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Diabetes (Type 1, Type 2 & Prediabetes)

About 40 million Americans have diabetes — and more than 1 in 4 adults with it don’t know. Another 115 million adults have prediabetes. Type 2, the most common kind, can often be prevented or delayed, and every type can be managed with the right care, habits and support.

Low blood sugar (below 70 mg/dL) can cause shaking, sweating, a fast heartbeat, dizziness, hunger, irritability or confusion (CDC). Treat it right away with the 15-15 rule: have 15 grams of carbs, wait 15 minutes, and check your blood sugar again. If it is still below 70 mg/dL, repeat. Once it is back in your target range, eat a balanced snack or meal (CDC, American Diabetes Association). Good choices are 4 ounces (½ cup) of juice or regular (not diet) soda, 1 tablespoon of sugar, honey or syrup, or glucose tablets or gel used as the label directs (CDC). Young children may need less than 15 grams — ask your child’s care team (ADA).

If someone is unconscious or can’t swallow safely: don’t give them any food or drink (NHS). Give glucagon if it has been prescribed and you know how to use it (ADA), and call 911 right away — or call 911 immediately if no glucagon is available (ADA, NIDDK). Get emergency care after any glucagon dose (CDC).

Very high blood sugar — go to the emergency room or call 911 for fruity-smelling breath, vomiting so you can’t keep food or drinks down, trouble breathing, blood sugar that stays at 300 mg/dL or above, or several signs of diabetic ketoacidosis (DKA) at once (CDC). DKA can also cause fast, deep breathing, a dry mouth, a flushed face, stomach pain and decreased alertness (MedlinePlus). Extremely high blood sugar with confusion, weakness, great thirst or decreased alertness can be hyperglycemic hyperosmolar syndrome (HHS), mostly seen in type 2 diabetes — it is also an emergency (MedlinePlus).

Foot problems — call your provider right away for a cut, blister or bruise that doesn’t start to heal after a few days, skin that becomes red, warm or painful (a possible infection), or a wound that turns black and smelly (NIDDK, CDC). See our cellulitis guide for signs of a spreading skin infection.

Heart attack — call 911: chest pain or discomfort; feeling weak, light-headed or faint; pain in the jaw, neck, back, arms or shoulders; or shortness of breath. Women are more likely to also have unusual tiredness and nausea or vomiting (CDC). Stroke — think B.E. F.A.S.T. and call 911: Balance loss, Eye (vision) changes, Face drooping, Arm drifting down, Speech slurred, Time to call 911. Note when symptoms started and call an ambulance rather than driving (CDC).

Never stop or change a diabetes medicine on your own, and never wait for a chiropractic, acupuncture or wellness appointment for any of these signs.

What is diabetes?

Your body breaks most food down into sugar (glucose), which goes into your bloodstream. Insulin, a hormone made by the pancreas, acts like a key that lets that sugar into your cells for energy. With diabetes, your body doesn’t make enough insulin or can’t use it as well as it should, so too much sugar stays in the blood. Over time that can cause heart disease, vision loss and kidney disease. There isn’t a cure yet, but losing weight if needed, eating well, being active, taking medicine as prescribed and getting diabetes education all really help (CDC).

The main types

  • Type 2 diabetes (about 90% to 95% of cases): cells don’t respond normally to insulin (insulin resistance). The pancreas makes more insulin to keep up, until it can’t, and blood sugar rises (CDC). It develops over many years, usually in adults, but more and more in children, teens and young adults, and it often has no symptoms at first (CDC). It can be prevented or delayed with lifestyle changes (CDC).
  • Prediabetes: blood sugar is higher than normal but not yet high enough for a type 2 diagnosis. It raises the risk of type 2 diabetes, heart disease and stroke (CDC) — and it can be reversed (see the prediabetes section below).
  • Type 1 diabetes (about 5% to 10%): thought to be an autoimmune reaction that destroys the insulin-making cells of the pancreas. People with type 1 need insulin every day to survive (CDC). It usually starts in children, teens or young adults but can begin at any age. Diet and lifestyle habits don’t cause it, and no one yet knows how to prevent it (CDC).
  • Gestational diabetes develops during pregnancy in women who didn’t already have diabetes, affecting 5% to 9% of U.S. pregnancies each year. It often has no symptoms (CDC). It usually goes away after the birth, but it raises the mother’s risk of type 2 diabetes later, and the child is more likely to have obesity and type 2 diabetes later in life (CDC).

How common is it?

CDC’s National Diabetes Statistics Report estimates that in 2023, 40.1 million people in the U.S. (12.0%) had diabetes, diagnosed or not. About 27.6% of adults with diabetes — 11.0 million people — didn’t know they had it. Another 115.2 million adults had prediabetes, including 31.3 million people aged 65 or older, and 2.1 million people had diagnosed type 1 diabetes (CDC National Diabetes Statistics Report). About 8 in 10 people with prediabetes don’t know it. Diabetes is the seventh leading cause of death in the U.S. and the No. 1 cause of kidney failure, lower-limb amputations and adult blindness (CDC).

Symptoms

Type 1 and type 2 diabetes can both start with few or no symptoms (CDC). When symptoms do appear, they can include:

  • Peeing often, feeling very thirsty or hungry, and losing weight without trying.
  • Tiredness, irritability or moodiness, and blurry vision.
  • Frequent urinary tract or yeast infections (CDC).
  • More common in type 2: cuts or sores that heal very slowly, dark patches of skin around the neck, armpits or groin, and numbness or tingling in the hands or feet (CDC).
  • Type 1: symptoms can appear suddenly, over a few weeks or months, and can be severe — including nausea, vomiting, stomach pain and DKA. In children, new bed-wetting or more accidents can be a sign (CDC).

Who is at risk?

  • Prediabetes and type 2: having overweight or obesity; being 45 or older; a parent, brother or sister with type 2 diabetes; being physically active less than 3 times a week; non-alcoholic fatty liver disease; ever having gestational diabetes or a baby who weighed over 9 pounds; and being African American, Hispanic or Latino, American Indian or Alaska Native (some Pacific Islander and Asian American people are also at higher risk) (CDC). Polycystic ovary syndrome also raises the risk of prediabetes (CDC). Smoking raises the risk of type 2 diabetes by 30% to 40% (CDC).
  • Type 1: a parent, brother or sister with type 1, and younger age (CDC).
  • Gestational: gestational diabetes in an earlier pregnancy, a baby over 9 pounds, overweight, being over 25, a family history of type 2 diabetes, PCOS, and some racial and ethnic groups (CDC).

Who should be tested?

  • U.S. Preventive Services Task Force (2021): screen adults aged 35 to 70 who have overweight or obesity for prediabetes and type 2 diabetes (grade B), and offer or refer people with prediabetes to effective prevention programs. Consider screening earlier in groups with higher rates of diabetes, and at a lower BMI (23 or more) in Asian American adults. Screening every 3 years may be reasonable after a normal result (USPSTF).
  • American Diabetes Association: recommends screening all adults 45 or older regardless of risk factors, and adults of any age with overweight or obesity plus one or more risk factors (as summarized by USPSTF).
  • Children and teens aged 10 to 18 with overweight or obesity and at least one more risk factor should be tested; people with normal results should be retested every 3 years, and people with prediabetes every year (NIDDK).
  • Pregnancy: pregnant women without known diabetes should be tested for gestational diabetes between 24 and 28 weeks, and those who had it should be tested again for type 2 diabetes, usually within 12 weeks after delivery (NIDDK).
  • Type 1: relatives of people with type 1 are 15 times more likely to develop it and should be offered a blood test for diabetes-related autoantibodies, from age 2. Two or more confirmed autoantibodies mean early-stage type 1, often years before insulin is needed (CDC).

A reading from a health fair, pharmacy or home meter can’t diagnose diabetes — follow up with your doctor (CDC, NIDDK).

What the test numbers mean

These cut-offs are for people who are not pregnant (CDC, NIDDK):

  • A1C (your average blood sugar over about 3 months; no fasting needed): normal below 5.7%; prediabetes 5.7% to 6.4%; diabetes 6.5% or above.
  • Fasting blood sugar (after at least 8 hours without food): normal 99 mg/dL or below; prediabetes 100 to 125 mg/dL; diabetes 126 mg/dL or above.
  • Glucose tolerance test (2 hours after a sugary drink): normal below 140 mg/dL; prediabetes 140 to 199 mg/dL; diabetes 200 mg/dL or above.
  • Random blood sugar (any time, used when there are symptoms): diabetes 200 mg/dL or above.

Usually a second test is used to confirm diabetes (NIDDK). Severe anemia, kidney failure, liver disease, some blood disorders such as sickle cell anemia, blood loss or transfusions, pregnancy and some medicines can make an A1C falsely high or low — tell your doctor if any apply (CDC).

Why it matters: complications

  • Heart and blood vessels: people with diabetes have twice the risk of heart disease and a greater risk of heart failure. Hardened, narrowed arteries can also cause a stroke or peripheral artery disease (PAD) in the legs (CDC). See our blood pressure, cholesterol and circulation guides.
  • Kidneys: about 1 in 3 adults with diabetes has chronic kidney disease, which often has no symptoms until it is advanced (CDC). (A separate Kidney guide is coming.)
  • Eyes: diabetic retinopathy is the leading cause of blindness in working-age adults; diabetes also raises the risk of cataracts and glaucoma (CDC).
  • Nerves and feet: about half of all people with diabetes have some nerve damage (neuropathy), most often in the feet and legs. Loss of feeling plus poor blood flow can lead to foot ulcers that become infected and, if they don’t heal, amputation (CDC). Nerve damage can also affect digestion, the bladder and sexual function (CDC). (A separate Neuropathy guide is coming.)

The good news: keeping blood sugar, blood pressure and cholesterol near your targets, not smoking, and regular eye, foot and kidney checks prevent or delay many of these problems (CDC, CDC, CDC).

Low blood sugar: who is at risk

Low blood sugar is especially common in type 1 diabetes, and people with diabetes can have lows as often as once or twice a week even with careful management (CDC). It can be a side effect of insulin and of some other medicines that make the pancreas release insulin, and can also follow too few carbs, more activity than usual, alcohol without enough food, or an illness that keeps you from eating (MedlinePlus, CDC). Some people stop noticing the warning signs (hypoglycemia unawareness) — more likely after 5 to 10 years of diabetes, with frequent lows, or with medicines such as beta blockers. Check more often, especially before driving (CDC). Glucagon should be prescribed for everyone who takes insulin or is at high risk of lows, and family and caregivers should know where it is and how to use it (ADA Standards of Care, 2026).

When to see a doctor: if you have symptoms of diabetes or any risk factors — don’t guess, get a blood test (CDC, CDC); if you have frequent lows, so your care team can look for patterns (CDC); or for burning, tingling, weakness or pain in your hands or feet that affects daily life or sleep, changes in digestion, urination or sexual function, or dizziness or fainting (CDC). Call your eye doctor for sudden changes in vision, such as blurring, spots, flashes or blind spots (CDC).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Lifestyle and diabetes education for everyone; insulin for type 1; for type 2, medicines such as metformin, GLP-1 and dual GIP/GLP-1 medicines, SGLT2 inhibitors (with heart and kidney benefits), DPP-4 inhibitors, sulfonylureas or insulin, chosen with you. Glucose monitoring (often a CGM) and yearly eye, foot and kidney checks. Medicare: diabetes screening $0; insulin no more than $35 a month; Part D out-of-pocket cap $2,100 in 2026 ($2,400 in 2027); medical nutrition therapy $0; self-management training 20% after the deductible. Other prescription costs: being researched. For many adults the A1C goal is below 7%, set individually. Many people need more than one medicine over time. Take them every day, even when you feel fine; never stop without your care team.
Chiropractic No role in treating diabetes or blood sugar. May help back or neck pain alongside medical care. Not recommended for diabetes, so no cost estimate is given. Reviews found no clear benefit of spinal manipulation for conditions outside the muscles and joints. Not a substitute for diabetes care.
Acupuncture Studied mainly for the burning, tingling pain of diabetic nerve damage (neuropathy) — not for lowering blood sugar. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. Medicare covers acupuncture only for chronic low back pain. Low-certainty evidence that it may ease neuropathy pain; many trials are poor quality. Tell your acupuncturist you have diabetes, and keep every foot check.
Herbal medicine Cinnamon, berberine, chromium and bitter melon have been studied. None has strong evidence, and products sold as a “natural diabetes cure” are illegal — some hide prescription drugs. Cost estimate being researched. At best weak, inconsistent effects on blood sugar. Some cause side effects or interactions, and tainted products can cause dangerous lows. Never replace a prescribed medicine.
Massage therapy Being researched — coming soon.
MBHA Wellness Coach The plate method and carb awareness, 150 minutes a week of activity, weight loss, the National Diabetes Prevention Program for prediabetes, quitting smoking, sleep, stress, glucose logs, daily foot checks and sick-day planning. Medicare Diabetes Prevention Program: $0 if you qualify. Other National DPP programs vary and may be free. MBHA coaching: being researched. Supports — never replaces — medical care. Losing 5% to 7% of body weight and being active can cut the risk of type 2 diabetes about in half for people with prediabetes.

Approach 1 of 6

Conventional medicine (AMA)

Diabetes is managed mostly by you, with support from a care team that may include your primary care doctor, a foot doctor, dentist, eye doctor, registered dietitian, diabetes educator and pharmacist (CDC). In the U.S., doctors follow the American Diabetes Association’s yearly Standards of Care in Diabetes; the 2026 edition is summarized below. The choice of medicine should be a shared decision that weighs how well it works, effects on the heart, kidneys and weight, the risk of low blood sugar, side effects, cost and your preferences (ADA Standards of Care, 2026).

1. Healthy habits and diabetes education come first — and stay

2. Type 1 diabetes: insulin, every day

People with type 1 must take insulin, several times a day, including with meals (NIDDK). Insulin can’t be taken as a pill; it is given by syringe, pen, pump or inhaler (CDC, CDC). The ADA recommends an insulin pump or multiple daily injections, teaching people to match mealtime insulin to what they eat, and offering automated insulin delivery systems (which link a pump and a glucose monitor) to adults on insulin (ADA Standards of Care, 2026). For people with stage 2 type 1 (found by screening, before symptoms), the FDA approved teplizumab in 2022 to delay progression to stage 3, when symptoms appear (ADA Standards of Care, 2026, CDC).

3. Type 2 diabetes: the main medicine families

Some people with type 2 can manage blood sugar with lifestyle changes alone; many also need medicine, and over time may need more than one (NIDDK). The ADA now advises starting medicine at diagnosis unless there is a reason not to (ADA Standards of Care, 2026). The families, by name only (your prescriber chooses the medicine and the dose):

  • Metformin (a pill) has historically been the first medicine for type 2. It is effective, safe, inexpensive and doesn’t cause lows by itself; the main side effects are stomach upset and diarrhea, and long-term use can lower vitamin B12, so B12 may be checked (ADA Standards of Care, 2026). Most people with type 2 start with it (NIDDK).
  • GLP-1 receptor agonists (for example semaglutide, dulaglutide and liraglutide; mostly injections) and the dual GIP and GLP-1 receptor agonist tirzepatide lower blood sugar strongly and help with weight loss. Several have proven heart benefits, and semaglutide has shown kidney benefits. Stomach and digestive side effects are possible; tell your surgical team you take one before any procedure with anesthesia (ADA Standards of Care, 2026). They are not substitutes for insulin (NIDDK).
  • SGLT2 inhibitors (for example empagliflozin, dapagliflozin and canagliflozin; pills) help the kidneys remove sugar. For people with heart failure, the ADA recommends one — whatever the A1C — to prevent heart-failure hospital stays; for chronic kidney disease it recommends an SGLT2 inhibitor or a GLP-1 medicine with proven benefit to slow the disease. Side effects include genital yeast infections, and rarely ketoacidosis, so ask about sick-day rules (ADA Standards of Care, 2026).
  • Heart, kidney or liver disease: for adults with or at high risk of heart disease, the plan should include a GLP-1 medicine and/or an SGLT2 inhibitor with proven heart benefit, regardless of A1C (ADA Standards of Care, 2026).
  • DPP-4 inhibitors (for example sitagliptin and linagliptin; pills) lower blood sugar moderately and don’t change weight; they aren’t combined with GLP-1 medicines (ADA Standards of Care, 2026).
  • Sulfonylureas (for example glipizide and glimepiride; pills) are inexpensive and effective but can cause low blood sugar and weight gain (ADA Standards of Care, 2026).
  • Pioglitazone is another lower-cost pill; it can cause fluid retention and isn’t used in heart failure (ADA Standards of Care, 2026).
  • Insulin may be needed in type 2 when blood sugar is very high or there are symptoms of high blood sugar, and at special times such as pregnancy or a hospital stay (ADA Standards of Care, 2026, NIDDK). Insulin, sulfonylureas and meglitinides are the diabetes medicines most likely to cause lows (ADA Standards of Care, 2026).

Ask whether your medicine can cause low blood sugar or other side effects, and take it as prescribed (NIDDK). Don’t ration or skip medicine because of cost — tell your care team instead (NIDDK). The ADA does not recommend compounded versions of these medicines that the FDA hasn’t approved, because their contents and safety are uncertain (ADA Standards of Care, 2026).

4. Weight-loss (metabolic) surgery and remission

For some people with obesity and type 2 diabetes, weight-loss surgery can bring blood sugar back to a healthy range, and some no longer need diabetes medicines afterward; how long this lasts varies (NIDDK). The ADA notes that losing 5% to 7% of body weight improves blood sugar, and that sustained loss of more than 10% usually brings greater benefits, including possible remission of type 2 diabetes (ADA Standards of Care, 2026). Remission is not a cure: keep up your checkups.

5. Individual targets and monitoring

6. Regular checks that prevent complications

7. Gestational diabetes

Go to all prenatal visits, check your blood sugar, eat well and stay active; if that isn’t enough, your doctor may prescribe insulin, metformin or another medicine (CDC). Insulin is safe to take during pregnancy (NIDDK). Don’t try to lose weight while pregnant (CDC). About half of women with gestational diabetes go on to develop type 2 diabetes, so ask how often to have your blood sugar checked afterward (CDC).

Medicare coverage and costs

  • Diabetes screening: covered if you have certain risk factors; $0 if your provider accepts assignment (Medicare.gov).
  • Insulin: no more than $35 for a one-month supply of each covered insulin under Part D or Part B, with no deductible — even with Extra Help (Medicare.gov).
  • Other prescriptions (Part D): once your out-of-pocket spending reaches $2,100 in 2026 ($2,400 in 2027), you pay nothing more for covered drugs that year (Medicare.gov). Medicare negotiated a price of $274 for a 30-day supply of semaglutide (Ozempic, Rybelsus, Wegovy) for 2027, down from a 2024 list price of $959; negotiated 2027 prices for the DPP-4 medicines Tradjenta and Janumet are $78 and $80 (CMS). What you pay still depends on your plan.
  • CGMs: may be covered if you take insulin or have a history of low blood sugar (Medicare.gov); test strips and meters are covered as equipment, at 20% after the Part B deductible (Medicare.gov).
  • Diabetes self-management training (DSMT): up to 10 hours of initial training and up to 2 hours of follow-up a year after that, with a doctor’s order; 20% after the Part B deductible (Medicare.gov).
  • Medical nutrition therapy: 3 hours the first year and 2 hours a year after that with a registered dietitian, on referral; $0 if you qualify (Medicare.gov).
  • Eye exam for diabetic retinopathy: once a year; 20% after the deductible (Medicare.gov). Therapeutic shoes or inserts are covered for severe diabetic foot disease (Medicare.gov).
  • Without Medicare, GLP-1 and other brand-name medicine prices: cost estimate being researched. The ADA lists metformin, sulfonylureas, pioglitazone and human insulin as lower-cost options to discuss (ADA Standards of Care, 2026).

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care has no role in treating diabetes, lowering blood sugar or preventing its complications. We found no trustworthy evidence that spinal adjustment affects diabetes.

What the research says

Only a small amount of high-quality research has looked at spinal manipulation for problems outside the muscles and joints. A comprehensive 2021 review found just 6 good-quality studies of such conditions (for example high blood pressure), and none showed a clear benefit (NCCIH).

If you see a chiropractor for back or neck pain

  • Mild side effects — more pain, stiffness or headache — are common and usually gone within 24 hours; serious problems are very rare, but may be more likely in people with other health problems (NCCIH).
  • MBHA suggests telling your chiropractor you have diabetes, keeping a fast-acting sugar with you if you take insulin or a sulfonylurea, and mentioning any numbness in your feet.
  • Never use chiropractic care in place of your diabetes medicines, monitoring or foot and eye checks. See our back pain guide for what chiropractic care can and can’t do.

What it costs

Not recommended for diabetes, so no cost estimate is given here.

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture isn’t a treatment for diabetes itself, and we found no good evidence that it lowers blood sugar. It has mainly been studied for diabetic peripheral neuropathy — the burning, tingling or numbness in the feet and legs that affects many people with diabetes. The evidence there is limited.

What the research says

  • 2013 review: 25 trials (1,649 people) reported uniformly positive results, but the trials were generally of poor quality, publication bias was likely, and the authors said no clinically relevant conclusions could be drawn (Chen et al., 2013).
  • 2025 meta-analysis: 14 randomized trials (1,169 people) gave low-certainty evidence that acupuncture may reduce neuropathy pain compared with sham (pretend) acupuncture, with little or no difference in physical or mental functioning or in side effects (Lan et al., 2025).
  • 2024 overview of 18 meta-analyses: the reviews reported better overall response and nerve conduction with acupuncture, alone or added to standard medicines, but 14 of the 18 were of low or critically low quality, and the authors called for better-designed trials (Jiang et al., 2024).

In short: acupuncture may ease neuropathy pain for some people, but the evidence is weak. It doesn’t restore lost feeling, so daily foot checks remain essential. Keeping blood sugar in range is one of the most important ways to prevent nerve damage or keep it from getting worse (CDC).

Safety

Few complications have been reported; problems have come from non-sterile needles and poor technique. The FDA requires sterile, single-use needles, and most states license acupuncturists (NCCIH). As a precaution, MBHA suggests telling your acupuncturist that you have diabetes, asking that needles not be placed in broken, infected or numb skin on the feet, and checking your feet after each visit.

Medicare coverage

Medicare covers acupuncture only for chronic low back pain (up to 12 treatments in 90 days, with up to 20 a year if you improve; 20% coinsurance) — not for diabetes or neuropathy (Medicare.gov).

What it costs

Published cash prices run about $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90 a visit (The Pricer).

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

Many supplements are marketed for blood sugar. According to the National Center for Complementary and Integrative Health (NCCIH), a few have weak evidence of a possible benefit, but the studies are small and inconsistent, and for most supplements there is no evidence of benefit for diabetes or its complications (NCCIH).

What the research says

  • Cinnamon: a 2019 review of 16 studies found it lowered fasting blood sugar and insulin resistance in people with prediabetes and type 2 diabetes, but the studies varied widely and more research is needed (NCCIH). Cassia cinnamon, the most common kind in U.S. stores, contains coumarin, which might worsen liver disease in large amounts (NCCIH, NCCIH).
  • Berberine (from plants such as goldenseal and barberry): a 2021 review of 46 studies suggested it may lower blood sugar, but most studies were from one country, results varied and some were of poor quality. It can cause stomach upset, may interact with medicines, and should not be used in pregnancy, while breastfeeding or in infants (NCCIH).
  • Chromium: a 2022 review of 16 studies suggested it may improve A1C and fasting blood sugar, but there have been a few reports of kidney, liver, muscle and skin problems after large doses, and long-term effects aren’t well studied (NCCIH).
  • Bitter melon, fenugreek, ginseng, milk thistle and Chinese herbal mixtures: research is limited in number, size and quality, and hasn’t proven that any of them work (NCCIH).
  • Alpha-lipoic acid didn’t lower blood sugar in a 2019 review; reviews of its use for neuropathy pain are inconsistent (NCCIH).

Safety: interactions, lows and tainted products

  • Herbs such as cinnamon, St. John’s wort or aloe taken with diabetes medicines can cause unwanted side effects — tell your providers about every supplement (NCCIH).
  • Some supplements have been linked to kidney damage, a particular concern because diabetes is the leading cause of kidney disease (NCCIH).
  • “Natural diabetes cures” are marketed illegally (NCCIH). The FDA has warned companies selling supplements, ayurvedic and other products that claim to treat or cure diabetes; these products haven’t been shown to be safe or effective (FDA). Some contained hidden prescription drugs, such as metformin, glyburide and phenformin (a drug removed from the U.S. market in 1978) (FDA).
  • In 2024 the FDA warned that an “herbal” blood sugar supplement contained hidden metformin and glyburide; glyburide can cause unsafe drops in blood sugar that may quickly become severe (FDA). A hidden drug can stack on top of your prescribed medicine.
  • Even when a product isn’t harmful in itself, using it in place of proven treatment is harmful (NCCIH).

Never replace or reduce a prescribed diabetes medicine in favor of an herb or supplement. Show every product to your doctor or pharmacist first, especially if you take insulin or a sulfonylurea, have kidney or liver disease, or are pregnant or breastfeeding. “Natural” doesn’t always mean safe (NCCIH). If you try something new, check your blood sugar more often and watch for lows. We don’t list doses here.

What it costs

Cost estimate being researched.

Approach 6 of 6

MBHA Wellness Coach

Diabetes is managed mostly by you, day by day (CDC). An MBHA Wellness Coach can help you build the habits below one at a time and stick with them — alongside, never instead of, your medical care and diabetes education. Only your care team should change your medicines.

Eat with a plan

A meal plan that fits your tastes, budget and medicines keeps blood sugar steadier. The plate method, carb awareness and portion tips are explained in the Eating, activity and the plate method section below (CDC).

Move most days

Aim for at least 150 minutes of moderate activity a week — for example 30 minutes on most days, starting with a 10-minute walk after dinner (CDC). Check with your doctor about which activities are best for you (CDC).

Weight and prediabetes

If you have prediabetes, losing about 5% to 7% of your body weight (10 to 14 pounds for a 200-pound person) and getting 150 minutes of activity a week can lower your risk of type 2 diabetes (CDC). A coach can help you find a CDC-recognized lifestyle change program — see the Prediabetes and the National Diabetes Prevention Program section below.

Quit smoking

Nicotine raises blood sugar, and people with diabetes who smoke have more complications. Quitting makes blood sugar easier to manage — check more often after you quit, because levels may drop, and ask your doctor before using nicotine replacement (CDC). Free quit help is available at 1-800-QUIT-NOW (CDC).

Sleep and stress

Enough sleep may improve mood, energy and blood sugar; most adults should aim for about 7 to 8 hours (NIDDK). Stress makes diabetes harder to manage; regular activity, enough sleep and relaxation exercises can help (CDC). Feeling stressed, sad or angry is common — ask your care team or a mental health professional for help (NIDDK).

Glucose monitoring habits

Check your feet every day

Look for cuts, redness, swelling, sores, blisters, corns or calluses, using a mirror or a helper (CDC). Details are in the Everyday foot care section below.

Plan for sick days

  • Before you get sick, keep several weeks of medicines and supplies, plus easy foods and drinks such as soup, crackers, applesauce, sports drinks and juice or regular soda (CDC). Ask your care team ahead of time whether to adjust your meals, activity or medicines when you are sick (NIDDK); MBHA suggests getting the answer in writing. Some medicines, such as SGLT2 inhibitors, need their own sick-day rules (ADA Standards of Care, 2026).
  • When sick: CDC advises continuing insulin and diabetes pills as usual, checking blood sugar every 4 hours, drinking plenty of water, trying to eat normally, and checking for ketones (CDC); check ketones if your blood sugar is 250 mg/dL or above (CDC).
  • Go to the emergency room for trouble breathing, ketones in your urine, being unable to keep liquids down for more than 4 hours, vomiting or severe diarrhea for more than 6 hours, or blood sugar below 60 mg/dL; don’t drive yourself if you feel foggy (CDC).

What it costs

Another approach

Prediabetes and the National Diabetes Prevention Program

More than 2 in 5 American adults have prediabetes (CDC), and about 8 in 10 don’t know it (CDC). The good news: you can reverse prediabetes and prevent or delay type 2 diabetes (CDC).

What works

  • Small weight loss plus activity: losing about 5% to 7% of your weight and getting at least 150 minutes a week of brisk walking or similar activity (CDC).
  • The National Diabetes Prevention Program (National DPP): a year-long, CDC-recognized lifestyle change program led by a trained Lifestyle Coach, with a group of people working on the same goals. You meet about weekly for 6 months, then once or twice a month; programs are offered in person, online or by distance learning, and some in Spanish (CDC). It can cut your risk of type 2 diabetes by 58% — 71% if you are over 60 (CDC). In the original research study, participants were still one-third less likely to develop type 2 diabetes 10 years later (CDC).
  • Who can join: adults 18 or older with a BMI of 25 or more (23 or more for Asian American people), not pregnant and without diagnosed diabetes, who have a prediabetes-range blood test in the past year, a history of gestational diabetes, or a high score on CDC’s Prediabetes Risk Test (CDC).
  • Metformin: both lifestyle programs and metformin have prevented or delayed type 2 diabetes in people with prediabetes, but lifestyle change worked better in the landmark Diabetes Prevention Program study, and metformin isn’t FDA-approved for this use (USPSTF). Talk it over with your doctor.

After a prediabetes result, your doctor will likely repeat the A1C every 1 to 2 years (CDC). Taking action also helps protect your kidneys (CDC).

What it costs

  • Medicare Diabetes Prevention Program: $0 if you qualify — 16 weekly sessions over 6 months, then 6 monthly follow-ups. You need an A1C of 5.7% to 6.4%, a fasting glucose of 110 to 125 mg/dL or a 2-hour glucose of 140 to 199 mg/dL in the past 12 months, a BMI of 25 or more (23 or more if Asian), and no diagnosis of diabetes or end-stage kidney disease (Medicare.gov).
  • Other National DPP programs: costs vary by location and format; some are free, and some employers and insurers cover them (CDC).

Another approach

Eating, activity and the plate method

There is no one “diabetes diet.” A good meal plan fits your goals, tastes, lifestyle and medicines; includes more non-starchy vegetables; has fewer added sugars and refined grains; and focuses on whole foods rather than highly processed ones (CDC). A registered dietitian or diabetes educator can build one with you (CDC).

The plate method

Start with a 9-inch dinner plate (CDC):

  • Fill half with non-starchy vegetables, such as salad, green beans and broccoli.
  • Fill one quarter with lean protein, such as chicken, beans, tofu or eggs.
  • Fill one quarter with carb foods: grains, starchy vegetables such as potatoes and peas, rice, pasta, beans, fruit or yogurt.
  • Drink water or a low-calorie drink such as unsweetened iced tea.

Carb awareness

  • Sugars and starches raise blood sugar; fiber doesn’t. In meal planning, one carb serving is about 15 grams (CDC).
  • Eating about the same amount of carbs at each meal can keep blood sugar steadier; if you take mealtime insulin, you’ll learn to match your insulin to your carbs (CDC). How many carbs are right depends on your age, weight, activity and more (CDC).
  • Juice raises blood sugar faster than whole fruit, and eating carbs with protein, fat or fiber slows the rise (CDC). The ADA says reducing carbs can help some adults, and an effective way is to eat fewer processed foods (ADA Standards of Care, 2026).
  • Use your hand to estimate portions: a palm for 3 ounces of meat, a fist for 1 cup or a medium fruit (CDC).

Activity

What it costs

Medical nutrition therapy with a registered dietitian is $0 under Medicare if you qualify (Medicare.gov). Other costs: being researched.

Another approach

Everyday foot care

Nerve damage can stop you from feeling a cut, blister or sore, and small problems can become serious. Checking your feet every day lets you catch problems early, and early treatment greatly lowers the risk of amputation (CDC). Most people with diabetes can prevent serious foot problems (CDC).

Daily habits

  • Look every day for cuts, redness, swelling, sores, blisters, corns, calluses or changes in skin or nails. Use a mirror or ask a family member to help.
  • Wash in warm (not hot) water, don’t soak, dry completely, and use lotion on the tops and bottoms — but not between the toes.
  • Never go barefoot, even indoors. Check inside shoes for pebbles, wear socks, and break in new, well-fitting shoes slowly.
  • Trim nails straight across and file sharp edges; have a podiatrist do it if you can’t see or reach your feet.
  • Don’t remove corns or calluses yourself or use over-the-counter removers, which can burn the skin.
  • Keep blood flowing: put your feet up when sitting and wiggle your toes several times a day; don’t smoke (CDC).

Get checked

Have your feet checked at every primary care visit and see a foot doctor at least once a year — more often if you have nerve damage (CDC). See your doctor or foot doctor right away for leg pain or cramping with activity; tingling, burning or pain; loss of feeling; changes in foot shape, color or temperature; dry, cracked skin; thick yellow toenails; fungal infections such as athlete’s foot between the toes; or a blister, sore, ulcer, infected corn or ingrown toenail (CDC). Our athlete’s foot guide covers treating fungal infections safely, and our circulation guide covers peripheral artery disease.

What it costs

Medicare covers therapeutic shoes or inserts for people with diabetes and severe diabetic foot disease, certified by the doctor treating your diabetes; you pay 20% after the Part B deductible (Medicare.gov). Other costs: being researched.

Still being researched: Massage therapy. We add each approach once its costs and results are sourced. Are you a practitioner with experience treating Diabetes (Type 1, Type 2 & Prediabetes)? Tell us.

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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The Monterey Bay Holistic Alliance is a charitable, independent registered nonprofit 501(c)(3) organization and does not endorse any particular products or practices. Claims and statements herein are for informational purposes only and have not been evaluated by the Food and Drug Administration. We strongly recommend that you seek out your trusted medical doctor or practitioner for diagnosis and treatment of any existing health condition. MBHA provides administrative support, education and navigation — not medical, legal or tax advice — and cannot guarantee claim, billing or fundraising outcomes. MBHA is not an emergency service: in an emergency, call 911 or go to the nearest emergency room.