Diabetes is a chronic condition that affects how your body uses insulin. This hormone controls how much blood sugar, also known as glucose, is released into your cells to be used as energy.
Over 34 million people in the US have diabetes, according to the Centres for Disease Control and Prevention (CDC). While there is no cure for diabetes, it can be managed with lifestyle and dietary changes, or medication like insulin.
Here's what you need to know to manage diabetes and lower blood sugar levels.
Types of diabetes
With all types of diabetes, your body either doesn't produce enough insulin, or isn't able to use insulin effectively.
Insulin is necessary to move blood sugar into your cells, where it is stored and used for energy. Without insulin, a condition called hyperglycaemia can occur, where blood sugar builds up in your bloodstream instead of traveling into your cells.
Type 1 diabetes
Type 1 diabetes makes up just 10% of all diagnosed diabetes cases in the US, according to the CDC. It is most commonly diagnosed in children, teenagers, and young adults.
Although the cause is unknown, type 1 diabetes may be due to an autoimmune response caused by an infection or other trigger. Your body mistakenly attacks and damages the beta cells in your pancreas that make insulin, so little or no insulin is produced.
There are not many risk factors for type 1 diabetes, though genetics is believed to play a role. The odds of the children of men with type 1 diabetes developing the condition is 1 in 17, according to the American Diabetes Association (ADA). For the children of women with type 1 diabetes, the odds are 1 in 25 if the woman is under the age of 25, or 1 in 100 after the age of 25.
A type 1 diabetes diagnosis requires some important lifestyle changes. You must take insulin every day in order to survive. Your blood sugar level needs to be frequently monitored. It's essential to carefully plan your meals and count carbohydrates.
"This can be a frustrating and tiresome adjustment, but it is crucial that patients educate themselves on how certain foods impact glucose levels," says endocrinologist Rocio Salas-Whalen, MD, of New York Endocrinology.
Type 2 diabetes
Type 2 diabetes makes up about 90% of all diagnosed diabetes cases in the US. It is most often diagnosed in adults, but the CDC notes that it is becoming increasingly diagnosed in children and teenagers.
With type 2, your body can produce insulin, but it is not able to use it effectively. This is called insulin resistance, which happens when your liver, muscle, and fat cells don't effectively take in the blood sugar from your blood to use it for energy. As a result, your blood sugar level increases, which can eventually lead to type 2 diabetes.
You are more at risk for type 2 diabetes if you:
- Are 45 years old or older
- Are overweight or obese
- Don't exercise regularly
- Have a family member with type 2 diabetes
In addition to eating a healthy diet, it's very important for people with type 2 diabetes to maintain a healthy weight, Salas-Whalen says, because this can also help them control blood sugar levels.
Gestational diabetes
Pregnant people may develop gestational diabetes, which is caused by the body's inability to produce the extra insulin needed during your pregnancy. Gestational diabetes can put your baby at risk for health problems later in life, such as obesity or type 2 diabetes.
About 7% of pregnant people in the US are diagnosed with gestational diabetes. It usually begins in the middle of your pregnancy, without any symptoms. You should be tested for it between your 24th and 28th weeks of pregnancy. It typically goes away after your baby is born, but you will have a higher risk of developing type 2 diabetes later in life.
If you have gestational diabetes, you'll need to work with your doctor to develop a healthy eating plan, and you should also remain physically active to help keep your blood sugar levels low. If a healthy diet and exercise don't lower your blood sugar levels, you may need to take insulin.
Prediabetes
Prediabetes is a condition where your blood sugar levels are elevated, but not yet high enough for a diabetes diagnosis. However, if left untreated, prediabetes can develop into type 2 diabetes.
More than a third of all US adults — over 88 million — have prediabetes, yet 84% of them don't know they have it, the CDC notes.
With lifestyle changes like a healthy diet, losing weight, and getting regular exercise, it's possible for prediabetes to be reversed or delayed. Your doctor may also prescribe medication to help lower your blood sugar level.
"A prediabetic still has the potential to avoid diabetes, which should be avoided in every possible way," Salas-Whalen says.
What are the signs of diabetes?
The signs of all types of diabetes can include the following:
- Urinating frequently, especially at night
- Feeling very thirsty or hungry
- Losing weight without trying to
- Blurred vision
- Numbness or tingling in your hands or feet
- Fatigue
- Dry skin
- Sores that take a long time to heal
However, these symptoms develop slowly over time, and it may be difficult to recognize them, especially if you have type 2 diabetes.
The signs of type 1 diabetes may be more severe, and can also include nausea or vomiting.
Normal blood sugar levels
Target blood sugar levels are different for those with diabetes. The follow chart depicts normal blood sugar levels for diabetics and non-diabetics:
Many people with diabetes with need to learn how to check their blood sugar multiple times a day using a glucose meter or a continuous glucose meter.
"Try not to think of blood sugars as 'good' or 'bad' or as a reflection of how well or bad you are doing," says Shelley Nicholls, DNP, APRN, CDCES, director of patient education at the Diabetes Research Institute. "Having a good understanding of what affects blood sugars and which of them a person can control or influence is the best tool a person with diabetes can have."
How to lower blood sugar
To treat diabetes, it is important to lower your blood sugar level and make sure it stays in a healthy range.
Doing this will not only increase your energy, but according to the ADA, each percentage point of A1C lowered reduces the possibility of long-term health complications — which could include serious heart, kidney, brain, eye, or foot problems — by 40%.
These are some of the best natural ways to lower and manage your blood sugar levels over time:
- Eat a healthy diet. This is critical for managing diabetes. "The best option is to meet with a dietitian to determine individual needs and goals," Nicholls says. Some of the best foods to lower blood sugar include whole grains, fruits and vegetables, oatmeal, and nuts.
- Exercise regularly. Physical activity helps prevent or delay type 2 diabetes, improves type 2 diabetes blood sugar control, and improves insulin sensitivity for people with type 1 diabetes, according to the ADA. You should aim for about 150 minutes of moderate exercise per week if you have diabetes.
- Lose weight. Maintaining a healthy weight can help prevent diabetes-related complications like heart disease and stroke, or help get rid of diabetes entirely. For example, nearly half of 140 adults with type 2 diabetes who participated in the United Kingdom-based Diabetes Remission Clinical Trial (DiRECT) went into remission after following a weight-loss program for one year.
- Drink lots of water. People who drank at least one litre of water a day were 28% less likely to have high blood sugar, according to a 2011 study published in the journal Diabetes Care.
- Manage stress. The stress hormone cortisol impedes your body's ability to use insulin effectively and increases your blood sugar level.
Diet for diabetes
It's important for people with diabetes to be careful about the foods they eat because they can impact your blood sugar levels. "Some foods can worsen diabetes, while other foods can actually improve diabetes control," Salas-Whalen says.
Carbohydrates and fibre especially affect your blood sugar levels in the following ways:
Carbohydrates. These are quickly broken down into sugars in your body and affect your blood sugar level more than proteins and fats, Nicholls says. Because people with diabetes can't efficiently process blood sugar, carbs can cause levels to spike, so it's important to discuss how many carbs you should eat per day with your doctor.
- Fibre. Foods with a high fibre content are difficult to digest, so the sugar is absorbed more slowly into your blood. Eating foods high in fibre, such as fruits, vegetables, beans, and whole grains can help regulate your blood sugar.
It can be helpful to follow a diet to manage your diabetes, as planning out your meals and snacks will help you control blood sugar levels effectively.
"Every person has different needs, so there is no one diet that is recommended for people with diabetes," Nicholls says. "The best option is to meet with a dietitian to determine individual needs and goals."
Here are some of the best diets for diabetics:
Mediterranean diet
The Mediterranean diet includes plant-based foods, lean meats, and healthy fats.
According to a 2009 study published in Diabetic Medicine, people who strictly followed a Mediterranean diet for three months had lower A1C percentages and lower blood sugar levels after meals than those who followed it less strictly.
DASH diet
The DASH diet, which stands for Dietary Approaches to Stop Hypertension, is mainly used to lower blood pressure, but it can also help lower blood sugar.
A 2017 study published in the ADA journal Diabetics Spectrum suggests that the DASH diet can lower insulin resistance and help you lose weight. A 2016 study published in the journal Nutrition found that a DASH diet can also help lower the risk for gestational diabetes by as much as 71%.
Keto diet
This high-fat, low-carb diet limits carbs to 20 to 50 grams daily in an effort to put your body in the metabolic state of ketosis, where you burn fat instead of carbs for fuel.
A 2017 study published in Nutrition & Diabetes found that overweight adults with type 2 diabetes or prediabetes who followed a keto diet had lower A1C levels and lost over 4% more weight after one year than those who followed a moderate-carbohydrate/low-calorie/low-fat diet.
There are also some health risks associated with the keto diet. If you have type 1 diabetes, your lowered blood sugar level may lead to hypoglycaemia and serious brain, kidney, or liver complications.
Another issue associated with this diet are "keto flu" symptoms that may include headache, nausea, and vomiting. It's important to consult with your doctor or a registered dietitian before starting a keto diet.
Diabetes medications
People with type 1 diabetes need to take insulin every day in order to survive. If people with type 2 diabetes are unable to reach their blood sugar target levels with diet and exercise, they may also need medication like insulin or metformin.
Insulin
People with type 1 diabetes generally need to take three to four doses of insulin every day, according to the ADA. Women with gestational diabetes may need to take insulin daily during their pregnancy if their bodies aren't producing enough of it naturally. Many people with type 2 diabetes may need one dose each day with or without other medications.
Insulin is injected in the fat under your skin using a syringe, insulin pen, or pump. It should be injected in the same area of the body, but not the same place each day. It's best to inject insulin at mealtime so it is more effectively processed in your body.
"The challenge with taking insulin is that it's tough to know precisely how much to take," Nicholls says. The amount is based on factors that may change throughout the day, such as food, exercise, and stress. "So, deciding on what dose of insulin to take is a complicated balancing act."
Taking an extra dose of insulin can also help you lower blood sugar fast if it's an emergency, though you may want to check in with your doctor beforehand.
Metformin
If you have type 2 diabetes, your doctor may prescribe metformin, a medication that lowers blood sugar by slowing your liver's production of glucose. It is the drug most commonly prescribed to treat type 2 diabetes.
Metformin is available in a liquid, pill, or extended-release tablet. You take it orally at mealtime two to three times a day. The extended-release tablet only needs to be taken once daily.
According to a 2012 scientific review published in Diabetes Care, metformin can effectively reduce A1C levels for people with type 2 diabetes by an average of 1.12%.
Takeaways
Although it's possible to control your diabetes and lower blood sugar levels, there is no specific cure.
"Because of this reality, lifestyle changes must be permanent and not temporary in order to avoid the potential long-term complications of diabetes," Salas-Whalen says.
To develop the best plan of treatment for diabetes, it's important to meet with your doctor for individualized recommendations.
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