Living with diabetes

If diabetes is detected early and treated effectively, there is no reason why you should not lead an active and healthy life, and reduce the chance of developing any future complications.

Noticing any early signs of complications is important, as is taking measures to avoid developing them in the first place.

Being diagnosed with diabetes can be a difficult time, but there are a number of support systems that may help. Patient organisations often have local groups where you can meet others who have diabetes. 

Structured education programmes may be available that can help in a number of ways, for example, by:

  • Teaching you to adjust your insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. dosing according to your diet
  • Identifying any health risks
  • Setting goals for self-management.[1]

This page will discuss the following considerations for people living with diabetes:

Self-monitoring

Blood sugar monitor skin prick

Home bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body.-testing kits are available that are accurate and easy to use. Some people keep a diary of the results to discuss with their healthcare team, so that they can learn how to manage their diabetes according to the findings.

Many healthcare professionals advise people with diabetes to monitor their bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. at home, although some believe that this does not actually improve the long-term management of diabetes.[2,3]

It is thought that self-monitoring may help people with diabetes to get a better understanding of how exercise, diet and medication can have an impact on bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. levels.[4]

Some scientific studies support this, suggesting that self-monitoring of bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. improves diabetes management and leads to a healthier lifestyle,[5] and this may be the case whether you are on insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels., other diabetes medication or no medication at all.[5]

Using a home bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. meter involves pricking a finger, then placing a drop of bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. onto a reagent strip before inserting the strip into an automated meter. Any high or low bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. levels may then be corrected by a change of diet, exercise, or modifying your medication.[6]

How often a person with diabetes should monitor their glucoseA simple sugar that is an important source of energy in the body. levels depends on how well their diabetes is controlled and what medication they are taking. For example, people who are on insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. may need to check their bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. more often than those who are taking oral diabetic medication.[6]

Get more practical help on self-monitoring in diabetes.

Regular check-ups

An important aspect of living a healthy life with diabetes is detecting any early signs of complications so that they can be treated straight away. Many patients will be offered annual check-ups to assess the health of their eyes, kidneys, nervous system and feet, as well as looking for any signs of heart disease.

Your doctor may check the pulses in your feet and look for abrasions in the skin and any lack of sensation or abnormalities in the joints.[7] The check-up should also include blood pressure measurement and bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. tests for lipids and kidney function.[8] A urine test for a protein called albuminA type of chemical called a protein, formed in the liver. can pick up kidney disease or infectionInvasion by organisms that may be harmful, for example bacteria or parasites..[7]

Annual eye tests are also very important to check visual acuity and look for any changes in the retina. Sometimes, retinal photography is used - this will allow for the assessment of any changes over time.[7]  An eye test can also look for cataracts and test for the presence of glaucomaIncreased pressure within the eye (intraocular pressure), which leads to visual loss..

It is also important to visit your dentist regularly, as people with diabetes are at higher risk of developing gum disease and other dental problems.

Stress management

Diabetes is a chronicA disease of long duration generally involving slow changes. condition that needs ongoing care. Understandably, being diagnosed with any serious condition can be a stressful time. It is usually helpful to be able to talk about your feelings with friends and family, and to find out as much as you can about your condition.

Joining local support groups and finding good sources of robust, trustworthy information can make a big difference.

It may be especially important to learn how to manage stressRelating to injury or concern. when you have diabetes. A number of studies have suggested that psychological stressRelating to injury or concern. can have a negative impact on bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. control in diabetes.

Feeling stressed prompts an outpouring of stressRelating to injury or concern. hormones, like adrenalineA hormone produced by the adrenal glands, which stimulates increases in the heart rate, breathing and metabolic rate. and cortisolA steroid hormone important for helping to regulate carbohydrate metabolism and the stress response., and releases glucoseA simple sugar that is an important source of energy in the body. into the bloodstream in preparation for a 'fight or flight' response. When you have diabetes, your cells may not be able to take up this glucoseA simple sugar that is an important source of energy in the body. properly, so bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. levels can increase.

Furthermore, stressRelating to injury or concern. may impair insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. release in people with type 2 diabetes, who may also be especially sensitive to the effects of stressRelating to injury or concern. hormones.[9]

In addition, anyone who is under stressRelating to injury or concern. is less likely to eat healthily or exercise properly, and more likely to indulge in unhealthy behaviours like smoking or drinking too much. For someone with diabetes, this can be especially detrimental.

Some studies have suggested that psychological therapies to lower stressRelating to injury or concern. in people with diabetes may have a positive effect on glucoseA simple sugar that is an important source of energy in the body. control, particularly in children.[10,11]

Any member of your diabetes healthcare team can help by answering questions you may have about your symptoms and treatment. It is important to seek help for any aspects that you find confusing or upsetting. Your doctor may also be able to recommend counselling or psychological therapies.

Other techniques that can help you to deal with stressRelating to injury or concern. include:

  • Exercise
  • Deep breathing
  • Progressive muscleTissue made up of cells that can contract to bring about movement. relaxation
  • Cognitive behaviour therapy.

Herbs and nutritional supplements

A number of herbs and nutritional supplements may help to lower bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. in people with diabetes. Many of these are products that have been used for a long time and seem to be safe,[12] although there is not enough evidence to draw definite conclusions about their effectiveness.[13]

Alpha-lipoic acid (ALA) is a natural substance made in small quantities in both plant and animal cells, including those of humans. The amounts obtained from foods are too tiny to have much effect, so concentrated high-dose supplements are used.

There is increasing evidence that ALA can help with bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. sugar control in people with type 2 diabetes, as well as improving the health of bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. vessels [14] and alleviating pain in diabetic neuropathy.[15,16]

American ginseng is widely used as a health supplement and may also have a role in treating type 2 diabetes. It has been shown to lower glucoseA simple sugar that is an important source of energy in the body. levels after eating in people with and without type 2 diabetes[17,18] and may increase the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. sugar-lowering effects of some medicines, including insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels..

Stevia, an extract of a plant with a long tradition of use in South America for the treatment of diabetes, is now used in many countries as a natural sweetener.

Some preliminary research suggests that it may help to lower bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. levels in people with diabetes, although further studies are needed. It may also increase the effectiveness of medications to lower bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body., including insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels..

Meals high in soluble fibre or resistantA microbe, such as a type of bacteria, that is able to resist the effects of antibiotics or other drugs. starch (a type of starch that is not digested in the small intestineThe section of gut, or gastrointestinal tract, from the stomach to the anus.) appear to result in lower levels of glucoseA simple sugar that is an important source of energy in the body. in the bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. after eating. The combination of resistantA microbe, such as a type of bacteria, that is able to resist the effects of antibiotics or other drugs. starch and soluble fibre together seems to be more effective than either on its own.[19, 20]

A type of soluble fibre called beta-glucan has been shown in some studies to help bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. sugar control in people with diabetes, although more research is needed to confirm the effects.

Guar gum, a soluble fibre derived from the Indian cluster bean, has been suggested to lower both glucoseA simple sugar that is an important source of energy in the body. and cholesterolA substance present in many tissues and an important constituent of cell membranes although high concentrations of a certain type of cholesterol in the blood are unhealthy. in people with diabetes [21]. However it may have gastrointestinal side effects such as abdominal pain and diarrhoeaWhen bowel evacuation happens more often than usual, or where the faeces are abnormally liquid., and causes an allergic reaction in some people.[22]

Psyllium is a herb with a husk rich in soluble fibre that has beneficial effects on bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. fats and may reduce high blood pressure after prolonged supplementation.[23] It has been shown to reduce the glucoseA simple sugar that is an important source of energy in the body. and insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. response to a meal in people with type 2 diabetes.[24] Like guar gum, psyllium may cause allergic reactions.

Gymnema is an Indian herb that has long been used by people with diabetes. Small studies suggest that it may enhance the production or activity of insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. in both type 1 and type 2 diabetes,[25, 26] and may reduce glycated haemoglobinHbA1c, a measure of how well glucose levels have been controlled over the previous three months or so in a person with diabetes. It is expressed as a percentage. levels.[27]

Preliminary evidence suggests that another Indian herb, Coccinia indica, may lower levels of fasting bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body., lessen the rise in bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. levels after eating and reduce glycated haemoglobinHbA1c, a measure of how well glucose levels have been controlled over the previous three months or so in a person with diabetes. It is expressed as a percentage. levels.[13,28]

There is tentative evidence that the spice cinnamon may reduce fasting bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. levels,[22] and perhaps also cholesterolA substance present in many tissues and an important constituent of cell membranes although high concentrations of a certain type of cholesterol in the blood are unhealthy. levels in people with type 2 diabetes.[29] One small study in healthy volunteers suggested it may also improve insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. sensitivity. [30] However not all studies have shown positive effects and those that have been demonstrated have generally been short-term. [31]

It is important to tell your doctor if you are taking any herbs or supplements.[32] Many of these, for example, guar gum, ALA, stevia and psyllium, should not be taken by women who are either pregnant or breastfeeding.

Interactions between supplements and medications are not uncommon. Furthermore, supplements that heighten the effects of insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. also affect diabetic control and increase the risk of developing low glucoseA simple sugar that is an important source of energy in the body. levels or hypoglycaemiaLow blood glucose levels..[22]

Learn more about diabetes and diet.

More about taking medicines safely.

Falling ill

If you fall ill it is important to remember:[2]

  • You need to keep taking your diabetes medication regularly
  • You also need to keep a close eye on your bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body., as illness can sometimes trigger high glucoseA simple sugar that is an important source of energy in the body. levels
  • If your bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. levels are high, you may need to consult your healthcare team about increasing your diabetes medication
  • It is important to maintain your fluid intake and get plenty of rest.

Pregnancy

It is quite possible for a woman with diabetes to have a normal pregnancy and a healthy baby, though it is advisable to plan carefully. The most important factor is to maintain tight bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. control, both before conceptionThe fertilisation of an ovum by a sperm cell: the start of pregnancy. and throughout pregnancy.[33]

You will need to be even more careful to eat healthily and to get plenty of exercise, and will probably need to monitor your bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. glucoseA simple sugar that is an important source of energy in the body. more frequently. Other tips that can help include:[34]

  • Ask your diabetes care team for pregnancy planning advice
  • Have your eyes checked - if you have advanced retinopathy, this should be treated before you become pregnant
  • Check with your doctor whether you need to change any of your medications, as some should not be taken by pregnant women - for example, some bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. pressure-lowering drugs and some tablets for type 2 diabetes
  • Make sure that you know how to test your bloodA fluid that transports oxygen and other substances through the body, made up of blood cells suspended in a liquid. or urine for ketonesA group of compounds that are produced by fat metabolism. if you have type 1 diabetes
  • Keep a glucagonA hormone produced by the pancreas that broadly opposes the actions of insulin and so increases the blood sugar (glucose) level. kit, and make sure someone nearby knows how to use it.

Learn more about pregnancy with diabetes.

Sexual dysfunction

The risk of sexual dysfunction may be increased with diabetes in both men and women.

Men are more likely to experience erectile dysfunctionInability to maintain a penile erection for sexual intercourse.,[35] while women with diabetes may be more likely to experience sexual issues such as difficulty becoming aroused, pain during intercourse (called dyspareuniaPain experienced by a woman during sexual intercourse.) and inability to achieve orgasm.[36]

Erectile dysfunction is a relatively common sexual health problem among men, and may be caused by any of a number of factors such as tiredness and stressRelating to injury or concern..

Men with diabetes are more likely than others to have erectile dysfunctionInability to maintain a penile erection for sexual intercourse.; it is important to remember though that having diabetes does not mean you will definitely develop this condition.[35]

You should speak to your doctor if you develop erectile dysfunctionInability to maintain a penile erection for sexual intercourse., not least because it can be an early sign of cardiovascular disease. There is a wide range of available treatments, which include:[37]

  • Counselling
  • Oral medication
  • Vacuum therapy
  • Penile injections.

Learn more about erectile dysfunction and its management.

Travel

Having diabetes need not stop you from travelling, although there are certain steps you can take to make journeys easier:

  • Carry a copy of your prescription for all medications, together with a letter from your doctor if you are carrying insulinA hormone produced by the beta cells of the pancreas that acts to lower blood glucose levels. and needles
  • Take a good supply of your diabetes medication with enough spare to allow for unforeseen delays or other problems
  • Plan your diabetes medication to take into account any change in time zones
  • Have all the appropriate vaccinations and follow recommended precautions about food and drinking water, to safeguard against illness at your destination
  • When taking out travel insurance, make sure that the company is aware of your diabetes and any other health problems.

More about travelling with a chronic condition.

Insurance

Having diabetes can affect many types of insurance policy, and may impact on travel, medical and life insurance policies especially.

You may also need to tell your motorRelating to the part of the nervous system that carries information from the brain and spinal cord to cause activity in a muscle or gland. insurance company about your diabetes. It is important to disclose all the facts, even if you are not asked direct questions about your health, as policies may otherwise be invalidated.

State benefits

In some countries, people with diabetes are entitled to help with the costs of medical care; for example, free prescriptions or eye examinations.

These benefits will vary from country to country and it is helpful to know what is offered in your country.

References: 
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  31. From type 2 diabetes to antioxidantA chemical that can neutralise damaging substances called oxygen free radicals. activity: a systematic review of the safety and efficacy of common and cassia cinnamon bark. Dugoua JJ, Seely D, Perri D et al. Can J Physiol Pharmacol. 2007 Sep;85(9):837-47.
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  35. The prevalence of erectile dysfunctionInability to maintain a penile erection for sexual intercourse. in the primary care setting. Grover SA, Lowensteyn I, Kaouache M et al. Arch Intern Med. 2006;166:213-9.
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  37. Erectile dysfunction: management update. Fazio L and Brock G. CMAJ. 2004;170:1429-37.