Diabetes

Type 2 Diabetes Management for Adults

What do I need to know about type 2 diabetes management?

Type 2 diabetes management means you control you blood sugar levels and prevent diabetes complications. Management will help you feel well and enjoy your daily activities. Your diabetes care team providers can help you make a plan to fit diabetes care into your schedule. Your plan can change over time to fit your needs and your family's needs.

What do I need to know about high blood sugar levels?

High blood sugar levels may not cause any symptoms. You may feel more thirsty or urinate more often than usual. Over time, high blood sugar levels can damage your nerves, blood vessels, tissues, and organs. The following can increase your blood sugar levels:

Large meals or large amounts of carbohydrates at one time
Less physical activity
Stress
Illness
A lower dose of diabetes medicine or insulin, or a late dose

What do I need to know about low blood sugar levels?

Symptoms include feeling shaky, dizzy, irritable, or confused. You can prevent symptoms by keeping your blood sugar levels from going too low.

Treat a low blood sugar level right away:
- - Drink 4 ounces of juice or have 1 tube of glucose gel.
  - Check your blood sugar level again 10 to 15 minutes later.
  - When the level goes back to normal, eat a meal or snack to prevent another decrease.
Keep glucose gel, raisins, or hard candy with you at all times to treat a low blood sugar level.
Your blood sugar level can get too low if you take diabetes medicine or insulin and do not eat enough food.
If you use insulin, check your blood sugar level before you exercise.
- - If your blood sugar level is below 100 mg/dL, eat 4 crackers or 2 ounces of raisins, or drink 4 ounces of juice.
  - Check your level every 30 minutes if you exercise longer than 1 hour.
  - You may need a snack during or after exercise.

Diabetes and Your Skin

What do I need to know about diabetes and my skin?

Diabetes can affect every part of your body, including your skin. Diabetes that is not well controlled can damage blood vessels and nerves. Damage to blood vessels can make it hard for blood to flow to tissues and organs. A lack of blood flow to your skin can cause ulcers that are difficult to heal. Skin ulcers are also called sores. People with diabetes can also have more bacterial skin infections than other people. Most skin conditions can be prevented with good blood sugar control. Skin sores can be hard to heal, or become life or limb-threatening, if not treated early.

What are common skin changes that I may see?

A smooth, dark thickness in the skin on your neck, groin, face, and underarms
Dry, flaky skin
Skin tags on your eyelids, neck, or underarms
Yellow color of your palms, soles of your feet, and nails
Dark patches on your shins
A constant redness of your face and neck
Thick skin on the back of your hands and the top of your feet

How can I prevent skin sores?

Keep your blood sugar within target range. Your diabetes care team provider will tell you what your blood sugar levels should be. High blood sugar levels increase your risk for skin infections and poor wound healing.
Keep your skin clean. Do not take hot baths or showers. They can cause your skin to get dry. Do not take a bubble bath if you have dry skin. Use moisturizing soaps.
Keep your skin from becoming too dry. Apply moisturizing lotion after baths or showers, especially in cold, dry weather. When you scratch dry, itchy skin, you can cause your skin to be open to infection. Bathe less during cold weather and use lotion to moisturize. Do not put lotion between your toes. Moisture between your toes could lead to skin breakdown. Use a humidifier to keep air in your home from being dry.
Keep areas where skin touches skin dry. Use talcum powder in areas such as armpits and groin. You may also need it under your breasts, and between your toes. Moisture in these areas can cause a fungal infection.
Treat cuts immediately. Clean minor cuts with soap and water. Cover them with sterile gauze.

Diabetes and Your Mouth

How can diabetes affect the health of my mouth?

Diabetes increases your risk for health problems in your mouth. These problems include gingivitis and gum disease. Gum disease damages your gums and the bone that holds your teeth in place. Severe gum disease can lead to tooth loss. Diabetes also increases your risk for other mouth problems, such as dry mouth, cavities, burning in your mouth, or thrush (fungal infection). Higher blood sugars cause higher levels of sugar in your saliva. This can lead to cavities and gum disease. Gum disease is more severe in people with diabetes. Gum disease also makes it harder to control blood sugar levels and increases inflammation throughout your body. Poor blood sugar control may make it harder to do oral surgeries, such as dental implants.

What are some signs and symptoms of mouth problems?

Red, swollen, or bleeding gums
Dryness, soreness, or pain
White patches on your gums, tongue, cheeks, or roof of your mouth
Bad taste in your mouth
Problems chewing, eating, or swallowing
Bad breath that does not go away when you brush your teeth

How can I keep my mouth healthy?

Keep your blood sugar within the recommended levels. Your diabetes care team provider will tell you what your blood sugar levels should be.
Brush and floss your teeth every day. Brush your teeth at least 2 times a day with fluoride toothpaste. Your dentist may recommend that you brush your teeth after each meal and sugary or starchy snack. Examples of starchy snacks include crackers and granola bars. Use dental floss to clean between your teeth at least once a day. Change your toothbrush at least every 3 months.
If you wear dentures, clean them regularly and take them out at night. Have your dentures adjusted if they do not fit right.
Regularly check your mouth for signs of problems. Contact your dentist if you notice any problems.
See your dentist regularly every 6 months for dental cleanings and oral exams, or as directed. Tell your dentist that you have diabetes.
Do not smoke. Smoking can make mouth problems worse. Smoking further increases your risk of mouth problems such as gum disease and thrush. Nicotine and other chemicals in cigarettes and cigars can also cause lung damage and other health problems. Ask your care team provider for information if you currently smoke and need help to quit. E-cigarettes or smokeless tobacco still contain nicotine. Talk to your care team provider before you use these products.

When should I call my dentist?

You have mouth problems that get worse.
You develop any new mouth problems.

Diabetes and Exercise

How will exercise help me manage diabetes?

Physical activity, such as exercise, can help keep your blood sugar level steady or improve insulin resistance. Activity can help decrease your risk for heart disease, and help you lose weight. Exercise can also help lower your A1c or keep it at goal. Your diabetes care team will help you create an exercise plan. The plan will be based on the type of diabetes you have and your starting fitness level.

What are some tips to help me create and meet my exercise goals?

Set a goal for 150 minutes (2.5 hours) of moderate to vigorous aerobic activity each week. Aerobic activity helps your heart stay strong. Aerobic activity includes walking, bicycling, dancing, swimming, and raking leaves. Spread aerobic activity over 3 to 5 days. Do not take more than 2 days off in a row. It is best to do at least 10 minutes at a time and 30 minutes each day. You can work up to these goals. Remember that any activity is better than no activity. Over time, you can make exercise more intense or last longer. You can also add more days of exercise as your fitness level improves. Your diabetes care team can help you make a step-by-step plan to achieve your goals.
Set a strength training goal of 2 to 3 times a week. Take at least 1 day off in between strength training sessions. Strength training helps you keep the muscles you have and build new muscles. Strength training includes lifting weights, climbing stairs, yoga, and tai chi.
Older adults should include balance training 2 to 3 times each week. These include walking backwards, standing on one foot, and walking heel to toe in a straight line.

What are some other healthy activity tips?

Stretch before and after you exercise to prevent injury.
Drink water or liquids that do not contain sugar before, during, and after exercise. Ask your dietitian or healthcare provider which liquids you should drink when you exercise.
Do not sit for longer than 30 minutes at a time. If you cannot walk around, at least stand up. This will help you stay active and keep your blood circulating. Try to be active throughout your day.

What do I need to know about exercise and my blood sugar levels?

Check your blood sugar level before and after exercise, if you use insulin. Healthcare providers may tell you to change the amount of insulin you take or food you eat.

If your blood sugar level is high, check your blood or urine for ketones before you exercise. Do not exercise if your blood sugar level is high and you have ketones.
If your blood sugar level is less than 100 mg/dL, have a carbohydrate snack before you exercise. Examples are 4 to 6 crackers, ½ banana, 8 ounces (1 cup) of milk, or 4 ounces (½ cup) of juice.

Diabetes and Nutrition

Why are nutrition plans important?

Nutrition plans help keep blood sugar levels steady. They also help delay or prevent complications of diabetes, such as diabetic kidney disease.

How do I create a nutrition plan?

A dietitian will help you create a nutrition plan to meet your needs and your family's needs. He or she may explain a plan such as the Dietary Approaches to Stop Hypertension (DASH) eating plan or the Mediterranean diet. The goal is for you to reach and maintain healthy weight, blood sugar, blood pressure, and lipid levels. You should meet with the dietitian at least 1 time each year. You will learn the following:

How food affects your blood sugar levels
How to create healthy eating habits
How to make food choices based on your activity level, weight, and glucose levels
How your favorite foods may fit into your plan
Foods that contain carbohydrates (sugars and starches), including simple and complex carbohydrates
How to keep track of all carbohydrates
Correct portion sizes for each food
Changes you can make to your plan if you get pregnant or are breastfeeding

What are some tips to do until I meet with the dietitian?

Do not skip meals. The goal is to keep your blood sugar level steady. Blood sugar levels may drop too low if you have received insulin and do not eat.
Eat more high-fiber foods. Examples include fresh or frozen fruits and vegetables, whole-grain breads, and beans. Fiber helps control or lower blood sugar and cholesterol levels. Choose whole fruits instead of fruit juice as much as possible. Sugar may be added to juice, and fiber may be removed.
Choose heart-healthy fats. Foods high in heart-healthy fats include olive oil, nuts, avocados, and fatty fish, such as salmon and tuna. Foods high in unhealthy fats include red meat, full-fat dairy products, and soft margarine. Unhealthy fats can increase your risk for heart disease, increase bad cholesterol, and lower good cholesterol.
Choose complex carbohydrates. Foods with complex carbohydrates include brown rice, whole-grain breads and cereals, and cooked beans. Foods with simple carbohydrates include white bread, white rice, most cold cereals, and snack foods. Your plan will include the amount of carbohydrate to have at one time or in a day. Your blood sugar level can get too high if you eat too much carbohydrate at one time. Blood sugar levels do not spike as high or drop as quickly with complex carbohydrates as with simple carbohydrates. Choose complex carbohydrates whenever possible.
Have less sodium (salt). The risk for high blood pressure (BP) increases with high-sodium foods. Limit high-sodium foods, such as soy sauce, potato chips, and canned soup. Do not add salt to food you cook. Limit your use of table salt. Read labels to have no more than 2,300 milligrams of sodium in one day.
Limit artificial sweeteners. These may be found in food or drinks, such as diet soft drinks or other low-calorie beverages. Artificial sweeteners are low in calories. They may help you lower your overall calories and carbohydrates. It is important not to have more calories from other foods to make up for the calories saved. Artificial sweeteners do not have any nutrition. Eat whole foods and drink water as much as possible. Your plan may include beverages with artificial sweeteners for a short time. These can help you transition from high-sugar beverages to water.
Use the plate method for each meal. This method can help you eat the right amount of carbohydrates and keep your blood sugar levels under control.
- - Draw an imaginary line down the middle of a 9-inch dinner plate. On one side, draw another line to divide that section in half. Your plate will have one large section and 2 small sections.
  - Fill the largest section with non-starchy vegetables. These include broccoli, spinach, cucumbers, peppers, cauliflower, and tomatoes.
  - Add a starch to one of the small sections. Starches include pasta, rice, whole-grain bread, tortillas, corn, potatoes, and beans.
  - Add meat or another source of protein to the other small section. Examples include chicken or turkey without skin, fish, lean beef or pork, low-fat cheese, tofu, and eggs.
    Add dairy products or fruit next to your plate if your meal plan allows. Examples of dairy include skim or 1% milk and low-fat yogurt. If you do not drink milk or eat dairy products, you may be able to add another serving of starchy food instead.
  - Have a low-calorie or calorie-free drink with your meal. Examples include water or unsweetened tea or coffee.

What do I need to know if I choose to drink alcohol?

Alcohol can cause health problems. Alcohol can cause hypoglycemia (very low blood sugar level), especially if you use insulin. Alcohol can cause high blood sugar and BP levels, and weight gain if you drink too much.
Hypoglycemia can happen hours after you drink alcohol. Check your blood sugar level for several hours after you drink alcohol. Have a source of fast-acting carbohydrates with you in case your level goes too low. You need immediate care if you have signs or symptoms of hypoglycemia, such as sweating, confusion, or fainting.
Limit alcohol as directed. Generally, men 65 or older and women should limit alcohol to 1 drink within 24 hours and 7 within 1 week. Men 21 to 64 years should limit alcohol to 2 drinks a day and 14 within 1 week. Your healthcare provider can tell you how many drinks are okay for you within 24 hours or within 1 week. A drink of alcohol is 12 ounces of beer, 5 ounces of wine, or 1½ ounces of liquor. Always have food when you drink alcohol. Your blood sugar may fall to a low level if you drink when your stomach is empty.
Always have food when you drink alcohol. Your blood sugar may fall to a low level if you drink when your stomach is empty.

Why is it important to maintain a healthy weight?

A healthy weight can help you control your diabetes. You can maintain a healthy weight with a nutrition plan and regular physical activity. Ask your healthcare provider what a healthy weight is for you. Ask him or her to help you create a weight loss plan, if needed. Together you can set weight loss and maintenance goals. For example, your goal may be to lose at least 7% of your extra weight in the first 6 months.

Basic Carbohydrate Counting

What is carbohydrate counting?

Carbohydrate counting is a way to plan your meals by counting the amount of carbohydrate in foods. Carbohydrates are the sugars, starches, and fiber found in fruit, grains, vegetables, and milk products. Carbohydrates increase your blood sugar levels. Carbohydrate counting can help you eat the right amount of carbohydrate to keep your blood sugar levels under control.

What do I need to know about planning meals using carbohydrate counting?

A carbohydrate serving contains about 15 grams (g) of carbohydrate. A dietitian or healthcare provider will tell you how many carbohydrate servings you should have for each meal and snack. The number of servings will be based on your age, weight, usual food intake, and physical activity level. It will also be based on your blood sugar levels and diabetes medicine.
Check your serving sizes using measuring cups or a food scale. Also read nutrition labels to find out how much carbohydrate is in the foods you eat. See "Total Amount of Carbohydrate" on the label for the amount. The amount of carbohydrate in the serving size listed on the package may be more than 15 g. Keep track of the amount of carbohydrate servings you have for each meal and snack. The number of carbohydrate servings you have may need to be adjusted based on your blood sugar levels. Do not avoid carbohydrates or skip meals. Your blood sugar may fall too low if you do not eat enough carbohydrate or you skip meals.

What are some foods that contain carbohydrate?

Breads: Each serving of food listed below contains about 15 g of carbohydrate.
- - 1 slice of bread (1 ounce) or 1 flour or corn tortilla (6 inch)
  - ½ of a hamburger bun or ¼ of a large bagel (about 1 ounce)
  - 1 pancake (about 4 inches across and ¼ inch thick)
Cereals and grains: Serving sizes of ready-to-eat cereals vary. Look at the serving size and the total carbohydrate amount listed on the food label. Each serving of food listed below contains about 15 g of carbohydrate.
- - ¾ cup of dry, unsweetened, ready-to-eat cereal or ¼ cup of low-fat granola
  - ½ cup of oatmeal or other cooked cereal
  - ⅓ cup of cooked rice or pasta
Starchy vegetables and beans: Each serving of food listed below contains about 15 g of carbohydrate.
- - ½ cup of corn, green peas, sweet potatoes, or mashed potatoes
  - ¼ of a large baked potato
  - ½ cup of beans, lentils, and peas (garbanzo, pinto, kidney, white, split, black-eyed)
Crackers and snacks: Each serving of food listed below contains about 15 g of carbohydrate.
- - 3 graham cracker squares or 8 animal crackers
  - 6 saltine-type crackers
  - 3 cups of popcorn or ¾ ounce of pretzels, potato chips, or tortilla chips
Fruit: Each serving of food listed below contains about 15 g of carbohydrate.
- - 1 small (4 ounce) piece of fresh fruit or ¾ to 1 cup of fresh fruit
  - ½ cup of canned or frozen fruit, packed in natural juice
  - ½ cup (4 ounces) of unsweetened fruit juice
  - 2 tablespoons of dried fruit
Desserts or sugary foods: Each serving of food listed below contains about 15 g of carbohydrate.
- - 2-inch square unfrosted cake or brownie
  - 2 small cookies
  - ½ cup of ice cream, frozen yogurt, or nondairy frozen yogurt
  - ¼ cup of sherbet or sorbet
  - 1 tablespoon of regular syrup, jam, or jelly
  - 2 tablespoons of light syrup
Milk and yogurt: Foods from the milk group contain about 12 g of carbohydrate per serving.
- - 1 cup of fat-free or low-fat milk
  - 1 cup of soy milk
  - ⅔ cup of fat-free, yogurt sweetened with artificial sweetener
Non-starchy vegetables: Each serving contains about 5 g of carbohydrate. Three servings of non-starch vegetables count as 1 carbohydrate serving.
- - ½ cup of cooked vegetables or 1 cup of raw vegetables. This includes beets, broccoli, cabbage, cauliflower, cucumber, mushrooms, tomatoes, and zucchini
  - ½ cup of vegetable juice

How do I use carbohydrate counting to plan meals?

Count carbohydrate amounts using serving sizes:
- - Pasta dinner example: You plan to have pasta, tossed salad, and an 8-ounce glass of milk. Your healthcare provider tells you that you may have 4 carbohydrate servings for dinner. One carbohydrate serving of pasta is ⅓ cup. One cup of pasta will equal 3 carbohydrate servings. An 8-ounce glass of milk will count as 1 carbohydrate serving. These amounts of food would equal 4 carbohydrate servings. One cup of tossed salad does not count toward your carbohydrate servings.
Count carbohydrate amounts using food labels: Find the total amount of carbohydrate in a packaged food by reading the food label. Food labels tell you the serving size of the food and the total carbohydrate amount in each serving. Find the serving size on the food label and then decide how many servings you will eat. Multiply the number of servings you plan to eat by the carbohydrate amount per serving.
- - Granola bar snack example: Your meal plan allows you to have 2 carbohydrate servings (30 grams) of carbohydrate for a snack. You plan to eat 1 package of granola bars, which contains 2 bars. According to the food label, the serving size of food in this package is 1 bar. Each serving (1 bar) contains 25 grams of carbohydrate. The total amount of carbohydrate in this package of granola bars would be 50 g. Based on your meal plan, you should eat only 1 bar.

What can I do to manage my blood sugar levels?

Check your blood sugar levels as directed and as needed.

Several items are available to use to check your levels. You may need to check by testing a drop of blood in a glucose monitor. You may instead be given a continuous glucose monitoring (CGM) device. The device is worn at all times. The CGM checks your blood sugar level every 5 minutes. It sends results to an electronic device such as a smart phone. A CGM can be used with or without an insulin pump. You and your diabetes care team providers will decide on the best method for you. The goal for blood sugar levels before meals is between 80 and 130 mg/dL and 2 hours after eating is lower than 180 mg/dL.\

Make healthy food choices.

Work with a dietitian to develop a meal plan that works for you and your schedule. A dietitian can help you learn how to eat the right amount of carbohydrates during your meals and snacks. Carbohydrates can raise your blood sugar level if you eat too many at one time. Examples of foods that contain carbohydrates are breads, cereals, rice, pasta, and sweets.

Eat high-fiber foods as directed.

Fiber helps improve blood sugar levels. Fiber also lowers your risk for heart disease and other problems diabetes can cause. Examples of high-fiber foods include vegetables, whole-grain bread, and beans such as pinto beans. Your dietitian can tell you how much fiber to have each day.

Get regular physical activity.

Physical activity can help you get to your target blood sugar level goal and manage your weight. Get at least 150 minutes of moderate to vigorous aerobic physical activity each week. Do not miss more than 2 days in a row. Do not sit longer than 30 minutes at a time. Your healthcare provider can help you create an activity plan. The plan can include the best activities for you and can help you build your strength and endurance.

Maintain a healthy weight.

Ask your team what a healthy weight is for you. A healthy weight can help you control diabetes and prevent heart disease. Ask your team to help you create a weight loss plan, if needed. Weight loss can help make a difference in managing diabetes. Your team will help you set a weight-loss goal, such as 10 to 15 pounds, or 5% of your extra weight. Together you and your team can set manageable weight loss goals.

Take your diabetes medicine or insulin as directed.

You may need diabetes medicine, insulin, or both to help control your blood sugar levels. Your provider will teach you how and when to take your diabetes medicine or insulin. You will also be taught about side effects oral diabetes medicine can cause. Insulin may be injected or given through a pump or pen. You and your providers will decide on the best method for you:

An insulin pump is an implanted device that gives your insulin 24 hours a day. An insulin pump prevents the need for multiple insulin injections in a day.
An insulin pen is a device prefilled with the right amount of insulin.
You and your family members will be taught how to draw up and give insulin if this is the best method for you. Your providers will also teach you how to dispose of needles and syringes.
You will learn how much insulin you need and when to give it. You will be taught when not to give insulin. You will also be taught what to do if your blood sugar level drops too low. This may happen if you take insulin and do not eat the right amount of carbohydrates.

Wear medical alert identification.

Wear medical alert jewelry or carry a card that says you have diabetes. Ask your provider where to get these items.

Do not smoke.

Nicotine and other chemicals in cigarettes and cigars can cause lung and blood vessel damage. It also makes it more difficult to manage your diabetes. Ask your provider for information if you currently smoke and need help to quit. Do not use e-cigarettes or smokeless tobacco in place of cigarettes or to help you quit. They still contain nicotine.

Check your feet each day for cuts, scratches, calluses, or other wounds.

Look for redness and swelling, and feel for warmth. Wear shoes that fit well. Check your shoes for rocks or other objects that can hurt your feet. Do not walk barefoot or wear shoes without socks. Wear cotton socks to help keep your feet dry.

Ask about vaccines you may need.

You have a higher risk for serious illness if you get the flu, pneumonia, COVID-19, or hepatitis. Ask your provider if you should get vaccines to prevent these or other diseases, and when to get the vaccines.

Talk to your provider if you become stressed about diabetes care.

Sometimes being able to fit diabetes care into your life can cause increased stress. The stress can cause you not to take care of yourself properly. Your care team providers can help by offering tips about self-care. Your providers may suggest you talk to a mental health provider who can listen and offer help with self-care issues.

Have your A1c checked as directed.

Your provider may check your A1c every 3 months, or 2 times each year if your diabetes is controlled. An A1c test shows the average amount of sugar in your blood over the past 2 to 3 months. Your provider will tell you what your A1c level should be.

Have screening tests as directed.

Your provider may recommend screening for complications of diabetes and other conditions that may develop. Some screenings may begin right away and some may happen within the first 5 years of diagnosis:

Examples of diabetes complications include kidney problems, high cholesterol, high blood pressure, blood vessel problems, eye problems, and sleep apnea.
You may be screened for a low vitamin B level if you take oral diabetes medicine for a long time.
Women of childbearing years may be screened for polycystic ovarian syndrome (PCOS).