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Diabetes Mellitus: Complete Guide to Management, Complications, and Diet

🏥 Comprehensive Patient Guide | 🍎 Complete Dietary Advice | 💊 Management Strategies

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Living Well with Diabetes Is Possible

What Is Diabetes Mellitus?

Diabetes mellitus is a chronic metabolic disorder characterized by elevated blood sugar (glucose) levels. This occurs either because your body doesn't produce enough insulin, doesn't use insulin effectively, or both. Insulin is a hormone produced by the pancreas that allows glucose from food to enter your cells for energy. Without proper insulin function, glucose accumulates in the bloodstream, leading to serious health complications over time.

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Global Epidemic

537 million adults worldwide have diabetes

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Rising Prevalence

Expected to reach 783 million by 2045

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Undiagnosed

50% don't know they have diabetes

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Manageable

Proper management prevents complications

Types of Diabetes

Type 1 Diabetes (5-10% of cases)

Type 2 Diabetes (90-95% of cases)

Gestational Diabetes

Prediabetes

Symptoms of Diabetes

Classic Symptoms

  • Polyuria (Frequent Urination): Especially at night; kidneys work overtime to eliminate excess glucose
  • Polydipsia (Excessive Thirst): Constant thirst due to fluid loss from frequent urination
  • Polyphagia (Increased Hunger): Always hungry despite eating; cells aren't getting energy
  • Unexplained Weight Loss: Despite eating more; body breaks down muscle and fat for energy
  • Fatigue: Persistent tiredness; cells aren't getting glucose they need
  • Blurred Vision: High blood sugar affects eye lens
  • Slow-Healing Wounds: Cuts, sores take weeks to heal
  • Frequent Infections: Yeast infections, urinary tract infections, skin infections
  • Tingling or Numbness: In hands or feet (early nerve damage)
  • Dark Skin Patches: Acanthosis nigricans—dark, velvety skin in armpits, neck

Type 1 vs Type 2 Symptom Onset

Type 1: Symptoms develop suddenly over weeks, often severe

Type 2: Symptoms develop gradually over years; many have no symptoms initially

Risk Factors for Type 2 Diabetes

Diagnosis of Diabetes

Blood Tests

Test Normal Prediabetes Diabetes
Fasting Blood Glucose
(8+ hours fasting)		 Less than 100 mg/dL 100-125 mg/dL 126 mg/dL or higher
HbA1c
(Average over 2-3 months)		 Below 5.7% 5.7-6.4% 6.5% or higher
Random Blood Glucose
(Any time of day)		 N/A N/A 200 mg/dL or higher (with symptoms)
Oral Glucose Tolerance Test
(2 hours after 75g glucose)		 Less than 140 mg/dL 140-199 mg/dL 200 mg/dL or higher

Monitoring Diabetes

Complications of Diabetes

Uncontrolled diabetes damages blood vessels and nerves throughout the body, leading to serious complications. The good news: proper management dramatically reduces these risks.

🚨 Acute Complications—Medical Emergencies

Diabetic Ketoacidosis (DKA)

More common in Type 1; life-threatening buildup of acids (ketones) in blood

  • Blood sugar usually >250 mg/dL
  • Excessive thirst and urination
  • Nausea, vomiting, abdominal pain
  • Fruity-smelling breath
  • Rapid breathing, confusion
  • Requires immediate ER care—can be fatal

Hyperosmolar Hyperglycemic State (HHS)

More common in Type 2; extremely high blood sugar without ketones

  • Blood sugar >600 mg/dL
  • Severe dehydration
  • Confusion, drowsiness
  • Visual hallucinations
  • Seizures or coma
  • Requires immediate ER care—50% mortality if untreated

Severe Hypoglycemia

Dangerously low blood sugar (below 70 mg/dL)

  • Shakiness, sweating, rapid heartbeat
  • Hunger, irritability, anxiety
  • Confusion, difficulty concentrating
  • Severe: seizures, loss of consciousness
  • Treat immediately with fast-acting carbs; call 911 if unconscious

Chronic Complications

Cardiovascular Disease

Diabetic Nephropathy (Kidney Disease)

Diabetic Retinopathy (Eye Disease)

Diabetic Neuropathy (Nerve Damage)

Diabetic Foot Complications

Diabetic foot problems are among the most serious complications, combining nerve damage and poor circulation. Diabetes is the leading cause of non-traumatic lower limb amputations—but 85% are preventable with proper care.

Why Diabetes Affects Feet

Common Diabetic Foot Problems

Ulcers (Open Sores)

  • 15% of diabetics develop foot ulcers
  • Usually on ball of foot or bottom of big toe
  • Often painless due to neuropathy
  • Can become infected, lead to amputation
  • 6% of ulcers require hospitalization

Infections

  • Even minor cuts can become serious infections
  • Can spread to bone (osteomyelitis)
  • May require IV antibiotics, surgery
  • Gangrene develops if blood flow severely reduced

Charcot Foot

  • Bones weaken and fracture, leading to deformity
  • Foot becomes swollen, red, warm
  • Often painless due to neuropathy
  • Requires immediate treatment to prevent permanent deformity

Other Problems

  • Calluses and corns (thickened skin at pressure points)
  • Blisters
  • Ingrown toenails
  • Fungal infections (athlete's foot)
  • Dry, cracked skin

Daily Foot Care for Diabetics

Essential Daily Routine

  1. Inspect feet daily: Check for cuts, blisters, redness, swelling. Use mirror for bottoms of feet
  2. Wash feet daily: Use warm (not hot) water and mild soap. Test water with elbow
  3. Dry thoroughly: Especially between toes (prevent fungal infections)
  4. Moisturize: Apply lotion to tops and bottoms (not between toes)
  5. Trim toenails carefully: Cut straight across, file edges. See podiatrist if you can't see well
  6. Never go barefoot: Even indoors—protect feet from injury
  7. Wear proper footwear: Well-fitting shoes and socks without tight elastic
  8. Check shoes before wearing: Feel inside for foreign objects, rough seams

When to See a Doctor Immediately

🚨 Emergency Foot Warning Signs

  • Any cut, blister, or sore on foot
  • Redness, warmth, or swelling
  • Pain in legs or feet (even when resting)
  • Ingrown toenail with redness or pus
  • Corns or calluses with redness or drainage
  • Foul odor from foot or wound
  • Black or discolored tissue
  • Fever with foot problem
  • Change in foot shape, size, or color

Don't wait—early treatment prevents amputation. See your doctor within 24 hours.

Professional Foot Care

Diabetic Kidney Disease (Nephropathy)

Diabetic nephropathy is kidney damage caused by diabetes—the leading cause of kidney failure requiring dialysis or transplant. One in three adults with diabetes has chronic kidney disease, but early detection and treatment can prevent progression.

Stages of Diabetic Kidney Disease

Stage Description GFR (mL/min) Symptoms
Stage 1 Kidney damage with normal function 90+ None; protein in urine
Stage 2 Mild decrease in function 60-89 Usually none
Stage 3 Moderate decrease in function 30-59 Fatigue, swelling, frequent urination
Stage 4 Severe decrease in function 15-29 Swelling, shortness of breath, nausea, poor appetite
Stage 5 Kidney failure Below 15 Severe symptoms; requires dialysis or transplant

Symptoms of Kidney Disease

Early stages often have no symptoms. As disease progresses:

Screening and Diagnosis

Treatment and Prevention

Protecting Your Kidneys

  • Control blood sugar: HbA1c below 7% (individualized target)
  • Control blood pressure: Target below 140/90 (usually below 130/80 for diabetics)
  • ACE inhibitors or ARBs: Blood pressure medications that protect kidneys
  • SGLT2 inhibitors: Diabetes medications with kidney protection benefits
  • Low-protein diet: May slow progression in advanced stages
  • Limit salt: Under 2,300 mg daily
  • Stay hydrated: Adequate water intake
  • Avoid NSAIDs: Ibuprofen, naproxen can harm kidneys
  • Don't smoke: Smoking accelerates kidney damage

Dialysis and Transplant

When kidneys fail (Stage 5), two options exist:

Dialysis

Kidney Transplant

Management of Diabetes

Blood Sugar Targets

Measurement Target for Most Adults Notes
Fasting/Before Meals 80-130 mg/dL Check in morning before eating
2 Hours After Meals Less than 180 mg/dL Peak blood sugar
HbA1c Below 7% Individualized; some need stricter/looser control
Bedtime 90-150 mg/dL Prevents overnight hypoglycemia

Medications for Type 2 Diabetes

Oral Medications

Injectable Medications

Insulin Therapy

Essential for Type 1; needed by some Type 2 diabetics

Types of Insulin

Type Onset Peak Duration
Rapid-Acting 10-15 min 1-2 hours 3-5 hours
Short-Acting 30 min 2-3 hours 6-8 hours
Intermediate 1-2 hours 4-6 hours 12-18 hours
Long-Acting 1-2 hours No peak 20-24+ hours

Insulin Delivery

Complete Dietary Guide for Diabetes

Nutrition is a cornerstone of diabetes management. The right diet helps control blood sugar, manage weight, prevent complications, and improve overall health. There's no one-size-fits-all diabetic diet—plans should be individualized based on type of diabetes, medications, activity level, and personal preferences.

Fundamental Principles

Core Dietary Guidelines

  • Consistent carbohydrate intake: Similar amounts at each meal helps stabilize blood sugar
  • Choose complex carbohydrates: Whole grains over refined grains
  • High fiber intake: 25-35 grams daily slows glucose absorption
  • Lean protein: Helps with satiety without raising blood sugar
  • Healthy fats: Unsaturated fats; limit saturated and trans fats
  • Portion control: Even healthy foods can raise blood sugar in large amounts
  • Regular meal timing: Eat at consistent times to avoid blood sugar swings
  • Limit added sugars: Avoid sugary drinks, desserts, processed foods

Carbohydrates: The Most Important Nutrient

Carbohydrates have the greatest impact on blood sugar. Understanding carbs is crucial for diabetes management.

Carbohydrate Counting

Glycemic Index (GI)

Measures how quickly foods raise blood sugar:

Foods to Eat Freely (Non-Starchy Vegetables)

Eat Unlimited Amounts—Very Low Impact on Blood Sugar

  • Leafy greens: spinach, lettuce, kale, collards
  • Cruciferous vegetables: broccoli, cauliflower, Brussels sprouts, cabbage
  • Peppers (all colors)
  • Tomatoes
  • Cucumbers
  • Zucchini and summer squash
  • Eggplant
  • Green beans
  • Asparagus
  • Celery
  • Mushrooms
  • Onions and garlic

Goal: Fill half your plate with non-starchy vegetables at every meal!

Best Carbohydrate Choices

Whole Grains (Portion Control Important)

  • Oatmeal (steel-cut or rolled oats)
  • Brown rice, wild rice
  • Quinoa
  • Barley
  • Whole wheat bread (check labels—truly whole grain)
  • Whole wheat pasta
  • Bulgur

Legumes (Excellent Choice—High Fiber, Low GI)

  • Lentils (all varieties)
  • Chickpeas (garbanzo beans)
  • Black beans
  • Kidney beans
  • Pinto beans
  • Navy beans
  • Split peas

Fruits (Moderate Portions—Natural Sugars)

Best Choices (Lower Sugar, High Fiber):

  • Berries: strawberries, blueberries, raspberries, blackberries
  • Apples (with skin)
  • Pears (with skin)
  • Oranges, grapefruit
  • Peaches, plums
  • Cherries

Limit (Higher Sugar): Bananas, grapes, mangoes, pineapple, watermelon

Portion: 1 small fruit or 1/2 cup = 15g carbs

Protein Choices

Lean Proteins (Little to No Impact on Blood Sugar)

  • Fish: Salmon, tuna, mackerel, sardines (omega-3 rich); white fish
  • Poultry: Chicken breast, turkey (skin removed)
  • Lean meats: Lean beef cuts (sirloin, tenderloin), pork tenderloin
  • Eggs: Excellent protein source
  • Plant proteins: Tofu, tempeh, edamame
  • Legumes: Beans, lentils (also good carb source)
  • Low-fat dairy: Greek yogurt, cottage cheese, milk
  • Nuts and seeds: Almonds, walnuts, chia seeds, flaxseeds (also healthy fats)

Portion: 3-4 oz (palm-sized) per meal

Healthy Fats

Choose Unsaturated Fats (Heart-Healthy)

  • Olive oil, avocado oil (for cooking)
  • Avocados
  • Nuts: almonds, walnuts, cashews, pecans
  • Seeds: chia, flax, pumpkin, sunflower
  • Fatty fish: salmon, mackerel, sardines
  • Natural nut butters (no added sugar)

Limit Saturated Fats

  • Fatty cuts of meat
  • Full-fat dairy
  • Butter, lard
  • Coconut oil (use sparingly)

Avoid Trans Fats Completely

  • Partially hydrogenated oils
  • Many fried foods
  • Some baked goods and processed snacks

Foods to Limit or Avoid

These Foods Spike Blood Sugar and Harm Health

Sugary Foods and Drinks

  • Regular soda, fruit juice, sweet tea
  • Candy, cookies, cakes, pastries
  • Ice cream, frozen desserts
  • Sweetened cereals
  • Syrup, honey, agave (use very sparingly)

Refined Carbohydrates

  • White bread, white rice
  • Regular pasta
  • Crackers, pretzels
  • Chips, processed snacks
  • Fast food

High-Fat Processed Meats

  • Bacon, sausage
  • Hot dogs
  • Deli meats (high sodium)

Alcohol

  • Can cause hypoglycemia, especially on empty stomach
  • If drinking: limit to 1 drink/day (women), 2/day (men)
  • Never drink on empty stomach
  • Monitor blood sugar closely

Sample Meal Plans

Sample Day 1 (Approximately 1,800 calories, 200g carbs)

Breakfast:

  • 1 cup steel-cut oatmeal with 1/2 cup berries
  • 1 tablespoon ground flaxseed
  • 1 boiled egg
  • Coffee or tea (unsweetened or with sugar substitute)

Mid-Morning Snack:

  • 1 small apple
  • 1 oz almonds (about 23 almonds)

Lunch:

  • Large salad with mixed greens, tomatoes, cucumbers, peppers
  • 4 oz grilled chicken breast
  • 1/4 avocado
  • 2 tablespoons olive oil vinaigrette
  • 1 small whole wheat roll

Afternoon Snack:

  • 1 cup low-fat Greek yogurt
  • 1/4 cup berries

Dinner:

  • 4 oz baked salmon
  • 1 cup steamed broccoli
  • 2/3 cup quinoa
  • Side salad with vinaigrette

Evening Snack (if needed):

  • 1/2 cup baby carrots with 2 tablespoons hummus

Sample Day 2 (Approximately 1,800 calories, 200g carbs)

Breakfast:

  • 2-egg vegetable omelet (spinach, mushrooms, peppers)
  • 2 slices whole wheat toast
  • 1 teaspoon olive oil spread
  • 1/2 grapefruit

Mid-Morning Snack:

  • 1/4 cup unsalted mixed nuts

Lunch:

  • Turkey and vegetable wrap (whole wheat tortilla)
  • 3 oz lean turkey breast
  • Lettuce, tomato, cucumber
  • 1 cup vegetable soup (low-sodium)
  • 1 medium orange

Afternoon Snack:

  • 1 string cheese
  • 10 whole grain crackers

Dinner:

  • 4 oz grilled lean sirloin steak
  • 1 medium baked sweet potato
  • 2 cups mixed roasted vegetables (Brussels sprouts, carrots, onions)
  • Side salad with olive oil dressing

Evening Snack:

  • 1 cup strawberries
  • 2 tablespoons whipped cream (sugar-free)

Dining Out Tips

Artificial Sweeteners

FDA-approved non-nutritive sweeteners are safe for diabetics:

Exercise and Physical Activity

Exercise is medicine for diabetes—it lowers blood sugar, improves insulin sensitivity, aids weight loss, reduces cardiovascular risk, and improves overall quality of life.

Benefits of Exercise

Exercise Recommendations

Weekly Exercise Goals

  • Aerobic exercise: 150 minutes moderate-intensity (or 75 minutes vigorous) spread over at least 3 days
  • Resistance training: 2-3 sessions per week targeting major muscle groups
  • Flexibility and balance: 2-3 times per week
  • Avoid sedentary time: Break up sitting every 30 minutes with light activity

Moderate-Intensity Activities

  • Brisk walking
  • Swimming, water aerobics
  • Cycling (leisurely)
  • Dancing
  • Gardening, yard work
  • Doubles tennis

Vigorous-Intensity Activities

  • Jogging, running
  • Fast cycling
  • Lap swimming
  • Aerobics classes
  • Singles tennis
  • Basketball, soccer

Exercise Safety for Diabetics

⚠️ Important Exercise Precautions

  • Check blood sugar before exercise: Don't exercise if below 100 mg/dL (risk of hypoglycemia) or above 250 mg/dL with ketones
  • Carry fast-acting carbs: Glucose tablets, juice box, candy
  • Check blood sugar after exercise: Can drop for up to 24 hours post-exercise
  • Stay hydrated: Drink water before, during, after exercise
  • Wear proper footwear: Well-fitting athletic shoes; check feet daily
  • Wear medical ID: Bracelet or necklace identifying diabetes
  • Exercise with a partner: Especially if history of hypoglycemia
  • Start slowly: Gradually increase intensity and duration
  • Get doctor clearance: Especially if complications present or haven't exercised recently

Living Well with Diabetes

Daily Diabetes Management Checklist

  • ✓ Check blood sugar as prescribed
  • ✓ Take medications at correct times
  • ✓ Eat balanced meals at regular times
  • ✓ Count carbohydrates
  • ✓ Engage in physical activity
  • ✓ Inspect feet daily
  • ✓ Stay hydrated
  • ✓ Manage stress
  • ✓ Get adequate sleep (7-9 hours)
  • ✓ Keep medical appointments

Sick Day Management

Illness can raise blood sugar even if you're not eating. Follow these guidelines:

Emotional and Mental Health

Frequently Asked Questions

Q: Can Type 2 diabetes be reversed?

In some cases, yes—through remission. Significant weight loss (10-15% of body weight) through diet and exercise can put Type 2 diabetes into remission, meaning blood sugar returns to normal without medications. However, this requires maintaining weight loss and healthy habits. Not all Type 2 diabetics can achieve remission, especially if disease is long-standing.

Q: Can I ever eat sweets with diabetes?

Yes, occasionally and in moderation. Diabetes doesn't mean never eating sweets again. The key is portion control, planning (work it into your carb budget), and choosing the right time (after a meal, not alone). Consider sugar-free alternatives, share desserts, and always check blood sugar after to see how your body responds.

Q: Why do I need to check my feet every day?

Diabetic neuropathy causes numbness, so you might not feel injuries. A small cut or blister can quickly become infected and lead to serious complications, even amputation. Daily inspection allows early detection of problems when they're easily treatable. Check for cuts, blisters, redness, swelling, or any changes.

Q: How often should I check my blood sugar?

It varies: Type 1 or insulin users: typically 4-10 times daily (before meals, bedtime, sometimes 2 hours after meals, before/after exercise). Type 2 on oral medications: varies widely, often daily fasting check or periodic testing. Your doctor will recommend a schedule based on your treatment plan. Continuous glucose monitors reduce finger-stick needs.

Q: Will I eventually need insulin?

Type 1: Always requires insulin immediately. Type 2: It's progressive—about 50% eventually need insulin as pancreas produces less over time. This doesn't mean you've failed; it's natural disease progression. Starting insulin when needed actually protects remaining pancreas function and prevents complications.

Q: Can I drink alcohol with diabetes?

In moderation, usually yes. Limit to 1 drink/day (women) or 2/day (men). Critical rules: never drink on empty stomach (causes hypoglycemia), check blood sugar before/after, carry glucose source, wear medical ID. Avoid sugary mixed drinks. Some medications interact with alcohol—ask your doctor.

Q: Is diabetes contagious or hereditary?

Not contagious—you can't catch diabetes. However, genetics play a role: Type 1 risk is 5-10% if parent or sibling has it. Type 2 has stronger genetic link—if one parent has it, 50% chance; both parents, 75% chance. But Type 2 is largely preventable through lifestyle, even with genetic risk.

Q: What's the difference between Type 1 and Type 2 diabetes?

Type 1: Autoimmune—body destroys insulin-producing cells; produces no insulin; requires insulin injections; usually starts young; cannot be prevented. Type 2: Insulin resistance—body doesn't use insulin properly; may still produce insulin; often manageable with lifestyle/oral medications initially; usually starts later; largely preventable.

Q: Can I have a normal pregnancy with diabetes?

Yes, with careful planning and management. Preconception: achieve good blood sugar control (HbA1c <6.5%) before conceiving. During pregnancy: requires frequent monitoring, medication adjustments, regular ultrasounds. Higher risk of complications but majority have healthy pregnancies and babies with proper care. Work closely with maternal-fetal medicine specialist.

Preventing Type 2 Diabetes

If you have prediabetes, you can prevent or delay Type 2 diabetes. Studies show lifestyle changes reduce diabetes risk by 58% (71% in people over 60).

Proven Prevention Strategies

  • Lose 5-7% of body weight: For 200-pound person, that's just 10-14 pounds
  • Exercise 150 minutes weekly: 30 minutes, 5 days per week
  • Eat healthy diet: Whole grains, vegetables, lean protein; limit refined carbs and sugar
  • Don't smoke: Smoking increases diabetes risk 30-40%
  • Limit alcohol: Excessive drinking increases risk
  • Get adequate sleep: Sleep deprivation increases diabetes risk
  • Manage stress: Chronic stress affects blood sugar and weight
  • Medications: Metformin reduces risk 31% in high-risk individuals

Who Should Be Screened for Diabetes?

Working with Your Healthcare Team

Your Diabetes Care Team

Regular Health Monitoring

Test/Exam Frequency Purpose
HbA1c Every 3-6 months Average blood sugar control
Blood pressure Every visit Cardiovascular health
Cholesterol panel Annually (more often if abnormal) Heart disease risk
Kidney function Annually Detect kidney disease early
Urine albumin Annually Protein in urine (kidney damage)
Dilated eye exam Annually Detect retinopathy
Comprehensive foot exam Annually Check circulation, nerve function
Dental exam Every 6 months Gum disease more common with diabetes
Flu vaccine Annually Prevent complications from influenza
Pneumonia vaccine Per CDC guidelines Prevent pneumococcal infection

Conclusion

Diabetes mellitus is a serious chronic condition affecting millions worldwide, but it's also one of the most manageable diseases in medicine. While diabetes requires daily attention and lifelong commitment, proper management allows you to live a long, healthy, fulfilling life with minimal complications.

Key Takeaways:

If you've been diagnosed with diabetes, remember that every healthy choice you make today reduces your risk of complications tomorrow. Small, consistent changes accumulate into major health benefits over time. Work closely with your healthcare team, educate yourself, connect with other diabetics for support, and never hesitate to ask questions.

Living with diabetes isn't easy, but it's absolutely possible to thrive. Millions of people with diabetes live full, active, healthy lives—pursuing careers, raising families, traveling the world, and achieving their dreams. With proper management, you can too.

💚 Take Control of Your Diabetes Today

Whether newly diagnosed or managing diabetes for years, commit to your health. Small steps lead to big changes.

Experiencing symptoms of very high or very low blood sugar? Check your blood sugar immediately and seek emergency care if needed.

📱 Share This Guide: Diabetes affects 1 in 10 adults globally. Share this comprehensive guide with family and friends—especially those with risk factors. Knowledge empowers prevention and better management.

📚 References and Further Reading

  1. American Diabetes Association. (2024). "Standards of Care in Diabetes—2024." Diabetes Care, 47(Supplement_1). Available at: https://diabetesjournals.org/care
  2. International Diabetes Federation. (2021). "IDF Diabetes Atlas, 10th Edition." Available at: https://diabetesatlas.org
  3. Diabetes Prevention Program Research Group. (2002). "Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin." New England Journal of Medicine, 346(6), 393-403. doi:10.1056/NEJMoa012512
  4. American Heart Association. (2023). "Cardiovascular Disease and Diabetes." Available at: https://www.heart.org
  5. National Institute of Diabetes and Digestive and Kidney Diseases. (2023). "Diabetic Kidney Disease." Available at: https://www.niddk.nih.gov
  6. Boulton, A. J., et al. (2008). "Comprehensive Foot Examination and Risk Assessment: A Report of the Task Force of the Foot Care Interest Group." Diabetes Care, 31(8), 1679-1685. doi:10.2337/dc08-9021
  7. Evert, A. B., et al. (2019). "Nutrition Therapy for Adults With Diabetes or Prediabetes: A Consensus Report." Diabetes Care, 42(5), 731-754. doi:10.2337/dci19-0014
  8. Colberg, S. R., et al. (2016). "Physical Activity/Exercise and Diabetes: A Position Statement of the American Diabetes Association." Diabetes Care, 39(11), 2065-2079. doi:10.2337/dc16-1728
  9. UK Prospective Diabetes Study Group. (1998). "Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33)." The Lancet, 352(9131), 837-853.
  10. Nathan, D. M., et al. (2005). "Intensive Diabetes Treatment and Cardiovascular Disease in Patients with Type 1 Diabetes." New England Journal of Medicine, 353(25), 2643-2653. doi:10.1056/NEJMoa052187

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