How can I be physically active safely if I have diabetes?

 

Be sure to drink water before, during, and after exercise to stay well hydrated. The following are some other tips for safe physical activity when you have diabetes.

Plan ahead

Talk with your health care team before you start a new physical activity routine, especially if you have other health problems. Your health care team will tell you a target range for your blood glucose level and suggest how you can be active safely.

Your health care team also can help you decide the best time of day for you to do physical activity based on your daily schedule, meal plan, and diabetes medicines. If you take insulin, you need to balance the activity that you do with your insulin doses and meals so you don’t get low blood glucose.

Prevent low blood glucose

Because physical activity lowers your blood glucose, you should protect yourself against low blood glucose levels, also called hypoglycemia. You are most likely to have hypoglycemia if you take insulin or certain other diabetes medicines, such as a sulfonylurea. Hypoglycemia also can occur after a long intense workout or if you have skipped a meal before being active. Hypoglycemia can happen during or up to 24 hours after physical activity.

Planning is key to preventing hypoglycemia. For instance, if you take insulin, your health care provider might suggest you take less insulin or eat a small snack with carbohydrates before, during, or after physical activity, especially intense activity.5

You may need to check your blood glucose level before, during, and right after you are physically active.

Take care of your feet

People with diabetes may have problems with their feet because of poor blood flow and nerve damage that can result from high blood glucose levels. To help prevent foot problems, you should wear comfortable, supportive shoes and take care of your feet before, during, and after physical activity.

What physical activities should I do if I have diabetes?

Most kinds of physical activity can help you take care of your diabetes. Certain activities may be unsafe for some people, such as those with low vision or nerve damage to their feet. Ask your health care team what physical activities are safe for you. Many people choose walking with friends or family members for their activity.

Doing different types of physical activity each week will give you the most health benefits. Mixing it up also helps reduce boredom and lower your chance of getting hurt. Try these options for physical activity.

Add extra activity to your daily routine

If you have been inactive or you are trying a new activity, start slowly, with 5 to 10 minutes a day. Then add a little more time each week. Increase daily activity by spending less time in front of a TV or other screen. Try these simple ways to add physical activities in your life each day:

  • Walk around while you talk on the phone or during TV commercials.
  • Do chores, such as work in the garden, rake leaves, clean the house, or wash the car.
  • Park at the far end of the shopping center parking lot and walk to the store.
  • Take the stairs instead of the elevator.
  • Make your family outings active, such as a family bike ride or a walk in a park.

If you are sitting for a long time, such as working at a desk or watching TV, do some light activity for 3 minutes or more every half hour. Light activities include

  • leg lifts or extensions
  • overhead arm stretches
  • desk chair swivels
  • torso twists
  • side lunges
  • walking in place
Do aerobic exercise

Aerobic exercise is activity that makes your heart beat faster and makes you breathe harder. You should aim for doing aerobic exercise for 30 minutes a day most days of the week. You do not have to do all the activity at one time. You can split up these minutes into a few times throughout the day.

To get the most out of your activity, exercise at a moderate to vigorous level. Try

  • walking briskly or hiking
  • climbing stairs
  • swimming or a water-aerobics class
  • dancing
  • riding a bicycle or a stationary bicycle
  • taking an exercise class
  • playing basketball, tennis, or other sports

Talk with your health care team about how to warm up and cool down before and after you exercise.

Do strength training to build muscle

Strength training is a light or moderate physical activity that builds muscle and helps keep your bones healthy. Strength training is important for both men and women. When you have more muscle and less body fat, you’ll burn more calories. Burning more calories can help you lose and keep off extra weight.

You can do strength training with hand weights, elastic bands, or weight machines. Try to do strength training two to three times a week. Start with a light weight. Slowly increase the size of your weights as your muscles become stronger.

Do stretching exercises

Stretching exercises are light or moderate physical activity. When you stretch, you increase your flexibility, lower your stress, and help prevent sore muscles.

You can choose from many types of stretching exercises. Yoga is a type of stretching that focuses on your breathing and helps you relax. Even if you have problems moving or balancing, certain types of yoga can help. For instance, chair yoga has stretches you can do when sitting in a chair or holding onto a chair while standing. Your health care team can suggest whether yoga is right for you.

Source: NIDDK

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The A1C Test & Diabetes

What is the A1C test?

The A1C test is a blood test that provides information about a person’s average levels of blood glucose, also called blood sugar, over the past 3 months. The A1C test is sometimes called the hemoglobin A1c, HbA1c, or glycohemoglobin test. The A1C test is the primary test used for diabetes management and diabetes research.

How does the A1C test work?

The A1C test is based on the attachment of glucose to hemoglobin, the protein in red blood cells that carries oxygen. In the body, red blood cells are constantly forming and dying, but typically they live for about 3 months. Thus, the A1C test reflects the average of a person’s blood glucose levels over the past 3 months. The A1C test result is reported as a percentage. The higher the percentage, the higher a person’s blood glucose levels have been. A normal A1C level is below 5.7 percent.

Can the A1C test be used to diagnose type 2 diabetes and prediabetes?

Yes. In 2009, an international expert committee recommended the A1C test as one of the tests available to help diagnose type 2 diabetes and prediabetes. 1 Previously, only the traditional blood glucose tests were used to diagnose diabetes and prediabetes.

Because the A1C test does not require fasting and blood can be drawn for the test at any time of day, experts are hoping its convenience will allow more people to get tested—thus, decreasing the number of people with undiagnosed diabetes. However, some medical organizations continue to recommend using blood glucose tests for diagnosis.

1 The International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care. 2009;32(7):1327–1334.

Why should a person be tested for diabetes?

Testing is especially important because early in the disease diabetes has no symptoms. Although no test is perfect, the A1C and blood glucose tests are the best tools available to diagnose diabetes—a serious and lifelong disease.

Testing enables health care providers to find and treat diabetes before complications occur and to find and treat prediabetes, which can delay or prevent type 2 diabetes from developing.

Has the A1C test improved?

Yes. A1C laboratory tests are now standardized. In the past, the A1C test was not recommended for diagnosis of type 2 diabetes and prediabetes because the many different types of A1C tests could give varied results. The accuracy has been improved by the National Glycohemoglobin Standardization Program (NGSP), which developed standards for the A1C tests.

The NGSP certifies that manufacturers of A1C tests provide tests that are consistent with those used in a major diabetes study. The study established current A1C goals for blood glucose control that can reduce the occurrence of diabetes complications, such as blindness and blood vessel disease. 2

2 Nathan DM, Genuth S, Lachin J, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The New England Journal of Medicine. 1993:329(14)977–986.

How is the A1C test used to diagnose type 2 diabetes and prediabetes?

The A1C test can be used to diagnose type 2 diabetes and prediabetes alone or in combination with other diabetes tests. When the A1C test is used for diagnosis, the blood sample must be sent to a laboratory that uses an NGSP-certified method for analysis to ensure the results are standardized.

Blood samples analyzed in a health care provider’s office, known as point-of-care (POC) tests, are not standardized for diagnosing diabetes. The following table provides the percentages that indicate diagnoses of normal, diabetes, and prediabetes according to A1C levels.

* Any test for diagnosis of diabetes requires confirmation with a second measurement unless there are clear symptoms of diabetes.
Diagnosis* A1C Level
Normal below 5.7 percent
Diabetes 6.5 percent or above
Prediabetes 5.7 to 6.4 percent

Having prediabetes is a risk factor for getting type 2 diabetes. People with prediabetes may be retested each year. Within the prediabetes A1C range of 5.7 to 6.4 percent, the higher the A1C, the greater the risk of diabetes. Those with prediabetes are likely to develop type 2 diabetes within 10 years, but they can take steps to prevent or delay diabetes.

Is the A1C test used during pregnancy?

The A1C test may be used at the first visit to the health care provider during pregnancy to see if women with risk factors had undiagnosed diabetes before becoming pregnant. After that, the oral glucose tolerance test (OGTT) is used to test for diabetes that develops during pregnancy—known as gestational diabetes. After delivery, women who had gestational diabetes should be tested for persistent diabetes. Blood glucose tests, rather than the A1C test, should be used for testing within 12 weeks of delivery.

Can blood glucose tests still be used for diagnosing type 2 diabetes and prediabetes?

Yes. The standard blood glucose tests used for diagnosing type 2 diabetes and prediabetes-the fasting plasma glucose (FPG) test and the OGTT—are still recommended. The random plasma glucose test, also called the casual glucose test, may be used for diagnosing diabetes when symptoms of diabetes are present. In some cases, the A1C test is used to help health care providers confirm the results of a blood glucose test.

Can the A1C test result in a different diagnosis than the blood glucose tests?

Yes. In some people, a blood glucose test may indicate a diagnosis of diabetes while an A1C test does not. The reverse can also occur—an A1C test may indicate a diagnosis of diabetes even though a blood glucose test does not. Because of these variations in test results, health care providers repeat tests before making a diagnosis.

People with differing test results may be in an early stage of the disease, where blood glucose levels have not risen high enough to show on every test. Sometimes, making simple changes in lifestyle—losing a small amount of weight and increasing physical activity—can help people in this early stage reverse diabetes or delay its onset.

Are diabetes blood test results always accurate?

All laboratory test results can vary from day to day and from test to test. Results can vary

  • within the person being tested. A person’s blood glucose levels normally move up and down depending on meals, exercise, sickness, and stress.
  • between different tests. Each test measures blood glucose levels in a different way. For example, the FPG test measures glucose that is floating free in the blood after fasting and only shows the blood glucose level at the time of the test. Repeated blood glucose tests, such as self-monitoring several times a day with a home meter, can record the natural variations of blood glucose levels during the day. The A1C test represents the amount of glucose attached to hemoglobin, so it reflects an average of all the blood glucose levels a person may experience over 3 months. The A1C test will not show day-to-day changes.

The following chart shows how multiple blood glucose measurements over 4 days compare with an A1C measurement.

Blood Glucose Measurements Compared with A1C Measurements Over 4 Days

Blood glucose chart
Note: Blood glucose (mg/dL) measurements were taken four times per day (fasting or pre-breakfast, pre-lunch, pre-dinner, and bedtime).

The straight black line indicates an A1C measurement of 7.0 percent. The blue line shows blood glucose test results from self-monitoring four times a day over a 4-day period.

  • within the same test. Even when the same blood sample is repeatedly measured in the same laboratory, the results may vary due to small changes in temperature, equipment, or sample handling.

Health care providers take these variations into account when considering test results and repeat laboratory tests for confirmation. Diabetes develops over time, so even with variations in test results, health care providers can tell when overall blood glucose levels are becoming too high.

Comparing test results from different laboratories can be misleading. People should consider requesting new laboratory tests when they change health care providers, or if their health care provider’s office changes the laboratory or clinic it uses for blood testing.

How accurate is the A1C test?

The A1C test result can be up to 0.5 percent higher or lower than the actual percentage. This means an A1C measured as 7.0 percent could indicate a true A1C anywhere in the range from ~6.5 to 7.5 percent.

The drawing below illustrates the range of possible true values when an A1C is 7.0 percent on the lab report. This range is based on the inherent variability of the laboratory test, often referred to as the coefficient of variation. Different degrees of laboratory variability result in different ranges of possible true values. The range illustrated is the maximum allowed by test methods approved by NGSP.

Blood Glucose Range 5 percent
Courtesy of David Aron, M.D., Louis Stokes Department of Veterans Affairs Medical Center

To put the A1C test into perspective, an FPG test result of 126 mg/dL obtained from a laboratory test accounting for typical variability within an individual person could indicate a true FPG anywhere in the range from ~110 to 142 mg/dL. This variation will be even greater if the blood sample is not processed promptly or is not put on ice, causing blood glucose levels in the sample to decrease. The drawing below illustrates the range of possible true values for an FPG of 126 mg/dL.

Blood glucose range from 110 mg/dL to 145 mg/dL
Courtesy of David Aron, M.D., Louis Stokes Department of Veterans Affairs Medical Center
Can the A1C test give false results?

Yes, for some people. The A1C test can be unreliable for diagnosing or monitoring diabetes in people with certain conditions that are known to interfere with the results. Interference should be suspected when A1C results seem very different from the results of a blood glucose test.

People of African, Mediterranean, or Southeast Asian descent, or people with family members with sickle cell anemia or a thalassemia are particularly at risk of interference. People in these groups may have a less common type of hemoglobin, known as a hemoglobin variant, that can interfere with some A1C tests. Most people with a hemoglobin variant have no symptoms and may not know that they carry this type of hemoglobin.

Not all of the A1C tests are unreliable for people with a hemoglobin variant. People with false results from one type of A1C test may need a different type of A1C test for measuring their average blood glucose level. The NGSP provides information for health care providers about which A1C tests are appropriate to use for specific hemoglobin variants at www.ngsp.org .

More information about problems with the A1C test and different forms of sickle cell anemia is provided in the NIDDK health topics:

False A1C results may also occur in people with other problems that affect their blood or hemoglobin. For example, a falsely low A1C result can occur in people with

  • anemia
  • heavy bleeding

A falsely elevated A1C result can occur in people who

  • are very low in iron, for example, those with iron deficiency anemia

Other causes of false A1C results include

  • kidney failure
  • liver disease
How is the A1C test used after diagnosis of diabetes?

Health care providers can use the A1C test to monitor blood glucose levels in people with type 1 or type 2 diabetes. The A1C test is not used to monitor gestational diabetes.

The American Diabetes Association recommends that people with diabetes who are meeting treatment goals and have stable blood glucose levels have the A1C test twice a year. Health care providers may repeat the A1C test as often as four times a year until blood glucose levels reach recommended levels.

The A1C test helps health care providers adjust medication to reduce the risk of long-term diabetes complications. Studies have demonstrated substantial reductions in long-term complications with the lowering of A1C levels.

When the A1C test is used for monitoring blood glucose levels in a person with diabetes, the blood sample can be analyzed in a health care provider’s office using a POC test to give immediate results. However, POC tests are less reliable and not as accurate as most laboratory tests.

How does the A1C relate to estimated average glucose?

Estimated average glucose (eAG) is calculated from the A1C. Some laboratories report eAG with the A1C test results. The eAG number helps people with diabetes relate their A1C to daily glucose monitoring levels. The eAG calculation converts the A1C percentage to the same units used by home glucose meters—milligrams per deciliter (mg/dL).

The eAG number will not match daily glucose readings because it is a long-term average rather than the blood glucose level at a single time, as measured with the home glucose meter. The following table shows the relationship between the A1C and the eAG.

Relationship between A1C and eAG
Source: Adapted from American Diabetes Association. Standards of medical care in diabetes—2014. Diabetes Care. 2014;37(Supp 1):S14–S80, table 8.
A1C eAG
Percent mg/dL
6 126
7 154
8 183
9 212
10 240
11 269
12 298
What A1C target should people have?

People will have different A1C targets depending on their diabetes history and their general health. People should discuss their A1C target with their health care provider. Studies have shown that people with diabetes can reduce the risk of diabetes complications by keeping A1C levels below 7 percent.

Maintaining good blood glucose control will benefit those with new-onset diabetes for many years to come. However, an A1C level that is safe for one person may not be safe for another. For example, keeping an A1C level below 7 percent may not be safe if it leads to problems with hypoglycemia, also called low blood glucose.

Less strict blood glucose control, or an A1C between 7 and 8 percent—or even higher in some circumstances—may be appropriate in people who have

  • limited life-expectancy
  • long-standing diabetes and difficulty attaining a lower goal
  • severe hypoglycemia
  • advanced diabetes complications such as chronic kidney disease, nerve problems, or cardiovascular disease
Will the A1C test show changes in blood glucose levels?

Large changes in a person’s blood glucose levels over the past month will show up in their A1C test result, but the A1C does not show sudden, temporary increases or decreases in blood glucose levels. Even though the A1C represents a long-term average, blood glucose levels within the past 30 days have a greater effect on the A1C reading than those in previous months.

Points to Remember
  • The A1C test is a blood test that provides information about a person’s average levels of blood glucose, also called blood sugar, over the past 3 months.
  • The A1C test is based on the attachment of glucose to hemoglobin, the protein in red blood cells that carries oxygen. Thus, the A1C test reflects the average of a person’s blood glucose levels over the past 3 months.
  • In 2009, an international expert committee recommended the A1C test be used as one of the tests available to help diagnose type 2 diabetes and prediabetes.
  • Because the A1C test does not require fasting and blood can be drawn for the test at any time of day, experts are hoping its convenience will allow more people to get tested—thus, decreasing the number of people with undiagnosed diabetes.
  • In the past, the A1C test was not recommended for diagnosis of type 2 diabetes and prediabetes because the many different types of A1C tests could give varied results. The accuracy has been improved by the National Glycohemoglobin Standardization Program (NGSP), which developed standards for the A1C tests. Blood samples analyzed in a health care provider’s office, known as point-of-care (POC) tests, are not standardized for use in diagnosing diabetes.
  • The A1C test may be used at the first visit to the health care provider during pregnancy to see if women with risk factors had undiagnosed diabetes before becoming pregnant. After that, the oral glucose tolerance test (OGTT) is used to test for diabetes that develops during pregnancy—known as gestational diabetes.
  • The standard blood glucose tests used for diagnosing type 2 diabetes and prediabetes—the fasting plasma glucose (FPG) test and the OGTT—are still recommended. The random plasma glucose test may be used for diagnosing diabetes when symptoms of diabetes are present.
  • The A1C test can be unreliable for diagnosing or monitoring diabetes in people with certain conditions that are known to interfere with the results.
  • The American Diabetes Association recommends that people with diabetes who are meeting treatment goals and have stable blood glucose levels have the A1C test twice a year.
  • Estimated average glucose (eAG) is calculated from the A1C to help people with diabetes relate their A1C to daily glucose monitoring levels.
  • People will have different A1C targets depending on their diabetes history and their general health. People should discuss their A1C target with their health care provider.

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Checks and Goals for Each Year

People who manage their diabetes care by eating healthy foods and living an active lifestyle often have good control of their blood sugar levels. Still, regular health checkups and tests are needed. These visits give you a chance to:

  • Ask your health care provider questions
  • Learn more about your diabetes and what you can do to keep your blood sugar in your target range
  • Make sure you are taking your medicines the right way

See Your Doctor

See your diabetes doctor for an exam every 3 to 6 months. During this exam, your doctor should check your:

  • Blood pressure
  • Weight
  • Feet

See your dentist every 6 months, also.

Eye Exams

An eye doctor should check your eyes every year. See an eye doctor who takes care of people with diabetes.

If you have eye problems because of diabetes, you will probably see your eye doctor more often.

Foot Exams

Your doctor should check the pulses in your feet and your reflexes at least once a year. Your doctor should also look for:

  • Calluses
  • Infections
  • Sores
  • Loss of feeling anywhere in your feet (peripheral neuropathy)

If you have had foot ulcers before, see your doctor every 3 to 6 months. It is always a good idea to ask your doctor to check your feet.

Hemoglobin A1C Tests

An A1c lab test shows how well you are controlling your blood sugar levels over a 3-month period.

The normal level is less than 5.7%. Most people with diabetes should aim for an A1C of less than 7%. Some people have a higher target. Your doctor will help decide what your target should be.

Higher A1C numbers mean that your blood sugar is higher and that you may be more likely to have complications from your diabetes.

Cholesterol

A cholesterol profile test measures cholesterol and triglycerides in your blood. You should have this kind of test in the morning, after not eating since the night before.

Adults with type 2 diabetes should have this test every 5 years. People with high cholesterol may have this test more often.

Blood Pressure

Blood pressure should be measured at every visit.

Kidney Tests

Once a year, you should have a urine test that looks for a protein called albumin.

Your doctor will also have you take a blood test every year that measures how well your kidneys work.

Talk with your health care team about

  • How well you can tell when you have low blood glucose.
  • How you are treating high blood glucose.
  • Tobacco use (cigarettes, cigars, pipes, smokeless tobacco).
  • Your feelings about having diabetes.
  • Your plans for pregnancy (if a woman).

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6 Things To Know About Type 2 Diabetes and Dietary Supplements

Diabetes is a group of chronic diseases that affect metabolism—the way the body uses food for energy and growth. Millions of people have diabetes, which can lead to serious health problems if it is not managed well. Conventional medical treatments and following a healthy lifestyle, including watching your weight, can help you prevent, manage, and control many complications of diabetes. Researchers are studying several complementary health approaches, including dietary supplements, to see if they can help people manage type 2 diabetes or lower their risk of developing the disease; however, there is currently not enough scientific evidence to suggest that any dietary supplements can help prevent or manage type 2 diabetes.

Here are 6 things you should know about taking dietary supplements for type 2 diabetes.

  1. A healthy diet, physical activity, and blood glucose testing are the basic tools for managing type 2 diabetes. Your health care providers will help you learn to manage your diabetes and track how well you are controlling it. It is critical not to replace proven conventional medical treatment for diabetes with an unproven health product or practice.
  2. Some dietary supplements may have side effects, including interacting with your diabetes treatment or increasing your risk of kidney problems. This is of particular concern because diabetes is the leading cause of chronic kidney disease and kidney failure in the United States. Supplement use should be monitored closely in patients who have or are at risk for kidney disease.
  3. Chromium (an essential trace mineral found in many foods) has been studied for preventing diabetes and controlling glucose levels, but research has found it has few or no benefits. There have been a few reports of kidney damage, muscular problems, and skin reactions following large doses of chromium.
  4. There is no evidence that magnesium helps to manage diabetes; however, research suggests that people with lower magnesium intake may have a greater risk of developing diabetes. A large 2007 study found an association between a higher intake of cereal fiber and magnesium and a reduced risk of developing type 2 diabetes. Large doses of magnesium in supplements can cause diarrhea and abdominal cramping, and enormous doses—more than 5,000 mg/day per day—can be deadly.
  5. There is no substantial evidence that herbs and other dietary supplements, including cinnamon and omega-3s, can help to control diabetes or its complications. Researchers have found some risks but no clear benefits of cinnamon for people with diabetes. For example, a 2012 review of the scientific literature did not support using cinnamon for type 1 or type 2 diabetes.
  6. Talk with your health care provider before considering any dietary supplement for yourself, particularly if you are pregnant or nursing, or for a child. Do not replace scientifically proven treatments for diabetes with unproven health products or practices. The consequences of not following your prescribed medical regimen for diabetes can be very serious.
https://nccih.nih.gov/health/tips/diabetes

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Physical activity and diabetes management (Spanish)

El Dr. Cervera Médico Endocrinólogo especialista en Diabetes nos platica sobre la importancia del ejercicio para nuestro estado de salud y para el manejo de nuestra diabetes.

 


Other treatment options for diabetes

When medicines and lifestyle changes are not enough to manage your diabetes, a less common treatment may be an option. Other treatments include bariatric surgery for certain people with type 1 or type 2 diabetes, and an “artificial pancreas” and pancreatic islet transplantation for some people with type 1 diabetes.

Bariatric surgery

Also called weight-loss surgery or metabolic surgery, bariatric surgery may help some people with obesity and type 2 diabetes lose a large amount of weight and regain normal blood glucose levels. Some people with diabetes may no longer need their diabetes medicine after bariatric surgery. Whether and for how long blood glucose levels improve seems to vary by the patient, type of weight-loss surgery, and amount of weight the person loses. Other factors include how long someone has had diabetes and whether or not the person uses insulin.1

Recent research suggests that weight-loss surgery also may help improve blood glucose control in people with type 1 diabetes who are obese.2

Researchers are studying the long-term results of bariatric surgery in people with type 1 and type 2 diabetes.

Artificial Pancreas

The NIDDK has played an important role in developing “artificial pancreas” technology. An artificial pancreas replaces manual blood glucose testing and the use of insulin shots or a pump. A single system monitors blood glucose levels around the clock and provides insulin or a combination of insulin and a second hormone, glucagon, automatically. The system can also be monitored remotely, for example by parents or medical staff.

In 2016, the FDA approved a type of artificial pancreas system called a hybrid closed-loop system. This system tests your glucose level every 5 minutes throughout the day and night, and automatically gives you the right amount of insulin.

You still need to manually adjust the amount of insulin the pump delivers at mealtimes. But, the artificial pancreas may free you from some of the daily tasks needed to keep your blood glucose stable—or help you sleep through the night without the need to wake and test your glucose or take medicine.

The hybrid closed-loop system is expected to be available in the U.S. in 2017. Talk with your health care provider about whether this system might be right for you.

The NIDDK has funded several important studies on different types of artificial pancreas devices to help better people with type 1 diabetes manage their disease. The devices may also help people with type 2 diabetes and gestational diabetes.

Pancreatic islet transplantation

Pancreatic islet transplantation is an experimental treatment for poorly controlled type 1 diabetes. Pancreatic islets are clusters of cells in the pancreas that make the hormone insulin. In type 1 diabetes, the body’s immune system attacks these cells. A pancreatic islet transplant replaces destroyed islets with new ones that make and release insulin. This procedure takes islets from the pancreas of an organ donor and transfers them to a person with type 1 diabetes. Because researchers are still studying pancreatic islet transplantation, the procedure is only available to people enrolled in research studies. Learn more about islet transplantation studies.

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What oral medicines treat type 2 diabetes? 

You may need medicines along with healthy eating and physical activity habits to manage your type 2 diabetes. You can take many diabetes medicines by mouth. These medicines are called oral medicines.

Most people with type 2 diabetes start medical treatment with metformin  pills. Metformin also comes as a liquid. Metformin lowers the amount of glucose that your liver makes and helps your body use insulin better. This drug may help you lose a small amount of weight.

Other oral medicines act in different ways to lower blood glucose levels. You may need to add another diabetes medicine after a while or use a combination treatment. Combining two or three kinds of diabetes medicines can lower blood glucose levels more than taking just one.

What other injectable medicines treat type 2 diabetes?

Besides insulin, other types of injected medicines are available. These medicines help keep your blood glucose level from going too high after you eat. They may make you feel less hungry and help you lose some weight. Other injectable medicines are not substitutes for insulin. Learn more about noninsulin injectable medicines .

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Non-insulin injectable medications

Besides insulin people with type 2 diabetes have other options, such as injectable drugs.

GLP-1 Receptor Agonists- stimulate insulin production while suppressing the liver’s glucose output. They may decrease appetite and promote some weight loss. They can initially cause nausea, which may get better or go away with time. They generally do not cause hypoglycemia, though if you are taking a sulfonylurea, your doctor may reduce the dose of that to reduce the risk for hypoglycemia.

•Albiglutide (Tanzeum); weekly

•Dulaglutide (Trulicity); weekly

•Exenatide (Byetta); twice daily

•Exenatide Extended Release (Bydureon); weekly

•Liraglutide (Victoza); daily

Amylin Analogue- slows food from moving too quickly through the stomach and helps keep after-meal glucose levels from going too high. It can suppress appetite and may cause weight loss.  It also reduces glucose production by the liver. It is taken before meals and may cause nausea, which usually reduces over time.

•Pramlintide (Symlin); with meals

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What are the different types of insulin? 

Several types of insulin are available. Each type starts to work at a different speed, known as “onset,” and its effects last a different length of time, known as “duration.” Most types of insulin reach a peak, which is when they have the strongest effect. Then the effects of the insulin wear off over the next few hours or so.

Source: Insulin basics. American Diabetes Association website.  Last edited 2015. Accessed August 25, 2016.
Types of Insulin and How They Work 
Insulin type How fast it starts to work (onset) When it peaks How long it lasts (duration)
Rapid-acting About 15 minutes after injection 1 hour 2 to 4 hours
Short-acting, also called regular Within 30 minutes after injection 2 to 3 hours 3 to 6 hours
Intermediate-acting 2 to 4 hours after injection 4 to 12 hours 12 to 18 hours
Long-acting Several hours after injection Does not peak 24 hours; some last longer

The chart above gives averages. Follow your doctor’s advice on when and how to take your insulin. Your doctor might also recommend premixed insulin, which is a mix of two types of insulin. Some types of insulin cost more than others, so talk with your doctor about your options if you’re concerned about cost.

What are the different ways to take insulin?

The way you take insulin may depend on your lifestyle, insurance plan, and preferences. You may decide that needles are not for you and prefer a different method. Talk with your doctor about the options and which is best for you. Most people with diabetes use a needle and syringe, pen, or insulin pump. Inhalers, injection ports, and jet injectors are less common.

Needle and syringe

You’ll give yourself insulin shots using a needle and syringe. You will draw up your dose of insulin from the vial, or bottle, into the syringe. Insulin works fastest when you inject it in your belly, but you should rotate spots where you inject insulin. Other injection spots include your thigh, buttocks, or upper arm. Some people with diabetes who take insulin need two to four shots a day to reach their blood glucose targets. Others can take a single shot.

Insulin shots involve drawing insulin from a vial into a syringe and then injecting it under your skin.

Pen

An insulin pen looks like a pen but has a needle for its point. Some insulin pens come filled with insulin and are disposable. Others have room for an insulin cartridge that you insert and then replace after use. Insulin pens cost more than needles and syringes but many people find them easier to use.

An insulin pen is a convenient way to take insulin

Pump

An insulin pump is a small machine that gives you small, steady doses of insulin throughout the day. You wear one type of pump outside your body on a belt or in a pocket or pouch. The insulin pump connects to a small plastic tube and a very small needle. You insert the needle under your skin and it stays in place for several days. Insulin then pumps from the machine through the tube into your body 24 hours a day. You also can give yourself doses of insulin through the pump at mealtimes. Another type of pump has no tubes and attaches directly to your skin, such as a self-adhesive pod.

Insulin pumps deliver insulin 24 hours a day.

Inhaler

Another way to take insulin is by breathing powdered insulin from an inhaler device into your mouth. The insulin goes into your lungs and moves quickly into your blood. Inhaled insulin is only for adults with type 1 or type 2 diabetes.

Injection port

An injection port has a short tube that you insert into the tissue beneath your skin. On the skin’s surface, an adhesive patch or dressing holds the port in place. You inject insulin through the port with a needle and syringe or an insulin pen. The port stays in place for a few days, and then you replace the port. With an injection port, you no longer puncture your skin for each shot—only when you apply a new port.

Jet injector

This device sends a fine spray of insulin into the skin at high pressure instead of using a needle to deliver the insulin.

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Insulin, Medicines, & Other Diabetes Treatments

Taking insulin or other diabetes medicines is often part of treating diabetes. Along with healthy food choices and physical activity, medicine can help you manage the disease. Some other treatment options are also available.

What medicines might I take for diabetes?

The medicine you take will vary by your type of diabetes and how well the medicine controls your blood glucose levels, also called blood sugar. Other factors, such as your other health conditions, medication costs, and your daily schedule may play a role in what diabetes medicine you take.

Type 1 diabetes
If you have type 1 diabetes, you must take insulin because your body no longer makes this hormone. You will need to take insulin several times during the day, including with meals. You also could use an insulin pump, which gives you small, steady doses throughout the day.

Type 2 diabetes
Some people with type 2 diabetes can manage their disease by making healthy food choices and being more physically active. Many people with type 2 diabetes need diabetes medicines as well. These medicines may include diabetes pills or medicines you inject under your skin, such as insulin. In time, you may need more than one diabetes medicine to control your blood glucose. Even if you do not take insulin, you may need it at special times, such as during pregnancy or if you are in the hospital.

Gestational diabetes
If you have gestational diabetes, you should first try to control your blood glucose level by making healthy food choices and getting regular physical activity. If you can’t reach your blood glucose target, your health care team will talk with you about diabetes medicines, such as insulin or the diabetes pill metformin, that may be safe for you to take during pregnancy. Your health care team may start you on diabetes medicines right away if your blood glucose is very high.

No matter what type of diabetes you have, taking diabetes medicines every day can feel like a burden sometimes. You may also need medicines for other health problems, such as high blood pressure or high cholesterol, as part of your diabetes care plan.

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Diabetes and dental disease

Because of high blood glucose, people with diabetes are more likely to have problems with their teeth and gums. There’s a lot you can do to take charge and prevent these problems. Caring for your teeth and gums every day can help keep them healthy. Keeping your blood glucose in a healthy range is also important. Regular, complete dental care helps prevent dental disease.

Healthy teeth and gums depend on regular care and managing your blood glucose levels.

Signs of Dental Disease

Sore, swollen, and red gums that bleed when you brush your teeth are a sign of a dental problem called gingivitis. Another problem, called periodontitis, happens when your gums shrink or pull away from your teeth. Like all infections, dental infections can make your blood glucose go up.

Preventing Dental Problems

Keep Your Blood Glucose Under Control

High blood glucose can cause problems with your teeth and gums. Work with your health care team to keep your glucose levels as close to normal as you can.

Brush Your Teeth Often

Brush your teeth at least twice a day to prevent gum disease and tooth loss. Be sure to brush before you go to sleep. Use a soft toothbrush and toothpaste with fluoride. To help keep bacteria from growing on your toothbrush, rinse it after each brushing and store it upright with the bristles at the top. Get a new toothbrush at least every 3 months.

Floss Your Teeth Daily

Besides brushing, you need to floss between your teeth each day to help remove plaque, a film that forms on teeth and can cause tooth problems. Flossing also helps keep your gums healthy. Your dentist or dental hygienist will help you choose a good method to remove plaque, such as dental floss, bridge cleaners, or water spray. If you’re not sure of the right way to brush or floss, ask your dentist or dental hygienist for help.

Get Regular Dental Care

Get your teeth cleaned and checked at your dentist’s office at least once every 6 months. If you don’t have a dentist, find one or ask your health care provider for the name of a dentist in your community.

See your dentist right away if you have trouble chewing or any signs of dental disease, including bad breath, a bad taste in your mouth, bleeding or sore gums, red or swollen gums, or sore or loose teeth.

Give your dentist the name and telephone number of your diabetes health care provider. Each time you visit, remind your dentist that you have diabetes.

Plan dental visits so they don’t change the times you take your insulin and meals. Don’t skip a meal or diabetes medicine before your visit. Right after breakfast may be a good time for your visit.

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Diabetes and foot problems

Nerve damage, circulation problems, and infections can cause serious foot problems for people with diabetes. There’s a lot you can do to prevent problems with your feet. Managing your blood glucose and not smoking or using tobacco can help protect your feet. You can also take some simple safeguards each day to care for and protect your feet. Over half of diabetes-related amputations can be prevented with regular exams and patient education.

It’s helpful to understand why foot problems happen. Nerve damage can cause you to lose feeling in your feet. Sometimes nerve damage can deform or misshape your feet, causing pressure points that can turn into blisters, sores, or ulcers. Poor circulation can make these injuries slow to heal.

Signs of Foot Problems

Your feet may tingle, burn, or hurt. You may not be able to feel touch, heat, or cold very well. The shape of your feet can change over time. There may even be changes in the color and temperature of your feet. Some people lose hair on their toes, feet, and lower legs. The skin on your feet may be dry and cracked. Toenails may turn thick and yellow. Fungus infections can grow between your toes. Blisters, sores, ulcers, infected corns, and ingrown toenails need to be seen by your health care provider or foot doctor (podiatrist) right away.

Protecting Your Feet

Get Your Health Care Provider to Check Your Feet at Least 4 Times a Year

Ask your health care provider to look at your feet at least 4 times a year. As a reminder, take off your shoes and socks when you’re in the exam room. Have your sense of feeling and your pulses checked at least once a year. If you have nerve damage, deformed feet, or a circulation problem, your feet need special care. Ask your health care provider to show you how to care for your feet. Also, ask if special shoes would help you.

Check Your Feet Each Day

You may have serious foot problems yet feel no pain. Look at your feet every day to see if you have scratches, cracks, cuts, or blisters. Always check between your toes and on the bottoms of your feet. If you can’t bend over to see the bottoms of your feet, use a mirror that won’t break. If you can’t see well, ask a family member or friend to help you. Call your health care provider at once if you have a sore on your foot. Sores can get worse quickly.

Wash Your Feet Daily

Wash your feet every day. Dry them with care, especially between the toes. Don’t soak your feet—it can dry out your skin, and dry skin can lead to infections. Rub lotion or cream on the tops and bottoms of your feet—but not between your toes. Moisture between the toes will let germs grow that could cause an infection. Ask your health care provider for the name of a good lotion or cream.

Trim Your Toenails Carefully

Trim your toenails after you’ve washed and dried your feet—the nails will be softer and safer to cut. Trim the nails to follow the natural curve of your Be sure to dry between your toes. Don’t cut into the corners. Use an emery board to smooth the edges.

If you can’t see well, or if your nails are thick or yellowed, get them trimmed by a foot doctor or another health care provider. Ask your health care provider for the name of a foot doctor. If you see redness around the nails, see your health care provider at once.

Treat Corns and Calluses Gently

Don’t cut corns and calluses. Ask your health care provider how to gently use a pumice stone to rub them. Don’t use razor blades, corn plasters, or liquid corn or callus removers—they can damage your skin.

Protect Your Feet from Heat and Cold

Hot water or hot surfaces are a danger to your feet. Before bathing, test the water with a bath thermometer (90° to 95°F is safe) or with your elbow. Wear shoes and socks when you walk on hot surfaces, such as beaches or the pavement around swimming pools. In summer, be sure to use sunscreen on the tops of your feet.

You also need to protect your feet from the cold. In winter, wear socks and footwear such as fleece- lined boots to protect your feet. If your feet are cold at night, wear socks. Don’t use hot water bottles, heating pads, or electric blankets—they can burn your feet. Don’t use strong antiseptic solutions or adhesive tape on your feet.

Always Wear Shoes and Socks

Wear shoes and socks at all times. Don’t walk barefoot—not even indoors.

Wear shoes that fit well and protect your feet. Don’t wear shoes that have plastic uppers, and don’t wear sandals with thongs between the toes. Ask your health care provider what types of shoes are good choices for you.

New shoes should be comfortable at the time you buy them—don’t expect them to stretch out. Slowly break in new shoes by wearing them only 1 or 2 hours a day.

Always wear socks or stockings with your shoes. Choose socks made of cotton or wool—they help keep your feet dry.

Before you put on your shoes each time, look and feel inside them. Check for any loose objects, nail points, torn linings, and rough areas—these can cause injuries. If your shoes aren’t smooth inside, wear other shoes.

Be Physically Active

Physical activity can help increase the circulation in your feet. There are many ways you can exercise your feet, even during times you’re not able to walk. Ask your health care team about things you can do to exercise your feet and legs.

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