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) |
|
|
Hypoglycemia, weight gain, rash, nausea, diarrhea Hypoglycemia, weight gain, rash, nausea, diarrhea |
| GlucoNorm (repaglinide) Starlix (nateglinide) |
|
|
|
| Januvia (sitagliptin) |
|
|
Stuffy nose, sore throat, rash, hives |
| Onglyza (saxagliptin) |
|
Upper respiratory infection, urinary tract infection, headache, hives, rash | |
| Trajenta (linagliptin) |
|
Cough, inflamed nose or throat, allergic reaction | |
| Glucobay (acarbose) | Slows digestion of sugars | Hypoglycemia, severe gas, stomach pain/cramps, abdominal discomfort | |
| Glucophage, Glumetza (metformin) |
|
|
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) |
|
|
Nausea, weight loss |
| Byetta (exenatide) |
|
Nausea, weight loss |
This Heart Institute presentation offers an overview of type 2 diabetes medications.
Best Practice Guidelines
Download the 2018 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:
- Take your medications as prescribed and learn more about managing your medications (Ontario Ministry of Health) with this video.
- Learn about managing your diabetes by attending a diabetes education program.
- Monitor and keep track of your blood sugar:
- Target: Blood sugar before meals should be between 4 and 6 mmol/L.
- Target: Blood sugar two hours after meals should be lower than 10 mmol/L.
- Follow the Heart Healthy Nutrition Plan
- Be active every day and use a physical activity log or diary. Being physically fit significantly decreases your risk for premature death.
- Achieve and maintain a healthy body weight, see the ABC's of diabetes
- Ensure good foot health: Take care of your feet.
- Visit your family doctor or diabetes specialist regularly.
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)