People with diabetes can live happy, healthy lives. The key is to follow a diabetes treatment plan to keep blood-sugar levels in a normal range. There are five important steps ("The Five M's") to managing diabetes and keeping blood-sugar levels in good control:

Meals

Balance what you eat and when to eat. A dietitian can help design a meal plan based on preferences and lifestyle. To keep blood-sugar levels steady, meal plans will have a variety of foods, specific amounts of foods and careful spacing of meals and snacks. (See Diet and Diabetes)

Motion

Exercise is good for everyone--especially people with diabetes. Regular planned activity can help to lower blood-sugar levels, make insulin work better, strengthen heart activity, improve blood circulation, lower cholesterol, relieve stress, improve physical condition and increase overall well being. An exercise program should be suited to ability--vigorous, moderate or light. For heart-healthy benefits, exercise should last 20 to 45 minutes, three to four times a week. However, blood-sugar levels are best controlled when body motion is done every day. Motion can work like medication for people with diabetes. Always consult with your diabetes health-care team (physician and/or diabetes educators such as a nurse, dietitian or pharmacist) before beginning an exercise program.

Check blood-sugar levels before and after exercise, especially if just starting a program. Do not exercise if ill, or if blood sugar is more than 250 mg/dl and you tested positive for ketones (see Monitoring). If blood sugar is under 100 mg/dl, eat before exercising. After breakfast is usually a good time for exercising, but find a time that's good for you and stay with it. About one to two hours after a meal is a good time for moderate exercise. Your program should have activities you enjoy.

This chart shows how many calories a 150-pound person would burn in 30 minutes.

Exercise may make blood sugar low enough (also called hypoglycemia) to have an insulin reaction. When you exercise away from home, carry some quickly dissolving candy or sugar tablets, diabetes identification, and a little money to make an emergency call if necessary. If you are careful you probably won't run into these problems--but be prepared!

Medication

Oral medications

There are many different kinds of oral diabetes medicine (pills), several of which are new on the market. People with Type 2 diabetes usually still make some of their own insulin, and these pills can help their bodies work better to lower blood-sugar levels. However, the insulin produced by the body may not be sufficient and insulin has to be injected.

Insulin

Many people with diabetes use manufactured insulin to take the place of the insulin they no longer make on their own. Insulin has to be injected because it's a protein and would be digested by the stomach if swallowed. People with diabetes inject insulin before eating, so it's working its hardest when blood-sugar levels are highest. Manufactured insulin comes in different types which work for shorter or longer times. Your physician will choose a regimen based on your own lifestyle, meal plan and exercise program.

Insulin can be delivered with a syringe, drawing up the insulin from a bottle, or you can use an insulin delivery system such as a pen-like device which uses a cartridge of insulin. Another type of delivery system is the insulin pump which is an external, battery-operated device designed to deliver insulin in specific programmed doses throughout the day. Again, you and your diabetes health-care team will decide which method is best suited for you.

Monitoring

Many meters are now available to meet individual needs for self-testing. The test results give a "snapshot" of the blood sugar level at any given moment. Self-testing with a meter allows a person to assess how their body responds to food, physical activity and exercise, diabetes medication(s), illness and stress. This snapshot testing can also tell whether a person is experiencing or at risk for developing hypoglycemia (low blood sugar). Your diabetes health-care team will tell you how often to test your blood and when--it?s usually before meals and bedtime. Keep track of test results in a logbook or diary, and note any event that might have affected your blood sugar such as being sick or exercising more than usual. This will help determine when you have a checkup if your treatment plan (diet, exercise and medications) matches your lifestyle.

However, the value of meter testing has its limitations. This type of testing can not give information about how well the overall diabetes treatment plan is working. Other tests are available to assess the blood sugar levels over longer periods of time. These are the glycosylated hemoglobin and fructosamine tests.

This test, often called Hemoglobin A_1C (HbA_1c), has been used since the 1970s and the first to measure an average blood sugar from a span of time. Hemoglobin is the protein found in red blood cells that transport oxygen from the lungs to the body tissues. Glucose (sugar) as it is circulating in the blood stream permanently attaches to the hemoglobin (a process called glycosylation). A measurement of hemoglobin that is glycosylated or "glazed with sugar" reveals the average blood-sugar level over the life span of most red blood cells--approximately three months. The HbA1c is a valuable test for assessing long-term blood sugar control.

Until recently, the HbA_1c could only be done in a physician's office or a laboratory. Now home tests are available at pharmacies and/or through some insurance companies. To use the home test kit, a person does a finger stick to obtain a blood sample and sends the sample to a laboratory to be analyzed. Results are sent to the person and his or her physician in one to two weeks. It is important to talk with your physician about the results and any changes needed in the diabetes care regimen.

Fructosamine Test

Another method that measures average blood-sugar control is the fructosamine test. It measures the amount of glycosylated protein, or protein that has bonded with glucose (sugar) in the bloodstream. The more sugar present in the blood, the more "sugary" protein in the blood. This test indicates average blood-sugar levels over a two-to-three week period. It is useful for an individual who has changed their treatment plan and needs to assess the effectiveness within weeks rather than months.

Fructosamine tests could only be done in laboratories until recently. Now the test can be done in a physician's office or a person can obtain a special meter to do his or her own tests. A glucoprotein meter performs both blood glucose and fructosamine tests. Available at pharmacies, this small meter uses different strips for each of the two tests and the procedures for each is similar to many blood sugar testing meters. There are general guidelines regarding normal range for fructosamine, but it is a good idea to consult with your physician about what values are most suitable for you.

The results from each test supply only some information toward assessing blood sugar control. However, compiling the results of all these tests can provide a more complete picture of how well the diabetes self-care plan is working and whether changes need to be made. It is important to talk with your physician about what is best for you.