The four things you have to do every day to lower high blood sugar are:

Eat healthy food Get regular exercise Take your diabetes medicine Test your blood sugar.

Experts say most people with diabetes should try to keep their blood sugar level as close as possible to the level of someone who does not have diabetes. This may not be possible or right for everyone. Check with your doctor about the right range of blood sugar for you.

You will get plenty of help in learning how to do this from your health care providers. Your main health care providers are your doctor, nurse, and dietitian.

A dietitian is someone who is specially trained to help people plan their meals.

Visit Resources for persons with Diabetes for more information about these health care providers and how to find one near you!

Bring a family member or friend with you when you see your doctor. Ask lots of questions. Before you leave, be sure you understand everything you need to know about taking care of your diabetes.

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People with diabetes do not need special foods. The foods on your diabetes eating plan are the same foods that are good for everyone in your family! Try to eat foods that are low in fat, salt, and sugar and high in fiber such as beans, fruits and vegetables, and grains. Eating right will help you:

1. Reach and stay at a weight that is good for your body.
2. Keep your blood sugar in a good range.
3. Prevent heart and blood vessel disease.

Your daily eating plan should include foods from these groups: Milk and milk products like yogurt. Meat, chicken or other poultry, fish, beans, cheese, and eggs. Fruits and vegetables. Bread, cereal, rice, noodles, and potatoes.

People with diabetes should have their own eating plan. Ask your doctor to give you the name of a dietitian who can work with you to develop an eating plan for you and your family. Your dietitian can help you plan meals to include foods that you and your family like to eat and that are good for you.

(Visit "Diabetes and Nutrition" for additional dietary information)

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Steps to take...

If you USE insulin

• Give yourself an insulin shot before you eat.
• Eat at about the same time and the same amount of food every day.
• Don't skip meals, especially if you have already given yourself an insulin shot because your blood sugar may go too low.

If you DON'T USE insulin

• Follow your meal plan.
• Don't skip meals, especially if you take diabetes pills because your blood sugar may go too low. Skipping a meal can make you eat too much at the next meal. It may be better to eat several small meals during the day instead of one or two big meals.

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Exercise is extremely important for your diabetes. Walking, swimming, dancing, riding a bicycle, playing baseball, and bowling are all good ways to exercise. You can even get exercise when you clean house or work in your garden. Exercise is especially good for people with diabetes because:

1. Exercise helps keep weight down.
2. Exercise helps insulin work better to lower blood sugar.
3. Exercise is good for your heart and lungs.
4. Exercise gives you more energy.

Before you begin exercising, talk with your doctor. Your doctor may check your heart and your feet to be sure you have no special problems. Your doctor or nurse will help you find safe exercises. Try to exercise regularly. Exercise at least three times a week for about 20 to 45 minutes each time. If you have not exercised in a while, begin slowly. Start with 5 to 10 minutes, and then work up to more time.

If you haven't eaten for over an hour or if your blood sugar is less than 100-120, eat or drink something like an apple or a glass of milk before you exercise.

When you exercise, carry a snack with you in case of low blood sugar. Wear or carry an identification tag or card saying that you have diabetes.

Regular exercise such as walking and bicycling can help keep your blood sugar in a good range.

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Steps to take...

If you USE insulin

• Exercise after eating, not before.
• Test your blood sugar before, during, and after exercising. Don't exercise when your blood sugar is over 240.
• Don't exercise right before you go to sleep, because it could cause low blood sugar during the night.

If you DON'T USE insulin

• See your doctor before starting an exercise program.
• Test your blood sugar before and after exercising if you take diabetes pills.

Take your diabetes medicine every day

Insulin and diabetes pills are the two kinds of medicines used to lower blood sugar.

If you use insulin

You need insulin if your body has stopped making insulin or if it doesn't make enough insulin. Everyone with type 1 diabetes needs insulin, and some people with type 2 diabetes need insulin.

Insulin cannot be taken as a pill. You will have to give yourself shots every day. Some people give themselves one shot a day. Some people give themselves two or more shots a day. You need to take your insulin every day. Never skip a shot, even if you are sick.

Insulin is injected with a needle. Your doctor will tell you what kind of insulin to use, how much, and when to give yourself a shot. Talk to your doctor before changing the type or amount of insulin you use or when you give your shots.

Your doctor or the diabetes educator will show you how to draw up insulin in the needle. They will also showyou the best places on your body to give yourself a shot. Ask someone to help you with your shots if your hands are shaky or you can't see well.

Good places on your body to give shots are:

The outside part of your upper arms. Around your waist and hips. The outside part of your upper legs. Avoid areas with scars and stretch marks Ask your doctor or nurse to check your skin where you give your shots.

You may be a little afraid at first to give yourself a shot. Most people find that the shots hurt less than they expected. The needles are small and sharp and do not go deep into your skin. Always use your own needles and never share them with anyone else. Your doctor or diabetes educator will tell you how to throw away used needles safely.

Keep extra insulin in your refrigerator in case you break the bottle you are using. Do not keep insulin in the freezer or in hot places like the glove compartment of your car. Also, keep it away from bright light. Too much heat, cold, and bright light can damage insulin.

If you take diabetes pills

If your body makes insulin, but the insulin doesn't lower your blood sugar, you may have to take diabetes pills. Diabetes pills only work in people who have some insulin of their own. Some pills are taken once a day, some are taken more often. Ask your doctor when you should take your pills.

Diabetes pills are safe and easy to take. Be sure to tell your doctor if your diabetes pills make you feel bad or if you have any other problems. Remember, diabetes pills do not lower blood sugar all by themselves. You will still have to follow an eating plan and exercise to help lower your blood sugar.

Sometimes, people who take diabetes pills may need insulin shots for a while. This may happen if you get very sick, need to go to a hospital, or become pregnant. You may need insulin shots if the diabetes pills no longer work to lower your blood sugar.

You may be able to stop taking diabetes pills if you lose weight and exercise every day. Losing even a little bit of weight can sometimes help to lower your blood sugar.

If you don't use insulin or take diabetes pills Many people with type 2 diabetes don't have to use insulin or take diabetes pills. However, everyone with diabetes needs to follow their doctors advice about eating and getting enough exercise. Ask your doctor when you should take your pills or insulin. Tell your other doctors that you take insulin or diabetes pills.

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You need to know how well you are taking care of your diabetes. You need to know if you are lowering your high blood sugar. The best way to find out is to test your blood to see how much sugar is in it. If your blood has too much or too little sugar in it, your doctor may need to change your eating, exercise, or medicine plan.

Ask your doctor how often and when you should test your blood sugar. Some people test their blood once a day. Others test their blood three or four times a day.

To test your blood sugar, you need a small needle called a lancet. You also need special blood testing strips that come in a bottle. Your doctor or diabetes educator will show you how to test your blood.

Here are the basic steps to follow:
(1) Prick your finger with the lancet to get a drop of blood.
(2) Place the blood on the end of the strip.
(3) The strip changes color in about a minute. Match the color of the strip to a color chart on the bottle or box that the strips came in. This will give you a round number for your blood sugar, like 80 or 140.
(4) Put the strip into the meter. The meter will give you an exact number for your blood sugar, like 128

Pricking your finger with a lancet may hurt a little. It's like sticking your finger with a pin. Use the lancet only once and be careful when you throw away used lancets. Ask your doctor or nurse how to throw them away safely.

You can buy lancets, strips, and meters at a drug store. Some of these items are costly, especially the blood testing strips. Lancets do not cost very much, and meters are often on sale. There are many different kinds of meters available in drug stores. If you decide to buy one, ask your doctor or diabetes educator for advice on what kind to buy.

Take your blood testing items with you when you see your doctor or nurse so that you can learn how to use them correctly.

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Urine tests

You may need to test your urine ketones when you are sick or if your blood sugar is over 240 before eating a meal. A urine test will tell you if you have "ketones" in your urine. Your body makes ketones when there is little or no insulin in your blood. When this happens glucose (sugar) can not be used for energy. Your body then starts breaking down other tissues, such as fat and muscle. Ketones are acids created by fat break down.

Large amounts of ketones can make you very sick. Call your doctor right away if you find ketones when you do a urine test. You may have a sickness called "ketoacidosis." Ketoacidosis is serious. If not treated, it can cause death. Signs of ketoacidosis are vomiting, weakness, fast breathing, and a sweet smell on the breath.

Ketoacidosis is much more likely to develop in people with insulin-dependent (type 1)diabetes. It is uncommon in people with type 2 diabetes.

You can buy strips for testing urine ketones at a drug store. Your doctor or diabetes educator will show you how to use them.

The hemoglobin A1c test

Another test for blood sugar, the hemoglobin A1c test, shows how well blood sugar was controlled for the past 3 months. It shows how much sugar is sticking to your red blood cells.

See your doctor for a hemoglobin A1c test every 3 months. To do the test, the doctor or nurse takes a sample of your blood. The blood is tested in a laboratory. The laboratory sends the results to your doctor.

If most of the blood sugar tests you do yourself show that your blood sugar is around 150, the hemoglobin A1c test should be almost normal. If most of your tests show high levels of blood sugar, then the hemoglobin A1c test is usually high.

Ask your doctor what your hemoglobin A1c test showed.

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Keep daily records

Write down the results of your blood tests every day in a record book. You can use a small notebook or ask your doctor for a blood testing record book. You may also want to write down what you eat, how you feel, and how much you have exercised.

By keeping daily records of your blood and urine tests, you can tell how well you are taking care of your diabetes. Show your book to your doctor. The doctor can use your records to see if you need to make changes in your insulin shots or diabetes pills, or in your eating plan. Ask your doctor or nurse if you don't know what your test results mean.

Things to write down every day in your notebook are:

• if you had very low blood sugar
• if you ate more or less food than you usually do
• if you felt sick or very tired
• what kind of exercise you did and for how long

Sample of a non insulin user record book:

Keeping records of your blood tests, insulin shots, and daily events helps you keep track of your diabetes.

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Steps to take...

If you USE insulin

Keep a daily record of:

• When you gave yourself an insulin shot.
• How much and what kind of insulin you gave in each shot.
• If you tested your urine and found ketones.

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Doctors Corner acknowledges the NIDDK as the primary source for this publication. This webpage has been modified by Doctors Corner to enhance readability and provide additional information of importance to our readers.

This material is not copyrighted and may be freely copied and distributed.

Doctors Corner INternet Group, Inc. 1997-2004

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