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Introduction

What is diabetes?

Diabetes is characterized by high blood sugar levels and metabolic abnormalities. Over time, elevated blood sugar levels damage vital organs and impair their ability to function.
The persistent presence of excess glucose (sugar) in the blood is known as hyperglycemia.

Types of Diabetes

Diabetes primarily occurs as type 1 or type 2. Although the causes of each disease differ, both types are characterized by elevated blood glucose levels.

Type 1 Diabetes

Type 1 diabetes is caused by a defect that prevents the pancreas from producing insulin, a hormone that plays a crucial role in regulating blood glucose levels. In the past, it was referred to as 'insulin-dependent diabetes' or 'juvenile diabetes' because it typically develops at a relatively young age.

For medical information on type 1 diabetes

Type 2 Diabetes

In type 2 diabetes, the body is unable to effectively utilize the insulin it produces. The combination of insulin resistance and reduced insulin production results in elevated blood glucose levels. Over 90% of diabetics are diagnosed with type 2 diabetes. Despite its prevalence, individuals may be unaware they have the disease. This is because the disease develops gradually, and its symptoms are less apparent compared to those of type 1 diabetes. Type 2 diabetes is more common in older individuals.

Untreated diabetes can lead to late complications, potentially affecting the blood vessels, eyes, kidneys, nervous system, and heart. Over time, deviations from normal blood glucose levels can result in cumulative damage. Therefore, it's important to manage blood sugar levels primarily through lifestyle changes, including regular physical activity, proper nutrition, medication, and beneficial health behaviors.

For medical information on type 2 diabetes

How do blood sugar imbalances and monitoring influence blood sugar levels?

Diabetes is a condition in which the body struggles to maintain normal blood sugar levels, leading to either hyperglycemia (high blood sugar) or hypoglycemia (low blood sugar).

What are normal blood sugar levels?

Sugar levels are typically determined by three indicators:

Fasting blood sugar levels: measured after not eating or drinking (except water) for at least 8 hours.
Postprandial blood sugar levels: measured about two hours after a meal, without consuming anything else in between.
Glycated hemoglobin (HbA1c) levels: 's average blood sugar levels over the past 3 months.

Diabetes typically contributes to higher values of all three indicators.

Normal ranges for a person without diabetes:

70-100 mg/dl	Fasting blood sugar levels
Up to 140 mg/dl	Two hours after eating
Up to 5.7%	Glycated hemoglobin

Up to 140 mg/dl

Two hours after eating

Up to 5.7%

Glycated hemoglobin

Ranges in diabetics:

80-130 mg/dl	Fasting blood sugar levels
140-180 mg/dl	Two hours after eating
6.5-8%, or more	Glycated hemoglobin

140-180 mg/dl

Two hours after eating

6.5-8%, or more

Glycated hemoglobin

How are blood sugar levels affected?

Many factors influence blood sugar levels. A healthy lifestyle, comprising proper nutrition, regular physical activity, and stress management, greatly influences blood sugar levels. Typically, lifestyle changes and proper medications will lead to changes in blood sugar levels, based on the extent of these changes.

Treating blood sugar imbalances

Blood sugar imbalances take two forms - hypoglycemia and hyperglycemia:

Hypoglycemia

When blood sugar levels drop below 70 mg/dL, potentially impairing functioning. Hypoglycemia can also occur in diabetic individuals with consistently high blood sugar levels. Some diabetic patients do not sense hypoglycemic episodes. It's important to treat hypoglycemia, as it can worsen and may even lead to loss of consciousness.

Signs of hypoglycemia (low blood sugar)

Cold sweat
Blurred vision and dizziness
Hunger
Weakness
Heart palpitations
Increased tremors
Nervousness
Confusion and balance problems
Slurred speech

Causes of hypoglycemia

Sudden increase in physical exertion
Reducing food intake or skipping meals
Consuming alcohol on an empty stomach
Excessively high insulin or medication dose

Treating hypoglycemia

Quickly boosting sugar intake must take priority.

Drink half a glass of sweetened beverage (not diet), consume three sugar cubes or teaspoons of sugar, or take sugar pills/drinks designated for diabetics (available over-the-counter at pharmacies).
Individuals treated with insulin should have a glucagon preparation on hand. It's crucial that a family member receive instructions from a nurse and learn how to administer the preparation to the diabetic patient if necessary.
After raising sugar levels, have a meal containing complex carbohydrates along with protein or fat, such as a sandwich with cheese or tahini, to prevent the prompt recurrence of hypoglycemia. Monitor blood sugar levels and consult with medical professionals regarding further treatment.

Hyperglycemia

When blood sugar levels are too high - over 250 mg/dL when fasting, accompanied by the following symptoms:Adhering to prescribed medications and maintaining a healthy lifestyle help prevent these conditions.

Treating hyperglycemia	Causes of hyperglycemia	Signs of hyperglycemia
Physical activity can help mitigate mild hyperglycemia	Consuming excessive carbohydrates beyond the recommended intake	Thirst
If your blood sugar exceeds 400 mg/dL, consult a Maccabi Nonstop nurse immediately !	Failure to adhere to prescribed medication dosages	Dry mouth
	Fever or inflammation	Excessive urination
	Stress-inducing situations	Weakness and fatigue

Physical activity can help mitigate mild hyperglycemia

Consuming excessive carbohydrates beyond the recommended intake

Thirst

If your blood sugar exceeds 400 mg/dL, consult a Maccabi Nonstop nurse immediately !

Failure to adhere to prescribed medication dosages

Dry mouth

Fever or inflammation

Excessive urination

Stress-inducing situations

Weakness and fatigue

What is self-monitoring of blood glucose?

Blood sugar levels change rapidly. It's crucial to independently measure them multiple times a day using a home glucometer, enabling you to identify imbalances and adjust treatment accordingly.

Advantages of self-monitoring

Accessible, reliable, and rapid testing
Greater self-awareness of changes and symptoms
Facilitates advance planning and helps prevent irregularities
Enables optimal disease management and control

Goals of self-monitoring

Recognizing fluctuations in blood sugar levels throughout the day

For treatment adjustment: beginning new regimens and altering medication dosage.
Detecting and treating hyperglycemia.
Detecting, preventing, and treating hypoglycemia (blood sugar levels dropping below 70 mg/dL).
Identifying and planning for various events affecting sugar levels, such as parties, illness, physical activity, and more.
Offering immediate data on how different foods affect sugar levels.

Self-monitoring guidelines

Measurements must adhere to the manufacturer's instructions
Update the device’s date and time settings
Make sure the testing strips are not damaged or expired
Wash your hands before every test
Prick your fingertip with the lancet
Squeeze a drop of blood onto the testing strip
Record and report as per medical recommendations
Check and calibrate the device

Diabetic patients who regularly self-monitor blood sugar levels are healthier and significantly reduce their odds of complications.

Insulin

Living with insulin

What is insulin?

Insulin is produced in the pancreas' beta cells and secreted into the bloodstream. Today, genetically engineered insulin can be administered via subcutaneous injection.
Insulin lowers blood sugar in two main ways:

By helping blood glucose (sugar) enter cells and be used as energy.energy
By encouraging glycogen generation, a sugar stored in the liver.

There are two main types of diabetes:

Type 1 diabetes: occurs when beta cells are destroyed, halting insulin production and necessitating insulin injections. This is the most common type in young patients.
Type 2 diabetes: occurs when insulin cannot be effectively utilized. This type of diabetes is more common, accounting for about 90% of all adult diabetics and requiring lifestyle changes, oral medication, and insulin injections.

When should insulin treatment begin?

For type 1 diabetes - upon diagnosis.

For type 2 diabetes - in the following cases:

Severe hyperglycemia - when sugar levels are significantly above normal.
Uncontrolled diabetes despite long-term use of oral medication.
When oral medication is contraindicated (kidney or liver disease).
When diabetes develops during pregnancy and cannot be managed through diet.

Insulin side effects

Hypoglycemia, low blood sugar level (less than 70 mg/dL) - it's important to treat this condition, as the imbalance can worsen and may even lead to loss of consciousness. Inject insulin as per the doctor's instructions and maintain a healthy lifestyle to prevent hypoglycemia.

Insulin storage

Refrigerate insulin until the expiration date indicated on the bottle
If using immediately, store insulin at room temperature in a cool, shaded area.
Unrefrigerated insulin remains usable for up to 6 weeks

What types of insulin are available, and how should they be administered?

a. Long-acting basal insulin (Lantus, Levemir, and Degludec)
Inject at a fixed time daily, regardless of meals, and at a fixed dose regardless of current sugar levels.
b. Insulin mixture (Novomix/Humalogmix)

Inject within 10 minutes before or at the start of the meal.
It is important to measure sugar levels before each injection.
Maintain consistent and scheduled injection times.
It is recommended to adjust doses based on pre-meal sugar levels and the meal's carbohydrate content.

c. Short- and rapid-acting insulin (Apidra/Novorapid/Humalog)

Inject within 10 minutes before or at the start of the meal.
Insulin dosage adjustments will be made according to the prescribed treatment plan.
It is important to measure blood sugar levels before each injection.
It is recommended to adjust doses based on pre-meal glucose levels and the meal’s carbohydrate content.
Learning to count carbs is crucial.
To adjust short-acting insulin doses effectively, it's important to consult with a dietician to understand two key formulas: Insulin-carbohydrate ratio: This formula calculates the amount of carbohydrates in different foods and determines the corresponding insulin units needed per dose to maintain balanced blood sugar levels. Correction factor: how many insulin units decrease blood sugar levels until the target level is reached.

Recommended insulin injection areas

Around the belly button
Upper arm
Outer thigh
Buttocks

Nutrition

Crafting a balanced meal plan

Healthy eating with diabetes follows the same principles as general nutritional recommendations. Ensure meals include a variety of nutrients to help maintain balanced blood sugar levels.

Key points

Planning according to your lifestyle and schedule is essential. Knowing in advance what and where you'll eat is important for ensuring varied, healthy, and tasty meals. Being overly hungry often leads to poor food choices. Low blood sugar levels greatly intensify feelings of hunger. In this physiological state, adhering to well-ordered and high-quality meals becomes challenging. Most of us tend to choose carb- and fat-rich foods.
Consuming imbalanced meals after experiencing low blood sugar (hypoglycemia) or intense hunger often leads to a significant spike in sugar levels (hyperglycemia).
Sharp fluctuations in sugar levels over time can harm health and long-term sugar levels. Therefore it's important to keep both hunger and satiety at moderate levels, which can only be achieved through advance meal planning.

Medication

Some medications necessitate eating at specific times. A dietitian’s personalized recommendations are essential for adapting one's schedule and menu to medication regimens.

Nutrients’ effects on sugar levels

Our diet relies on five essential nutrients:

Carbohydrates - the "fuel" and primary energy source for our bodies, found as simple sugars or starch in food.
Proteins - composed of amino acids, they serve as the body’s building blocks and can also be a source of energy.
Fats - energy-rich substances that act as a reserve of calories and contribute to the proper functioning of various systems.
Vitamins - play numerous, diverse roles in various processes.
Minerals - serve multiple functions in growth, development, and various processes.

Carbohydrates

Have the greatest impact on sugar levels. Identifying carbohydrates in the diet is essential for moderating sugar levels. Carbohydrates are divided into two categories, simple sugars and starches:
1. Simple sugars - white sugar. Reducing consumption of foods high in simple sugars is recommended, as they rapidly impact blood sugar levels.

Foods containing simple sugars:

Sweets, cakes, candies, honey, jam, date syrup, sweet drinks
Fruits
Liquid milk products such as milk, labneh, yogurt, buttermilk and Eshel

2. Starch - a complex carbohydrate. Typically, its digestion and absorption rate is slower, resulting in a more gradual and moderate effect on blood sugar levels. A balanced diet regularly includes starches.

Starches are mostly found in:

Rice, corn, quinoa, buckwheat, potatoes, sweet potatoes
Wheat products such as bread, crackers, cereals
Legumes such as lentils, beans, chickpeas, peas

Proteins

Protein is found in animals food products, such as meat, chicken, fish, turkey, eggs, and dairy.
Plant-based foods like legumes, almonds, and nuts are rich sources of protein.
The Western diet typically doesn't lack protein. Protein is digested and absorbed slowly, resulting in a minimal to inconsequential effect on sugar levels in most cases.

Fat

Fats are categorized into vegetable fats, which are recommended for regular consumption, and animal fats, which should be minimized due to their high saturated fat and cholesterol content.
Vegetable fats are found in foods like olive oil, sesame products (tahini), canola oil, avocado, almonds, and nuts.
Animal fats are found in foods such as butter, cream, fatty meat cuts, chicken skin, and dairy products with over 5% fat content.
Fats do not break down into carbohydrates after consumption, thus they do not elevate blood sugar levels.
Different nutrients synergistically affect carbohydrate absorption rates, which helps slow the rise in sugar levels and promotes sustained feelings of satiety. Hence, a meal comprising all nutrients constitutes a balanced diet, fostering stable blood sugar levels.

Using carbohydrates to balance blood sugar levels

Carbohydrates play a crucial role in balancing blood sugar levels.

What are carbohydrates?

Carbohydrates can be categorized into two groups: visible and hidden. Some foods contain carbohydrates that are easily identifiable, while in others, you need to actively search for and check their carbohydrate content.

Visible carbohydrates

1. Starches (complex Carbohydrates):

Grains: Wheat products, including bread, crackers, pasta, couscous, semolina, bulgur, and various pastries. Rice, rice cakes, oats (Quaker), rye products, pearl barley, buckwheat, and quinoa

Starchy vegetables: corn, potatoes and sweet potatoes
Legumes: Lentils, peas, beans (of all colors), chickpeas, fava beans, soybeans and black-eyed peas
2. Simple sugars (processed white sugar and natural sugars):
Fruits: Fresh, cooked (compote), or dried, and juices
Sugars and natural sweeteners: white sugar, brown sugar, jam, honey, date syrup
Liquid milk products: animal milk and plant-based substitutes like soy and rice milk. Yogurt, buttermilk, and dairy desserts

Hidden carbohydrates

"No added sugar" may appear on ready-made products that do not contain white sugar, though they may contain other sweeteners like date syrup or honey.
"Sugar-free" pastries can certainly contain flour, oats, or other carbohydrate sources.
"Natural juices without added sugar" or "jam without added sugar" contain a significant amount of fruit, which inherently contains carbohydrates.

Identifying hidden carbohydrates

Check the ingredient list on the product packaging. The first ingredient listed is the one present in the largest quantity in the product. Following that, the quantities decrease accordingly. If a carbohydrate sweetener (such as sugar, honey, or date syrup) is listed at the top of the ingredient list, it is likely a significant component of the product.
Check the nutrition facts table. This table displays the amount of carbohydrates in 100 grams of the product. The higher the value, the greater the carbohydrate content. For instance, one slice of regular bread contains 15 grams of carbohydrates.

It's advisable to consult a dietitian regarding the recommended amount of carbohydrates for each meal, as that may vary based on numerous factors.

What can we do when we lack information about a product’s ingredients? (at a restaurant or when dining elsewhere)

Get to know the suspect foods:

Salad dressings and pasta sauces typically contain sugar
Salads like cabbage, matbucha, and pickles contain sugar
Asian cuisine like noodle dishes, sushi, and stir-fries contain sugar
Cakes and sweet pastries naturally have high sugar content

If you identify carbohydrates - balance your sugar levels. There is no sweeping recommendation to avoid these foods. When diabetes is well-managed, they can be included in the menu, but less often. The main goal is to identify the carbohydrates.

10 golden rules for proper nutrition and maintaining health with diabetes

It's important to recognize and identify the carbohydrates in food. Work with a dietitian to adjust the amount of carbohydrates you should consume per meal.
Choose carbohydrates from whole grains like whole wheat bread, buckwheat, quinoa, oats (such as Quaker), and legumes.
Limit consumption of sugary foods like fruit, milk, yogurt, and sweets. They can be included in the menu in limited quantities after consulting with a dietitian.
Incorporate foods rich in dietary fiber, including unpeeled vegetables and fruits, whole wheat bread, legumes (such as beans, chickpeas, peas, lentils, and fava beans), whole grain rice, and oats (such as Quaker). Dietary fiber offers health benefits such as stabilizing blood sugar and managing blood lipids.
Include vegetables at most meals. Vegetables help manage diabetes and can be consumed without restriction, either fresh, baked, or boiled, but preferably not fried.
Choose vegetable fats such as olive oil, canola oil, avocado, tahini, seeds, and nuts.
Reduce the intake of food high in animal fats, including butter, chocolate, whipped cream, dairy products with over 5% fat, sausages, fatty meat cuts, high-fat snacks, and cakes. Select low-fat cooking methods such as steaming, roasting, and baking rather than frying.
Avoid foods containing trans fats, such as cookies, pastries, fried foods, packaged snacks, and margarine-containing products.
Monitor the salt (sodium) content in store-bought foods. Choose foods with reduced salt and use a variety of spices when cooking at home to minimize salt usage.
Drink water regularly throughout the day. You can consume soda and carbonated diet drinks that are carbohydrate-free.

Physical Activity

Physical activity for diabetics

Regular physical activity helps prevent the onset of diabetes and significantly aids in its management:

Delays disease progression by enhancing blood sugar control.
Positively impacts blood lipid levels.
Reduces the risk of cardiac events.
Enhances mood and quality of life.

Recommended for all individuals with diabetes. Consult a doctor before starting any activity. Consultation is especially necessary for patients with kidney, eye, balance, and foot issues.

Physical activity recommendations for diabetics

To regulate insulin levels, it's recommended to engage in at least 150 minutes of aerobic exercise per week, as insulin levels naturally fluctuate throughout the day.
Incorporate strength training sessions 2-3 times a week, which complements aerobic exercise.
Avoid sitting for more than 90 minutes at a time.
Finding enjoyable activities helps maintain motivation and persistence. You can engage in walking, swimming, cycling, various classes, dancing and more. Walking is highly recommended because it's accessible, affordable (only requiring good walking shoes), easy to start, and safe.

Advantages of physical activity

Physical activity enhances the absorption of sugar into muscle cells. Absorption increases during aerobic activity and as it intensifies.
Both aerobic activity and strength exercises decrease blood sugar levels for at least 24 hours post-training.
Physical activity enhances fat metabolism in the blood and helps maintain lipid levels.

Safe exercise guidelines for diabetics

Recommended frequency: 4-6 times weekly, preferably at the same time each day to help maintain balanced blood sugar levels. It's advisable to exercise at least 3 times a week to ensure no more than a two-day gap between sessions.
Recommended duration: 30-60 minutes. Start with a 10-15 minute activity and gradually increase the duration. Daily physical activity, like walking for over 10 minutes, contributes to overall health.
Nutrition during exercise: If you are active for more than an hour continuously, it is recommended to consume a serving of carbohydrates during the session.
Physical intensity: For optimal exercise, aim for a light to moderate intensity where you can comfortably hold a conversation while exercising. Exercising too intensely can lead to muscle and skeletal injuries.

When is the best time to exercise?

1-2 hours after eating.
Avoid exercising in severe weather conditions, such as extreme heat or cold.
Avoid exercising when you are sick.
Before starting or changing your exercise routine, consult with your healthcare team - doctors, nurses, physical therapists, fitness consultants, and dietitians - to tailor the program to your medical treatment and nutritional needs

Keep in mind:

If your blood sugar is below 100 mg, have a snack high in carbohydrates before exercising and wait for sugar levels to rise.
Avoid exercising with type 1 diabetes if blood sugar levels exceed 250 mg and ketones are present in the urine.
Always consult with your healthcare team to determine the appropriate blood sugar range for your chosen physical activity.

When should you stop exercising?

Symptoms of low blood sugar (hypoglycemia) may include hunger, headaches, limb tremors, dizziness, sweating, rapid pulse, blurred vision, and weakness.
If experiencing these symptoms, stop exercising, consume 15 grams of simple carbohydrates (equivalent to 3 teaspoons of sugar) or a sweet drink, and rest.
Stop physical activity if also experiencing shortness of breath, chest pressure, heart palpitations, tremors, or sharp pain in the legs or hands.

Preparing for exercise

Choose a well-lit, flat route with good air circulation whenever possible.
Avoid exercising in severe weather conditions - extreme heat or cold.
Wear wide and comfortable shoes for physical activity and opt for white cotton socks to keep feet ventilated and to easily spot any injuries.
Bring water and sugar with you.
When starting a new physical activity, it's advised to monitor sugar levels before, during, and after the activity.

Exercise and insulin injections

Consult your doctor about adjusting your insulin dose for physical activity.
Consult a physiotherapist and dietitian about timing exercise and dietary supplements.
Avoid exercising muscles where insulin was injected within an hour and a half of injection. Ideally, if insulin is needed before exercise, inject in an inactive area like the stomach or hands.
To keep sugar levels balanced, aim for daily physical activity.
For type 1 diabetes, discuss target blood sugar levels during exercise with your doctor, physiotherapist, and nutritionist.

Individualized advice

Diabetics can get personalized advice from an exercise consultant, who will work on a customized plan with you. This service is available at Maccabi's physiotherapy institutes.

Diabetes Complications

Late diabetes complications and prevention

Diabetes can lead to health complications, reduced quality of life, and disability. Diabetes complications arise when diabetes remains uncontrolled over time. Risk of complications rises with age, prolonged illness, and unmanaged risk factors like hypertension, high blood lipids, obesity, smoking, and increased mental stress. Complications result from damage to both large and small blood vessels and the nervous system.

Organs at risk of damage and associated health risks:

Kidneys - diabetic kidney disease (diabetic nephropathy)
Damage to the kidney’s small blood vessels reduces renal filtration capacity, leading to varying degrees of kidney failure, potentially requiring dialysis.
Eyes - diabetic eye disease (diabetic retinopathy)
Damage to retinal blood vessels can result in reduced vision and blindness.
Nervous system - nerve damage (diabetic neuropathy)
Damage to small blood vessels in the peripheral and autonomic nervous system. May present as altered sensation, particularly in the lower limbs, with symptoms like burning or numbness, sexual dysfunction, digestive issues, and bladder problems.
Foot - diabetic foot disease
Certain risk factors associated with blood vessel and nerve damage in the legs can result in reduced blood flow, decreased sensation, slow-healing wounds, ulcers, and an elevated risk of limb amputation.
Heart - cardiovascular diseases
Mainly myocardial infarction (heart attack) and heart failure.
Brain - stroke
Sexual dysfunction

The changes that damage blood vessels and the nervous system occur gradually. In the early stages, there may be no outward symptoms like pain, sensory issues, or vision changes. Therefore, it’s recommended that diabetics have regular medical check-ups to minimize the risk of complications or detect them early.

The risk of developing complications from diabetes can be minimized through self-management:

Maintaining a healthy lifestyle: good nutrition, exercise, not smoking, and stress reduction.
Regular self-monitoring of blood glucose levels.
Regular tests: lipid profile, hemoglobin A1C, kidney function, eye exam, foot exam, and blood pressure monitoring.
Regular appointments with a doctor, nurse, dietitian, social worker, and exercise counselor.
Adhering to prescribed medications as directed by the doctor.
Preventative foot care.
Diabetic patients incorporating these habits into their regular routines are healthier and significantly reduce their likelihood of complications.

Diabetic foot care guidelines

Some diabetics are at risk of developing a complication known as "diabetic foot". Regular check-ups and recommended regimens can prevent foot complications like infections, injuries, and hospitalizations.

Here are monitoring and treatment recommendations:

Annual foot exam by a nurse at the clinic.
Check your feet daily, including between the toes. If unable to check feet independently (e.g., due to vision issues or disability), use caregivers, family, or a mirror.
Thoroughly wash and dry feet, especially between the toes.
Water temperature should be below 37°C.
Footwear should fit well, with accommodations for patients with arch damage, vascular issues, or foot deformities.
Inspect or feel inside your shoes daily.
Avoid walking barefoot both at home and outdoors.
Wear cotton or wool socks.
Wear seamless socks, or put on socks with the seam facing outward.
Always wear socks when wearing shoes.
Change socks daily.
Keep a safe distance from heating elements like ovens or electrical devices to prevent burns.
Avoid using chemical substances, bandaids, or sharp tools to remove warts and dry skin. Consult a medical professional.
Follow recommendations from medical staff to soften skin on the feet (excluding between toes).
Trim nails straight across.
If you have vision problems, avoid cutting your nails yourself.
Seek treatment from a medical professional if you notice skin damage or a local infection on your foot.
Engage in exercises and physical activity to enhance blood circulation in the feet.

Mental health and diabetes

Juggling a heavy workload? Your daughter is getting married?

Any change can induce stress. Some stress is necessary for functioning, but excessive and prolonged stress can lead to headaches, stomach aches, increased heart rate, sleep and appetite disturbances, and even conditions like hypertension, heart disease, and diabetes.

Stress, anxiety and diabetes

Physiologically, stress heightens readiness by increasing blood flow to muscles and enhancing oxygen intake in the lungs. In diabetic patients, the liver releases a higher amount of stored sugar to provide extra fuel to the muscles. High blood sugar is harder for cells to absorb.
From a behavioral perspective, stress can interfere with consistent adherence to necessary regimens for managing diabetes (including medication, proper nutrition, and regular physical activity), and it may even lead to health-endangering behaviors.

Physical warning signs

Headaches
Digestive issues
Muscle spasms
Sweat
Sleep disorders
Changes in blood sugar levels
Back pain

Psychological warning signs

Difficulty concentrating and focusing
Irritability and nervousness
Fatigue

Managing stressful situations

Developing awareness of the link between stressful situations and diabetes is important
Learn to listen to your body and recognize warning signs of stress
Identify ongoing sources of stress, proactively prepare for them, and seek to address or change them
Try to develop a positive outlook - stressful situations can be seen as opportunities for growth and change
Maintain a healthy lifestyle - including rest, proper nutrition, physical activity and avoiding alcohol and smoking
Incorporate self-calming relaxation techniques (such as guided imagery) into your routine
Don't hesitate to seek support from a professional or a family member when needed
You should not keep the disease a secret. Sharing is helpful and liberating
Learn to manage your time effectively and allocate a portion to activities you enjoy.

Remember, effectively managing stress and tension significantly impacts both your mental and physical health, and helps with aspects of diabetes management.
Consult with the social worker at your medical center or diabetes institute, or with mental health therapists at Maccabi for support

Depression and diabetes

What is depression?

Depression is a mood disturbance lasting at least two weeks.

Depression symptoms and warning signs to consider:

Concentration and memory problems
Sleep disturbances or sleep disorders
Fatigue and loss of energy
Decreased appetite
Reduced libido
Low self-esteem

Connection between diabetes and depression

Diabetes impacts not only the patient's physical health but also their mental well-being and that of their close family members.
Diabetics are at a heightened risk of experiencing depression and developing medical complications.
There's a reciprocal relationship between depression and diabetes, underscoring the importance of treating both conditions.
Early detection of depression and personalized treatment are crucial for managing diabetes and preventing complications.

Depression treatment options

Antidepressant medication - reduces symptoms and improves functioning.
Short-term cognitive behavioral therapy - shifts perceptions of reality and fosters positive behavior.
Combining both approaches is the most effective strategy for treating depression and preventing recurrence.

Coping with diabetes when routines change

Holidays, trips, family events, and other changes pose unique challenges for maintaining proper nutrition and a healthy lifestyle. How do you manage diabetes in non-routine circumstances?
Some choose to stay home while others embrace the "you only live once" mentality and break every rule. As with most situations, a balanced approach can be found here too.

Key guidelines for non-routine situations

Plan ahead - anticipate upcoming events like special meals or trips. Take some time to consider the menu options and ensure there are suitable choices for you. If unsure about available food options, bring something you will be able to eat.
Avoid getting hungry - it makes proper food choices more challenging. Make sure to eat on time and not skip meals, even if you anticipate a large meal later in the day. If you are traveling abroad or uncertain about your next meal, pack a snack like whole grain crackers, nuts, or dried fruits.
Use a glucometer to track your sugar levels in non-routine situations. Do not stop taking your normal medications. Avoid hypoglycemia by carrying a sugar source with you at all times.
Stay physically active, even during vacations and holidays.
Use the break from your routine to explore new activities.
Use the time away from your regular schedule to relax and recharge. Periodic destressing can significantly ease the burden of everyday pressures.
Enjoy yourself! Don’t refrain from foods and activities you love.