Living with diabetes column, part two of a three-part series

By: Bonnie Clark
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 Diabetes complications are caused by high levels of blood sugar over time that irritates the linings of small blood vessels in our bodies.

These complications can include vision changes that can lead to blindness, high blood pressure and heart disease, kidney failure, loss of sensation in the hands or feet, and non-healing foot ulcers that can lead to amputations.

To prevent or slow the development of these complications, the American Academy of Diabetes Educators recommends that individuals with diabetes consistently perform seven self-care behaviors. These behaviors include healthy eating, being active, monitoring, taking medication, problem solving, reducing risks, and healthy coping.

Healthy eating

Perhaps the most challenging aspect of diabetes care involves developing a healthy meal plan. This can be done by dividing a 9-inch dinner plate in half, and filling half of the plate with non-starchy vegetables. One-fourth of the plate should be filled with protein, and the other fourth of the plate should be filled with grains and starchy foods. The meal may also include small servings of fruit and dairy, as well as a low-calorie drink.

Meal planning involves counting carbohydrates, which can be determined by identifying the portion size and total carbohydrates per serving from the Nutrition Facts label. A general rule is that a meal should consist of 45 to 60 grams of carbohydrates, while snacks can have 15 to 20 grams of carbohydrates. What’s important to remember is that people with diabetes are still able to eat the foods that they enjoy but they need to count carbs and monitor portion sizes.

Being active

The American Diabetes Association recommends that people with diabetes exercise at a moderate level of intensity for 30 minutes a day and at least five days per week. Simple ways that exercise can be added into the day include walking the dog, taking the stairs at work, and doing Tai chi. It’s important to start slowly and exercise with a friend, if possible.


Monitoring blood sugar levels involves performing a finger stick blood sugar between two and four times per day, and recording these levels in a log. Self-monitoring of blood glucose is considered the cornerstone of diabetes care and controlling blood sugar levels is the most reliable way to prevent diabetes complications. In addition, the hemoglobin A1C blood test should be checked every three to six months, depending on whether the level is well controlled.

Taking medications

Medications to help control blood sugar must be taken every day at around the same time of day and timed with meals to prevent low blood sugar. Some people with diabetes take medications by mouth, others must give themselves injections of insulin into the fat layer under the skin, while others take both oral and injectable medications. It also recommended that they receive an annual flu vaccine, as well as immunizations for pneumonia and hepatitis B as needed.

Problem-solving, reducing risks and healthy coping

Problem-solving with diabetes involves remembering that no one is perfect and not becoming upset with oneself for getting off track. If this happens, the person with diabetes should analyze what happened, learn from it and then make plans to prevent the situation from happening again. Reducing risks of diabetes complications includes smoking cessation, seeing the healthcare provider regularly, and having annual exams of the eyes, teeth and feet. In addition, the person with diabetes should check their feet daily for any sores or wounds. Healthy coping with diabetes involves thinking positive and seeking support from friends, family and the healthcare provider, as needed. It is also important to remember that diabetes complications can still occur as the disease progresses, even if the person consistently performs the required self-care behaviors.

One more column is planned for this series that will discuss how family, friends and co-workers can better support a person with diabetes, and measures that can be taken to help prevent diabetes for yourself.


Bonnie Clark is a nursing instructor at Sacramento City College and an RN for 34 years. She is currently providing classes at Lincoln Medical Practice on living with diabetes. Two more monthly columns are planned for this series. The second column discusses the complex regimen that is required for a person with diabetes to follow to control their blood sugar and the complications that can happen if their blood sugar is not controlled over time. The third column discusses how family, friends and co-workers can better support someone with diabetes and measures that can be taken to help prevent diabetes for yourself. For more information, email