When you are diagnosed with diabetes, you may feel scared, shocked, overwhelmed, or even angry. You may also feel helpless. But the truth is, when it comes to controlling your diabetes, you are not at all helpless. There are many things you can do to help stay healthy and prevent or delay any complications of diabetes. You must take an active part in your own treatment plan.

Positive Lifestyle Changes

Lifestyle changes are an important part of managing your diabetes - and they are steps that only you can take for yourself. Your doctor, diabetes educator, or dietitian can give you assistance and tips, but only you can follow through.

• Eating well -Ask to be referred to a dietitian who will help you develop a flexible, nutritious, and appealing meal plan. If you are going to stick with it long term, it's important that your meal plan fits in with your culture and preferences and still includes your favourite foods in addition to being well-balanced, higher in fibre, and lower in fat, sugar, and salt.

• Limiting alcohol consumption -Do not have more than one or two drinks per day (fewer than 14 per week for men and fewer than 9 per week for women). Alcohol may cause low blood sugar, it may interact with your >medications, and may cause weight gain and other health-related problems.

• Attaining and maintaining a healthy weight -Ask your doctor or your dietitian about your BMI (body mass index: a number calculated based on your weight and height) and your waist circumference. Being overweight or obese carries a greater risk of developing future health problems, including complications of diabetes. Where on your body you carry your extra weight is also important. If you have a bigger waistline (102 cm/40 inches or greater for men or 88 cm / 35 inches or greater for women), you are also at higher risk for health problems.

• Being physically active - Regular physical activity can help you lower your blood sugar level, lose or maintain weight, lower your blood pressure, reduce medications or insulin, cope with stress, tone up your muscles, and keep your heart healthy. Walking is an excellent activity choice. A pedometer (step counter) can be a helpful tool to measure how many steps you currently take in a day and can help motivate you to increase this number. Just 150 minutes per week of moderate intensity exercise (such as brisk walking, dancing, or biking) spread out over 3 non-consecutive days can make a big difference in your health. If you combine that aerobic exercise with three sessions per week of resistance exercise (such as weightlifting), your health will benefit even more. Before starting any new exercise plan, talk to your doctor.

• Learning how to manage stress -Everyone faces stress sometimes in life, and it can affect your health. Stress can actually cause your blood sugar levels to be higher. Learning helpful ways of dealing with stress can make it easier to control your blood sugar.

• Quitting smoking - Like diabetes, smoking increases your risk of heart attacks and strokes. If you have diabetes and you smoke, you multiply your level of risk. Quitting smoking now can help you stay healthier, longer.

Diabetes Medications

Since the Canadian discovery of insulin in 1921, diabetes has become a highly controllable disease, with many additional types of medications becoming available. Because we now understand how important it is to get blood sugar under control quickly, your doctor may only give each agent a few months to work before adding another agent or strategy to your treatment regimen. Insulin is prescribed for people with type 1 diabetes, but it is also used in type 2 diabetes when healthy lifestyle and a combination of oral antihyperglycemic agents (blood-sugar-lowering pills) are not enough to keep blood sugar under control. Insulin is also used in gestational diabetes when lifestyle changes do not provide enough control.

There are various types of diabetes medications, all of which work differently to lower blood sugar levels.

Oral Antihyperglycemic Agents

Note: Oral diabetes medications are not recommended for women who are pregnant or trying to become pregnant. If you plan to become pregnant, talk to your health care provider about controlling your diabetes with diet and/or insulin.

Enzyme Blocker (Alpha-glucosidase Inhibitors)
Enzyme blockers modify the digestion of sugars and starches in the small intestine to reduce the peaks in blood sugar that occur during digestion. These drugs should be taken with the first bite of meals.

Biguanides
This type of medication works to reduce the overproduction of glucose by the liver. It also makes muscle tissue more sensitive to insulin, so blood sugar is more easily absorbed. It is often used in combination with other diabetes medications and sometimes also with insulin. Biguanides should be taken with food to minimize stomach upset and metallic taste.

Insulin Secretagogues (Sulfonylureas and Non-sulfonylureas)
Insulin secretagogues stimulate the pancreas to produce more insulin. One type of insulin secretagogue, called sulfonylurea, has been around for many years and includes many different brand names. All sulfonylureas have similar effects on blood sugar, but they may have differing side effects, frequency of dosing, and interactions with other drugs. A second type of insulin secretagogue, often called non-sulfonylurea, works to stimulate insulin production more rapidly and for a shorter period of time than the sulfonylureas. Non-sulfonylureas are taken just before each of your meals.

Insulin Sensitizers (Thiazolidinediones)
Insulin sensitizers are a new class of drugs that make the body more sensitive to the effects of the insulin it is already producing and enable it to use insulin more efficiently. These drugs may also work by decreasing the amount of sugar that is released by the liver. They can be taken with or without food.

Antiobesity Agent
This medication blocks about one-third of the fat in food from being digested. In combination with a lower calorie diet, it can lead to weight loss, which can enable better blood sugar control.

Insulin

The hormone insulin is required for the body to use the blood glucose it gets from food for energy. The pancreas in people with type 1 diabetes has stopped producing insulin. That's why people with type 1 diabetes always have to take insulin injections. Some people with type 2 diabetes also take insulin. In people with type 2 diabetes, insulin is sometimes used in combination with oral medications. Insulin is taken by injection, from once to several times a day. There are several types of insulin that differ in how they are made, how they work in the body, how quickly they act, and how long they last. As well, there are several delivery methods, including syringes, pens, and pumps. Your doctor will prescribe the type that will work best with your lifestyle.

Approved uses of listed medications were current at the time of publishing:

Approved uses of listed medications were current at the time of printing. *Approved, but not yet available, in Canada. Table adapted from the Canadian Diabetes Association 2003 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada.

Preventing Heart Problems

The most common cause of death for people with diabetes is heart disease, but proper treatment and lifestyle changes can lessen your chances of developing it. That's why it is very important to reduce all risk factors, especially high blood pressure and high cholesterol. Talk to your doctor about taking a low-dose ASA (aspirin) daily to help protect your heart. Your doctor may also prescribe medications to help reduce high blood pressure and/or lower high cholesterol. Of course, lifestyle changes such as weight loss, a balanced diet, regular physical activity, and quitting smoking will help protect your heart as well.