A diabetes diagnosis comes with a list. Eat this. Don't eat that. Watch this number. Take this tablet. Walk more. Sleep better.
Six hours of education, and you go home overwhelmed.
Here's the truth nobody tells you on the way out: not everything on that list matters equally. A handful of things make most of the difference. The rest is supporting cast.
1. Know your HbA1c — and your personal target
HbA1c is the most important number you have. It tracks your average blood sugar over three months and predicts most of the long-term complications.
If you don't know your latest HbA1c, ask. It's your single most useful piece of information.
The general targets:
- 48 mmol/mol if you're managing with diet and lifestyle, or one non-hypo medication
- 53 mmol/mol if you're on insulin or sulphonylureas (where hypos are a risk)
These are population averages. If you're older, frail, or have heart disease, the right target may be more relaxed — tight control isn't always safer. Talk to your team about your number.
2. The 10-minute walk after meals
This is the most underused intervention in diabetes, and the evidence is unusually clean.
Walk for 10-15 minutes within half an hour of eating, and the post-meal blood sugar spike is blunted by about 12% — more than the same exercise done at another time of day.
The mechanism is simple. Walking muscles pull glucose out of the blood directly, without waiting for insulin. You're literally burning the meal off, gently, while it's still being absorbed.
You don't need a fast pace. Comfortable is fine. Three times a day, after meals, compounds over months into a meaningful HbA1c drop. Ten minutes after lunch is more useful per minute than thirty minutes at the gym at 7pm.
3. Look at your feet daily
Roughly half of people with type 2 diabetes will develop nerve damage in their feet at some point. Reduced sensation means small cuts, blisters, and pressure spots go unnoticed — and can become serious quickly.
The fix is simple: look at your feet every day. Soles, between toes, heels. Thirty seconds. Anything new — wound, blister, colour change, warm spot — gets reported to your doctor or diabetes nurse promptly.
If it's been more than 12 months since your last foot check, ask for one. Most diabetes complications affecting feet are preventable when caught early.
4. Have sick-day rules ready
When you catch a stomach bug or flu, your blood sugar misbehaves. Stress hormones push it up. Nausea pushes intake down. The combination can become a real medical emergency — especially with certain medications.
The basics for type 2 diabetes during illness:
- Never stop insulin without medical advice, even if you're not eating.
- Pause SGLT2 inhibitors (dapagliflozin, empagliflozin, canagliflozin) — they raise the risk of a dangerous condition called euglycaemic DKA when you're sick.
- Pause metformin if vomiting or diarrhoea makes it hard to stay hydrated.
- Monitor glucose more often than usual.
- Sip fluids regularly, even if you can't eat.
- Call your doctor if you can't keep fluids down, sugar stays very high, or you feel worse than the illness itself explains.
Ask your doctor or diabetes nurse for a written set of sick-day rules at your next visit. Having them before you're ill is when they're most useful.
5. The bit nobody talks about
Depression and anxiety are roughly twice as common in people with diabetes as in the general population. There's a name for the specific emotional weight of this condition — diabetes distress. Worry about complications. Frustration with numbers that won't behave. The mental load of constant decisions.
It's common. It's measurable. It responds to support. But only if anyone asks about it — and most reviews don't.
If your annual diabetes review hasn't included a question about how you're coping, raise it yourself. The mental side of this condition is part of the evidence base, not a soft add-on.
Curiosity first. — Dr. Brugal