Diabetes: Using a food guide

  Introduction
A food guide is a tool for planning a balanced diet. A healthy diet provides the nutrients your body needs and decreases your risk for heart disease and other conditions. Many people use the MyPyramid guide to plan a healthy diet.
Key points

  1. People with diabetes can use a modified version of MyPyramid to help them spread the amount of carbohydrate they eat throughout the day.
  2. A food guide contains the same foods your family eats. You do not have to eat special foods.
  3. You can successfully follow this method by:
    1. Planning your family meals ahead of time so you can enjoy the same foods as other family members.
    2. Providing lots of variety in the foods you eat so it's easier to follow your plan.
    3. Testing your blood sugar after meals to see what effect different foods have on your blood sugar level.
  4. Women with diabetes who are pregnant or breast-feeding need the same nutrition as pregnant or breast-feeding women who do not have diabetes. Pregnant women need more of all nutrients, but they especially need iron and folic acid and should get supplements of these. During the second and third trimester, you also need about 300 calories per day more than you did before pregnancy. Regular meals and snacks are important to prevent low blood sugar during pregnancy and breast-feeding. Talk to your registered dietitian or certified diabetes educator about changes you may need to make to your food plan.

 What is a food guide for people with diabetes?
 Why use a food guide for diabetes?
 How to use a food guide in your diet for diabetes
 Where to go from here

What is a food guide for people with diabetes?
A food guide is a way to plan a healthy diet.

  1. Foods within each group have similar nutrient content. For example, the foods in the milk and milk products group have similar amounts of calcium, protein, vitamin D, and riboflavin.
  2. Each group has a recommended number of servings.

Test Your Knowledge

  1. A food guide for people with diabetes is used to:
    1. Record my daily food intake.
    1. Choose special foods.
    1. Plan my diet.
    1. Develop an exchange list.
  1. One of the advantages of using a food guide for people with diabetes is that you can eat the same food as everyone else in your family.
    1. True
    1. False

Continue to Why use a food guide for diabetes?
Return to Diabetes: Using a food guide
Why use a food guide for diabetes?
Carbohydrate is the nutrient that most affects your blood sugar level. The more carbohydrate you eat at one time, the higher your blood sugar level will rise. Spreading carbohydrate intake throughout the day helps keep your blood sugar levels within your target range. A food guide for diabetes can help you plan your diet accordingly.
Eating the recommended number of servings from each food group every day gives you the proper amount of nutrients to meet your needs and reduces your risk for heart disease and other conditions. Eating regular meals can help you spread carbohydrate intake throughout the day.
Test Your Knowledge

  1. A food guide for people with diabetes:
    1. Lists special foods I should eat.
    1. Outlines the way to count the nutrients in my diet.
    1. Guides the planning of daily meals and snacks.

Continue to How to use a food guide in your diet for diabetes
Return to Diabetes: Using a food guide
How to use a food guide in your diet for diabetes
Here are some ways to start using a food guide for diabetes.
Eat regular meals
Eat 4 to 6 smaller meals and snacks throughout the day to spread your intake of food throughout the day. Plan several meals at a time. Plan to double some recipes and freeze the leftovers to use for other meals. Reuse menu plans.
Use the food guide
The food guide for diabetes can help you to:

  1. Become familiar with the different food groups. Post a copy of the groups in a food guide for diabetes in a convenient place, such as on your refrigerator door.
  2. Plan meals to include food from all the groups. A registered dietitian can help you plan the food groups to include in each meal and snack.
    1. Breakfast usually includes food from the milk, fruit, and grains food groups. Meat and vegetables also may be eaten at breakfast.
    2. Lunch and dinner usually include foods from most or all food groups.
    3. Snacks may include only one or two food groups (usually a fruit or bread).
    4. Milk and milk products are a separate group. If you don't like or can't drink milk, you will need to find a way to add to your diet more calcium, vitamin D, and other nutrients that milk provides. Talk with a registered dietitian about how to get enough calcium and other nutrients. If you are pregnant, you need extra calcium and may need to take supplements.
  3. Eat standard portions. Sometimes what you may consider a serving is much larger than the recommended serving size. For example, if you eat a plateful of spaghetti (about 2 cups), you have eaten 6 servings from the grain group in a food guide. It's easy to eat more servings from a food group than are recommended for a balanced diet. You don't always need to measure and weigh the food you eat, but it may be helpful when you are first learning what makes a standard portion. It can also be helpful to know what a serving size looks like.
    1. 1 ounce (1 oz)
    2. 3 ounces (3 oz)
    3. ½ cup
    4. 1 cup
    5. 1 teaspoon (1 tsp)
    6. 1 tablespoon (1 Tbsp)

Other suggestions
Other suggestions for helping you be successful in using a food guide include:

  1. Checking your blood sugar level before and 1 hour after a meal to see how food affects your blood sugar.
  2. Recording what you eat on a food record form. Review your record with your registered dietitian or certified diabetes educator at each visit and whenever you think your plan needs adjusting. See an example of a food

Groups in a food guide for diabetes
By Caroline Rea, RN, BS, MS
When you have diabetes, it is important to limit and spread the amount of carbohydrate you eat evenly throughout the day. A food guide for diabetes is slightly different from the MyPyramid guide for people who do not have diabetes. A few vegetables, such as potatoes and corn, are listed with the bread, cereal, rice, and pasta group because they contain more carbohydrate than other vegetables. Cheese is not in the milk group, because the process of turning milk into cheese removes the carbohydrate.
The six food groups are listed below with examples. The amount of food that counts as 1 serving is also listed. If you eat a larger portion, count it as more than 1 serving.
Talk to your registered dietitian or your certified diabetes educator about how many servings from each group that you need in a day. Everybody is different, some people may need more servings from one group than another.



Breads, cereal, rice, pasta, and starchy vegetables

Servings

Examples*

Talk to your registered dietitian or your certified diabetes educator about how many servings from this group that you need in a day.

  1. 1 slice of bread (1 oz)
  2. 1 oz of ready-to-eat cereal (Check the box label for the amount equal to 1 oz.)
  3. 1/2 cup of cooked cereal
  4. 1/3 cup of pasta, rice, or other cooked grain
  5. 1/4 cup of cooked dry beans, lentils, or split peas
  6. 1/2 cup of corn or peas
  7. 1 small potato (3 oz)
  8. 1/2 cup of sweet potato or yam
  9. 1 cup of winter squash

*Each serving contains about 15 grams (g) of carbohydrate.

Vegetables

Servings

Examples*

Talk to your registered dietitian or your certified diabetes educator about how many servings from this group that you need in a day.

  1. 1 cup of raw leafy vegetables
  2. 1/2 cup of other vegetables, cooked or chopped raw
  3. 1/2 cup of vegetable juice

*Each serving contains about 5 grams (g) of carbohydrate.

Fruits

Servings

Examples*

Talk to your registered dietitian or your certified diabetes educator about how many servings from this group that you need in a day.

  1. 1 small piece of fresh fruit, such as an apple or orange
  2. 1/2 a banana
  3. 1/2 cup of chopped, cooked, or canned fruit
  4. 1/2 cup of fruit juice
  5. 2 Tbsp of dried fruit

*Each serving contains about 15 grams (g) of carbohydrate.

Milk and yogurt

Servings

Examples*

Choose low-fat and fat-free foods more often.
Talk to your registered dietitian or your certified diabetes educator about how many servings from this group that you need in a day.

  1. 1 cup of milk
  2. 6 oz of yogurt without added sugar

*Each serving contains about 15 grams (g) of carbohydrate.

Meat and meat alternatives

Servings

Examples

Talk to your registered dietitian or your certified diabetes educator about how many servings from this group that you need in a day.

Count the following as equal to 1 oz of meat:

  1. 1 egg
  2. 2 Tbsp of peanut butter
  3. 1 oz of cheese
  4. 1/4 cup of cottage cheese
  5. 1/2 cup of tofu
  6. 1/4 cup of cooked dry beans, lentils, or split peas
  7. 3 thin slices of ham
  8. 1/6 chicken breast

Fats, sweets, and alcohol

Servings

Examples

Eat less fat, especially saturated fat (animal fat or fat that is solid at room temperature). Saturated fat usually is found in meat, cheese, and butter.
Talk to your registered dietitian or your certified diabetes educator about how many servings from this group that you need in a day.

Saturated

  1. 1 tsp butter or hard stick margarine
  2. 1 Tbsp cream cheese

Unsaturated

  1. 1 tsp olive oil or soft margarine
  2. 1 Tbsp oil-based salad dressing
  3. 1/8 of an avocado
  4. 2 Tbsp nuts or nut butter

Talk to your registered dietitian or your certified diabetes educator about ways to have limited amounts of sweets in your meal plan.

  1. 1/2 cup of ice cream
  2. 1 small cupcake or muffin
  3. 2 small cookies

If you drink alcohol, limit it to no more than 1 drink a day for women and 2 drinks a day for men. Note for women who are pregnant: No amount of alcohol is known to be safe for the fetus.

  1. 12 oz of beer
  2. 5 oz of wine
  3. 1.5 oz of hard liquor

 

Type 2 Diabetes: Living With the Disease
By Caroline Rea, RN, BS, MS
Is this topic for you?
This topic is for adults who have had type 2 diabetes for more than a few months. Before reading this topic, you may want to read Type 2 Diabetes: Recently Diagnosed.
If this topic does not answer your questions, see:
Type 2 Diabetes, if you want to learn about type 2 diabetes but do not have the disease.
Type 2 Diabetes: Recently Diagnosed, if you have been told recently that you have type 2 diabetes.
Type 2 Diabetes in Children, if your child has been diagnosed with this disease.
Type 2 Diabetes: Living With Complications, if you have eye, kidney, heart, nerve, or blood vessel disease caused by your diabetes.
If you are looking for information about type 1 diabetes, see the topic Type 1 Diabetes.
What is diabetes?
Type 2 diabetes is a lifelong disease that develops when the pancreas cannot produce enough insulin or when the body's tissues become resistant to insulin. Insulin is a hormone that helps the body’s cells use sugar (glucose) for energy. It also helps the body store extra sugar in muscle, fat, and liver cells.
How can you manage diabetes?
You play a major role in managing your diabetes. The most important thing is to control your blood sugar. To do this:
Eat a balanced diet. If you are overweight, reduce your calorie intake to lose some weight. Losing as little as 10 to 20 pounds can improve your blood sugar levels. There are many ways to manage how much and when you eat. Your doctor, a diabetes educator, or a dietitian can help you find a plan that works for you.
Exercise regularly. Try to do moderate activity at least 2½ hours a week. One way to do this is to be active 30 minutes a day, at least 5 days a week. Exercise helps control your blood sugar by using glucose for energy during and after activity. It also helps you stay at a healthy weight; lower high cholesterol; raise HDL, or "good," cholesterol; and lower high blood pressure.
Take your medicine or insulin as directed, if prescribed by your doctor.
Check your blood sugar levels regularly, as advised by your doctor.
The goal is to keep your blood sugar in a target range. You and your doctor may decide to keep your blood sugar as close to normal as possible. This is called tight control. It’s the best way to reduce your chance of having more problems from diabetes. These are called complications.
Taking care of your diabetes takes time and energy every day. But it will help you feel better and may prevent, or at least delay, complications.
How can you deal with high and low blood sugar?
Even when you are careful and do all the right things, you can have problems with high or low blood sugar. It is important to know what signs to look for and what to do if this happens.
High blood sugar(hyperglycemia) usually happens over a few days or weeks. Early symptoms include:
Feeling very thirsty.
Urinating more often than usual.
Feeling very hungry.
Having blurred vision.
People with diabetes can get high blood sugar for many reasons, including not taking their diabetes medicines, eating more than usual (especially sweets), not exercising, or being sick or under a lot of stress. If you have high blood sugar, follow your treatment plan for lowering it. This may mean taking missed doses of insulin or medicine. Call your doctor if you don't know what to do. Treating high blood sugar is important. If it is left untreated, it can lead to hyperosmolar state, a dangerous condition.
You can get low blood sugar (hypoglycemia) if you take insulin or a sulfonylurea pills for diabetes. It can happen suddenly. Early symptoms include:
Sweating.
Feeling weak.
Feeling shaky.
Feeling very hungry.
Symptoms of low blood sugar may vary over time. You may also have these symptoms if you have a sudden large drop in blood sugar, even though the level does not drop below the normal or near-normal range. Eat 1 tablespoon of sugar, ½ cup of orange juice, or another carbohydrate. Wait 15 minutes, and then check your blood sugar.
What are the complications of diabetes and their symptoms?
Over time, high blood sugar can cause complications such as problems with your eyes, heart, blood vessels, nerves, and kidneys. High blood sugar also makes you more likely to get serious illnesses or infections. Complications can lead to blindness, kidney failure, removal of a limb (amputation), heart attack, stroke, and death. This is why it is so important to keep your blood sugar in your target range.
If you had the disease several years before you were diagnosed, you may already have a complication from diabetes. Even if you don't have problems now, the longer you have diabetes, the more likely you are to get one or more complications.
Be sure to tell your doctor if you notice any new symptoms, such as chest pain, numbness, or a shooting pain in your hands or feet.
How can you prevent complications?
You may be able to prevent, or at least delay, problems from diabetes by keeping your blood sugar level as close to normal as you can. Treatment of high blood pressure or high cholesterol can also help. If you smoke, quit. Smoking increases your risk for complications.
If you are age 40 or older, talk to your doctor about whether to take a low-dose aspirin each day to help prevent heart attack, stroke, or other large blood vessel disease. People with diabetes are 2 to 4 times more likely than people who don't have diabetes to die from heart and blood vessel diseases. 1
See your doctor every 3 to 6 months. During these visits, your doctor will review your treatment and do tests and exams to see if your blood sugar is staying within your target range and if you have any complications. It’s also important to have regular checkups with your eye doctor and dentist. Diabetes can cause vision and dental problems.
Will your treatment change over time?
The goal of treatment is to always keep your blood sugar as close to your target range as you can. At first, you may be able to treat diabetes with diet and exercise alone. At some point, you may need to use insulin or take pills to control your diabetes.
You always need to:
Eat a balanced diet with enough calories to help you stay at a healthy weight. If you are overweight, reduce your calorie intake to lose some weight.
Get regular exercise.
Check your blood sugar regularly during the day, as advised by your doctor.
Health Tools
Health Tools help you make wise health decisions or take action to improve your health.

 

Causes of High and Low Blood Sugar
Even with careful treatment for type 2 diabetes, you may experience periods of high and low blood sugar.
High blood sugar may develop if you:
Skip a dose of your oral medicine for diabetes or skip a required dose of insulin.
Eat too much.
Are feeling a lot of emotional stress or are ill (such as with a severe case of the flu) or have an infection, especially if you are not eating or drinking enough.
Are taking medicines that can raise blood sugar levels as a side effect, such as sleeping pills, some anti-inflammatory medicines (corticosteroids), and some decongestants.
If you take insulin, you may have some mornings when your blood sugar level is very high. This could happen because of the Somogyi effect. Talk with your health professional if this occurs.
Low blood sugar is not likely to develop unless you take insulin or some oral medicines for type 2 diabetes. Low blood sugar may develop if you:
Take too many doses of your oral medicine in a day, take the doses too close together, or take your full dose of medicine when you are not going to eat your usual amount of food.
Exercise too much without eating enough food.
Skip a meal.
Drink too much alcohol, especially on an empty stomach.
Take other medicines that can lower blood sugar levels, such as large doses of aspirin and medicines for psychiatric disorders.
Have reduced kidney function.
Develop other endocrine problems, such as Addison's disease or hypothyroidism.
Symptoms
High blood sugar
Because you have type 2 diabetes, you should learn to recognize and treat symptoms of high blood sugar, which include increased thirst, frequent urination, and blurred vision. High blood sugar usually develops slowly over hours or days, so you can treat your symptoms before they become severe and require medical attention.
Low blood sugar
If you take insulin or oral diabetes medicines, such as glipizide (Glucotrol), glimepiride (Amaryl), or glyburide (DiaBeta, Glynase, or Micronase) you may experience low blood sugar (hypoglycemia). Glyburide stays in the body longer, so it is more likely than other medicines to cause low blood sugar.
Learn to recognize symptoms of low blood sugar, which include sweating, weakness, and hunger. Treating low blood sugar promptly will help avoid loss of consciousness, which can occur with severe low blood sugar.
Symptoms of complications
Symptoms of diabetic complications include:
Chest pain; shortness of breath with exercise or other exertion; heart attack; stroke; or tight or squeezing pain in the calf, foot, thigh, or buttock that occurs during exercise and causes changes in skin color, decreased sensation, and leg cramps. These are symptoms of large blood vessel complications, or macrovascular disease.
Burning pain, numbness, or swelling in your feet or hands, which may indicate nerve damage (diabetic neuropathy). When only one nerve is involved (focal neuropathy), you may have symptoms in one part of your body. An example is double vision, which can happen when diabetes affects the nerves that control your eye muscles.
A wound that won't heal or that looks infected, which may indicate damage to the blood vessels that supply that area.
Blurred or distorted vision; seeing floaters or flashes of light, large floating red or black spots, or large areas that look like floating hair, cotton fibers, or spiderwebs; or pain in your eyes. These may indicate diabetic retinopathy.
Frequent bloating, belching, constipation, nausea and vomiting, diarrhea, and abdominal pain, which may indicate gastroparesis related to diabetic autonomic neuropathy.
Profuse sweating or reduced sweating, feeling dizzy or weak when you sit or stand up suddenly, difficulty sensing when your bladder is full or difficulty emptying your bladder completely, erection problems or vaginal dryness, or hypoglycemia unawareness. These also may indicate diabetic neuropathy.
You will not have any symptoms of kidney damage (diabetic nephropathy) until the condition is severe. Then you may notice swelling in your feet, legs, and throughout your body. Having regular tests for protein in the urine is the only way to detect diabetic nephropathy before symptoms develop.
What Happens
Although your experience with type 2 diabetes may be different from that of others with the disease, everyone with diabetes has to pay attention to eating a healthy, balanced diet and exercising regularly. Eating too much carbohydrate can cause your blood sugar levels to rise quickly. A plate format is a simple way to plan a balanced diet. For information, see:
Diabetes: Using a plate format for eating.
It is important to have a healthy eating lifestyle—including eating whole grains, lean meats, fish, and vegetables—and to reduce calorie intake if you need to lose weight. You may be able to keep your blood sugar levels within your target range with only these measures for a while, but you will likely need to take oral diabetes medicines as time goes on.
As diabetes progresses, your pancreas may produce less and less insulin. If your blood sugar level is persistently high, it also may cause your pancreas to produce less insulin. This is called glucose toxicity. When your pancreas produces too little or no insulin, you will have to give yourself shots of insulin.
Because it is difficult to achieve the perfect balance of insulin and blood sugar level that your body would have if you didn't have diabetes, you will experience high blood sugar levels from time to time. If you take insulin or certain oral diabetes medicines, you also may experience low blood sugar. Early treatment of high or low blood sugar can prevent a medical emergency.
What could happen if your blood sugar level is very high?
Symptoms of high blood sugar (hyperglycemia) usually develop gradually over a period of hours or days. Early symptoms are increased thirst, frequent urination, increased hunger, and blurred vision. But you may not have any early symptoms. If your blood sugar level continues to rise and you do not drink enough liquids, you can become dehydrated.
If you do not take your diabetes medicine (pills or insulin), or if you have a severe infection or other illness or become severely dehydrated, your blood sugar may rise to a dangerous level called a hyperosmolar state. Left untreated, the condition can lead to coma and death. Hyperosmolar state usually is treated in a hospital and often in the intensive care unit. There you are closely observed and receive frequent blood tests for glucose and electrolytes. You will receive insulin and other fluids through a vein (intravenous, or IV) to bring your blood sugar down and correct the dehydration.
Complications
Long-term diabetic complications are caused by persistently high blood sugar levels continuing over months or years. You may already have one or more complications, because you may have had the disease for several years before being diagnosed. There are four types of complications:
Microvascular disease, which affects your eyes or kidneys. Diabetic retinopathy (eye disease) and diabetic nephropathy (kidney disease) develop without early noticeable signs. You are also at risk for other eye diseases, such as cataracts and glaucoma.
Macrovascular disease, which affects your heart and the large blood vessels throughout your body. Diabetes damages the lining of large blood vessels and contributes to developing atherosclerosis. Atherosclerosis and a greater tendency toward blood clot formation can lead to peripheral arterial disease, heart attack, or stroke.
Diabetic neuropathy, which affects the nerves in your body. Diabetic neuropathy can decrease or completely block the movement of nerve impulses or messages to organs, legs, arms, and other parts of your body. Nerve damage can affect both the functioning of internal organs, such as the stomach (gastroparesis), and your ability to feel pain when injured. When blood vessels and nerves are affected, broken bones (fractures) and joint deformities can develop within weeks without noticeable pain, especially in your feet (Charcot foot).
Weakened immune system, which puts you at risk for difficult-to-treat and persistent infections and delayed healing of wounds, especially in your feet. Severe infections in your feet may lead to amputation.
Other health problems
People with diabetes often already have other health problems, such as high blood pressure and high cholesterol, or they develop them as diabetes progresses. These conditions can contribute to the development and worsening of complications from diabetes.
Can the progression of diabetes be prevented?
From the time you are diagnosed with diabetes, work closely with your health professional to keep your blood sugar levels within a normal or near-normal range. If you do so, you may slow the progression of any complication you already have and prevent or delay the development of others. You also may feel better and be more in control of your life.
Eat a balanced diet. If you are overweight, reduce your calorie intake to lose some weight. Losing as little as 10 to 20 pounds can improve your blood sugar levels. Try to do at least 2½ hours a week of moderate activity. One way to do this is to be active 30 minutes a day, at least 5 days a week. 2, 3
What Increases Your Risk
You are more likely to develop complications from type 2 diabetes if you:
Have persistently high blood sugar over time. The higher your blood sugar and the longer it remains too high, the greater your risk for developing complications.
Have the disease for a long time. The longer you have diabetes, the more likely you are to develop complications, even if blood sugar levels are controlled.
Diabetic nephropathy (kidney disease) develops in 20% to 30% of people with type 2 diabetes. 4
Diabetic retinopathy (eye disease) develops in more than 60% of people with type 2 diabetes by 20 years after diagnosis. 5
Most people with diabetes develop some diabetic neuropathy (nerve damage) over the years, but only about 13% to 15% have noticeable symptoms. 6
Already have one complication. Having one complication from diabetes increases your risk for developing other complications.
Have other risk factors. Smoking, psychiatric disorders (such as depression), high blood pressure, high cholesterol, and a family history of diabetic complications may increase your risk for developing a complication. Not having health insurance coverage for supplies and other medical expenses related to diabetes care can contribute to poorer control of the disease and the development of complications.
When to Call a Doctor
Call 911 or other emergency services immediately if you or your child is:
Unconscious or becomes very sleepy unexpectedly. You or your child may have low blood sugar, called hypoglycemia. While you wait for emergency help, follow:
Emergency care for low blood sugar in people taking oral diabetes medicine.
Emergency care for low blood sugar.
Emergency care for low blood sugar in a child.
Drowsy, confused, breathing fast, and your or your child’s breath smells fruity. You or your child may have high blood sugar, called hyperglycemia. A life-threatening condition called diabetic ketoacidosis could be present.
Call a doctor immediately if you or your child is vomiting and cannot keep down liquids and:
Your blood sugar is 300 mg/dL or higher.
Your child’s blood sugar is 250 mg/dL or higher.
Call a doctor if you or your child:
Is sick for more than 2 days (unless it is a mild illness, such as a cold), and you or your child:
Has been vomiting or had diarrhea for more than 6 hours.
Has followed the doctor's advice but it has not worked. Learn what to do when you are sick and have diabetes.
Has blood sugar levels that are often above 300 mg/dL, and urine tests for ketones show more than 2+ or moderate or higher ketones.
Has a blood sugar level that stays below the target range after you or your child eats some quick-sugar food.
Has a blood sugar level that stays high after you or your child takes a missed dose of insulin or oral diabetes medicines or after you or your child takes an extra dose of insulin (if prescribed by the doctor).
Has frequent problems with high or low blood sugar levels. The insulin dose or schedule may need to be changed.
Is having difficulty knowing when blood sugar is low (hypoglycemia unawareness).
Has problems following the meal plan or getting physical activity, and you want help.
Watchful Waiting
Watchful waiting is a period of time during which you and your health professional observe your symptoms or condition without changing your treatment plan. Watchful waiting is not appropriate if you:
Are having high or low blood sugar levels frequently.
Begin to notice symptoms of complications from diabetes. Early treatment of complications can prevent or delay worsening of the condition.
Who to See
Health professionals who may be involved in your treatment for type 2 diabetes include:
A family medicine doctor, general practitioner, or internist.
A certified diabetes educator (CDE).
A registered dietitian.
An endocrinologist.
If you have signs of diabetic complications, you may be referred to a specialist. For more information, see the topic Type 2 Diabetes: Living With Complications.
Exams and Tests
People with type 2 diabetes should see a health professional every 3 to 6 months throughout life for tests and exams to monitor the condition and adjust treatment. You also need yearly screening tests for eye problems (diabetic retinopathy) and kidney problems (diabetic nephropathy).


Tests you need, and how often you need them

Time interval

Exams and tests

Every 3 to 6 months

Visit your health professional for:
A review of your blood sugar levels since your last checkup. Your health professional may evaluate whether your treatment needs to be changed.
A blood pressure check. Keep your blood pressure below 130/80 mm Hg. 7 If you have high blood pressure, ask whether you should monitor your blood pressure at home.
An examination of your feet for signs of injury, infection, or other foot problems.
A hemoglobin A1c or similar test (glycosylated hemoglobin, or glycohemoglobin). If your blood sugar levels are stable and your treatment hasn't changed, this test may be done every 6 months.

Every 6 months

Visit your dentist for an exam to check for gum problems.

Every year

Visit an ophthalmologist or optometrist for a dilated eye exam (ophthalmoscopy) to look for signs of diabetic retinopathy and glaucoma, which is increasing in people with diabetes. Some health professionals may recommend less frequent eye exams if you have no signs of diabetic retinopathy or glaucoma.
Visit your health professional for:
A fasting cholesterol (LDL and HDL) and triglyceride test. If your levels are normal, you may be tested every 2 years.
Keep your LDL cholesterol level less than 100 mg/dL, or aim for keeping it at 70 mg/dL, your triglyceride level less than 150 mg/dL, and if possible, men need to keep their HDL cholesterol level more than 40 mg/dL and women more than 50 mg/dL. 8
A thorough examination of your feet, including testing your ability to feel a thin, flexible piece of plastic.
A urine test for protein, an indicator of kidney damage. Either of the following tests may be done: 4
Microalbuminuria dipstick test, to estimate the amount of protein in a urine sample
Spot urine test for microalbuminuria, to measure the exact amount of protein in a urine sample
If one of these urine tests shows 30 micrograms or more of protein per milligram (mcg/mg) of creatinine in your urine, you have some amount of kidney damage.

Other possible tests
You may also need:
A blood glucose test. This test may be used to check the accuracy of your blood sugar meter to see whether your home blood sugar tests are reliable. It also may be done if your health professional is adjusting your diabetes medicine.
An electrocardiogram (ECG or EKG), if you have had a heart attack or have heart disease or high blood pressure. An EKG may be done after a diabetes diagnosis even if you have not had a heart attack, because people with diabetes have a higher-than-average risk of heart disease. The test also provides a baseline against which to compare future tests in case of chest pain.
An exercise electrocardiogram (treadmill EKG test) before you begin a vigorous exercise program.
An electromyogram (EMG) and nerve conduction study, if your health professional suspects that you may have diabetic neuropathy.
An ankle-brachial index (ABI) measurement, which can be used to test for peripheral arterial disease if you are older than 50.
Eye exams during pregnancy
If you become pregnant, you need to have an ophthalmoscopy during the first 3 months and close follow-up throughout pregnancy and for 1 year after delivery, because pregnancy increases your risk for eye disease. 8 If you already have eye disease and become pregnant, the eye disease can rapidly become worse.
Treatment Overview
Your treatment for type 2 diabetes will change over time to meet your individual needs. But the focus of your treatment will always be to keep your blood sugar levels within a normal or near-normal range to prevent complications from diabetes, such as eye, kidney, heart, blood vessel, and nerve disease. You play an important role in managing your condition. By learning about diabetes and working with your health professional to create a plan for treatment, you can improve your health and quality of life.
How can you manage your diabetes?
Follow your diet
It is important to follow a healthy, balanced diet that includes whole grains, lean meat, fish, and vegetables. To help control your blood sugar and reduce your risk for complications from diabetes, limit alcohol. And reduce calories if you need to lose weight.
Of the three major nutrients (carbohydrate, protein, and fat), carbohydrate has the greatest effect on blood sugar. Because you have diabetes, it's important that you include the proper amount of carbohydrate in your daily diet and that you space carbohydrate evenly throughout the day. You can use one of the following approaches:
Diabetes: Counting carbs if you don't use insulin (preferred)
Diabetes: Counting carbs if you use insulin (preferred)
Diabetes: Using a food guide
Diabetes: Using a plate format for eating
Planning meals to manage diabetes often means looking at food in a new way. Some people may have trouble accepting the changes they need to make in their lifestyle. You may find it helpful to read about how emotions influence what we eat, when we eat, and how much we eat:
Diabetes: Coping with your feelings about your diet
Take an aspirin daily
If you are age 40 or older, talk to your health professional about taking a low-dose aspirin daily to help prevent heart attack, stroke, and other large blood vessel disease (macrovascular disease). People with diabetes are 2 to 4 times more likely than people who don't have diabetes to die from heart and blood vessel diseases. 1
Exercise regularly
Exercise helps control your blood sugar, because you use glucose for energy during and after activity. It also helps you stay at a healthy weight; lower high cholesterol; raise high-density lipoprotein (HDL), or "good," cholesterol; and lower high blood pressure. These benefits help prevent cardiovascular disease.
Do activities that raise your heart rate. Try to do moderate activity at least 2½ hours a week. 2 One way to do this is to be active 30 minutes a day, at least 5 days a week. Also try to include resistance exercises in your program at least twice a week. 2, 3 These activities can include things like weight lifting or yard work. See the topic Fitness for more ideas.
It may help to keep track of your exercise on an activity log Click here to view a form.(What is a PDF document?) . Work with your doctor to develop a safe exercise program.
Maintain blood sugar control
Diabetes: Checking your blood sugar
Diabetes: Preventing high blood sugar emergencies
Lower high blood pressure and high cholesterol
It's important to keep your blood pressure and cholesterol at recommended levels to reduce your risk of heart disease and large blood vessel disease.
Blood pressure should be less than 130/80 millimeters of mercury (mm Hg) in people with diabetes. Moderate exercise, such as brisk walking, for at least 2½ hours a week can help lower blood pressure. But you may need to take one or more medicines, such as angiotensin-converting enzyme (ACE) inhibitors or thiazide diuretics, to achieve your goal. 8
A low-fat diet, exercise, and weight loss can lower your cholesterol. Your body needs insulin to process fats, as it does with carbohydrate. If your diabetes is poorly controlled, the fats in your blood (particularly triglycerides) can rise significantly. You should strive for a goal of less than 100 milligrams per deciliter (mg/dL) or aim for keeping it at 70 mg/dL, for low-density lipoprotein (LDL), or "bad," cholesterol. Adults with diabetes need to keep their HDL cholesterol level more than 40 mg/dL for men and more than 50 mg/dL for women. Triglycerides should be less than 150 mg/dL. You may need to take lipid-lowering medicines, such as statins, to reach your goals. Statins reduce LDL levels and the risk of heart disease in people with diabetes. 9 They also have been shown to reduce the risk of heart attack and stroke by one-third in people with diabetes, even those who do not have high LDL levels or existing heart disease. 10
Take care of yourself in other ways
Don't smoke.
Take care of your skin and your teeth and gums.
Know what to do when you are sick.
Grieve the things you feel you have lost because of diabetes.
Wear identification to let medical personnel know that you have diabetes so they can give you appropriate care. You can buy medical identification in bracelets, necklaces, or other forms of jewelry at your local drugstore.
Know why foot care is important, and take care of your feet daily. For information, see:
Diabetes: Taking care of your feet.
Limit your alcohol intake to no more than 1 drink a day for women (none if you are pregnant) and 2 drinks a day for men.
See your health professional regularly. For more information, see the Exams and Tests section of this topic.
If you take oral diabetes medicine
Take your medicine as directed. If you take one of the medicines with low blood sugar as a side effect, learn to deal with low blood sugar. For information, see:
Diabetes: Dealing with low blood sugar from medicines.
If you need to take insulin
If you become severely ill, have surgery, become pregnant, or breast-feed, you may need insulin injections temporarily even though you normally take only oral medicine. You should be able to return to your usual treatment after the situation is over.
As type 2 diabetes progresses, your pancreas may produce less and less insulin. This means that you have to take insulin for the rest of your life, usually by giving yourself a shot several times a day for the rest of your life.
If you take insulin, learn how to deal with low blood sugar and give yourself an insulin shot. See:
Diabetes: Dealing with low blood sugar from insulin.
Diabetes: Giving yourself an insulin shot.
Also, learn how to:
Take precautions when you are driving. Do not drive if your blood sugar is below 70 milligrams per deciliter (mg/dL). 8
Take precautions to prevent problems while traveling.
Other issues
Talk with your health professional if you want to know about:
Treatment changes to prepare for pregnancy. For more information see:
Pregnancy and diabetes: Planning for pregnancy.
Finding a support group.
Immunizations. See the topic Immunizations for the recommended immunization schedule.



 

What to Think About
The United Kingdom Prospective Diabetes Study (UKPDS) showed that keeping blood sugar levels within a normal or near-normal range helps decrease a person's chances of developing complications from diabetes. Every effort you make to get your blood sugar level closer to a normal or near-normal range leads to some lowering of your risk for complications.
Prevention
Keeping your blood sugar levels within a normal or near-normal range is the best way to reduce your risk of complications from type 2 diabetes. The higher your blood sugar level, the greater your risk for developing eye, kidney, heart, blood vessel, and nerve disease. 11
Be sure you have:
An exercise program. Exercise helps control your blood sugar, because you use glucose for energy during and after activity. It also helps you stay at a healthy weight; lower high cholesterol; raise HDL, or "good," cholesterol; and lower high blood pressure. Do activities that raise your heart rate. Try to do moderate activity at least 2½ hours a week. 2 One way to do this is to be active 30 minutes a day, at least 5 days a week. Also include resistance exercises in your program. 3 Resistance exercises can include activities like weight lifting or even yard work. See the topic Fitness for ideas on to how add daily activity to your life.
A daily aspirin, if your doctor says it is okay. People with diabetes are 2 to 4 times more likely than people who don't have diabetes to die from heart and blood vessel diseases. If you are 40 or older, talk to your health professional about taking a low-dose aspirin daily to help prevent heart attack, stroke, or other large blood vessel disease (macrovascular disease). 12
Adequate treatment for high blood pressure and high cholesterol. These conditions increase your risk for developing diabetic complications, especially heart and blood vessel diseases. 13
Yearly screening for protein in your urine. This is the only way to detect early kidney damage (diabetic nephropathy). If evidence of kidney damage is found, medicine can help slow, or possibly reverse, the damage.
Yearly eye exams by an ophthalmologist or optometrist. This is the only way to monitor your eyes for signs of damage (diabetic retinopathy).
A plan to take care of your feet daily.
And two more important things to act on are:
Don't smoke. If you don't smoke, you can slow down the damage to your blood vessels from diabetes 14
Keep your immunizations up to date. Diabetes affects your immune system, increasing your risk for developing a severe illness, such as influenza or pneumonia. See the topic Immunizations for the recommended immunization schedule.



 

Home Treatment
You play a major role in treating your type 2 diabetes. Be sure to:
Follow your diet.
Exercise regularly.
Maintain blood sugar control.
Take an aspirin if recommended.
Control blood pressure and cholesterol.
Follow your diet
Carbohydrate affects your blood sugar more than other nutrients. When you know how much carbohydrate is in your food, you can spread the amount throughout the day, which helps prevent high blood sugar after meals. Use one of the following methods for keeping track of carbohydrate in your daily diet:
Diabetes: Counting carbs if you don't use insulin (preferred)
Diabetes: Using a food guide
Diabetes: Using a plate format for eating
Exercise regularly
Exercise helps control your blood sugar, because you use glucose for energy during and after activity. It also helps you stay at a healthy weight; lower high cholesterol; raise HDL, or "good," cholesterol; and lower high blood pressure. These benefits help prevent cardiovascular disease, the main cause of death in people who have diabetes.
Do activities that raise your heart rate. Try to do moderate activity at least 2½ hours a week. 2 One way to do this is to be active 30 minutes a day, at least 5 days a week. Also include resistance exercises in your program. 3 Resistance exercises can include activities like weight lifting or even yard work. It may help to keep track of your exercise on an activity log Click here to view a form.(What is a PDF document?) . See the topic Fitness for ideas on to how add daily activity to your life.
Walking, running, bike riding, and swimming are good activities for people with diabetes. But some activities can make complications more likely. For instance, weight lifting can increase the risk of retinal bleeding if you have eye disease (diabetic retinopathy). If you have diabetic neuropathy, running may lead to foot problems. Check with your health professional before you begin an exercise program to find out what activities are best for you. Work with your health professional to develop a safe exercise program.
Maintain blood sugar control
Check your blood sugar as often as prescribed by your doctor.
Diabetes: Checking your blood sugar
Prevent high blood sugar levels.
Diabetes: Preventing high blood sugar emergencies
Deal with low blood sugar levels, if you take insulin or certain oral diabetes medicines.
Diabetes: Dealing with low blood sugar from medicines
Getting your blood sugar in a normal or near-normal range is very important if you are thinking about getting pregnant. For more information, see:
I have diabetes. Should I get pregnant now?
Take an aspirin daily
If you are 40 or older, talk to your health professional about taking a low-dose aspirin daily to help prevent heart attack, stroke, or other large blood vessel disease (macrovascular disease). People with diabetes are 2 to 4 times more likely than people who don't have diabetes to die from heart and blood vessel diseases. 1
Control blood pressure and cholesterol
It's important to keep your blood pressure and cholesterol at recommended levels to reduce your risk of heart and large blood vessel disease. Exercise can help keep your blood pressure at the recommended level of less than 130/80 millimeters of mercury (mm Hg). In some cases, one or more medicines may be needed. For more information, see the Treatment Overview section of this topic.
A low-fat diet, exercise, and weight loss can lower your cholesterol. The body needs insulin to process fats, as it does with carbohydrate. If your diabetes is poorly controlled, the fats in your blood (particularly triglycerides) can rise significantly. You should strive for a goal of less than 100 milligrams per deciliter (mg/dL) or aim for keeping it at 70 mg/dL, for low-density lipoprotein (LDL), or "bad," cholesterol. Triglycerides should be less than 150 mg/dL. Adults with diabetes need to keep their HDL cholesterol level more than 40 mg/dL for men and more than 50 mg/dL for women. Your health professional may recommend cholesterol-lowering medicines called statins to cut your risk of heart disease even if you do not have high LDL levels or existing heart disease.



 

Medications
Several oral medicines are available to treat type 2 diabetes. These medicines increase insulin production, decrease insulin resistance, or slow intestinal absorption of carbohydrate.
You may need more than one medicine to adequately control your diabetes. Together, two or more medicines may work more effectively than a single medicine to lower blood sugar level. Taking two medicines together may reduce side effects by allowing lower doses of each. But in some cases, taking two medicines can increase the risk of side effects, such as low blood sugar (hypoglycemia).
You may need to take insulin temporarily if you have surgery or are severely ill, pregnant, or breast-feeding. You also may need to take insulin daily as a shot if lifestyle and pills (oral medicines) are not controlling your blood sugar, or if your pancreas stops producing insulin.
Medicines also may be needed to prevent or slow the development of complications.
Medication Choices
Aspirin may be recommended to prevent heart attack, stroke, or other large blood vessel disease (macrovascular disease). 1 If you are age 40 or older, talk to your health professional about whether you should take a low-dose aspirin daily.
Medicines that increase insulin production are:
Sulfonylureas, such as glipizide (Glucotrol), glyburide (DiaBeta, Glynase, or Micronase), glimepiride (Amaryl), the combination medicine glyburide and metformin (Glucovance), the combination of sitagliptin and metformin (Janumet), or the combination of glipizide and metformin (Metaglip).
Meglitinides, such as repaglinide (Prandin), nateglinide (Starlix), and the medicine that combines repaglinide and metformin (Prandimet).
Medicines that decrease insulin resistance are:
Biguanides, such as metformin (Glucophage or Glucophage XR), the combination medicine glyburide and metformin (Glucovance), the medicine that combines rosiglitazone and metformin (Avandamet), the medicine that combines metformin and glipizide (Metaglip), and the medicine that combines repaglinide and metformin (Prandimet).
Thiazolidinediones, such as rosiglitazone (Avandia), pioglitazone (Actos), or the combination of rosiglitazone and metformin (Avandamet).
Medicines that slow intestinal absorption of carbohydrate are:
Alpha-glucosidase inhibitors, such as acarbose (Precose) or miglitol (Glyset).
New medicines recently approved by the U.S. Food and Drug Administration (FDA) include:
Incretin mimetics, such as exenatide (Byetta). Exenatide lowers both fasting blood sugar and blood sugar after you eat. Your doctor may recommend Byetta if you have not been able to control your blood sugar with oral medicines such as metformin or a sulfonylurea. Byetta may be taken by itself or with other oral medicines. It is given as a shot 2 times a day, before morning and evening meals.
Amylinomimetics, such as pramlintide (Symlin). Pramlintide lowers blood sugar after you eat. Your doctor may recommend pramlintide if you already take insulin but still cannot control your blood sugar. Pramlintide is only used with insulin. You take it as a shot before meals.
Dipeptidyl peptidase IV (DPP-4) inhibitors, such as sitagliptin (Januvia). Sitagliptin lowers blood sugar. It does this by allowing the body to release insulin for longer than usual after blood sugar rises.
Insulin
Insulin
Medications to control blood pressure and cholesterol
You may need medicines to lower your blood pressure and cholesterol, reducing your risk for heart disease and large blood vessel disease.
Angiotensin-converting enzyme (ACE) inhibitors or thiazide diuretics may be used to lower your blood pressure to the goal of less than 130/80 millimeters of mercury (mm Hg).
Cholesterol-lowering medicines known as statins reduce LDL levels and the risk of heart disease in people with diabetes. 9 They also have been shown to reduce the risk of heart attack and stroke by one-third in people with diabetes, even those who do not have high LDL levels or existing heart disease. 10
What to Think About
You will need to take ACE inhibitors or ARBs if you have protein in your urine, a sign of diabetic nephropathy. Effective control of your blood sugar also is essential to prevent progression of nephropathy.
The U.S. Food and Drug Administration (FDA) has announced a possible safety issue with the drug rosiglitazone (Avandia). A new study shows that people who take Avandia may raise their chance of having a heart attack. They may also raise their chance of death from heart disease.
Manufacturers of rosiglitazone (Avandia), pioglitazone (Actos), rosiglitazone and glimepiride (Avandaryl), rosiglitazone and metformin (Avandamet), and pioglitazone and glimepiride (Duetact) have added a warning that these drugs may cause or worsen heart failure in certain people.
If you take any of these medicines, do not stop taking them. Call your doctor to talk about which medicine is best for you.
Surgery
There are no surgeries to treat type 2 diabetes.
Studies indicate that the large weight loss provided by stomach surgery improves blood sugar control in people who are extremely overweight. 15 But this is a difficult procedure, and it can only be done on people who meet specific criteria. If you are extremely overweight, talk with your doctor about whether you would be a good candidate for stomach surgery. For more information, see the topic Obesity.
Other Treatment
Avoid products that promise a cure for type 2 diabetes. No cure exists. Also avoid products that are advertised only by testimonials of satisfied customers. These products or remedies may be harmful and costly. If you have questions about a product for diabetes, check with your local American Diabetes Association office, your doctor, or a diabetes educator.
Other types of meal plans
You may hear of people with diabetes who follow meal plans other than those typically recommended by diabetes experts. Talk with a registered dietitian before you choose an alternate meal planning method for your or your child's diabetes diet.
Complementary therapies
Other types of treatment for diabetes are provided by therapists or others who do not operate within mainstream medical practice. Their unconventional approaches may be attractive, particularly if you are not having much success with conventional medical treatments. None of these complementary therapies is proven to effectively treat diabetes. But you may benefit from safe nontraditional therapies that complement conventional medical treatment for your disease. Complementary therapies such as acupuncture, massage, or biofeedback, for instance, may help relieve stress, relieve muscle tension, and improve your overall well-being and quality of life.
You should not use complementary therapies alone to treat your diabetes.
Talk with your doctor if you are using the following or other complementary or alternative therapies:
Acupuncture
Massage therapy
Biofeedback
Chiropractic therapy
Herbal medicines and natural substances such as vanadium, magnesium, or chromium. Studies indicate that soluble fiber, a natural substance, may help you keep blood sugar levels within a normal or near-normal range.
Osteopathy
Other Places To Get Help
Online Resource



Children With Diabetes

Web Address:

www.childrenwithdiabetes.com

 

This Web site is for children with diabetes and for their families. It offers a variety of information and resources, from basic facts about diabetes to legal support, as well as school information for students and their teachers, diabetes camps throughout the United States, chat rooms for children and for their parents, and a valuable link-site connection to other diabetes-related Web sites.

 

Organizations



American Association of Diabetes Educators

100 West Monroe Street

Suite 400

Chicago, IL  60603

Phone:

1-800-338-3633

Fax:

(312) 424-2427

E-mail:

aade@aadenet.org

Web Address:

www.aadenet.org

 

The American Association of Diabetes Educators is made up of doctors, nurses, dietitians, and other health professionals with special interest and training in diabetes care. The Web site can supply the names of these types of health professionals in your local area.

 

American Diabetes Association (ADA)

1701 North Beauregard Street

Alexandria, VA  22311

Phone:

1-800-DIABETES (1-800-342-2383)

E-mail:

AskADA@diabetes.org

Web Address:

www.diabetes.org

 

The American Diabetes Association (ADA) is a national organization for health professionals and consumers. Almost every state has a local office. ADA sets the standards for the care of people with diabetes. Its focus is on research for the prevention and treatment of all types of diabetes. ADA provides patient and professional education mainly through its publications, which include the monthly magazine Diabetes Forecast, books, brochures, cookbooks and meal planning guides, and pamphlets. ADA also provides information for parents about caring for a child with diabetes.

 

National Diabetes Education Program (NDEP)

1 Diabetes Way

Bethesda, MD  20814-9692

Phone:

1-800-438-5383 to order materials
(301) 496-3583

E-mail:

ndep@mail.nih.gov

Web Address:

http://ndep.nih.gov

 

The National Diabetes Education Program (NDEP) is sponsored by the U.S. National Institutes of Health (NIH) and the U.S. Centers for Disease Control and Prevention (CDC). The program's goal is to improve the treatment of people who have diabetes, to promote early diagnosis, and to prevent the development of diabetes. Information about the program can be found on two Web sites: one managed by NIH (http://ndep.nih.gov) and the other by CDC (www.cdc.gov/team-ndep).

 

National Diabetes Information Clearinghouse (NDIC)

1 Information Way

Bethesda, MD  20892-3560

Phone:

1-800-860-8747

Fax:

(703) 738-4929

TDD:

1-866-569-1162 toll-free

E-mail:

ndic@info.niddk.nih.gov

Web Address:

http://diabetes.niddk.nih.gov

 

This clearinghouse provides information about research and clinical trials supported by the U.S. National Institutes of Health. This service is provided by the National Institute of Diabetes and Digestive and Kidney Disease (NIDDK), a part of the National Institutes of Health (NIH).









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