Everyone with diabetes aged 6 months and older should get a seasonal flu shot. Close household contacts and out-of-home caregivers of people with diabetes also should be vaccinated against the flu each year.
People with type 1 diabetes who engage in regular exercise require less insulin.2 However, in the short term, exercise can induce low blood sugar or even occasionally increase blood sugar.3 Therefore, people with type 1 diabetes should never begin an intensive exercise program without consulting a healthcare professional.
The American Diabetes Association (ADA) recommends that people with diabetes limit their daily alcohol consumption to one drink for women and two drinks for men.4 The Centers for Disease Control defines one drink as equivalent to a 12 ounce can of beer, 8 ounces of malt liquor, 5 ounces of wine, and 1.5 ounces of hard liquor. Similar to research on healthy people, preliminary studies in adults with diabetes find reduced risk of heart disease with light to moderate drinking.5 Beyond moderate drinking, alcohol will be more harmful than beneficial. Drinking alcohol with type 1 diabetes can result in hypoglycemia or hyperglycemia, depending on the circumstances, but moderate amounts of alcohol ingested with food are less likely to affect blood glucose levels.6 People with diabetes who drink two or more drinks per day were reported to have a high risk for eye damage in one preliminary study,7 but another, larger study found no association between alcohol use and eye damage.8 However, alcohol consumption does have numerous downsides, including risk of addiction and increased risk of several types of cancer. For this reason, it is not advised that people who do not drink begin doing so simply for its possible heart-protective benefits. Ask your doctor what is best for you, taking into account your personal medical history.
People with diabetes who smoke are at higher risk for kidney damage,9heart disease,10 and other diabetes-related health problems. Smokers also are more likely to develop diabetes,11 so it's important for people with diabetes who smoke to quit.
Most healthcare providers agree on the necessity of self-monitoring of blood glucose (SMBG) by people with type 1 diabetes. Advocates of SMBG, such as the American Diabetes Association (ADA), have observed that SMBG by people with diabetes has revolutionized management of the disease, enabling them to achieve and maintain specific blood glucose and laboratory value goals.12 These observations are well-supported in the medical literature.13 Children should be taught proper techniques for SMBG as well. A study of children and adolescents with type 1 diabetes showed that, after adjusting for several factors, increased SMBG frequency was associated with lower A1C—the more intensive the SMBG, the better the child’s A1C, suggesting SMBG significantly improves glucose control. In the range of 0–5 tests per day, A1C decreased by 0.46% per additional test per day.14
Detractors point out that indiscriminate use of self-monitoring is of questionable value and adds enormously to healthcare costs.15 The ADA acknowledges that accuracy of SMBG is instrument- and technique-dependent. Errors in technique and inadequate use of control procedures have been shown to lead to inaccurate test results.16 Nevertheless, it is likely that self-monitoring of blood glucose, if used properly, can have a positive effect by increasing patient involvement in overall diabetes care.17 Pharmacists and healthcare practitioners can teach people with diabetes important skills that will enhance their ability to properly self-manage blood glucose. Regular follow-up visits with a diabetes healthcare practitioner, including downloading and reviewing SMBG results, is important.18