Your Options for Managing Diabetes

Everything you and your loved ones need to know about diabetes treatment options

Diabetes is a chronic condition in which the pancreas doesn't produce insulin or the body can't use insulin effectively. Because diabetes impairs the body's ability to process glucose (blood sugar), following a diabetic diet is one of the most important aspects of managing the condition.

If your blood sugar remains high even after you've made dietary and other lifestyle changes, you may need oral medications or insulin to manage your diabetes symptoms effectively.

This guide outlines the major treatment options for diabetes and explains what you can expect with each one.

Diabetes Diet

Diet is one of the most important considerations in the management of diabetes. Although diet is important, there's no one-size-fits-all approach that works for every diabetic. The right diet for you depends on your age, weight, cultural background, food allergies and preferences, blood sugar levels and many other factors. That said, some foods are better for diabetics than others.

Glycemic Index

Your doctor may recommend that you follow the glycemic index when choosing foods and beverages. The glycemic index of a food corresponds to how quickly your blood sugar increases after you eat it. Low-GI foods result in slow, steady increases while high-GI foods cause rapid spikes.

Chickpeas, kidney beans, lentils and soy milk have GIs at the lower end of the range, and watermelon, pineapple, potatoes, rice crisps and popcorn have GIs at the higher end of the range. Eating low-GI foods can help you maintain better control of your blood sugar.

Diabetes and Carbohydrates

One of the most common myths associated with diabetes is that all diabetics need to limit their intake of carbohydrates to control their blood sugar. It's true that you need to monitor your carbohydrate intake, but it's not always necessary to limit carbohydrate consumption.

In many cases, it's more important to worry about the quality of the carbohydrates you eat rather than the amount of carbs consumed each day.

High-quality carbohydrates contain fiber, which helps slow the digestion of starches and sugars, preventing sudden spikes in blood sugar. They also contain phytochemicals, which may help prevent cell damage and reduce your risk of some cancers.

If you're worried about the quality of the carbohydrates you consume, try adding these foods to your diet:

  • Apples
  • Oranges
  • Berries
  • Spinach
  • Tomatoes
  • Squash
  • Carrots
  • Artichokes
  • Kidney beans
  • Black beans
  • Quinoa 
  • Brown rice
  • Whole-grain breads

Low-quality carbohydrates are typically made with refined grains. These grains have been stripped of some of their most nutritious components to make them shelf-stable and change their texture.

Many products made with refined grains also have added sugars, high levels of sodium and saturated fats to make them taste better, making them high in calories.

If carbohydrate quality is a concern, limit your consumption of these foods:

  • Crackers
  • Potato chips
  • Bagels
  • Cereals sweetened with sugar
  • White rice
  • Baked goods
  • Microwave popcorn
  • Rolls and other breads

The Importance of Fiber

Fiber is important for diabetics because it slows down the absorption of glucose; it may even reduce your cholesterol and insulin levels, lowering your risk of diabetes complications. How much fiber you need depends on how many calories you consume each day.

The United States Department of Agriculture recommends 14 grams for every 1,000 calories in your diet; therefore, someone following a 2,000-calorie diet should aim for 28 grams of fiber daily.

For best results, try to maintain a good balance of soluble and insoluble fiber in your diet. Soluble fiber dissolves in water to form a gel-like substance; this is the form of fiber that may help you control your glucose levels and lower your cholesterol. Insoluble fiber doesn't dissolve in water, and its main benefit is that it helps food move quickly through your gastrointestinal tract.

Peas, oats, beans, citrus fruits and apples are some of the foods high in soluble fiber, and wheat bran, cauliflower, potatoes and nuts are good sources of insoluble fiber.

Fats and Protein

Fats

Although you should limit your intake of saturated fats and avoid trans fats, a study published in the "Diabetes Care" journal notes that replacing some carbohydrate foods with high-quality fats can result in better control of your blood sugar.

It's especially helpful to eat foods with omega-3 fatty acids, which may reduce your risk of heart disease and some types of cancer. Omega-3 fatty acids are found in fatty fish, flaxseed oil, canola oil and soybean oil.

The American Diabetes Association recommends focusing on polyunsaturated and monounsaturated fats when planning a diet to manage diabetes. Polyunsaturated fats help lower your risk of heart disease and may reduce your low-density lipoprotein (LDL) level.

LDL contributes to plaque buildup on the walls of your arteries, so a high LDL level can increase your risk of heart disease, stroke and heart attack. Walnuts, peanut butter, sunflower seeds and eggs are some of the dietary sources of polyunsaturated fats.

Monounsaturated fats also protect the cardiovascular system by reducing your LDL level. Safflower oil, avocados, olives, peanut butter, olive oil, almonds and cashews are good sources of monounsaturated fats.

When adding polyunsaturated and monounsaturated fats to your diet, read food labels carefully to be sure you're not inadvertently increasing your intake of low-quality carbohydrates. If you enjoy peanut butter, for example, look for a natural variety without added sugars.


Protein

Researchers typically focus on the role of carbohydrates in a diabetic diet, resulting in a lack of studies on the role of protein in managing diabetes. One study showed that diabetics who got 30% of their daily calories from protein had better control of their fasting glucose levels compared to diabetics who got just 15% of their daily calories from protein.

The higher-protein group also demonstrated lower insulin needs and better control of their weight. Lentils, lean meats, nuts, seeds, eggs, seafood and poultry are all good sources of protein.

Before increasing your protein intake, talk to your doctor or a registered dietitian. Over time, high glucose levels can damage your kidneys, causing a chronic condition called diabetic kidney disease.

About one in three adults with diabetes develop diabetic kidney disease at some point in their lives. When you have kidney disease, your kidneys can't filter out all the wastes produced by protein metabolism, causing those wastes to build up in the bloodstream. If you have diabetic kidney disease, your doctor may instruct you to limit your protein intake to prevent further organ damage.

Diet Plans

The following diets may help you shed pounds, prevent diabetes complications and maintain good control of your blood sugar. They aren't the only diets used to manage diabetes, but they have been shown to help diabetics control their glucose levels and avoid some complications.

Before trying any diet plan, seek advice from a medical professional who knows your health history and can make recommendations based on your age, weight, glucose levels and overall health status.


Ornish Lifestyle Program

The Ornish program, developed by Dr. Dean Ornish, aims to prevent or reverse heart disease, but it can also help diabetics control their glucose levels, lose weight and prevent high blood pressure.

Unlike many diet plans, the Ornish program doesn't focus on calorie restriction; instead, it limits fat consumption to no more than 10% of your daily calories. As a result, the plan includes very few animal products. Low-fat dairy products and egg whites are allowed, but poultry, meats and full-fat dairy products aren't.

The Ornish program emphasizes the consumption of legumes and other high-fiber foods.


Vegetarian and Vegan Diets

Plant-based eating has many potential benefits, including a reduced risk of heart disease, better control of your diabetes, improved physical function and a lower risk of certain cancers.

Vegetarian and vegan diets emphasize the consumption of nuts, seeds, fruits, vegetables and other plant-based foods; the main difference is that a vegetarian diet includes eggs and dairy products while a vegan diet excludes animal products completely. Following one of these diets may help you reduce your hemoglobin A1C, lose weight and lower your LDL level, all of which are beneficial for people with diabetes.


Mediterranean Diet

The Mediterranean diet emphasizes plant-based foods and limits the consumption of red meats and desserts. If you follow the Mediterranean diet, you'll also eat poultry, cheese, eggs and yogurt a few times per week. In the PREDIMED trial, one group of participants followed a general low-fat diet, and the other group followed a Mediterranean eating plan.

After four years, the people who followed the Mediterranean diet had better fasting glucose levels than the people who followed a general low-fat diet. They also had a reduced need for medications to control their glucose levels. 

Physical Activity

Physical activity is extremely important for anyone with diabetes. In Type 1 diabetics, regular exercise leads to improvements in insulin sensitivity, muscle strength and cardiovascular health, among other benefits. In Type 2 diabetics, physical activity can help with glucose control and prevent the condition from getting worse over time. Before starting an exercise program, seek advice from a licensed medical professional. Although exercise has many benefits, there are also some potential risks for people with diabetes.

Types of Exercise

Unless your doctor advises against it, you should incorporate aerobic exercise and resistance exercise into your fitness routine. Aerobic exercise conditions your cardiovascular system while resistance exercise increases muscle strength and improves your overall endurance.

One of the main benefits of aerobic exercise for diabetics is that it increases your insulin sensitivity, making it easier to keep your glucose levels in check. Aerobic exercise may also reduce your LDL level, lower your blood pressure and help you lose weight.

Walking, jogging, cycling and swimming are just a few examples of aerobic exercises you can do to help manage your diabetes.

Some people with diabetes experience reduced muscle strength and a decline in muscle function after their diagnosis. Resistance training can help you increase your muscle strength, making you better-equipped to engage in aerobic exercise and perform other daily activities.

Resistance exercise also increases insulin sensitivity, reduces blood pressure and improves your cardiovascular health in general. Incorporate resistance exercise into your routine by using handheld weights while you walk or trying one of the weight machines at your local gym.

Exercise and Blood Sugar

When you exercise, your muscles contract, causing the cells to use glucose for energy. As a result, exercise can lead to hypoglycemia (low blood sugar) if you take insulin or an oral medication for glucose control.

Checking your blood sugar before and after exercise can help you avoid fainting, shaking, dizziness and other symptoms of hypoglycemia.

The American Diabetes Association recommends following the 15-15 rule, which includes the following steps:

  • Check your blood sugar after exercising or if you experience symptoms of hypoglycemia during your workout.

  • If your glucose level is 100 milligrams per deciliter or lower, consume 15 to 20 grams of carbohydrate. You can eat 1 tablespoon of honey or sugar, drink 4 ounces of regular soda or juice, use one glucose gel tube or take four glucose tablets (4 grams of glucose per tablet).

  • Check your sugar again 15 minutes later. If it's above 100 milligrams per deciliter, then you don't need to do anything else. If it's still below 100 milligrams per deciliter, consume another 15 grams of carbohydrate.

  • Continue repeating this procedure until your blood sugar reaches at least 100 milligrams per deciliter.

To prevent hypoglycemia during exercise, avoid skipping meals, exercising too strenuously or exercising for longer than recommended by your doctor.

Considerations for Diabetics

If you have nerve damage caused by diabetes (diabetic neuropathy), you have an increased risk of developing foot ulcers.

To prevent them, wear comfortable, supportive shoes that are not too big or too small. You should have about 1/2 an inch of space between the tip of the shoe and your toes. Avoid wearing socks with elastic bands, as the elastic can reduce blood flow to your feet, further increasing your risk of ulcers.

After your workout, inspect your feet to see if they have any blisters or other wounds. If they do, tend to the wounds promptly to prevent complications.

Oral Medications

Your insurance company should cover oral diabetes medications, but check your plan documents to determine what level of coverage you can expect. If you don't have insurance, ask your pharmacist if there are any discounts available for self-pay customers.

Some drug manufacturers even have discount programs available to help defray the cost of brand-name drugs.

Alpha-Glucosidase Inhibitors

Alpha-glucosidase inhibitors reduce blood glucose levels by slowing down the absorption of carbohydrates in your small intestine. They can also reduce your insulin levels after meals and snacks. Examples of AGIs include voglibose, acarbose and miglitol.

ome of the most common side effects of AGIs are caused by the fermentation of unabsorbed carbohydrates in your GI tract. These side effects include bloating, flatulence, abdominal cramping and diarrhea. AGIs aren't recommended for people with liver or kidney disease.

Biguanides

Biguanides reduce blood glucose levels by increasing the utilization of glucose by your body. They also slightly reduce the amount of glucose produced by your liver. Metformin, one of the most common biguanides, may be used on its own or in combination with another drug to control blood glucose levels without stimulating the release of additional insulin.

Biguanides aren't recommended for people with advanced liver and kidney disease, alcoholism, dehydration or active infections. If you take a diuretic for high blood pressure or heart failure, your doctor may recommend a different type of medication.

Potential side effects of metformin and other biguanides include flatulence, abdominal cramps, nausea, vomiting and diarrhea.

DPP-4 Inhibitors

DPP-4 inhibitors reduce blood glucose levels by inhibiting the DPP-4 enzyme, which is involved in the metabolism of carbohydrates. Suppression of the DPP-4 enzyme triggers the release of insulin, inhibits glucagon secretion and slows down the emptying of the stomach.

Saxagliptin, alogliptin, linagliptin and sitagliptin are DPP-4 inhibitors that have been approved by the U.S. Food and Drug Administration.

DPP-4 inhibitors shouldn't be used by people with Type 1 diabetes or anyone who is in diabetic ketoacidosis. The most common side effects of these drugs include urinary tract infections, joint pain, headaches and swelling of the nasal passages.

Meglitinides

Meglitinides are intended for Type 2 diabetics who have poor control over their glucose levels. They work by stimulating the release of insulin from the pancreas, which causes glucose to enter the cells instead of staying in the bloodstream.

Because meglitinides are intended to stimulate short bursts of insulin to prevent your blood sugar from getting too high during and after meals, your doctor may have you take it 15 to 30 minutes before eating.

Repaglinide and nateglinide are classified as meglitinides. Possible side effects include dizziness, diarrhea, upset stomach, cold symptoms, flu symptoms and weight gain.

SGLT2 Inhibitors

SGLT2 inhibitors increase excretion of glucose in the urine, which reduces the amount of glucose in the blood. They are often used with metformin and other medications to help Type 2 diabetics improve their blood sugar control. The FDA has not approved this type of drug for use in Type 1 diabetics.

Canagliflozin, empagliflozin and dapagliflozin are all SGLT2 inhibitors. Possible side effects include genital yeast infections, urinary tract infections, increased urination, nausea, increased cholesterol levels and thirst.

Sulfonylureas

Sulfonylureas are used to treat diabetes in Type 2 diabetics with poor glucose control. These oral tablets trigger the release of insulin from the pancreas, reducing the amount of glucose in the blood.

Unlike meglitinides, sulfonylureas are designed to stimulate the release of insulin over several hours. Therefore, your doctor may recommend that you take one of these medications in the morning and/or evening. Glipizide, chlorpropamide, glimepiride and glyburide are all classified as sulfonylureas.

These medications may cause hypoglycemia, especially in older people and people with damaged kidneys, so be sure to check your blood sugar regularly while taking a sulfonylurea. Other side effects include weight gain, hunger, upset stomach, skin reactions, dizziness, nervousness, confusion and dark-colored urine.

Insulin

If you have Type 1 diabetes, you'll need to take insulin for the rest of your life since your pancreas can't produce enough to meet your daily needs. Insulin is also used in Type 2 diabetics who haven't responded to lifestyle changes or other medications.

How much insulin you need and how many times you take it each day will depend on factors such as whether you have Type 1 or Type 2 diabetes and how much your blood sugar levels vary throughout the day.

Rapid insulin helps prevent sudden spikes in blood sugar after you eat. They typically work for two to four hours and then wear off.

Intermediate-acting, long-acting and ultralong-acting insulin prevents your blood sugar level from getting too high by helping your body use glucose more efficiently. The effects typically last anywhere from eight to 40 hours. Possible side effects of insulin include dizziness, shakiness, sweating, hunger, trouble concentrating, increased heart rate and blurred vision.

The risk of side effects is higher if you take too much or too little of your insulin at one time.

Insulin isn't available as an oral medication because your digestive system would destroy it before it had any effect on your blood sugar. Therefore, many people inject their insulin with a traditional needle and syringe or a pen-like object designed specifically for giving injections.

If you have difficulty giving yourself injections, your medical team may recommend an insulin pump instead. An insulin pump delivers controlled doses of insulin throughout the day, keeping your blood sugar under control. You may also be eligible to take inhaled insulin, which you breathe in through your nose at the beginning of each meal. 

Resources for Managing Diabetes