Let's Talk About Diabetes
Everything you ever wanted to know (and then some) on the causes, symptoms, and treatments of this chronic condition, and how to keep living your life, disease be damned.
Whether you’ve just been diagnosed or think you could have diabetes, you’re probably nervous, confused, and maybe even a little scared. That’s normal, and everyone featured on HealthCentral with a chronic illness felt just like you do now. But we—and they—are here for you. On this page alone, you’ll discover not only the realities and challenges of the condition, but also the best treatments, helpful lifestyle changes, wisdom from people who have been where you are now, and all the critical information to help you not just manage—but thrive. We’re sure you’ve got a lot of questions...and we’re here to answer them.
Our Pro Panel
We went to some of the nation's top experts in diabetes to bring you the most up-to-date information possible.
Katherine Araque, M.D.
Director of Endocrinology
Pacific Neuroscience Institute at Providence Saint John’s Health Center
Santa Monica, CA
Stelios Mantis, M.D.
Rush University Medical Center
Peter Goulden, M.D.
Medical Director of the Division of Endocrinology and Metabolism
Mount Sinai St. Luke's
New York, NY
About 23 million people in the United States have been diagnosed with diabetes. It’s estimated that another 7 million have it, but don’t know it yet. An additional 80 million Americans have prediabetes—higher-than-normal blood sugar that increases the risk of developing type 2 diabetes. Type 2 is the most common form of the disease: Between 90 and 95 percent of people with diabetes have it.
Yes, diabetes is a disease that causes people to have higher-than-normal levels of sugar (or glucose) in their blood. There are three main types: type 1, type 2, and gestational diabetes. Type 1 is mostly an autoimmune disease that stops the pancreas from producing insulin. In type 2, most people make enough insulin, but their bodies don’t use it well. Gestational diabetes only happens during pregnancy.
The disease is sneaky: It can have almost no visible symptoms. That’s why the U.S. Preventive Services Task Force recommends screening for adults over 40 who have risk factors such as abdominal obesity. Some signs to look out for include extreme thirst, blurry vision, and an increased need to pee.
The first step is a blood test, usually the A1C (or glycated hemoglobin) test which measures what percentage of your red blood cells have been coated with glucose over the past two to three months. The higher your blood sugar, the higher your score: A result below 5.7 is considered normal; 5.7 to 6.4 is prediabetic; 6.5 or above suggests diabetes.
What Is Diabetes, Anyway?
Everyone’s heard of diabetes. It’s one of the most common chronic diseases in the world and rates are still on the rise. Yet most people don’t fully understand what causes it or how it affects everyday life. Many think that because the disorder is so widespread, it isn’t serious. But if left untreated, diabetes can lead to heart disease, vision loss, and even limb amputation.
At its most basic, diabetes mellitus (the official name) is a group of disorders that cause people to have higher-than-normal levels of sugar—or, glucose—in their blood. Glucose comes from the protein, carbohydrates, and fats that you eat and drink, as well your liver, which makes and stores the substance.
If everything is going according to plan, your pancreas releases a hormone called insulin that helps move glucose from the bloodstream into some of the cells of your body to be used for energy. But if your body is resistant to insulin, or doesn’t make enough of it, the glucose gets stuck hanging out in your blood. That’s when your doc will tell you that you have “high blood sugar.” As time goes on, the extra sugar in your blood causes inflammation and other major health troubles.
About 30 million people in the United States have diabetes, but nearly one quarter of them don’t know it. Let’s take a closer look.
Most Common Types of Diabetes
There are several different types of diabetes and each has its own causes. It’s important to get an accurate diagnosis for which form of the disease you have because treatment will differ depending on type. Here are the basics you should know:
If someone’s blood sugar is higher than normal, but not high enough to be diagnosed as type 2 diabetes, that’s considered prediabetes. That means an A1C blood test result between 5.7% and 6.4%. More than one in three adults in the United States has prediabetes, and the majority of them don’t know it, according to the Centers for Disease Control and Prevention (CDC).
That’s a problem because people with prediabetes have an increased risk of developing type 2. Luckily, prediabetes can be reversed: Exercise and diet changes are often prescribed to lower blood sugar and reduce the risk. In some cases, a doctor may also prescribe metformin, a blood-sugar lowering drug to help prevent type 2.
You’re at risk of prediabetes if you:
Have a parent or sibling with type 2 diabetes
Have ever had gestational diabetes
Are 45 or older
Aren’t physically active at least three times per week
Type 1 Diabetes
Also called “juvenile” diabetes because it’s often diagnosed in childhood, type 1 diabetes is mostly an autoimmune disorder in which your immune system attacks and destroys insulin-making cells in the pancreas. Because of this, your body no longer produces its own insulin, so you need insulin injections every day. It’s thought that a combination of genetics and environmental factors may cause the disease to develop in the first place.
Most people with type 1 diabetes are diagnosed during childhood or young adulthood, but a small number of people may not develop the disease until their 30s, 40s, or even 50s.
Type 1 Diabetes Complications
Having type 1 diabetes also puts you at risk for other health problems, especially if left untreated. Some possible complications include:
Cardiovascular disease: People with diabetes are at increased risk of heart disease, stroke, and high blood pressure.
Diabetic neuropathy: Over time, having high blood sugar can lead to nerve damage, called diabetic neuropathy. This manifests in symptoms of tingling, pain, numbness, or burning and affects about one-half of people with diabetes. Additionally, nerve damage that occurs in the feet can lead to poor blood flow that can result in increased risk of foot problems like major infections from cuts and blisters.
Kidney disease (nephropathy): Having diabetes makes you more likely to develop chronic kidney disease. That’s because diabetes can damage the filtering system in your kidneys that removes waste from your blood.
Eye problems: Your eyes are also at increased risk of health problems with diabetes, such as glaucoma and cataracts. You also may experience damage to the blood vessels in the part of your eye called the retina, a condition known as diabetic retinopathy, which can result in loss of sight.
Skin problems: People with diabetes are more prone to skin infections and other disorders.
Pregnancy complications: Type 1 diabetes can lead to problems for you and your baby if you are pregnant. For example, your risk of miscarriage, stillbirth, and birth defects are higher if your diabetes is unmanaged in pregnancy.
Type 2 Diabetes
People with type 2 diabetes do produce their own insulin, but their bodies don’t use it very well. They are insulin-resistant.
Type 2, also called “adult-onset”, diabetes is the most common form of the disease. Between 90% and 95% percent of all people with diabetes have type 2. It usually develops in middle age but is sometimes seen in older kids or teens. Most people with type 2 don’t need to take insulin, but they may need other medications to help bring down blood sugar.
Type 2 Diabetes Complications
It’s important to treat type 2 diabetes because, like type 1, it can wreak havoc on your body in other ways. People with type 2 diabetes experience the same long-term complications of diabetes as type 1 (see above list), including diabetic neuropathy, skin problems, kidney disease, eye problems, cardiovascular disease and more.
Gestational diabetes refers to temporary high blood sugar that happens only in pregnancy. Doctors suspect that it’s related to hormonal changes that happen during this time. Every year, about 2% to 10% of pregnant women in the United States will experience gestational diabetes, according to the CDC.
Most pregnant women are screened for gestational diabetes during their second trimester with a glucose tolerance test, which involves drinking a glucose-containing beverage on an empty stomach and then having blood drawn to check sugar levels.
Gestational diabetes is usually treated with exercise and diet changes (such as eating less starch and more veggies, fruits, and protein). Some women may need insulin injections, too.
Most of the time, blood sugar levels return to normal once the baby is born; but if you have gestational diabetes during pregnancy, you are also at higher-than-average risk for developing type 2 later in life. In fact, about 50% of people with gestational diabetes end up getting type 2.
Gestational diabetes also puts your baby at risk of health problems. For example, babies with mothers who have gestational diabetes have a higher chance of low blood sugar, preterm birth (which can lead to breathing problems and other issues), being born greater than nine pounds (which can lead to difficult delivery or C-section), and getting type 2 diabetes later in life.
Other Types of Diabetes
Though rare, these types of diabetes can cause serious health issues if left untreated:
Monogenic diabetes: Accounting for 1% to 5% of all cases, this rare type of diabetes is caused by a mutation in a single gene. In most cases, the disease is due to a person’s pancreas not being able to make enough insulin; the condition is usually found in kids. If untreated, monogenic diabetes can lead to damage of the blood vessels in your eyes and kidneys.
Secondary diabetes: Sometimes, diabetes is a side-effect of another disease, such as Cushing’s syndrome and cystic fibrosis (more on this below). Certain medications, including niacin, diuretics, HIV medicines, and anti-seizure drugs, can also lead to high blood sugar. These forms of diabetes have similar risk of complications to other forms of diabetes.
Cystic fibrosis-related diabetes: If you have cystic fibrosis, you are at risk of this type of diabetes. Basically, the scarring of the pancreas that occurs in cystic fibrosis can make it tough for your pancreas to make the insulin you need. Cystic fibrosis-related diabetes has some features of type 1 diabetes and some features of type 2 diabetes.
What Causes Diabetes in the First Place?
The causes of diabetes differ depending on what type you have. No matter what type it is, though, issues with insulin are the core of the disease. With type 1 diabetes, it’s believed that a combination of environmental factors (like viruses) and your genes trigger the body to start attacking insulin-producing cells. With type 2, lifestyle factors and genes contribute to insulin problems. Typically, this starts with insulin resistance, in which your body simply doesn’t use insulin as well as it should.
Causes of Type 1
Type 1 diabetes is mostly an autoimmune disorder. In this case, your immune system attacks your body in the same way it might attack invaders like bacteria or viruses, destroying certain cells in your pancreas in a misguided attempt to protect the body. These cells, called beta cells, are the ones that produce insulin. When your body attacks and destroys them, you can no longer make your own insulin.
Doctors believe that type 1 diabetes may be caused by a combination of genes and environmental factors. Type 1 diabetes is treatable with daily insulin injections but isn’t curable; and lifestyle changes like diet and exercise won’t reverse it.
Causes of Type 2
Type 2 diabetes is usually caused by a combination of factors. It tends to run in families, and certain genes make you more likely to develop it. It’s also more common in some ethnic groups, including Native Americans, African Americans, Pacific Islanders, Asians, and Latinos.
How you eat and how active you are also important. Carrying extra body fat, especially in your belly, can contribute to insulin resistance, a situation where your pancreas makes plenty of insulin, but doesn’t use it well, so sugar builds up in your blood rather than going into your cells for energy. Insulin resistance is a major cause of type 2 diabetes.
Sometimes, type 2 diabetes is caused by an underactive pancreas and your body doesn’t make enough insulin.
Causes of Gestational Diabetes
Genetics and hormonal changes during pregnancy are the culprits of this type. You’re at increased risk of getting this form of diabetes if you:
Have had it in a past pregnancy
If you are overweight prior to pregnancy
Have polycystic ovary syndrome
Have given birth to a baby over nine pounds
Have a family history of type 2 diabetes
All women become insulin-resistant late in pregnancy, thanks to hormones released mostly by the placenta. Most of the time, the pancreas amps up production of insulin to make up the difference, but in cases where it can’t keep up, blood sugar levels rise and gestational diabetes develops.
What Are the Risk Factors for Diabetes?
Now that we know what causes diabetes to develop in the first place, you’re likely wondering whether you are at risk of developing this particular condition. It’s true that there are certain factors that can make you more likely to get diabetes. Knowing your risk factors arms you with knowledge—knowledge you can use to take steps to reduce that risk and stay as healthy as possible. Here’s what you need to know.
Type 1 Diabetes Risk Factors
Compared with type 2 diabetes, risk factors for type 1 diabetes are a little less-understood. That said, a few of the main risk factors are clear:
Family history. If your parent or sibling has type 1 diabetes, you’re also more likely to develop the condition.
Younger age. Children, teens, and young adults are the most likely to get type 1 diabetes (that’s why it’s sometimes called “juvenile diabetes”), although it’s possible to get it at any age.
Race. In the United States, you’re more likely to develop type 1 if you are white compared with Black and Latinx Americans.
Type 2 Diabetes Risk Factors
Risk factors for developing type 2 diabetes include:
Prediabetes. Having prediabetes greatly raises your chances of going on to develop full-blown type 2.
Being overweight. Having excess weight has been linked to increased risk of type 2 diabetes.
Being 45 or older. Unlike type 1, older folks are more likely to develop type 2 diabetes.
Family history. Having a parent or sibling with type 2 diabetes makes you more likely to get the disease.
History of gestational diabetes. If you’ve been diagnosed with gestational diabetes during a pregnancy or had a baby over nine pounds in weight, you’re at higher risk of type 2 diabetes.
Race. Black Americans, Latinx Americans, American Indians, and Alaska Natives are at higher risk of type 2 diabetes.
Do I Have the Symptoms of Diabetes?
A tricky truth about this disease: Sometimes, there are no symptoms or symptoms are so mild that they’re easy to miss. That’s why nearly all pregnant women are screened for gestational diabetes, and the U.S. Preventive Services Task Force recommends screening for adults over 40 who have risk factors such as abdominal obesity.
Other times, symptoms are sudden and clear. Here’s what you need to know.
First Signs of Diabetes
Having any of the following signs does not necessarily mean you have diabetes. Instead, consider them a signal to call your doctor:
Major thirst: When your blood has too much sugar in it, your body pulls water from surrounding tissues to try to dilute it. That leaves you dehydrated and thirsty. Some diabetics feel like no matter how much they drink, they can’t quench their thirst.
A lot of pee: When there’s too much sugar in the blood, your kidneys try and filter it out. They dump it into your urine, creating more pee. In more advanced stages of the disease, damaged nerves around the bladder may cause some people to feel the urge to pee frequently, even if little or nothing comes out. You also have a higher risk of urinary tract infections (UTIs).
Blurry vision: High blood sugar can lead to a leaking of fluids into your eye, causing the lens to swell. That leads to trouble focusing.
The munchies: If you’re hungry all the time, even after a good meal, it could be a sign that your muscles and other tissues aren’t getting the energy—i.e. glucose—they need from the food you’re eating, because it’s hung up in your bloodstream. Your muscles tell your brain that they’re starving (even though you ate plenty), making you hungry again and continuing the cycle.
Increase in infections: Type 2 diabetes makes it harder for your immune system to fight off infections, including yeast infections or UTIs. It might also take longer for cuts to heal, because extra glucose prevents white blood cells from doing their repair work.
Weight loss: Losing weight without changing your diet could be a sign of type 1 diabetes. If your body can’t get the glucose it needs from food, it will start to break down its own fat, muscles, and other tissues for fuel, leading to weight loss.
Fatigue: You may feel exhausted and weak because your brain, muscles, and other body systems aren’t getting the energy they need to work properly. If you’re dehydrated, that can make you tired, too.
Type 1 Diabetes vs. Type 2 Diabetes Symptoms
When you have type 1 diabetes, your symptoms may start fast, taking only a couple of weeks to ramp up. In contrast, type 2 diabetes develops much more gradually and can take several years. In fact, symptoms may be so mild at first that you don’t even realize anything is off. That’s why it’s important to get regular checkups at your doctor—they may be able to catch changes early with blood tests and help prevent type 2 from getting worse.
Diabetes Symptoms in Women
Diabetes may affect you differently based on your sex. Risks tend to be greater and complications more severe in women. For example, women with diabetes have double the increased heart disease risk of men, according to the CDC. Women also have a greater risk of complications from diabetes like blindness, kidney disease, and even depression.
Women with diabetes also are at an increased risk of vaginal yeast infections and urinary tract infections. Keeping your blood sugar levels under control can help reduce this risk.
On top of all that, those who menstruate may find their blood sugar levels are trickier to predict before and after your period thanks to changing hormones. Those hormone changes can cause difficulties in your sex life, too—talk with your doctor if you’re concerned about painful sex or low libido.
Finally, diabetes can make it harder to get pregnant and raises your risk of pregnancy complications. Getting your diabetes under control before getting pregnant is ideal, along with regular checkups throughout pregnancy.
Diabetes Symptoms in Men
All that said, men aren’t off the hook when it comes to diabetes. Not only are men more likely to get type 2 diabetes at a lower weight than women are, but men are actually more likely to have undiagnosed diabetes. So don’t put off those regular checkups with your doctor, and make an appointment if you notice any strange new symptoms.
Your diabetes also triples your risk of getting erectile dysfunction (ED). Thankfully, there are tons of treatments available to help with this. Due to nerve damage with diabetes, you also may experience overactive bladder or incontinence, UTIs, or a condition called retrograde ejaculation, which is when semen is released into your bladder.
Diabetic Ketoacidosis and Diabetic Coma
In severe cases, your diabetes—in particular, type 1 diabetes—may lead you to develop a condition called diabetic ketoacidosis (DKA). This can happen if your body doesn’t get enough glucose, so your body starts burning fat to get the energy it needs. This process produces chemicals called ketones. If ketones build up in the blood, it makes your blood more acidic, and high levels can actually poison you.
The earliest warning signs of DKA include:
Having to pee frequently
Feeling very thirsty or having dry mouth
Having high blood glucose levels
Having high levels of ketones in the urine
Full-blown DKA results in the following symptoms:
Feeling tired all the time
Dry, flushed skin
Nausea, vomiting, or abdominal pain
Breath that smells fruity
Confusion or difficulty focusing
If you think you may have DKA, it’s important to get medical attention right away. DKA can lead to diabetic coma, which is when you pass out for a long time, and in the most severe cases, death.
DKA can affect people with any type of diabetes, but it’s rare in type 2.
How Do Doctors Diagnose Diabetes?
Getting diagnosed with diabetes involves blood tests and potentially additional testing to figure out which type you have. Correct diagnosis is important since treatment differs depending on type.
What to Expect at the Doctor’s Office
It’s normal to be nervous as you head to your doctor’s appointment to explore a potential diagnosis of diabetes. Knowing what you may expect during your appointment can help calm the nerves. Your doctor will likely do a physical exam and ask you questions about your symptoms and family history. Typically, the first course of action to test for diabetes is to do a blood test.
Blood Tests for Diabetes
The first step in getting a diabetes diagnosis is a blood test. There are several possible types.
A1C (or Glycated Hemoglobin) Test
This common test measures what percentage of your red blood cells have been coated with glucose over the past two to three months. The higher your blood sugar, the higher your score. An A1C result below 5.7 is considered normal; 5.7 to 6.4 is prediabetic; 6.5 or above suggests diabetes.
Fasting Blood Sugar Test
Blood will be drawn first thing in the morning before you eat or drink anything other than water. A result under 100 milligrams per deciliter is normal; 100 to 125 mg/dL is prediabetic; 126 mg/dL or above indicates diabetes. Your doctor will likely want to do the test twice before diagnosing you.
Glucose Tolerance Test
After getting your blood drawn on an empty stomach, you’ll drink a glucose drink, then have blood drawn again after one or two hours. If your blood sugar is under 140 mg/dL two hours after downing the sugar drink, that’s normal; 140 to 199 is prediabetic; 200 md/dL or over indicates diabetes.
Random Blood Sugar Test
Blood is drawn at any time of day, whether you’ve eaten recently or not. A result of 200 mg/dL means you may have diabetes.
To help differentiate between type 1 and type 2 diabetes, your doctor may also draw blood for an “autoantibody” test, to see if your immune system is attacking your pancreas. People with type 1 often test positive for several specific autoantibodies, while those with type 2 (or the rare monogenic diabetes) won’t.
Urine Test for Diabetes
If your doctor suspects that you have type 1 diabetes, she may want to test your urine for ketones, chemicals your body produces when it breaks down fat for energy.
The test can be done at home or in a lab or doctor’s office by peeing into a specimen cup. Extremely high levels of ketones are a sign of ketoacidosis, a potentially fatal complication of diabetes that requires emergency treatment.
What Is the Best Treatment for Diabetes?
Whatever your path of treatment, most likely you’ll start by checking your glucose every day, or even several times per day, in order to make decisions about insulin dosages, food, and exercise. This is a whole lifestyle so we’ll break it down in detail after we talk about other treatments. Beyond self-monitoring, here are a few types of treatments your doctor will consider, based on your diabetes type:
Type 1 Diabetes Treatments
The main treatment for type 1 diabetes is insulin. Here’s what you need to know.
All people with type 1 diabetes need to take insulin daily. There are a couple of different ways insulin can be delivered to the body:
Injection: This is the most common way to take insulin. To inject the drug, you will use a syringe or “pen,” usually in your belly, upper arm, thigh, or butt.
Insulin pump: People who need multiple injections per day or are at high risk of ketoacidosis may prefer an insulin pump, which automatically delivers insulin throughout the day through a tiny catheter that’s worn on your body.
Insulin inhaler: Some adults with type 1 or 2 diabetes can also use inhaled insulin, a powder you breathe into your lungs through an inhaler.
The Dangers of Too Much Insulin
Accidentally getting too much insulin is dangerous—it can cause your blood sugar to plummet and lead to hypoglycemia. This can happen if you accidentally inject the wrong dose at the wrong time, or inject your insulin but then skip your scheduled meal afterward. If you’ve overdosed on insulin, it’s important to seek medical care right away. In the most severe cases, an insulin overdose can lead to seizures or coma.
Insulin Questions for Your Doctor
If your doctor prescribes you insulin for your diabetes, it can feel overwhelming. It’s important to ask questions so you understand the ins and outs of your treatment. Some questions you may want to ask your doctor include:
What are the details of my prescription? (Name, strength of dose, etc.)
How do I safely store my insulin?
How does insulin work?
When should I first start taking it?
How do I take my insulin? Do I need any other supplies?
How long does it take to feel the effects?
At what times should I take my insulin? How do I need to plan my meals/snacks around it?
Are there any foods or drinks (including alcohol) I can’t have while on this medication?
What happens if I forget to take it?
What should I do if my blood sugar levels are too high or too low?
What side effects might I experience?
Type 2 Diabetes Treatments
For type 2 diabetes, there are several treatment options. They may be used alone or in combination with each other.
Some people with type 2 diabetes may need to take insulin as well. While you may not need to take it regularly, there may be special cases where you do need insulin, such as if you are pregnant.
Several pills (or liquids), used in combination with each other or with insulin, can help lower blood sugar in people with type 2 diabetes. These are some of the common meds:
Metformin: Sold under brands names Glucophage, Glumetza, Fortamet, and Riomet, metformin is a drug that slows the breakdown of carbohydrates you eat into sugar and reduces how much glucose your liver produces. It’s usually the first drug prescribed for type 2 diabetes. Potential side effects include B-12 deficiency, for which you can take supplements, along with bloating, nausea, abdominal pain, and diarrhea.
Thiazolidinediones: Actos (rosiglitazone) and Avandia (pioglitazone) are drugs that reduce circulating fat concentrations and improve sensitivity to insulin. That said, they do come with potential side effects, such as a risk of bone fractures, weight gain, congestive heart failure, bladder cancer (pioglitazone), and high cholesterol (rosiglitazone).
Sulfonylureas: Amaryl (glimepiride), Glucotrol (glipizide) and glyburide—brand names include DiaBeta, Glynase, and Micronase—work by triggering the pancreas to produce more insulin and are effective in controlling blood glucose and lowering A1C levels. Side effects to watch out for on these meds include weight gain and, if you skip a meal, low blood sugar.
Meglitinide: Prandin (repaglinide) and Starlix (nateglinide) also work by causing the pancreas to release more insulin, but they are a shorter-term drug used mainly to keep your blood sugar at a healthy level during mealtimes. Potential side effects are similar to those of sulfonylureas.
DPP-4 Inhibitors: Januvia (Sitagliptin), Onglyza (saxagliptin), and Tradjenta (linagliptin) are DPP-4 inhibitors that also trigger the pancreas to produce more insulin. That said, they tend to only have a modest effect on blood-sugar levels, and can come with side effects like joint pain and risk of pancreatitis.
SGLT2 inhibitors: Farxiga (dapagliflozin), Invokana (canagliflozin), and Jardiance (empagliflozi) boost the amount of sugar the kidneys can remove from your blood. Another plus: They may help lower your risk of heart attack and stroke. Again, however, there are potential side effects, including risk of gangrene, risk of amputation (canagliflozin), risk of bone fractures (canagliflozin), vaginal yeast infections, low blood pressure, urinary tract infections, and high cholesterol.
Alpha-glucosidase inhibitors: Glyset (miglitol) and Orecose (acarbose) slow the digestion and breakdown of starches into glucose and regulate how much glucose is absorbed by the small intestine. They generally don’t lead to weight loss or gain, but they can have digestive side effects too, like gas, diarrhea, abdominal cramping, and bloating.
GLP-1 receptor agonists: Victoza (liraglutide), Trulicity (dulaglutide), and Ozempic (semaglutide) are examples of GLP-1 receptor agonist drugs. These medications work by helping your body use its insulin more efficiently, in turn lowering your blood sugar. Some of these may lead to weight loss and decrease your risk of heart disease if you are at high risk. Possible side effects you may experience include nausea and vomiting and, rarely, pancreatitis.
Diet and Exercise
Eating well and exercising will help your health no matter what type of diabetes you have. That said, type 1 diabetes can’t be treated or cured through lifestyle changes. No matter how well you eat, you can’t make your pancreas be able to produce insulin again.
Diet can be used to help treat type 2 and gestational diabetes, though. Plus, regular exercise can also reduce insulin resistance and improve the way your body uses insulin, keeping type 2 diabetes in check.
Here are some key diet and exercise tips to help manage your diabetes:
Quit the sugary drinks. One of the most important diet changes someone with type 2 can make is to reduce or cut out sugary drinks like soda and juices that may hike up blood sugar.
Vary your food groups. It’s important to eat a range of healthy foods to get you the nutrients you need. For example, prioritize lean protein, low-starch vegetables, heart-healthy fats, and whole grains.
Try a meal plan. Some people with diabetes may work with their doctor or a dietitian to come up with a personalized meal plan. This can help you make sure you’re staying on target with the foods you need to help balance your blood sugar. As part of your meal planning, you also may need to count your carbs since they affect your blood glucose more than other foods.
Get moving. Getting at least 30 minutes of exercise on at least five days per week is ideal to help with your diabetes. A mix of aerobic and strength-training exercises is the goal. Find an activity you enjoy, like riding your bike or hiking. Good old walking does the trick, too!
Stay safe while working out. Getting physical activity is a must with diabetes, but make sure you know the signs of low blood sugar so you can stop and stay safe—confusion, weakness, dizziness, and profuse sweating. And since people with diabetes are at increased risk of foot problems, make sure you’re wearing supportive shoes during exercise.
Gestational Diabetes Treatments
Like with type 2 diabetes, diet and exercise are often the first-line treatments for gestational diabetes. If that isn’t enough to help get your blood sugar to a healthy level, you may be prescribed diabetes medications like insulin or metformin while you are pregnant.
Your Diabetes Care Team
Diabetes may be diagnosed by your primary-care provider or a doctor who specializes in hormonal disorders like diabetes called an endocrinologist. After your diagnosis, you may work with a variety of other healthcare professionals to help manage different aspects of your condition:
Ophthalmologist or optometrist. These are eye doctors who can help you diagnose and manage diabetes-related eye conditions.
Registered Dietitian Nutritionist. Dietitians are nutrition experts who can help you learn about the best ways to plan meals to better manage your diabetes.
Podiatrist. Podiatrists are foot doctors. When you have diabetes, you are at increased risk of having issues with blood flow to the feet, which can cause problems, so working with a podiatrist can be especially important.
Mental-health professionals. Working with a psychiatrist, psychologist, or therapist may be helpful when navigating the challenges of living with a chronic illness like diabetes. Living with diabetes can bring an emotional toll, so having a mental-health professional you trust to help you navigate these stressors is key.
Pharmacist. A pharmacist is an expert in medications—working closely with one can be helpful when navigating your diabetes medications to make sure you know how to take them properly and know what may interact with them.
Fitness professional. A physiologist, personal trainer, or physical therapist can also be an important addition to your diabetes healthcare team. It's their job to help you come up with an appropriate exercise program and make sure you are doing it safely.
Blood Sugar and Diabetes
Many diabetes symptoms area related to blood-sugar levels being out of your target range, so monitoring your blood-sugar levels to make sure they are within your range is the name of the game with diabetes. Your doctor will let you know whether you should be monitoring your blood glucose regularly—this is usually the case for people who are taking insulin or who are having trouble controlling their blood-glucose levels. They will likely want you to keep a strict log of your blood-sugar readings so they can review it with you during appointments.
Typical targets are 80-130 mg/dL before a meal and under 180 mg/dL one to two hours after you start eating a meal. That said, these targets can vary depending on things like your age, so your doctor can let you know what your target blood-sugar range should be.
Self-Monitoring Your Blood Glucose
To monitor your blood glucose, you’ll likely use a home glucose meter to poke your fingertip with a specialized lancet “pen,” then drop the blood onto a test strip in the meter. In some cases, your doc might suggest a continuous glucose monitor, where a tiny sensor is inserted under the skin of your abdomen, arm, or thigh to check glucose levels regularly. The device will alert you if levels fall too low.
Self-monitoring your glucose is handy since you can use it anytime, anywhere—without the assistance of a doctor. But if you’re using test strips, it’s important to know that sometimes they can give inaccurate readings. This may happen if the test strips have been stored in a location that is too hot or too cold, or if they are expired. You also may have inaccurate readings if your glucose level is very high or very low. Always check with your doctor if you get a reading that’s way outside your normal range.
How to Check Your Blood Sugar
The main way to check your blood glucose levels is to use a blood glucose meter. Here’s how it works:
Wash your hands and put a test strip into your blood-glucose meter.
Use your lancing device to prick the side of your fingertip. This will produce a drip of blood to be tested,
Hold the test strip to the blood. Your blood glucose reading will show up on the meter.
When to Test Your Blood Sugar
When you test your blood sugar is a more complicated question because it varies from person to person. If you have type 1 diabetes, typical times you may need to test your levels include:
Before meals and snacks
Before and after exercise
Before going to bed
If you have type 2, you may need to test your blood sugar before meals and at bedtime.
To get specific instructions on when and how often you should be checking your blood sugar, talk with your doctor. Factors including what kind of medication you are taking can also impact your reading schedule.
How to Use a Continuous Glucose Monitor (CGM)
Some people track their blood-sugar levels with a continuous glucose monitor (CGM) instead of a meter with test strips. Typically, people who use a CGM have type 1 diabetes. With a CGM, there is a sensor inserted beneath your skin that automatically measures your blood glucose every few minutes. Usually, you need to change your sensor every week or two—although some types of CGMs have sensors that can be worn longer.
High Blood Sugar (Hyperglycemia)
When your blood sugar is too high, it’s called hyperglycemia. This can happen if your body doesn’t get the amount of insulin it needs or can’t use it efficiently. This can be caused by:
Eating too much food or more carbs than usual
Not getting enough of your diabetes medications (insulin or oral medications)
Side effects of other medications
Not being physically active
Stress, illness, or being on your period
Signs that you may have high blood sugar include a high reading on your glucose monitor, high levels of sugar in the urine, having to urinate frequently, and feeling thirstier than usual.
It’s important to treat hyperglycemia because it can develop into ketoacidosis (diabetic coma), which is a dangerous illness that needs to be treated immediately. Signs include shortness of breath, fruity odor on the breath, nausea and vomiting, and dry mouth.
Many times, exercising can be effective in lowering your blood-sugar level. That said, you don’t want to exercise if your urine has ketones because it can actually make things worse. So if your blood sugar is over 240 mg/dl, it’s important to check your urine for ketones before exercising. If you have ketones, check with your doctor about the best way to bring your blood sugar down. They may suggest eating less or adjusting your medication dose or timing.
Low Blood Sugar (Hypoglycemia)
When your blood-sugar levels fall too low, it’s called hypoglycemia. When this happens, you need to take steps to get your levels back where they need to be. Signs of low blood sugar include:
Nervousness or anxiety
Sweating or chills
Lightheadedness or dizziness
Increased heart rate
Sleepiness or weakness
These symptoms are a sign to check your blood sugar and take action if it is low. Talk with your doctor: Along with diet, your physician may also suggest other methods, such as glucose tablets, to help you raise your levels.
Does Diabetes Treatment Cause Complications?
Any medication has potential side effects, and those for diabetes are no exception. But none are as serious as the alternative effects of not treating it—effects like heart disease, vision loss, nerve pain, foot ulcers, and even amputations.
These are some side effects for the most common diabetes treatments:
Continuous glucose monitoring: Skin irritation, pain, sore muscles. This treatment is typically used in type 1 diabetes but may be used for other types as well.
Insulin: Low blood sugar, headaches, weight gain, flu-like symptoms. Infection of infusion site if using an insulin pump. Again, this is most commonly used in type 1, but people with type 2 may take insulin as well.
Oral medications: For people with type 2 diabetes taking oral drugs, nausea, diarrhea, gas, sweating, feeling anxious or shaky, weight gain, swelling may be potential side effects.
How to Handle Low Blood Sugar From Insulin Overdose
If you have more insulin than you should, it can be dangerous and lead to diabetic shock, which is a term for extremely low blood sugar. How you act depends on how serious the overdose is.
Mild insulin overdose. If your blood sugar falls under 70 mg/dL. Often, mildly low blood sugar can be treated with the “15-15 Rule,” according to the American Diabetes Association. This means eating 15 grams of carbs (such as a small snack or glucose tablets) and then checking your blood sugar after 15 minutes. If after that time your blood sugar is still under 70 mg/dL, have another serving of 15 grams of carbs and repeat.
Moderate to severe insulin overdose. If your blood sugar is severely low, you can use a glucagon kit to treat it. You should have one of these on hand—ask your doctor if they can prescribe it. This kit allows you to inject glucagon, a hormone, into your body, which helps your body release stored glucose and up your blood sugar. If you don’t have a glucagon kit and your blood sugar is this low, call 911 or go to the ER right away. Emergency medics can give you medication to help bring your levels back up and revive you if you have passed out. If you are with someone who has passed out from hypoglycemia and you don’t have a glucagon kit or know how to use it, call 911 right away.
Diabetes During Pregnancy
Whether you had diabetes already before pregnancy or you develop gestational diabetes during pregnancy, diabetes can pose risks to both you and your baby. You can reduce these risks by getting your blood-sugar levels into your target range prior to getting pregnant.
Type 1 and Type 2 Diabetes and Pregnancy
If you have type 1 diabetes or type 2 diabetes and get pregnant, there are certain risks you should be aware of:
Birth defects. Your baby is at risk of serious birth defects if your blood sugar is not in control when key organs of the baby are forming during the first two months of pregnancy.
High birth weight. If your diabetes isn’t well managed, then your baby’s blood sugar can rise, too. That causes them to grow more. Having an extra-large baby can make delivery difficult and raise your risk of C-section.
High blood pressure (preeclampsia). Having diabetes increases your risk of high blood pressure. High blood pressure in pregnancy can lead to a condition called preeclampsia, which is when you have high blood pressure, protein in the urine, and swollen fingers and toes. This can lead to complications for you and the baby, such as preterm birth and even risk of you having a seizure or stroke.
Preterm birth. Diabetes raises the chances that your baby will be born too early. This can lead to issues in the baby such as breathing problems, heart problems, intestinal problems, bleeding in the brain, and vision problems.
Low blood sugar (hypoglycemia). If your blood sugar gets low during pregnancy due to taking diabetes medications, it can be dangerous for you and your baby. That’s why it’s important to monitor blood sugar closely during pregnancy. Plus, if your diabetes isn’t well-managed while you are pregnant, your baby can also get low blood sugar after they are born, which requires close monitoring.
Miscarriage or stillbirth. Women with uncontrolled diabetes have an increased risk of losing their pregnancy before 20 weeks (miscarriage) or after 20 weeks (stillbirth).
Because of these risks, it’s super important that you take steps to get your diabetes under control before you conceive—and all throughout your pregnancy, too. Doing so can help increase your chances of a healthy pregnancy. This means that ideally, you would work with your doctor before you get pregnant and come up with a plan together to get your blood sugar under control before you conceive. Before and during pregnancy, you should see your doctor regularly so they can closely monitor you for any issues that may arise and treat them promptly. It’s also important for women with diabetes to eat a healthy diet and get enough physical activity, which can increase their chances of a healthy pregnancy and birth.
Gestational diabetes is when you develop diabetes for the first time while you are pregnant. Women with gestational diabetes are at risk of many of the pregnancy complications above, including having an extra-large baby with higher risk of C-section, high blood pressure, and low blood sugar.
Many women with gestational diabetes find success in treating their gestational diabetes by eating healthy foods and exercising regularly. It will also be important to watch your blood sugar closely and take any medications your doctors prescribe you.
About six to 12 weeks after your baby is born, you will also want to be tested for diabetes, since gestational diabetes raises your risk of developing type 2 diabetes.
Diabetes in Children (Juvenile Diabetes)
It’s true: Kids can develop diabetes, too. Here’s what you should know about the risks of each type.
Type 1 Diabetes in Children
Type 1 diabetes is sometimes referred to as juvenile diabetes because it usually develops first in children. First signs that a child may be developing type 1 include:
Urinating more frequently, with possible bedwetting even after being potty trained
Being very thirsty and hungry
Increase in tiredness
If your kiddo is showing any of these signs, it’s important to get them checked out. Leaving type 1 diabetes untreated can lead to major health problems.
Type 2 Diabetes in Children
Type 2 diabetes can occur at any age, including in children, even though it used to be called “adult onset” diabetes. Over the years, it’s become more common in kids as rates of childhood obesity have gone up. Risk factors for type 2 include being overweight, having a family member who also has type 2, or being born to a mom who had gestational diabetes.
Early signs of type 2 diabetes are similar to those listed above for type 1. Additionally, your child may also have darkening of parts of their skin, such as around their armpits or neck.
What's Life Like With Diabetes?
Look, it’s a disease—and living with it can be stressful. Some people don’t understand the condition and can’t grasp what you’re going through.
But because diabetes is relatively common, there are a lot of people who do understand and can help make life a little easier.
One of the biggest challenges can be the amount of so-called “self-management” you need to do—checking blood sugar, giving yourself injections, taking medications correctly, and sticking to a healthy diet.
For that reason, many people find working with a certified diabetes educator (CDE) useful. These healthcare providers (often registered nurses or registered dietitians) know the ins and outs of diabetes treatment and are able to come up with systems and solutions that work in real life.
If you find yourself feeling depressed and overwhelmed in the face of your diabetes diagnosis, don’t hesitate to tell your doctor. You are far from alone in feeling this way, and working with a diabetes educator, support group, or mental-health counselor can get you back on track.
Where Can I Find Diabetes Communities?
Talking to people who know exactly what you’re going through can be just as important as finding a treatment plan that works. Here are some places to start to make connections, find resources, and meet friends.
Top Diabetes Instagrammers
There’s no shortage of Instagrammers from the #T1D and #T2D communities — here’s a sprinkling of some of our faves who are sharing diabetes-friendly recipes and stigma-squashing real-talk.
Mila Clarke Buckley, @thehangrywoman
Follow because: She turns her lifestyle with diabetes (diagnosed with type 2 in 2016) into digital storytelling, sharing how to live with diabetes and still enjoy the finer things in life, like cheeseburgers and travel.
Michelle Laine, APRN-BC, @diabadassaprn
Follow because: This Yale University grad, family nurse practitioner, and Muay Thai kickboxing enthusiast is also a type 1 diabetes patient. Laine doesn’t sugarcoat (pardon the pun) her disease, but she does promise to never let it hold her back.
Carrie Lane, @officialcarrielane
Follow because: As a mama-to-be, Laine, who has type 1 diabetes, shares all about prepping to get pregnant, your ideal A1C levels during pregnancy, and how your body (and mind) change throughout. She’ll no doubt keep sharing through motherhood, so there’s no better time to go ahead and give her a follow.
Carl Franklin and Carrie Brown, @2ketodudes
Follow because: It’s no surprise to anyone that a lot of these 'grammers talk about food, because diabetes—especially type 2—is managed, in large part, with how you fuel your body. Their recipes range from gourmet eye candy to “hey, I can make that!”
Christel Oerum, @diabetesstrong_ig
Follow because: She turned a personal blog about exercise and nutrition for type 1 diabetes into one of the largest diabetes health websites, and created the ebook Fit With Diabetes to inspire anyone who is insulin-dependent.
Top Diabetes-Related Podcasts
If you’re an audiophile, you’re in luck—there is a plethora of podcasts about living with diabetes to help you feel less alone and more connected to this welcoming community.
2 Keto Dudes. This podcast follows Carrie Brown and her pal Carl Franklin on their journey from metabolic syndrome and type 2 diabetes to a cleaner and healthier life, which they credit to following a keto diet. Expect convos on the pros, cons, and controversies of keto.
Juicebox. Scott Benner is an author, blogger, and proud stay-at-home dad of a daughter with type 1 diabetes. Though he doesn’t have diabetes himself, he had to learn to manage diabetes as if it were his own, since his daughter was only 2 when she was diagnosed.
My Lazy Pancreas. Type 1 diabetes doesn’t have to hold you back from being an athlete. Kyle Masterman, whose goal is to cycle across Australia, brings on guests who are breaking barriers in sports and fitness—all while living with diabetes. Give it a listen on the way to the gym to help kick your butt into gear.
Diabetes Daily Grind. Amber Clour, who has lived with type 1 diabetes since childhood, brings together a team of people with type 1 or type 2 diabetes on this engaging podcast. The focus: Real advice about everyday life. No fluff, just reality.
Top Diabetes Support Groups and Non-Profits
Want to get more connected with other people living the diabetes life? These nonprofits provide seemingly endless resources, including virtual and IRL support groups to connect directly with others who just get it.
American Diabetes Association. With more than 565,000 volunteers, 540,000 members, and 400 staff, this nonprofit is a force to be reckoned with. At the heart of their mission: Raising awareness about the impact of insulin prices and treatments for those with diabetes and advocating for policy changes.
Diabetes Research Institute Foundation. It starts here with the scientists who are working to find a cure for those living with diabetes. Their goal, a little unconventional, is to put themselves out of business. A cure means their work is done!
JDRF (Formerly called Juvenile Diabetes Research Foundation). This one’s for the kids—or, more often than not, parents of kiddos fighting type 1 diabetes. The nonprofit is the leading global organization funding type 1 diabetes research, having raised $2 billion for research to date.
Taking Control of Your Diabetes. The founder of this nonprofit is an endocrinologist who was diagnosed with type 1 diabetes at age 15. Steve Edelman, M.D., brings together patients and experts at conferences across the United States to help them better understand and manage their lives with diabetes.
DiabetesSisters. Hey ladies, welcome to the sisterhood. While diabetes does not discriminate, there’s a whole world of the disease that only affects women (hello pregnancy, menopause, and other hormone-imbalanced moments). Come here for peer support, education, and stories of hope.
While a diagnosis of diabetes can certainly throw your world off-kilter in some ways, you can learn to manage the condition and get back to living the life you want. These days, there are tons of highly effective ways to get your blood-glucose levels under control, from tried-and-true medications to meaningful changes to your diet and exercise routine. And remember, you’re not alone: As you navigate this condition, don’t hesitate to reach out to those who can help you—whether that’s a loved one, your doctor, or others in the diabetes community. We’re all here for you.
—Additional reporting by Lara DeSanto
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