Diabetes
General Resources
Note from Your Doctor: Diabetes
Oceanview Family Practice
Assessment: Diabetes Medication Decision Tool
Learn how different medications affect your risk of complications from diabetes
Assessment: What is Your Target A1C?
Diabetes Canada
A General Resource
Diabetes Medication
Decision Aid
Diabetes &Diet: Physicians Association for Nutrition
Physicians Association for Nutrition
Meal Planning
Diabetes Canada
Can I Stop Taking my Diabetes Medication?
Diabetes Medication
Decision Aid
Checking Blood Sugars when you are on Insulin: What you Need to Know
Physicians Association for Nutrition
Glycemic Index
Learn which foods will raise your blood sugar more than others
The Benefits of Plant Based Nutrition: Treatment & Prevention of Type 2 Diabetes
Diabetes Medication
Decision Aid
Summary & Suggestions
- Maintain a healthy weight, or lose weight if you are overweight. Eat fruits, vegetables & whole grains. Use the plate method to plan your meal. Make water your drink of choice and avoid sugary drinks. Limit processed foods. Try to choose foods with a low glycemic index most often.
- Exercise regularly. Aim for 150 mins/week or around 20 mins/day. If you are taking insulin, PAY ATTENTION to you blood sugar before, during and after exercise.
- Try to get enough sleep.
- Avoid/limit alcohol intake. If you do drink, make sure you do it as safely as possible.
- Stop smoking.
- Manage your stress.
- Pay attention to your feet!
What is Diabetes?
Diabetes is a group of diseases that affect how the body uses sugar (glucose). Glucose an important source of energy for your muscles and tissues. It is also the most important source of fuel for your brain. Normally, you eat and your blood sugar rises causing insulin to be released from your pancreas. Insulin shifts glucose from your blood into your muscles and organs so that it can be stored as energy for later use. That is how insulin keeps your blood sugar from going too high… by moving it from the blood into your cells. Insulin also regulates how you metabolize carbohydrates, protein and fats.
If you have diabetes, you have too much sugar in your blood. This can happen either because you don’t have enough insulin (Type 1 Diabetes), or the insulin you have isn’t working properly (Type 2 Diabetes). You can also be diagnosed with Pre-Diabetes (Impaired Glucose Tolerance) which means your blood sugar is higher than normal, but not high enough to be diagnosed with diabetes. Women may have high blood sugar while they’re pregnant. This is called gestational diabetes, and it often goes away after the pregnancy is over. Both Pre-Diabetes and Gestational Diabetes are risk factors for developing diabetes later on.
Want to know if you are at risk for developing diabetes? Take this quiz: https://www.diabetes.ca/about-diabetes
WHAT IS A NORMAL BLOOD SUGAR & HOW IS DIABETES DIAGNOSED?
Diabetes can be diagnosed by checking your blood sugar. Blood sugar can be checked in 2 ways:
- check your actual blood sugar before you eat (fasting sugar)
- check your A1C, which tells you what your blood sugars have been like for the past 3 months
Blood Sugar/A1C Levels:
| Category | FASTING SUGAR | A1C |
| Normal | 4-5.9 | 5.9 or lower |
| Pre-Diabetes | 6-6.9 | 6-6.4 |
| Diabetes | 7 or higher | 6.5 or higher |
*Note that different labs may have different normal values. Sometimes the test that the lab uses changes and the normal values change as a result. These are the current values in Nova Scotia.
If your test results show Pre-Diabetes (also called Impaired Glucose Tolerance), you may be asked to go for another test called a “Glucose Tolerance Test” (or GTT). This will further clarify if you meet the criteria for Pre-Diabetes, or if you actually have Diabetes. To learn more about the GTT, check here:
https://www.healthlinkbc.ca/tests-treatments-medications/medical-tests/oral-glucose-tolerance-test
WHAT ARE THE HEALTH PROBLEMS CAUSED BY Diabetes?
Diabetes can cause a variety of health problems if blood sugar is not controlled. These include (but are not limited to):
- heart attack
- stroke
- vascular disease (causing poor circulation, pain and trouble walking)
- kidney failure/dialysis
- eye disease/blindness (retinpopathy)
- damaged nerves in arms/legs (neuropathy) causing pain, numbness, trouble walking, poor balance and difficulty with urination and bowel movements
What Can You Do to Control Your Diabetes?
(Or Decrease Your Chances of Developing Diabetes?)
1 – EAT A HEALTHY DIET & MAINTAIN A HEALTHY WEIGHT
What Do I Eat?
Plan your meals in advance so you are not tempted by last minute fast & unhealthy options. Incorporate lots of fresh fruits and vegetables (especially non starchy vegetables like kale, cucumber, broccoli, green beans), whole grains (like brown rice, quinoa, farro) and healthy proteins (lentils, beans tofu, fish and poultry).
Certain foods will make your blood sugar go up more than others. Some are obvious, like foods that taste sweet: candy, baked goods, ice cream, soda pop, etc. BUT, there are lots of other foods (that don’t even taste sweet) that will raise your blood sugar too! The more processed a food is, the more it will raise your blood sugar. This is only partly due to the fact that many processed foods have added sugar. The other reason is that processed foods have already been, well… processed. Which means your body has to do less work to finish digesting them. So, instead of taking time to break down the food, which would mean a slower release of sugar and other nutrients into your blood stream, processed foods get digested more quickly, often resulting in a faster and higher rise in blood sugar. Note that foods made with white flour, (white bread, white pasta) and white rice all count as processed foods.
One way to know how much a food will raise your blood sugar is to learn about the glycemic index (GI) of foods. The higher the (GI), the higher that food will make your blood sugar. Lower GI foods raise your blood sugar less, keep you full longer and can help you lose weight.
| Category | GI | Examples |
| Low | Less than 55 | Whole grain bread, brown rice, grapefruit |
| Moderate | 56-59 | Sweet potato, rye bread, Special K |
| High | 70 or more | Potato, white bread, cheerios, pizza |
(GI less than 55 is considered LOW. A GI between 56-69 is MODERATE, and a GI of 70 is HIGH.)
You can learn more about Glycemic Index here:
- https://www.diabetes.ca/en-CA/resources/tools—resources/the-glycemic-index-(gi)
- https://glycemic-index.net/glycemic-index-chart/
How Much?
It is not only important to pick healthier foods, but also to know how much to eat! (This is much less of an issue if eating a strictly whole food plant based diet). Understanding serving sizes is important.
Have a look at this infographic:
Or learn more here: https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/portion-control/art-20546800
One of the easiest ways to plan your meal is using the “PLATE METHOD” which helps you eat a healthy balance of food as well as limit portion sizes.
Make the most of your meal by using a 9” plate and filling HALF YOUR PLATE WITH FRUITS AND VEGETABLES. Aim for a colourful plate with variety! (Note that potatoes, don’t count as vegetables on the healthy eating plate because they can cause a significant rise in blood sugar).
FILL 1/4 OF YOUR PLATE WITH WHOLE GRAINS. Whole wheat, brown rice, oats, quinoa, barley, and wheat berries, and the foods made with them (like whole wheat bread or pasta) have a much milder effect on blood sugar and insulin compared to white bread, white rice etc
FILL 1/4 OF YOUR PLATE WITH HEALTHY PROTEIN. Beans, lentils, nuts, seeds, fish and poultry are all healthy protein sources. Limit red meat, and avoid processed meats (like cold cuts, bacon, hot dogs and sausages)
CHOOSE HEALTHY PLANT OILS IN MODERATION. Olive, canola and sunflower oils are good options instead of butter and margarine.
MAKE WATER YOUR BEVERAGE OF CHOICE. Avoid sugary drinks like soda pop, and limit juice to 1 small glass/day. (It’s always better to eat your fruit, then to drink it!). Coffee or tea in moderation can also be good choices. (Be careful with these if caffeine causes your blood pressure to rise!)
Remember to eat regularly throughout the day WITHOUT SKIPPING MEALS. This is especially important if you take insulin or other medications for diabetes.
You can learn more about basic meal planning for diabetes here: https://www.diabetes.ca/resources/tools—resources/basic-meal-planning
If you are taking insulin, you may need to learn about carbohydrate counting. You can learn more here: https://www.diabetes.ca/DiabetesCanadaWebsite/media/Managing-My-Diabetes/Tools%20and%20Resources/basic-carbohydrate-counting.pdf?ext=.pdf
2 – Exercise Regularly
When you move your body, your muscles use blood sugar for energy. Exercising regularly also helps your body use your insulin more effectively. These effects work together to lower your blood sugar. Usually, the more intense your activity, the longer the effect lasts. But even light activities, like walking, housework, and gardening help.
How much?
Aim for 150 minutes or 2.5 hours (or 20 minutes per day) moderate-vigourous activity per week. Most adults should also include strength building exercises two days per week.
If you are new to exercising, or haven’t been very physically active for a long time, talk to us, so we can ensure that you are ready to start on your physical fitness journey!
When?
It is important for people with diabetes to keep an exercise schedule that lines up with meal and medication schedules. Talk to us if you are not sure how to get going!
Do I need to check my blood sugar first?
If you are not taking insulin or other diabetes medications, you probably don’t need to check your blood sugar before or during exercise. For those who are taking insulin or some diabetes medications, testing blood sugar before/during/after exercise is important. Both insulin/diabetes medications and exercise reduce blood sugar levels, so it is important
ind that the more intense your exercise, the higher, the risk of low blood sugar. This is also true if the exercise is new to you, or if you are working at an increased intensity. It is extremely important to be aware of symptoms of low blood sugar, which can include: feeling weak, tired, hungry, lightheaded, shaky, confused, or anxious.
Do I need a snack before exercising?
If you take insulin, you may want to lower your insulin dose before you exercise. If you take insulin and your blood sugar is less than 5 mmol/L, you should have a snack that has 15-30g of carbohydrates (or 10-20g of glucose products) before you exercise. If your blood sugar is between 5–6.9mmol/L, you should have a snack that has 5–15g of carbohydrates (or 10g of glucose products). This should prevent your blood sugar from dropping too low while you’re exercising. However, BE PREPARED! Make sure you have a small snack/glucose tablets/glucose gel with you while you are exercising. It is important to also carry medical identification that identifies you as a diabetic in case of emergency.
Stay hydrated!
Make sure to drink plenty of water or other fluids while you are exercising. Dehydration can significantly affect blood sugar levels.
What happens after exercise?
Since low blood sugar can happen, even after you were finished, exercising, you may need to watch your blood sugar level closely for several hours after intense exercise.
3 – Try to Get Enough Sleep
Unstable blood sugar levels, along with stress and worry about the disease can cause sleep problems in people with diabetes.
In turn, irregular/poor sleep patterns can:
- increase blood sugar in both people with diabetes AND non-diabetics
- increase the risk of developing diabetes
- increase hunger/appetite and decrease feelings of fullness leading to weight gain
Learn more about sleep and diabetes here: https://www.sleepfoundation.org/physical-health/lack-of-sleep-and-diabetes
If you are struggling with sleep, let us know so we can help!
You can also learn more here: “Notes From Your Doctor: Sleep”
4 – Limit Alcohol Use
Alcohol can cause low blood sugar shortly after you drink and for many hours afterwards. HOW? Your liver usually releases sugar to prevent falling blood sugar levels, but your liver is also responsible for metabolizing alcohol. So when you drink, your liver is busy and may not release the sugar it normally would to keep your blood sugar level stable.
Talk to us to find out if it is safe for you to drink
If you have diabetes, drinking too much alcohol can lead to nerve damage. However, if your diabetes is under control, it may be okay for you to have an occasional drink.
If you are going to drink alcohol:
- Men should have no more than 2 drinks/day (or a maximum of 14/week, but NOT ALL AT ONCE! Binge drinking can lead to many other problems). Women should not have more than 1-2 drinks/day (or a maximum of 9/week, again not all at once).
- Don’t drink on an empty stomach. This will help prevent low blood sugar.
- Try light beer, dry wines and sugar-free mixers (like club soda, seltzer or diet tonic). These have fewer calories and carbohydrates than other alcoholic drinks.
- Make sure to include calories from any alcohol you drink in your daily diet plan.
- Since alcohol can lower your blood sugars long after you’ve had your last drink, it is important to check your blood sugar level before you go to sleep. If you’re level is less than 5.6 mmol/L. You should have a snack before going to sleep to counter and he drop in blood sugar.
5 – Don’t Smoke
Smoking increases your risk of developing Type 2 diabetes. The more you smoke, the higher your risk! Diabetics who smoke are also more likely to have complications from diabetes than those who don’t smoke. Smoking makes your diabetes harder to control and increases your chances of developing:
- heart disease
- kidney disease
- eye disease/blindness (retinopathy)
- poor circulation
- nerve damage (neuropathy) in arms and legs causing numbness, pain weakness, poor coordination and difficulty walking
If you have diabetes and quit smoking, you are better able to control your blood sugar levels!
6 – Manage Your Stress
Stress can increase your blood sugar. HOW? The hormones that your body makes when you’re under stress for a long period of time get you ready to respond to a threat. Think of coming upon a bear in the woods… you need plenty of sugar in your blood to give you energy to run away! It is also very hard to make all the right choices to manage your diabetes when you have a lot of other worries! In fact, you are more likely to resort to unhealthy habits like alcohol, caffeine, over eating unhealthy foods, or sitting in front of the television to cope with our stress. These behaviours can also increase your blood sugar.
What can you do to help manage your stress?
- Eat healthy food regularly. Try to avoid processed foods that are high in salt, sugar and additives. Avoid caffeine and other stimulants.
- Exercise regularly. This not only lowers your blood sugar, but will improve your stress levels and feelings of well being over time.
- Get enough sleep. Too little sleep can make problems seem worse than they are.
- Identify the things that cause you stress and try to stay away from them if possible. If not, learn relaxation techniques, try yoga or meditation to help you relax. Look at some free Apps that cab help you get started (Calm, Headspace). You may find that working with a psychologist or clinical social worker can help.
- Try not to turn to alcohol, cannabis or smoking. Although these might make you feel better for a short period of time, they will make things worse over the long term if used regularly.
- Try connecting with friends or family. Social connection has been shown to help decrease anxiety.
To learn more about managing your stress, check out: “Notes From Your Doctor: Stress” or https://cmha.ca/brochure/stress/
7 – Pay Attention to Your Feet!
High blood sugar from diabetes can lead to damage of the nerves and blood vessels in your feet. The nerve damage is called diabetic neuropathy, and this can leave you with pain, tingling or even numbness in your feet. If you cannot feel your feet well, you won’t know if you have a cut, blister, or open sore on your foot. Wounds like this can get infected, and if you have poor circulation (due to the damaged blood vessels in your feet), the infections can be hard to heal. If infections cannot be healed, this can cause problems for the skin, muscles and tissues around the infection. Sometimes severe infections require amputation of a toe, or part of your foot/leg to prevent the infection from spreading.
What can you do?
The best way to protect your feet is by controlling your blood sugar levels. This will help keep your nerves and blood vessels, healthy, or prevent any damage from getting worse.
The next step is to keep the skin on your feet as healthy as possible:
- check your feet (bottoms too!) every day, looking for cuts, redness, blisters, or places where your shoes may be rubbing.
- wash and dry your feet every day with warm, soapy water.
- trim toenails straight across so that they don’t angle down and into the skin. If you have trouble trimming your own toenails, let us know so we can try to get someone to help you with that.
- always wear well fitted shoes/socks/slippers that don’t rub or irritate your feet. Avoid going barefoot- even indoors!
- protect your feet from hot and cold. Use sunscreen and don’t walk barefoot on the beach. In cold weather, wear warm socks.
- keep the blood flow moving. Put your feet up when you are sitting. Wiggle your toes, circle, flex and point your feet throughout the day.
- have your feet you checked regularly in the office. Unless you have noticed a problem with your feet, we will do this for you once per year.
FAQ
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That depends on what you mean by sick. For most illnesses, you should continue to take all of your medications as prescribed. However, if you are unable to eat or drink normally (i.e. if you have an upset stomach, or have lost your appetite) OR if you are not able to keep your food in (i.e. if you have a lot of vomiting, diarrhea) you MAY NEED TO DECREASE/STOP YOUR DIABETES MEDICATION to avoid having your blood sugar go too low. If you are unsure, please contact us so we can help!