Diabetes Management: Daily Routine Guide

Most Type 2 diabetes patients test fasting blood sugar (before breakfast) and 2 hours after meals. Target ranges: fasting 80-130 mg/dL, 2 hours after meals below 180 mg/dL. Test strips cost 15-75 USD for 100 strips depending on the brand and insurance. Continuous glucose monitors (CGM) like Freestyle Libre (75-150 USD per month) provide 24-hour readings without finger pricks. Log results in a notebook or app (mySugr, One Drop) and bring the log to every doctor visit.

A1C measures your average blood sugar over 2-3 months. The American Diabetes Association recommends an A1C below 7% for most adults, which corresponds to an average blood sugar of about 154 mg/dL. Every 1% reduction in A1C reduces the risk of eye, kidney, and nerve complications by 25-40%. If your A1C has been stable at goal for 2-3 consecutive tests, your doctor may extend testing to every 6 months. A1C tests cost 20-50 USD and are covered by insurance with a diabetes diagnosis.

Symptoms of low blood sugar (below 70 mg/dL): shakiness, sweating, confusion, fast heartbeat, irritability, and hunger. Treatment (the Rule of 15): consume 15 grams of fast-acting carbohydrate (4 glucose tablets, 4 oz juice, or 5 pieces of hard candy), wait 15 minutes, retest, and repeat if still below 70. Always carry glucose tablets or a small juice box. If you take insulin or sulfonylureas, low blood sugar episodes are more common before meals and during exercise.

Metformin (the most common first-line medication) should be taken with meals to reduce stomach side effects. Extended-release metformin (taken once daily with dinner) causes less GI upset than immediate-release. GLP-1 receptor agonists (Ozempic, Trulicity) are injected weekly and help with both blood sugar control and weight loss. SGLT2 inhibitors (Jardiance, Farxiga) lower blood sugar and protect kidney and heart health. Never skip doses or adjust medication without consulting your doctor.

Unopened insulin vials and pens should be stored in the refrigerator (36-46 degrees F). Once opened, most insulin can be kept at room temperature for 28 days (check your specific brand). Never freeze insulin or expose it to temperatures above 86 degrees F. Rotate injection sites (abdomen, thighs, upper arms) and space injections at least 1 inch apart within each area. Using the same spot repeatedly causes lipohypertrophy (hardened tissue) that reduces insulin absorption by 20-30%.

Diabetes management costs the average patient 9,600 USD per year. Insulin costs 50-800 USD per month without insurance depending on the type. Patient assistance programs: Lilly Insulin Value Program (35 USD per month), Novo Nordisk Patient Assistance Program (free for qualifying patients), and GoodRx coupons (often reduce costs 40-80%). The Inflation Reduction Act caps Medicare insulin copays at 35 USD per month. Ask your doctor about older, less expensive insulin analogs if cost is a barrier.

The diabetes plate method is the simplest meal planning approach endorsed by the ADA. Fill half your 9-inch plate with non-starchy vegetables (broccoli, salad, green beans, peppers), one quarter with lean protein (chicken, fish, tofu, eggs), and one quarter with carbohydrates (brown rice, sweet potato, whole grain bread). This method naturally limits carbohydrates to 30-45 grams per meal. Drink water or unsweetened beverages on the side.

Carbohydrates have the largest direct effect on blood sugar. Most adults with Type 2 diabetes aim for 30-60 grams of carbs per meal and 15-20 grams per snack. Learn to read nutrition labels for total carbohydrates (not just sugar). One carb serving equals 15 grams: 1 slice of bread, 1/3 cup of rice, 1 small piece of fruit, or 1/2 cup of beans. Consistency matters more than restriction. Eating similar amounts of carbs at the same times each day creates predictable blood sugar patterns.

Low-glycemic foods (GI below 55) cause a gradual blood sugar rise: steel-cut oats, sweet potatoes, most legumes, berries, and whole grain bread. High-glycemic foods (GI above 70) spike blood sugar rapidly: white rice, white bread, instant oatmeal, potatoes, and sugary cereals. Pairing carbohydrates with protein, fat, or fiber slows digestion and reduces the blood sugar spike. Adding 1 tablespoon of vinegar to a meal (in salad dressing or water) can reduce post-meal blood sugar by 20-30%.

Walking, cycling, swimming, or dancing at a pace where you can talk but not sing counts as moderate intensity. Spread activity across at least 3 days per week with no more than 2 consecutive rest days. Exercise improves insulin sensitivity for 24-72 hours after each session, meaning your cells absorb blood sugar more efficiently. A 30-minute walk after dinner can lower post-meal blood sugar by 30-50 mg/dL. Start with 10-minute sessions if 30 minutes feels overwhelming.

Strength training (bodyweight exercises, resistance bands, or weights) builds muscle mass, which is the primary tissue that absorbs blood sugar from the bloodstream. Two to three sessions per week of 20-30 minutes targeting major muscle groups (legs, back, chest, core) can lower A1C by 0.3-0.5% independently of aerobic exercise. Start with bodyweight exercises (squats, push-ups, rows) if you are new to strength training. The combination of aerobic and resistance exercise produces the best A1C results.

Exercise lowers blood sugar, which is beneficial but can cause hypoglycemia in people taking insulin or sulfonylureas. Check blood sugar before exercise: if below 100 mg/dL, eat a 15-gram carb snack before starting. If above 250 mg/dL with ketones, do not exercise until levels drop. Carry glucose tablets during workouts. Blood sugar can continue to drop for up to 24 hours after exercise, so monitor before bed after evening workouts. Metformin alone rarely causes exercise-induced hypoglycemia.

Diabetic retinopathy affects 28% of adults with diabetes and is the leading cause of blindness in working-age adults. It develops silently with no symptoms until vision loss occurs. A dilated eye exam (ophthalmologist dilates your pupils and examines the retina) detects early changes that can be treated before vision loss occurs. Cost: 100-250 USD, covered annually by most insurance with a diabetes diagnosis. Early detection and treatment prevent 90% of diabetes-related blindness.

Diabetes damages nerves (neuropathy) and blood vessels in the feet, making cuts and sores slow to heal and easy to miss. Check your feet daily for cuts, blisters, redness, swelling, and skin changes. Use a mirror for the bottoms of your feet. Wear properly fitted shoes (never go barefoot). See a podiatrist annually for a comprehensive exam including monofilament testing (checks nerve sensation). Diabetic foot ulcers lead to 80,000 amputations per year in the US, and most are preventable with daily inspection.

Diabetic kidney disease (nephropathy) affects 30-40% of people with diabetes and develops over 10-15 years. Two tests detect early damage: urine albumin-to-creatinine ratio (UACR, measures protein in urine) and estimated GFR from a blood test (measures kidney filtration rate). Normal UACR is below 30 mg/g. Elevated levels caught early can be slowed with medication (ACE inhibitors or ARBs) and blood sugar control. Annual testing is critical because early kidney damage has no symptoms. This guide is informational only, not medical advice.