Diabetes management requires awareness. Know what makes your blood sugar level rise and fall — and how to control these day-to-day factors.Keeping your blood sugar levels within the range recommended by your doctor can be challenging. That's because many things make your blood sugar levels change, sometimes unexpectedly. Following are some factors that can affect your blood sugar levels.FoodHealthy eating is a cornerstone of healthy living — with or without diabetes. But if you have diabetes, you need to know how foods affect your blood sugar levels. It's not only the type of food you eat, but also how much you eat and the combinations of food types you eat.What to do:Learn about carbohydrate counting and portion sizesMake every meal well balancedCoordinate your meals and medicationsAvoid sugar-sweetened beveragesExercisePhysical activity is another important part of your diabetes management plan. When you exercise, your muscles use sugar (glucose) for energy. Regular physical activity also helps your body use insulin more efficiently.These factors work together to lower your blood sugar level. The more strenuous your workout, the longer the effect lasts. But even light activities — such as housework, gardening or being on your feet for extended periods can improve your blood sugar.

Diabetic nephropathy is a serious complication of type 1 diabetes and type 2 diabetes. It's also called diabetic kidney disease. In the United States, about 1 in 3 people living with diabetes have diabetic nephropathy.Diabetic nephropathy affects the kidneys' ability to do their usual work of removing waste products and extra fluid from your body. The best way to prevent or delay diabetic nephropathy is by maintaining a healthy lifestyle and adequately managing your diabetes and high blood pressure.Over many years, the condition slowly damages your kidneys' delicate filtering system. Early treatment may prevent or slow the disease's progress and reduce the chance of complications.Kidney disease may progress to kidney failure, also called end-stage kidney disease. Kidney failure is a life-threatening condition. At this stage, treatment options are dialysis or a kidney transplant.SymptomsIn the early stages of diabetic nephropathy, you would most likely not notice any signs or symptoms. In later stages, signs and symptoms may include:Worsening blood pressure controlProtein in the urineProtein in the urineIncreased need to urinateReduced need for insulin or diabetes medicineConfusion or difficulty concentratingShortness of breathLoss of appetiteNausea and vomitingPersistent itchingFatigue

Foot problems in patients with diabetes remain a major public health issue and are the commonest reason for hospitalization of patients with diabetes with prevalence as high as 25%. Ulcers are breaks in the dermal barrier with subsequent erosion of underlying subcutaneous tissue that may extend to muscle and bone, and superimposed infection is a frequent and costly complication. The pathophysiology of diabetic foot disease is multifactorial and includes neuropathy, infection, ischemia, and abnormal foot structure and biomechanics. Early recognition of the etiology of these foot lesions is essential for good functional outcome. Managing the diabetic foot is a complex clinical problem requiring a multidisciplinary collaboration of health care workers to achieve limb salvage. Adequate off-loading, frequent debridement, moist wound care, treatment of infection, and revascularization of ischemic limbs are the mainstays of therapy. Even when properly managed, some of the foot ulcers do not heal and are arrested in a state of chronic inflammation. These wounds can frequently benefit from various adjuvants, such as aggressive debridement, growth factors, bioactive skin equivalents, and negative pressure wound therapy. While these, increasingly expensive, therapies have shown promising results in clinical trials, the results have yet to be translated into widespread clinical practice leaving a huge scope for further research in this field.