Health Matters 7/19: Managing diabetes for a happier, healthier you

By Sandra Byer-Lubin, R.D.

An estimated 30.3 million Americans have diabetes, a chronic condition where your body does not produce enough insulin or does not use it efficiently or both, according to the American Diabetes Association. 

More than 7 million of those people are undiagnosed. 

Left unmanaged, diabetes can lead to serious medical complications, including heart disease as well as nerve, kidney and eye damage. 

That is why it is important to know your blood glucose levels and take steps to manage diabetes now so you can reduce your risk for problems in the future. 

Understanding Diabetes 

Diabetes is a disease that occurs when your glucose or blood sugar levels are too high. 

Your body relies on insulin, a hormone produced by the pancreas, to help regulate your blood sugar and transfer it to your cells for energy.

If the pancreas doesn’t make enough insulin or your body doesn’t use insulin well, sugar builds up in your blood, starving your cells of energy and causing damage throughout your body. 

While there are several types of diabetes, the most common is type 2, which occurs primarily in middle-aged and older adults, according to the National Institutes of Health. 

In people with type 2 diabetes, elevated glucose levels trigger the pancreas to produce more insulin to manage blood sugar. This works at first, but over time the beta cells of the pancreas can’t make enough insulin to keep the blood sugars normal. 

Moreover, in people with type 2 diabetes, cells may become resistant to insulin, which is another reason blood sugar may remain high. This is greatly exacerbated by abdominal fat and inactivity.

Most people do not have any signs of diabetes early on, but symptoms that can indicate more advanced diabetes can include:

  • Increased thirst
  • Frequent urination 
  • Unexplained weight loss
  • Fatigue 
  • Irritability 
  • Blurred vision 

A simple blood test can determine if you have diabetes, which is characterized by a fasting blood sugar level of 126 mg/dl or above.  A healthy fasting glucose level is below 100 mg/dl. 

Another test, which reflects your average glucose level over the past three months is a hemoglobin A1C level, or A1C.  Diabetes is diagnosed if your A1C level is above 6.5%.

A fasting glucose level between 100 and 125 mg/dl is considered prediabetes and is a warning to take control before diabetes develops. An A1C of 5.7 – 6.4% can also indicate prediabetes. 

Taking Action 

Diabetes management is a lifelong process and is critical to avoiding complications such as heart disease, stroke, kidney disease, eye damage, nerve damage, periodontal disease and foot problems. 

Whether diagnosed with diabetes or prediabetes, to lower your chances of developing complications and improve your quality of life, take action. 

  • Monitor your blood sugar. Knowing your blood sugar levels is the first step in managing diabetes. In addition to daily fingerstick blood sugar tests, an A1C blood test can measure your average blood sugar level over the past three months. A new tool, continuous glucose monitoring, automatically tracks blood glucose levels throughout the day and night. Seeing how your levels change in real time can help you make informed decisions balancing food, exercise and medications. 
  • Watch your carbs and eat a healthy diet. Carbohydrates are sugars your body needs for energy. However, when it comes to carbs, it is possible to have too much of a good thing. In general, a low to moderate carbohydrate intake is 30-60 grams per meal and 15-30 grams for a snack. High carbohydrate foods tend to include pasta, breads and sweets. Foods high in fiber, including vegetables, whole grains, fresh fruits and nuts, as well as protein and fat, can help slow down the increase in blood sugar and reduce quick spikes. 
  • Exercise. Exercise can help your body use insulin better and lower blood glucose. The American Diabetes Association recommends aiming for 30 minutes of moderate-to-vigorous intensity aerobic exercise at least five days a week or a total of 150 minutes per week. The association also recommends doing some type of strength training at least two times per week in addition to aerobic activity. It is important to note though if 30 minutes of exercise seems too much, even small, 10-15 minute increments of exercise or activity several times daily can be beneficial and reduce glucose levels.  
  • Maintain a healthy weight. Being overweight or obese can increase your risk for diabetes, as well as complications from the disease. Eating a healthy diet and exercising can help you achieve and maintain a healthy weight. 
  • Reduce stress. Stress can raise your blood sugar. Identify ways to reduce stress whether through deep breathing exercises, meditating, exercising or doing an activity you enjoy. 
  • Take your medications and see your doctor regularly. In some cases, diabetes may be able to be managed through diet and lifestyle changes, but often medication is also necessary. Be sure to take medication as prescribed and see your doctor regularly to monitor your condition and address any new or worsening medical issues. Some newer medications can help with weight loss, blood pressure control and reduction of the risk for cardiovascular and renal (kidney) disease.

A Personalized Approach 

Successful diabetes management is not always easy and patients often feel overwhelmed with a new diagnosis. The Diabetes Management Program at Penn Medicine Princeton Medical Center can help patients develop a personalized management plan, including education on nutrition, weight loss strategies, exercise and medications, assistance with glucose monitoring and emotional support. Patients are generally referred to the program by their primary care doctor. 

For more information or to find a physician with Penn Medicine Princeton Health, call 1-888-742-7496.  

Sandra Byer-Lubin is a registered dietitian and certified diabetes educator with Penn Medicine Princeton Health.