Blood sugar control can be a balancing act.
If you have diabetes, you’ll likely experience both highs and lows over the course of a week. Or you might even have both on the same day.
It’s possible to have balanced blood sugars when living with diabetes, but it can take some trial and error to see what works best for you.
Keep reading to learn how to manage your blood sugar levels.
What is a normal blood sugar level?
In a person without diabetes, a normal blood sugar range usually falls between 70-140 mg/dL. A normal blood sugar range for someone with diabetes can vary depending on many factors (patient age, other health conditions, etc.).
Blood sugar levels fluctuate throughout the day, such as after eating meals and snacks. There are different blood sugar guidelines from different organizations, which are summarized below:
American Diabetes Association (ADA) blood sugar goals (1):
| Pre-meal: | 1-2 hours after starting a meal: | Hemoglobin A1c (average blood sugar over the past 90 days): |
| 80-130 mg/dL | Less than 180 mg/dL | Less than 7% |
American Association of Clinical Endocrinologists (AACE) blood sugar goals (2):
| Fasting: | 2 hour postprandial (after meal): | Hemoglobin A1c (average blood sugar over the past 90 days): |
| Less than 110 mg/dL | Less than 140 mg/dL | 6.5% or lower |
Blood sugar goals for women with gestational diabetes are the most strict, as high blood sugar during pregnancy can lead to adverse outcomes in the mother and baby. Blood sugar goals for gestational diabetes are below:
| Fasting/before meals: | 1 hour after a meal: | 2 hours after a meal: |
| 95 mg/dL or less | 140 mg/dL or less | 120 mg/dL or less |
The numbers above are guidelines for the general population and don’t take into consideration your personal health history. You should ask your healthcare provider what your blood sugar target range is.
How to manage blood sugar levels
Diet
If you have high blood sugar, here are three helpful tips to help you lower your blood sugar levels.
Avoid sugary drinks
Sweet drinks like soda, sweetened tea and coffee, and fruit-flavored drinks are very high in added sugar. Liquids are emptied from your stomach very quickly, meaning the sugar from the drinks is available in your bloodstream way faster than eating solid food with carbohydrates or sugar.
Sugary drinks are one of the leading culprits behind spikes in blood sugar levels. One 12-ounce can of standard cola provides 33 grams of added sugar, which is beyond the daily recommendation of fewer than 25 grams of added sugar per day for women and close to the limit of fewer than 36 grams of added sugar per day for men.
Practice portion control with carbohydrates
Carbohydrates (carbs) are a type of nutrient your body uses for energy. You can find carbohydrates in foods like grains, fruit, legumes, vegetables, and some dairy products like milk and yogurt.
Many vegetables are very low in carbohydrates, but a few vegetables are considered starchy and raise your blood sugar more, like potatoes, winter squash, corn, and peas.
To practice portion control of carbohydrates and promote healthy blood sugar levels, try keeping your carbohydrate portions to a quarter of your plate, similar to the Diabetes Plate Method. This method doesn’t require carbohydrate counting but helps you visualize your carbohydrate portions using a standard plate.
Eat a balanced diet
Protein is one of the three main nutrients, along with carbohydrates and fat. Unlike carbohydrates, protein doesn’t raise blood sugar levels. Eating protein with carbohydrates can promote more balanced blood sugar levels and help prevent blood sugar spikes.
Examples of protein include meat (red and white meat), poultry, fish, eggs, nuts and nut butter, seeds, legumes, and soy products.
Like protein, dietary fat doesn’t have a significant impact on your blood sugar levels and can make you feel full. Healthy fats are low in saturated fat, which is recommended when you have diabetes for your heart health.
Healthy fats typically come from plant-based foods like nuts, seeds, vegetable oils, and avocados, but they’re also found in fatty fish like salmon, mackerel, and sardines.
Medication
High blood sugar
If your healthcare provider recommends medication to manage your diabetes, there are several options, including pills and injections. Some of the most common diabetes drugs include metformin, sulfonylureas, insulin injections, and non-insulin injectables.
Some medications come with a risk of low blood sugar, such as sulfonylureas and insulin. Metformin is a common drug to start with because it tends to be effective, isn’t expensive, and doesn’t cause low blood sugar. You can try different medication regimens to find what works for you.
Low blood sugar
Glucagon is a hormone that helps raise blood sugar levels. You can get a prescription for a glucagon injection from your healthcare provider. You use a glucagon injection like an insulin pen and inject it into the thigh, abdomen, or upper arm.
Supplements
Some supplements might help improve insulin sensitivity and help lower blood sugar levels if you have type 2 diabetes. Supplement claims aren’t always backed by research, so you should ask a trusted healthcare provider for guidance, or do your own research before starting a supplement.
Some popular supplements for diabetes include cinnamon, berberine, magnesium, and vitamin D, among others.
Exercise
High blood sugar
Exercise is a great way to lower high blood sugar. Exercising causes your body to use up extra glucose, which lowers your blood glucose levels.
The key to exercise is to find something you find enjoyable. Try to make exercise fun by doing things like walking with a friend, hiking, biking, swimming, dancing, or paddleboarding. Activities like horseback riding and gardening are also forms of exercise since they can increase your heart rate and can build muscle.
Resistance exercise can also be helpful because it builds muscle, improving insulin sensitivity. Body weight exercises like pushups, squats, and lunges can build muscle, as well as using resistance bands.
Low blood sugar
If you’re prone to low blood sugar, you can still exercise, but you need to take some precautions.
You might need to check your blood sugar before you exercise. If it’s low, treat it until it’s normal before beginning your exercise.
Blood sugar levels typically fall after exercise, or when you’re doing endurance activities that last more than an hour. Be sure to eat enough carbohydrates before, during, and after exercising to prevent low blood sugar. Pretzels, glucose gels, and dried fruit are all great choices to have on hand while exercising.
What are the symptoms of high blood sugar?
One of the dangerous things about diabetes is that you might not feel it when your blood sugar is high. If your blood sugar is very high (around 250-300 mg/dL) you can start to develop symptoms of hyperglycemia, but you might not be able to differentiate between a blood sugar of 120 mg/dL and 160 mg/dL.
Instead of relying on feel, the most accurate way to determine if you have high blood sugar is to check it with a glucometer, a machine that measures blood sugar levels at home.
If you have type 1 diabetes, very high blood sugar can lead to diabetic ketoacidosis (DKA), a serious condition that must be treated immediately.
Some possible symptoms of high blood sugar include:
- Increased urination
- Increased thirst
- Hunger
- Fatigue
- Blurry vision
- Headache
Symptoms of diabetic ketoacidosis include:
- Increased thirst
- Increased urination
- Fast, deep breathing
- Dry skin and mouth
- Flushed face
- Fruity-smelling breath
- Headache
- Muscle stiffness or aches
- Fatigue
- Nausea and vomiting
- Stomach pain
- Positive urine ketone test
Very high blood sugar levels in people with type 2 diabetes can lead to diabetic hyperglycemic hyperosmolar syndrome, or HHS. HHS is more likely to impact people with poorly controlled blood sugar levels, heart and/or kidney problems, and dehydration.
Symptoms of HHS include:
- Blood sugar level of 600 milligrams per deciliter (mg/dL) or higher
- Excessive thirst
- Dry mouth
- Increased urination
- Warm, dry skin
- Fever
- Drowsiness, confusion
- Hallucinations
- Vision loss
- Convulsions
- Coma
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What are the symptoms of low blood sugar?
There are several common symptoms associated with low blood sugar (hypoglycemia). However, not everyone will experience all of these symptoms, and low blood sugar symptoms can change over time. If you suspect you have hypoglycemia, the best thing to do is check your blood sugar levels.
The most common symptoms of hypoglycemia include:
- Feeling shaky and/or dizzy
- Sweating
- Hunger
- Feeling irritable or moody
- Feeling anxious or nervous
- Headache
Some people experience nocturnal hypoglycemia, which is when low blood sugar occurs overnight while sleeping. Symptoms of low blood sugar overnight include:
- Damp sheets or night clothes from sweating
- Nightmares
- Feeling tired, irritable or confused after waking up
If hypoglycemia isn’t treated, it can become a low blood sugar emergency. Signs and symptoms of severe hypoglycemia include:
- Clumsiness or jerky movements
- Muscle weakness
- Slurred speech or difficulty speaking
- Blurry or double vision
- Drowsiness
- Confusion
- Convulsions or seizures
- Unconsciousness/fainting
- Coma
- Death
How to manage blood sugar in an emergency
Emergency high blood sugar
If your blood sugar level is very high (over 250 mg/dL), you should contact your healthcare provider immediately to determine the next step. If you have type 1 diabetes and think you’re going into DKA, you should seek emergency medical care.
In the meantime, avoid eating or drinking foods high in carbohydrates/sugar – drink only water, not sugary drinks like soda or juice. If you’re hungry, eat protein-rich foods like cheese, meat, eggs, and nuts to help keep your blood sugar levels from rising even more.
If you have short-acting insulin, your healthcare provider might recommend taking an extra dose to help lower your blood sugar level quickly. This is called a correction dose, and should only be done under the guidance of your healthcare provider since taking too much short-acting insulin can lead to low blood sugar.
Emergency low blood sugar
For blood sugar levels below 70 mg/dL, you need to consume 15 grams of carbohydrates immediately. ½ cup of juice, one tablespoon of honey, or one tablespoon of sugar dissolved in water all contain about 15 grams of carbohydrates. Avoid eating carbs with protein added (like peanut butter crackers), which can take longer to raise your blood sugar.
Re-check your blood sugar in 15 minutes – if it’s still below 70 mg/dL, repeat the 15 grams of carbohydrate treatment and check your blood sugar again in 15 minutes.
For severe low blood sugar (below 50 mg/dL, and/or if the person is unresponsive) – seek emergency medical care. If you have a glucagon injection (available by prescription), it should be used.
Conclusion
There are many aspects of blood sugar management for those living with diabetes. Diet, exercise, supplements, and medication are all different areas that you can work on to help achieve your target blood sugar levels. Be kind and patient with yourself as you work to figure out what works best for you because everyone is different!
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