American Diabetes Month: What are the dos and don’ts of managing the condition and reducing complications?
For type 1 diabetes, insulin is required because none or very little is being made by the body. For type 2 diabetes, diet and exercise may be enough
You can manage your diabetes and live a long and healthy life by taking care of yourself each day. It is common to feel overwhelmed, sad, or angry when you are living with diabetes. However, since diabetes can affect almost every part of the body, you need to manage your blood glucose or blood sugar levels to prevent health problems.
Do you need to take medicines?
The type of diabetes a person has determines the medicine they will need. For type 1 diabetes, insulin is required because none or very little is being made by the body. For type 2 diabetes, diet and exercise may be enough, but many could be prescribed medicines as well. It is important to take the prescribed medicines for diabetes and any other health problems even when you feel good. “These medicines may include diabetes pills or medicines you inject under your skin, such as insulin. In time, you may need more than one diabetes medicine to control your blood glucose,” suggests the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), which is part of the US National Institutes of Health (NIH).
If a woman has gestational diabetes (one that develops during pregnancy), experts recommend focusing on a healthy diet first to control blood glucose levels. “If you can’t reach your blood glucose target, your healthcare team will talk with you about diabetes medicines, such as insulin, that may be safe for you to take during pregnancy. Your health care team may start you on diabetes medicines right away if your blood glucose is very high,” explains researchers.
However, even with diabetes pills or insulin, a healthy diet and regular exercise are still important for the best diabetes control. Work with your healthcare team to improve your diabetes self-care. You can also ask your healthcare provider to refer you to Diabetes Self-Management Education and Support (DSMES) services, which help people with diabetes learn how to take the best care of themselves. Find more details here.
What steps can you can take to stay healthy?
Keeping your blood sugar levels within the range recommended by your doctor can be challenging since many things make your blood sugar levels change, sometimes unexpectedly. But you can take some action.
Manage your ABCs: This includes (A) getting a regular A1C test to measure the average blood sugar levels over the past 3 months and staying in the target range as much as possible (it is different from the blood sugar checks you do each day); trying to keep your blood pressure (B) below 140/90 mm Hg, or the target set by the doctor; controlling (C) cholesterol levels and stopping the habit of smoking. The physician may also prescribe medicines that can help manage your blood sugar, blood pressure, and cholesterol levels. Not managing them properly can increase the chances of having a heart attack, stroke, or other complications of diabetes.
Keep track of your blood sugar: You may want to check it one or more times a day. “Many people with diabetes aim to keep their blood glucose at these normal levels: 80 to 130 mg/dL before a meal, and less than 180 mg/dL about 2 hours after a meal starts. Talk with your health care team about the best target range for you. Be sure to tell your healthcare professional if your glucose levels often go above or below your target range,” advises the NIDDK.
Eat healthy: This is key to managing blood sugar. But what does it mean to eat well? Simply put, eat healthy foods in the right amounts at the right times so your blood sugar stays in your target range as much as possible.
Experts recommend making a diabetes meal plan with help from one’s healthcare team. Say no to foods that are high in calories, as well as saturated fat, trans fat, sugar, and salt. Eating more fiber, opting for fruits and vegetables, and drinking water instead of juice and regular soda, are advised. These actions are also known to prevent or delay type 2 diabetes.
“Keeping track of the carbs in all your meals, snacks, and drinks can help you match your activity level and medicines to the food you eat,” emphasizes the US Centers for Disease Control and Prevention (CDC). Find more details here and here.
Be active: This makes your body more sensitive to insulin (the hormone that allows cells in your body to use blood sugar for energy), which helps manage diabetes. Physical activity also helps control blood sugar levels and lowers the risk of heart disease and nerve damage. Researchers recommend setting realistic goals to stay more active most days of the week. At least 150 minutes per week of moderate-intensity physical activity, such as brisk walking, is advised.
However, experts advise against committing to too many changes at once and instead recommend taking it slow. “Start slow by taking 10-minute walks, 3 times a day. Try to work up to 30 minutes or more of physical activity on most days of the week,” says NIDDK.
If you are overweight, even losing a modest amount of weight can lower your blood sugar as well as triglycerides, which is a type of fat in your blood. Modest weight loss means 5% to 7% of body weight, just 10 to 14 pounds for a 200-pound person. Find details here.
Most people are not meeting targets
More than 70% of Americans with diabetes are not meeting all management targets, which play a crucial role in preventing diabetes complications, according to a recent analysis by the CDC.
The analysis included adults aged 20 years and older, who reported having received a diagnosis of diabetes (excluding gestational diabetes) from a healthcare provider. The authors defined the goals as A1C less than 8%, blood pressure 140/90 mmHg, non-HDL-C less than 130 mg/dL, and being a nonsmoker. Non-HDL cholesterol subtracts high-density lipoprotein (HDL, or ‘good’) cholesterol number from your total cholesterol number. So it contains all the ‘bad’ types of cholesterol.
During 2017-2018, the proportion of US adults with self-reported diabetes who met ABCs goals was ‘suboptimal.’ About 26.4% met combined goals nationally, and state-level estimates ranged from 22.3% to 28.2%. The lowest prevalence was in Wisconsin, and the highest was in Utah. The investigators also found that for individual goals, 75.4% met the A1C goal, 70.4% met the blood pressure goal, 55.8% met the cholesterol goal, and 86% were current nonsmokers.
Among adults with diabetes who attained the A1C goal, the lowest prevalence was 73.7% (Texas), and the highest prevalence (77.2%) was in Alaska. The lowest prevalence of meeting the BP goal was 62.8% in DC, and the highest (74.8%) was in Alaska. The lowest prevalence of achieving the non-HDL-C goal was 52.8% in Wisconsin, and the highest was 62.8% in DC. The lowest prevalence of achieving the nonsmoking goal (79.3%) was in Tennessee, and the highest (91.8%) was in Utah. “When comparing the individual goal, the prevalence of achieving the nonsmoking goal was the highest, and that of achieving the non-HDL-C goal was the lowest. Besides, there was a relatively larger variation among states in achieving the nonsmoking goal than other goals,” write authors.
Some potential factors, such as access to healthcare and the difference in individual socio-demographic factors, might explain the variation in the achievement of goals. One study found that a lack of healthcare coverage and low use of health care services were associated with poor management of diabetes. Another study suggested that persons with higher socioeconomic status were more likely to manage diabetes more effectively. “These estimates provide data that public health departments could use in their planning efforts to achieve the goals and thus reduce diabetes-related complications at the state level,” concludes the team.