin for a short-term period, but the benefits that extend to people with long-standing type 1 include better glycemic control and the potential to prevent diabetic complications.

Of course, these findings refer to just one boy. Further research on a larger scale will be needed to confirm the results among people with type 1 diabetes of different durations. However, the Paleolithic ketogenic diet appears to be a fascinating area for future type 1 diabetes research.

Do you have any experience of the Paleolithic ketogenic diet? Has it helped improve your blood glucose levels?

Picture: thepaleodiet.com

Type 1 Diabetes: How Is It Treated?

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Your teachers follow a lesson plan that outlines what you’ll study each day. Your parents may have a plan to help you pay for college. And your weekend social plans determine whether you’re seeing a movie, heading to a concert, or playing basketball at the gym.

People with type 1 diabetes need to follow a different type of plan. A treatment plan, also called a diabetes management plan, helps people to manage their diabetes and stay healthy and active. Everyone’s plan is different, based on a person’s health needs and the suggestions of the diabetes health care team.

Diabetes Treatment Basics

The first thing to understand when it comes to treating diabetes is your blood glucose level, which is the amount of glucose in the blood. Glucose is a sugar that comes from the foods we eat and also is formed and stored inside the body. It’s the main source of energy for the cells of the body, and is carried to them through the blood. Glucose gets into the cells with the help of the hormone insulin.

So how do blood glucose levels relate to type 1 diabetes? People with type 1 diabetes can no longer produce insulin. This means that glucose stays in the bloodstream and doesn’t get into the cells, causing blood glucose levels to go too high.

High blood sugar levels can make people with type 1 diabetes feel sick, so their treatment plan involves keeping their blood sugar levels within a healthy range, while making sure they grow and develop normally. To do that, people with type 1 diabetes need to:

  • take insulin as prescribed
  • eat a healthy, balanced diet with accurate carbohydrate counts
  • check blood sugar levels as prescribed
  • get regular physical activity

Following the treatment plan can help a person stay healthy, but it’s not a cure for diabetes. Right now, there’s no cure for diabetes, so people with type 1 diabetes will need treatment for the rest of their lives. The good news is that sticking to the plan can help people feel healthy and avoid diabetes problems later.

Take Insulin as Prescribed

People who have type 1 diabetes must take insulin as part of their treatment. Because their bodies can’t make insulin anymore, they need to get the right amount to keep their blood sugar levels in a healthy range.

The only way to get insulin into the body now is by injection with a needle or with an insulin pump. If someone tried to take insulin as a pill, the acids and digestive juices in the stomach and intestines would break down the medicine, and it wouldn’t work.

Different kinds of insulin are used for different purposes. The types of insulin you use and the number of shots you take each day will depend on what’s best for you and your daily schedule.

As you grow and change, the amount of insulin you will need to take can change. Getting insulin injections today is nearly painless, thanks to smaller needles. Insulin pumps (which deliver insulin through a small tube placed just under the skin) cut down on the number of injections needed.

Your diabetes health care team will teach you how and when to give yourself insulin shots.

Eat a Healthy, Balanced Diet

People with type 1 diabetes have to pay a little more attention to their meals and snacks than people who don’t have diabetes. They need to eat a balanced, healthy diet and pay closer attention to what they eat and when they eat it.

They also have to balance the food they eat with the amount of insulin they take and their activity level. That’s because eating some foods will cause blood sugar levels to go up more than others, whereas insulin and exercise will make blood sugar go down. How much the blood sugar level goes up after eating depends on the type of nutrients the food contains.

The three main types of nutrients found in foods are carbohydrates (or carbs), proteins, and fats, which all provide energy in the form of calories. Foods containing carbs cause blood sugar levels to go up the most. Foods that contain mostly protein and/or fat don’t affect blood sugar levels as much. Our bodies need all of these nutrients — in different amounts — to function normally.

As part of your diabetes treatment, you and the diabetes health care team will create a written diabetes meal plan that will include foods with all of the essential nutrients. Meal plans typically consist of breakfast, lunch, and dinner with scheduled between-meal snacks.

The diabetes meal plan won’t tell you specific foods to eat, but it will guide you in selecting choices from the basic food groups and help you eat nutritious, balanced meals. Each meal and snack in the plan contains a certain amount of carbs and works with the types and amount of insulin you take.

Your meal plan is made just for you, based on your age, activity level, schedule, and food likes and dislikes. It also should be flexible so you know how to handle diabetes in special situations like at parties and on holidays. Following your meal plan should make it easier to keep your blood sugar levels within a healthy range.

In addition to giving you some ideas about what to eat, the plan also might recommend limiting foods that contain lots of fat or calories and that don’t contain vitamins and minerals. Everyone who eats a healthy diet should limit these foods anyway, because eating too much of them can lead to too much weight gain or long-term health problems like heart disease.

Check Blood Sugar Levels

Checking your blood sugar levels is another part of your diabetes treatment plan. It lets you know how well the other parts of your treatment — like your insulin injections and meal plan — are working.

By keeping your blood sugar levels in a healthy range, you’ll feel better and reduce the risk that you’ll develop diabetes problems later. Testing your blood sugar level is the only way to know how you are doing with your diabetes control.

Your diabetes care team may recommend that you use a continuous glucose monitor (CGM). A CGM is a wearable device that can measure blood sugar every few minutes around the clock. It’s measured by a thread-like sensor inserted under the skin and secured in place. Sensors can stay in place for about a week before they have to be replaced and are accurate enough to replace frequent finger-stick testing. The more frequent CGM blood sugar readings can help you and the care team do an even better job of troubleshooting and adjusting your insulin doses and diabetes management plan to improve blood sugar control.

A blood glucose meter or CGM tells you what your blood sugar level is at the moment. Your doctor may also send you for another type of blood sugar test that tells you how your blood sugar levels have been for the 3 months before the test.

Exercise Regularly

Exercise is also an important part of diabetes treatment. Regular physical activity helps keep blood sugar levels in a healthy range. It also can reduce the risk of other health problems that people with diabetes may be more likely to get, like heart disease.

Most types of exercise are great for people with type 1 diabetes — from walking the dog or riding a bike to playing team sports. Try to exercise every day for maximum benefit.

You can talk to your diabetes health care team about planning your exercise along with your meals and insulin. They’ll offer specific suggestions to help you get ready for exercise or join a sport and give you written instructions to help you respond to any diabetes problems that may occur during exercise, like hypoglycemia (low blood sugar), or hyperglycemia (high blood sugar).

Putting It All Together

Treating and managing diabetes can seem complicated at times. But your diabetes health care team is there for you. Your diabetes management plan should be easy to understand, detailed, and written down for you so that you can refer to it whenever you need to.

You also might hear about alternative treatments for diabetes, such as herbal remedies and vitamin or mineral supplements. These practices can be risky, especially when people stop following the treatment plan their doctor has given them. So get the facts by talking to your diabetes health care team.

Reviewed by: Shara R. Bialo, MD Date reviewed: August 2018

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