Must-Have Checklist for Managing Diabetes

Diabetes, Featured Article
on November 1, 2013
checklist for managing diabetes

Diabetes is a 24/7 disease that can wear out and trip up even the most attentive patients. No one knows that better than diabetes educators, who have walked patients through every dilemma imagin- able and watched many make the same mistakes.

“Learning to deal with diabetes is like going back to school again,” says diabetes educator Amy Campbell, a registered dietitian and manager of clinical education programs at the renowned Joslin Diabetes Center in Boston. “You have to learn new ways of eating, how to deal with physical activity, how to check blood sugar. Diabetes education is lifelong.”

Use these tips from Campbell and other top diabetes edu- cators as your personal diabetes management checklist to help keep you on track year-round.

Don’t assume your blood sugar is fine because you feel fine. Often, low blood sugar makes you feel shaky and light-headed—but not always. Guessing your levels based on how you feel is a common mistake patients make. “Sometimes people don’t get symptoms because their body acclimates,” says Campbell. “The only way to know your blood sugar is to check it.” Ask your doctor how often.

Move as much as you can. “Exercise triggers the release of chemicals that help clear glucose, or blood sugar, from the blood,” says Hillary Wright, director of nutrition counseling at the Domar Center for Mind-Body Health in Boston and author of The Pre- Diabetes Diet Plan. “It works naturally the way some diabetes medicktions work, sensitizing you to insulin’s action.” Intimidated by the gym? Do your own house or yard work, take the stairs whenever possible, and walk with a friend instead of grabbing coffee.

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Eat early and often. Wright suggests eating small portions often—breakfast, lunch, afternoon snack, dinner—to head off hunger. “Eating lean protein, healthy fats like olive oil and non-starchy vegetables like broccoli and cauliflower can fill you up without raising your blood sugar as much as other foods.”

Track your choices to keep you accountable. A food log “helps you think first and make reasonable choices,” says Wright. Likewise, recording your activity can motivate you to keep upping the ante. Get a pedometer and aim for 10,000 steps a day. Or try a smartphone app like Moves, available on iTunes.

Don’t demonize sugar. “All carbohydrates—sugars and starches—raise blood sugar,” says Gary Scheiner, owner of Integrated Diabetes Services in Wynnewood, Pa., and 2014 Diabetes Educator of the Year. “What you want is carbs that burn [and raise blood sugar] slowly, which makes it easier to control it.” Think beans, nuts, berries and non-starchy vegetables like asparagus, tomatoes and zucchini.

Keep your stress in check. When you’re stressed, you produce more of the hormone cortisol, which lifts blood sugar, says Scheiner. When you’re faced with a busy schedule or an anxiety-inducing event, relax by keeping a journal, talking to others, exercising more or practic- ing calming breathing exercises.

Re-evaluate your treatment plan often. Illness like flu or a cold can raise blood sugar levels, as can lack of sleep, says Campbell. Some medi- cations like prednisone taken for inflammation can too. Be mindful of the changes in your routine that could have an effect on your blood sugar, and talk to your healthcare team about how to adjust your treatment plan.

Beware of Internet advice. It’s tempting to hang out on Internet message boards and trade tips with other patients. But use caution. “What works for one person may be harmful to another,” says Campbell. Check with your diabetes healthcare team for credible websites such as (the website of the American Diabetes Association) and Joslin Diabetes Center’s site at

Ask for an A1C reading at every doctor’s visit. “That’s an average of blood sugar readings over the past two to three months,” says Campbell. You’re aiming for a reading below seven. Blood pressure checks are key too: A blood pressure level of 140/90 or higher can raise your risk of heart disease, which is already elevated when you have diabetes.

Check your kidneys and eyes once a year. Kidney disease is one complication of diabetes, so it’s a good idea to have a microalbumin test for protein in the urine to determine whether your kidneys are filtering properly. An annual dilated eye test is important to check for broken or bleeding blood vessels, which can be caused by high blood sugar and may lead to blindness.

Check your feet regularly for cuts and infections. “Nerves can be damaged by high blood sugar,” Campbell says, “and nerves in the legs and feet are often the first affected so that you lose sensation.” An undetected cut can lead to serious infection.

Take advantage of free or low-cost resources. Diabetes education classes are often held at local hospitals and medical centers, or free at some YMCAs. Initially, Medicare covers 10 hours of classes, then two hours every year. (For more information, go to Private health plan coverage varies, although many use Medicare coverage as a template, says Campbell.

Accept an imperfect journey. “Behavior changes such as new diet and exercise habits take about 12 weeks to become second nature,” says Wright. “So, there will be lapses. The process is two steps forward, three steps back. Perfection is the enemy of good enough.”