You have what it takes to rein in your diabetes and achieve your goal numbers. Start by partnering with your care team to create the treatment plan that yields results!

Receiving a diagnosis of type 2 diabetes can feel overwhelming, but it can also be the beginning of a journey toward better health. By making small, positive changes every day, you have the power to take control of your future.

What’s more, today we understand diabetes—and how to manage it—better than ever.

Just ask Nancy Wernick Topiol, who had revamped her diet and started exercising when diagnosed with diabetes a decade ago, but still couldn’t bring her A1C (an average measure of blood sugar levels from the past three months) back down to where it should be. Now, with the help of a GLP-1 RA medication, Nancy is thrilled that her A1C level has dropped to the lowest it’s ever been.

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Take a stand today!
No matter where you are in your diabetes journey, it’s not too late to get inspired by Nancy as well as Brian and Roger, who share their own blood sugar-lowering strategies here. And in this guide, you’ll find even more tools and tips that can help you along the way. But first, let’s take a closer look at diabetes, what it is and how it affects your body.

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What is diabetes?
Diabetes is a metabolic disorder that disrupts your body’s ability to produce or use insulin, which causes blood sugar levels to rise. Normally, beta cells, found in the pancreas, make insulin—the hormone that helps blood sugar enter cells to be used for energy. (Hormones are a natural chemical found in the body.)

In type 1 diabetes, beta cells are destroyed by the immune system, so the body does not make enough insulin. In type 2 diabetes, beta cells either don’t produce enough insulin and/or the body’s cells do not respond correctly to insulin (known as insulin resistance).

When blood sugar is unable to enter the body’s cells, it builds up in the bloodstream. Over time, excess blood sugar can lead to body-wide damage, including vision loss, heart disease, kidney disease and nerve damage.

Early symptoms of diabetes can include:

• frequent urination
• slow-healing wounds
• blurry vision
• fatigue
• increased thirst and hunger
• weight loss
• tingling in hands and/or feet
• very dry skin
• increased infections

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Medicine can help

If you have type 1 diabetes, you will need to use insulin to treat the condition. If you have type 2 diabetes, oral medications, non-insulin injectables and/or insulin can help you manage your blood sugar levels. (Click here for information on medication options for people with type 2 diabetes.)

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What that means
Work with your diabetes care team to identify your blood sugar and A1C goals, and create an action plan to achieve them. Lifestyle changes are also important, so be sure to discuss those topics with your provider, as well.

A special concern for people of color

37 million American have diabetes—and that number is on the rise, especially in Black, Hispanic, Native American and Asian Communities.

The rate of diabetes in Black people is 60% higher compared with White people, more than 50% higher in Hispanics and Native Americans and more than 40% higher in Asian Americans.

What does that mean for you? If you are a person of color and have experienced any symptoms, be sure to tell your healthcare provider and ask that your blood sugar levels be tested.

Luckily, getting prompt and effective treatment can help stave off complications for all people with diabetes.

After decades of struggling with their health, Nancy, Brian and Roger paved their own paths to wellness. Now, thanks to medications and lifestyle tweaks, they’re feeling better than ever. Here, they share the tricks that made all the difference. —by Diane Herbst

“I’m full of energy—and unstoppable!”
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NANCY WERNICK TOPIOL, 64
JACKSON, NJ

Most days, Nancy Wernick Topiol can be found walking four miles with a friend through her community in Jackson, NJ, or taking high-intensity interval training classes. At home, the retired teacher likes to cook up tasty whole-food, high-protein meals that are low in sugar. And when she’s not busy with that, Nancy travels to Florida to visit her 32-year-old daughter, Marla, and the pair take hours-long brisk walks. “I feel really good,” says the 64-year-old, “so full of energy!”

It’s a far cry from a decade ago, when Nancy ate an abundance of processed foods. She would huff and puff when she walked even small distances as she carried 270 pounds on her 5-foot frame. And a routine blood test showed her lifestyle was taking a toll: Her A1C—which measures a person’s average blood sugar levels over the previous three months—was 8.7%. (A normal A1C level is below 5.7% , 5.7% to 6.4% indicates pre-diabetes and 6.5% and above indicates diabetes.) Nancy was officially diagnosed with type 2 diabetes.

“I felt exhausted all the time,” says Nancy, who at the same time was diagnosed with sleep apnea. “I felt like I was walking around with an anvil on my head.”

“I was nervous to make changes”

Nancy was no stranger to diabetes—her mother, father and many of her paternal relatives had had the condition as well. “I always knew in the back of my head it was in the cards,” she says. “But in the past, any attempt to ‘get healthy’ had meant going on an extremely restrictive diet, which I’d eventually give up on and gain all the weight back.”

This time, though, things were different. Her endocrinologist prescribed a medication to help lower her blood sugar and sent her to a nutritionist, who gave Nancy a list of healthy foods to eat. “It was good in that the list focused on what I could eat, and from then,” she says, “something just sort of clicked.”

“I learned what worked for me”

Determined not to repeat the mistakes of her past, Nancy began making slow changes instead of resorting to extreme dieting.

“I started investigating healthy food choices, swapping out foods high in carbs for vegetables and high-protein pasta and working on portion control, because whatever you put in front of me, I would eat.” At restaurants, Nancy immediately asked for a takeout doggy bag and cut her portion in half, only eating the food remaining on her plate. She learned that taking a bite of food and then following it with a sip of water helped her feel full.

And instead of making drastic cuts, she made small ones—things like just eliminating sugary sodas to start. “I thought, 'You know what, Nancy, you have to make a lifestyle change,' ” she recalls. “ ‘Diets’ don’t work. If you go on a ‘diet,’ you feel like you’re depriving yourself. By doing small changes and swaps, I never felt deprived.”

Nancy also joined a gym and started lifting weights under the guidance of a trainer. These small, consistent changes added up—Nancy’s A1C went down to 6.4%, and she dropped 90 pounds.

“Now I’m in charge of my health!”

But then in 2022, her weight loss plateaued, and her A1C rose to 7.3%. At the same time, Nancy read about GLP-1 receptor agonists (GLP-1 RAs), and how they could help with lowering blood sugar levels. Seeing that Nancy met the appropriate requirements, her healthcare provider added the medication to her regimen.

The new medication helped lower her A1C to 5.9%, “the lowest it’s ever been,” she says. And her sleep apnea disappeared.

Now, thanks to her lifestyle changes and new treatment plan, she’s lost a total of 120 pounds and has her diabetes under control—and she loves sharing her story with others. “Everybody is so proud of me because it was a struggle,” she says. “I lost a whole person! Life is a journey, and this is part of that journey. People are so hard on themselves, and I learned that if I make a mistake, so be it—it doesn’t define me, and I get back on track and do better.”

Small steps that make a BIG difference

Nancy’s goal was to get her diabetes and weight under control. “I realized that if I make small changes, it becomes a part of life and I don’t feel deprived,” she says. Here, Nancy shares the strategies that have helped her manage diabetes, lose 120 pounds and regain her health:

Move past any guilt.
For decades, Nancy tried every diet out there, which inevitably led to feelings of deprivation and then loss of control. “I used to be like, Oh, well, I ate the pizza; I might as well have ice cream or something else for dessert,” she recalls. “I learned to say, Okay, you enjoyed it. Don’t feel guilty.” Nancy says it’s important to accept you will have setbacks—acknowledging that can make it easier to get back on a healthy track.

Learn your triggers.
Nancy learned that sugar is hidden in many everyday foods, even peanut butter and many frozen foods, and that sugar triggers her desire to eat even when she isn’t hungry. “I learned to read labels,” she says. “People don’t realize how much added sugar is in everyday foods. And I started learning to cook healthier.”

Personalize your plan.
When it comes to cooking, Nancy relies on the art of substitution. “I just kept looking at things and tailored my eating to my needs and desires,” she says. For inspiration, she recommends the Eat This, Not That! books and website as well as The Sugar Solution. “The other day I made a banana bread with cottage cheese,” Nancy says. “It’s high protein, and you don’t put sugar in it. It’s sweetened with pure maple syrup, which has a lower glycemic index. It’s an effective way for me to manage my blood sugar.” 

Think desserts are off-limits? Not true! Having diabetes doesn’t mean you have to give up Aunt Betty’s pecan pie or Grandma Ethel’s from-scratch peach cobbler. Read on! —by Constance Brown-Riggs, MSEd, RDN, CDCES, CDN

You can have your cake—and keep your blood sugar within range, too. In fact, the American Diabetes Association says that desserts can be part of a healthy diet. Here are some strategies for doing just that:

Budget for it.
If you want to have that brownie, find out how many carbs it has (for a packaged food, check the nutrition label; if you’re dining out, try the restaurant’s website; and for homemade eats, enter the ingredients into the analyzer at happyforks.com/analyzer), and budget for it throughout the day.

Check your levels.
A chocolate chip cookie might cause your blood sugar to skyrocket while bread pudding doesn’t. The only way to know for sure? Check your blood sugar! Test two hours before and after eating a sweet to see how it affects you. It can help guide your choices and your portion sizes, too.

Fill your dessert plate this way.
Try half a slice of cake and fill the rest of your plate with nuts or berries to balance it with fiber and nutrient-dense foods.

Make it yourself. 
That way, you can control the ingredients. For example, you can cut sugar by using substitutes like stevia, sucralose or monk fruit, or use berries, apples or other fruit for natural sweetness. To cut back on saturated fat, you can replace the butter or oil with Greek yogurt. And instead of white flour, use whole wheat flour. 

Time it right.
Forget the saying “Life is short, eat dessert first.” Turns out saving treats for the end of a meal is a smart move for people with diabetes. One study shows that eating proteins and fats before your carbs—like having steak before dessert—can help prevent blood sugar spikes after meals. The reason: Proteins and fats slow down digestion, help your body release insulin at the right time and keep insulin in your system longer. Another way to slow digestion—and feel full longer—is to include high-fiber foods like whole grains, legumes, fruits and vegetables in your main meal.

Your new go-to dessert!

This cobbler gets most of its sweetness from fruit, and odds are you already have most of the ingredients in your pantry. If you keep frozen peaches and berries on hand, you’ll always be able to whip it up when the mood strikes.

One serving equals one serving of fruit!

Peach and Blueberry Cobbler

Makes 8 servings

For filling:

• 2 cups peaches, cut in chunks (frozen or fresh)
• 1 cup blueberries (frozen or fresh)
• 2 Tbsp brown sugar
• 1/2 tsp cinnamon
• 1/4 tsp ground nutmeg
• 2 Tbsp cornstarch
• 1 Tbsp canola oil

For topping:

• 1 cup whole-wheat flour
• 1/4 cup white sugar
• 1/4 cup brown sugar
• 1 tsp baking powder
• 1/2 tsp salt
• 6 Tbsp butter, unsalted
• 1/4 cup boiling water

 

Preheat oven to 425°F.

Combine peaches, blueberries, brown sugar, cinnamon, nutmeg and cornstarch in a bowl. Make sure fruit is well-coated.

Using the oil, grease a 1½-quart casserole dish. Pour fruit mixture into dish.

Bake in oven for 10 minutes; remove and raise oven temperature to 435°F.

While fruit is baking, make topping. Combine flour, sugars, baking powder and salt in a bowl.

Blend in butter with your fingers or with a pastry blender until mixture is coarse, then stir in water.

When filling is done baking, drop spoonfuls of the topping onto the mixture and bake at 435°F for about 30 minutes.

Nutrition facts: Calories 232, Fat 9 g (Saturated Fat 5 g), Cholesterol 25 mg, Sodium 200 mg, Carbohydrate 35 g, Fiber 3 g, Sugar 20 g, Protein 3 g

Source: Med-South Cookbook ©2020 UNC-CH Center for Health Promotion and Disease Prevention