Learning How to Manage Diabetes Means Learning How to Live with Diabetes—Here’s What to Expect

Learning How to Manage Diabetes Means Learning How to Live with Diabetes—Here’s What to Expect

There’s currently no cure for diabetes. But that doesn’t mean it’s impossible to learn how to manage diabetes. In fact, if you live with type 2 diabetes, you can achieve remission by maintaining healthy blood sugar levels (defined as an A1C level of less than 6.5%) for three months or more after stopping diabetes medication, according to a recent consensus statement from the American Diabetes Association (ADA), the Endocrine Society, the European Association for the Study of Diabetes, and Diabetes UK. How do you get there? It’s all about understanding your condition, how it works, and your role in managing it.

Figuring out how to manage diabetes will depend on several different factors, of course, including what type of diabetes you have. If you live with type 1 diabetes, for example, that means your pancreas produces little or no insulin, a hormone your body needs to use glucose (a.k.a. sugar) for energy. So, in addition to monitoring your blood sugar and developing a healthy diet, exercise, and general lifestyle habits, you’ll likely need to use insulin as well.

With type 2 diabetes, the pancreas can usually produce some insulin, though it might not be enough or it might not work effectively enough (a.k.a. insulin resistance) to regulate blood sugar levels consistently, so you might need a combination of medication and lifestyle changes to get your numbers back within range. While insulin is less commonly used to manage type 2 diabetes, other medications such as metformin might become part of your self-care plan, and you’ll still need to keep an eye on your blood sugar levels with some regularity.

The same goes for gestational diabetes (GDM), a type of diabetes diagnosed during pregnancy. Some level of insulin resistance is common in all pregnancies, but if your pancreas can’t make enough extra insulin to compensate for your body’s insulin resistance during that time, then you may wind up dealing with elevated blood sugars that can lead to a GDM diagnosis.

No matter which type of diabetes you’re diagnosed with, you’ll want to work closely with experts who specialize in your condition and various diabetes management strategies (think: endocrinologists, registered dietitians, certified diabetes care and education specialists) so you can figure out a unique treatment plan that works for you.

While that plan will look different from person to person, here’s what you need to stay on top of when managing diabetes.

How to Manage Diabetes with Blood Sugar Monitoring

Regardless of which type of diabetes you live with, monitoring your blood sugar is a key part of managing the condition.

You can check your numbers using the finger-prick method with a glucose meter, which measures blood sugar at a single point in time, or by using a continuous glucose monitor (CGM), which automatically measures glucose every few minutes via a sensor inserted into the upper arm or near your navel. CGMs are usually prescribed to people living with type 1 diabetes, but in some cases, people with type 2 diabetes may be prescribed a CGM as well, particularly if they’re using multiple daily insulin injections to regulate their blood sugar.

Research shows that glucose meters tend to be just as accurate as CGMs, but since the two devices measure glucose in different areas of the body, their readings can sometimes have different values, says One Drop coach, Lindsay Vettleson, a registered dietitian/nutritionist (RDN), certified diabetes care and education specialist (CDCES), and certified personal trainer (CPT). “You’ll usually see the most variability in values after eating, exercising, or taking medications,” she adds. (To get a more complete picture of your health, double-check your CGM data with a glucose meter and dive into real-time predictions and insights that help you learn more about your health.)

As for how often you should check your blood sugar, that will vary from person to person. Generally speaking, it's recommended that people who use insulin check at least four times a day (typically before meals and before going to sleep). For those who don't use insulin, how often you check will largely depend on how well you're managing your diabetes at that time, so it's key to establish those guidelines with your doctor.

While any type of diabetes will require some form of blood sugar monitoring, living with type 1 diabetes, specifically, will sometimes entail testing for ketones in your urine as well, particularly when you’re sick or your blood sugar levels exceed 240 mg/dl. Ketones are acidic chemicals that build up when your cells don’t get the glucose they need and your body begins burning fat for energy instead, which can potentially lead to diabetic ketoacidosis (DKA), a serious and potentially fatal complication. Be sure to talk to your doctor about specifics on when and how to monitor your own ketones, and what to do if you find high levels in a home test.

How to Manage Diabetes with Medication

Much like the method of blood sugar monitoring you choose, the type of medication you might need (if you need medication at all) depends on the type of diabetes you live with and what your health needs are, exactly.

Whatever the circumstances are, remember that there’s no shame in needing medication. What really matters is that you understand your diabetes and the power you have to steer your health in the right direction, whether with healthy eating, physical activity, stress management, getting enough sleep, taking medication, or all of the above.

How to Manage Diabetes with Insulin

In type 1 diabetes, the immune system destroys beta cells in the pancreas that release insulin, meaning your body can’t produce insulin on its own, so you’ll need to take insulin—either in the form of insulin shots or via an insulin pump (a small device that delivers insulin through a tube inserted under the skin)—to manage your blood sugar, says Vettleson. (While insulin is occasionally used to manage type 2 and gestational diabetes, it’s not usually the first line of treatment, but rather an alternative if you’re having trouble hitting your blood sugar targets with lifestyle changes and other medications, according to the Mayo Clinic.)

There are five types of insulin, which can be categorized as fast-acting, intermediate-acting, or long-acting, according to the Diabetes Teaching Center (DTC) at the University of California, San Francisco (UCSF).

Fast-acting insulin includes rapid-acting insulin analogs (which you might know as insulin aspart or insulin glulisine) and regular human insulin. As its name suggests, fast-acting insulin absorbs quickly from your fat tissue into your bloodstream to help manage high blood sugar, especially during meals. Depending on which type you take, fast-acting insulin can start working within five to 60 minutes, and effects tend to last between four and eight hours.

Intermediate-acting insulin absorbs more slowly into the bloodstream, but the effects last longer, meaning it can be helpful for managing sugar levels overnight, while fasting, and between meals. NPH insulin, a type of intermediate-acting insulin, takes about one or two hours to start working, and its effects can last over 12 hours, depending on the dose. Pre-mixed insulin, which combines NPH with a form of fast-acting insulin, can start working within 10-20 minutes and may last as long as an entire day, depending on the dose.

Finally, long-acting insulin (such as insulin glargine or insulin detemir) takes about an hour and a half to two hours to absorb into the bloodstream, with a plateau effect that usually lasts about 12-24 hours, making it another good option for overnight blood sugar management, during a fasting period, or between meals.

One of the most common challenges with insulin is timing, says One Drop coach, Rukiyyah Khan, a diabetes prevention specialist who’s certified in plant-based nutrition. “Taking insulin too far before a meal, for example, can cause low sugar levels prior to eating and a later spike,” she explains. “Taking insulin too close to a meal, on the other hand, can cause a quick spike, because the insulin hasn’t kicked in, and then a more gradual drop-off in blood sugar.”

It’ll take time and patience, but Khan, who lives with type 1 diabetes, says experimenting with your personal insulin timing (with your doctor’s guidance, of course) is the best way to figure out what works for you. What it really comes down to, she continues, is not just understanding how insulin can interact with different types of food, exercise, and other activities throughout your day, but also accepting that these effects won’t always be consistent or predictable, no matter how hard you try.

“It can be challenging to know what’s successful and what’s not because there are so many variables that can impact blood sugar,” she explains. “You can get an idea of what does or doesn’t work for your body by measuring how your treatments are working, but it’s not always exact. Some days you can dose the same amount of the same insulin for the same food and get a completely different result.” (Here are some expert-approved tips for making all that diabetes data less overwhelming.)

Metformin, DPP-4 Inhibitors, and Other Common Medications for Diabetes

With type 2 diabetes, beta cells in the pancreas aren’t totally destroyed the way they are in type 1 diabetes; rather, beta-cell function is usually around 50% when you’re first diagnosed with type 2 diabetes, explains Vettleson. While changes in lifestyle habits like diet and exercise alone can be beneficial, others might need medication to help them hit their blood sugar targets consistently.

Metformin, for example, manages insulin resistance by reducing the amount of sugar released by the liver. It not only benefits A1C levels but also can help with weight management and reduce the risk of cardiovascular disease, says Vettleson.

Other medications for diabetes work by helping the body make more insulin, such as sulfonylureas (Glipizide, Glyburide, Glimepiride) and dipeptidyl peptidase-4 (DPP-4) inhibitors (Januvia, Tradjenta). Similar to metformin, glucagon-like peptide (GLP-1) agonists (Trulicity, Rybelsus) also reduce the amount of sugar made by the liver, in addition to helping the body make more insulin. (Learn more about medications for diabetes here.)

How to Manage Diabetes with Diet, Exercise, and Weight Management

You already know that healthy eating and exercise habits are an important part of managing not just diabetes, but really, your overall health.

Yes, regular diet and exercise can help you maintain a healthy weight—which, in and of itself, benefits blood sugar levels and helps lower your risk of diabetes complications like high blood pressure—but there’s more to it than that.

With nutrition, for example, sticking to foods that are high in nutrients like fiber (which slows your body’s absorption of sugar, which can help lower blood sugar) and low in saturated fat, refined carbohydrates, and sugar, will help you manage your blood sugar levels and your weight. Still, what works best for you might not work well for someone else with the same condition, so it’s best to consult a registered dietitian (RD) to help you figure out a meal plan that’s right for you, specifically. (In case you don’t know, several of our One Drop coaches are not only registered dietitians/nutritionists, but also certified diabetes care and education specialists, registered nurses, and even personal trainers.)

Similarly, there’s no one-size-fits-all approach to exercise when managing diabetes, either. Generally speaking, regular exercise (the ADA recommends a minimum of 150 minutes per week) can increase your body’s insulin sensitivity and improve your muscles’ ability to use glucose for energy, explains Susan Juechter, RD, CDCES.

There are health benefits to both aerobic exercise and resistance training, but the latter can help more with muscle growth—and, the more muscle you have, the more glucose can be put to use, explains One Drop coach, Amy Crees, RDN.

“The biggest challenge for exercise is understanding the impact it will have on blood sugars,” notes Khan. For example, intense cardio can sometimes lead to a rapid drop in blood sugar, she explains, while weightlifting can spike blood sugar in the short-term—hence why it’s important to monitor your levels closely before, during, and after exercise, she says.

The same goes for eating, adds Khan. Your own blood sugars might react differently to the same exact meal eaten on two separate days, depending on what else was happening during that time (stress, medication changes, etc.).

For Khan, managing the unpredictability of how medication can interact with diet and exercise “has been a matter of taking frequent breaks from whatever is making life feel difficult,” she shares. For instance, “if I’m obsessing over carbs, I’ll take a week where I estimate carbs and give myself grace if I don’t get it right.” As for exercise, Khan says, she sometimes “takes the intensity down” to walking or doing yoga, “which tend to be easier on the body and typically cause fewer blood sugar highs and lows,” she explains.

No matter how you decide to shape your diet and exercise habits, One Drop coach, Julia Dugas, RDN, CPT recommends being realistic with yourself about new lifestyle changes and how quickly you can implement them. In other words, on paper, changing your eating habits and starting a new workout routine might seem like two to-do items, but anyone who’s actually followed through with these healthy habits knows there’s way more on that checklist than just two items.

“When we change our eating habits, we also have to change our shopping habits, spending habits, cooking habits, and may even need to learn how to prepare and cook completely different foods,” explains Dugas. It’s the same with a new exercise routine, she adds; it’s not only the actual workouts, but also potentially a new morning or bedtime routine, maybe a new commute, and possibly even new expenses if you’re joining a gym, buying new shoes, or signing up for exercise classes.

“There’s a domino effect of everything we do, and it’s never as simple and clear-cut as we think it will be,” continues Dugas. “Focus on one thing at a time until it’s a habit—until it’s easy to do consistently. Then, when it’s something you do mostly automatically, you can consider layering in a new behavior.” (Learn more about how habits become changes that last.)

Mental Health and Emotional Support

As you’ve probably gathered by now, learning how to manage diabetes entails a lot of work—continuous work, day in and day out, which, for many people living with the condition, can lead to feelings of burnout that make it harder to follow through with healthy habits.

To combat the burnout, it’s crucial to manage your stress levels—not just as a means of handling any negative emotions you might have about living with diabetes, but also as an additional strategy for regulating your blood sugar, as stress hormones like cortisol can make blood sugar levels rise. Technically, cortisol is supposed to trigger your liver to release sugar into the bloodstream and spike your blood sugar because, from an evolutionary standpoint, this process provides a readily available source of energy to help you respond to whatever’s causing your stress, explains One Drop coach, Alexa Stelzer, RDN, CDCES. However, when this process happens chronically, elevated cortisol levels can contribute to chronically high blood sugars, too, she says.

Of course, mental self-care and stress management looks different for everyone. Some people benefit from traditional mindfulness practices like meditation; others enjoy working through their emotions with a therapist; maybe you’ll find that a combination of the two works well for you. (And don’t forget the importance of a consistent sleep schedule.)

Regardless of what your own self-care plan looks like, be sure to establish a support system—whether it’s your friends or family, other people living with diabetes, or even your One Drop coach—that allows you to share your experiences and connect with people who just get it.

“Having friends and peers who live with the same condition as you can be helpful as a different kind of support system,” adds Dugas. “Facebook groups, such as our private One Drop Premium Members Facebook Group, can be great spaces to find peer-to-peer support.”

Khan says she’s found many of her own “diabuddies” through similar social media pages and online support groups, though she also notes that “having a health coach with scientific knowledge is great because they can help you understand the reason behind many of the diabetes-related decisions you have to make each day.”

“I also recommend looking into financial support resources from major diabetes organizations— such as the Juvenile Diabetes Research Foundation (JDRF), Beyond Type 1, and the ADA—including college scholarships, insulin cost help, and mental health support, as diabetes management can be costly,” which can take an additional toll on your mental well-being, adds Khan.

Ready to put these tips to the test? Create your own diabetes management plan with One Drop’s Complete Diabetes package, which includes a glucose meter, test strip plan, and a One Drop Premium membership with live one-on-one coaching.

This article has been clinically reviewed by Jamillah Hoy-Rosas, MPH, RDN, CDCES, and VP of clinical operations and program design at One Drop, and Lisa Goldoor, RN, BSN, CDCES, clinical health coach and type 1 diabetes pod manager at One Drop.

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Allie Strickler
Nov 22, 2021

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