The key to steady blood sugar levels around the clock and from year to year, according to Jesse Vander Heide, a certified diabetes educator at Oregon Health and Science University in Portland, is to develop a routine that you’re confident you can stick to over time. “Anybody can do something for a week,” Heide says. “With diabetes, we want to look at the long-term picture. How can you do this for one day — and for five years? How can you do this for rest of your life? Until we have some sort of cure for type 2 diabetes, [these are the timeframes] we are looking at.” Heide urges people to think about all aspects of having type 2 diabetes: How you like to take your medication, how you check your blood sugar, how you eat. “All of these things should be what you can keep up in the long-term,” he says. Routine is vital to success — as is understanding your disease. Here’s a morning-to-night routine that can help you successfully manage type 2 diabetes.
In the Morning
Check your blood sugar. If you have type 2 diabetes, you should check your blood sugar level every morning before you eat, says Marjorie Cypress, CDE, a nurse practitioner at ABQ Health Partners in Albuquerque, New Mexico, and past president of health care and education at the American Diabetes Association. This gives you a good baseline idea where you stand and allows you to make adjustments throughout the day. Take your medication on time. If you’re prescribed long-acting basal insulin, which is designed to keep your blood sugar levels steady over the course of the night and between meals, you may want to consider the AM as the time to do it, before the distractions of the day take over. But consistency is what really matters, Heide says. Whether that’s morning or night, aim to take your basal insulin at the same time each day. “We tend to cater [this decision] more towards what the person has an easier time remembering,” he explains. If you’re prescribed other medications to take in the morning, be sure to take these consistently as well. Eat breakfast — and also take a look forward in your day. If you skip breakfast, you’re already starting your day on the wrong foot. “Many people tend to skip breakfast, and it’s one of the most important meals of the day,” Cypress says. “You skip breakfast and you get hungrier and hungrier, and that’s one of the reasons people tend to overeat later in the day.” In fact, while eating regular meals will help keep your blood sugar levels steady, skipping them and then binging later can cause spikes — morning, noon, or night. “Sometimes we put people on standard doses of diabetes medications for meals, and as the meals fluctuate, they can be at risk for high blood sugar or low blood sugar,” Heide says. And when a person “is on standard doses of rapid acting insulin (bolus), one of the things we try to talk about is consistency of meals (such as eating the same amount of carbohydrates at every meal),” Heide says. That requires some awareness of what you’re eating, such as the carb and macronutrient composition of the food, he says. For these and other reasons, when it comes to managing type 2 diabetes, understanding how to fit food and medication into your life is an example of how knowledge is power, says Heide. This means understanding how the insulin or other medications you’ve been prescribed affect your blood sugar. And since diets are hard to maintain, educators and doctors now focus more on eating strategies and plans instead. These involve looking at larger overall patterns that enable you to get nutritious food and also help keep your blood sugar levels steady throughout the day. Give your feet a once-over. Over time, high blood sugar can cause nerve damage and loss of sensation in your feet. In extreme cases, a person with diabetes can end up needing to have a foot amputated if an unnoticed cut becomes severely infected. Check your feet for any sores or cuts each morning. Also check your shoes before putting them on to make sure there’s nothing in your shoe that could cause a sore. Check your feet again at bedtime, as well.
In the Afternoon
Take a satisfying lunch break. Don’t eat lunch at your desk — that’s a sure way to rush and feel stressed. Instead, sit down somewhere else and eat, then take a short walk afterward. Plan a healthy lunch ahead of time or you might resort to unhealthy fast food. You get a triple-win against diabetes with a lunch break: The regular meal and the exercise help keep your blood sugar level stable, and you can release some pressure from work. Have healthy snacks on hand. Afternoon snacking is a good way to set yourself up for healthy eating once you are home. “Most people like to snack in the afternoon, and I think that’s important because you don’t want to get home and start grabbing anything because you’re so hungry,” Cypress says. But make it a sensible snack to help keep your blood sugar steady and also avoid being so hungry that you overeat later on. Get a little extra activity. Physical activity is crucial to blood sugar control. When you’re active, your cells burn blood sugar through a process that doesn’t rely on insulin. Activity also lets your body use insulin more efficiently. Take the stairs instead of an elevator. Get up from your desk and go talk to co-workers instead of emailing them. Experts recommend getting 30 minutes of physical activity each day, but it doesn’t have to be all at once, says Don Kain, MA, RD, a certified diabetes educator with Oregon Health & Science University in Portland. Every time you get up and move around, you’re adding to your 30-minute total. If you’re worn out from work, he says, try to fit in a short walk in the late afternoon. It’s a good idea to check your blood sugar before and after exercise to help determine how different activities affect your blood sugar, Heide says. If you take insulin as part of your type 2 diabetes management, you may be at risk for hypoglycemia (low blood sugar) if you don’t adjust your insulin dose or carbohydrate intake before exercise. Talk to your doctor about how best to balance activity with food and your medication. “It’s not a one size fits all scenario,” says Heide. “Variables to consider include the type of exercise they are doing, the type of meal they had beforehand, and the type of insulin they are taking. All of those factors make up a puzzle of what we recommend.” Keep moving while you watch TV or listen to a book on tape. Position weights — or even a treadmill or other workout unit — nearby. The goal is to stay in motion, at least for a portion of the time. Do sit-ups or push-ups during commercials. Even physical activity that’s not aerobic can help your body’s ability to use insulin efficiently, and keep your blood sugar levels stable.
At Bedtime
Brush and floss your teeth. Brush in the morning and at night, and floss every night. “People with diabetes are at increased risk for periodontal disease and general dental problems,” Kain says. Apply some lotion. Keep your skin moisturized to prevent peeling, cracking, and developing sores that can be symptoms of diabetes. Apply lotion every night before bed. Finally, do an end-of-day blood sugar check. Here’s where you see how your diabetes management routine pays off. “Checking your blood sugar at bedtime gives you a good idea what happened during the day,” Cypress says. In many ways, the healthiest day — and year and decade — for the person with type 2 diabetes is patched together with common sense and awareness, Heide says. “Almost everything that we teach people about diabetes are things that would be useful for someone who doesn’t have diabetes!” Additional reporting by Andrea Peirce
