Insulin, Medicines, & Other Diabetes Treatments

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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.

Diabetes and dental disease

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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.

Diabetes and foot problems

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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.

Diabetes and nerve system

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Diabetic nerve damage (also called diabetic neuropathy) is a problem for many people with diabetes. Over time, high blood glucose levels damage the delicate coating of nerves. This damage can cause many problems, such as pain in your feet. There’s a lot you can do to take charge and prevent nerve damage. A recent study shows that controlling your blood glucose can help prevent or delay these problems. Controlling your blood glucose may also help reduce the pain from some types of nerve damage.

Some Signs of Diabetic Nerve Damage

Some signs of diabetic nerve damage are the pain, burning, tingling, or loss of feeling in the feet and hands. It can cause you to sweat abnormally, make it hard for you to tell when your blood glucose is low, and make you feel light-headed when you stand up.

Nerve damage can lead to other problems. Some people develop problems swallowing and keeping food down. Nerve damage can also cause bowel problems, make it hard to urinate, cause dribbling with urination, and lead to bladder and kidney infections. Many people with nerve damage have trouble having sex. For example, men can have trouble keeping their penis erect; a problem called impotence (erectile dysfunction). If you have any of these problems, tell your healthcare provider. There are ways to help in many cases.

Protecting Your Nerves From Damage

Keep Your Blood Glucose in Control- High blood glucose can damage your nerves as time goes by. Work with your health care team to keep your glucose levels as close to normal as you can.

Have a Physical Activity Plan- Physical activity or exercise may help keep some nerves healthy, such as those in your feet. Ask your health care team about an activity that is healthy for you.

Get Tested for Nerve Damage –Nerve damage can happen slowly. You may not even be aware you’re losing feeling in your feet. Ask your health care provider to check your feet at each visit. At least once a year, your provider should test how well you can sense temperature, pinprick, vibration, and position in your feet. If you have signs of nerve damage, your provider may want to do more tests. Testing can help your provider know what is wrong and how to treat it. Keep track of your foot exams.

What healthy food choices should I make?

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Eat Less Saturated Fat

  • Eat baked, broiled, or stewed fish and meats instead of fried.
  • Use nonfat or low-fat salad dressing, mayo, and margarine.
  • Try a food lower in fat in a favorite dish—for example, make mac and cheese with fat-free or low-fat cheese and milk.

Eat Less Sugar

  • Drink water, sugar-free soda, or unsweetened iced tea instead of fruit drinks, regular soda, or sweet tea.
  • Keep cold water in the fridge.
  • Share dessert with someone else when you’re eating out, instead of having a whole dessert.

Eat Healthy Portions

  • When eating out, share a meal with someone else or put half in a box to take home.
  • Eat slowly and take a break between bites.
  • Do not skip meals—when you skip a meal, it’s easy to overeat at the next meal

Diabetes and kidney health

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Diabetes can cause diabetic kidney disease (also called diabetic nephropathy), which can lead to kidney failure. There’s a lot you can do to take charge and prevent kidney problems. A recent study shows that controlling your blood glucose can prevent or delay the onset of kidney disease. Keeping your blood pressure under control is also important.

The kidneys keep the right amount of water in the body and help filter out harmful wastes. These wastes, called urea, then pass from the body in the urine. Diabetes can cause kidney disease by damaging the parts of the kidneys that filter out wastes. When the kidneys fail, a person has to have his or her blood filtered through a machine (a treatment called dialysis) several times a week or has to get a kidney transplant.

Taking Care of Your Kidneys

Your health care provider can learn how well your kidneys are working by testing for microalbumin (a protein) in the urine. Microalbumin in the urine is an early sign of diabetic kidney disease. You should have your urine checked for microalbumin every year.

Your health care provider can also do a yearly blood test to measure your kidney function. If the tests show microalbumin in the urine or if your kidney function isn’t normal, you’ll need to be checked more often.

On the records page, write down the dates and the results of these tests. Ask your health care provider to explain what the results mean.

Protecting Your Kidneys

Keep Your Blood Glucose under Control

High blood glucose can damage your kidneys as time goes by. Work with your health care team to keep your glucose levels as close to normal as you can.

Keep Your Blood Pressure In Balance

High blood pressure (or hypertension) can damage your kidneys. You may want to check your blood pressure at home to be sure it stays lower than 130/80. Have your health care provider check your blood pressure at least 4 times a year. Your doctor may have you take a blood pressure pill, called an ACE inhibitor, to help protect your kidneys.

Diabetes and eye health

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Diabetic eye disease (also called diabetic retinopathy) is a serious problem that can lead to loss of sight. There’s a lot you can do to take charge and prevent such problems. A recent study shows that keeping your blood glucose level closer to normal can prevent or delay the onset of diabetic eye disease. Keeping your blood pressure under control is also important. Finding and treating eye problems early can help save sight.

Signs of Diabetic Eye Disease

Because diabetic eye disease may be developing even when your sight is good, regular dilated eye exams are important for finding problems early. Some people may notice signs of vision changes. If you’re having trouble reading, if your vision is blurred, or if you’re seeing rings around lights, dark spots, or flashing lights, you may have eye problems. Be sure to tell your healthcare team or eye doctor about any eye problems you may have.

Protecting Your Sight

Keep Your Blood Glucose under Control

High blood glucose can damage your eyes with time. Work with your health care team to keep your blood glucose levels in the target range.

Keep Your Blood Pressure under Control

High blood pressure can damage your eyes. Have your health care provider check your blood pressure at least 4 times a year. If your blood pressure is higher than 130/80, ask your health care provider how to keep your blood pressure at a healthy level. You may need medicine to keep your blood pressure at a healthy level.

Even if you’re seeing fine, you need regular, complete dilated eye exams to protect your sight. Ask your health care provider to help you find an eye doctor who cares for people with diabetes. Before the exam, a doctor or nurse will put drops in your eyes to dilate the pupils.

You should have your eyes dilated and examined once a year. Keep track of these exams by using the records. Even if you’ve lost your sight from diabetic eye disease, you still need to have regular eye care. If you haven’t already had a complete eye exam, you should have one now if any of these conditions apply to you—

  • You’ve had type 1 diabetes for 5 or more year.
  • You have type 2 diabetes.
  • You’re going through puberty and you have diabetes.
  • You’re pregnant and you have diabetes.
  • You’re planning to become pregnant and you have diabetes.

If you can’t afford an eye exam, ask about a payment plan or a free exam. If you’re 65 or older, Medicare may pay for diabetic eye exams (but not glasses). Ask your eye doctor to accept the Medicare fee as full payment.

Discuss Your Physical Activity Plan

If you have diabetic eye disease, talk with your health care provider about the kind of physical activity that is best for you.

Treating Diabetic Eye Disease

Treating eye problems early can help save sight. Laser surgery may help people who have advanced diabetic eye disease. An operation called a vitrectomy may help those who have lost their sight from bleeding in the back of the eye.

If your sight is poor, an eye doctor who is an expert in low vision may be able to give you glasses or other devices that can help you use your limited vision more fully. You may want to ask your health care provider about support groups and job training for people with poor vision.

Managing Your Diabetes at Work, School, and During Travel

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Staying in charge of your diabetes no matter what your day holds—work, school, travel, or special events—takes planning ahead. Many days will go smoothly, but some days will hold surprises, such as extra activity or delays that throw your schedule off.

Plan ahead for these times by always keeping a treatment for low blood glucose. If you have any signs that your glucose may below, go ahead and treat it right away.

Stay as close to your eating, activity, and medicine schedule as you can. Keep track of your blood glucose so you can pick up changes early. Always wear or carry identification that says you have diabetes.

Talk with your health care team about your planned schedule and activities. Ask for help in planning ahead for work, school, travel, and special events. When you read the rest of this section, you may think of more questions to ask.

At Work and School

Talk with your health care team about the type of activity you do at work or at school. From time to time, you and your healthcare team may need to make changes in your activity, medicine, or eating.

Many people take supplies for checking their glucose to school or work so they can check if at regular break times. Some people choose to show their fellow workers, their teachers, or their classmates how to help if they should ever have a problem. They teach them how to tell when their glucose is low and how to treat it. Some people like to have written steps on file at their place of work or with their teacher.

During Travel

When you plan a trip, think about your day-to-day schedule and try to stay as close to it as you can. For example, if you usually check your blood glucose at noon and then eat lunch, plan to do this on your trip, as well. Trips can hold surprises—in delays and changes. Even the types of food and supplies you can buy on your trip may not be the same as those you get at home.

Before you travel, work with your health care provider to plan your timing for medicine, food, and activity. Talk about what to do if you find changes in your glucose readings.

Plan ahead for trips:

  • Keep snacks with you that could be used to prevent—or treat—low blood glucose.
  • Carry extra food and drink supplies with you, such as cracker packs and small cans of juices or bottled water.
  • Carry glucose testing supplies with you.
  • Take along all the diabetes medicine you’ll need. Keep medicines in the original pharmacy container with the printed label that clearly identifies the medicine.

When you travel, be sure to

  • Test your glucose often and keep track of it.
  • Wear identification that says you have diabetes.
  • Let others know how they can help you.
  • Check new airline travel tips by contacting the Federal Aviation Administration (FAA) or 800-322-7873.

If you’re traveling in a different time zone, you may need to change your timing of food, medicine, and activity. Ask your health care provider to help you with this. Talk about the food and drink choices that would be healthy for you. If you’ll be in another country, ask your doctor to write a letter explaining that you have diabetes. It’s also a good idea to get your doctor to write a prescription for you to get insulin or supplies if needed.

Self-care plan

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Many people avoid the long-term problems of diabetes by taking good care of themselves. Work with your health care team to reach your goals:

  • Use your diabetes meal plan. If you do not have one, ask your health care team about one.
    • Make healthy food choices such as fruits and vegetables, fish, lean meats, chicken or turkey without the skin, dry peas or beans, whole grains, and low-fat or skim milk and cheese.
    • Keep fish and lean meat and poultry portion to about 3 ounces (or the size of a deck of cards). Bake, broil, or grill it.
    • Eat foods that have less fat and salt.
    • Eat foods with more fiber such as whole grains cereals, breads, crackers, rice, or pasta.
  • Get 30 to 60 minutes of physical activity on most days of the week. Brisk walking is a great way to move more.
  • Stay at a healthy weight by using your meal plan and moving more.
  • Ask for help if you feel down. A mental health counselor, support group, member of the clergy, friend, or family member who will listen to your concerns may help you feel better.
  • Learn to cope with stress. Stress can raise your blood glucose (blood sugar). While it is hard to remove stress from your life, you can learn to handle it.
  • Stop smoking. Ask for help to quit.
  • Take medicines even when you feel good. Ask your doctor if you need aspirin to prevent a heart attack or stroke. Tell your doctor if you cannot afford your medicines or if you have any side effects.
  • Check your feet every day for cuts, blisters, red spots, and swelling. Call your health care team right away about any sores that do not go away.
  • Brush your teeth and floss every day to avoid problems with your mouth, teeth, or gums
  • Check your blood glucose (blood sugar). You may want to test it one or more times a day. Use the card at the back of this booklet to keep a record of your blood glucose numbers. Be sure to take this record to your doctor visits.
  • Check your blood pressure if your doctor advises.
  • Report any changes in your eyesight to your doctor.

Actions you could take:

  • Talk with your health care team about your blood glucose targets. Ask how and when to test your blood glucose and how to use the results to manage your diabetes.
  • Discuss how your self-care plan is working for you each time you visit your health care team.

Know Your Diabetes ABCs – A1C, Blood Pressure and Cholesterol

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Talk to your healthcare team about how to manage your A1C (blood glucose or sugar), Blood pressure, and Cholesterol. This will help lower your chances of having a heart attack, a stroke, or other diabetes problems. Here’s what the ABCs of diabetes stand for:

A for the A1C test

The A1C Test shows you what your blood glucose has been over the last three months. The A1C goal for many people is below 7. High blood glucose levels can harm your heart and blood vessels, kidneys, feet, and eyes.

B for Blood pressure.

The blood pressure goal for most people with diabetes is below 140/90. It may be different for you. Ask what your goal should be.

High blood pressure makes your heart work too hard. It can cause heart attack, stroke, and kidney disease.

C for Cholesterol.

Ask what your cholesterol numbers should be.

LDL or “bad” cholesterol can build up and clog your blood vessels. It can cause a heart attack or a stroke. HDL or “good” cholesterol helps remove cholesterol from your blood vessels.

Actions you could take:

  • Ask your health care team:
    • What your A1C, blood pressure, and Cholesterol numbers are
    • What should your ABC numbers be
    • What you can do to reach your targets

Diabetes and heart health

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To protect your heart and blood vessels, eat right, get physical activity, don’t smoke, and maintain healthy blood glucose, blood pressure, and cholesterol levels. Choose a healthy diet, low in salt. Work with a dietitian to plan healthy meals. If you’re overweight, talk about how to safely lose weight. Ask about a physical activity or exercise program. Quit smoking if you currently do. Get a hemoglobin A1C test at least twice a year to determine what your average blood glucose level was for the past 2 to 3 months. Get your blood pressure checked at every doctor’s visit, and get your cholesterol checked at least once a year. Take medications if prescribed by your doctor.

How to manage your diabetes?

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Healthy eating, physical activity, and insulin injections are the basic therapies for type 1 diabetes. The amount of insulin taken must be balanced with food intake and daily activities. Blood glucose levels must be closely monitored through frequent blood glucose testing.

Healthy eating, physical activity, and blood glucose testing are the basic therapies for type 2 diabetes. In addition, many people with type 2 diabetes require oral medication, insulin, or both to control their blood glucose levels.

People with diabetes must take responsibility for their day-to-day care, and keep blood glucose levels from going too low or too high.

People with diabetes should see a health care provider who will monitor their diabetes control and help them learn to manage their diabetes. In addition, people with diabetes may see endocrinologists, who may specialize in diabetes care; ophthalmologists for eye examinations; podiatrists for routine foot care; and dietitians and diabetes educators who teach the skills needed for daily diabetes management.