Being diagnosed with diabetes, or knowing someone who is diagnosed with the condition, may throw up many questions about how it fits into your daily life, from how it makes you feel, to managing diabetes at work, or while you are driving.
Here we've got information to help you manage all of this, starting with how to talk about diabetes and some tips on having those conversations.
Talking about diabetes
Talking about diabetes can be tricky, awkward, difficult, funny, and everything in between. From telling someone you’ve just met about your diabetes, to trying to explain carb counting to relatives, or avoiding that conversation with your doctor – we want to make it easier for you to have those conversations. We've written sometips to help you start talking. Remember, you can also call our freehelplinewith questions or to simply just have a chat.
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Gestational diabetes can affect any woman during pregnancy. It may increase the risk of developing type 2 diabetes later in life. So, know how to reduce sugar levels during pregnancy.
Pregnancy is not just about morning sickness or mood swings. Some pregnant women may even develop high blood sugar levels. This condition is known as gestational diabetes. It usually disappears after giving birth, but high blood sugar levels can affect pregnancy and may even lead to type 2 diabetes later in life. The good news is that if you have gestational diabetes, you can control it by making lifestyle changes. Watch your diet and weight to reduce sugar levels during pregnancy.
What is gestational diabetes?
Gestational diabetes is one of the types of diabetes that develops only during pregnancy. “It occurs when the body cannot produce enough insulin to regulate blood sugar levels effectively during this period,” says internal medicine expert Dr Gaurav Jain.
While gestational diabetes can affect any pregnant woman, it is more common in women who have risk factors such as being overweight or having a family history of diabetes. This condition usually occurs during the second half of pregnancy, and often goes away after childbirth. But women with gestational diabetes and possibly their children are at a greater risk of being affected by type 2 diabetes in the future, according to the World Health Organization.
What are the signs of gestational diabetes?
“Gestational diabetes often does not present noticeable symptoms, which is why it is typically identified through routine glucose screenings during pregnancy,” says the expert. However, some women may experience the following symptoms if they have gestational diabetes:
Connection between body weight and gestational diabetes
There seems to be a connection between the weight of a pregnant woman and gestational diabetes. About half of the gestational diabetes cases could be avoided if the body weight of pregnant women was maintained in the normal range, as per a study published in The Lancet Public Health in October 2024.
Obesity is indicated by a higher-than-30 body mass index. Researchers, who followed nearly two million births in Sweden for 20 years starting from 2000, found the link between weight and gestational diabetes.
“This connection is largely related to insulin resistance. Excess body weight, especially fat around the abdomen, can make it more difficult for the body to use insulin effectively,” says Dr Jain. During pregnancy, the placenta produces hormones that make the body’s cells less responsive to insulin, leading to higher blood sugar levels. If a woman is already insulin-resistant due to excess weight before pregnancy, the increased demand for insulin during pregnancy can overwhelm her body’s ability to maintain normal blood sugar levels, resulting in gestational diabetes.
Achieving and maintaining a healthy weight before conception may reduce the risk of insulin resistance, improve overall metabolism, and increase the likelihood of a healthy pregnancy. “Women who are overweight or obese are not only at a higher risk of gestational diabetes but also for other pregnancy complications such as preeclampsia, cesarean delivery, and birth complications,” says the expert.
Gestational diabetes is more common in overweight women. Image courtesy: Freepik
How to reduce sugar levels during pregnancy?
During a 2020 study published in the Nutrients journal, lifestyle modification alone was found to be sufficient to control blood sugar levels in 70 to 85 percent of the women diagnosed with gestational diabetes. Here’s what to do:
1. Balanced diet
The gestational diabetes diet should be a balanced one consisting of whole grains, lean proteins, vegetables as well as healthy fats can help maintain balanced blood sugar levels. “Eat foods with a low glycaemic index, which can be digested and absorbed more slowly, and so can prevent blood sugar spikes,” says the expert.
2. Regular physical activity
Regular exercise can help lower blood sugar by improving the body’s ability to use insulin. Activities like walking, swimming, and prenatal yoga are safe options for most pregnant women, but talk to your doctor before starting a new fitness routine.
3. Eat smaller, more frequent meals
Eating smaller meals more frequently helps prevent large fluctuations in blood sugar. “Avoiding long gaps between meals can reduce the risk of hypoglycaemia (low blood sugar) and hyperglycaemia (high blood sugar),” says Dr Jain.
Don’t give up exercise even if you are pregnant! Image courtesy: Shutterstock
4. Include fibre-rich foods
Fibre is a nutrient that is known for slowing down the absorption of sugar into the bloodstream. Including fiber-rich foods like vegetables, legumes, fruits, and whole grains in your meals can help keep blood sugar levels steady.
5. Stay hydrated
Drinking enough water, usually 8 to 10 glasses per day, is essential for blood sugar regulation. Dehydration can lead to increased blood sugar levels as the body struggles to remove excess sugar from the bloodstream.
6. Avoid sugary foods and drinks
Minimise the intake of sugary snacks, desserts, and drinks, as these can cause rapid spikes in blood sugar. Opt for naturally sweet foods, such as fruits, and choose water, herbal teas or unsweetened beverages over sugary drinks.
7. Incorporate healthy fats
Including sources of healthy fats, such as avocados, nuts, seeds, and olive oil, in your diet can help manage blood sugar levels. These fats slow down digestion and the absorption of carbohydrates, preventing sugar spikes.
8. Get adequate sleep
Poor sleep can impact insulin sensitivity and lead to higher blood sugar levels, so sleep for 7 to 9 hours. Good quality sleep each night can support your overall health and blood sugar regulation.
9. Manage stress
Stress can increase blood sugar levels by triggering the release of stress hormones, such as cortisol, which can interfere with insulin function. Practice stress management techniques, such as meditation, deep breathing, or prenatal massage, to keep stress in check.
Make sure to maintain a healthy weight before conception by eating well and working out. This can help to reduce the risk of gestational diabetes. Also, regularly check your blood sugar levels so that you can make dietary and lifestyle changes accordingly.
Before you head to the supermarket, set yourself up for success by knowing the best fruits, veggies and snacks to buy
You know that maintaining a healthy diet is important for everyone, but when it comes to type 2 diabetes, it’s crucial for managing symptoms and helping to prevent complications. “Proper nutrition, combined with regular physical activity and weight management, can significantly reduce the risk of developing type 2 diabetes, and can manage symptoms to the point where you don’t need medication to control your blood sugar,” says nutrition and wellness expert Samantha Cassetty, MS, RD, founder of Sam’s Plate and co-author ofSugar Shock.
Type 2 diabetes is diagnosed when blood sugar (also known as blood glucose) is persistently elevated above the normal range over a long period of time. At the same time, your body doesn’t make enough insulin or doesn’t use the hormone properly to transport glucose from the bloodstream to the cells to be used for energy. The glucose then builds up in the blood instead of being absorbed by the cells, and this leads to high blood sugar levels, which over time can lead to serious health complications if not managed properly. This is why eating a well-balanced diet that helps control blood glucose levels is essential. “I always tell my patients that everyone should eat as if they have type 2 diabetes because we can all benefit from this kind of well-balanced, healthy plan,” says Amy Kimberlain, RDN, LDN, CDCES, and spokesperson for the Academy of Nutrition and Dietetics.
And thoughtfully creating a diabetes-friendly grocery list sets you up for success to create well-balanced meals with plenty of whole foods, like fruits, vegetables, lean proteins and whole grains that help to balance blood sugar levels.
A full diabetes-friendly grocery list
As you prep a weekly grocery list and meal plan with type 2 diabetes in mind, remember: The key is to limit added sugar, refined carbs and starchy foods, and make changes you can live with. Start by choosing items from these categories and food groups (and follow our expert diabetes-friendly tips) to help manage blood sugar while making your meals delicious.
Pro tip: “Starchy vegetables like corn, potatoes and peas impact blood sugar levels, so be sure to limit them on your plate," says Kimberlain. Non-starchy options like lettuce, tomatoes, broccoli, asparagus, carrots and mushrooms generally have less impact on blood sugar, but it really depends on the individual, which is why it's important to check blood glucose levels with a continuous glucose monitor (CGM) or finger prick tests.
Meat, poultry, seafood and meat alternatives
Firm tofu
Ground chicken, turkey or extra-lean (90%+) beef
Fresh fish
Skinless chicken or turkey breast
Veggie burgers
Dairy and dairy alternatives
Eggs (or egg alternatives)
Grass-fed butter
Low-fat cheese
Low-fat or fat-free cottage cheese
Low-fat or skim milk (or low-sugar milk alternative like soy milk)
Low-fat or fat-free unsweetened yogurt
Pro tip: Opt for sources that are low in saturated fat and added sugar. Watch out for added sugar in flavoured non-fat yogurts and milk alternatives. Aim for 8 grams (the equivalent of two teaspoons) or fewer per serving.
Whole grains
Brown rice, wild rice, quinoa, farro
Low-sugar granola
Whole grain cereal
Whole wheat or whole grain bread, tortillas, pita and English muffins
Whole wheat pasta (or legume pasta such as chickpea)
Pro tip: Healthier carbs (whole grains, as well as legumes and starchy vegetables) are digested more slowly than complex carbs, so they promote more stable blood sugar levels, says Cassetty.
Legumes, nuts and seeds
Legumes: black beans, chickpeas, kidney beans, lentils
Pro tip: While these items are high in carbs, legumes are good sources of protein and fibre, which makes them a good choice when balanced on your plate with healthy fats, protein, etc. Research has shown that a diet high in legumes is associated with a lower risk of developing type 2 diabetes, not to mention heart disease, high blood pressure and high cholesterol.
For many people with diabetes, the everyday pressure of managing a chronic condition – and the stigma that goes with it – can be overwhelming. The result? Mental health issues like diabetes distress and eating disorders are surprisingly common.
Although these can often be treated and even prevented, success depends on early intervention. But this is easier said than done.
Roche spoke with UK-based professor of health psychology, Katharine Barnard-Kelly PhD, whose research focuses on the psychosocial barriers and enablers of optimal diabetes self-management. Prof Barnard-Kelly believes there’s an underlying systemic issue that needs to be addressed and she shared not only why, but also how healthcare teams can include regular mental health check-ins with their diabetes patients – even when it’s hard.
Roche: When we began raising awareness about diabetes and mental well-being, we heard from many people with diabetes from different countries that they wished it were a more integral part of their regular doctor visits. In your opinion, how is mental well-being generally approached in consultations?
Katharine: It’s currently not addressed effectively in routine visits for people with diabetes in most places. The medical world continues to exist in a medical model of healthcare where physical outcomes, such as HbA1c, continue to dominate, which is a mistake because the reality is that any long-term condition, especially diabetes, requires a mental, physical and social well-being approach.
Roche: How important is it to prioritise mental health check-ins during regular diabetes check-ups?
Katharine: It’s absolutely crucial. We surveyed nearly 500 people with diabetes about their perceptions on mental health in routine care last year, and the overwhelming majority stated how much they wanted their healthcare provider to ask them about their mental well-being: ‘Just ask me.’ It’s essential to show this empathy because the challenges associated with living with diabetes go way beyond the maths and the mechanisms of glycaemic control.
Roche: Which factors may be hindering healthcare professionals from bringing up the subject of mental well-being with their diabetes patients?
Katharine: Healthcare professionals are often criticised for not touching on mental health in routine visits, but much of that criticism is unfair because they’re trained in a medical model of healthcare that hasn’t prepared them for the psychological side of living with a chronic condition. We conducted research on this and spoke to many people working in diabetes healthcare. The most common response was: ‘What will I do with that answer? If I ask, how can I support this person when I have no expertise and no resources to share?’ However, having said that, there is no need to be a psychologist to have compassion for the challenges of the daily burden of living with diabetes. I would say 80–90% of people with diabetes don’t need psychological resources, they just want to be heard and for someone to acknowledge that they're trying their best.
Roche: What should a healthcare professional (HCP) do if a patient tells them they need psychological help?
Katharine: Listening is a great place to start, and the good news is that answers and solutions don’t need to be available right away. An HCP just needs to show understanding and let their patients know that their problem is being looked into. And they can easily harness the power of their wider multidisciplinary teams by asking colleagues if they've ever come across a specific problem and what they'd recommend as a suitable next step. All they need to do is signpost safe, evidenced-based resources that can help people with diabetes, and, if somebody is struggling, a telephone call between visits to check in on them could help. It’s the little things that make a massive difference.
Roche: What could better equip healthcare professionals to be more proactive about introducing the subject of mental well-being into discussions with their patients?
Katharine: There are evidence-based and theory-driven tools available that can transform the medical model into a physical, mental and social well-being model for every patient, in every visit. Often we hone in so deeply on glycaemic control that all the other psychosocial stuff just gets left behind. But if tools are used that help with pre-clinic planning by getting the patient to answer a set of holistic questions, this can be very insightful for the patient and connect certain dots for them. For the healthcare professional, it sets the baseline for a streamlined, solution-oriented visit where the needs of patients are understood without them having to struggle to articulate them. Resources and care pathways can be offered to those patients, and then healthcare professionals can feel like they’re delivering excellent healthcare, because they are.
Roche: Can you give an example of how that would work?
Katharine: Often sexual health comes up for women in the pre-clinic questionnaire because 80% of women with diabetes will experience vaginal dryness at some point. If you don’t want to have sex because it’s painful, your relationship suffers, and that then brings with it a sense of low self-worth, loss of attractiveness. There’s actually a really easy fix to that, but a young woman isn’t terribly likely to tell her 60-year-old male endocrinologist: ‘I don’t wanna have sex.’ But how’s she going to know this on her own? It’s a problem directly related to diabetes but it’s never talked about. If someone’s relationship is crumbling, quite frankly, then their attention to self-management and glycaemic control is not going to be 100%. With a tool or platform, though, it’s all there in one place, and the doctor can then bring it up and explain the root of the problem and suggest how to solve it.
Roche: What changes in the healthcare system would make it easier for mental well-being to be addressed in routine visits?
Katharine: I’m a psychologist; you wouldn’t expect me to take someone’s appendix out, so why would you expect a medic to deliver psychological support? It’s wholly unfair; they don’t have the expertise, training or support. This is why it’s up to healthcare systems to take responsibility for supporting healthcare professionals in delivering more holistic care, and that includes appropriate training and feedback mechanisms so they are comfortable and confident to do so. But this requires starting right at the top. For example, we could embed psychosocial training much more deeply into medical school and then students would learn as they come through that physical and mental health need to be treated equally. Because if they’re not, then one will surely suffer as a consequence of the other.
The easy answer is often the right one
Even though it can be really challenging for a healthcare professional to bring up the topic of mental well-being in a diabetes consultation, it’s worth the effort. It’s often the small things that can make people with diabetes feel so much better, and identifying these tiny tweaks and easy fixes that could address their unmet needs starts with just a few simple questions.
Improving prevention practices and increasing access to mental health resources isn’t going to happen overnight. We’ll only be able to drive meaningful change for people with diabetes by working together across the industry, healthcare systems and regulatory bodies. According to Katharine Barnard-Kelly, however, one of the steps that healthcare teams can take right now is to equip themselves with the tools and strategies they need to put mental well-being on the table — at every check-up.
When Dr. Darlene Francois diagnoses patients at Jessie Trice Community Health System in Miami with diabetes, many are devastated and confused. Some cry. Some worry about what they’ll be able to eat, what it means for their lives, for the future of their health. Some don’t know what diabetes is.
That’s when Francois introduces them to Leon Bain.
Bain sits with patients, talks about different types of diabetes, what it’s like to live with it. Bain is not a doctor, but he is an expert. He has managed his own Type 1 diabetes since he was in his early 20s. And for patients who don’t know anyone with this condition, meeting someone with personal experience can be a huge comfort.
“You’ll see a sigh of relief literally come over them,” says Bain, who has worked at the health system as a peer support coach for five years.
Bain and other peer supporters talk with primary care providers as part of Project Echo. Credit: Courtesy of the University of Florida
Type 1 diabetes is not a medical condition that can be treated in a doctor’s office alone. It requires regular doses of insulin alongside constant management of diet and other aspects of daily life — a process that can be both practically and emotionally exhausting. Peer support coaches like Bain are bridging the gap between exam rooms and patients’ everyday lives, helping people with diabetes understand the disease, access treatment resources, and learn strategies that keep them in good health.
“The best, most amazing endocrinologist, they’re going to only see [patients] for a very short time, a few times in an entire year,” says Ashby Walker, director of health equity at the University of Florida Diabetes Institute. “This is every single day, 24 hours a day. A coach goes beyond the clinical encounter in ways that providers never could.”
More than 38 million Americans have some form of diabetes, a family of conditions that affect how the body converts food to energy. A small subset, about two million people, have forms of the disease that require treatment with insulin, a hormone that regulates blood sugar. For the most part, this applies to Type 1 diabetes, an autoimmune disease that is often diagnosed in children, though it also is true with some forms of Type 2. Without insulin and careful ongoing management of diet and lifestyle, the condition can be fatal.
“It’s just incredibly burdensome, mentally, physically, economically,” says Dr. Michael Haller, chief of paediatric endocrinology at the University of Florida and a collaborator on the research project.
There are significant disparities in how the disease affects people of different backgrounds. Globally, historically marginalized communities aredisproportionately impacted by diabetes and face worse health outcomes. For people with diabetes that requires insulin, there are devices that can help manage the condition, like wearable pumps that supply insulin and monitors that track blood sugar levels. But those technologies can be expensive, and use of them is lower among populations that are at highest risk of poor outcomes. In the US, for instance,Black children with Type 1 diabetes have higher rates of complications and are more likely to be hospitalized, while they also use technology at lower rates than other groups.
As difficult as it is to manage insulin-requiring diabetes, it is possible. Haller and Walker worked together on a research initiative, Project ECHO, which aimed to train up primary care providers at health clinics in underserved areas to better treat diabetes. They added an extra component: embedding a non-medical professional with personal diabetes experience in more than 35 federally qualified health centers in Florida and California. Bain, in Miami, was one of them.
A peer support coach shows a patient how to track her blood glucose levels using an app. Credit: Jesse S. Jones / University of Florida College of Medicine Communications Department
Physicians can offer patients advice, says Haller, like recommending they track carbohydrates in their diet to calculate insulin doses. Still, there’s a gap between hearing what a doctor says in an office and applying it in daily life.
“We tell patients these things all the time, but it just doesn’t get communicated,” he says. “It’s why I think peer coaching as a model can be so powerful.”
When Bain meets a new patient, he stays in touch — by text, by phone, in one-on-one meetings and community-building events.
“One of the things I’ve seen is acceptance,” Bain says. When he shows patients that he is living well with diabetes, they become more receptive to lifestyle and treatment options.
Bain works closely with Francois, a family nurse practitioner who specializes in diabetes. She spends her days treating patients. When she connects them with Bain, she sees how his personal experience with the disease builds credibility.
“He opens doors that I could not open,” she says.
Peer coaches don’t give medical advice, Bain explains, but they can speak about their own experiences. When a patient asks about what to do when their blood sugar is too low, Bain shares how he deals with it, like the rule of 15 — eat 15 grams of carbohydrates and check blood sugar 15 minutes later. He also serves as a conduit for all kinds of other resources, connecting patients with teams that help navigate medical issues and broader social factors, like access to healthy foods.
Diabetes support coaches and doctors meet via videoconference. Credit: Louis Brems / University of Florida College of Medicine Communications Department
One of the biggest impacts of the peer support program is that many more patients are now using technology, like wearable insulin pumps and continuous glucose monitors.
Those technologies make life much easier — “it’s like having an electronic pancreas,” says Bain — but they can be expensive, hard to get and intimidating. Many patients have never heard of insulin pumps, Bain says. Using the equipment can be challenging for people who are not tech-literate, and there’s a steep learning curve to understand how to properly use the equipment to adjust blood sugar levels. And the idea of injecting insulin is off-putting. Bain remembers when he was first told that he would have to start giving himself injections. “I was petrified,” he says.
Some patients shut down, say they won’t do it. “That’s when I’ll step in and say, ‘It’s not really as bad as you think,” Bain says. “‘Let’s talk about my journey.’”
Before the peer coach program, very few Jessie Trice Community Health System patients used insulin pumps, according to Chief Medical Officer Dr. Joycelyn Lawrence. Bain and Francois’s efforts have helped more people to both accept the technology and access it. They find ways to make sure patients can get equipment, by navigating health insurance options and offering patients technology that has been donated.
“We’ve seen an improvement, a consistent improvement, in the numbers of patients that have controlled diabetes, and we know that that’s because of this program,” Lawrence says.
A cross health systems that participated in Project ECHO, there was a similar increase in the use of continuous glucose monitors and insulin pumps, according to Walker and Haller. There were also clear emotional benefits: Researchers found that during the Covid-19 pandemic, patients who worked with a coach had lower levels of diabetes-related distress than other patients.
There are challenges: Peer support isn’t common in the US health system, so setting up peer support programs alongside medical providers can be logistically challenging. Burnout is also a risk, notes Walker, as peer supporters are dealing with the stresses of the disease themselves.
There are many different models of peer support, according to Ed Fisher, a professor at UNC Chapel Hill who heads thePeers for Progress program. Some are more formal and connected directly to health centres, like through Project ECHO. Others can be more community-based, or even come through apps and tech platforms.
While various peer support programs focused on diabetes have been linked to lower blood sugar levels, improved mental health and more, the approach is also useful for many other chronic conditions — from heart disease to mental health.
“Peer support is intrinsically destigmatizing, because in peer support, I help you today, you help me tomorrow,” says Fisher.
Bain has seen how powerful the connections forged around a chronic condition can be.
Over the summer, he hosted 13 people at a diabetes education event at a clinic in Miami Gardens. At one point, one attendee started to talk about how they manage diabetes. Then another one chimed in. Soon, all of them were sharing stories, relating to each other, laughing together. At events like this, Bain strives to connect people with various resources that can help them navigate life with diabetes. And the companionship and community that forms among participants, he says, is a valuable resource in itself.
“Imagine being on an island and you’re by yourself,” Bain says, “and then all of a sudden, 13 people show up that are now in the same position.”
