Everything you need to know about managing your blood sugars when you have diabetes.

Maya Feller, M.S., R.D., C.D.N.
August 31, 2020
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Managing blood sugars while focusing on maintaining target ranges helps to minimize unwanted complications that come with significant variations in blood sugar levels. When you have diabetes, understanding your numbers as well as options for self-management will help you live a healthier life. Here we tell you everything you need to know about keeping your blood sugar balanced day after day.

It's important to remember that there is no one size that fits all, especially with diabetes. Additionally, there is no one "diabetes diet." However, you can make nutrition and lifestyle choices and modifications that support your individual health outcomes. Generally, the recommendations support creating a balanced plate that provides an abundance of vegetables, fruits and whole grains coming from minimally processed sources, while being mindful of added sugars, added salts and fats, like synthetic fats and saturated fat, that can do damage when eaten in large amounts. Additionally, incorporating intentional physical activity into your routine further supports balanced blood sugars.

Target numbers

Each person has a blood sugar target range that will take their age, current health and lifestyle into consideration. This is the desired healthy range for their individual blood glucose levels. Blood sugars can be checked with a blood glucose monitor where an individual pricks their finger or with a continuous glucose monitor (CGM), or via an A1C. A1C, also called hemoglobin A1C, is a blood test that provides a 3-month retrospective look at blood sugar averages. This test is often used as a diagnostic tool in combination with other tests when diagnosing diabetes. The A1C is likely to be expressed in percentages rather than mg/dL like the values from the CGM or glucometer.

Typical Glucometer & CGM general targets for people living with diabetes

  • Before meals (fasting blood sugar): 80-130 mg/dL
  • 2 hours post-meal: less than 180 mg/dL

Hemoglobin A1C

  • Expected or normal range: < 5.7%
  • Prediabetes: 5.7 to 6.4%
  • Diabetes: ≥ 6.5%

Fasting blood sugars

Fasting blood sugar levels are usually taken at the start of the day when you have not had anything to eat or drink, other than waterm within the previous eight hours. This test may be used as a diagnostic tool as well as to check how medications or any diet modifications for a person who has been diagnosed with diabetes is working.

  • Normal: <100 mg/dL

  • Prediabetes: 100- 125 mg/dL

  • Diabetes: ≥ 126 mg/dL

Goal for people living with diabetes: 80 - 130 mg/dL

Managing elevated blood sugars

A person may experience hyperglycemia or elevated blood sugars in response to nutrition, stress and/or illness. High blood sugar symptoms may include:

  • Extreme fatigue

  • Difficulty concentrating

  • Increased thirst

  • Increased urination

  • Dry mouth

  • Blurry vision

Some easy ways to help bring your blood sugars back down include going for a quick walk to use up some of that excess glucose in your system, drinking water and taking insulin, if that's something you're using. Read more here: These Are the Fastest Ways to Stabilize Your Blood Sugar If You Have Diabetes

If left untreated, hyperglycemia can result in ketoacidosis, a toxic buildup of ketones in the blood which can be fatal. The CDC recommends checking your urine for ketones if you are ill and your blood sugars are at or above 240 mg/dL. If you are regularly experiencing hyperglycemia, you will need to consult and work with your health care team to safely bring your blood sugars back within target range.

Managing blood sugar lows

Hypoglycemia or low blood sugars below 70 mg/dL can occur as a result of nutrition shifts such as skipping meals or unintentionally taking too much medicine, and increasing exercise can also cause low blood sugars. Some symptoms of low blood sugar may include:

  • Dizziness

  • Shaking

  • Confusion

  • Hunger

  • Unintentional sweating

If you feel that you are experiencing hypoglycemia, check your blood sugars. The CDC recommends drinking 4 ounces of 100% juice or taking 4 glucose tablets, waiting 15 minutes and rechecking your blood sugars. If your blood sugars remain low, repeat with a snack and wait 15 minutes then recheck your blood sugars. It's always recommended to follow up with your health care team when you regularly experience hypoglycemia.

Exercise and Blood Sugars

Exercising has numerous benefits including improving cardiovascular health, improving blood sugars, lowering insulin resistance, building lean body mass and supporting mood and cognition. It's important to time medication intake and meals so that exercise doesn't increase the risk of hypoglycemia. For people taking insulin, Harvard Medical School suggests having a piece of fruit if your blood sugar reading is below 100 mg/dL before exercise and testing again after exercising. For people who are experiencing hyperglycemia, 250 mg/dL or above, the recommendation is not to exercise as it can further increase high blood sugars and cause unwanted complications.

Diabetes medications

Oral and non-insulin injectable pharmacological therapies for the management of blood sugars are prescribed based on each person's pancreatic function (the pancreas is where insulin is made) as well as their body's ability to utilize insulin. These medications can improve how much insulin your pancreas creates (insulin secretion), how effective the cells are at utilizing insulin (insulin sensitivity) and more. The net result is improved blood sugars. Some of the current oral and injectable medications for type 2 diabetes are:

  • 1st-generation sulfonylureas (chlorpropamide)

  • 2nd-generation sulfonylureas (glipizide, glyburide)

  • Meglitinides (repaglinide, nateglinide)

  • Biguanides (metformin)

  • Thiazolidinediones, aka TZDs or glitazones (rosiglitazone, pioglitazone)

  • Alpha-glucosidase inhibitors (acarbose, miglitol, voglibose)

  • DPP-4 inhibitors (sitagliptin, saxagliptin, vildagliptin, linagliptin, alogliptin)

  • Bile acid sequestrant

  • Dopamine agonist

  • SGLT2 inhibitors (dapagliflozin, canagliflozin)

  • GLP-1 receptor agonists

Injectable insulin

Types of insulin vary based on the length of time they remain in your system, how quickly they enter the bloodstream and begin to work, and when they peak. Insulin is injected so that it can quickly reach the bloodstream and begin lowering blood sugars in response to food or drink.

Getting to know your numbers and how your body responds to nutrition and physical activity is an important part of managing your blood sugars. Regular monitoring will provide you with insight into when modifications are needed. When building meals and snacks, be mindful of the type and quantity of carbohydrates consumed. A good rule of thumb is to make the majority of your plate or snack a nonstarchy vegetable balanced with protein and starchy food of your choice.

Bottom line

Your blood sugar is bound to bounce around from time to time. What's most important is that it's within target range most of the time. Talk with your diabetes care team about the best ways to keep your blood sugars balanced, so you can feel good and energized day after day.