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Welcome to the Diabetes Page



Diabetes is a serious chronic disease that can be managed through lifestyle changes and medication. Over 18 million Americans have diabetes, and another 41 million adults ages 40 to 74 have pre-diabetes. Whether you just found  out you have diabetes or have been dealing with it for years, you can control your diabetes and live a long, active life. If you are at risk or have pre-diabetes, you can take small steps to prevent the disease.

What Is Diabetes?

If you just found out you have diabetes or want to know more about the disease, this section will help answer your questions. Learn more about the different types of diabetes, including their causes, risk factors, symptoms, and complications.

Diabetes Control

Diabetes is a serious disease, but it is controllable. Learn more about the disease, treatments, monitoring the ABCs of diabetes, and preventing severe complications.

Diabetes Prevention

Diabetes prevention is proven, possible, and powerful. Learn more about the risks for developing type 2 diabetes and the "small steps" you can take to delay or prevent the disease before it starts.

Resources on Children and Adolescents

Children with type 1 and type 2 diabetes and their caregivers face special challenges. Take advantage of all of the NDEP's resources to equip children with diabetes, their caregivers, and school personnel with the tools they need to succeed.

Diabetes Organizations

Diabetes may be difficult to manage, but you don't have to do it alone. Learn about organizations in your community that can help.

What Diabetes Is

Diabetes means that your blood glucose (often called blood sugar) is too high. Your blood always has some glucose in it because your body needs glucose for energy to keep you going. But too much glucose in the blood isn't good for your health.

How do you get high blood glucose?

Glucose comes from the food you eat and is also made in your liver and muscles. Your blood carries the glucose to all the cells in your body. Insulin is a chemical (a hormone) made by the pancreas. The pancreas releases insulin into the blood. Insulin helps the glucose from food get into your cells. If your body doesn't make enough insulin or if the insulin doesn't work the way it should, glucose can't get into your cells. It stays in your blood instead. Your blood glucose level then gets too high, causing pre-diabetes or diabetes.

What is pre-diabetes?

Pre-diabetes is a condition in which blood glucose levels are higher than normal but are not high enough for a diagnosis of diabetes. People with pre-diabetes are at increased risk for developing type 2 diabetes and for heart disease and stroke. The good news is if you have pre-diabetes, you can reduce your risk of getting diabetes. With modest weight loss and moderate physical activity, you can delay or prevent type 2 diabetes and even return to normal glucose levels.

What are the signs of diabetes?

  • The signs of diabetes are
  • being very thirsty
  • urinating often
  • feeling very hungry or tired
  • losing weight without trying
  • having sores that heal slowly
  • having dry, itchy skin
  • losing the feeling in your feet or having tingling in your feet
  • having blurry eyesight

You may have had one or more of these signs before you found out you had diabetes. Or you may have had no signs at all. A blood test to check your glucose levels will show if you have pre-diabetes or diabetes.

What kind of diabetes do you have?

People can get diabetes at any age. There are three main kinds. Type 1 diabetes, formerly called juvenile diabetes or insulin-dependent diabetes, is usually first diagnosed in children, teenagers, or young adults. 

In this form of diabetes, the beta cells of the pancreas no longer make insulin because the body's immune system has attacked and destroyed them. Treatment for type 1 diabetes includes taking insulin shots or using an insulin pump, making wise food choices, exercising regularly, taking aspirin daily (for some), and controlling blood pressure and cholesterol.

Type 2 diabetes

Formerly called adult-onset diabetes or noninsulin-dependent diabetes, is the most common form of diabetes. People can develop type 2 diabetes at any age--even during childhood. This form of diabetes usually begins with insulin resistance, a condition in which fat, muscle, and liver cells do not use insulin properly. 

At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, it loses the ability to secrete enough insulin in response to meals. Being overweight and inactive increases the chances of developing type 2 diabetes. 

Treatment includes using diabetes medicines, making wise food choices, exercising regularly, taking aspirin daily, and controlling blood pressure and cholesterol. Some women develop gestational diabetes during the late stages of pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin. Diabetes can start at any age.

This guide is for people who have either type 1 diabetes or type 2 diabetes.

  • If you use insulin, look at the white boxes for "Action Steps."
  • If you don't use insulin, look at the gray boxes for "Action Steps."

Why do you need to take care of your diabetes?

After many years, diabetes can lead to serious problems in your eyes, kidneys, nerves, and gums and teeth. But the most serious problem caused by diabetes is heart disease. When you have diabetes, you are more than twice as likely as people without diabetes to have heart disease or a stroke. If you have diabetes, your risk of a heart attack is the same as someone who has already had a heart attack. 

Both women and men with diabetes are at risk. You may not even have the typical signs of a heart attack. You can reduce your risk of developing heart disease by controlling your blood pressure and blood fat levels. If you smoke, talk with your doctor about quitting. Remember that every step toward your goals helps! Later in this guide, we'll tell you how you can try to prevent or delay long-term problems. 

The best way to take care of your health is to work with your health care team to keep your blood glucose, blood pressure, and cholesterol in your target range.

What's a desirable blood glucose level?

Everyone's blood has some glucose in it. In people who don't have diabetes, the normal range is about 70 to 120. Blood glucose goes up after eating, but returns to the normal range 1 or 2 hours later. Ask your health care team when you should check your blood glucose with a meter. Talk about whether the blood glucose targets listed below are best for you. Then write in your own targets.

Blood Glucose Targets for Most People
When Target levels My target levels

Before meals 90 to 130 _____________ 1 to 2 hours after the start of a meal less than 180 _____________

It may be hard to reach your target range all of the time. But the closer you get to your goal, the more you will reduce your risk of diabetes-related problems and the better you will feel. Every step helps.

Taking Care of Your Diabetes Every Day

  • Do four things every day to lower high blood glucose:
  • Follow your meal plan.
  • Get regular exercise.
  • Take your diabetes medicine.
  • Check your blood glucose.

Experts say most people with diabetes should try to keep their blood glucose level as close as possible to the level of someone who doesn't have diabetes. The closer to normal your blood glucose is, the lower your chances are of
developing damage to your eyes, kidneys, and nerves. 

Check with your doctor about the right range for you. The chart in chapter one shows target blood glucose ranges. Your health care team will help you learn how to reach your target blood glucose range. Your main health care providers are your doctor, nurse, diabetes educator, and dietitian. 

When you see your health care provider, ask lots of questions. Before you leave, be sure you understand everything you need to know about taking care of your diabetes.

A diabetes educator is a health care worker who teaches people how to manage their diabetes. Your educator may be a nurse, a dietitian, or another kind of health care worker.

A dietitian is someone who's specially trained to help people plan their meals. For more information about these health care providers and for help in finding them, see chapter six. The next sections of this guide will tell you more about the four main ways you take care of your diabetes: Follow your meal plan, get regular exercise, take your diabetes medicine, and check your blood glucose.

Follow Your Meal Plan

People with diabetes don't need to eat special foods. The foods on your meal plan 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, vegetables, and grains. Eating
right will help you

  • Reach and stay at a weight that's good for your body.
  • Keep your blood glucose in a desirable range.
  • Prevent heart and blood vessel disease.

Your daily meal plan should include foods from these groups: Source: U.S. Department of Agriculture/U.S. Department of Health and Human Services People with diabetes should have their own meal plan. Ask your doctor to give you the name of a dietitian who can work with you to develop a meal plan. 

Your dietitian can help you plan meals to include foods that you and your family like to eat and that are good for you too. Ask your dietitian to include foods that are heart-healthy to reduce your risk of heart disease.


If you use insulin

  • Follow your meal plan.
  • Don't skip meals, especially if you've already taken your insulin, because your blood glucose may go too lo w. (See chapter 3 for information on how to handle hypoglycemia, also called low blood sugar.)


If you DON'T use insulin

  • Follow your meal plan.
  • Don't skip meals, especially if you take diabetes medicine, because your blood glucose may go too low. It may be better to eat several small meals during the day instead of one or two big meals.

Get Regular Exercise

Exercise is good 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

  • Exercise helps keep weight down.
  • Exercise helps insulin work better to lower blood glucose.
  • Exercise is good for your heart and lungs.
  • 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. If you have high blood pressure or eye problems, some exercises like weightlifting may not be safe. Your health care team can help you find safe exercises. 

Try to exercise almost every day for a total of about 30 minutes. If you haven't exercised lately, begin slowly. Start with 5 to 10 minutes, and then add more time. Or exercise for 10 minutes, three times a day. If you haven't eaten for more than an hour or if your blood glucose is less than 100 to 120, have a snack before you exercise. (See chapter 3 for snack ideas.) Being active helps you feel better. 

When you exercise, carry glucose tablets or a carbohydrate snack with you in case you get hypoglycemia (low blood sugar). Wear or carry an identification tag or card saying that you have diabetes. The groups listed in chapter six have more information about diabetes and


If you use insulin

  • See your doctor before starting an exercise program.
  • Check your blood glucose before, during, and after exercising. Don't exercise when your blood glucose is over 240 or if you  have ketones in your urine (see below).
  • Don't exercise right before you go to sleep, because it could cause hypoglycemia (low blood sugar) during the night.


If you don't use insulin

  • See your doctor before starting an exercise program.

Take Your Diabetes Medicine Every Day

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

If You Use Insulin

  • You need insulin if your body has stopped making insulin or if it doesn't make enough. Everyone with type 1 diabetes needs insulin, and many people with type 2 diabetes do too. Insulin can't be taken as a pill. You'll give yourself shots every day or use an insulin pump. 
  • Insulin pumps are small machines that connect to narrow tubing, ending with a needle just under the skin near the abdomen. Insulin is delivered through the needle. Keep extra insulin in your refrigerator in case you break the bottle you're using. Don't 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 use a whole bottle of insulin within 30 days, you can keep that bottle at room temperature. If you don't use a whole bottle of insulin within 30 days, then store it in the refrigerator. You may need insulin to control your blood glucose.

If You Take Diabetes Pills

If your body makes insulin, but the insulin doesn't lower your blood glucose, you may need diabetes pills. Some pills are taken once a day, and others are taken more often. Ask your health care team when you should take your pills.
Be sure to tell your doctor if your pills make you feel sick or if you have any other problems. 

Remember, diabetes pills don't lower blood glucose all by themselves. You'll still want to follow a meal plan and exercise to help lower your blood glucose. Sometimes, people who take diabetes pills may need insulin shots for a while. 

If you get sick or have surgery, the diabetes pills may no longer work to lower your blood glucose. You may be able to stop taking diabetes pills if you lose weight. (Always check with your doctor before you stop taking your diabetes pills.) Losing 10 or 15 pounds can sometimes help you reach your target blood glucose level. Many people with type 2 diabetes take pills to help keep blood glucose in their target range.

If You Don't Use Insulin or Take Diabetes Pills

Many people with type 2 diabetes don't need insulin or diabetes pills. They can take care of their diabetes by using a meal plan and exercising regularly.

Check Your Blood Glucose as Recommended

You'll want to know how well you're taking care of your diabetes. The best way to find out is to check your blood to see how much glucose is in it. If your blood has too much or too little glucose, you may need a change in your meal plan, exercise plan, or medicine. 

Ask your doctor how often you should check your blood glucose. Some people check their blood glucose once a day. Others do it three or four times a day. You may check before eating, before bed, and sometimes in the middle of the night. Your doctor or diabetes educator will show you how to check your blood using a blood glucose meter. 

Your health insurance or Medicare may pay for the supplies and equipment you need. Checking your blood glucose will help you see if your diabetes treatment plan is working.

Take Other Tests for Your Diabetes

Urine Tests

You may need to check your urine if you're sick or if your blood glucose is over 240. A urine test will tell you if you have ketones in your urine. Your body makes ketones when there isn't enough insulin in your blood. 

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 serious condition called ketoacidosis. If it isn't treated, it can cause death. Signs of ketoacidosis are vomiting, weakness, fast breathing, and a sweet smell on the breath. Ketoacidosis is more likely to develop in people with type 1 diabetes. You can buy strips for testing ketones at a drug store. Your doctor or diabetes educator will show you how to use them.

The A1C Test

Another test for blood glucose, the A1C, also called the hemoglobin A1C test, shows what your overall blood glucose was for the past 3 months. It shows how much glucose is sticking to your red blood cells. The doctor does this test to see what your blood glucose is most of the time. Have this test done at least twice a year.

Ask your doctor what your A1C test showed.

A result of under 7 usually means that your diabetes treatment is working well and your blood glucose is under control. If your A1C is 8 or above, it means that your blood glucose may be too high. You'll then have a greater chance of getting diabetes problems, like kidney damage. You may need a change in your meal plan, exercise plan, or diabetes medicine.

A1C Results

Target for most people with diabetes under 7 Time to change my diabetes care plan 8 or above
My last result __________
My target __________

Talk with your doctor about what your target should be. Even if your A1C is higher than your target, remember that every step toward your goal helps reduce your risk of diabetes problems.

Keep Daily Records

Print and make copies of the daily diabetes record page. Then write down
the results of your blood glucose checks every day.

You may also want to write down what you ate, how you felt, and whether you exercised. By keeping daily records of your blood glucose checks, you can tell how well you're taking care of your diabetes. 

Show your blood glucose records to your health care team. They can use your records to see whether you need changes in your diabetes medicines or in your meal plan. If you don't know what your results mean, ask your health care team. 

Things to write down every day in your record book are:

  • results of your blood glucose checks your diabetes medicines: times and amounts taken
  • if your blood glucose was very low (see chapter three)
  • if you ate more or less food than you usually do
  • if you were sick
  • if you found ketones in your urine what kind of exercise you did and for how long


If you use insulin

Keep a daily record o

  • If Your blood glucose numbers.
  • The times of the day you took your insulin.
  • The amount and type of insulin you took.
  • Whether you had ketones in your urine.


If you DON'T use insulin

  • Keep a daily record of Your blood glucose numbers.
  • The times of the day you took your diabetes pills.
  • Sample of a record page for a person who doesn't use insulin or diabetes pills.

When Your Blood Glucose Is Too High or Too Low

Sometimes, no matter how hard you try to keep your blood glucose in your target range, it's too high or too low. Blood glucose that's too high or too low can make you very sick. Here's how to handle these emergencies.

What You Need to Know About High Blood Glucose

If your blood glucose stays over 180, it may be too high. (Go back to the chart.) It means you don't have enough insulin in your body. High blood glucose can happen if you miss taking your diabetes medicine, eat too much, or don't get enough exercise. Sometimes, the medicines you take for other problems cause high blood glucose. 

Be sure to tell your doctor about other medicines you take. Having an infection or being sick or under stress can also make your blood glucose too high. That's why it's very important to check your blood glucose and keep taking your insulin or diabetes pills when you're sick. (For more about how to take care of yourself when you're sick, see chapter five.) 

If you're very thirsty and tired, have blurry vision, and have to go to the bathroom often, your blood glucose may be too high. Very high blood glucose may also make you feel sick to your stomach.

If your blood glucose is high much of the time or if you have symptoms of high blood glucose, call your doctor.  

You may need a change in your insulin or diabetes pills, or a change in your meal plan.

What You Need to Know About Low Blood Glucose (Hypoglycemia)

Hypoglycemia happens if your blood glucose drops too low. It can come on fast. It's caused by taking too much diabetes medicine, missing a meal, delaying a meal, exercising more than usual, or drinking too much alcohol. Sometimes, medicines you take for other health problems can cause blood glucose to drop. 

Hypoglycemia can make you feel weak, confused, irritable, hungry, or tired. You may sweat a lot or get a headache. You may feel shaky. If your blood glucose drops lower, you could pass out or have a seizure. If you have any of these symptoms, check your blood glucose. If the level is 70 or below, have one of the following right away:

  • 2 or 3 glucose tablets
  • 1/2 cup (4 oz.) of any fruit juice
  • a piece of fruit or a small box of raisins
  • 1/2 cup (4 oz.) of a regular (not diet) soft drink
  • 5 or 6 pieces of hard candy
  • 1 or 2 teaspoons of sugar or honey

Have one of these "quick fix" foods when your blood glucose is low. After 15 minutes, check your blood glucose again to make sure that it's no longer too low. Once your blood glucose is stable, if it will be at least an hour before your next meal, have a snack. If you take insulin or a diabetes pill that can cause hypoglycemia, always carry food for emergencies. 

It's a good idea also to wear a medical identification bracelet or necklace. If you take insulin, keep a glucagon kit at home and also at a few other places where you go often. Glucagon is given as an injection with a syringe and quickly raises blood glucose. Show your family, friends, and co-workers how to give you a glucagon injection if you pass out because of hypoglycemia. 

You can prevent hypoglycemia by eating regular meals, taking your diabetes medicine, and checking your blood glucose often. Checking will tell you whether your glucose level is going down. You can then take steps, like eating some fruit, crackers, or other snacks, to raise your blood glucose. When you have hypoglycemia, have a snack to bring your blood glucose back to normal.


If you use insulin

  • Tell your doctor if you have hypoglycemia often, especially at the same time of the day or night several times in a row.
  • Tell your doctor if you've passed out from hypoglycemia.
  • Ask your doctor about glucagon. Glucagon is a medicine that raises blood glucose. 
  • If you pass out from hypoglycemia, someone should call 911 and give you a glucagon shot.


If you DON'T use insulin

  • Tell your doctor if you have hypoglycemia often, especially at the same time of the day or night several times in a row.
    Be sure to tell your doctor about other medicines you are taking. 


  • Some diabetes pills can cause hypoglycemia. Ask your doctor whether your pills can cause hypoglycemia.

Why It's Important to Take Care of Your Diabetes

Taking care of your diabetes every day will help keep your blood glucose in your target range and help prevent other health problems that diabetes can cause over the years. This part of the guide describes those problems. We tell you about them not to scare you, but to help you understand what you can do to keep them from happening.

Do what you can every day to keep your blood glucose in the range that's best for you.

Follow your meal plan every day. Get regular exercise every day. Take your diabetes medicine
every day. Check your blood glucose as recommended.

Diabetes and Your Heart and Blood Vessels

The biggest problem for people with diabetes is heart and blood vessel disease. Heart and blood vessel disease can lead to heart attacks and strokes. It also causes poor blood flow (circulation) in the legs and feet. To check for heart and blood vessel disease, your health care team will do some tests. 

At least once a year, have a blood test to see how much cholesterol is in your blood. Your health care provider should take your blood pressure at every visit. He or she may also check the circulation in your legs, feet, and neck. The best way to prevent heart and blood vessel disease is to take good care of yourself and your diabetes.

  • Eat foods that are low in fat and salt.
  • Keep your blood glucose on track. Know your A1C. The target for most people is under 7.
    If you smoke, quit.
  • Exercise regularly.
  • Lose weight if you need to.
  • Ask your health care team whether you should take an aspirin every day.
  • Keep your blood pressure on track. The target for most people is under 130/80. If needed, take medicine to control your blood pressure
  • Keep your cholesterol level on track. The target for LDL cholesterol for most people is under 100. 
  • If needed, take medicine to control your blood fat levels.

What's a desirable blood pressure level?

Blood pressure levels tell how much your blood is pushing against the walls of your blood vessels. Your pressure is given as two numbers: The first is the pressure as your heart beats and the second is the pressure as your heart relaxes. 

If your blood pressure is higher than your target, talk with your health care team about changing your meal plan, adding exercise, or taking medicine.

Blood Pressure Results

  • Target for most people with diabetes under 130/80
  • My last result ____________
  • My target ____________

What are desirable blood fat levels?

Cholesterol, a fat found in the body, appears in different forms. If your LDL cholesterol ("bad" cholesterol) is 100 or above, you are at increased risk of heart disease and may need treatment. 

A high level of total cholesterol also means a greater risk of heart disease. But HDL cholesterol ("good" cholesterol) protects you from heart disease, so the higher it is, the better. It's best to keep triglyceride (another type of fat) levels under 150. 

All of these target numbers are important for preventing heart disease. 

Target Blood Fat Levels for People With Diabetes Total cholesterol under 200 My last result_____

My target_____ LDL cholesterol under 100 

My last result_____

My target_____ HDL cholesterol above 40 (men) 

My last result_____

My target_____ above 50 (women)

My last result_____

My target_____ Triglycerides under 150 

My last result_____

Rose is 55 years old and teaches at a junior high school on an American Indian reservation in New Mexico. Rose has had type 2 diabetes for almost 10 years. 

When she first found out she had diabetes, she weighed too much and didn't get much exercise. After talking it over with her doctor, Rose began an exercise program. 

She lost weight, and her blood glucose began to come down. She felt better too. Now Rose teaches an exercise class in her spare time.

Chapter 2

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Source National Diabetes Information Clearinghouse (NDIC)


© Anthony George 2005