Diabetes Care
Diabetes is managed rather than cured, and most of the managing is done by the person who has it. This covers the numbers worth knowing, the checks that catch complications before they cause symptoms, and the two emergencies to recognise.
Reviewed by Dr. Mohan Gayenlast reviewed
Targets are individual. A younger person may be given a tighter one and an older person with other conditions a looser one, deliberately. Never change insulin or tablet doses on the strength of a general page.
Numbers are listed for 55 countries and can change — if your country is not here, or you are not sure, 112 reaches emergency services across the European Union and works from a mobile in much of the world. Do not drive yourself.
Recognise a hypo — and treat it immediately
A hypo is blood sugar below about 70 mg/dL. It can happen with insulin and with some tablets, and it needs treating within minutes, not investigating.
- Shaking, sweating, hunger, pounding heart, anxiety, tingling around the mouth, confusion, difficulty concentrating, slurred speech.
- TREAT FIRST: 15 grams of fast sugar — 3–4 glucose tablets, half a cup of fruit juice or regular soft drink, or a tablespoon of sugar or honey.
- Wait 15 minutes and recheck. If still below 70, repeat. Then eat a proper snack or meal if one is not due soon.
- If the person is drowsy, unconscious or fitting, give NOTHING by mouth. Put them on their side and call an ambulance.
- Chocolate and biscuits are poor treatments — the fat slows sugar absorption exactly when speed is what you need.
Recognise diabetic ketoacidosis
DKA is the opposite emergency — very high sugar with ketones — and it is life-threatening. It is commonest in type 1 diabetes, often triggered by an infection or by missed insulin.
- High blood sugar with excessive thirst and passing large amounts of urine.
- Nausea, vomiting, abdominal pain.
- Deep, rapid breathing; a sweet or fruity smell on the breath.
- Drowsiness and confusion.
- GO TO HOSPITAL. Never stop insulin because you are unwell and not eating — that is precisely when DKA happens. Sick-day rules exist; ask your doctor for yours before you need them.
The numbers, and how often
| What | Usual target for many adults | How often |
|---|---|---|
| HbA1c | Below 7 % for many adults — individualised | Every 3 months until stable, then every 6 months |
| Fasting / pre-meal glucose | 80 – 130 mg/dL | As advised by your doctor |
| Glucose 1–2 hours after a meal | Below 180 mg/dL | As advised |
| Blood pressure | Below 130 / 80 mmHg for most | Every visit |
| LDL cholesterol | Individualised and often well below 100 mg/dL | Yearly, or as advised |
| Kidneys — urine albumin and eGFR | Albumin-to-creatinine ratio below 30 mg/g | Yearly |
The checks that catch damage before you feel it
Diabetic eye, kidney and nerve damage are all silent until they are advanced. Every one of these checks exists because waiting for symptoms is waiting too long.
- EYES: a dilated retinal examination every year. Diabetic retinopathy causes no symptoms until sight is already threatened, and it is treatable when caught early.
- FEET: a proper foot examination at least yearly, and your own look every single day. Check between the toes and under the soles — a mirror helps.
- KIDNEYS: urine albumin-to-creatinine ratio and eGFR every year.
- TEETH: dental review twice a year. Gum disease and blood sugar make each other worse.
- VACCINES: influenza every year, and pneumococcal as advised.
Foot care, specifically
Foot problems are the commonest reason people with diabetes end up in hospital, and most of them start as something small that was not felt — because the nerves stopped reporting it.
- Look at your feet every day, including between the toes and the soles.
- Wash daily in lukewarm water — test it with your hand or elbow, never your feet — and dry carefully between the toes.
- Moisturise the skin but not between the toes.
- Never walk barefoot, indoors or outdoors. Check inside shoes before putting them on.
- Do not cut corns or calluses, and do not use corn-removing plasters. See a podiatrist.
- ANY new ulcer, blister, colour change, swelling, or a wound that is not healing needs to be seen within 24 hours. Do not wait to see if it settles.
This is general health information for education, not medical advice, and not a diagnosis. It cannot see you, your history, your allergies or your medicines. Never use it to start, stop or change a treatment, and never let it delay you seeking care. If you are worried about symptoms, speak to a qualified doctor; if they are severe or sudden, seek emergency help.
Where this comes from: Targets and monitoring intervals consistent with the American Diabetes Association Standards of Care. Individual targets vary and are set by your own doctor.
Where this is written from: This site is written from Indian clinical practice. Drug availability and brand names, vaccination schedules, national health programmes and some reference cut-offs differ between countries — a schedule or a threshold that is standard here may not be standard where you are. If you are reading outside India, check anything on this page against your own country’s guidance before you act on it.
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Living with diabetes — targets, checks and the things that go wrong.