You can manage your diabetes and live a long and healthy life by taking care of yourself each day.

Diabetes can affect almost every part of your body. Therefore, you will need to manage your blood glucose levels, also called blood sugar. Managing your blood glucose, as well as your blood pressure and cholesterol, can help prevent the health problems that can occur when you have diabetes.

How can I manage my diabetes?

With the help of your health care team, you can create a diabetes self-care plan to manage your diabetes. Your self-care plan may include these steps:

Manage your diabetes ABCs

Knowing your diabetes ABCs will help you manage your blood glucose, blood pressure, and cholesterol. Stopping smoking if you smoke will also help you manage your diabetes. Working toward your ABC goals can help lower your chances of having a heart attack, stroke, or other diabetes problems.

A for the A1C test

The A1C test shows your average blood glucose level over the past 3 months. The A1C goal for many people with diabetes is below 7 percent. Ask your health care team what your goal should be.

B for Blood pressure

The blood pressure goal for most people with diabetes is below 140/90 mm Hg. Ask what your goal should be.

C for Cholesterol

You have two kinds of cholesterol in your blood: LDL and HDL. LDL or “bad” cholesterol can build up and clog your blood vessels. Too much bad cholesterol can cause a heart attack or stroke. HDL or “good” cholesterol helps remove the “bad” cholesterol from your blood vessels.

Ask your health care team what your cholesterol numbers should be. If you are over 40 years of age, you may need to take a statin drug for heart health.

S for Stop smoking

Not smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels. Blood vessel narrowing makes your heart work harder. E-cigarettes aren’t a safe option either.

If you quit smoking

• you will lower your risk for heart attack, stroke, nerve disease, kidney disease, diabetic eye disease, and amputation
• your cholesterol and blood pressure levels may improve
• your blood circulation will improve
• you may have an easier time being physically active

If you smoke or use other tobacco products, stop. Ask for help so you don’t have to do it alone. You can start by calling the national quitline at 1-800-QUITNOW or 1-800-784-8669.

Keeping your A1C, blood pressure, and cholesterol levels close to your goals and stopping smoking may help prevent the long-term harmful effects of diabetes. These health problems include heart disease, stroke, kidney disease, nerve damage, and eye disease. You can keep track of your ABCs with a diabetes care record. 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.

Follow your diabetes meal 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.

Make physical activity part of your daily routine

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 medicine

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.

Cope with your diabetes in healthy ways

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.

Depression is common among people with a chronic, or long-term, illness. Depression can get in the way of your efforts to manage your diabetes. Ask for help if you feel down. A mental health counselor, support group, clergy member, friend, or family member who will listen to your feelings may help you feel better.

Try to get 7 to 8 hours of sleep each night. Getting enough sleep can help improve your mood and energy level. You can take steps to improve your sleep habits. If you often feel sleepy during the day, you may have obstructive sleep apnea, a condition in which your breathing briefly stops many times during the night. Sleep apnea is common in people who have diabetes. Talk with your health care team if you think you have a sleep problem.

Remember, managing diabetes isn’t easy, but it’s worth it.

1. How do I manage my ABCs?

A: Get a regular A1C test to measure your average blood sugar over 2 to 3 months.

B: Try to keep your blood pressure below 140/90 mm Hg (or the target your doctor sets).

C: Control your cholesterol levels.

s: Stop smoking or don’t start.

Keeping your ABC numbers close to target levels can lower your risk of long-term health problems. Ask your health care team to help you set personal targets.

2. How will I know if my medicines are working?

Are your ABC numbers close to or at your target levels?

• If the answer is yes, then your medicines and efforts are working. Keep up the good work!
• If the answer is no, then meet with your health care team to see if your treatment plan needs to be changed. Be sure to take all of your medicines and blood sugar records when you meet with your care team. Bring prescription and over-the-counter medicines.

3. When and where can I learn more about how to manage my diabetes?

You can get help that matches your needs, goals, and life experiences.

Go to the Find a Diabetes Education Program in Your Area website to find programs that are recognized by the American Diabetes Association or accredited by the Association of Diabetes Care & Education Specialists.

The best times for diabetes education and support are:

• When you’re first diagnosed with diabetes.
• Once a year when you review your educational, nutritional, and emotional needs.
• When new complications come up—for example, changes in your physical or emotional health or financial needs.
• During changes in your care—for example, changes to your health care team, treatment plan, or living situation.

4. What vaccines should I have?

Getting vaccinated is an important part of staying healthy, especially when you have diabetes. That’s because people with diabetes have a higher risk of serious health problems that vaccines can prevent.

Ask your health care team what vaccines you need and when.

5. When should I schedule health care appointments?

• See your regular health care team twice a year or more.
• See an eye doctor, foot doctor, and dentist once a year or more.

Regular health care helps you stay healthy, especially when you have diabetes. Ask to set up your next visit before you leave your health care provider’s office.

When you have diabetes, you will have a lot to manage. But you can take it one step at a time. Your health care team will help you set goals and make a treatment plan you can stick with. Visit CDC’s Diabetes website for information on how to manage your diabetes and live your healthiest life!

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.

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. The sensor measures glucose levels in the fluids between your body’s cells every few minutes and can show changes in your glucose level throughout the day and night. 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.

What are the recommended targets for blood glucose levels?

Many people with diabetes aim to keep their blood glucose at these normal levels:

• Before a meal: 80 to 130 mg/dL
• About 2 hours after a meal starts: less than 180 mg/dL

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.

What happens if my blood glucose level becomes too low?

Sometimes blood glucose levels drop below where they should be, which is called hypoglycemia. For most people with diabetes, the blood glucose level is too low when it is below 70 mg/dL.

Hypoglycemia can be life threatening and needs to be treated right away.

What happens if my blood glucose level becomes too high?

Doctors call high blood glucose hyperglycemia.

Symptoms that your blood glucose levels may be too high include

• feeling thirsty
• feeling tired or weak
• headaches
• urinating often
• blurred vision

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.

Besides a primary care professional, your health care team may include

• an endocrinologist for more specialized diabetes care
• a registered dietitian, also called a nutritionist
• a nurse
• a certified diabetes educator
• a pharmacist
• a dentist
• an eye doctor
• a podiatrist, or foot doctor, for foot care
• a social worker, who can help you find financial aid for treatment and community resources
• a counselor or other mental health care professional

When you see members of your health care team, ask questions. Write a list of questions you have before your visit so you don’t forget what you want to ask.

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. Your blood glucose levels are more likely to go up when you’re sick or have an infection.

What Are Behavioral Programs for Diabetes?

In behavioral programs for diabetes, a trained provider helps you learn to manage your diabetes. Some behavioral programs are one-on-one. Some are done in a group. The program may be done in person, on the phone, or online. The trained provider may be a health care professional, such as a nurse, pharmacist, or dietitian. Or, the trained provider may be a person who is not a health care professional but is trained to provide behavioral programs for diabetes.

There are several types of behavioral programs for diabetes, including:

• Diabetes self-management education. This type of program is focused on education about diabetes, the disease process, and treatment. A trained provider can help you learn how to manage your diabetes as part of your daily life. He or she can also help you set specific goals to manage your diabetes on your own. You will likely meet with the provider one or more times a week for at least a month. A trained provider may continue to support you after the program ends.
• Lifestyle programs. In this type of program, a trained provider helps you learn how to make specific lifestyle changes to help you manage your diabetes. Lifestyle changes can help lower the risk of health issues from diabetes. Lifestyle programs may focus on diet, physical activity, or both.
  • Dietary program: Teaches you how to eat a healthy diet in order to lose weight, manage your blood sugar, and lower your risk of health issues from diabetes.
  • Physical activity program: Teaches you how to do the right amount and the right types of physical activity. Some types of physical activity make your heart beat fast. Other types help strengthen your bones and muscles.

A behavioral program for diabetes can help you:

• Learn more about diabetes and how to follow your management plan
• Set goals and learn problem-solving skills to help manage your diabetes
• Develop healthy behaviors, such as eating a healthy diet and being active
• Learn how to maintain a healthy weight
• Learn how to check your blood sugar (if needed) and take your medicines correctly
• Take steps to lower your risk for health issues from diabetes (see the section below for more information about possible health issues from diabetes)

The trained provider may also talk with you about:

• Signs of health issues from diabetes
• Yearly tests to check for any health issues from diabetes (such as a urine test to check for kidney damage, a foot exam, and an eye exam)
• How to cope with stress related to living with diabetes

What Have Researchers Found?

Researchers found the following about behavioral programs for people with type 2 diabetes:

• Behavioral programs helped people with type 2 diabetes manage their diabetes.
• Diabetes self-management education programs that worked best:
  • Included 11 or more hours of meeting time with the trained provider.
  • Often included continued support after the program ended.
• Behavioral programs that had some in-person meetings worked better than programs done only over the phone or online.
• Lifestyle programs focused on diet or physical activity worked best to lower body mass index (BMI). Body mass index is a measurement based on your height and weight that helps your health care professional check if you are at a healthy weight.

Why Is It Important To Manage Type 2 Diabetes?

It is important for people with type 2 diabetes to try to keep their blood sugar level within a healthy range.

Having high blood sugar (a condition called "hyperglycemia") can cause serious health issues in the long term. These may include:

• Heart disease and heart attack
• Stroke
• Kidney problems
• Eye problems and possibly blindness
• Nerve damage
• Foot problems, which in severe cases may lead to amputation (loss) of the foot

It is also important to watch for signs that your blood sugar is too low (a condition called "hypoglycemia"). If your blood sugar gets too low, you may suddenly feel weak, become dizzy, or faint. If not treated right away, hypoglycemia can be life threatening.

When your blood sugar level is within a healthy range, you are likely to:

• Feel less tired and have more energy
• Heal better and have fewer skin infections
• Feel less thirsty, need to urinate less often, and have fewer bladder infections

Talking With Your Health Care Professional

You may want to ask your health care professional:

• How could a behavioral program help me manage my type 2 diabetes?
• How do I sign up for a behavioral program?
• How often and for how many months would I need to meet with the trained provider?
• How long would each program session be?
• Would my insurance cover the cost of the behavioral program?
• Will I follow up with you after finishing the behavioral program?

Intermittent fasting’s greatest benefit is weight loss, but research shows that intermittent fasting periods do more than just burn fat.

Some of the other potential health benefits of intermittent fasting include:

• Lowered blood insulin and sugar levels with the potential reversal of type 2 diabetes
• Improved mental clarity and concentration
• Increased energy
• Improved blood cholesterol profile
• Reduced risk of heart disease, cancer, and other diseases
• Reduced inflammation
• Potential for a longer life

In addition, intermittent fasting is easy to implement and makes your day simpler. There are less meals to plan and cook, which also means you’re more likely to stick with it!

Getting a flu vaccine during 2020-2021 is more important than ever because of the ongoing COVID-19 pandemic. Flu vaccination is especially important for people with certain underlying medical conditions, like asthma, heart disease, and diabetes.People with these types of conditions are at higher risk of developing serious complications from flu. Many of these conditions also increase the risk for serious outcomes from COVID-19.

People with diabetes (type 1, type 2, or gestational), even when well-managed, are at high risk of serious flu complications, which can result in hospitalization and sometimes even death. Pneumonia, bronchitis, sinus infections and ear infections are examples of flu-related complications. In recent seasons, about 30 percent of adult flu hospitalizations reported to CDC have had diabetes. Flu also can make chronic health problems, like diabetes, worse. This is because diabetes can make the immune system less able to fight infections. Acute illnesses can make it harder to control your blood sugar. Flu may raise your sugar levels, but sometimes people don’t feel like eating when they are sick and a reduced appetite can cause blood sugar levels to fall. It is important for people with diabetes to follow the sick day guidelines if they become ill.

What is Diabetes?

Diabetes is a chronic (long-lasting) disease that affects how your body turns food into energy. There are three main types of diabetes: type 1, type 2, and gestational diabetes (diabetes while pregnant). More than 100 million Americans are living with diabetes (30.3 million) or prediabetes (84.1 million).

A Flu Vaccine is the Best Protection Against Flu

Flu vaccination is especially important for people with diabetes because they are at high risk of developing serious flu complications. Flu vaccines are updated each season as needed to keep up with changing viruses. Also, immunity wanes over time; annual vaccination is recommended for the best possible protection against flu. A flu vaccine protects against the flu viruses that research indicates will be most common during the upcoming season. Flu vaccines for 2020-2021 have been updated from last season’s vaccines to better match circulating viruses. Immunity from vaccination sets in after about two weeks.

• Flu vaccination has been shown to reduce the risk of getting sick with flu as well as reduce the risk of having a serious flu outcome like a stay in the hospital or even being admitted to the intensive care unit (ICU).
• Flu vaccination also has been associated with reduced hospitalizations among people with diabetes (79%).

CDC recommends that everyone 6 months and older get a seasonal flu vaccine each year by the end of October.

Flu Vaccines for People with Diabetes

• Injectable influenza vaccines (flu shots) are recommended for use in people with diabetes and other health conditions. The flu shot has a long, established safety record in people with diabetes.
• The live attenuated influenza vaccine (LAIV), also known as the nasal spray vaccine, is recommended as an option for use in people 2 through 49 years old who are not pregnant. But, people with some chronic medical conditions (such as diabetes) should generally not received LAIV. Your doctor or other health care professional can answer any questions you might have about flu vaccine.

Get pneumococcal vaccines.

• Having flu increases your risk of getting pneumococcal disease. Pneumonia is an example of a serious that can cause death.
• People who have diabetes also should be up to date with pneumococcal vaccination to help protect against pneumococcal disease. Pneumococcal vaccination should be part of a diabetes management plan. Talk to your health care provider to find out which pneumococcal vaccines are recommended for you.

Other Preventive Actions for People with Diabetes

In addition to getting a flu vaccine, people with diabetes should take the same everyday preventive actions CDC recommends of everyone, including avoiding people who are sick, covering coughs, and washing hands often.

Specific Health Actions for People with Diabetes

• Plan ahead to maintain sufficient supplies of your regular medications for chronic medical conditions (e.g. at least a 2-week supply)

Symptoms and Treatment

If you get flu symptoms call your health care provider right away. There are antiviral drugs that can treat flu illness and that may prevent serious flu complications. CDC recommends prompt flu treatment for people who have flu infection or suspected flu infection and who are at high risk of serious flu complications, such as people with diabetes.

Symptoms

Flu symptoms can include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. Some people may also have vomiting and diarrhea, though this is more common in children People may be infected with flu and have respiratory symptoms without a fever.

Treatment

• Treatment should begin as soon as possible because antiviral drug treatment works best when started early (within 48 hours after symptoms start).
• Antiviral drugs require a prescription from a health care provider. These medicines fight against flu by keeping flu viruses from making more viruses in your body.
• Antiviral drugs can make your flu illness milder and make you feel better faster. They may also prevent serious health problems that can result from flu illness.
• There are four FDA-approved flu antiviral drugs recommended by CDC this season that can be used to treat flu.

When to Seek Emergency Medical Care

Anyone experiencing any of the following emergency warning signs of flu sickness, including people with diabetes, should seek medical attention right away.

Emergency Warning Signs of Flu

People experiencing these warning signs should obtain medical care right away.

In children

• Fast breathing or trouble breathing
• Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin tone
• Ribs pulling in with each breath
• Chest pain
• Severe muscle pain (child refuses to walk)
• Dehydration (no urine for 8 hours, dry mouth, no tears when crying)
• Not alert or interacting when awake
• Seizures
• Fever above 104°F
• In children less than 12 weeks, any fever
• Fever or cough that improve but then return or worsen
• Worsening of chronic medical conditions

In adults

• Difficulty breathing or shortness of breath
• Persistent pain or pressure in the chest or abdomen
• Persistent dizziness, confusion, inability to arouse
• Seizures
• Not urinating
• Severe muscle pain
• Severe weakness or unsteadiness
• Fever or cough that improve but then return or worsen
• Worsening of chronic medical conditions

Each year thousands of adults in the United States get sick from diseases that could be prevented by vaccines — some people are hospitalized, and some even die. People with diabetes (both type 1 and type 2) are at higher risk for serious problems from certain vaccine-preventable diseases. Getting vaccinated is an important step in staying healthy. If you have diabetes, talk with your doctor about getting your vaccinations up-to-date.

Why Vaccines are Important for You

• Diabetes, even if well managed, can make it harder for your immune system to fight infections, so you may be at risk for more serious complications from an illness compared to people without diabetes.
  • Some illnesses, like influenza, can raise your blood glucose to dangerously high levels.
  • People with diabetes have higher rates of hepatitis B than the rest of the population. Outbreaks of hepatitis B associated with blood glucose monitoring procedures have happened among people with diabetes.
  • People with diabetes are at increased risk for death from pneumonia (lung infection), bacteremia (blood infection) and meningitis (infection of the lining of the brain and spinal cord).
• Immunization provides the best protection against vaccine-preventable diseases.
• Vaccines are one of the safest ways for you to protect your health, even if you are taking prescription medications. Vaccine side effects are usually mild and go away on their own. Severe side effects are very rare.

Vaccines You Need

• Influenza vaccine to protect against seasonal flu every year
• Pneumococcal vaccine to protect against serious pneumococcal diseases
• Tdap vaccine to protect against tetanus, diphtheria, and whooping cough
• Hep B vaccine to protect against hepatitis B
• Zoster vaccine to protect against shingles

There may be other vaccines recommended for you based on your lifestyle, travel habits, and other factors. Talk to your healthcare professional about which vaccines are right for you.

Getting Vaccinated

You regularly see your provider for diabetes care, and that is a great place to start! If your healthcare professional does not offer the vaccines you need, ask for a referral so you can get the vaccines elsewhere. Adults can get vaccines at doctors’ offices, pharmacies, workplaces, community health clinics, health departments and other locations. To find a place near you to get a vaccine, go to http://vaccine.healthmap.org. Most health insurance plans cover recommended vaccines. Check with your insurance provider for details and for a list of vaccine providers covered by your plan. If you do not have health insurance, visit www.healthcare.gov to learn more about health insurance options.

You don’t get really good at dealing with diabetes overnight. But over time, you’ll figure out how to go from getting it done to taking it in stride. See if any of these tips are familiar (or worth trying!).

Remember when you first found out you had diabetes and learned the basics of taking care of yourself?

• Make and eat healthy food.
• Be active most days.
• Test your blood sugar often.
• Take medicines as prescribed, even if you feel good.
• Learn ways to manage stress.
• Cope with the emotional side of diabetes.
• Go to checkups.

One way or another, you’ve had to try to make it all fit with family, work, school, holidays, and everything else in your life. Here’s our short list of tips to help – you’re probably familiar with many, but some may be new (feel free to use!).

Eat Well

• Take the time to cook. You’re not saving time by sitting in the drive-thru anyway.
• Look online for budget-friendly, easy-to-make recipes. Many are so good you’ll want to eat right out of the pan.
• Write down or take photos of all your meals and snacks. This one trick makes you much more aware of everything you eat and helps you stay in control.
• You can’t go wrong with veggies. Take a free online cooking class to learn the secrets of making them taste delicious.
• Skip “diabetic” foods. They often cost more than “regular” food, and they don’t taste very good anyway.
• Make the same food for you and your family. Healthy eating for everyone!
• Try Meatless Monday (or any day of the week). Beans and lentils are cheap, tasty, and really good for you.
• Make family favorites with a twist: substitute veggies for some of the rice or pasta, or blend veggies until smooth and add to sauces.

Be Active

• Exercise is still one of the best tools for managing diabetes, and it’s free!
• Break a sweat regularly, but also find little ways to be active throughout the day, like climbing stairs and walking.
• Work out with a friend. You’re more likely to stick with it because you won’t want to let them down.
• Try an activity tracker (many apps are free). It’s very motivating to watch your steps add up.
• Check out all the online workout videos. There’s something for everyone, at every level of fitness.

Manage Stress

• Try meditation or yoga to slow down and relax. Choose from thousands of free videos online to get started.
• Get moving! Taking a walk can help you unwind, and the effect can last for hours.
• Call or make plans to get together with a friend who understands you.

Do Things You Can Keep Doing

• For new habits, start small. Little successes make it easier to take on bigger goals.
• Make goals specific. Instead of “I’m going to get in shape,” think “I’m going to walk after dinner on weekdays.”
• Make good choices easier. Stick to just one or two healthy breakfast options, bring your lunch instead of buying, leave the dog’s leash by the door.

Keep Learning

Diabetes self-management education and support services can help you learn skills to manage diabetes when you’re first diagnosed, and at these other key times as well:

• During checkups with your doctor.
• When a new event or health problem affects how you take care of yourself.
• When any other big life event, like changing your job or home, affects your diabetes care.

See the Big Picture

What’s most important to you? 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. Here’s to making diabetes a part of life instead of life being all about diabetes!

At age 50, life expectancy- the number of years a person is expected to live- is 6 years shorter for people with type 2 diabetes than for people without it. People with type 2 diabetes can reduce their risk of complications and live longer by achieving their treatment goals.

What did this study examine?

This study measured average increases in life expectancy years for people with type 2 diabetes who met four different treatment goals. Researchers divided study participants into six groups based on sex and three age ranges. People with diabetes can use results to estimate their own likely life expectancy increase.

What’s important about this study?

By predicting life expectancy related to diabetes treatment goals, findings from this study can help people with diabetes and their doctors focus on treatment goals with the most impact. Decision makers can use this study to support diabetes programs in the United States.

What are the terms to know?

This study examined four diabetes treatment measures:

• Body mass index (BMI) is a measure of weight based on height.
• Hemoglobin A1C, or A1C, is a blood test that measures average blood sugar over the past 3 months.
• Low-density lipoprotein (LDL) cholesterol can build up in the blood vessels, causing damage to vessel walls.
• Systolic blood pressure (SBP) measures the force of blood pushing against artery walls as it moves through the body. Blood pressure is measured with a top and bottom number, and SBP refers to the top number.

What were the results?

• Managing weight, blood sugar, blood pressure, and cholesterol can increase life expectancy by 3 years for the average person with type 2 diabetes. And for people with the highest levels of BMI (average 41.4 kg/m), A1C (average 9.9%), LDL (average 146.2 mg/dl) and SBP (average 160.4 mmHg), reducing these levels can potentially increase life expectancy by more than 10 years.
• The benefits in life expectancy from meeting treatment goals in this study were highest in adults ages 51 to 60, compared to those 61 and older.
• Of the four treatment goals studied, reduced BMI on average was associated with the greatest gain in life expectancy, followed by reduced A1C.
• The benefit of weight loss may have been underestimated since it is often connected with other treatment goals in this study. Weight loss must be maintained in the long term for life expectancy benefits to apply.

What is the take-home message?

Living well with diabetes requires more than blood sugar management. Diabetes management is also connected to weight, blood pressure, and cholesterol. This study shows how people with type 2 diabetes can reduce their risk of complications and extend their lives.

If you have diabetes, managing your health can seem overwhelming. I’ll share some tips for taking charge of your diabetes and your health.

Managing your diabetes ABCs is a key part of your diabetes care plan. It’s the first step toward a healthier you! A is for A1C, a test your doctor uses to check your average blood glucose level. B is for blood pressure, and C is for cholesterol.

Elevated blood glucose levels, blood pressure, and cholesterol can damage your blood vessels and organs like your heart, eyes, and kidneys. To help prevent these problems, practice good self-care to keep your ABCs in a healthy range.

Manage your ABCs by planning healthy meals, being active, not smoking, and taking your medicines on time.

Work with your health care team to check your ABCs and create a diabetes care plan that works for you.

Why do I need to know my blood sugar numbers?

Your blood sugar numbers show how well your diabetes is managed. And managing your diabetes means that you have less chance of having serious health problems, such as kidney disease and vision loss.

As you check your blood sugar, you can see what makes your numbers go up and down. For example, you may see that when you are stressed or eat certain foods, your numbers go up. And, you may see that when you take your medicine and are active, your numbers go down. This information lets you know what is working for you and what needs to change.

How is blood sugar measured?

There are two ways to measure blood sugar.

• Blood sugar checks that you do yourself. These tell you what your blood sugar level is at the time you test.
• The A1C (A-one-C) is a test done in a lab or at your provider’s office. This test tells you your average blood sugar level over the past 2 to 3 months.

How do I check my blood sugar?

You use a blood glucose meter to check your blood sugar. This device uses a small drop of blood from your finger to measure your blood sugar level. You can get the meter and supplies in a drug store or by mail.

Read the directions that come with your meter to learn how to check your blood sugar. Your health care team also can show you how to use your meter. Write the date, time, and result of the test in your blood sugar record. Take your blood sugar record and meter to each visit and talk about your results with your health care team.

What are target blood sugar levels for people with diabetes?

A target is something that you aim for or try to reach. Your health care team may also use the term goal. People with diabetes have blood sugar targets that they try to reach at different times of the day. These targets are:

• Right before your meal: 80 to 130
• Two hours after the start of the meal: Below 180

Talk with your health care team about what blood sugar numbers are right for you.

How often should I check my blood sugar?

The number of times that you check your blood sugar will depend on the type of diabetes that you have and the type of medicine you take to treat your diabetes. For example, people who take insulin may need to check more often than people who do not take insulin. Talk with your health care team about how often to check your blood sugar.

The common times for checking your blood sugar are when you first wake up (fasting), before a meal, 2 hours after a meal, and at bedtime. Talk with your health care team about what times are best for you to check your blood sugar.

What should I do if my blood sugar gets too high?

High blood sugar is also called hyperglycemia (pronounced hye-per-gly-see-mee-uh). It means that your blood sugar level is higher than your target level or over 180. Having high blood sugar levels over time can lead to long-term, serious health problems.

If you feel very tired, thirsty, have blurry vision, or need to pee more often, your blood sugar may be high.

Check your blood sugar and see if it is above your target level or over 180. If it is too high, one way to lower it is to drink a large glass of water and exercise by taking a brisk walk. Call your health care team if your blood sugar is high more than 3 times in 2 weeks and you don’t know why.

What should I do if my blood sugar gets too low?

Low blood sugar is also called hypoglycemia (pronounced hye-poh-gly-see-mee-uh). It means your blood sugar level drops below 70. Having low blood sugar is dangerous and needs to be treated right away. Anyone with diabetes can have low blood sugar. You have a greater chance of having low blood sugar if you take insulin or certain pills for diabetes.

Carry supplies for treating low blood sugar with you. If you feel shaky, sweaty, or very hungry, check your blood sugar. Even if you feel none of these things, but think you may have low blood sugar, check it.

If your meter shows that your blood sugar is lower than 70, do one of the following things right away:

• chew 4 glucose tablets
• drink 4 ounces of fruit juice
• drink 4 ounces of regular soda, not diet soda or
• chew 4 pieces of hard candy

After taking one of these treatments, wait for 15 minutes, then check your blood sugar again. Repeat these steps until your blood sugar is 70 or above. After your blood sugar gets back up to 70 or more, eat a snack if your next meal is 1 hour or more away.

If you often have low blood sugar, check your blood sugar before driving and treat it if it is low.

What do I need to know about the A1C test?

The A1C test tells you and your health care team your average blood sugar level over the past 2 to 3 months. It also helps you and your team decide the type and amount of diabetes medicine you need.

What is a good A1C goal for me?

For many people with diabetes, the A1C goal is below 7. This number is different from the blood sugar numbers that you check each day. You and your health care team will decide on an A1C goal that is right for you.

How often do I need an A1C test?

You need to get an A1C test at least 2 times a year. You need it more often if:

• your number is higher than your goal number
• your diabetes treatment changes

How do I pay for these tests and supplies?

Medicare, Medicaid and most private insurance plans pay for the A1C test and some of the cost of supplies for checking your blood sugar. Check your plan or ask your health care team for help finding low cost or free supplies. Ask your health care team what to do if you run out of test strips.

What if I have trouble getting to my blood sugar goals?

There may be times when you have trouble reaching your blood sugar goals. This does not mean that you have failed. It means that you and your health care team should see if changes are needed. Call your health care team if your blood sugar is often too high or too low. Taking action will help you be healthy today and in the future.

John's Story

At each visit, John and his health care team look at his A1C test results, his blood glucose meter and his blood sugar record to see if his treatment is working. At today’s visit, John’s A1C and blood sugar numbers are too high. John and his health care team talk about what he can do to get closer to his A1C and blood sugar goals. John decides he will be more active. He will:

• increase his walking time to 30 minutes every day after dinner.
• check his fasting blood sugar in the morning to see if being more active improves his blood sugar.
• call his doctor in 1 month for a change in medicine if his blood sugar levels are still too high.
• have his A1C tested again in 3 months to see if his new plan is working.

Things to remember

• Check your blood sugar as many times a day as your health care team suggests.
• Have your A1C checked at least 2 times a year.
• Keep a record of your blood sugar and A1C numbers.
• Take your blood glucose meter and blood sugar record to your visit and show them to your health care team. Tell your health care team how you think you are doing.
• Call your health care team if your blood sugar is often too high or too low.

Work with your health care team and decide what changes you need to make to reach your blood sugar goals.

Nutrition and physical activity are important parts of a healthy lifestyle when you have diabetes. Along with other benefits, following a healthy meal plan and being active can help you keep your blood glucose level, also called blood sugar, in your target range. To manage your blood glucose, you need to balance what you eat and drink with physical activity and diabetes medicine, if you take any. What you choose to eat, how much you eat, and when you eat are all important in keeping your blood glucose level in the range that your health care team recommends.

Becoming more active and making changes in what you eat and drink can seem challenging at first. You may find it easier to start with small changes and get help from your family, friends, and health care team.

Eating well and being physically active most days of the week can help you

• keep your blood glucose level, blood pressure, and cholesterol in your target ranges
• lose weight or stay at a healthy weight
• prevent or delay diabetes problems
• feel good and have more energy

What foods can I eat if I have diabetes?

You may worry that having diabetes means going without foods you enjoy. The good news is that you can still eat your favorite foods, but you might need to eat smaller portions or enjoy them less often. Your health care team will help create a diabetes meal plan for you that meets your needs and likes.

The key to eating with diabetes is to eat a variety of healthy foods from all food groups, in the amounts your meal plan outlines.

The food groups are

• vegetables
  • nonstarchy: includes broccoli, carrots, greens, peppers, and tomatoes
  • starchy: includes potatoes, corn, and green peas
• fruits—includes oranges, melon, berries, apples, bananas, and grapes
• grains—at least half of your grains for the day should be whole grains
  • includes wheat, rice, oats, cornmeal, barley, and quinoa
  • examples: bread, pasta, cereal, and tortillas
• protein
  • lean meat
  • chicken or turkey without the skin
  • fish
  • eggs
  • nuts and peanuts
  • dried beans and certain peas, such as chickpeas and split peas
  • meat substitutes, such as tofu
• dairy—nonfat or low fat
  • milk or lactose-free milk if you have lactose intolerance
  • yogurt
  • cheese

Eat foods with heart-healthy fats, which mainly come from these foods:

• oils that are liquid at room temperature, such as canola and olive oil
• nuts and seeds
• heart-healthy fish such as salmon, tuna, and mackerel
• avocado

Use oils when cooking food instead of butter, cream, shortening, lard, or stick margarine.

What foods and drinks should I limit if I have diabetes?

Foods and drinks to limit include

• fried foods and other foods high in saturated fat and trans fat
• foods high in salt, also called sodium
• sweets, such as baked goods, candy, and ice cream
• beverages with added sugars, such as juice, regular soda, and regular sports or energy drinks

Drink water instead of sweetened beverages. Consider using a sugar substitute in your coffee or tea.

If you drink alcohol, drink moderately—no more than one drink a day if you’re a woman or two drinks a day if you’re a man. If you use insulin or diabetes medicines that increase the amount of insulin your body makes, alcohol can make your blood glucose level drop too low. This is especially true if you haven’t eaten in a while. It’s best to eat some food when you drink alcohol.

When should I eat if I have diabetes?

Some people with diabetes need to eat at about the same time each day. Others can be more flexible with the timing of their meals. Depending on your diabetes medicines or type of insulin, you may need to eat the same amount of carbohydrates at the same time each day. If you take “mealtime” insulin, your eating schedule can be more flexible.

If you use certain diabetes medicines or insulin and you skip or delay a meal, your blood glucose level can drop too low. Ask your health care team when you should eat and whether you should eat before and after physical activity.

How much can I eat if I have diabetes?

Eating the right amount of food will also help you manage your blood glucose level and your weight. Your health care team can help you figure out how much food and how many calories you should eat each day.

Weight-loss planning

If you are overweight or obese, work with your health care team to create a weight-loss plan.

These tools may help:

• The Body Weight Planner can help you tailor your plans to reach and maintain your goal weight.
• The SuperTracker lets you track your food, physical activity, and weight.

To lose weight, you need to eat fewer calories and replace less healthy foods with foods lower in calories, fat, and sugar.

If you have diabetes, are overweight or obese, and are planning to have a baby, you should try to lose any excess weight before you become pregnant. Learn more about planning for pregnancy if you have diabetes.

Meal plan methods

Two common ways to help you plan how much to eat if you have diabetes are the plate method and carbohydrate counting, also called carb counting. Check with your health care team about the method that’s best for you.

1. Plate method

The plate method helps you control your portion sizes. You don’t need to count calories. The plate method shows the amount of each food group you should eat. This method works best for lunch and dinner.

Use a 9-inch plate. Put nonstarchy vegetables on half of the plate; a meat or other protein on one-fourth of the plate; and a grain or other starch on the last one-fourth. Starches include starchy vegetables such as corn and peas. You also may eat a small bowl of fruit or a piece of fruit, and drink a small glass of milk as included in your meal plan.

Your daily eating plan also may include small snacks between meals.

2. Portion sizes

• You can use everyday objects or your hand to judge the size of a portion.
• 1 serving of meat or poultry is the palm of your hand or a deck of cards
• 1 3-ounce serving of fish is a checkbook
• 1 serving of cheese is six dice
• 1/2 cup of cooked rice or pasta is a rounded handful or a tennis ball
• 1 serving of a pancake or waffle is a DVD
• 2 tablespoons of peanut butter is a ping-pong ball

3. Carbohydrate counting

Carbohydrate counting involves keeping track of the amount of carbohydrates you eat and drink each day. Because carbohydrates turn into glucose in your body, they affect your blood glucose level more than other foods do. Carb counting can help you manage your blood glucose level. If you take insulin, counting carbohydrates can help you know how much insulin to take.

The right amount of carbohydrates varies by how you manage your diabetes, including how physically active you are and what medicines you take, if any. Your health care team can help you create a personal eating plan based on carbohydrate counting.

The amount of carbohydrates in foods is measured in grams. To count carbohydrate grams in what you eat, you’ll need to

• learn which foods have carbohydrates
• read the Nutrition Facts food label, or learn to estimate the number of grams of carbohydrate in the foods you eat
• add the grams of carbohydrate from each food you eat to get your total for each meal and for the day

Most carbohydrates come from starches, fruits, milk, and sweets. Try to limit carbohydrates with added sugars or those with refined grains, such as white bread and white rice. Instead, eat carbohydrates from fruit, vegetables, whole grains, beans, and low-fat or nonfat milk.

In addition to using the plate method and carb counting, you may want to visit a registered dietitian (RD) for medical nutrition therapy.

What is medical nutrition therapy?

Medical nutrition therapy is a service provided by an RD to create personal eating plans based on your needs and likes. For people with diabetes, medical nutrition therapy has been shown to improve diabetes management. Medicare pays for medical nutrition therapy for people with diabetes. If you have insurance other than Medicare, ask if it covers medical nutrition therapy for diabetes.

Will supplements and vitamins help my diabetes?

No clear proof exists that taking dietary supplements such as vitamins, minerals, herbs, or spices can help manage diabetes. You may need supplements if you cannot get enough vitamins and minerals from foods. Talk with your health care provider before you take any dietary supplement since some can cause side effects or affect how your medicines work.

Why should I be physically active if I have diabetes?

Physical activity is an important part of managing your blood glucose level and staying healthy. Being active has many health benefits.

Physical activity

• lowers blood glucose levels
• lowers blood pressure
• improves blood flow
• burns extra calories so you can keep your weight down if needed
• improves your mood
• can prevent falls and improve memory in older adults
• may help you sleep better

If you are overweight, combining physical activity with a reduced-calorie eating plan can lead to even more benefits. In the Look AHEAD: Action for Health in Diabetes study,overweight adults with type 2 diabetes who ate less and moved more had greater long-term health benefits compared to those who didn’t make these changes. These benefits included improved cholesterol levels, less sleep apnea, and being able to move around more easily.

Even small amounts of physical activity can help. Experts suggest that you aim for at least 30 minutes of moderate or vigorous physical activity 5 days of the week. Moderate activity feels somewhat hard, and vigorous activity is intense and feels hard. If you want to lose weight or maintain weight loss, you may need to do 60 minutes or more of physical activity 5 days of the week.

Be patient. It may take a few weeks of physical activity before you see changes in your health.

How can I be physically active safely if I have diabetes?

Be sure to drink water before, during, and after exercise to stay well hydrated. The following are some other tips for safe physical activity when you have diabetes.

Plan ahead

Talk with your health care team before you start a new physical activity routine, especially if you have other health problems. Your health care team will tell you a target range for your blood glucose level and suggest how you can be active safely.

Your health care team also can help you decide the best time of day for you to do physical activity based on your daily schedule, meal plan, and diabetes medicines. If you take insulin, you need to balance the activity that you do with your insulin doses and meals so you don’t get low blood glucose.

Prevent low blood glucose

Because physical activity lowers your blood glucose, you should protect yourself against low blood glucose levels, also called hypoglycemia. You are most likely to have hypoglycemia if you take insulin or certain other diabetes medicines, such as a sulfonylurea. Hypoglycemia also can occur after a long intense workout or if you have skipped a meal before being active. Hypoglycemia can happen during or up to 24 hours after physical activity.

Planning is key to preventing hypoglycemia. For instance, if you take insulin, your health care provider might suggest you take less insulin or eat a small snack with carbohydrates before, during, or after physical activity, especially intense activity.4

You may need to check your blood glucose level before, during, and right after you are physically active.

Stay safe when blood glucose is high

If you have type 1 diabetes, avoid vigorous physical activity when you have ketones in your blood or urine. Ketones are chemicals your body might make when your blood glucose level is too high, a condition called hyperglycemia, and your insulin level is too low. If you are physically active when you have ketones in your blood or urine, your blood glucose level may go even higher. Ask your health care team what level of ketones are dangerous for you and how to test for them. Ketones are uncommon in people with type 2 diabetes.

Take care of your feet

People with diabetes may have problems with their feet because of poor blood flow and nerve damage that can result from high blood glucose levels. To help prevent foot problems, you should wear comfortable, supportive shoes and take care of your feetbefore, during, and after physical activity.

What physical activities should I do if I have diabetes?

Most kinds of physical activity can help you take care of your diabetes. Certain activities may be unsafe for some people, such as those with low vision or nerve damage to their feet. Ask your health care team what physical activities are safe for you. Many people choose walking with friends or family members for their activity.

Doing different types of physical activity each week will give you the most health benefits. Mixing it up also helps reduce boredom and lower your chance of getting hurt. Try these options for physical activity.

Add extra activity to your daily routine

If you have been inactive or you are trying a new activity, start slowly, with 5 to 10 minutes a day. Then add a little more time each week. Increase daily activity by spending less time in front of a TV or other screen. Try these simple ways to add physical activities in your life each day:

• Walk around while you talk on the phone or during TV commercials.
• Do chores, such as work in the garden, rake leaves, clean the house, or wash the car.
• Park at the far end of the shopping center parking lot and walk to the store.
• Take the stairs instead of the elevator.
• Make your family outings active, such as a family bike ride or a walk in a park.

If you are sitting for a long time, such as working at a desk or watching TV, do some light activity for 3 minutes or more every half hour. Light activities include

• leg lifts or extensions
• overhead arm stretches
• desk chair swivels
• torso twists
• side lunges
• walking in place

Do aerobic exercise

Aerobic exercise is activity that makes your heart beat faster and makes you breathe harder. You should aim for doing aerobic exercise for 30 minutes a day most days of the week. You do not have to do all the activity at one time. You can split up these minutes into a few times throughout the day.

To get the most out of your activity, exercise at a moderate to vigorous level. Try

• walking briskly or hiking
• climbing stairs
• swimming or a water-aerobics class
• dancing
• riding a bicycle or a stationary bicycle
• taking an exercise class
• playing basketball, tennis, or other sports

Talk with your health care team about how to warm up and cool down before and after you exercise.

Do strength training to build muscle

Strength training is a light or moderate physical activity that builds muscle and helps keep your bones healthy. Strength training is important for both men and women. When you have more muscle and less body fat, you’ll burn more calories. Burning more calories can help you lose and keep off extra weight.

You can do strength training with hand weights, elastic bands, or weight machines. Try to do strength training two to three times a week. Start with a light weight. Slowly increase the size of your weights as your muscles become stronger.

You can do strength training with hand weights, elastic bands, or weight machines.

Do stretching exercises

Stretching exercises are light or moderate physical activity. When you stretch, you increase your flexibility, lower your stress, and help prevent sore muscles.

You can choose from many types of stretching exercises. Yoga is a type of stretching that focuses on your breathing and helps you relax. Even if you have problems moving or balancing, certain types of yoga can help. For instance, chair yoga has stretches you can do when sitting in a chair or holding onto a chair while standing. Your health care team can suggest whether yoga is right for you.

When you first found out you had diabetes, you tested your blood sugar often to understand how food, activity, stress, and illness could affect your blood sugar levels. By now, you’ve got it figured out for the most part. But then—bam! Something makes your blood sugar zoom up. You try to adjust it with food or activity or insulin, and it dips really low. You’re on a rollercoaster no one with diabetes wants to ride.

Knowledge is power! Look out for these surprising triggers that can send your blood sugar soaring:

1. Sunburn—the pain causes stress, and stress increases blood sugar levels.

2. Artificial sweeteners—more research needs to be done, but some studies show they can raise blood sugar.

3. Coffee—even without sweetener. Some people’s blood sugar is extra-sensitive to caffeine.

4. Losing sleep—even just one night of too little sleep can make your body use insulin less efficiently.

5. Skipping breakfast—going without that morning meal can increase blood sugar after both lunch and dinner.

6. Time of day—blood sugar can be harder to control the later it gets.

7. Dawn phenomenon—people have a surge in hormones early in the morning whether they have diabetes or not. For people with diabetes, blood sugar can spike.

8. Dehydration—less water in your body means a higher blood sugar concentration.

9. Nose spray—some have chemicals that trigger your liver to make more blood sugar.

10. Gum disease—it’s both a complication of diabetes and a blood sugar spiker.

Watch out for other triggers that can make your blood sugar fall. For example, extreme heat can cause blood vessels to dilate, which makes insulin absorb more quickly and could lead to low blood sugar. If an activity or food or situation is new, be sure to check your blood sugar levels before and after to see how you respond.

Mistakes … we all make them. When you’re first diagnosed with diabetes, there’s lots to learn, and a few mistakes are bound to happen. Here are 3 common ones, along with tips to help you avoid them:

1. Not Testing Enough

Everyone’s diabetes is different, and your treatment plan needs to work for you. For a custom fit, test your blood sugar often when you’re first learning how your body responds to food and activity. Keep track of eating, exercise, and blood sugar levels so you can spot highs and lows and figure out what caused them. Then work with your doctor to adjust your treatment plan as needed.

Getting sick affects your blood sugar levels too. You may not feel like eating, which makes blood sugar harder to manage. If you have a flu-like illness, test every four hours, track the results, and call your doctor if your blood sugar is lower than 70 mg/dL or stays over 240 mg/dL for 2 tests in a row. If your blood sugar is very high, also test your urine for ketones using an over-the-counter ketone test kit. Call your doctor if your ketones are high. High ketones can be an early sign of diabetic ketoacidosis, which is a medical emergency and needs to be treated right away.

2. Not Moving Enough

People with diabetes get big benefits from being physically active, such as better control of blood pressure, blood sugar levels, and weight. Physical activity can also help lower LDL (“bad”) cholesterol, raise HDL (“good”) cholesterol, and reduce the risk of heart disease and nerve damage.

You don’t have to spend hours at the gym. A smart move is setting a reasonable, specific goal, such as walking for 15 minutes after dinner. Build up gradually until you’re active for 30 minutes on most days. Be sure to check with your doctor about which activities are best for you and if there are any you should avoid.

Still dragging your feet? Test your blood sugar before and after you’ve been active and see the fruits of your labor. Make it a habit, and physical activity can also lower your A1c.

3. Not Checking Up

You’ve got diabetes, and you’re managing it well—eating healthy, being active most days of the week, taking meds as prescribed. In fact, you feel pretty good. People who feel good can skip a few doctor’s appointments, right?

Wrong! Seeing your health care team regularly is an essential part of your treatment. For one thing, you may not know if you’re developing a diabetes-related health complication because there may not be any symptoms. Following your schedule of checkups and tests will help catch complications early when treatment is most effective. Another big reason not to miss checkups: adjusting your treatment plan with your doctor or dentist as needed so you can be your healthiest and feel your best.

Did you know that people who have diabetes—both type 1 and type 2—feel the heat more than people who don’t have diabetes? Some reasons why:

• Certain diabetes complications, such as damage to blood vessels and nerves, can affect your sweat glands so your body can’t cool as effectively. That can lead to heat exhaustion and heat stroke, which is a medical emergency.
• People with diabetes get dehydrated (lose too much water from their bodies) more quickly. Not drinking enough liquids can raise blood sugar, and high blood sugar can make you urinate more, causing dehydration. Some commonly used medicines like diuretics (“water pills” to treat high blood pressure) can dehydrate you, too.
• High temperatures can change how your body uses insulin. You may need to test your blood sugar more often and adjust your insulin dose and what you eat and drink.

It’s the Heat and the Humidity

Even when it doesn’t seem very hot outside, the combination of heat and humidity (moisture in the air) can be dangerous. When sweat evaporates (dries) on your skin, it removes heat and cools you. It’s harder to stay cool in high humidity because sweat can’t evaporate as well.

Whether you’re working out or just hanging out, it’s a good idea to check the heat index—a measurement that combines temperature and humidity. Take steps to stay cool (see sidebar) when it reaches 80°F in the shade with 40% humidity or above. Important to know: The heat index can be up to 15°F higher in full sunlight, so stick to the shade when the weather warms up.

Physical activity is key to managing diabetes, but don’t get active outdoors during the hottest part of the day or when the heat index is high. Get out early in the morning or in the evening when temperatures are lower, or go to an air-conditioned mall or gym to get active.

Your Blood Sugar Knows Best

Kids out of school, vacations, get-togethers, family reunions. The summer season can throw off your routine, and possibly your diabetes management plan. Check your blood sugar more often to make sure it’s in your target range no matter what the summer brings. It’s especially important to recognize what low blood sugar feels like and treat it as soon as possible.

Warm-weather wisdom:

• Drink plenty of water—even if you’re not thirsty—so you don’t get dehydrated.
• Avoid alcohol and drinks with caffeine, like coffee and energy or sports drinks. They can lead to water loss and spike your blood sugar levels.
• Check your blood sugar before, during, and after you’re active. You may need to change how much insulin you use. Ask your doctor if you would like help in adjusting your dosage.
• Wear loose-fitting, lightweight, light-colored clothing.
• Wear sunscreen and a hat when you’re outside. Sunburn can raise your blood sugar levels.
• Don’t go barefoot, even on the beach or at the pool.
• Use your air conditioner or go to an air-conditioned building or mall to stay cool. In very high heat, a room fan won’t cool you enough.

Too Hot to Handle

Know what else feels the heat? Diabetes medicines, supplies, and equipment:

• Don’t store insulin or oral diabetes medicine in direct sunlight or in a hot car. Check package information about how high temperatures can affect insulin and other medicines.
• If you’re traveling, keep insulin and other medicines in a cooler. Don’t put insulin directly on ice or on a gel pack.
• Heat can damage your blood sugar monitor, insulin pump, and other diabetes equipment. Don’t leave them in a hot car, by a pool, in direct sunlight, or on the beach. The same goes for supplies such as test strips.

But don’t let the summer heat stop you from taking your diabetes medicine and supplies with you when you’re out and about. You’ll need to be able to test your blood sugar and take steps if it’s too high or too low. Just make sure to protect your diabetes gear from the heat.

Stormy Weather

June 1 marked the beginning of hurricane season. Severe thunderstorms with hail, high winds, and tornadoes are more likely in warm weather, too. People with diabetes face extra challenges if a strong storm knocks out the power or they have to seek shelter away from home. Plan how you’ll handle medicine that needs refrigeration, such as insulin. And be prepared by packing an emergency go-bag—a supply kit you can grab quickly if you need to leave your home.

Here’s to staying cool, staying safe, and enjoying the long summer days!

Your Summer Checklist

• Drink plenty of water.
• Test your blood sugar often.
• Keep medicines, supplies, and equipment out of the heat.
• Stay inside in air-conditioning when it’s hottest.
• Wear loose, light clothing.
• Get medical attention for heat-related illness.
• Make a plan in case you lose power.
• Have a go-bag ready for emergencies.

From wildfires to hurricanes, disasters seem to be getting more and more common. Being prepared for an emergency is important for everyone, but it’s even more important if you have a chronic health condition like diabetes. Routines suddenly change, supplies and medicines can be hard to get and hard to store, and added stress makes it harder to manage your blood sugar. Read on for important information about storing and using insulin in an emergency.

Using Insulin

In a power outage when refrigerated insulin isn’t available:

• Try to keep your insulin as cool as possible, but make sure not to freeze it. Insulin that has been frozen can break down and will be less effective.
• Keep your insulin away from direct heat and out of direct sunlight, which also make it less effective.
• For up to 4 weeks, you can use insulin in opened or unopened vials that have been stored at room temperature (between 59°F and 86°F).
• Realistically, you may have to use insulin that has been stored above 86°F. If so, monitor your blood sugar regularly. If you’re living in an emergency shelter, let someone in charge know if your blood sugar is too high or low, so they can get help if needed. Contact your doctor as soon as the emergency is over.

Switching Insulin

In an emergency, you may need to use a different insulin brand or type instead of your usual insulin. You should work with your doctor if you need to switch insulin brands or types, but that might not be possible in crisis conditions. In that case, follow this emergency guidance from the US Food & Drug Administration (FDA) and be sure to monitor your blood sugar closely and get medical attention as soon as possible.

Using an Insulin Pump

If you use an insulin pump, you may be able to substitute another insulin for your usual insulin.. Check the instructions for your pump to see which insulin types will work. The guidance also explains which insulin types you can use instead of your usual insulin if you need to switch from using your pump to using injectable insulin (taken with a needle).

Getting Back to Normal

When you can get your usual insulin and store it properly, throw away any insulin that was stored at room temperature or exposed to very high or low temperatures. Plan to visit your doctor if you have questions about managing your diabetes going forward or have any other health concerns.

Insulin Storage and Effectiveness

Insulin for Injection

Insulin from various manufacturers is often made available to patients in an emergency and may be different from a patient's usual insulin. After a disaster, patients in the affected area may not have access to refrigeration. According to the product labels from all three U.S. insulin manufacturers, it is recommended that insulin be stored in a refrigerator at approximately 36°F to 46°F. Unopened and stored in this manner, these products maintain potency until the expiration date on the package.

Insulin products contained in vials or cartridges supplied by the manufacturers (opened or unopened) may be left unrefrigerated at a temperature between 59°F and 86°F for up to 28 days and continue to work. However, an insulin product that has been altered for the purpose of dilution or by removal from the manufacturer’s original vial should be discarded within two weeks.

Note: Insulin loses some effectiveness when exposed to extreme temperatures. The longer the exposure to extreme temperatures, the less effective the insulin becomes. This can result in loss of blood glucose control over time. Under emergency conditions, you might still need to use insulin that has been stored above 86°F.

You should try to keep insulin as cool as possible. If you are using ice, avoid freezing the insulin. Do not use insulin that has been frozen. Keep insulin away from direct heat and out of direct sunlight.

When properly stored insulin becomes available again, the insulin vials that have been exposed to these extreme conditions should be discarded and replaced as soon as possible. If patients or healthcare providers have specific questions about the suitability of their insulin, they may call the respective manufacturer at the following numbers:

Lilly: 1-800-545-5979
Sanofi-Aventis: 1-800-633-1610
Novo Nordisk: 1-800-727-6500

Additional Storage Information for Insulin Pumps

Insulin contained in the infusion set of a pump device (e.g., reservoir, tubing, catheters) should be discarded after 48 hours. Insulin contained in the infusion set of a pump device and exposed to temperature exceeding 98.6°F should be discarded.

Insulin Switching

Switching insulin should always be done in consultation with a physician and requires close medical supervision, and if possible, close monitoring of blood glucose. If medical supervision is not possible under emergency conditions, the following recommendations may be considered. Make sure to closely monitor your blood glucose and seek medical attention as soon as possible.

Short-acting (regular insulin) and Rapid-acting Insulins

One brand of regular insulin (e.g., Humulin R, Novolin R) may be substituted for another brand of regular insulin and for rapid-acting insulins (e.g., Humalog, NovoLog, Apidra), and vice versa, on a unit-per-unit basis in emergency conditions.

Regular insulins are to be injected approximately 30 minutes before the start of each meal. Rapid-acting insulins begin working more rapidly than regular insulin and are to be injected no more than 15 minutes before the start of each meal to avoid dangerously low blood glucose levels.

Intermediate and Long-acting Insulins

One intermediate-acting insulin product (e.g., Humulin N, Novolin N) may be substituted for another intermediate-acting insulin product on a unit-per-unit basis in emergency conditions. Likewise, these intermediate insulins may also be substituted for long-acting insulins (e.g., Lantus, Levemir) on a total unit-per-day basis, or vice versa in emergency conditions.

• Importantly,when switching from a once a day long-acting insulin (e.g., Lantus, Levemir) to an intermediate-acting insulin the dose of the once a day long-acting insulin should be cut in half and given as two injections of intermediate acting insulin, one in the morning with breakfast and one in the evening with dinner to avoid dangerously low blood glucose levels.
• When switching from an intermediate-acting to a once a day long-acting insulin, add up the total amount of intermediate-acting insulin units for one day, and give it as a single long-acting insulin dose once a day.

Close monitoring of blood glucose and adjustment in insulin dose may be needed in the transition period.

Insulin Mixes

Switching between types of insulin should be done in consultation with a physician and requires medical supervision, and if possible, close monitoring of blood glucose.

What is an Insulin Mix

Insulin mixes contain a ratio of intermediate- and short/rapid-acting insulin. The first number denotes the quantity of intermediate insulin and the second number denotes the quantity of short/rapid-acting insulin delivered with each dose administered. For example, each dose of a 70/30 mix contains 70% intermediate-acting insulin and 30% short/rapid-acting insulin.

Switching from Your Insulin Mix: Substitution or Replacement

Patients using pre-mixed insulin products (e.g., Humulin 70/30, Humalog Mix 75/25, Novolin 70/30, NovoLog Mix 70/30) have the following options to consider:

• In emergency conditions, one insulin mix product may be substituted for another on a unit-per-unit basis.
  • Insulin mixes containing a rapid-acting insulin analog (e.g., Humalog Mix, Novolog Mix) should be injected closer (within 15 minutes) to the start of the meal compared to mixes containing regular insulin (e.g., Humulin 70/30).
• If an insulin mix is not available, patients should follow this two-step process:
  • First, substitute an intermediate-acting component of the mix (e.g., for most of the examples listed above this will be approximately 70% of the total units for each dose) with an intermediate-acting or a long-acting insulin on a unit-per-unit basis.
    • Substituting with an intermediate-acting insulin:
      • Give 70% of total units for each dose
    • Substituting with a long-acting insulin:
      • Add up the total insulin units given in one day
      • Give 70% as one daily dose
  • Second, if regular or rapid-acting insulins are also available, they may be used before major meals in doses equivalent to approximately 30% of the total dose of pre-mixed insulin and in combination with the intermediate- or long-acting insulin usually taken before that meal.
  • Note: Inject longer and shorter acting insulins separately unless directed otherwise by a physician.

Insulin Pumps

Switching between types of insulin should be done in consultation with a physician and requires medical supervision, and if possible, close monitoring of blood glucose.

Using a Different Insulin in Your Insulin Pump

• Patients administering insulin using a pump device may be able to substitute rapid-acting insulin (e.g., Humalog, Novolog, Apidra) for another on a unit-per-unit basis in emergency conditions. Patients should check the instructions for use of the pump device to see if available insulins are compatible with their devices.

Switching from an Insulin Pump to Injected Insulin

• Patients using insulin pumps who must switch to injected insulin may substitute intermediate or long-acting insulin for the total “basal” dose infused over 24-hours on a unit-per-unit basis in emergency conditions.
  • For example, an individual using a pump with a basal rate of 1 unit per hour has a total 24-hour “basal” dose of 24 units.
  • For an intermediate insulin, the 24 units should generally be administered as two injections of 12 units, and for a long-acting insulin, the 24 units should generally be administered as one injection daily.
• If regular or rapid-acting insulin is also available, patients should administer these insulins with each meal. The individual should substitute their meal time “bolus” dose on a unit-per-unit basis to an injected dose.
  • For example, an individual using a “bolus” dose of 5 units on the pump to cover the breakfast meal should inject 5 units of regular or rapid-acting insulin to cover the breakfast meal.

So far, you’ve had diabetes; it hasn’t had you. You’ve been watching what you eat, making time for physical activity, taking meds, checking your blood sugar, checking your blood sugar again. But then something takes the wind out of your sails. Maybe you’ve been trying hard but not seeing results. Or you developed a health problem related to diabetes in spite of your best efforts.

When you feel discouraged and frustrated, you may slip into unhealthy habits, stop monitoring your blood sugar, even skip doctor’s appointments. It happens to many—if not most—people with diabetes, often after years of good management. You’re in the land of diabetes burnout. How can you get back to healthy living as soon as possible?

Get Your Team Involved

Call on your primary care doctor, eye doctor, podiatrist, dietitian, diabetes educator—anyone and everyone—to help you refocus on your goals. It’s easier for you to see what’s not working instead of what you’re doing right. Your team can remind you of the progress you’ve made and help you with new ideas and strategies.

Don’t Let Perfect be the Enemy of Good

Perfect blood sugar control isn’t necessary and may not even be possible. And sometimes seeing the little picture is better than the big one. Try taking small steps—such as lowering your A1c by 1%—instead of focusing on big goals. You’re still headed in the same direction, but you’ll have more successes along the way.

Connect with People Who Get You

Tap into encouragement, insights, and support from people who’ve been there. Online communities for people with diabetes such as the American Diabetes Association’s Community page and the American Association of Diabetes Educators’ Diabetes Online Community are great ways to connect with others who share your experience. If you prefer to get involved in person, this directory of diabetes support groups will help you find one nearby.

Diaversary: The anniversary of the day someone was diagnosed with diabetes.

Life’s major milestones—graduation, a new job, birthdays, weddings—mark how we’ve grown and changed in important ways. But what about the day you found out you had diabetes?

Like the diabetes experience, the diagnosis experience is different for everyone. If you were very young when you were diagnosed, you may not remember it clearly. If you weren’t so young, it’s likely a day you’ll never forget. Either way, your diagnosis came with big life changes. Having diabetes means you need to think about your health every day.

Many people see the day they were diagnosed as a chance to reflect on the challenges they’ve faced and the successes they’ve experienced in living with diabetes. It’s a chance to celebrate the progress they’ve made and the people in their life who have supported them.

And while the day you found out you had diabetes was important, how you manage it every day is what counts over the long run. However you mark the day—or don’t—three cheers for all you do to keep yourself healthy. Every bit counts!

There isn’t a cure yet for type 1 or type 2 diabetes, but when there is it will be something for ALL of us to celebrate.

Diabetes is a group of chronic diseases that affect metabolism—the way the body uses food for energy and growth. Millions of people have diabetes, which can lead to serious health problems if it is not managed well. Conventional medical treatments and following a healthy lifestyle, including watching your weight, can help you prevent, manage, and control many complications of diabetes. Researchers are studying several complementary health approaches, including dietary supplements, to see if they can help people manage type 2 diabetes or lower their risk of developing the disease; however, there is currently not enough scientific evidence to suggest that any dietary supplements can help prevent or manage type 2 diabetes.

Here are 6 things you should know about taking dietary supplements for type 2 diabetes.

1. A healthy diet, physical activity, and blood glucose testing are the basic tools for managing type 2 diabetes. Your health care providers will help you learn to manage your diabetes and track how well you are controlling it. It is very important not to replace proven conventional medical treatment for diabetes with an unproven health product or practice.

2. Some dietary supplements may have side effects, including interacting with your diabetes treatment or increasing your risk of kidney problems. This is of particular concern because diabetes is the leading cause of chronic kidney disease and kidney failure in the United States. Supplement use should be monitored closely in patients who have or are at risk for kidney disease.

3. Chromium (an essential trace mineral found in many foods) has been studied for preventing diabetes and controlling glucose levels, but research has found it has few or no benefits. There have been a few reports of kidney damage, muscular problems, and skin reactions following large doses of chromium.

4. There is mixed evidence that magnesium helps to manage diabetes—benefits of magnesium supplements on diabetes have been found in some, but not all clinical studies. However, research suggests that people with lower magnesium intake may have a greater risk of developing diabetes. A large 2007 study found an association between a higher intake of cereal fiber and magnesium and a reduced risk of developing type 2 diabetes. Large doses of magnesium in supplements can cause diarrhea and abdominal cramping, and very large doses—more than 5,000 mg/day per day—can be deadly.

5. There is no strong evidence that herbs and other dietary supplements, including cinnamon, alpha-lipoic acid, and omega-3s, can help to control diabetes or its complications. Researchers have found some risks but no clear benefits of cinnamon for people with diabetes. For example, a 2012 review of the scientific literature did not support using cinnamon for type 1 or type 2 diabetes.

6. Talk with your health care provider before considering any dietary supplement for yourself, particularly if you are pregnant or nursing, or for a child. Do not replace scientifically proven treatments for diabetes with unproven health products or practices. The consequences of not following your prescribed medical regimen for diabetes can be very serious.

Your body takes care of countless tasks for you. You might not notice all it’s doing to keep you healthy until something goes wrong.

Diabetes is a serious disease that happens when your body has trouble managing and using blood glucose, a sugar that your body uses as fuel. When you have diabetes, you must actively take on this process yourself. New technologies are being tested to make it easier for you to control diabetes and to help you stay healthy.

More than 100 million Americans are living with diabetes or prediabetes, a condition where blood glucose levels are higher than normal, but not high enough to be considered diabetes. People with diabetes must frequently check their blood glucose (or blood sugar) and take quick action if it gets too high or low. They must also constantly consider how all meals, physical activity, and things like stress will affect their blood glucose.

Types of Diabetes

How people with diabetes manage their blood glucose levels depends, in part, on the type of diabetes they have. The most common are type 1, type 2, and gestational diabetes.

With type 1 diabetes, your body doesn’t make enough of a hormone called insulin. Insulin signals the body’s cells to let glucose inside. The body can’t produce enough insulin because the immune system, your body’s defense against germs and foreign substances, mistakenly attacks and destroys the cells in your pancreas that make insulin.

Type 2 diabetes is the most common. It occurs when either your body’s cells have trouble using insulin or your body doesn’t produce enough insulin to handle the glucose in your blood.

Both types can develop at any age. Type 1 is most often diagnosed in children and young adults, while type 2 shows up most in middle-age and older people. Gestational diabetes occurs only during pregnancy, but increases your chances of developing type 2 later in life.

Diabetes symptoms can vary by type. Some shared symptoms include increased thirst, hunger, and urination. Symptoms of type 1 can start quickly, over a few weeks. Type 2 symptoms tend to develop slowly over years, making them less noticeable.

Blood Glucose Control

Many people with diabetes check their blood glucose with a blood glucose meter. This portable machine measures how much glucose is in the blood. You get a drop of blood by pricking the side of your fingertip with a small, specialized needle. Then you apply the blood to a test strip. The meter shows you how much glucose is in your blood at that moment.

People with type 1 diabetes, and some people with type 2, correct and manage their blood glucose with injections of synthetic insulin. A missed, or miscalculated, dose can lead to serious complications, immediately and over time. Diabetes increases your risk for blindness, heart disease, stroke, kidney failure, and amputation.

“It’s a significant burden to self-test sugar levels several times a day, count carbohydrates with each meal, take into account the impact of physical activity, and then calculate the amount of insulin you need to inject multiple times a day with a syringe or the help of an insulin pump,” explains Dr. Guillermo Arreaza-Rubín, who heads NIH’s Diabetes Technology Program. Any error in this management may lead to life-threatening complications like severe hypoglycemia, which is very low blood glucose.

“Hypoglycemia is one of the main reasons people with type 1 visit hospital emergency rooms every day,” Arreaza-Rubín says. “It happens more frequently during the night and is a major cause of fear and anxiety among people with diabetes and their families.”

Help From Technology

NIH funded-scientists are testing promising technologies to help people better manage diabetes. For example, “artificial pancreas” systems monitor blood glucose levels and provide insulin, or a combination of insulin and another important hormone, automatically. The devices vary in how easy they are to set up and use.

“Our device, called the iLet, is designed to minimize the guesswork and time drain that comes with managing type 1 diabetes,” says Dr. Edward Damiano, a biomedical engineering expert at Boston University who’s co-founded a company to further develop the technology. The device only requires that you type in your body weight to get started. “The system does the heavy lifting of regulating blood glucose, freeing up the user to live a less burdened and more spontaneous life.”

Previous studies have shown that artificial pancreas systems can be safer than the current standard for insulin delivery. Several different devices are now being tested in more people for longer periods of time. Researchers are looking at safety, user-friendliness, the physical and emotional health of the participants, and cost.

Safety is a priority for researchers. “When people with type 1 exercise, their blood glucose can respond in unpredictable and potentially dangerous ways,” explains University of Virginia engineer Dr. Marc Breton. He led a recent study that showed an artificial pancreas system improved glycemic control and reduced hypoglycemia in adolescents with type 1 diabetes as they participated in winter sports, like skiing and snowboarding.

“The artificial pancreas performed very well in an extremely challenging environment,” he says. “Eventually, it may allow people with diabetes the freedom to participate safely in physical activities that they likely avoided in the past.”

One FDA-approved artificial pancreas is already available for people with diabetes. Devices that are more fully automated may become available to the public within the next couple years. Researchers are considering how to use these systems for people with type 2, gestational diabetes, and other conditions involving elevated blood glucose levels.

Other scientists are taking different approaches to replace insulin more effectively. For example, “smart insulins” would become active only when needed. Researchers are also looking for ways to regenerate or replace insulin-producing cells—and to stop the body from attacking them.

“These technologies will help make managing diabetes easier and will help make people who use them healthier,” says Damiano. “I see them as a bridge to a cure for type 1 diabetes.”

While future tools may make it easier to manage your diabetes, you can learn how to manage diabetes with the tools we have now to live a long, healthy life. Medications, glucose monitors, and insulin pumps are all available now to help people with diabetes. If you have diabetes, talk with your health care provider about your options.