Managing Blood Sugar Day to Day: A Practical Guide

Living with diabetes or prediabetes can feel overwhelming at first, but most of good blood sugar control comes down to simple routines repeated every day. You do not need to be perfect. You need to be consistent.

Understand your numbers

In Canada, blood sugar (glucose) is measured in millimoles per litre, or mmol/L. Your health care team will set personal targets with you, but Diabetes Canada's general targets for most adults with diabetes are:

• Fasting or before meals: 4 to 7 mmol/L
• Two hours after the start of a meal: 5 to 10 mmol/L
• A1C (your average over about three months): 7% or lower

Some people are given different targets. Older adults, people who have frequent lows, and pregnant people often have their own goals, so always follow the targets your doctor or nurse practitioner gives you.

Keep a simple log or use your meter's app to note readings, meals, activity and anything unusual such as illness or poor sleep. Patterns over a week or two are far more useful than any single reading.

Build a balanced plate

Canada's Food Guide plate is a helpful starting point, and it works well for diabetes too.

• Fill half your plate with vegetables and fruit, leaning on vegetables such as broccoli, green beans, carrots, peppers, cabbage and leafy greens
• Fill a quarter with whole grain foods such as steel-cut or large-flake oats, barley, brown rice, whole grain bread or whole wheat pasta
• Fill a quarter with protein foods such as lentils, chickpeas, beans, tofu, eggs, fish, chicken or lean meat
• Choose water as your usual drink instead of juice, pop or sweetened coffee drinks

Frozen vegetables and canned beans (rinsed to reduce salt) are affordable year-round options during long Canadian winters. Plain Greek yogurt with berries, a handful of unsalted nuts, or an apple with peanut butter make steadier snacks than muffins or granola bars.

A registered dietitian can help you adapt your favourite family and cultural foods. Many provinces offer free dietitian advice by phone, and diabetes education programs are often available through local hospitals and community health centres.

Spread carbohydrates through the day

Large amounts of carbohydrate at one meal tend to cause bigger spikes. Eating regular meals at similar times each day, with a similar amount of carbohydrate, helps your medicines and your body work together. Avoid skipping meals, especially if you take insulin or a medicine that can cause lows.

Keep moving

Physical activity helps your muscles use glucose and improves how your body responds to insulin.

• Aim for at least 150 minutes of moderate activity a week, such as brisk walking, cycling or swimming
• Add resistance exercise, such as bands, weights or body-weight moves, two or three times a week
• Break up long periods of sitting with a few minutes of movement every 30 minutes or so
• In winter, try mall walking, an indoor track, or an online exercise video at home

Check your blood sugar before and after new activities if you use insulin or a sulfonylurea, and carry a fast-acting sugar with you.

Take medicines as prescribed

Take your diabetes medicines at the same times each day. Do not stop or change doses on your own, even if your readings look good. If you have side effects or trouble paying for your medicines, talk to your pharmacist. There are often lower-cost options, and your pharmacist can check what your provincial drug plan or private insurance covers.

Know the signs of low blood sugar

A reading below 4 mmol/L is considered low. Symptoms can include shakiness, sweating, a fast heartbeat, hunger, confusion or irritability.

• Take 15 g of fast-acting carbohydrate, such as 4 dextrose tablets, 3/4 cup of juice or regular pop, or 1 tablespoon of honey
• Recheck in 15 minutes and repeat if you are still below 4 mmol/L
• Once you are back in range, have a snack or your next meal if it is more than an hour away

If you use insulin, ask your health care provider whether you should have glucagon at home, and show family members how to use it.

Plan for sick days

Illness can push blood sugar up or down. Keep drinking fluids, check your sugar more often, and ask your pharmacist or doctor ahead of time which medicines you may need to pause when you are vomiting or dehydrated. Diabetes Canada sick-day guidance is a good thing to review with your care team before you need it.

Look after the rest of your body

Diabetes affects more than blood sugar. Keep up with regular checks:

• Blood pressure at every visit, or at home
• Cholesterol and kidney tests as your provider recommends
• A dilated eye exam on the schedule your provider suggests
• Daily foot checks for cuts, blisters or colour changes

When to get help

Contact your health care provider if your readings are often above your target, if you have frequent lows, or if you feel unwell. Go to an emergency department or call 911 if you are confused, very drowsy, vomiting and unable to keep fluids down, or have readings that stay very high with signs of dehydration.

Our pharmacists are available 24/7 if you have questions about your meter, your medicines or what a reading means.