DIABETES

Intro

Diabetes is a disease that occurs when your blood glucose, also called blood sugar, is too high. Blood glucose is your main source of energy and comes from the food you eat. Insulin, a hormone made by the pancreas, helps glucose from food get into your cells to be used for energy. Sometimes your body doesn’t make enough—or any—insulin or doesn’t use insulin well. Glucose then stays in your blood and doesn’t reach your cells.

Diabetes occurs when the pancreas, a gland behind the stomach, does not produce enough of the hormone insulin, or the body cannot use insulin properly. Insulin helps carry sugar from the bloodstream into the cells. Once inside the cells, sugar is converted into energy for immediate use or stored for the future. That energy fuels many of our bodily functions.

The body produces glucose from the foods you eat. The liver also releases sugar when you are not eating. The pancreas produces the hormone insulin, which allows glucose from the bloodstream to enter the body’s cells where it is used for energy. In type 2 diabetes, too little insulin is produced, or the body cannot use insulin properly, or both. This results in a build-up of glucose in the blood. 

Common risk factors include:

• Being obese or overweight
• Not getting enough exercise
• A family history of type 2 diabetes
• Being 45 or older
• African American, Latino/Hispanic or American Indian family background
• Having had gestational diabetes
• Giving birth to a baby weighing more than 9 pounds

Preventing prediabetes is done with lifestyle changes, including a healthy diet that is high in vegetables and fruits and low in fat and processed foods. 

Regular physical activity, averaging 30 minutes five days per week, is also important. Maintaining a healthy weight or losing 5–10% of your weight if you are overweight, can also help.

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CONTENTS

• Intro
• What are the different types of diabetes
• The most common types of diabetes are 
• Differences between Type-1 and Type-2 diabetes include
• Gestational diabetes
• Other types of diabetes
• What health problems can people with diabetes develop
• Treatment
• Diabetes complications
• Diabetic neuropathy
• Peripheral Neuropathy 
• Autonomic Neuropathy
• Consult doctor if you find
• Preventing Eye Problems
• Cholesterol
• Preventing Heart Problems
• Kidney Disease and Diabetes
• Protecting Your Kidneys
• Prevention

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People with diabetes are at risk of developing serious health problems (complications).

If your blood glucose level stays too high for too long, 

complications can include:

• Blindness
• Kidney disease and failure
• Nerve damage which can result in nerve pain or injury to the feet or other extremities without feeling pain
• Heart attacks (with or without symptoms)
• Stroke

Over time, having too much glucose in your blood can cause health problems. 

Although diabetes has no cure, you can take steps to manage your diabetes and stay healthy.

Sometimes people call diabetes “a touch of sugar” or “borderline diabetes”. 

These terms suggest that someone doesn’t really have diabetes or has a less serious case, but every case of diabetes is serious.

What are the different types of diabetes

Prediabetes occurs when blood glucose levels are higher than normal, but not high enough for a diabetes diagnosis. 

Over time, this can increase your risk of heart disease and stroke, as well as your risk of developing type 2 diabetes. 

Unfortunately, prediabetes symptoms are hard to spot, so many people have the condition and do not know it.

Monogenic Diabetes (MODY) is the least common form of diabetes. It is developed as a result of single gene mutations. Monogenic diabetes appears in several forms and most often affects young people.

Type B Insulin Resistance is a very rare form of diabetes and a component of an autoimmune disorder. 

The most common types of diabetes are 

Type-1, Type-2, and Gestational diabetes.

Type-1 Diabetes

If you have type 1 diabetes, your body does not make insulin. Your immune system attacks and destroys the cells in your pancreas that make insulin. Type 1 diabetes is usually diagnosed in children and young adults, although it can appear at any age. 

People with type 1 diabetes need to take insulin every day to stay alive. Type 1 diabetes, sometimes called insulin-dependent diabetes or juvenile diabetes, can develop at any age but most often occurs in children, teens, and young adults. In type 1 diabetes, a person’s pancreas produces little or no insulin, so insulin treatment is needed for a lifetime.

The causes of type 1 diabetes are not fully known. In most cases, the body’s immune system attacks and destroys the part of the pancreas that produces insulin. 

This occurs over a period of time. So early on in type 1 diabetes, people may not have any symptoms. It is only when enough of the insulin producing cells are affected and insulin levels are low that the blood sugar rises and symptoms of diabetes start to occur. 

Because type 1 is an autoimmune disease, people with other autoimmune, conditions, such as Hashimoto’s disease or primary adrenal insufficiency (also known as Addison's Disease), are more likely to develop type 1 diabetes. Overall, cases of type 1 diabetes seem to be increasing.

The symptoms of type 1 diabetes can look like other conditions or medical problems. 

If you (or your child) have these symptoms, talk with your doctor as soon as possible.

• Increased thirst
• Increased urination
• Constant hunger
• Weight loss
• Blurred vision
• Constantly feeling tired

People with type 1 diabetes must have daily injections of insulin to keep a normal level of glucose in the blood. 

Blood glucose is kept under the best control with three or more injections per day using long and short acting insulin, or when insulin is delivered throughout the day with an insulin pump. 

A healthy diet, exercise, and regular monitoring of blood glucose levels are also important to manage diabetes.

Type-2 diabetes

If you have type 2 diabetes, your body does not make or use insulin well. You can develop type 2 diabetes at any age, even during childhood. However, this type of diabetes occurs most often in middle-aged and older people. Type 2 is the most common type of diabetes.

Type 2 diabetes is the most common form of the disease, affecting 90–95% of people with diabetes. In type 2 diabetes, the body is resistant to the action of insulin, meaning it cannot use insulin properly, so it cannot carry sugar into the cells. 

Although the body makes some insulin, it is not enough to overcome this resistance. You are more likely to develop type 2 diabetes if you are overweight, have a family history of diabetes, or have a history of diabetes during pregnancy. Other groups more likely to have the disease are people over age 45 and non-Caucasians. A simple blood test can tell you if you have diabetes.

Individuals with this condition have a pancreas that is able to produce insulin, but their bodies are unable to use or process the insulin that is made. Over time, the pancreas may stop creating insulin altogether, but type 2 diabetes starts with the inability to process the insulin that is made.

People with both type 1 and type 2 have high blood glucose levels, but the reasons for those high levels differ. 

Differences between Type-1 and Type-2 diabetes include:

Age of diagnosis: Type 1 is typically diagnosed in children or young people (but it can be diagnosed in older individuals as well), while type 2 diabetes is generally diagnosed in adults and occasionally children.

Treatment options: For individuals with type 1 diabetes, the only effective treatment is insulin. For people with type 2 diabetes, oral medications (pills), insulin, or non-insulin injectables may be used.

Hypoglycemia: Blood sugar levels can drop to dangerously low levels in people with type I diabetes, but it can also occur in individuals with type 2 diabetes. Certain medications, such as insulin, may increase the risk of hypoglycemia.

Preventability: While certain experimental medications may postpone the development of type 1 diabetes, there are no means of preventing type 1 diabetes. Type 2 diabetes can sometimes be prevented with lifestyle changes. Being older (over 45) and overweight are the greatest risk factors for developing diabetes. 

Other factors that increase your chances of developing high blood glucose include:

• Having a parent or sibling with diabetes
• Having an African American, Latino/Hispanic, or American Indian family background
• Having had gestational diabetes (diabetes during pregnancy) or giving birth to a baby weighing more than 9 pounds
• Having high blood pressure (140/90 mm Hg or higher)
• Having low levels of HDL (good) cholesterol (below 35 mg/dL in men or 45 mg/dL in women) or high levels of triglycerides (above 250 mg/dL)
• Having polycystic ovary syndrome (PCOS)
• Being physically inactive

Gestational diabetes

Gestational diabetes develops in some women when they are pregnant. 

Most of the time, this type of diabetes goes away after the baby is born. 

However, if you’ve had gestational diabetes, you have a greater chance of developing type 2 diabetes later in life. Sometimes diabetes diagnosed during pregnancy is actually type 2 diabetes. 

Gestational Diabetes is a temporary form of diabetes that can occur when a woman is pregnant. During pregnancy, the placenta produces hormones that help the baby develop. 

These hormones also block the effects of insulin in the woman’s body, increasing her blood sugar levels. Most women who with gestational diabetes have no symptoms.

If a woman has high blood sugar in pregnant, she will have to follow a special diet for the rest of the pregnancy. 

In some cases, she may also need to take insulin. High blood sugar in women with gestational diabetes can affect them and their baby. 

These risks include: 

• Premature delivery and preeclampsia (pregnancy-induced high blood pressure).
• The baby grows too large. 
• Very large babies may get stuck in the birth canal and have birth injuries. 
• Large size also increases the chances of needing a cesarean (surgical) delivery.

• May cause stillbirth. Uncontrolled gestational diabetes also increases the risk of jaundice and breathing problems in the newborn.
• After birth, the baby may develop low blood sugar (hypoglycemia), a potentially dangerous condition.
•  While in the womb, the baby’s pancreas produces large amounts of insulin in response to the mother’s high blood sugar, and it continues to do so after delivery.

• Without the sugar supplied by the mother, excess insulin can cause the baby’s own glucose level to drop too low.
•  Any pregnant woman can develop the condition, but some women are at greater risk than others.

 Among women with the below risk factors, as many as 14 in 100 develop gestational diabetes. Known risk factors include:

• Age (older than 25 years; the risk is even greater after age 35)
• Race (occurs more often in African Americans, Hispanics, American Indians, and Asian Americans)
• Overweight and obesity
• Personal history of gestational diabetes or prediabetes
• Having delivered a baby weighing more than 9 pounds
• Family history of type 2 diabetes (in parents or siblings)

Other types of diabetes

Less common types include monogenic diabetes, which is an inherited form of diabetes, and cystic fibrosis-related diabetes External link.

Who is more likely to develop type 2 diabetes?

You are more likely to develop type 2 diabetes if you are age 45 or older, have a family history of diabetes, or are overweight. 

Physical inactivity, race, and certain health problems such as high blood pressure also affect your chance of developing type 2 diabetes. 

You are also more likely to develop type 2 diabetes if you have prediabetes or had gestational diabetes when you were pregnant. Learn more about risk factors for type 2 diabetes.

What health problems can people with diabetes develop?

Over time, high blood glucose leads to problems such as

• heart disease
• stroke
• kidney disease
• eye problems
• dental disease
• nerve damage
• foot problems

Three blood tests  used to check Levels of glucose in your blood and diagnose prediabetes or diabetes:

Fasting Blood Glucose Test (FBG): Blood is drawn in the morning after you go without food overnight or for at least 8 hours.

Oral Glucose Tolerance Test (OGTT): This test is also done in the morning after going without food overnight or for at least 8 hours. Blood is drawn before you drink 8 ounces of a sugar solution and 2 hours after. This test is more precise but less convenient than the FBG test.

Hemoglobin A1C Test (A1C): This test shows what your average blood glucose levels have been over the past 3 months. You can eat and drink normally before the test.

If you are living with diabetes, lifestyle is an important part of your care. It is very important that you eat a good balance of real foods every day and exercise regularly. Managing your diabetes also means taking medicine, if needed, and testing your blood sugar levels each day.

Treatment

It's very important to take your diabetes medications as recommended by your doctor. Left untreated, diabetes can lead to serious, even life-threatening complications. 

Complications can lead to loss of vital body functions (such as with your kidneys), blindness, the need for amputation of toes or feet, and even death (especially from cardiovascular disease). 

By taking your medications as recommended, you greatly reduce your risk of developing diabetes-related complications. 

Treatment includes changes in lifestyle (diet and exercise), plus medicine (if needed). Diabetes can be treated with oral medicines (pills), insulin, and/or other injected medicines. 

People with type 1 diabetes always need insulin. 

People with type 2 diabetes usually need treatment with oral medicines for several or even many years, but may eventually need insulin to maintain glucose control.

Your treatment will depend on the type of diabetes you have.

Insulin helps you manage your blood glucose levels by "unlocking" cells so that they can access your blood glucose for the energy they need. 

Without sufficient insulin or when your cells have a condition called insulin resistance, where they cannot use the insulin your pancreas makes properly, blood glucose builds up, and can eventually damage your arteries and cause other problems that can lead to complications. 

Over time, many people need additional help in controlling blood glucose levels. This is when doctors typically prescribe insulin. 

Insulin is a hormone made by the pancreas. It helps carry sugar from the blood into the cells. The cells use the sugar as energy for the body to work. 

If you have type 1 diabetes (T1D), your body makes very little or no insulin. That’s why you need to take insulin. 

If you have type 2 diabetes (T2D), your body makes too little insulin or can’t use the insulin it makes properly. You must take insulin if you have T1D. 

You may need to take insulin to help better manage your blood sugar levels if you have T2D.

The type of insulin you take is based on three factors: how long it takes to start working (onset), when it is at its strongest action (peak), and how long it lasts (duration). 

Some types of insulin are called basal insulins. These last longer and give you a steady dose of insulin throughout the day and night. Other types are called mealtime, rapid, or bolus insulins. 

These usually last a shorter time but give you insulin to handle the spikes in blood sugar after a meal.

Mealtime (or “bolus”) insulin: Used before meals to control the rise of blood glucose levels after eating. 

Rapid-acting: Insulin glulisine (Apidra), Insulin lispro (Humalog), Insulin aspart (NovoLog), and Inhaled insulin human (Afrezza).

Short-acting: Regular (Humulin R, Novolin R). 

Background (or "basal") Insulin: Controls your blood glucose levels between meals and throughout the night. This is usually used once or twice daily. 

It can be used alone or in combination with oral medicines or rapid-acting insulin.

Intermediate-acting: NPH (Humulin N, Novolin N)

Long-acting: Insulin detemir (Levemir), Insulin glargine (Lantus, Basaglar, Toujeo), and Insulin degludec (Tresiba)

Pre-mixed Insulin: Combination of bolus and basal insulin that controls blood glucose levels after and between meals. 

These are usually used twice daily before breakfast and dinner. They can be used alone or in combination with oral medicines. 

The type of insulin your doctor prescribes will depend on the type of diabetes you have, your lifestyle (when and what you eat, how much you exercise), your age, your body’s response to insulin.

It also depends on how often you are able or willing to check your blood glucose and give yourself injections. 

People with type 1 diabetes typically need both basal and mealtime insulin. Most people with type 2 diabetes who use insulin may start with just basal (long-acting) insulin initially.

Type 2 Diabetes Medications

People with type 2 diabetes usually need treatment with oral medicines for several or even many years but may eventually need insulin to maintain glucose control. 

There are many types of medications that can be prescribed for you. The various options may be overwhelming—memorizing all the names and technical terms isn't important, but understanding that there ARE options is what you need to know. Work with your doctor to determine which of these might be most helpful for you.

Diabetes complications

The high blood sugar of mismanaged diabetes can result in dangerous complications. Diabetes is the most common cause of blindness, kidney failure, and non-traumatic amputation of the toes, feet, or legs. Mismanaged diabetes can also lead to heart disease, stroke, nerve damage, and decreased blood flow, which could cause amputation. People with diabetes may have life-threatening reactions to extremely high blood sugar, as well as extremely low blood sugar caused by diabetes medications.

Diabetic neuropathy

Diabetic neuropathy is nerve damage from high blood glucose (sugar) levels in people with diabetes. Nerves throughout the body can suffer damage. 

People with poor glucose control and who have had diabetes for a long time are at highest risk for nerve damage. Smokers are especially at risk. About 60–70% of people who have had diabetes for many years have some form of nerve damage, but not everyone has symptoms.

The most common types of diabetic neuropathy are those that affect the limbs and those that affect organs and muscles inside the body.

Peripheral Neuropathy 

The first type (called peripheral neuropathy or distal polyneuropathy or DPN) affects the sensitivity of your feet, legs, hands, and arms. It also can affect the movement of your limbs. 

Symptoms of DPN include:

• Pain, tingling, and burning
• Numbness and loss of feeling
• Muscle weakness
• Skin ulcers (open sores)

About half of people who have DPN might not have symptoms, except for losing feeling in their feet. Because of this feeling loss, they could injure their feet and not know it. Untreated foot injuries can lead to ulcers and infection and, sometimes, amputation.

Autonomic Neuropathy

The second type (called autonomic neuropathy) affects your urinary tract, digestive system, sex organs, sweat glands, eyes, and heart. 

Symptoms of autonomic neuropathy include:

• Bladder problems (loss of bladder control, not being able to fully empty the bladder, frequent urinary tract infections)
• Digestive system problems (bloating, nausea, vomiting, diarrhea, constipation)
• Erectile dysfunction in men and sexual problems in women
• Too much or too little sweating
• Dizziness when you stand up, from sudden drops in your blood pressure

Consult doctor if you find:

• Frequent numbness or pain in your feet, legs, hands, or arms An ulcer (sore) on your foot or leg that isn’t healing
• A swollen foot or a leg infection
• Digestive problems such as bloating, nausea, vomiting or constipation
• Problems with urination or sexual function
• Dizziness when you stand

Good blood glucose control (keeping blood glucose from being too high or too low) may prevent further nerve damage but usually can’t reverse damage that’s already happened. 

Your doctor may prescribe medicines for pain that occurs with some types of nerve damage and suggest certain vitamins if needed.

The most effective way to prevent damage is to keep your blood glucose level under good control. You can do so by eating a healthy diet, exercising regularly, and reaching a healthy weight. 

Avoiding smoking and limiting alcoholic beverages can also help. Your doctor or diabetes educator can help you plan your healthy lifestyle.

You also can do a lot to prevent leg ulcers and amputations. 

Protect your feet by:

• Checking them every day (see the tips below)
• Always wearing shoes (or slippers) and clean, dry socks
• Choosing shoes that are comfortable and fit well
• Seeing a podiatrist (foot doctor) regularly for foot care if you need help
• Good foot care
• Wash and dry your feet and check them every day. Choose a regular time, such as after your shower in the morning.
• Look for blisters, calluses, bruises, redness, swelling, cracked skin, sores, or cuts
• Cut your nails once a week or as needed.
• Put lotion on dry skin but not between your toes.

Diabetic retinopathy is a complication of diabetes where high blood glucose causes damage to the blood vessels in the light-sensitive part of the retina (the back part of the eye). 

The retina plays a vital role in vision, it records the images the eye takes in and converts them into electrical signals sent to the brain. 

The brain then interprets the electrical signals, so you understand what you are seeing. Diabetes is a major cause of retinopathy. 

More than 80% of people who have had diabetes 20 years or longer develop diabetic retinopathy.

Diabetic retinopathy occurs in both type 1 and type 2 diabetes; the likelihood of developing the condition increases with duration of disease and is higher in people with mismanaged blood glucose levels. Retinopathy means “diseases of the retina.” It is an broad term describing several conditions. 

The most common are:

Non-proliferative retinopathy an early stage sign of retinopathy where blood vessels swell or become blocked

Macular edema is when fluid leaks into the macula (center of the retina) causing vision to blur

Proliferative retinopathy is damage to the blood vessels depriving the retina of oxygen

Damage to the retina can occur without symptoms and can eventually cause vision problems that cannot be corrected by eyeglasses or contact lenses. 

It is critical for people with diabetes to get regular eye exams from an eye doctor.

Preventing Eye Problems

• Smoking can increase chances of developing retinopathy. Talk with your doctor about ways to help you stop smoking
• Control your blood sugar, blood pressure, and blood fats (triglycerides)
• Be physically active for at least 30 minutes a day
• Maintain a healthy weight
• Limit carbohydrates and sugar, eat foods high in fiber, healthy fats and protein

Treatment depends on the type of retinopathy you have. Controlling blood pressure and blood sugar can prevent eye problems. The appearance of diabetic retinopathy is associated with the rapid increase of a protein called vascular endothelial growth factor (VEGF) in the retina. 

VEGF stimulates the production of new blood vessels in the retina to bring more oxygen to the tissue but because blood circulation is prevented due to diabetes. Blood vessel leakage from diabetic retinopathy can cause fluid to accumulate in the center of the retina, which is the most sensitive part of the retina that is responsible for vision. 

If macular edema is present, or complications have progressed to proliferative retinopathy the following treatment is most commonly used are: 

Anti-VEGF, injection which help reduce the production of protein in the retina

Corticosteroids, medicine to reduce swelling or the amount of fluid present in the retina

Focal/grid macular laser surgery, laser treatment that helps to repair damage to the eye tissue by sealing the vessels that are leaking or eliminating damaged blood vessels all together

Cholesterol

Cholesterol and triglycerides, known as lipids, are fatty substances that the body normally produces. Dyslipidemia means that lipid levels in the blood are too high or low. 

The most common types of dyslipidemia are:

• High levels of low-density lipoprotein (LDL or “bad”) cholesterol
• Low levels of high-density lipoprotein (HDL or “good”) cholesterol
• High levels of triglycerides (fats in the blood)

Dyslipidemia contributes to atherosclerosis (“hardening” of the arteries), a disease in which fatty deposits called plaque buildup in the arteries over time. 

The arteries are blood vessels that carry blood from the heart to the rest of the body. If plaque narrows your arteries, you are more likely to have heart disease, heart attack, peripheral artery disease (reduced blood flow in the limbs, most often the legs), and stroke.

People with diabetes are more likely to develop atherosclerosis, heart disease, poor circulation, and stroke than people who do not have diabetes. 

Many people with diabetes have several risk factors that contribute to atherosclerosis and its complications. These include high blood pressure, excess weight, and high blood glucose (sugar) levels. Dyslipidemia further raises the risk of atherosclerosis in people with diabetes.

The most common dyslipidemia in diabetes is a combination of high triglycerides and low HDL cholesterol levels. People with diabetes may also have high LDL cholesterol.

Dyslipidemia has no symptoms (what you feel). Health care providers detect it by a blood test called a lipid profile. 

This test measures the amount of cholesterol, triglycerides, and other fats in your blood. People usually have a lipid profile after fasting overnight.

Many things can affect your lipid levels. They include:

• Age, sex, and family history of heart disease
• Lifestyle factors such as what you eat, level of physical activity, alcohol use, and smoking
• High blood pressure
• High blood glucose levels
• Some medications

Preventing Heart Problems

You can improve your lipid levels with a heart-healthy diet and weight loss, increased physical activity, and good blood pressure and blood glucose control. 

By limiting fat intake, especially animal fats and trans fats artificial fats found in some foods), you can lower LDL cholesterol. Adding more fruits, vegetables, and fiber to your diet also helps reduce lipid levels. You may also need medication.

Among the drugs available to treat dyslipidemia, statins are often the first choice for lowering total and LDL-cholesterol levels. Pregnant women should never use statins.

Other drugs that lower cholesterol include cholesterol-absorption blockers (ezetimibe), bile acid sequestrants (cholestyramine, colestipol, and colesevelam hydrochloride), and nicotinic acid (niacin).

 You may need to use these in combination if a single drug does not help reach target levels. 

Fibrates (gemfibrozil, fenofibrate, and clofibrate) and extended-release niacin may be used to lower triglycerides or raise HDL cholesterol levels.

Kidney Disease and Diabetes

The kidneys are two fist-sized organs located in your back. To maintain life, you need at least one to work well. The work done by the kidneys is called renal function. 

The three major renal functions are to:

• Remove waste and excess water from your body
• Maintain the body’s chemical balance
• Produce hormones that regulate red blood cell production and blood pressure, and contribute to bone health

Diabetes is the most common cause of kidney failure in the United States. If your kidneys stop working, you will need special treatment such as dialysis (a method of filtering waste from the blood) or a kidney transplant to stay alive.

A frequent complication of diabetes is high blood pressure (hypertension). Constant high blood pressure also leads to gradual kidney damage and adds to the effects of diabetes. 

Advanced kidney disease is often permanent. For this reason, high blood pressure and diabetes should be identified and treated early.

Anyone can develop diabetes, high blood pressure, or kidney disease. However, people who are obese and people with a family history of any of these conditions have a higher risk.

Kidney damage is diagnosed with urine and blood tests. The earliest sign of kidney problems in people with diabetes is the presence of small amounts of protein in the urine. 

If not treated, this condition leads to more protein in the urine, then to gradual loss of kidney function, and finally to chronic (permanent) kidney disease. A urine test can detect these conditions.

Several blood tests can test the kidney’s ability to filter and detoxify (clean) the blood. These include creatinine and blood urea nitrogen (BUN) tests

Protecting Your Kidneys

Protecting your kidneys begins by knowing if you have any of the risk factors for kidney disease—obesity, high blood pressure, and/or diabetes. Therefore, periodic check-ups of body weight, blood pressure, and blood glucose can help spot problems early.

Doctors use different types of medications to treat high blood glucose levels in people with diabetes, including oral medications (pills) and insulin. 

It is important to keep glucose levels as close to normal as possible. Recommended glucose levels are below 130 mg/dL in the morning and 180 mg/dL after meals. 

The hemoglobin A1C blood test evaluates how well you are controlling your blood glucose levels over time. This is done usually every three to six months. A test result below 7% shows good glucose control.

In people with diabetes and hypertension, blood pressure should be less than 130/80 mm Hg. Several types of medications are used to lower blood pressure and protect kidney function.

If you have risk factors for diabetes, high blood pressure, and/or kidney disease, talk with your doctor. Preventing and treating kidney disease will depend on your particular condition. 

For example, if you have diabetes your doctor may recommend a urine test at least once a year to check for protein in your urine, and blood tests to check your kidney function.

You can also protect your health by eating a healthy diet, exercising most days of the week, not smoking, and avoiding abuse of alcohol and other drugs. 

These include over-the-counter medications such as aspirin, acetaminophen, and ibuprofen. If you have high blood pressure, you should limit your intake of salt. 

If you have diabetes, you should limit carbohydrates. People with weakened kidney function may need to adjust their diets to also limit protein, cholesterol, and potassium.

Prevention

Exercise regularly

Regular exercise can help you reach and maintain a moderate weight and increase insulin sensitivity

Increased insulin sensitivity means your cells can more effectively use the available sugar in your bloodstream.

Exercise also helps your muscles use blood sugar for energy and muscle contraction.

If you have problems with blood sugar management, consider routinely checking your levels before and after exercising. 

This will help you learn how you respond to different activities and keep your blood sugar levels from getting too high or low

Exercise snacks simply mean that you break up your sitting time every 30 minutes for just a few minutes throughout the day. 

Some of the recommended exercises include light walking or simple resistance exercises like squats or leg raises.

Other useful forms of exercise include weightlifting, brisk walking, running, biking, dancing, hiking, swimming, and more. 

In fact, any activity that regularly gets you up and moving — regardless of the intensity — beats a sedentary lifestyle.

Manage your carb intake

• Your carb intake strongly influences your blood sugar levels. 
• Your body breaks carbs down into sugars, mainly glucose. 
• Then, insulin helps your body use and store it for energy.
• When you eat too many carbs or have insulin-function problems, this process fails, and blood glucose levels can rise. 
• People with diabetes manage their carb intake by counting carbs and being aware of how many they need.

Eat more fiber

Fiber slows carb digestion and sugar absorption, thereby promoting a more gradual rise in blood sugar levels. There are two types of fiber — insoluble and soluble.

While both are important, soluble fiber has explicitly been shown to improve blood sugar management, while insoluble fiber hasn’t been shown to have this effect.

A high fiber diet can improve your body’s ability to regulate blood sugar and minimize blood sugar lows. This could help you better manage type 1 diabetes.

Foods that are high in fiber include:

• vegetables
• fruits
• legumes
• whole grains

The recommended daily intake of fiber is about 25 grams for women and 35 grams for men. That’s about 14 grams for every 1,000 calories.

Drink water and stay hydrated

Drinking enough water could help you keep your blood sugar levels within healthy ranges.

In addition to preventing dehydration, it helps your kidneys flush out any excess sugar through urine.

One review of observational studies showed that those who drank more water had a lower risk of developing high blood sugar levels. Drinking water regularly may rehydrate the blood, lower blood sugar levels, and reduce diabetes risk.

Implement portion control

Portion control can help you regulate your calorie intake and maintain a moderate weight. Consequently, weight management promotes healthy blood sugar levels and has been shown to reduce the risk of developing type 2 diabetes.

Here are some helpful tips for managing portion sizes:

• measure and weigh your portions
• use smaller plates
• avoid all-you-can-eat restaurants
• read food labels and check the serving sizes
• keep a food journal
• eat slowly

 Choose foods with a low glycemic index

The glycemic index (GI) measures how quickly carbs break down during digestion and how rapidly your body absorbs them. \

This affects how quickly your blood sugar levels rise. 

The GI divides foods into low, medium, and high GI and ranks them on a scale of 0–100. 

Low GI foods have a ranking of 55 or less. 

Some examples of foods with a low to moderate GI include:

• bulgur
• barley
• unsweetened Greek yogurt
• oats
• beans
• lentils
• legumes
• whole wheat pasta
• non-starchy vegetables

Try to manage your stress levels

Stress can affect your blood sugar levels. When stressed, your body secretes hormones called glucagon and cortisol, which cause blood sugar levels to rise. 

One study including a group of students showed that exercise, relaxation, and meditation significantly reduced stress and lowered blood sugar levels. 

 Monitor your blood sugar levels

Monitoring blood glucose levels can help you better manage them. 

You can do so at home using a portable blood glucose meter, which is known as a glucometer. 

You can discuss this option with your doctor.

Keeping track allows you to determine whether you need to adjust your meals or medications. 

It also helps you learn how your body reacts to certain foods. 

Try measuring your levels regularly every day and keeping track of the numbers in a log. 

Also, it may be more helpful to track your blood sugar in pairs — for example, before and after exercise or before and 2 hours after a meal.

Get enough quality sleep

Getting enough sleep feels excellent and is necessary for good health. 

In fact, poor sleeping habits and a lack of rest can affect blood sugar levels and insulin sensitivity, increasing the risk of developing type 2 diabetes. 

They can also increase appetite and promote weight gain. 

To improve the quality of your sleep, try to:

• follow a sleep schedule
• avoid caffeine and alcohol late in the day
• get regular exercise
• cut down on screen time before bed
• keep your bedroom cool
• limit your naps
• create a bedtime routine
• use soothing and calming scents such as lavender
• avoid working in your bedroom
• take a warm bath or shower before bed
• try meditation or guided imagery