🍎 Stuff Every Diabetic Should Know: Training Guide

Insulin and blood sugar

Insulin is a hormone that helps blood sugar move into cells so it can be used for energy. Blood sugar is also called glucose.

In type 1 diabetes, the immune system attacks insulin-making cells in the pancreas. The body makes little or no insulin.

In type 2 diabetes, the body does not use insulin well. At first the pancreas makes extra insulin, but over time it may not make enough to keep blood sugar normal.

The main types

Type 1 is an autoimmune disease and can start at any age. Adults diagnosed with type 2 who are not responding to usual treatment may need antibody tests to check which type they have.

Gestational diabetes is diabetes first diagnosed during pregnancy. Pregnancy hormones can block insulin, and the diagnosis does not mean the person had diabetes before or will have it after.

Type 2 is the most common form of diabetes. It involves many factors such as family history, age, and activity, not a single cause.

Myths that matter

Diabetes is not contagious. You cannot catch it from someone like a cold.

No type of diabetes is mild. All types can affect the heart, eyes, kidneys, and feet over time, but managing diabetes lowers those risks.

Starting insulin for type 2 diabetes is not a failure. Type 2 often changes over time, and many people eventually need insulin to reach a healthy blood sugar level.

Signs that may point to diabetes

Classic warning signs include urinating often, feeling very thirsty, feeling very hungry, extreme tiredness, blurry vision, and slow-healing cuts. Some people, especially with type 2, have mild symptoms or none.

Type 2 symptoms often develop slowly over several years. Numbness or tingling in the hands or feet can also be a sign.

Gestational diabetes usually has no noticeable symptoms. That is why testing during pregnancy is so important.

A home blood glucose meter cannot diagnose diabetes. Anyone with symptoms should be tested by a health care professional in an office or lab.

Test numbers that matter

An A1C below 5.7% is normal. An A1C from 5.7% to 6.4% is prediabetes, and 6.5% or higher is in the diabetes range.

A fasting blood sugar under 100 mg/dL is normal. Fasting means only water for at least 8 hours, usually overnight before a morning test.

A fasting blood sugar of 100 to 125 mg/dL is prediabetes, and 126 mg/dL or higher is in the diabetes range.

Most diabetes test results are repeated on a second day to confirm. If blood sugar is very high or classic symptoms are present, a doctor may not need the second test.

Pregnant people without an earlier diabetes diagnosis are usually tested for gestational diabetes between 24 and 28 weeks of pregnancy.

Risk factors and prevention

Having had gestational diabetes raises the chance of developing type 2 later. Regular follow-up testing after delivery helps catch it early, and a follow-up test for type 2 is usually done within 12 weeks after delivery.

Risk factors for gestational diabetes include a hormone disorder called polycystic ovary syndrome, being over age 25, a family history of type 2, and having had gestational diabetes before.

The American Diabetes Association treatment plan for overweight or obesity should aim for at least 5% to 7% weight loss. Even a small amount of weight loss can help reverse prediabetes.

A1C: the long view

An A1C test shows your average blood sugar over the past 2 to 3 months. Sugar sticks to hemoglobin in red blood cells, and those cells are replaced about every three months.

Many adults with diabetes aim for an A1C of 7% or less. Your care team may set a higher or lower goal based on age, health history, and risk of lows.

CGM and time in range

A continuous glucose monitor uses a tiny sensor under the skin to estimate glucose every few minutes. Many CGMs can sound an alarm when glucose goes too low or too high.

Time in range is the share of the day glucose stays between 70 and 180 mg/dL. Most people aim for at least 70% of readings in range, but goals can differ.

Goals that help prevent lows

If someone is not meeting glucose goals or has recent treatment changes, the ADA suggests checking glycemic status every 3 months. Otherwise, at least twice a year is typical.

For many adults using a CGM, the ADA goal is less than 4% of time below 70 mg/dL. Very low readings are dangerous and worth catching early.

The ADA goal for time below 54 mg/dL is less than 1%. One percent of a day is only about 14 minutes.

Recognizing a low

For many people with diabetes, low blood sugar means below 70 mg/dL. Your care team may give you a different number, so ask what counts as low for you.

A low triggers adrenaline, which can cause shakiness, sweating, a fast heartbeat, hunger, and confusion. Symptoms vary from person to person.

Overnight lows can cause nightmares, crying out, sweat-soaked pajamas or sheets, and waking up tired or confused. A CGM alarm can help catch lows during sleep.

Some people have hypoglycemia unawareness, meaning they do not feel early warning signs. Checking more often and using a CGM alarm helps, especially before driving.

The ADA recommends screening people at risk for hypoglycemia unawareness at least once a year.

Treating a low

The 15-15 rule says have 15 grams of fast-acting carbs and recheck in 15 minutes. If still low, repeat until blood sugar is back in range.

Fast-acting carb choices include glucose tablets or 4 ounces, about half a cup, of regular juice. Young children often need less than 15 grams, and their care team sets the amount.

For a conscious person with a low, the ADA says glucose is the preferred treatment. Oral glucose is also recommended in first-aid kits, but only for an alert person who can swallow.

Severe lows and glucagon

The ADA sorts lows into levels. Level 1 is below 70 but at least 54 mg/dL. Level 2 is below 54 mg/dL and needs quick action. Level 3 is a severe event that needs help from another person.

Glucagon is a hormone that tells the liver to release stored glucose. It is used for severe lows when someone cannot safely eat or drink or when the 15-15 rule is not working.

Ready-to-use glucagon comes as a nasal powder or a premixed pen, and older kits need mixing first. The ADA says glucagon should be prescribed for everyone taking insulin or at high risk for lows.

After giving glucagon, call 911 right away. A severe low is an emergency, and professional help should be on the way.

Teach family, friends, and coworkers when and how to give glucagon in case you cannot do it yourself.

Special situations and safety

Drinking alcohol can cause low blood sugar, even hours later, and can hide early low symptoms. Monitor blood sugar closely during and after drinking.

If you feel low while driving, pull over safely, then check and treat. Do not start driving again until your blood sugar is back to a safe level.

Many people wear a medical ID bracelet or necklace so first responders know they have diabetes if they cannot speak. The ADA also suggests keeping a diabetes alert card in your wallet, especially when driving.

Avoiding even mild lows for several weeks can help bring back warning signs if you have hypoglycemia unawareness.

High blood sugar and emergencies

Classic warning signs of diabetes include urinating often, feeling very thirsty, feeling very hungry, extreme tiredness, blurry vision, and slow-healing cuts. New bedwetting after being fully potty trained can be a sign of type 1 in children.

In diabetic ketoacidosis, the body cannot use sugar without enough insulin, so it burns fat and makes ketones. High ketones cause DKA, a medical emergency.

DKA is most common in type 1 diabetes, but it can happen in type 2 diabetes too. Sometimes DKA is the first noticeable sign of undiagnosed diabetes.

Hyperosmolar hyperglycemic state is a very high blood sugar emergency mostly seen in type 2 diabetes. Blood sugar often climbs over 600 mg/dL, causing extreme thirst, confusion, and vision changes. It is an emergency, so call 911 or go to an emergency room.

Triggers and ketones

The two most common DKA triggers are illness and missed insulin. A clogged insulin pump can also interrupt insulin, so use the emergency steps from your care team.

Ketone test kits are sold over the counter so you can check ketones at home. Diabetic ketoacidosis is most common in type 1 diabetes, but people with type 2 can develop it too, so learn the warning signs and emergency plan from your care team.

Planning for sick days

Illness and stress release hormones that can push blood sugar up. Check blood sugar more often than usual, about every 2 to 4 hours, and keep notes.

The ADA suggests making a written sick-day plan with your care team before you get sick, including when to call the doctor. Your care team should help make a written plan for illness or fasting.

If you are sick and have trouble keeping water down, take small sips about every 15 minutes. If vomiting keeps going, call your care team.

The ADA recommends a yearly flu shot for people with diabetes.

The Diabetes Plate and carb basics

The Diabetes Plate starts with a 9-inch plate. Fill half with non-starchy vegetables, one quarter with protein foods, and one quarter with carbohydrate foods.

Water is the best drink choice because it has no calories or carbs and no effect on blood glucose. Unsweetened tea, coffee, sparkling water, and diet drinks are other low or zero calorie options.

Combination foods like pizza can still fit. Choose a thin or vegetable-based crust, pile on vegetables, stick to one or two slices, and add a side salad so half the meal is non-starchy vegetables.

In carb counting, one carb choice or carb serving is about 15 grams of carbohydrate. A dietitian or care team can set personal carb goals.

Total carbohydrate on a label includes sugar, starch, and fiber. When counting carbs, use the total number, because even starchy foods like a baked potato raise blood glucose.

A small piece of whole fruit or about half a cup of frozen or canned fruit has about 15 grams of carbohydrate. Dried fruit is concentrated, so only 2 tablespoons of raisins or dried cherries has about 15 grams.

Reading labels and sweeteners

Always check serving size first because all nutrition information on the label is for one serving. If you eat more than one serving, you get more calories, carbs, and other nutrients.

For example, a bag of chips with 2 servings and 11 grams of carbs per serving has 22 grams of carbohydrate if you eat the whole bag.

Added sugars are already included in total carbohydrate, so do not add them on top. Sugars naturally found in milk and fruit do not count as added sugars, but honey and syrups do count as added sugars.

The % Daily Value guide says 5% DV or less is low and 20% DV or more is high. Look for high fiber and lower added sugars, sodium, and saturated fat.

Net carbs has no legal definition, so the ADA recommends using total carbohydrate on the label. Sugar alcohols have fewer calories than sugar but are not zero, and no sugar added does not mean low carbohydrate.

Sucralose is one of the sweeteners FDA approved as a food additive. Purified stevia and monk fruit extracts are allowed through a different safety route, and monk fruit comes from a plant native to Southern China.

Smart food swaps and portions

Fiber does not raise blood sugar. Look for whole grain or whole wheat as the first ingredient, because whole grains keep the bran, germ, and endosperm.

The glycemic index ranks carb foods from 0 to 100, and 55 or less is low. Ripe fruits and vegetables tend to have a higher glycemic index than less ripe ones.

Fruit juice raises blood sugar faster than whole fruit because whole fruit keeps its fiber. Sugary drinks like soda and sweet tea also hit glucose quickly because they have no fiber or protein to slow digestion.

At a fast-food restaurant, try half unsweetened iced tea and half diet lemonade. A small fruit cup has almost half the carbs of a small fry, and you may be able to swap a sandwich bun for whole grain bread or lettuce.

A meal high in protein and fat can change how quickly the body absorbs carbs. Fiber and protein help slow down how quickly food is digested, so total carbs and meal balance both matter.

For portions, a half cup of beans gives about as much protein as an ounce of meat. A quarter cup of nuts is about a golf ball, a serving of meat is about your palm, a half cup of ice cream is about a tennis ball, and 3 cups of light popcorn has about 15 grams of carbs.

Smart snacks combine protein, healthy fats, and fiber. Nut butter with apple slices or celery is one ADA-recommended combo.

Planning, myths, and expert support

Sweets can fit in smaller portions, and no food is off-limits. The goal is not to cut carbs to zero, but to avoid eating too many.

Fruit is not off-limits if you count it as a carbohydrate. Berries are a superstar fruit with antioxidants, vitamins, and fiber.

Many fun-size Halloween candies do not have a Nutrition Facts label. Look up the carb info online ahead of time, and consider trading extra candy for a special activity, small toy, or movie night.

Cook with olive or canola oil instead of butter, margarine, or shortening. You can also lighten sour cream in a dip by mixing it with plain yogurt, or replace half the cream cheese with hummus.

A registered dietitian nutritionist can individualize medical nutrition therapy. ADA supports high-fiber carbs with at least 14 grams of fiber per 1,000 calories, sodium under 2,300 mg per day when appropriate, a Mediterranean-style pattern as an option, and plant proteins like nuts, seeds, and legumes.

ADA does not recommend vitamins, minerals, herbs, or spices just for blood sugar benefit. Nonnutritive sweeteners should replace sugary products only in moderation and for the short term.

Before beginning a religious fast, get a prefast risk assessment and plan made well ahead with the care team.

High fiber food labels

A package that says "high fiber" must have at least 5 grams of fiber per serving. A package that says "good source of fiber" means at least 2.5 grams per serving.

Fiber helps you feel full and supports blood glucose management. Most people do not eat enough fiber. Healthy adults need about 25 to 38 grams a day on average.

Milk and yogurt as carb foods

A cup of milk counts as a carb food in diabetes meal planning. Milk and yogurt contain natural sugar even when no sugar is added.

Because they contain carbohydrate, include milk and yogurt in your meal plan. The Diabetes Plate places yogurt and kefir in the carb section, while cottage cheese counts as protein.

How activity affects glucose

After more exercise than usual, blood sugar can stay lower than normal for up to 24 hours. Check before, during, and after activity, and ask your care team how to prevent lows.

The ADA gives most adults a goal of 150 or more minutes of moderate-to-vigorous aerobic activity each week, spread over at least three days.

The ADA recommends resistance exercise on two or three nonconsecutive days each week for adults, on top of aerobic activity.

Movement goals for families and older adults

Children and teens with diabetes should aim for at least 60 minutes of moderate or vigorous aerobic activity daily. Muscle- and bone-strengthening activity is also recommended at least three days weekly.

The ADA recommends flexibility and balance training for most older adults with diabetes two or three times weekly, matched to ability and care-team guidance.

Prolonged sitting should be interrupted at least every 30 minutes. Small movement breaks can interrupt long periods of sitting.

Everyday health and emotional well-being

People with diabetes should not use tobacco or vape. If you use either, your care team can connect you with effective help to quit. Tobacco smoke can also harm circulation in the feet.

Diabetes care should screen for sleep health and disruptions. Sleep and diabetes can affect each other, and sleep-promoting routines and habits are recommended.

Diabetes distress is the emotional burden of daily diabetes care. It is distinct from depression or anxiety, and support is available from the care team.

The ADA recommends anxiety screening at least once a year for people with diabetes. Referral is suggested when symptoms interfere or cannot be addressed in routine visits.

Ongoing self-management support

Diabetes self-management education and support is especially important at four critical times: diagnosis, yearly review or missed goals, complicating factors, and transitions in life or care.

DSMES supports decisions, self-care skills, problem-solving, and teamwork. It is ongoing, not a one-time class.

Daily foot care

People with diabetes should check their feet every day. A good habit is to look each evening when you take off your shoes, and a mirror or helper works if bending over is hard.

Do not walk barefoot, even indoors. If diabetes has affected the nerves in your feet, you could step on something and not feel it, so wear shoes or slippers at home.

Before washing feet, test the water because nerve damage can hide a burn. Use warm, not hot, water and aim for 90°F to 95°F, or test with an elbow, and avoid soaking because it can dry out skin.

Routine checks and heart health

Most people with diabetes need a dilated eye exam once a year. Diabetic eye disease often has no early warning signs, and drops widen the pupils so the doctor can see the back of the eye.

Kidney disease often has no symptoms, so testing is the only way to know. A urine test looks for a protein called albumin, and a blood test checks how well the kidneys filter.

Diabetes raises the risk of gum disease. Brushing twice a day, flossing daily, and regular dental checkups lower the risk.

Adults with diabetes are nearly twice as likely to have heart disease or stroke as adults without diabetes. Managing A1C, blood pressure, and cholesterol, and not smoking, lowers that risk.

Insulin storage

Unopened insulin should normally be stored in the refrigerator at 36°F to 46°F. It works until the expiration date on the package, but always check your own product's label too.

Per FDA general guidance, insulin in the maker's vial or cartridge can stay unrefrigerated at 59°F to 86°F for up to 28 days and still work. Some products have different limits, so follow your label.

Do not use insulin that has been frozen. Extreme cold and heat make insulin less effective, and a sunny car dashboard is a bad place to leave it.

Sharps disposal

Put used needles and lancets straight into a sharps disposal container. Never put loose needles in the trash or recycling, and never flush them.

Seal the sharps container when it is about three-quarters full. Overfilling raises the risk of an accidental needle stick, and you should follow your community's rules for disposal.

Drop-off options can include pharmacies, hospitals, doctors' offices, health departments, and police or fire stations, depending on where you live. Keep sharps containers out of reach of children and pets.