Thanks for caring about your friend. The single best tip I can offer is: ask your friend how you can help! Everybody is different, and your friend is the expert on his/her diabetes and the kind of support that is needed. Just by letting your friend know that you care, and that you care enough to ask, is an enormous gift.

The illness is a stressful life event. The individual must accept the diagnosis and treatment along with many changes. There are several factors that can reduce stress and contribute to coping with the illness. One of these factors is social support.
Being surrounded by friends and family provides satisfaction to a person. It is vital for someone with an illness to have love and support from their loved ones. A friend could give emotional support, be present, listen actively, allow the person to express themselves emotionally, and be available for advice and encouragement through healthy activities to help.

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Most studies in psychosomatic research aim to prove the relationship between psychological factors and medical conditions, agreeing that stress may affect the outcome of this chronic illness. Stress affects glucose levels through physiological changes caused by stress, that is, changes in the neuroendocrine system, especially the activation of the hypothalamus-pituitary-adrenal axis, which affects glucose metabolism.

Moreover, stress may affect compliance: less self-monitoring of glucose than necessary, quitting the diet, skipping medication, or quitting exercise, which could impact blood glucose level control.

You bet it can! In particular, we know that physical stresses (like surgery) or major catastrophes (like a major earthquake or hurricane) can drive up glucose levels. This is because the body’s stress response leads to the release of hormones, like epinephrine and cortisol, which directly raise glucose levels.

And what about emotional stress? In many cases emotional stress may lead people to overeat or forget to take one’s diabetes medications, both of which can lead to glucose rises. And emotional stress can directly affect the same hormones, epinephrine and cortisol, thus driving up glucose. But emotional stress is tricky—for some people, it may have little impact on glucose levels, or only certain types of stress may cause a problem, or glucose levels may only be sensitive to stress at certain times of day. The best bet is to use your glucose monitoring system and consult with your HCP to find out how stress affects YOUR glucose levels.

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By taking action to manage your diabetes more effectively, even if you have not been doing so for many years, you canmake it more likely that you can live a long and healthy life. It is never too late to positively affect your diabetes and your quality of life, even if you are (gasp)… over 50!

In some respects, taking your wellbeing seriously applies even more so to those older than 50 years old. This is because the risk of developing many chronic conditions such as insulin resistance, diabetes, heart disease, osteoporosis, and arthritis increase with age. For women, decreased estrogen levels after menopause can increase the risk of bone disorders such as Osteopenia or Osteoporosis, making it even more important to maintain healthy nutrition and exercise patterns. Lastly, maintaining frequent physical and cognitive function activities can help preserve mobility, muscle mass, bone density, and help one stay independent for as long as possible.

Yes, you can—wellness can begin at any age by focusing on mental, physical, and social well-being. Depending on your age, you might consider practices such as meditation, breathing exercises or walking. It’s beneficial to follow a regular diet and exercise routine. Regardless of age, proper guidance tailored to your specific needs can be valuable.

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Everyone values the feeling of well-being and satisfaction with our lifestyle. Individual adaptation to the disease helps them better control their diabetes, which leads to fewer symptoms and, therefore, a better quality of life. Treatment has three issues: medication compliance, dietary adjustment, and physical activity, which control symptoms and increase the sense of well-being. Thus, healthy behaviors contribute to the decrease of symptoms, anxiety, distress, and depression and the increase in the quality of life.

Blood sugar levels may be influenced not only by food intake but also by factors such as mental health, stress levels, mood, physical activity, and daily routines, including sleep, meal timing, and wake-up patterns. Unhealthy habits and social relationships also play a role in managing diabetes. Therefore, a well-rounded, healthy lifestyle can significantly support diabetes management and overall well-being.

Living well generally has so many benefits, including helping diabetes. For example, managing stress and optimizing sleep quality/duration can have very direct and immediate benefits on blood sugar. High stress and inadequate sleep raise our stress hormone cortisol, which in turn leads to higher and difficult to manage glucose levels. Furthermore, sticking to a focused nutrition strategy or gameplan can make it much simpler and easier to keep blood sugars in control. Similarly, physical activity can make our bodies more sensitive to insulin, increasing the effectiveness of insulin our bodies make or that we administer through injections/insulin pumps. And of course, physical activity can be a great way to de-stress.

A healthy lifestyle is very important for everyone, especially for people with diabetes. Diabetes is associated with a large number of complications and can cause other diseases. By changing your lifestyle, you can help protect yourself from the effects of diabetes. A healthy lifestyle can include physical activity and a diet adapted to your health condition and the appropriate amount and quality of sleep. Gradual introduction of changes will make it less of a burdensome and difficult process. You should be doing this under the supervision of a dietitian or doctor, who can help you adjust the changes to your health condition, type of work, activity and the time and financial possibilities.

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It’s important to give yourself grace and to remember that your glucose levels are not a reflection of who you are as a person. Oftentimes, diabetes can be a very unpredictable disease, and many factors that impact our glucose levels are beyond our control, such as 1) variable absorption of injected insulin, 2) stress, 3) sleep, etc. When focusing on restoring stability to glucose levels, I’d recommend trying hard to resist the temptation to overtreat, whether that be with taking too much medicine/insulin (either too much at a time, or too frequently) or with eating too many carbohydrates to elevate blood sugar. Of course I understand this is much easier said than done!

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India faces an alarming rise in diabetes, a trend I've observed over the past 40 years, including 20 years of specialized practice. Some of the primary causes are overeating and insufficient exercise, compounded by several factors:

Rapid urbanization has reduced physical activity and increased reliance on processed, sugary, and fatty foods. Indians now enjoy a variety of cuisines, often indulging excessively. Traditional diets are shifting toward refined carbs, sugary drinks, and fast food. Many Indians have a sweet tooth, often beginning and ending meals with desserts. Frequent celebrations revolve around calorie-rich foods, with sweets offered as prasad during spiritual events. Sedentary habits, even among children, and minimal physical activity contribute to obesity and diabetes. Many remain undiagnosed until complications arise due to limited screening and education. Diabetes management varies widely among practitioners, with no standardized approach. Genetics and an aging population further exacerbate the issue. Addressing these requires lifestyle education, structured healthcare policies, and regular screening.

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It sure gets old, doesn’t it? Probably the single most common concern voiced by people with type 1 diabetes is the “24/7 problem” (i.e., “I never get a break!”), and this can seem like an impossible problem to solve. For some people, the solution is to re-set your glucose expectations (ideally in collaboration with a trusted healthcare professional). What is your personal A1C goal, or—assuming you are wearing a CGM-- your time-in-range (TIR) goal? For example, the international consensus is that if your TIR percentage is 70%, then you are succeeding. No need to drive yourself crazy by trying to make it to 80%, 90% or 100%! Give yourself a break. If you are experiencing lots of lows, or are very fearful about lows, you may benefit by an adjustment to your insulin settings, so that your glucose levels can ride a bit higher, and you won’t have to be so constantly fearful that a severe low could occur at any time. Of course, there are many other strategies, such as how best to use your CGM alarms, but all of these depend on your personal situation. Consider meeting with a good CDCES who can help you to find safe and effective methods that can give you the break that you need and deserve.

One effective way to help reduce the mental load is to integrate your treatment into your daily routine, much like brushing your teeth. By creating a daily plan, using technology as an electronic monitoring tool, and setting reminder alarms, you can make this process more manageable. Ask a family member for assistance with the monitoring. Also, it can be useful to engage in recreational activities, which distracts one from thinking about monitoring. Practice mindfulness.

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An increase in glucose levels at night can be caused by several factors - too early dinner, a poorly balanced dinner, intense physical activity in the evening and no meal after it, but also the dawn effect or, less frequently, the Samogoya effect.

The dawn effect is a physiological mechanism of glucose level increase between 3 and 5 a.m.

In people with diabetes, glucose level does not equalize due to disrupted metabolic mechanisms. The Samogoya effect is morning hyperglycemia caused by too high a dose of insulin in the evening.

To avoid morning hyperglycemia, you should:

• maintain proper glucose levels during the day

• do not engage in physical activity late in the evening

• eat dinner with an adequate supply of protein, fats and vegetables and less carbohydrates

• avoid fruits or sweets in the evening

• always remember to eat a breakfast as balanced as dinner

• be physically active during the day.

It is best to analyze your lifestyle with a dietician or doctor to identify the cause.

My patients frequently ask me why their blood sugars rise overnight, even though that is a period of time where they are not eating anything (because they are sleeping). This scenario where glucose levels tend to rise in the early morning (typically between 2am and 8am) is often referred to as the “Dawn Phenomenon.” One major contributing factor to this is that our liver actually generates glucose in the fasting state through a process called gluconeogenesis. This process ensures that our vital organs have the fuel they need, regardless of whether you’ve eaten recently. Another main contributing factor is that as part of our biological clock, our bodies make higher levels of hormones such as cortisol, epinephrine, and glucagon in the pre-dawn hours, which contribute to increased glucose release into the bloodstream.

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If your sugar level is high, it can affect your saliva and increase bacterial growth in the buccal mucosa, which sometimes causes a bad taste in the mouth.

Feeling unwell might be due to high sugar levels. You may be able to improved your taste buds by gargling warm salt water before and after meals. Chewing on cardamom can also provide freshness and enhance taste.

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Of course I’d start by recommending discussing with your health care professional. But generally speaking, the saying” the sooner the better” applies for those attempting to reverse their prediabetes, while the adage “Better late than never” also applies. A landmark study called the Diabetes Prevention Program (DPP) Study showed that intensive lifestyle changes, including weight loss through diet and exercise, was even more effective than metformin, a common first-line diabetes medication. Therefore, I’d strongly recommend dietary modifications focused on increasing whole, high fiber, low glycemic foods. Also, it is recommended to try to target at least 150 minutes/week of aerobic activity. Lastly, reducing stress and increasing sleep quality/quantity can contribute to better blood sugar control.

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When you are in a low glucose range, your brain may no longer be receiving all of the glucose fuel it needs, and so you may experience “neuroglycopenic” symptoms, which we more commonly refer to as “brain sputtering”. You can’t think clearly, and even the simplest of tasks may take longer to complete. You may even need help to recognize what is going on and to get the urgent treatment you need to raise your glucose levels. This can be a very big problem, as you’ve experienced. One of the solutions is to train yourself to start treating glucose levels (with, say, glucose tabs or some other fast-acting glucose) at a higher point, even if you feel fine. You want to catch and treat those low glucose levels while you can still think fairly clearly!

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