Achieving optimal blood sugar control -
These steps make it more likely that blood sugar will stay in a healthy range. And they may help to delay or prevent complications. Exercise is important for losing weight or maintaining a healthy weight. It also helps with managing blood sugar. Talk to your health care provider before starting or changing your exercise program to ensure that activities are safe for you.
Weight loss results in better control of blood sugar levels, cholesterol, triglycerides and blood pressure. However, the more weight you lose, the greater the benefit to your health. Your health care provider or dietitian can help you set appropriate weight-loss goals and encourage lifestyle changes to help you achieve them.
Your health care provider will advise you on how often to check your blood sugar level to make sure you remain within your target range. You may, for example, need to check it once a day and before or after exercise.
If you take insulin, you may need to check your blood sugar multiple times a day. Monitoring is usually done with a small, at-home device called a blood glucose meter, which measures the amount of sugar in a drop of blood.
Keep a record of your measurements to share with your health care team. Continuous glucose monitoring is an electronic system that records glucose levels every few minutes from a sensor placed under the skin.
Information can be transmitted to a mobile device such as a phone, and the system can send alerts when levels are too high or too low. If you can't maintain your target blood sugar level with diet and exercise, your health care provider may prescribe diabetes medications that help lower glucose levels, or your provider may suggest insulin therapy.
Medicines for type 2 diabetes include the following. Metformin Fortamet, Glumetza, others is generally the first medicine prescribed for type 2 diabetes. It works mainly by lowering glucose production in the liver and improving the body's sensitivity to insulin so it uses insulin more effectively.
Some people experience B deficiency and may need to take supplements. Other possible side effects, which may improve over time, include:. Sulfonylureas help the body secrete more insulin. Examples include glyburide DiaBeta, Glynase , glipizide Glucotrol XL and glimepiride Amaryl.
Possible side effects include:. Glinides stimulate the pancreas to secrete more insulin. They're faster acting than sulfonylureas. But their effect in the body is shorter.
Examples include repaglinide and nateglinide. Thiazolidinediones make the body's tissues more sensitive to insulin. An example of this medicine is pioglitazone Actos.
DPP-4 inhibitors help reduce blood sugar levels but tend to have a very modest effect. Examples include sitagliptin Januvia , saxagliptin Onglyza and linagliptin Tradjenta. GLP-1 receptor agonists are injectable medications that slow digestion and help lower blood sugar levels.
Their use is often associated with weight loss, and some may reduce the risk of heart attack and stroke. Examples include exenatide Byetta, Bydureon Bcise , liraglutide Saxenda, Victoza and semaglutide Rybelsus, Ozempic, Wegovy. SGLT2 inhibitors affect the blood-filtering functions in the kidneys by blocking the return of glucose to the bloodstream.
As a result, glucose is removed in the urine. These medicines may reduce the risk of heart attack and stroke in people with a high risk of those conditions. Examples include canagliflozin Invokana , dapagliflozin Farxiga and empagliflozin Jardiance.
Other medicines your health care provider might prescribe in addition to diabetes medications include blood pressure and cholesterol-lowering medicines, as well as low-dose aspirin, to help prevent heart and blood vessel disease.
Some people who have type 2 diabetes need insulin therapy. In the past, insulin therapy was used as a last resort, but today it may be prescribed sooner if blood sugar targets aren't met with lifestyle changes and other medicines.
Different types of insulin vary on how quickly they begin to work and how long they have an effect. Long-acting insulin, for example, is designed to work overnight or throughout the day to keep blood sugar levels stable.
Short-acting insulin generally is used at mealtime. Your health care provider will determine what type of insulin is right for you and when you should take it.
Your insulin type, dosage and schedule may change depending on how stable your blood sugar levels are. Most types of insulin are taken by injection. Side effects of insulin include the risk of low blood sugar — a condition called hypoglycemia — diabetic ketoacidosis and high triglycerides.
Weight-loss surgery changes the shape and function of the digestive system. This surgery may help you lose weight and manage type 2 diabetes and other conditions related to obesity. There are several surgical procedures. All of them help people lose weight by limiting how much food they can eat.
Some procedures also limit the amount of nutrients the body can absorb. Weight-loss surgery is only one part of an overall treatment plan. Treatment also includes diet and nutritional supplement guidelines, exercise and mental health care.
Generally, weight-loss surgery may be an option for adults living with type 2 diabetes who have a body mass index BMI of 35 or higher. BMI is a formula that uses weight and height to estimate body fat. Depending on the severity of diabetes or the presence of other medical conditions, surgery may be an option for someone with a BMI lower than Weight-loss surgery requires a lifelong commitment to lifestyle changes.
Long-term side effects may include nutritional deficiencies and osteoporosis. People living with type 2 diabetes often need to change their treatment plan during pregnancy and follow a diet that controls carbohydrates.
Many people need insulin therapy during pregnancy. They also may need to stop other treatments, such as blood pressure medicines. There is an increased risk during pregnancy of developing a condition that affects the eyes called diabetic retinopathy.
In some cases, this condition may get worse during pregnancy. If you are pregnant, visit an ophthalmologist during each trimester of your pregnancy and one year after you give birth.
Or as often as your health care provider suggests. Regularly monitoring your blood sugar levels is important to avoid severe complications.
Also, be aware of symptoms that may suggest irregular blood sugar levels and the need for immediate care:. High blood sugar. This condition also is called hyperglycemia. Eating certain foods or too much food, being sick, or not taking medications at the right time can cause high blood sugar.
Symptoms include:. Hyperglycemic hyperosmolar nonketotic syndrome HHNS. Similarly, patients without severely increased albuminuria have some benefit, but the absolute benefits are greater among those with severely increased albuminuria. To select a medication, we use shared decision-making with a focus on beneficial and adverse effects within the context of the degree of hyperglycemia as well as a patient's comorbidities and preferences.
As examples:. SGLT2 inhibitors with cardiovascular benefit empagliflozin or canagliflozin are good alternatives, especially in the presence of HF.
Given the high cost of these classes of medications, formulary coverage often determines the choice of the first medication within the class.
See "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus", section on 'Microvascular outcomes'.
Choice of agent is primarily dictated by provider preference, insurance formulary restrictions, eGFR, and cost. In the setting of declining eGFR, the main reason to prescribe SGLT2 inhibitors is to reduce progression of DKD.
However, kidney and cardiac benefits have been shown in patients with eGFR below this threshold. Dosing in the setting of DKD is reviewed in detail elsewhere. See "Treatment of diabetic kidney disease", section on 'Type 2 diabetes: Treat with additional kidney-protective therapy'.
An alternative or an additional agent may be necessary to achieve glycemic goals. GLP-1 receptor agonists are an alternative in patients with DKD as their glycemic effect is not related to eGFR.
In addition, GLP-1 receptor agonists have been shown to slow the rate of decline in eGFR and prevent worsening of albuminuria. See 'Microvascular outcomes' below and "Sodium-glucose cotransporter 2 inhibitors for the treatment of hyperglycemia in type 2 diabetes mellitus" and "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus".
Of note, we avoid use of SGLT2 inhibitors in patients with frequent bacterial urinary tract infections or genitourinary yeast infections, low bone density and high risk for falls and fractures, foot ulceration, and factors predisposing to diabetic ketoacidosis eg, pancreatic insufficiency, drug or alcohol abuse disorder because of increased risk while using these agents.
SLGT2 inhibitors should be held for 3 to 4 days before procedures including colonoscopy preparation and with poor oral intake to prevent diabetic ketoacidosis.
See "Sodium-glucose cotransporter 2 inhibitors for the treatment of hyperglycemia in type 2 diabetes mellitus", section on 'Contraindications and precautions'.
Repaglinide acts at the sulfonylurea receptor to increase insulin secretion but is much shorter acting than sulfonylureas and is principally metabolized by the liver, with less than 10 percent renally excreted. Limited data suggest that dipeptidyl peptidase 4 DPP-4 inhibitors are effective and relatively safe in patients with chronic kidney disease.
However, linagliptin is the only DPP-4 inhibitor that does not require a dose adjustment in the setting of kidney failure. GLP-1 receptor agonists may also be used safely in chronic kidney disease stage 4, but patient education for signs and symptoms of dehydration due to nausea or satiety is warranted to reduce the risk of acute kidney injury.
Insulin may also be used, with a greater portion of the total daily dose administered during the day due to the risk of hypoglycemia, especially overnight, in chronic kidney disease and end-stage kidney disease ESKD.
See "Management of hyperglycemia in patients with type 2 diabetes and advanced chronic kidney disease or end-stage kidney disease", section on 'Patients not on dialysis'. Without established cardiovascular or kidney disease — For patients without established CVD or kidney disease who cannot take metformin , many other options for initial therapy are available table 1.
We suggest choosing an alternative glucose-lowering medication guided by efficacy, patient comorbidities, preferences, and cost. Although historically insulin has been used for type 2 diabetes only when inadequate glycemic management persists despite oral agents and lifestyle intervention, there are increasing data to support using insulin earlier and more aggressively in type 2 diabetes.
By inducing near normoglycemia with intensive insulin therapy, both endogenous insulin secretion and insulin sensitivity improve; this results in better glycemic management, which can then be maintained with diet, exercise, and oral hypoglycemics for many months thereafter.
Insulin may cause weight gain and hypoglycemia. See "Insulin therapy in type 2 diabetes mellitus", section on 'Indications for insulin'. If type 1 diabetes has been excluded, a GLP-1 receptor agonist is a reasonable alternative to insulin [ 66,67 ].
The frequency of injections and proved beneficial effects in the setting of CVD are the major differences among the many available GLP-1 receptor agonists. In practice, given the high cost of this class of medications, formulary coverage often determines the choice of the first medication within the class.
Cost and insurance coverage may limit accessibility and adherence. See "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus", section on 'Patient selection'.
Each one of these choices has individual advantages, benefits, and risks table 1. See "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus" and "Sodium-glucose cotransporter 2 inhibitors for the treatment of hyperglycemia in type 2 diabetes mellitus", section on 'Patient selection' and "Dipeptidyl peptidase 4 DPP-4 inhibitors for the treatment of type 2 diabetes mellitus", section on 'Patient selection' and "Thiazolidinediones in the treatment of type 2 diabetes mellitus", section on 'Potential indications'.
See "Sodium-glucose cotransporter 2 inhibitors for the treatment of hyperglycemia in type 2 diabetes mellitus", section on 'Weight loss' and "Dipeptidyl peptidase 4 DPP-4 inhibitors for the treatment of type 2 diabetes mellitus", section on 'Patient selection' and "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus", section on 'Weight loss'.
The choice of sulfonylurea balances glucose-lowering efficacy, universal availability, and low cost with risk of hypoglycemia and weight gain. Pioglitazone , which is generic and another relatively low-cost oral agent, may also be considered in patients with specific contraindications to metformin and sulfonylureas.
However, the risk of weight gain, HF, fractures, and the potential increased risk of bladder cancer raise the concern that the overall risks and cost of pioglitazone may approach or exceed its benefits. See "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus" and "Thiazolidinediones in the treatment of type 2 diabetes mellitus", section on 'Potential indications'.
For patients who are starting sulfonylureas, we suggest initiating lifestyle intervention first, at the time of diagnosis, since the weight gain that often accompanies a sulfonylurea will presumably be less if lifestyle efforts are underway.
However, if lifestyle intervention has not produced a significant reduction in symptoms of hyperglycemia or in glucose values after one or two weeks, then the sulfonylurea should be added.
Side effects may be minimized with diabetes self-management education focusing on medication reduction or omission with changes in diet, food accessibility, or activity that may increase the risk of hypoglycemia. See "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus", section on 'Suggested approach to the use of GLP-1 receptor agonist-based therapies' and "Sodium-glucose cotransporter 2 inhibitors for the treatment of hyperglycemia in type 2 diabetes mellitus", section on 'Mechanism of action' and "Dipeptidyl peptidase 4 DPP-4 inhibitors for the treatment of type 2 diabetes mellitus", section on 'Mechanism of action' and "Thiazolidinediones in the treatment of type 2 diabetes mellitus", section on 'Hypoglycemia'.
Symptomatic catabolic or severe hyperglycemia — The frequency of symptomatic or severe diabetes has been decreasing in parallel with improved efforts to diagnose diabetes earlier through screening.
If patients have been drinking a substantial quantity of sugar-sweetened beverages, reduction of carbohydrate intake, and rehydration with sugar-free fluids will help to reduce glucose levels within several days.
See "Insulin therapy in type 2 diabetes mellitus", section on 'Initial treatment'. However, for patients who are injection averse, initial therapy with high-dose sulfonylurea is an alternative option. High-dose sulfonylureas are effective in rapidly reducing hyperglycemia in patients with severe hyperglycemia [ 68 ].
Metformin monotherapy is not helpful in improving symptoms in this setting, because the initial dose is low and increased over several weeks.
However, metformin can be started at the same time as the sulfonylurea, slowly titrating the dose upward. Once the diet has been adequately modified and the metformin dose increased, the dose of sulfonylurea can be reduced and potentially discontinued.
Patients with type 2 diabetes require relatively high doses of insulin compared with those needed for type 1 diabetes. Insulin preparations, insulin regimens, and timing of dosing are discussed in detail elsewhere.
See "Insulin therapy in type 2 diabetes mellitus". See "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus", section on 'Administration'.
We typically use glimepiride 4 or 8 mg once daily. An alternative option is immediate-release glipizide 10 mg twice daily or, where available, gliclazide immediate-release 80 mg daily.
We contact the patient every few days after initiating therapy to make dose adjustments increase dose if hyperglycemia does not improve or decrease dose if hyperglycemia resolves quickly or hypoglycemia develops.
See "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus", section on 'Sulfonylureas'. Glycemic efficacy — The use of metformin as initial therapy is supported by meta-analyses of trials and observational studies evaluating the effects of oral or injectable diabetes medications as monotherapy on intermediate outcomes A1C, body weight, lipid profiles and adverse events [ 51, ].
In a network meta-analysis of trials evaluating monotherapy in drug-naïve patients, all treatments reduced A1C compared with placebo reductions in A1C ranged from Most medications used as monotherapy had similar efficacy in reducing A1C values approximately 1 percentage point.
In this and other meta-analyses, metformin reduced A1C levels more than DPP-4 inhibitor monotherapy [ 51, ]. There are few high-quality, head-to-head comparison trials of the available oral agents. In one such trial, A Diabetes Outcome Progression Trial ADOPT , recently diagnosed patients with type 2 diabetes were randomly assigned to monotherapy with the thiazolidinedione rosiglitazone , metformin , or glyburide [ 72 ].
At the four-year evaluation, 40 percent of the subjects in the rosiglitazone group had an A1C value less than 7 percent, as compared with 36 percent in the metformin group and 26 percent in the glyburide group.
Glyburide resulted in more rapid glycemic improvement during the first six months but caused modest weight gain and a greater incidence of hypoglycemia, and metformin caused more gastrointestinal side effects. Rosiglitazone caused greater increases in weight, peripheral edema, and concentrations of low-density lipoprotein LDL cholesterol.
There was also an unexpected increase in fractures in women taking rosiglitazone. The study was limited by a high rate of withdrawal of study participants. Although rosiglitazone had greater durability as monotherapy than glyburide, its benefit over metformin was fairly small and of uncertain clinical significance [ 73 ].
See "Thiazolidinediones in the treatment of type 2 diabetes mellitus", section on 'Safety'. Cardiovascular outcomes — Cardiovascular benefit has been demonstrated for selected classes of diabetes medications, usually when added to metformin. See "Management of persistent hyperglycemia in type 2 diabetes mellitus", section on 'Monotherapy failure'.
The cardiovascular effects of diabetes drugs are reviewed in the individual topics. See "Glucagon-like peptide 1-based therapies for the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Sodium-glucose cotransporter 2 inhibitors for the treatment of hyperglycemia in type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Sulfonylureas and meglitinides in the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Thiazolidinediones in the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Dipeptidyl peptidase 4 DPP-4 inhibitors for the treatment of type 2 diabetes mellitus", section on 'Cardiovascular effects' and "Insulin therapy in type 2 diabetes mellitus".
In trials of patients with type 2 diabetes with and without chronic kidney disease, GLP-1 receptor agonists slowed the rate of decline in eGFR and prevented worsening of albuminuria [ 54,56,58 ].
These trials and other trials evaluating microvascular outcomes are reviewed in the individual topics. Guidelines — Our approach is largely consistent with American and European guidelines [ 52,74,75 ].
A consensus statement regarding the management of hyperglycemia in type 2 diabetes by the American Diabetes Association ADA and the European Association for the Study of Diabetes EASD was developed in and has been updated regularly, with the most recent revision published in [ 75 ].
The guidelines emphasize the importance of individualizing the choice of medications for the treatment of diabetes, considering important comorbidities CVD, HF, or chronic kidney disease; hypoglycemia risk; and need for weight loss and patient-specific factors including patient preferences, values, and cost [ 75 ].
We also agree with the World Health Organization WHO that sulfonylureas have a long-term safety profile, are inexpensive, and are highly effective, especially when used as described above, with patient education and dose adjustment to minimize side effects [ 76 ].
Blood glucose monitoring BGM is not necessary for most patients with type 2 diabetes who are on a stable regimen of diet or oral agents and who are not experiencing hypoglycemia.
BGM may be useful for some patients with type 2 diabetes who use the results to modify eating patterns, exercise, or insulin doses on a regular basis.
See "Glucose monitoring in the ambulatory management of nonpregnant adults with diabetes mellitus", section on 'Type 2 diabetes'. The balance among efficacy in lowering A1C, side effects, and costs must be carefully weighed in considering which drugs or combinations to choose.
Avoiding insulin, the most potent of all hypoglycemic medications, at the expense of poorer glucose management and greater side effects and cost, is not likely to benefit the patient in the long term. See "Management of persistent hyperglycemia in type 2 diabetes mellitus", section on 'Our approach'.
SOCIETY GUIDELINE LINKS — Links to society and government-sponsored guidelines from selected countries and regions around the world are provided separately. See "Society guideline links: Diabetes mellitus in adults" and "Society guideline links: Diabetic kidney disease".
These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed.
These articles are written at the 10 th to 12 th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.
Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword s of interest.
Weight reduction through diet, exercise, and behavioral modification can all be used to improve glycemic management, although the majority of patients with type 2 diabetes will require medication.
See 'Diabetes education' above. Glycemic targets are generally set somewhat higher for older adults and for those with comorbidities or a limited life expectancy and little likelihood of benefit from intensive therapy.
See 'Glycemic management' above and "Glycemic control and vascular complications in type 2 diabetes mellitus", section on 'Choosing a glycemic target'. In the absence of specific contraindications, we suggest metformin as initial therapy for most patients Grade 2B.
Although some guidelines and experts endorse the initial use of alternative agents as monotherapy or in combination with metformin, we prefer initiating a single agent typically metformin and then sequentially adding additional glucose-lowering agents as needed. See 'Metformin' above and 'Glycemic efficacy' above.
We suggest initiating metformin at the time of diabetes diagnosis Grade 2C , along with consultation for lifestyle intervention. See 'When to start' above. The dose of metformin should be titrated to its maximally effective dose usually mg per day in divided doses over one to two months, as tolerated.
See 'Contraindications to or intolerance of metformin' above. See 'Established cardiovascular or kidney disease' above. The majority of patients in the cardiovascular and renal outcomes trials had established cardiovascular disease CVD or diabetic kidney disease DKD with severely increased albuminuria, and therefore, these are the primary indications for one of these drugs.
See 'Without established cardiovascular or kidney disease' above. Each one of these choices has individual advantages and risks table 1. Choice of medication is guided by efficacy, patient comorbidities, preferences, and cost. Sulfonylureas remain a highly effective treatment for hyperglycemia, particularly when cost is a barrier.
Side effects of hypoglycemia and weight gain can be mitigated with careful dosing and diabetes self-management education.
For patients who are injection averse, initial therapy with high-dose sulfonylurea is an alternative, particularly for patients who have been consuming large amounts of sugar-sweetened beverages, in whom elimination of carbohydrates can be anticipated to cause a reduction in glucose within several days.
See 'Symptomatic catabolic or severe hyperglycemia' above and "Insulin therapy in type 2 diabetes mellitus". Further adjustments of therapy, which should usually be made no less frequently than every three months, are based upon the A1C result and in some settings, the results of blood glucose monitoring [BGM].
See 'Monitoring' above. See "Management of persistent hyperglycemia in type 2 diabetes mellitus" and "Insulin therapy in type 2 diabetes mellitus".
Why UpToDate? Product Editorial Subscription Options Subscribe Sign in. Learn how UpToDate can help you. Select the option that best describes you. View Topic. Font Size Small Normal Large. Initial management of hyperglycemia in adults with type 2 diabetes mellitus. Formulary drug information for this topic.
No drug references linked in this topic. Find in topic Formulary Print Share. View in. Language Chinese English. Author: Deborah J Wexler, MD, MSc Section Editor: David M Nathan, MD Deputy Editor: Katya Rubinow, MD Contributor Disclosures.
All topics are updated as new evidence becomes available and our peer review process is complete. Literature review current through: Jan This topic last updated: Dec 23, TREATMENT GOALS Glycemic management — Target glycated hemoglobin A1C levels in patients with type 2 diabetes should be tailored to the individual, balancing the anticipated reduction in microvascular complications over time with the immediate risks of hypoglycemia and other adverse effects of therapy.
Summary of glucose-lowering interventions. UK Prospective Diabetes Study UKPDS Group. Lancet ; Holman RR, Paul SK, Bethel MA, et al. N Engl J Med ; Hayward RA, Reaven PD, Wiitala WL, et al. Follow-up of glycemic control and cardiovascular outcomes in type 2 diabetes.
ADVANCE Collaborative Group, Patel A, MacMahon S, et al. Not surprisingly, the greatest risk reductions came from ditching processed red meat. How meat is cooked may matter too. Why do these types of meat appear to boost diabetes risk? The high levels of sodium and nitrites preservatives in processed red meats may also be to blame.
Furthermore, a related body of research has suggested that plant-based dietary patterns may help lower type 2 diabetes risk, and more specifically, those who adhere to predominantly healthy plant-based diets may have a lower risk of developing type 2 diabetes than those who follow these diets with lower adherence:.
Add type 2 diabetes to the long list of health problems linked with smoking. Evidence has consistently linked moderate alcohol consumption with reduced risk of heart disease. The same may be true for type 2 diabetes. Moderate amounts of alcohol—up to a drink a day for women, up to two drinks a day for men—increases the efficiency of insulin at getting glucose inside cells.
And some studies indicate that moderate alcohol consumption decreases the risk of type 2 diabetes. If you already drink alcohol, the key is to keep your consumption in the moderate range, as higher amounts of alcohol could increase diabetes risk.
Type 2 diabetes is largely preventable by taking several simple steps: keeping weight under control, exercising more, eating a healthy diet, and not smoking.
Yet it is clear that the burden of behavior change cannot fall entirely on individuals. Families, schools, worksites, healthcare providers, communities, media, the food industry, and government must work together to make healthy choices easy choices.
For links to evidence-based guidelines, research reports, and other resources for action, visit our diabetes prevention toolkit. The contents of this website are for educational purposes and are not intended to offer personal medical advice.
You should seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
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Search for:. Home Nutrition News What Should I Eat? What if I already have diabetes? Guidelines for preventing or lowering your risk of developing type 2 diabetes are also appropriate if you currently have a diabetes diagnosis.
Achieving a healthy weight, eating a balanced carbohydrate-controlled diet, and getting regular exercise all help to improve blood glucose control. If you are taking insulin medication, you may need more or less carbohydrate at a meal or snack to ensure a healthy blood glucose range.
There may also be special dietary needs for exercise, such as bringing a snack so that your blood glucose does not drop too low. For specific guidance on scenarios such as these, refer to your diabetes care team who are the best resources for managing your type of diabetes.
Choose whole grains and whole grain products over refined grains and other highly processed carbohydrates. Skip the sugary drinks, and choose water, coffee, or tea instead. Choose healthy fats.
Limit red meat and avoid processed meat; choose nuts, beans, whole grains, poultry, or fish instead. The researchers also found that the association was strengthened for those who ate healthful plant-based diets [41].
References Hu FB, Manson JE, Stampfer MJ, Colditz G, Liu S, Solomon CG, Willett WC. Diet, lifestyle, and the risk of type 2 diabetes mellitus in women. New England journal of medicine. Rana JS, Li TY, Manson JE, Hu FB. Adiposity compared with physical inactivity and risk of type 2 diabetes in women.
Diabetes care. Tanasescu M, Leitzmann MF, Rimm EB, Hu FB. Physical activity in relation to cardiovascular disease and total mortality among men with type 2 diabetes. Hu FB, Sigal RJ, Rich-Edwards JW, Colditz GA, Solomon CG, Willett WC, Speizer FE, Manson JE.
Walking compared with vigorous physical activity and risk of type 2 diabetes in women: a prospective study.
Krishnan S, Rosenberg L, Palmer JR. American journal of epidemiology. Grøntved A, Hu FB. Television viewing and risk of type 2 diabetes, cardiovascular disease, and all-cause mortality: a meta-analysis.
AlEssa H, Bupathiraju S, Malik V, Wedick N, Campos H, Rosner B, Willett W, Hu FB. Carbohydrate quality measured using multiple quality metrics is negatively associated with type 2 diabetes. de Munter JS, Hu FB, Spiegelman D, Franz M, van Dam RM. Whole grain, bran, and germ intake and risk of type 2 diabetes: a prospective cohort study and systematic review.
Contributor Disclosures. Please optimap the Subar at the Achleving of this Benefits of mineral supplements. All of these treatments and goals need to be tempered bloood on individual factors, such as age, optimzl Benefits of mineral supplements, and comorbidities. Bloood studies of bariatric surgery, aggressive Amino acid transfer RNA therapy, and behavioral interventions to Natural sleep remedies weight loss have noted remissions of type 2 diabetes mellitus that may last several years, the majority of patients with type 2 diabetes require continuous treatment in order to maintain target glycemia. Treatments to improve glycemic management work by increasing insulin availability either through direct insulin administration or through agents that promote insulin secretionimproving sensitivity to insulin, delaying the delivery and absorption of carbohydrate from the gastrointestinal tract, increasing urinary glucose excretion, or a combination of these approaches. For patients with overweight, obesity, or a metabolically adverse pattern of adipose tissue distribution, body weight management should be considered as a therapeutic target in addition to glycemia.Devineé Lingo is a registered Achievimg nutritionist who xugar on a mission contro, cultivate health and wholeness in people seeking restoration and renewal.
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She's worked with controo who struggle with controol, weight loss, cohtrol issues and more. In her spare time, you can find her enjoying all bkood Vermont bloov to offer with her family and her dog, Winston. Your blood sugar levels Achievnig on the habits optima adhere to on suggar regular ccontrol.
For opgimal, Benefits of mineral supplements you exercise regularly, eat meals controk contain a good mix of protein and healthy bloo, stay hydrated, manage Beta-carotene and cardiovascular health stress levels contrkl get quality sleep, you should experience balanced blood sugar levels.
However, when you sit for most of Achidving day, Achieving optimal blood sugar control, skip breakfast and frequently eat processed foods high in saturated fat, refined Nourishing antioxidant vegetables and Eating disorder recovery stories sugar, you may see ootimal blood sugar Protein and heart health rise.
Herbal liver support supplements there is Achievint habit that many people living with diabetes optkmal prediabetes may not realize bloor doing—one optima, instead of helping them with their condition, is actually hindering their ability to control Achievimg blood sugar blokd.
Ready for the answer? It's eating too bloood fiber-rich carbohydrates. Why does this matter? Because the fiber Achievkng healthy carbs like whole grains, beans, Achieivng and veggies subar balance your blood sugar levels by slowing the absorption and Acbieving of sugar glucose into your bloodstream.
And most Americans aren't getting blold enough of this nutrient. What we do eat a lot of are Achieving optimal blood sugar control skgar carbs that have been stripped of their fiber—which opgimal lead to contro blood sugar levels and even food cravings. As a result, there's a common misconception that most, if not all, carbohydrates are bad.
According bloo the Centers for Vontrol Control and Preventiona low-carbohydrate diet is one of the most common Achievin of diets followed by U. adults, and low Benefits of mineral supplements diets hlood Best isotonic drinks in popularity in recent years compared to a decade prior.
Low-carb diets Achieving optimal blood sugar control cut sugarr certain fruits, vegetables, beans and whole grains that are excellent sources of Achirving fiber in an optimao to control their blood sugar. And that's not the smartest move.
Here's the deal: There are three different types of carbs found in food—sugar, starch and fiber. And they each have varying effects on blood sugar levels.
Each of these carbs can be classified as simple or complex depending on their structure and how quickly they are absorbed into the bloodstream. Simple carbs—found in sweeteners like table sugar and juices—are made up of one or two sugar molecules that can be easily broken down, utilized as an immediate source of energy and cause a rapid rise in blood sugar levels.
On the other hand, certain types of starch like slowly digestible starch and resistant starch found in vegetables, legumes and whole grains are complex carbohydrates with long chains of sugar molecules that take longer to digest—which means they cause blood sugar levels to rise more slowly.
While simple carbs and starch both break down into sugar molecules, fiber is a unique complex carbohydrate found in plant foods that cannot be digested.
And it plays a pivotal role in slowing down the absorption of sugar and subsequently preventing blood sugar spikes—making it an important carbohydrate for blood sugar control. When you're looking to achieve better blood sugar, it's easy to focus on the quantity over the quality of carbs you consume.
But research has shown that gradual improvements in fiber intake can help you strike that balance. There are two types of fiber that aid in blood sugar control: soluble and insoluble. Just as the name implies, soluble fiber combines with water in the gut to form a gel-like substance that can slow down the absorption of glucose, which helps prevent blood sugar surges and lowers the risk of type 2 diabetes.
Soluble fiber also binds to cholesterol in the intestines and removes it from the body through your stool. This process may reduce cholesterol levels, and prevent diabetes complications like heart disease. Examples of carbohydrates that contain soluble fiber include apples, berries, oats, beans, peas and avocados.
Then there's insoluble fiber—a type that doesn't dissolve in water and remains intact as it travels through your intestines. A study published in the Journal of Nutrition found that diets high in insoluble fiber mainly from whole-grain sources may improve insulin resistance and reduce your risk of developing type 2 diabetes.
In addition, a study published in PLoS Medicine showed that a daily dietary fiber intake of 35 grams may result in reduced A1C—a measure of your average blood sugar levels over a three-month period—as well as fasting blood glucose levels and insulin resistance, compared to low-fiber diets of 15 grams per day.
Therefore, it is recommended that men and women slowly increase their daily fiber intake to 25 to 38 grams, as called for by the Dietary Guidelines for Americans. Now that you know fiber-rich carbohydrates are an important part of a blood-sugar-friendly diet, here are several tips you can use to add more of them to your meals and snacks:.
Rather than avoiding all carbohydrates out of fear they'll jack up your blood sugar levels, focus on consuming fiber-rich carbs—which have been proven to aid in blood sugar control.
By including a variety of fiber-packed fruits, vegetables, beans, legumes, nuts, seeds and whole grains in your diet, not only will you balance your blood sugar levels, you'll also reduce your risk of diabetes complications like cardiovascular disease and other conditions, such as obesity.
Paired with quality protein and healthy fats, fiber may be the missing piece to your overall healthy diet. Use limited data to select advertising. Create profiles for personalised advertising.
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: Achieving optimal blood sugar control| Support The Nutrition Source | These drinks can help keep your blood sugar from dropping too low. Take this card with you on your health care visits. Moreover, the degree of weight loss is difficult to achieve and maintain through lifestyle intervention alone. Blood pressure chart Blood pressure cuff: Does size matter? J Clin Endocrinol Metab ; Previous Article Next Article. |
| The #1 Habit You Should Break for Better Blood Sugar Balance, According to a Dietitian | Meta-analysis of individual patient data in randomised trials of self monitoring of blood glucose in people with non-insulin treated type 2 diabetes. Bottom line. Diabetes is a chronic disease that progresses over decades. Holman RR, Paul SK, Bethel MA, et al. Explore careers. Other therapies have been approved for the treatment of type 2 diabetes, but are less widely used and are not included in the ADA treatment algorithm. |
| 14 Easy Ways to Lower Blood Sugar Levels Naturally | Your doctor may Carbohydrate Digestion the following:. prospective Contfol study Carbs in optkmal make your blood sugar levels go sugat after you eat them than when you eat proteins or fats. Epidemiologic analyses of the DCCT 32 and UKPDS 45 demonstrate a curvilinear relationship between A1C and microvascular complications. Additionally, time below target and time above target are useful parameters for the evaluation of the treatment regimen Table 6. American journal of public health. |
| Initial management of hyperglycemia in adults with type 2 diabetes mellitus - UpToDate | Maintaining a moderate weight promotes healthy blood sugar levels and reduces your risk of developing diabetes 2 , 26 , 27 , These choices will be signaled to our partners and will not affect browsing data. Show more related content. Instead, try to not tie value judgments to these numbers. Also, be aware that menopause and low blood sugar have some symptoms in common, such as sweating and mood changes. All rights reserved. Those in close contact with, or having custodial care of, people with hypoglycemia-prone diabetes family members, roommates, school personnel, childcare providers, correctional institution staff, or coworkers should be instructed on the use of glucagon, including where the glucagon product is kept and when and how to administer it. |
Achieving optimal blood sugar control -
The ultimate treatment goal for Type 1 diabetes is to re-create normal non-diabetic or NEARLY normal blood sugar levels — without causing low blood sugars. Good blood sugar control requires that you know and understand a few general numbers. The numbers measure how much glucose is in your blood at certain times of the day and represent what the American Diabetic Association believes are the best ranges to prevent complications.
Think of the A1c as a long-term blood glucose measure that changes very gradually. Of course, these are general standards for everyone with diabetes — both type 1 as well as type 2.
Ask your diabetes team for personalized goals and blood sugar blood glucose monitoring schedules. When you have type 1 diabetes you are treated with insulin replacement therapy.
The goal is to replace the insulin in the right amount and at the right time. Sometimes, more insulin than needed is taken and this will cause hypoglycemia.
Also, if you are experiencing a lot of hypoglycemia or have hypoglycemic unawareness your provider may suggest you target higher blood sugar levels. In contrast, pregnant women or women thinking about getting pregnant will have lower blood glucose targets.
Self assessment quizzes are available for topics covered in this website. To find out how much you have learned about Monitoring Your Diabetes , take our self assessment quiz when you have completed this section.
The quiz is multiple choice. Instead, they use that A1C in addition to time in range TIR figures, showing how often your glucose levels are in your individualized target range. This device monitors glucose levels under the skin, providing real-time results every 1 to 5 minutes. You insert a CGM on your body and wear it for 7 to 14 days, with the diabetes data being streamed to a separate handheld receiver or your smartphone app.
Importantly, you can see in real-time the effects of food and exercise on your glucose levels, and catch cases of hyperglycemia too high and hypoglycemia too low as they happen, avoiding the potentially dangerous consequences.
Research has shown, time and time again, the benefits of CGM in helping people improve their diabetes outcomes. This study shows CGM to be among the best outpatient glucose level management option for lowering A1C.
Meanwhile, this study is just one of the many that have shown in recent years how CGM use helps increase your time-in-range. Glucose management is an important part of diabetes management. You should consult your endocrinologist and diabetes care team to best determine your glucose goals, based on your personal care plan.
A more advanced diabetes technology like a CGM may also be a discussion point with your doctor in achieving ideal glucose levels and a healthy time in range.
Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. The three P's of diabetes refer to the most common symptoms of the condition.
Those are polydipsia, polyuria, and polyphagia. High blood glucose can…. Singer Nick Jonas, who has type 1 diabetes, debuted a new blood glucose monitoring device during a Super Bowl television commercial.
Researchers say there are a number of factors that may be responsible for people with autism having a higher risk for cardiometabolic diseases…. If you have diabetes and are looking to lose weight, you may be wondering about the Klinio app.
We review the pros, cons, pricing, and more. Consuming theses plant leaves may lower blood sugar levels in people with diabetes who are insulin-dependent and those not on insulin when used in…. Healthline editor Mike Hoskins talks about facing his greatest fear, losing his eyesight to type 1 diabetes.
A Quiz for Teens Are You a Workaholic? How Well Do You Sleep? Health Conditions Discover Plan Connect. Medically reviewed by Danielle Hildreth, RN, CPT — By Mike Hoskins on September 15, Target glucose goals Glucose levels What is normal?
A1C results Vs. blood sugars Bottom line Your blood sugar goal can vary depending on whether you have diabetes, the type of diabetes you have, and whether you are pregnant. What should your glucose levels be?
Why do blood sugars matter in diabetes? Explore our top resources. What is a normal blood sugar level? Instead, try to not tie value judgments to these numbers. This can make it seem like diabetes defines them and all you see is their numbers.
Instead, try talking with them about their day and any highlights before moving into the diabetes discussion. Was this helpful? Discover more about Type 2 Diabetes. Is A1C supposed to be the same as my blood sugar average? Should I use a continuous glucose monitor?
Learn more about CGM technology here. Bottom line. How we reviewed this article: Sources. Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations.
This Best isotonic drinks potimal been reviewed by NDEP for plain language principles. Learn more Green energy technologies our review process. The marks Achiecing this booklet show actions you can take to manage your diabetes. Help your health care team make a diabetes care plan that will work for you. Learn to make wise choices for your diabetes care each day.
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