In short
- Public health agencies describe managing type 2 diabetes as a combination of habits, checks and, for many people, medicine.
- NIDDK sums up the core targets as the diabetes ABCs: A1C, blood pressure, cholesterol, and stopping smoking.
- Meals, activity, sleep and stress all affect blood glucose. Regular eye, foot, kidney and dental checks help catch problems early.
- You do not have to do this alone. The sources all point to a care team and to diabetes education programs.
The diabetes ABCs
NIDDK uses a simple memory aid for the targets that matter most in diabetes care. It says managing them may lower the chance of heart attack, stroke, kidney disease, blindness and amputation.
- A for A1C. The blood test that reflects average glucose over about three months. NIDDK gives below 7 percent as the goal for most people, while noting that yours may differ. The A1C guide explains why.
- B for blood pressure. High blood pressure can damage the heart, kidneys, brain and eyes. NIDDK says some people with diabetes have a goal below 130/80, and that your team will tell you yours.
- C for cholesterol. Unhealthy cholesterol levels can clog blood vessels. NIDDK suggests asking how often you need a cholesterol test and what your level should be; some people are prescribed medicine for it.
- S for stop smoking. Smoking and diabetes both narrow blood vessels. NIDDK says e-cigarettes are not a safe alternative, and encourages asking for help to quit.
Metformin, if it is part of your plan, works on the A. The rest of this page is about everything around it.
Eating and drinking
NIDDK says there is no single right or wrong way to choose healthy food when you have diabetes, and that what you eat, how much, and when are all part of a meal plan. Some of its general points:
- Carbohydrates raise blood glucose. The body turns carbohydrates into glucose. Some fruits, beans and starchy vegetables such as potatoes and corn have more than other foods, so NIDDK suggests keeping carbohydrates in mind when planning meals.
- Choose drinks with little or no added sugar, such as water, unsweetened tea or coffee, or low-fat milk, and limit sugary foods and sweet drinks.
- Favorite foods are not banned. NIDDK says you can still have them, perhaps in smaller portions or less often.
- Alcohol. NIDDK says to limit alcohol and, if you drink, to eat at the same time. MedlinePlus's metformin page asks you to tell your doctor about your drinking and to ask how much is safe for you.
- Supplements. NIDDK says there is no clear proof that particular foods, herbs, spices or supplements help manage diabetes, and to talk with your clinician before taking any, because some can cause side effects or affect how diabetes medicines work.
NIDDK describes two common ways to plan portions. Carbohydrate counting means keeping track of carbohydrates at each meal or snack; NIDDK says not everyone with diabetes needs to do this. The plate method divides a plate so that half is non-starchy vegetables, a quarter is high-fiber carbohydrate foods, and a quarter is protein foods.
NIDDK suggests working with a registered dietitian or diabetes educator to build a plan that suits you, and notes that some insurance covers medical nutrition therapy. If you have overweight or obesity, NIDDK suggests asking your care team how to manage your weight.
Physical activity
NIDDK says regular physical activity helps people manage diabetes and may help lower blood glucose, blood pressure and cholesterol, and improve sleep and mood. Its general guidance for most adults is at least 150 minutes a week of moderate activity, such as brisk walking, which can be split into shorter sessions through the day, plus muscle-strengthening activity on two days a week if you can.
NIDDK also says to talk with your clinician before starting a new activity or changing how much you do, because the right activity depends on your health, meal plan and medicines. It adds that any activity is better than none, and suggests starting slowly with something you enjoy.
Activity can lower blood glucose during and after exercise. NIDDK says some diabetes medicines, such as sulfonylureas or insulin, can make glucose drop too low during exercise, so ask your care team whether you need to plan anything around being active.
Sleep, stress and mood
NIDDK says enough sleep may improve mood, energy and blood glucose, and that most adults should aim for about 7 to 8 hours a night. It also links sleep apnea, where breathing stops briefly during sleep, with type 2 diabetes, and says treating it can help.
Feeling stressed, sad or angry is common with diabetes, according to NIDDK, and long-term stress can raise blood glucose and blood pressure. CDC suggests regular activity, enough sleep and relaxation exercises, and talking with your doctor or diabetes educator about other ways to manage stress.
NIDDK notes that depression is common among people with long-term illnesses such as diabetes and can be treated. If you often feel sad, hopeless or anxious, tell your doctor.
Regular checks
NIDDK describes a range of problems that diabetes can lead to over time, and the checks that help catch them early:
| Area | What NIDDK says |
|---|---|
| Eyes | A dilated eye exam at least once a year. |
| Feet | A foot check at each visit with the care team, because nerve damage and poor blood flow can lead to serious foot problems. |
| Kidneys | Blood and urine tests, because kidney disease from diabetes usually has no symptoms at first. |
| Mouth | A dentist visit at least once a year, and brushing twice a day. |
| Heart and blood vessels | Managing blood glucose, blood pressure and cholesterol, and not smoking. |
CDC adds that regular appointments with your care team help keep your treatment plan on track and let you hear about new approaches. NIDDK suggests keeping track of your ABCs and other results from checkups so you can discuss them at visits.
Support and education
CDC says everyone with diabetes can benefit from diabetes self-management education and support, often shortened to DSMES, whether they were diagnosed last week or years ago. It suggests asking your doctor to recommend a diabetes educator.
NIDDK describes the wider team that can help: a primary care clinician, a diabetes educator, nurse or registered dietitian, specialists if other health problems develop, and a social worker who may help with costs and community resources. NIDDK also says to plan ahead with your team for special situations such as being sick, fasting, travelling or emergencies.
Small steps
CDC's tips for living with diabetes favour small, practical changes over big ones: start new habits small, because small successes make larger goals easier; make good choices easier, for example, as CDC puts it, by leaving the dog's leash by the door; and eat the same healthy meals as the rest of the household. NIDDK makes the same point: starting with small changes and building from there may benefit your health, and family, friends and other trusted people can help.
Worked example
This example is invented and describes no real person. Someone recently diagnosed picks two changes for the first month: a ten-minute walk after lunch on weekdays, and swapping one sweet drink a day for water. They write both on the question list for their next visit, along with a request to see a diabetes educator, so their care team can say whether these fit their plan.
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