Whether you’ve been living with diabetes your whole life, you’ve recently received a diagnosis, or you’re caring for a loved one with diabetes, this guide will provide you with a comprehensive overview of how to manage diabetes.

In this guide, you’ll find information about:

• The three main types of diabetes
• Factors that affect blood glucose levels
• Diet
• Exercise
• Blood glucose monitoring
• Stress management
• Routine health checks

If you have diabetes, either your pancreas doesn’t produce insulin or your body doesn’t properly use insulin. Insulin is a hormone that allows your cells to absorb glucose from the blood and use it as energy. Glucose is the main source of fuel for your brain and body. 

There are three main types of diabetes: type 1 diabetes, type 2 diabetes, and gestational diabetes. Here are the key differences:

• Type 1 diabetes: If you have type 1 diabetes, your pancreas is unable to make insulin. Approximately 5-10% of people living with diabetes have type 1.
• Type 2 diabetes: If you have type 2 diabetes, your pancreas can produce insulin, but your body doesn’t use insulin effectively. Approximately 90-95% of people living with diabetes have type 2.
• Gestational diabetes: Gestational diabetes is a form of diabetes that can develop during pregnancy in people without pre-existing diabetes. It usually develops around the 24th week of pregnancy. In people with gestational diabetes, the hormones produced during pregnancy have a blocking effect on insulin, making it less effective. This is known as insulin resistance. 

Regardless of what type of diabetes you have, you will need to complete several self-care steps each day to keep your blood sugar levels within your optimal range to protect your health and prevent serious health complications such as stroke, heart disease, chronic kidney disease, nerve damage, and vision loss.

To best understand how to manage diabetes, it’s important to learn about the various factors that can cause your blood glucose levels to rise and fall. The biggest factors to keep in mind are diet and physical activity. 

Diet is considered the largest factor that influences your blood glucose levels. This is because when you eat, your body breaks down the food into sugars which then enter the bloodstream and elevate your blood glucose levels. Carb-heavy foods, large meals, and beverages containing carbohydrates in the form of simple sugars can cause your blood glucose levels to rise. On the other hand, if you forget to eat a meal or don’t eat enough carbs, your blood glucose levels can drop. If you don’t take steps to bring your levels back to your target range, you may experience hyperglycemia or hypoglycemia.

Physical activity can also have a big impact on your blood glucose levels—most of which are positive impacts. Regular exercise improves blood glucose control, increases insulin sensitivity, helps you maintain a healthy weight, and improves mental wellness. 

Other factors, including illness, hormones, hydration, smoking, alcohol, and certain medications, can also impact your blood glucose levels. Checking your blood glucose levels often can enable you to correlate your glucose levels with these types of lifestyle variables.

The goal of diabetes management is to keep your blood glucose levels as close to your target range as possible. While your target range should be determined with the guidance of your healthcare team, the American Diabetes Association recommends the following targets for non-pregnant adults living with diabetes:

• Before a meal (preprandial plasma glucose): between 80-120 mg/dL
• One to two hours after the beginning of a meal (postprandial plasma glucose): less than 180 mg/dL

Because no two people living with diabetes are the same, effective diabetes management may look different for everyone. While there’s no one-size-fits-all approach, there are general guidelines that can help you better understand how to manage your diabetes on a daily basis. 

Work with your healthcare team to develop a detailed diabetes management plan. This plan may involve eating a diabetes-friendly diet, exercising regularly, taking insulin or other blood glucose-lowering medications, and monitoring your blood glucose levels.

What you eat (and drink) is one of the biggest factors that can affect your blood glucose levels and ability to manage your diabetes. Eating thoughtfully chosen, well-balanced meals and snacks can help you keep your blood glucose levels, cholesterol, blood pressure, and weight in your target ranges, reducing the risk of diabetes-related health complications. While you should always work with your healthcare team for specific guidance on creating a diabetes-friendly diet, there are general considerations for how to craft healthy meals. One of the easiest ways to throw together a meal is by using the diabetes plate method.

To follow the method, fill half of your 9-inch diameter plate with non-starchy vegetables, a quarter with lean protein, and a quarter with carbs. 

Here are some examples of non-starchy vegetables, lean proteins, and carbs as well as healthy beverage options you can use to put together a meal.

Exercise is considered to be a fundamental pillar of diabetes management. It can improve blood glucose control, lower LDL cholesterol (“bad” cholesterol”), lower blood pressure, reduce stress and anxiety, and strengthen your muscles and bones. 

The American Diabetes Association recommends 150 minutes of moderate-intensity exercise per week. That’s only about 20 minutes each day—and it doesn’t necessarily mean strenuous cardio workouts. Any movement or activity that gets your heart rate up can be valuable to your diabetes management. Scheduling this time into each day and choosing exercises that bring you joy is a great way to help prioritize movement. 

Based on your diabetes type and exercise duration and intensity, your healthcare team can provide you with guidance on the appropriate glucose testing and medication schedules.

Many people living with diabetes need to take insulin or other blood glucose-lowering medications. If you have type 1 diabetes, you will need to take insulin as part of your treatment plan, as your pancreas is unable to produce insulin. If you have type 2 diabetes, you may or may not need to take insulin. In general, approximately 30% of people living with type 2 diabetes require insulin or other blood glucose-lowering medications. Insulin or other medications are used in type 2 diabetes when diet and exercise aren’t enough to keep your blood glucose levels in your target range. Blood glucose-lowering medications may include:

• Alpha-glucosidase inhibitors
• Biguanides
• Bile Acid Sequestrants
• Dopamine-2 Agonists
• DPP-4 inhibitors
• Meglitinides
• SGLT2 Inhibitors
• Sulfonylureas
• TZDs 
  

The above classes of medications lower blood glucose levels in different ways and may therefore be used in combination. Consequently, your healthcare team may recommend oral combination therapy, such as biguanide and sulfonylurea.

If your treatment plan involves insulin, your healthcare team will likely give you the option of multiple daily injections (MDI) therapy or insulin pump therapy. MDI therapy can be accomplished via a needle and syringe or an insulin pen. Both MDI and insulin pump therapy work by mimicking the natural secretion of insulin by the body experienced by people without diabetes.

Stress can affect everyone—your job, marriage, friendships, financial pressures, and parenting can all cause stress. People with diabetes may also experience additional stressors, such as diabetes distress and burnout. Finding ways to manage stress is important not only for your mental health but also for your physical health. Research has demonstrated that emotional distress in people with diabetes is associated with poor glycemic control, poor self-care, and adverse diabetes outcomes. Additionally, stress can cause some people with diabetes to skip or forget meals, eat too much or too little, forget to take medication, or avoid exercise—all of which can make it more difficult to manage your diabetes. 

The good news is there are plenty of ways to relieve stress. You may consider:

• Talking to someone you trust about your stress
• Making time to meditate, work on deep breathing exercises, or practice yoga
• Talking to other people who are living with diabetes
• Working with your healthcare team to find ways to simplify your day-to-day diabetes management
• Taking a step back and doing one thing at a time
• Making time each day to do something you enjoy

Identifying the source of your stress can be very helpful. If you can’t seem to identify the cause of your stress, consider keeping a stress journal. Take notes on when you are feeling stressed and try to determine a pattern. From here, find ways to reduce your triggers.

People living with type 1 and type 2 diabetes are at an elevated risk of serious health conditions including heart, kidney, and eye disease. Because of this, it’s important to regularly get tests done by your healthcare team. The American Diabetes Association recommends the following health screenings for people living with diabetes. The target zones listed below are based on their Standards of Medical Care in Diabetes. Be sure to ask your healthcare team about your specific target zones.