Living with diabetes day to day: the practical things

Most diabetes advice concentrates on diagnosis and medication. What people actually need help with is the daily management — what to do when you are ill, why feet matter so much, how to recognise a low, and how to keep a routine going for years rather than weeks. That is what this article is about.

Taking medicines consistently

Diabetes medicines work by keeping your blood sugar within a range over time, so consistency matters more than perfection on any one day. Take them at the same times, link each dose to something fixed in your day, and keep a few days spare so running out is never a reason to miss.

If a medicine is causing side effects, say so rather than quietly stopping. Stomach upset with metformin, for example, often settles if the dose is built up slowly or a slow-release version is used. People abandon effective treatment over problems that have straightforward solutions.

Recognising a low blood sugar

If you take insulin or certain tablets, your sugar can fall too low. The early signs are shaking, sweating, hunger, a pounding heart, irritability and difficulty concentrating. Left to continue it causes confusion and eventually loss of consciousness.

Treat it immediately with something sugary that acts fast — glucose tablets, a sugary drink, or a few teaspoons of sugar — then follow with something starchy such as bread once you feel better, to stop it dropping again. Carry fast sugar with you always, and make sure the people around you know what to do.

Sick-day rules

• Illness usually raises blood sugar, even when you are eating less.
• Do not stop your diabetes medicine simply because you are not eating — ask first.
• Check your blood sugar more often than usual.
• Drink plenty of fluids, in small amounts if you are nauseated.
• If you cannot keep fluids down, or sugars stay very high, seek help the same day.

Some diabetes medicines do need pausing during illness with vomiting, diarrhoea or dehydration, because of the strain on the kidneys. Which ones depends on what you take, so ask us to write it down for you in advance and keep that note with your medicines.

Feet, every single day

Diabetes can reduce sensation in the feet and slow healing, which means a small injury can go unnoticed and become a serious wound. Foot problems are among the most common reasons people with diabetes end up in hospital, and the great majority of them are preventable.

Look at your feet every day, including between the toes and the soles — use a mirror or ask somebody if you cannot see them easily. Wash and dry them carefully, moisturise but not between the toes, and cut nails straight across. Never walk barefoot, check inside shoes before putting them on, and do not use corn removers or hot water bottles on your feet.

Any wound, blister, colour change, swelling, warmth or unusual smell should be seen within a day or two, not watched for a week. This is the single piece of advice in this article most worth acting on.

The checks that should be happening

A long-term blood sugar test a few times a year, blood pressure at every visit, an annual eye examination, an annual foot examination, and periodic kidney and cholesterol checks. Eye and kidney damage develop silently, which is exactly why they are checked before anything is noticeable.

Keep your own record of results. Clinics change, files go missing, and the person with the clearest picture of your diabetes over the years should be you.

Food, without the mythology

There is no special diabetic food to buy, and products marketed that way are usually expensive and unnecessary. What helps is regular meals rather than long gaps and then a large meal, smaller portions of starchy foods, choosing wholegrain where you can, plenty of vegetables, and treating sugary drinks as an occasional thing rather than a daily one.

Ugali, rice, chapati and potatoes all raise blood sugar; none of them is forbidden, and portion size is the lever that matters. Pairing them with vegetables and a protein slows the rise considerably.

The checks that should be happening

• A long-term blood sugar test a few times a year.
• Blood pressure at every visit.
• An eye examination every year.
• A foot examination every year.
• Kidney and cholesterol checks, and your own copy of every result.

Questions we are asked about this

Should I stop my diabetes medicine if I am not eating?

Not without advice. Illness usually raises blood sugar even when you eat less, so stopping can be the wrong move. Some medicines do need pausing during vomiting, diarrhoea or dehydration — ask us to write down which ones apply to you and keep that note with your medicines.

How often should I check my feet?

Every day, including between the toes and the soles. Use a mirror or ask somebody if you cannot see them easily. Any wound, blister, colour change, swelling or unusual smell should be seen within a day or two rather than watched for a week.

Do I need to buy special diabetic foods?

No. They are usually expensive and unnecessary. What helps is regular meals, smaller portions of starchy foods, plenty of vegetables and treating sugary drinks as occasional. Ugali, rice and chapati are not forbidden; portion size is the lever.

What should I carry in case of a low?

Something fast-acting such as glucose tablets or a sugary drink, and then something starchy to follow once you feel better. Carry it always, and make sure the people around you know where it is and what the signs look like.

This article is general information from the Dantrio Pharmacy team. It cannot take the place of advice from a pharmacist or doctor who knows your medical history. If you feel seriously unwell, seek medical help straight away.