Diabetes is managed day by day by the person who has it, not by the clinic. What follows is what that management is made of, in the order it matters.
Food
- The amount of starch matters more than which starch. Smaller portions of fufu, rice, plantain, yam and bread, on a plate that is half vegetables.
- Add beans, groundnuts, fish, eggs or meat to every meal. Protein and fibre slow the sugar down.
- Cut sugary drinks entirely: soft drinks, sweetened juice, sugar in tea. This is usually the single biggest change available.
- Eat at regular times, especially if you take insulin or tablets that can drop your sugar.
- Fruit is fine in ordinary portions. Fruit juice is not: it is sugar without the fibre.
Movement and weight
Thirty minutes of walking most days lowers blood sugar directly, by making muscle take up sugar without needing insulin. Losing even five to ten percent of body weight improves control substantially in type 2, and in some people brings it back to normal for years.
Medicines
- Take them as prescribed, at the same times, whether or not you feel unwell.
- Never stop insulin because you feel better or because you are fasting. Type 1 without insulin becomes a life-threatening emergency within a day or two.
- If you fast for religious reasons, discuss it with a clinician beforehand. Doses usually have to change.
- Keep insulin cool. A clay pot with wet sand, in the shade, works where there is no fridge.
Feet, every single day
Look at both feet daily, including between the toes and the soles. Nerve damage means a wound can go unnoticed until it is deep. Wash and dry them, especially between the toes, never walk barefoot, cut nails straight across, and check inside shoes before putting them on. A small foot wound seen today is a dressing; seen in three weeks it is an amputation.
The checks that catch damage early
- Blood sugar, as often as your clinician advises, and HbA1c every few months where it is available.
- Blood pressure at every visit. Diabetes and high pressure together multiply the damage.
- Eyes, once a year. Damage to the retina is silent until sight is already lost.
- Kidneys, with a urine test, once a year.
- Feet, examined at every clinic visit.
Emergencies
- Low sugar: shaking, sweating, hunger, confusion, irritability. Take sugar, sweet drink or glucose immediately, then eat something starchy. If they cannot swallow, do not force it: go now.
- Very high sugar: vomiting, deep fast breathing, fruity breath, severe thirst, drowsiness. Go to hospital immediately.
- A foot wound that is black, smells, or is spreading redness.
- Any sudden change in vision.
What not to do
- Do not stop prescribed medicine to try a herbal preparation. Several sold for diabetes here contain hidden ingredients or damage the kidneys.
- Do not treat diabetes with diet alone if a clinician has prescribed medicine.
- Do not skip meals to lower sugar while on insulin. That causes dangerous lows.
