Managing Diabetes

Diabetes is a serious health condition. Eating a healthy diet, staying physically active, and monitoring your condition are important steps in managing your diabetes. However, not everyone manages diabetes the same way so it’s important to work closely with your healthcare provider.

Effects on the body

Just as every human body is unique, diabetes behaves slightly differently in everyone who has it. Its effects can also change as a person’s health profile changes following fluctuations in weight, dietary patterns, exercise routines, medication regimens, and other factors. The following are some of the health concerns most often seen in people with diabetes.
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    Cardiovascular disease

    Over time, high blood sugar levels can damage the blood vessels and nerves that support the heart. This can lead to increased risk of heart disease and stroke.
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    Nerve problems

    When blood vessels deliver less oxygen to the nerves, the nerves can become damaged - a condition called "neuropathy". This can cause pain and numbness, especially in the arms, legs, feet, and toes.
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    Kidney issues

    Diabetes is one of the most common causes of kidney disease and kidney failure. The high glucose levels damage the blood vessels in the kidneys.
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    Eye/vision concerns

    Eye damage — again, the result of damage to blood vessels due to high glucose levels — can be a complication of diabetes, as can blurred and double vision.
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    Foot problems

    Nerve damage caused by diabetes - neuropathy - can make it harder to feel heat, cold, or even pain in the feet. This can put people with diabetes at increased risk for foot damage and injuries and can slow the healing process.
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    Skin conditions

    Dry skin is a common concern among people with diabetes. Dryness can lead to cracking and peeling, which makes people more at risk for skin infections.
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    Hearing impairment

    Studies show that people with diabetes are twice as likely to have hearing loss as people who don’t have diabetes.

Treatment and Monitoring

Your healthcare team will guide you in how best to manage your specific form of diabetes. Your treatment recommendations may change over time. That might be because your health profile changes, and it might be due to new technologies or medications. Below are some of the most common treatment methods.
Blood glucose monitoring
Monitoring your blood sugar levels is an important part of managing your diabetes. Knowing and understanding your numbers allows you and your healthcare team to determine how nutrition, medications, and physical activity impact your blood sugar levels, and to adjust your care plan as needed.
Diet and exercise modifications

Healthy eating habits and regular fitness regimens are important components of good health in general, but they’re essential for people with diabetes. Diet and exercise changes can dramatically improve overall health — and can actually reverse type 2 diabetes.

Insulin Therapy

All people diagnosed with type 1 diabetes and some people with type 2 diabetes need to take insulin. Insulin is taken by injection or an insulin pump.

Insulin injections

People with diabetes can inject themselves with insulin using syringes, pens, and other devices (Parents of young children should be responsible for injections). The number of times each day a person needs injections depends on the individual.

Insulin pump

This small, battery-powered device delivers insulin through a soft tube placed under the skin. The insulin is administered in a steady stream or through surge doses that the patient controls. People who use insulin pumps still need to monitor their glucose levels regularly.

Oral medications

In addition to nutrition and exercise, your provider may prescribe a medication you take by mouth to help you in getting your glucose levels to target.


Self-monitoring gives you the information you need to maintain healthy blood sugar levels before and after eating, exercise, and rest. Self-monitoring is done with:
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    Lancets and lancing devices

    Tiny blades used to prick the skin to draw blood.
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    Test strips

    Chemically treated strips of paper that are inserted into a monitoring device.
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    Blood glucose monitors

    Small machines that read blood samples put on test strips, then measure and report blood sugar levels.

Health Screenings

Certain health screenings are performed regularly to improve health outcomes and reduce the risk of developing diabetes-related complications. Talk to your provider about your health goals and how to meet them, and work together to develop a schedule that includes tests/exams appropriate for you. Below are general care guidelines for most adults with diabetes.

  • Primary Care Provider (PCP) visits, every 3-6 months–A1C checked
  • Annual Exams
    • Physical exam
    • Retinal eye exam
    • Foot exam at each Provider visit. Talk with your provider about how to perform at-home foot checks in between office visits
    • Blood work and urine test to check kidney function
  • Dental exam, every 6 months
  • Vaccinations are recommended for people with diabetes. Hyperglycemia can decrease the effectiveness of your white blood cells, increasing the risk for infections. Develop a vaccination schedule with your provider that includes the following vaccines:
    • Influenza (Flu shot)
    • COVID-19
    • Pneumococcal (Pneumonia)
    • Tetanus, Diphtheria, Pertussis (TDAP)
    • Hepatitis A
    • Hepatitis B
    • Zoster (Shingles)
    • Human Papilloma Virus (HPV)

Regular provider visits

You need to see your primary care and other healthcare providers regularly. They will monitor your progress and work closely with you if adjustments in your diabetes management routine should be made.

Your Healthcare Team

Work with your healthcare team to create an individualized plan that works for YOU and YOUR diabetes. Appropriate nutrition and lifestyle changes, along with medication and regular screenings and monitoring, can help you better manage your diabetes and may reduce the risk of developing diabetes-related complications. If you have diabetes, you will probably interact with more than one type of healthcare professional as you manage your condition.
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    Primary care providers

    Your primary care provider is usually the main doctor, nurse practitioner, or physician assistant. This person will be part of your care team to help you manage diabetes.
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    Diabetes educators

    These credentialed professionals work with you to develop healthy self-care habits and reduce the risk of complications that can arise.
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    Registered dietitians

    These nutrition experts help you map out food plans best suited to your health profile, medications, desired weight, and more.
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    These are physicians who specialize in the endocrine system — which includes the pancreas — and are experts in diabetes treatment.
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    Eye doctors

    It’s important to have regular eye exams with your optometrist or ophthalmologist annually or as recommended by your provider.
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    If you develop any of the foot-related complications that can crop up in people with diabetes, your PCP may refer you to a podiatrist.
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    If your diabetes leads to issues with your renal system, your primary provider may refer you to a nephrologist.
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    Mental health professionals

    Managing diabetes can be overwhelming and can lead to stress or event depression for individuals with diabetes or their family members.

Know your numbers

Checking your blood sugar levels can help improve outcomes. Talk to your provider about your individual blood sugar targets.
Other important things you can do are seeing your provider regularly and getting the right screenings every year. These tests can help prevent serious health complications such as heart disease, blindness, kidney failure and amputations. Below is a list of recommended tests. Talk to your provider about how often you should receive these tests.
Generally, the American Diabetes Association recommends:
blood cells

A1c (hemoglobin)

This simple blood test is the primary method for managing your diabetes. It pro

Eye exam

A dilated eye exam checks for damage to the blood vessels in your retina (a layer of tissue within the eye). It can help prevent diabetic retinopathy, a condition that can cause severe vision loss or blindness.


Unhealthy cholesterol levels can contribute to heart disease. LDL, the “bad” cholesterol, should be below 100. HDL, the “good” cholesterol, should be above 40 for men and above 50 for women.


A urine test measures the protein level in your kidneys; an increase in protein could be a sign they aren’t working as well as they should.


Regular comprehensive foot exams and proper foot care can help prevent amputations.

Understand your A1C result

Hemoglobin (A1C OR HbA1C)

This blood test estimates your average blood sugar levels over the past 3 months. The American Diabetes Association (ADA) recommends an A1C of less than 7.0% for most adults, but discuss your individual A1C goal with your provider as they might suggest a different goal for you.

Have your A1C checked by your provider every 3-6 months, or as recommended by your provider.

  • High A1C readings over time can increase your risk of developing diabetes-related complications. An A1C greater than or equal to 8.0% may signify unmanaged diabetes.
  • If your A1C is high despite following your recommended treatment plan, talk with your provider about considering changes to your plan.

Know what to do about low and high blood sugar

Low Blood Sugar (Hypoglycemia)

A blood sugar level below 70 mg/dL is considered low; however, each person’s goals are different. Your provider may recommend that you take action to increase your blood sugar at a different level. Discuss that level/number with your provider so you know when to take action.

There are three levels of low blood sugar. Each level may require a different treatment approach based on the severity and potential risk. It’s important to take immediate action to treat low blood sugar, as untreated hypoglycemia can lead to loss of consciousness, seizures, and death.

Level 1: Less than 70 mg/dL

Level 2: Less than 54 mg/dL; seriously low blood sugar

Level 3: Severe low blood sugar defined as not having a threshold; external assistance needed to treat


  • Shaky, fast heartbeat, sweating, dizzy, anxious, hungry, blurry vision, weakness or fatigue, headache, irritable
  • Low blood sugar during the night (nocturnal hypoglycemia): vivid dreams, night sweats, waking up hungry or with a headache, elevated/rebound or low blood sugar levels in the morning

NOTE: Consult your provider if you experience nocturnal hypoglycemia, as changes to your medication and treatment plan may be necessary.

When to Call Your Provider

  • If your blood sugar level stays low (below 70 mg/dL) or you do not feel better after 30 minutes
  • You experience Level 1 hypoglycemia more than once in a week
  • You experience Level 2 or Level 3 hypoglycemia

If you struggle to notice the signs/symptoms of hypoglycemia when your blood sugar drops, you could have a condition known as hypoglycemia unawareness. It’s important to discuss it with your provider.

High Blood Sugar (Hyperglycemia)

Hyperglycemia is a blood sugar level above your recommended range. Frequent high blood sugar levels over time can increase the risk for diabetes-related complications so it’s important to work with your healthcare team to establish a management/treatment plan.

Blood sugar levels above 250 mg/dL may require you to take special action.

Possible Causes
  • Too much food
  • Inadequate insulin or medication
  • Illness
  • Stress
  • Infection
  • Extreme thirst
  • Frequent urination
  • Dry skin
  • Hunger
  • Drowsiness
  • Slow-healing wounds
  • Check your blood sugar levels as recommended by your provider.
  • Call your provider if your blood sugar levels are higher than your goal for 3 consecutive days and you do not know why
  • Follow a consistent meal schedule; a carbohydrate-controlled meal plan may be recommended
  • Take medications as prescribed; exceptions as noted by your provider (e.g., when you’re sick)

Sick Day Recommendations

Not feeling well? Illness and stress related to feeling unwell can cause blood sugar levels to rise. Left untreated, this cycle can lead to serious health issues.

When to Call Your Provider
  • You are unable to eat or drink
  • You vomit more than once
  • You have diarrhea more than 5 times or for more than 24 hours
  • Blood glucose is higher than 250 mg/dL on two or more readings within 24 hours
  • Your temperature is higher than 101 degrees F
  • You test positive for ketones in urine or blood