Like diabetes, high blood pressure can damage your blood vessels. High cholesterol is a concern, too, since the resulting damage is often worse and more rapid when you have diabetes.

When these conditions team up, they can lead to a heart attack, stroke or other life-threatening conditions. Eating a healthy, reduced-fat and low salt diet, avoiding excess alcohol, and exercising regularly can go a long way toward controlling high blood pressure and cholesterol.

Your health care provider may also recommend taking prescription medication, if necessary. Schedule two to four diabetes checkups a year, in addition to your yearly physical and routine eye exams.

During the physical, your health care provider will ask about your nutrition and activity level and look for any diabetes-related complications — including signs of kidney damage, nerve damage and heart disease — as well as screen for other medical problems.

He or she will also examine your feet for any issues that may need treatment. Diabetes increases your risk of getting certain illnesses.

Routine vaccines can help prevent them. Ask your health care provider about:. Diabetes may leave you prone to gum infections. Brush your teeth at least twice a day with a fluoride toothpaste, floss your teeth once a day and schedule dental exams at least twice a year.

Call your dentist if your gums bleed or look red or swollen. High blood sugar can reduce blood flow and damage the nerves in your feet.

Left untreated, cuts and blisters can lead to serious infections. Diabetes can lead to pain, tingling or loss of sensation in your feet. If you have diabetes and other cardiovascular risk factors, such as smoking or high blood pressure, your doctor may recommend taking a low dose of aspirin every day to help reduce your risk of heart attack and stroke.

If you don't have additional cardiovascular risk factors, the risk of bleeding from aspirin use may outweigh any of its benefits.

Ask your doctor whether daily aspirin therapy is appropriate for you, including which strength of aspirin would be best.

Alcohol can cause high or low blood sugar, depending on how much you drink and whether you eat at the same time. If you choose to drink, do so only in moderation, which means no more than one drink a day for women and two drinks a day for men. Always drink with a meal or snack, and remember to include the calories from any alcohol you drink in your daily calorie count.

Also, be aware that alcohol can lead to low blood sugar later, especially for people who use insulin.

If you're stressed, it's easy to neglect your usual diabetes care routine. To manage your stress, set limits. Prioritize your tasks. Learn relaxation techniques.

Get plenty of sleep. And above all, stay positive. Diabetes care is within your control. If you're willing to do your part, diabetes won't stand in the way of an active, healthy life. There is a problem with information submitted for this request.

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By Mayo Clinic Staff. Thank you for subscribing! Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry. Show references American Diabetes Association.

Standards of medical care in diabetes — Diabetes Care. Smoking and diabetes. Centers for Disease Control and Prevention. Accessed Oct. Wexler DJ. Overview of general medical care in nonpregnant adults with diabetes mellitus. National Institute of Diabetes and Digestive and Kidney Diseases.

Caring for diabetic feet. Foot complications. American Diabetes Association. Type 1 diabetes mellitus. Mayo Clinic; Boden MT, et al. Exploring correlates of diabetes-related stress among adults with type 1 diabetes in the T1D exchange clinic registry.

Diabetes Research and Clinical Practice. Guo J, et al. Perceived stress and self-efficacy are associated with diabetes self-management among adolescents with type 1 diabetes: A moderated mediation analysis. Journal of Advanced Nursing.

Products and Services The Mayo Clinic Diet Online A Book: The Essential Diabetes Book. See also Medication-free hypertension control A1C test Alcohol: Does it affect blood pressure? Alpha blockers Amputation and diabetes Angiotensin-converting enzyme ACE inhibitors Angiotensin II receptor blockers Anxiety: A cause of high blood pressure?

Artificial sweeteners: Any effect on blood sugar? Bariatric surgery Beta blockers Beta blockers: Do they cause weight gain? Beta blockers: How do they affect exercise? Blood glucose meters Blood glucose monitors Blood pressure: Can it be higher in one arm?

Blood pressure chart Blood pressure cuff: Does size matter? Blood pressure: Does it have a daily pattern? Potential gene-environment G × E interactions also occur between TCF7L2 risk-variant rs and lifestyle modifications physical activity, MNT, and dietary changes.

Decreased insulin resistance and reduced risk in TCF7L2 risk-variant carriers is significantly affected by lifestyle modifications [ , ]. A common SNP in fat mass and obesity associated gene FTO rs is associated with increased risk of T2DM.

Increased physical activity reduces the FTO rsinduced obesity and associated risk of T2DM [ ]. SNP in glucokinase regulatory protein gene results in an insulin-raising allele, GCKRrs Its interaction with the whole grain increased whole grain intake results in reduced fasting insulin in the carriers [ ].

The po-tassium voltage-gated channel subfamily Q member 1 KCNQ1 is a susceptible gene in T2DM. Mutations in KCNQ1 are associated with decreased insulin secretion. Reduced expression of noncoding RNA Kcnq1ot1 in Kcnq1 genetic region leads to increase in cyclin-dependent kinase inhibitor 1C Cdkn1c expression, resulting in reduced pancreatic β-cell mass and insulin release.

Collectively, the emerging investigations to explore the interactions between gene and environmental factors suggest a high influence of dietary patterns, physical exercise, and other lifestyle interventions on the expression of genes that are peculiar to the development of T2DM.

Apart from gene expression, environmental factors also tend to exert a potential impact on gut microbiota. The gut environment is affected by a number of factors including the diet, pH, and nutrient absorption. While the presence of Firmicutes and Proteobacteria increases under the influence of carbohydrates and simple sugar-rich diet, saturated fats, and animal protein-rich diet encourages the proliferation of Bacteroidetes and Actinobacteria [ ].

This allowed and increased secretion of LPS, fat content, body weight, and inflammatory reactions associated with T2DM [ ]. Reduction in butyrate is largely responsible for the loss of tight intestinal barrier. An intestinal pH of 5.

In addition, the hypoglycemic agents utilized for the antidiabetic therapy also pose a remarkable influence on the gut microbiota. Metformin and acarbose are known to increase the proliferation of lactobacilli, Akkermansia, and several other bacteria that are acknowledged to exert beneficial effects in diabetes [ ].

Gut microbiota composition also affects the regulation of expression of different genes in T2DM. Although reports are limited in terms of potential interactions between gut microbes and T2DM associated gene variants, existing reports on the influence of gut microbes in the expression genes that are crucial in T2DM are highly suggestive of a complex gene-microbes interplay in the etiology of T2DM.

Also, microbiome plays a crucial role in the epigenetic regulation of genes by the modification of DNA methylation [ ]. prausnitzii , a short-chain fatty acid-producing bacteria was found crucial in epigenetic regulation of FFA receptor gene in patients of T2DM.

A significant reduced presence of F. prausnitzii was evident in such patients. As a result, a considerably low methylation in the promoter region of FFA receptor gene is observed in these individuals [ ].

Increased release of pro-inflammatory cytokines is a key event in T2DM. Microbes are largely known to be associated with increased release of inflammatory cytokines by producing the products such as LPS that promote low-grade inflammation and endotoxemia.

On contrary, several microbes are known to induce the expression of anti-inflammatory cytokines, including the IL and IL, that have proven roles in improving the insulin sensitivity Roseburia intestinalis , Bacteroides fragilis , Akkermansia muciniphila , Lactobacillus plantarum , and Lactobacillus casei [ ].

Two other beneficial microbes — Bacteroides vulgatus and Bacteroides dorei — are observed to increase the expression of tight junction genes in T2DM to compensate with the compromised gut permeability leaky gut [ ]. A major contribution of probiotics is observed in the case of glucose metabolism and homeostasis.

For instance, L. gasseri BNR17 is known to increase the expression of GLUT-4 transporter gene [ ]. Another gut microbe, L.

casei is witnessed to increase the expression of multiple T2DM-related genes, including ClC, GlyRα1, -SLC26A3, SLC26A6, GABAAα1, Bestrophin-3, and CFTR, thus resulting in a significant reduction in hyperglycemia [ ].

It appears to be of vital importance to consider the potential interplay between various T2DM-related genes and these microbes. Undoubtedly, the absence of these microbes among the gut microbiota can be largely responsible for the altered regulation of different genes in T2DM patients.

Also, exploring the interactions between different T2DM-associated gene variants and gut microbiota is warranted to further understand the complex interactions between environmental factors, gut microbiota, and genetics in the development of T2DM. The guidelines for the pharmacological management of diabetes provided by American Diabetes Association suggest that metformin be prescribed as the initial intervention to T2DM patients.

However, the same guideline also indicates that vitamin B 12 deficiency is a prominent side effect observed in metformin consumers and a periodic vitamin B 12 measurement is required in such patients [ , ]. Furthermore, metformin is also notorious for causing lactic acidosis, especially in patients with kidney disease, liver injury, or other CVS complications that create a low level of oxygen in circulation [ ].

The employability of SGTL2 inhibitors with almost all classes of hypoglycemic agents makes them ideal candidates to be combined when dual and triple combination therapies are warranted [ ].

In an ideal scenario, a drug used in combination should be able to reverse the pathology with an improved overall health status of the patient and ensure that no new complications arise due to the existing management strategies. In case of T2DM, drug combination should not only be able to just merely reduce the glycosylated hemoglobin levels HbA1C but also an improved overall metabolic condition of the patient is expected through such interventions [ ].

The combination of SGTL2 inhibitors with metformin may have proved beneficial in curbing hyperglycemia that cannot be controlled by metformin alone [ ], but the adverse effects associated with the SGTL2 inhibitors still remain unresolved.

Genital infections caused by SGTL2 inhibitors due to high glycosuria still remain an unfocussed aspect while prescribing such combinations.

In addition, during the event of excessive osmotic diuresis caused by SGTL2 inhibitors, a low extracellular fluid volume and subsequent hypotension is another complication that may arise [ ]. Multiple reports have also raised concerns regarding the use of SGTL2 inhibitors in diabetes due to their substantial involvement in causing diabetic ketoacidosis [ ].

Two separate reports published in claimed that canagliflozin, an SGTL2 inhibitor is implicated in pancreatitis in T2DM patients [ , ]. GLP-1 agonists are also a preferred class of adjuvant hypoglycemic agents that are combined with first-line hypoglycemics [ ].

Apart from gastrointestinal disorders nausea, vomiting, and constipation , infections and acute renal injury, a major raising concern regarding the use of GLP-1 agonists is their association with pancreatitis [ , ]. Cases of acute pancreatitis are reported with the use of liraglutide and exenatide [ , ].

More importantly, recent reports also raise concerns regarding the long-term reliance on incretin-based therapies due to frequently reported cases of their association with pancreatitis and pancreatic cancer [ ]. Studies based on FDA Adverse Events Reporting System demonstrated that incretin-based therapies are associated with the increased incidences of pancreatic and thyroid cancer [ , ].

Exenatide use is also positively associated with the incidences of bone fractures [ ]. Failure of monotherapy in diabetes is simply managed by the dual or triple drug combination therapies that involve the addition of supportive hypoglycemic agents with the first-line drugs.

However, adding the supportive or second-line drugs in combination seldom includes the assessment of risk factors associated with these new additions. The sole aim of these therapies remains to be a controlled glycemic condition. Unfortunately, in the pursuit of maintaining normal blood glucose levels, the occurrence of new complications is largely taken for granted.

Monotherapies supplemented with herbal extracts or phytoconstituents have showed appreciable improvements in the blood glucose levels in diabetic patients.

Chemical constituents from plants have also proved to be promising alternatives. Table 1 represents the known effects of different phytoconstituents in diabetes exerted through multiple targets.

As a result, unlike in the case of conventional single target therapy where chances of treatment failures are high, therapy failures with multi-targeting approach are rare. Multiple targets of different phytoconstituents in the management of T2DM and their possible outcomes [ ].

Diabetes is a metabolic disorder that is influenced by a variety of factors. Recent insights into the pathogenesis of diabetes have unraveled newer pathways and factors that contribute substantially in disease development and progression.

Insulin resistance and β-cell dysfunction are the 2 major events that are largely responsible for the onset of diabetes. A major objective of this review is to focus on the unfocused aspects of diabetes to develop better strategies for diabetes treatment.

In this review, we have discussed the factors that have played crucial roles in the etiology of T2DM but have not received adequate attention. We have also discussed the efficiency of existing approaches in the treatment of T2DM. Lifestyle modifications that favor the improvement of management of diabetes and their complex interplays with genetics and gut environment is a crucial factor that warrants further research in the development of more efficient and individualized therapy approaches for disease treatment.

The use of multidrug combination therapy in diabetes may have improved health outcomes in T2DM patients and also result in additional complications that need serious consideration.

Moreover, more attention is required toward the developing comorbidities during diabetes. The diabetic milieu accelerates the formation of advanced glycation end products that may encourage the development of diabetic complications and even cancer in diabetic patients.

Multiple pathways are involved in diabetes that can contribute to the manifestation of comorbidities that are largely neglected during disease treatment. Multitargeting is a promising approach for the treatment of T2DM as it includes multiple pathways.

The failure of single target approaches is the major challenge faced in T2DM treatment. Phytoconstituents are promising as they interact with multiple pathways simultaneously. However, the reluctance to rely on phytoconstituents as the main therapy still remains as a limiting factor for such drugs to serve as mainstream interventions.

The authors are thankful to B. Patel Pharmaceutical Education and Research Development PERD Center, Ahmedabad, and AYUSH — Center of Excellence, Center for Complimentary and Integrative Health CCIH , Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, for providing facilities for the successful completion of the work.

The authors are also thankful to those colleagues whose work could not be cited directly owing to space constraints. Borse and Abu Sufiyan Chhipa contributed equally; Vipin Sharma and Devendra Pratap Singh contributed equally. Sign In or Create an Account.

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Volume 30, Issue 2. Understanding the Diabetes Machinery: The Unfocused Aspects. Lifestyle Modifications, Environmental Factors, and Management of T2DM. Interplay of Genetics, Gut Microbiota, Lifestyle, and Environmental Factors. Current Approaches for Diabetes Management: What Are We Missing?

Alternatives: Phytoconstituents. Conflict of Interest Statement. Article Navigation. Review Articles August 20 Management of Type 2 Diabetes: Current Strategies, Unfocussed Aspects, Challenges, and Alternatives Subject Area: General Medicine.

Borse ; Swapnil P. a AYUSH-Center of Excellence, Center for Complementary and Integrative Health CCIH , Interdisciplinary School of Health Sciences, Savitribai Phule Pune University SPPU , Pune, India. b Department of Pharmacology and Toxicology, B.

Patel Pharmaceutical Education and Research Development PERD Centre, Thaltej, India. This Site. Google Scholar. Abu Sufiyan Chhipa ; Abu Sufiyan Chhipa. c Institute of Pharmacy, Nirma University, Ahmedabad, India. Vipin Sharma ; Vipin Sharma. d Translational Health Science and Technology Institute, Faridabad, India.

Devendra Pratap Singh ; Devendra Pratap Singh. e Sun Pharmaceutical Industries Ltd. Manish Nivsarkar Manish Nivsarkar. director perdcentre. Med Princ Pract 30 2 : — Article history Received:. Cite Icon Cite. toolbar search Search Dropdown Menu. toolbar search search input Search input auto suggest.

Type 2 diabetes is a multifactorial disorder that leads to a disturbed glucose homeostasis. Combinational therapies employed after failure of monotherapy result in comorbidities. Phytoconstituents are better alternatives owing to their multitargeting capability.

Table 1. View large. View Large. Search ADS. Physiology of the pancreatic α-cell and glucagon secretion: role in glucose homeostasis and diabetes.

Assessment of human pancreatic islet architecture and composition by laser scanning confocal microscopy. From the triumvirate to the ominous octet: a new paradigm for the treatment of type 2 diabetes mellitus.

Beta amyloid and hyperphosphorylated tau deposits in the pancreas in type 2 diabetes. Documentation of hyperglucagonemia throughout the day in nonobese and obese patients with noninsulin-dependent diabetes mellitus. Predominant role of gluconeogenesis in increased hepatic glucose production in NIDDM.

The role of alpha-cell dysregulation in fasting and postprandial hyperglycemia in type 2 diabetes and therapeutic implications. Lack of suppression of glucagon contributes to postprandial hyperglycemia in subjects with type 2 diabetes mellitus.

Hypoglycaemia: the limiting factor in the glycaemic management of type I and type II diabetes. Reversal of defective glucagon responses to hypoglycemia in insulin-dependent autoimmune diabetic BB rats.

Intrahepatic islet transplantation in type 1 diabetic patients does not restore hypoglycemic hormonal counterregulation or symptom recognition after insulin independence. Van Der Meulen. Urocortin3 mediates somatostatin-dependent negative feedback control of insulin secretion.

Somatostatin secreted by islet delta-cells fulfills multiple roles as a paracrine regulator of islet function. Hypertrophy and hyperplasia of somatostatin-containing D-cells in diabetes. The role of pancreatic polypeptide in the regulation of energy homeostasis.

Mouse pancreatic polypeptide modulates food intake, while not influencing anxiety in mice. Decreased food intake and body weight in pancreatic polypeptide-overexpressing mice. Adipose tissue: an endocrine organ playing a role in metabolic regulation.

Role of adipose tissue insulin resistance in the natural history of T2DM: results from the San Antonio metabolism study. Increased circulating resistin is associated with insulin resistance, oxidative stress and platelet activation in type 2 diabetes mellitus.

Differences in risk of insulin-dependent diabetes in offspring of diabetic mothers and diabetic fathers. Progressive loss of beta-cell function leads to worsening glucose tolerance in first-degree relatives of subjects with type 2 diabetes.

Beta-cell genes and diabetes: molecular and clinical characterization of mutations in transcription factors. Gestational diabetes mellitus and impaired glucose tolerance during pregnancy: long-term effects on obesity and glucose tolerance in the offspring.

Defective insulin signaling in placenta from pregnancies complicated by gestational diabetes mellitus. Resistin gene polymorphism in offspring of patients with type 2 diabetes mellitus.

The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. The association of vitamin D status and vitamin D replacement therapy with glycemic control, serum uric acid levels, and microalbuminuria in patients with type 2 diabetes and chronic kidney disease.

Alpha cell function in health and disease: influence of glucagon-like peptide Role of the incretin pathway in the pathogenesis of type 2 diabetes mellitus. Plasma insulin, cholecystokinin, galanin, neuropeptide Y and leptin levels in obese women with and without type 2 diabetes mellitus.

Regulation of cholecystokinin secretion by intraluminal releasing factors. Erratum: shifts in clostridia, bacteroides and immunoglobulin-coating fecal bacteria associated with weight loss in obese adolescents.

Inflammation as a link between obesity, metabolic syndrome and type 2 diabetes. De Kort. Gastrointestinal motility and glycemic control in diabetes: the chicken and the egg revisited?

Inflammation in obesity and diabetes: islet dysfunction and therapeutic opportunity. Interactions between gut microbiota and host metabolism predisposing to obesity and diabetes. Effects of different modes of exercise training on glucose control and risk factors for complications in type 2 diabetic patients: a meta-analysis.

American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise.

The relationship between dietary habits, blood glucose and insulin levels among people without cardiovascular disease and type 2 diabetes; the ATTICA study. Vegetable but not fruit consumption reduces the risk of type 2 diabetes in Chinese women. The prevention and control the type-2 diabetes by changing lifestyle and dietary pattern.

Toward improved management of NIDDM: a randomized, controlled, pilot intervention using a lowfat, vegetarian diet. Nutrition care process and model: ADA adopts road map to quality care and outcomes management. Success of nutrition-therapy interventions in persons with type 2 diabetes: challenges and future directions.

The clinical and cost effectiveness of medical nutrition therapy for patients with type 2 diabetes mellitus. Stress increases the risk of type 2 diabetes onset in women: a year longitudinal study using causal modelling. Stress and type 2 diabetes: a review of how stress contributes to the development of type 2 diabetes.

Disruption of multisystem responses to stress in type 2 diabetes: investigating the dynamics of allostatic load. Type 2 diabetes mellitus and psychological stress: a modifiable risk factor. Effect of psychological stress on glucose control in patients with type 2 diabetes.

Insomnia with objective short sleep duration is associated with type 2 diabetes: a population-based study. De Bacquer. Day napping and short night sleeping are associated with higher risk of diabetes in older adults. Adverse metabolic consequences in humans of prolonged sleep restriction combined with circadian disruption.

Short sleep duration is associated with reduced leptin, elevated ghrelin, and increased body mass index. Nocturnal rise of leptin in lean, obese, and non-insulin-dependent diabetes mellitus subjects.

Chronopharmacological assessment identified GLUT4 as a factor responsible for the circadian variation of the hypoglycemic effect of tolbutamide in rats.

The role of leptin and ghrelin in the regulation of food intake and body weight in humans: a review. Gene-environment and gene-treatment interactions in type 2 diabetes: progress, pitfalls, and prospects.

Evidence for an influence of TCF7L2 polymorphism rs on insulin resistance and sensitivity indices in overweight children and adolescents during a lifestyle intervention. Gene-environment interactions in the development of type 2 diabetes: recent progress and continuing challenges.

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Effects of short chain fatty acid producing bacteria on epigenetic regulation of FFAR3 in type 2 diabetes and obesity. Bacteroides vulgatus and bacteroides dorei reduce gut microbial lipopolysaccharide production and inhibit atherosclerosis.

Anti-obesity effect of Lactobacillus gasseri BNR17 in high-sucrose diet-induced obese mice. Lactobacillus casei reduces susceptibility to type 2 diabetes via microbiota-mediated body chloride ion influx.

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Euglycemic diabetic ketoacidosis: a potential complication of treatment with sodium-glucose cotransporter 2 inhibition.

Your healthcare team can prescribe a treatment suited to your condition. This may be a combination of healthy diet, regular physical activity and medication.

Rest assured that taking medication when required can result in fewer complications in the long-term. However, keep in mind that your tablets or insulin injections should be taken with healthy eating and regular physical activity. Your medication should never be a substitute for a healthy lifestyle.

Find out more about medications for type 2 diabetes. There are many resources available to help you manage your diabetes care. These resources are easy to access, free and available now. What is type 2 diabetes? A few signs to watch out for: Feeling tired all the time Going to the toilet a lot more often Feeling thirsty Blurred vision Numbness or pain in your hands or feet Cuts or wounds that heal slowly.

If you have one or more of these symptoms, ask your GP about getting a diabetes test. Take it with you on your health care visits.

Talk about your goals and how you are doing, and whether you need to make any changes in your diabetes care plan. Make a diabetes meal plan with help from your health care team. Following a meal plan will help you manage your blood glucose, blood pressure, and cholesterol.

Choose fruits and vegetables, beans, whole grains, chicken or turkey without the skin, fish, lean meats, and nonfat or low-fat milk and cheese. Drink water instead of sugar-sweetened beverages.

Choose foods that are lower in calories, saturated fat , trans fat , sugar, and salt. Learn more about eating, diet, and nutrition with diabetes. Set a goal to be more physically active.

Try to work up to 30 minutes or more of physical activity on most days of the week. Brisk walking and swimming are good ways to move more. If you are not active now, ask your health care team about the types and amounts of physical activity that are right for you.

Learn more about being physically active with diabetes. Following your meal plan and being more active can help you stay at or get to a healthy weight. If you are overweight or obese, work with your health care team to create a weight-loss plan that is right for you.

Take your medicines for diabetes and any other health problems, even when you feel good or have reached your blood glucose, blood pressure, and cholesterol goals. These medicines help you manage your ABCs. Ask your doctor if you need to take aspirin to prevent a heart attack or stroke.

Tell your health care professional if you cannot afford your medicines or if you have any side effects from your medicines. Learn more about insulin and other diabetes medicines.

For many people with diabetes, checking their blood glucose level each day is an important way to manage their diabetes. Monitoring your blood glucose level is most important if you take insulin. The results of blood glucose monitoring can help you make decisions about food, physical activity, and medicines.

The most common way to check your blood glucose level at home is with a blood glucose meter. You get a drop of blood by pricking the side of your fingertip with a lancet.

Then you apply the blood to a test strip. The meter will show you how much glucose is in your blood at the moment.

Ask your health care team how often you should check your blood glucose levels. Make sure to keep a record of your blood glucose self-checks. You can print copies of this glucose self-check chart. Take these records with you when you visit your health care team. Continuous glucose monitoring CGM is another way to check your glucose levels.

Most CGM systems use a tiny sensor that you insert under your skin. If the CGM system shows that your glucose is too high or too low, you should check your glucose with a blood glucose meter before making any changes to your eating plan, physical activity, or medicines.

A CGM system is especially useful for people who use insulin and have problems with low blood glucose. Talk with your health care team about the best target range for you. Be sure to tell your health care professional if your glucose levels often go above or below your target range.

Sometimes blood glucose levels drop below where they should be, which is called hypoglycemia. Hypoglycemia can be life threatening and needs to be treated right away. Learn more about how to recognize and treat hypoglycemia.

If you often have high blood glucose levels or symptoms of high blood glucose, talk with your health care team. You may need a change in your diabetes meal plan, physical activity plan, or medicines. Most people with diabetes get health care from a primary care professional.

Being fit for yourself and your family? Having fun? Having energy? Everything you do to take care of yourself gives you more of what matters most.

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If you take diabetes medicine called insulin at mealtimes, it's important to know the amount of carbohydrates in foods and drinks.

That way, you can take the right dose of insulin. Among all foods, carbs often have the biggest impact on blood sugar levels. That's because the body breaks them down into sugar, which raises blood sugar levels.

Some carbs are better for you than others. For example, fruits, vegetables and whole grains are full of nutrients. They have fiber that helps keep blood sugar levels more stable too. Eat fewer refined, highly processed carbs. These include white bread, white rice, sugary cereal, cakes, cookies, candy and chips.

Get to know the plate method. This type of meal planning is simpler than counting carbs. The plate method helps you eat a healthy balance of foods and control portion sizes.

Use a 9-inch plate. Fill half of the plate with nonstarchy vegetables. Examples include lettuce, cucumbers, broccoli, tomatoes and green beans. Divide the other half of the plate into two smaller, equal sections. You might hear these smaller sections called quarters.

In one quarter of the plate, place a lean protein. Examples include fish, beans, eggs, and lean meat and poultry. On the other quarter, place healthy carbohydrates such as fruits and whole grains.

Be mindful of portion sizes. Learn what portion size is right for each type of food. Everyday objects can help you remember. For example, one serving of meat or poultry is about the size of a deck of cards.

A serving of cheese is about the size of six grapes. And a serving of cooked pasta or rice is about the size of a fist. You also can use measuring cups or a scale to help make sure you get the right portion sizes. Balance your meals and medicines.

If you take diabetes medicine, it's important to balance what you eat and drink with your medicine. Too little food in proportion to your diabetes medicine — especially insulin — can lead to dangerously low blood sugar.

This is called hypoglycemia. Too much food may cause your blood sugar level to climb too high. This is called hyperglycemia. Talk to your diabetes health care team about how to best coordinate meal and medicine schedules. Limit sugary drinks. Sugar-sweetened drinks tend to be high in calories and low in nutrition.

They also cause blood sugar to rise quickly. So it's best to limit these types of drinks if you have diabetes. The exception is if you have a low blood sugar level.

Sugary drinks can be used to quickly raise blood sugar that is too low. These drinks include regular soda, juice and sports drinks. Exercise is another important part of managing diabetes.

When you move and get active, your muscles use blood sugar for energy. Regular physical activity also helps your body use insulin better. These factors work together to lower your blood sugar level. The more strenuous your workout, the longer the effect lasts. But even light activities can improve your blood sugar level.

Light activities include housework, gardening and walking. Talk to your healthcare professional about an exercise plan. Ask your healthcare professional what type of exercise is right for you. In general, most adults should get at least minutes a week of moderate aerobic activity.

That includes activities that get the heart pumping, such as walking, biking and swimming. Aim for about 30 minutes of moderate aerobic activity a day on most days of the week. Most adults also should aim to do strength-building exercise 2 to 3 times a week.

If you haven't been active for a long time, your healthcare professional may want to check your overall health first. Then the right balance of aerobic and muscle-strengthening exercise can be recommended.

Keep an exercise schedule. Ask your healthcare professional about the best time of day for you to exercise. That way, your workout routine is aligned with your meal and medicine schedules. Know your numbers. Talk with your healthcare professional about what blood sugar levels are right for you before you start exercise.

Check your blood sugar level. Also talk with your healthcare professional about your blood sugar testing needs. If you don't take insulin or other diabetes medicines, you likely won't need to check your blood sugar before or during exercise. But if you take insulin or other diabetes medicines, testing is important.

Check your blood sugar before, during and after exercise. Many diabetes medicines lower blood sugar. So does exercise, and its effects can last up to a day later. The risk of low blood sugar is greater if the activity is new to you.

The risk also is greater if you start to exercise at a more intense level. Be aware of symptoms of low blood sugar.

These include feeling shaky, weak, tired, hungry, lightheaded, irritable, anxious or confused. See if you need a snack. Have a small snack before you exercise if you use insulin and your blood sugar level is low.

The snack you have before exercise should contain about 15 to 30 grams of carbs. Or you could take 10 to 20 grams of glucose products.

This helps prevent a low blood sugar level. Stay hydrated. Drink plenty of water or other fluids while exercising. Dehydration can affect blood sugar levels. Be prepared. Always have a small snack, glucose tablets or glucose gel with you during exercise.

You'll need a quick way to boost your blood sugar if it drops too low. Carry medical identification too. In case of an emergency, medical identification can show others that you have diabetes.

It also can show whether you take diabetes medicine such as insulin. Medical IDs come in forms such as cards, bracelets and necklaces.

Adjust your diabetes treatment plan as needed. If you take insulin, you may need to lower your insulin dose before you exercise. You also may need to watch your blood sugar level closely for several hours after intense activity.

That's because low blood sugar can happen later on. Your healthcare professional can advise you how to correctly make changes to your medicine. You also may need to adjust your treatment if you've increased how often or how hard you exercise.

Insulin and other diabetes medicines are designed to lower blood sugar levels when diet and exercise alone don't help enough. How well these medicines work depends on the timing and size of the dose.

Medicines you take for conditions other than diabetes also can affect your blood sugar levels. Store insulin properly. Insulin that is not stored properly or is past its expiration date may not work.

Keep insulin away from extreme heat or cold. Don't store it in the freezer or in direct sunlight. Tell your healthcare professional about any medicine problems. If your diabetes medicines cause your blood sugar level to drop too low, the dosage or timing may need to be changed.

Your healthcare professional also might adjust your medicine if your blood sugar stays too high. Be cautious with new medicines. Talk with your healthcare team or pharmacist before you try new medicines.

That includes medicines sold without a prescription and those prescribed for other medical conditions. Ask how the new medicine might affect your blood sugar levels and any diabetes medicines you take. Sometimes a different medicine may be used to prevent dangerous side effects.

Or a different medicine might be used to prevent your current medicine from mixing poorly with a new one. With diabetes, it's important to be prepared for times of illness.

When you're sick, your body makes stress-related hormones that help fight the illness. But those hormones also can raise your blood sugar. Changes in your appetite and usual activity also may affect your blood sugar level. The American Diabetes Association ADA note in guidelines that self-management and education are crucial aspects of diabetes care.

Diabetes self-management can reduce blood sugar levels, mortality risk, and healthcare costs, as well as weight in people with excess weight. In this article, we discuss strategies that people with diabetes can use every day to improve their health.

Two important indicators of diabetes control are levels of glycated hemoglobin and blood glucose. Doctors recommend that people using insulin check their glucose levels. The right frequency of these checks varies from person to person, but doctors usually recommend monitoring levels before and after meals, at bedtime, and before exercising.

People with diabetes who are not taking insulin should also check their blood sugar levels. Self-monitoring can provide information about the effects of dietary changes, physical activity, and medication on blood sugar levels.

There are also continuous glucose monitors , which provide real-time information about blood sugar levels. These automatically measure levels every 5 minutes through a small sensor inserted under the skin.

When a person uses it appropriately, this type of technology can improve health outcomes. A healthcare team can use at-home blood sugar readings to modify medication, nutrition , and self-management plans. It is important for people with diabetes or prediabetes to achieve and maintain a healthy weight.

When doctors closely monitor weight loss progress, a person more likely to achieve their goals. Research suggests that, among people with excess weight, modest, consistent weight loss can help manage type 2 diabetes and slow the rate at which prediabetes becomes diabetes.

They also noted that making dietary adjustments can lower glycated hemoglobin levels by 0. Nutrition therapy can also lead to improvements in the quality of life. To facilitate these lifestyle adjustments, the ADA recommend consulting a registered dietitian with expertise in diabetes and weight management.

Following a meal plan can be among the most challenging aspects of diabetes self-management. Developing a plan with a registered dietitian who is knowledgeable about diabetes-specific nutrition can help. For some people, dietary changes alone are not enough to control blood sugar levels.

Diabetes is a progressive disease, which means that it can worsen over time. The ADA recommend using a combination of medication and nutrition therapy to reach blood sugar targets. The basis of meal planning involves portion control and favoring healthful foods.

The diabetes plate method is one tool designed to help people control their calorie and carbohydrate intakes. It involves mentally dividing the plate into three sections.

Half of the plate should contain nonstarchy vegetables , a quarter can contain grain-based and starchy foods, and the remaining quarter should contain protein. Research has shown that exercise can help control blood sugar levels, reduce cardiovascular risk factors, promote weight loss, and improve well-being.

Researchers behind one study found that engaging in a structured exercise program for at least 8 weeks lowered glycated hemoglobin levels by an average of 0. The ADA recommend exercising for at least 10 minutes per session and getting a total of at least 30 minutes of exercise on most days of the week.

If a person exercises every day — or lets no more than 2 days pass between workouts — this may help reduce insulin resistance.

Members of a diabetes healthcare team can help develop and tailor an exercise plan that is safe and effective. In addition to exercising regularly, it is important to avoid spending long periods in a seated position.

Breaking up sedentary periods every 30 minutes can help with controlling blood sugar. Ask your doctor if you need to take aspirin to prevent a heart attack or stroke. Tell your health care professional if you cannot afford your medicines or if you have any side effects from your medicines.

Learn more about insulin and other diabetes medicines. For many people with diabetes, checking their blood glucose level each day is an important way to manage their diabetes.

Monitoring your blood glucose level is most important if you take insulin. The results of blood glucose monitoring can help you make decisions about food, physical activity, and medicines. The most common way to check your blood glucose level at home is with a blood glucose meter.

You get a drop of blood by pricking the side of your fingertip with a lancet. Then you apply the blood to a test strip. The meter will show you how much glucose is in your blood at the moment. Ask your health care team how often you should check your blood glucose levels. Make sure to keep a record of your blood glucose self-checks.

You can print copies of this glucose self-check chart. Take these records with you when you visit your health care team. Continuous glucose monitoring CGM is another way to check your glucose levels. Most CGM systems use a tiny sensor that you insert under your skin.

If the CGM system shows that your glucose is too high or too low, you should check your glucose with a blood glucose meter before making any changes to your eating plan, physical activity, or medicines.

A CGM system is especially useful for people who use insulin and have problems with low blood glucose. Talk with your health care team about the best target range for you. Be sure to tell your health care professional if your glucose levels often go above or below your target range. Sometimes blood glucose levels drop below where they should be, which is called hypoglycemia.

Hypoglycemia can be life threatening and needs to be treated right away. Learn more about how to recognize and treat hypoglycemia.

If you often have high blood glucose levels or symptoms of high blood glucose, talk with your health care team. You may need a change in your diabetes meal plan, physical activity plan, or medicines. Most people with diabetes get health care from a primary care professional.

Primary care professionals include internists, family physicians, and pediatricians. Sometimes physician assistants and nurses with extra training, called nurse practitioners, provide primary care.

You also will need to see other care professionals from time to time. A team of health care professionals can help you improve your diabetes self-care.

Remember, you are the most important member of your health care team. When you see members of your health care team, ask questions. Watch a video to help you get ready for your diabetes care visit.

You should see your health care team at least twice a year, and more often if you are having problems or are having trouble reaching your blood glucose, blood pressure, or cholesterol goals. At each visit, be sure you have a blood pressure check, foot check, and weight check; and review your self-care plan.

Talk with your health care team about your medicines and whether you need to adjust them. Routine health care will help you find and treat any health problems early, or may be able to help prevent them. Talk with your doctor about what vaccines you should get to keep from getting sick, such as a flu shot and pneumonia shot.

Preventing illness is an important part of taking care of your diabetes. Feeling stressed, sad, or angry is common when you live with diabetes. Stress can raise your blood glucose levels, but you can learn ways to lower your stress.

Try deep breathing, gardening, taking a walk, doing yoga, meditating, doing a hobby, or listening to your favorite music. Consider taking part in a diabetes education program or support group that teaches you techniques for managing stress.