Diabetes

Set My Goal

Taking Action to Manage Your Blood Sugars

Diagnosis and Treatment

There are three bloods tests that can help your doctor determine whether you have diabetes:

1. Fasting Plasma Glucose (FPG):
FPG measures the amount of glucose in your blood while you are fasting. Fasting consists of not eating or drinking for at least eight to 10 hours before blood is drawn. Water is acceptable.

2. Random (non-fasting) Blood Glucose:
Blood is drawn at any time of day without fasting. The target values for a non-fasting blood glucose test differ from the fasting blood glucose test. A result that’s greater than or equal to 11.1 mmol/L indicates symptoms of diabetes.

3. Oral Glucose Tolerance Test (OGTT):
This test allows for two blood samples to be drawn in a two-hour period. The first blood sample is taken immediately after consuming a sweetened drink. You then retake the blood test two hours later to determine whether diabetes is present.

The recommended screening test is the FPG, but a different test may be administered depending on other risk factors and any previous abnormal results.

If your doctor suspects diabetes after giving you the FPG, he or she will likely recommend the oral glucose tolerance test to confirm the diagnosis and determine the appropriate treatment.

Treatment will vary based on the type of diabetes you have, your risk factors for other conditions, and the test results. Normally, type 2 diabetes can be treated with lifestyle changes, and these are important to controlling type 1 diabetes as well. In fact, lifestyle changes alone can reduce your risk of developing type 2 diabetes by as much as 60%. These changes in habits can also help reduce other risk factors, such as high blood pressure and cholesterol. But medications, particularly those targeted to risk factors, may still be necessary.

Medication and Insulin Therapy for Diabetes

Regardless of your lifestyle, if you were diagnosed with type 1 diabetes, you will require treatment with insulin injections. There are four main types of insulin available. You will be prescribed insulin based on your lifestyle choices, including activity level and eating habits.

The four types of insulin have different activation times following injection:

  • Long acting (basal insulin)
  • Intermediate acting (basal insulin)
  • Short acting (bolus insulin)
  • Very rapid acting (bolus insulin)

Each type takes effect at a different rate, peaks at a different time, and varies according to duration. This video presentation offers an overview of insulin (University of Ottawa Heart Institute), its role, side effects, and response time.

Medication for Type 2 Diabetes

Type 2 diabetes can be treated with medication to help your body better control blood glucose. Some of the available brand and generic drugs are described in the chart below. Medication is usually started if two to three months of lifestyle management show little or no improvement in blood glucose levels.

Brand (generic) Action When It Should Be Taken Possible Side Effects
Diabeta (glyburide)
Diamicron (gliclazide)
Amaryl (glimepiride)
  • Acts directly on pancreas
  • Stimulates release of insulin
  • Take immediately before, with, or immediately after eating a meal and never at bedtime

Hypoglycemia, weight gain, rash, nausea, diarrhea

Hypoglycemia, weight gain, rash, nausea, diarrhea

GlucoNorm (repaglinide)
Starlix (nateglinide)
  • Slows digestion of starches and sugars
  • Take before each meal; do not take without food
Januvia (sitagliptin)
  • Acts on gut and hormones when food is ingested
  • Suppresses glucose secretion from liver if blood sugar is high
  • Take 5 mg tablet once a day, same time each day
Stuffy nose, sore throat, rash, hives
Onglyza (saxagliptin)
  • Take 5 mg tablet once a day, same time each day
Upper respiratory infection, urinary tract infection, headache, hives, rash
Trajenta (linagliptin)
  • Take 5 mg tablet once a day with or without a meal
Cough, inflamed nose or throat, allergic reaction
Glucobay (acarbose) Slows digestion of sugars   Hypoglycemia, severe gas, stomach pain/cramps, abdominal discomfort
Glucophage, Glumetza (metformin)
  • Helps insulin work better
  • Decreases sugar production by liver
  • Take 4 tablets a day with meals
Diarrhea, nausea, metallic taste, increased fertility
Not recommended for people with kidney disease, heart failure, or liver failure
Actos (pioglitazone) Fluid retention, weight gain
Avandia (rosiglitazone) Increased fractures, increased fertility
Not recommended for people with heart failure or liver failure
Victoza (liraglutide)
  • Mimics action of hormones
  • Lowers blood glucose
  • Increases insulin release
  • Slows production of glucose in liver
  • Inject once a day
Nausea, weight loss
Byetta (exenatide)
  • Inject twice a day, before breakfast and supper
Nausea, weight loss

This Heart Institute presentation offers an overview of type 2 diabetes medications.

Best Practice Guidelines

Download the 2013 Canadian Diabetes Guidelines.

Prevention of Diabetes

No one knows how to prevent type 1 diabetes, but paying careful attention to your lifestyle choices can delay or lower your risk of developing the condition.

Lifestyle is also key in the prevention or delay of type 2 diabetes, which means healthy eating, regular physical activity, and weight control, as well as cholesterol and blood pressure management. The following are tips specific to the three main components of healthy living:

  • Eat well by following Canada’s Food Guide. This video explains how to manage your nutrition (Ontario Ministry of Health).
  • Enjoy regular physical activity. Getting at least 150 minutes each week will help keep your blood glucose within a healthy range and promote a healthy weight. Understand the warning signs of low blood glucose (pdf).
  • Achieve a healthy weight. Obesity is a leading cause of type 2 diabetes. Combining physical activity and a healthy diet is the best way to achieve a healthy body weight. In fact, reducing your body weight by 5% to 7% can prevent 58% to 71% cases of diabetes.11 This video explains how to manage your weight (Ontario Ministry of Health).

Change is possible; hear Susan’s story, along with other real-life stories.

Managing Diabetes

If you have diabetes, it is important to take your medication and live a heart-healthy lifestyle. The following are tips to help you achieve this:

It's natural to have questions about what food to eat. A registered dietitian can help personalize your meal plan. If you have diabetes and are taking insulin, speak with your family doctor. You may need to see an endocrinologist (a doctor who specializes in diabetes).

Monitoring your Blood Glucose Levels

The most important thing about caring for yourself and managing your diabetes is self- testing your glucose levels. You will use a glucose monitor (glucometer) to do this. It will help you keep your levels within a healthy target range.

You can purchase a glucometer at any local pharmacy. Ask your pharmacist to hel you choose the one that’s right for you. 

Before you head home with your glucose monitor, be sure you understand how to use it.

This video can help you manage your blood glucose (Ontario Ministry of Health).

How Often Should You Test Your Blood Glucose?

Type 1 Diabetes:

  • At least three times a day with a glucometer
  • Measure before and after meals

Type 2 Diabetes:

  • Hb A1c should be measured every three months (ordered through a physician request for blood work).
  • At least once a day with a glucometer

Gestational Diabetes:

  • Blood glucose should be measured with an oral glucose tolerance test at six weeks and at six months after giving birth.
  • When planning another pregnancy
  • If diabetes is no longer present, then every three years (or more often, depending on other risk factors)