Dr Praveen Ramachandra
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Patient education: Diabetes


The management of diabetes includes the following steps

  • Lifestyle Self Management
  • Nutrition and Exercise
  • Foot Care
  • Checking Your Blood Sugar

·        Good Health Care Follow Up


Lifestyle Self Management

Lifestyle is Key to Diabetes Self Management. In many cases, one can control diabetes through better nutrition, a healthy weight, physical activity, and regular checkups with your health care team.
Sometimes medication is also necessary, which your health care provider will determine. Medication, if prescribed by your doctor or nurse practitioner, is a crucial component of diabetes management and should be taken as directed. Some medications need to be timed with meals, and if so your doctor or nurse practitioner will instruct you on appropriate timing.


                                                                                                                          Fig 1: Self management of diabetes


What, when and how much you eat are all important factors in managing diabetes. With the help of your dietitian or health care professional, you should develop and follow a meal plan based on your individual needs


Nutrition Tips for People with Type 2 Diabetes

  •         You should schedule and follow a consistent meal plan.

  •         Eat a balanced diet with a variety of foods, including fruits, vegetables, whole grain foods, low-fat dairy products, and lean meat, poultry, fish or meat alternatives.

  •         Eat the right amount of carbohydrate foods for good blood sugar control. Your dietician can determine how much carbohydrate food your body needs at each meal.

  •         Choose lower fat options and limit saturated fats.

  •         Use sugar in moderation. Consider lower sugar options if available.

  •        Check nutrition labels.

  •         Get your fiber. The American Dietetic Association recommends that all people eat 20-35 grams of fiber per day. Fruits, vegetables, beans and whole grain foods are good sources of fiber.

  •        Drink plenty of water.

  •    Use less salt.


                                                                                                                                  Fig 2: Diabetic diet

Nutrition Tips for People with Type 1 Diabetes

People with type 1 diabetes should follow good general nutrition guidelines, and in addition, the insulin dose can be adjusted to the mealtime carbohydrates, which allows for more flexibility in meal planning. Your health care provider can help determine how much insulin you need at each meal.


Physical activity is good for your health. But it’s especially important for people with diabetes or those trying to prevent the disease.
In addition to improving blood sugar control, decreasing the risk of diabetes, and maintaining overall good health and weight management, being active boosts brain activity, helps you deal with stress and improves your mood.

Type2 diabetes is closely linked to being overweight. Along with healthy eating habits, regular physical activity helps the body to use insulin better, which helps to reduce the risk of Type 2 diabetes. It is very important to ask doctors advice first, before starting any exercise program. Your doctor can give you an appropriate exercise prescription based on your personal health status.

Foot Care

It is very important to check your feet daily, keep them clean and soft, wear well-fitting, breathable shoes and socks, and report to your health care provider, if any changes you observe.


                                                                                                                         Fig. 3: Tips for good foot care in diabetes

Checking Your Blood Sugar

If your doctor has instructed you to check your blood sugar, be sure to follow instructions for frequency and times of day, as this can help to identify blood sugar patterns which may need to be corrected. Also it helps the health care provider to determine your personal blood sugar goals.

Always check your blood sugar if you feel symptoms of high blood sugar (thirst, frequent urination, fatigue, blurry vision), or low blood sugar (lightheadedness, dizzy, confusion, sweating, shaking, fast or pounding heartbeat) and call your doctor. It is important to immediately treat low blood sugar (<70) with a simple carbohydrate such as sugar, chocolate, fruit juice, regular soda pop, or glucose tablets/powder.


                                                                                                                                  Fig 4: Regular checking of blood glucose level

Check your blood sugar more often when you are sick, as infection can make blood sugar rise. And be sure to get plenty of fluids and drink some carbohydrate- containing fluids if you can’t eat. It is very important to continue taking your diabetes medications when you are sick. If you are unsure of dosages if unable to eat, call your doctor and take his advice.

Good Health Care Follow Up

Finally, it is very important to see your doctor regularly to monitor your diabetes, make adjustments in medications, order appropriate tests, and prescribe education for you to better manage your diabetes.

Summary of the guidelines that will help you manage your diabetes for a lifetime of good health


1.    Plan what you eat and follow a balanced meal plan. See your dietitian at least once a year.

2.    Exercise at least five times a week for 30 minutes each session. Talk to your doctor before starting any exercise program. Tell your doctor what kind of exercise you want to do so adjustments can be made to your medicine schedule or meal plan, if necessary.

3.    Follow your medicine schedule as prescribed by your doctor.

4.    Know what medicines (brand and generic names) you are taking and how they work. Keep a list of your medicines with you at all times.

5.    Test your blood glucose regularly, as recommended by your health care provider. Test your blood glucose more often when you're sick.

6.    Try to continuously keep your blood glucose level at the recommended range. If your blood glucose is less than 70 mg/dl and you have more than one unexplained low blood glucose reaction a week, call your doctor. If your blood glucose is greater than 160 mg/dl for more than a week or if you have two consecutive readings greater than 300 mg/dl, call your doctor.

7.    Contact your doctor when your blood glucose is over 300 mg/dl. Test your urine for ketones if recommended by your doctor.

8.    Record your blood glucose and urine ketone test results in a record keeping log. Bring your log book with you to all of your doctor's visits.

9.    Keep your scheduled appointments with your health care providers. See your doctor at least every three to four months for regular check-ups if you are treated with insulin. See your doctor every four to six months if you are treated with other diabetes medicines or if you are managing diabetes with diet and exercise alone. More frequent visits might be necessary if your blood glucose is not controlled or if complications of diabetes are progressing. Make sure your health care provider checks your blood pressure and weight, and examines your feet and insulin injection sites.

10. Have a glycosylated hemoglobin test (HbA1c) at least two times a year or more frequently as recommended by your doctor.

11. Have an eye exam (including a retinopathy screening test) and urinalysis test (to rule out diabetic nephropathy) and neuropathy screening once a year, or as recommended by your doctor. (Your doctor might request that you have these tests more frequently.)

12. Have your cholesterol and triglyceride levels checked (lipid profile test) once a year.

13. Have a dental exam every six months.

14. If you have any signs of infection, call your doctor or health care provider.

15. Practice good foot and skin care.


17. Try to manage stress as best as you can. You might think about attending a stress management workshop to help you learn better coping methods.

18. Discuss your travel plans with your doctor. Make sure to bring enough medicine and supplies with you on your trip. Keep medicines, syringes, and blood glucose testing supplies in your carry-on bag. Do not check these supplies in case your luggage is lost.

19. Continue learning about your diabetes to maintain and improve your health. Attend a diabetes class or schedule visits with your diabetes educator at least once a year.