Even if you eat on a rigid
schedule, the amount of sugar in your blood can
change unpredictably. With help from your
diabetes treatment team, you'll learn how your
blood sugar level changes in response to:
-
Food.
What and how much you eat will affect your
blood sugar level. Blood sugar is typically
highest one to two hours after a meal.
-
Physical
activity. Physical activity moves
sugar from your blood into your cells. The
more active you are, the lower your blood
sugar level.
-
Medication.
Any medications you take may affect your
blood sugar level, sometimes requiring
changes in your diabetes treatment plan.
-
Illness.
During a cold or other illness, your body
will produce hormones that raise your blood
sugar level.
-
Alcohol.
Alcohol can cause either high or low blood
sugar, depending on how much you drink and
if you eat at the same time.
-
Stress.
The hormones your body may produce in
response to prolonged stress may prevent
insulin from working properly.
-
For women,
fluctuations in hormone levels. As
your hormone levels fluctuate during your
menstrual cycle, so can your blood sugar
level — particularly in the week before your
period. Menopause may trigger fluctuations
in your blood sugar level as well.
In addition to
daily blood sugar monitoring, your doctor may
recommend regular A1C testing to measure your
average blood sugar level for the past two to
three months. Compared with repeated daily blood
sugar tests, A1C testing better indicates how
well your diabetes treatment plan is working
overall. An elevated A1C level may signal the
need for a change in your insulin regimen or
meal plan.
Healthy eating
Contrary to popular perception, there's no
diabetes diet. You won't be restricted to a
lifetime of boring, bland foods. Instead, you'll
need plenty of fruits, vegetables and whole
grains — foods that are high in nutrition and
low in fat and calories — and fewer animal
products and sweets. In fact, it's the best
eating plan for the entire family. Even sugary
foods are OK once in a while, as long as they're
included in your meal plan.
Yet
understanding what and how much to eat can be a
challenge. A registered dietitian can help you
put together a meal plan that fits your health
goals, food preferences and lifestyle. Once
you've covered the basics, remember the
importance of consistency. To keep your blood
sugar on an even keel, try to eat the same
amount of food with the same proportion of
carbohydrates, proteins and fats at the same
time every day.
Physical activity
Everyone needs regular aerobic exercise, and
people who have type 2 diabetes are no
exception. Get your doctor's OK to exercise.
Then choose activities you enjoy, such as
walking, swimming or biking. What's most
important is making physical activity part of
your daily routine. Aim for at least 30 minutes
of aerobic exercise most days of the week.
Stretching and strength training exercises are
important, too. If you haven't been active for a
while, start slowly and build up gradually.
Remember that
physical activity lowers blood sugar. Check your
blood sugar level before any activity. You might
need to eat a snack before exercising to help
prevent low blood sugar.
Diabetes medications and insulin therapy
Some people who have type 2 diabetes can manage
their blood sugar with diet and exercise alone,
but many need diabetes medications or insulin
therapy.
Many oral or
injected medications can be used to treat type 2
diabetes. Some diabetes medications stimulate
your pancreas to produce and release more
insulin. Others inhibit the production and
release of glucose from your liver, which means
you need less insulin to transport sugar into
your cells. Still others block the action of
stomach enzymes that break down carbohydrates or
make your tissues more sensitive to insulin.
In addition to
diabetes medications, your doctor might
prescribe low-dose aspirin therapy to help
prevent heart and blood vessel disease.
Some people
who have type 2 diabetes need insulin therapy as
well. Because stomach enzymes interfere with
insulin taken by mouth, insulin must be
injected. Often, insulin is injected using a
fine needle and syringe or an insulin pen
injector — a device that looks like an ink pen,
except the cartridge is filled with insulin.
An insulin
pump also may be an option. The pump is a device
about the size of a cell phone worn on the
outside of your body. A tube connects the
reservoir of insulin to a catheter that's
inserted under the skin of your abdomen. The
pump is programmed to dispense specific amounts
of insulin automatically. It can be adjusted to
deliver more or less insulin depending on meals,
activity level and blood sugar level.
Many types of
insulin are available, including rapid-acting
insulin, long-acting insulin and intermediate
options. Examples include insulin lispro (Humalog),
insulin aspart (NovoLog) and insulin glargine (Lantus).
Depending on your needs, your doctor may
prescribe a mixture of insulin types to use
throughout the day and night.
In October
2007, the manufacturer of inhaled insulin (Exubera)
announced a decision to stop selling the drug
because too few people are using it. If you use
inhaled insulin, work with your doctor to adjust
your diabetes treatment plan as soon as possible.
In the meantime, it's safe to continue using
inhaled insulin as directed.
The decision
about which medications are best depends on many
factors, including your blood sugar level and
the presence of any other health problems. Your
doctor might even combine drugs from different
classes to help you control your blood sugar in
several different ways.