Managing diabetes comes down to a combination of eating patterns, physical activity, sleep, monitoring, and, for many people, medication. The general target for most adults with type 2 diabetes is an HbA1c below 7%, though your ideal number depends on your age, how long you’ve had diabetes, and other health conditions. Here’s what actually moves the needle.
Dietary Patterns That Lower Blood Sugar
What you eat matters, but the overall pattern of your diet matters more than any single food. Two approaches have the strongest evidence: low-carbohydrate diets and Mediterranean-style diets. In a 16-week trial of 100 people with type 2 diabetes, a low-carbohydrate diet dropped average HbA1c from 8.6% to 6.6%, while a Mediterranean diet brought it from 8.6% to 7.4%. Both produced meaningful improvement, but the low-carb approach had a larger effect on blood sugar specifically.
A Mediterranean diet emphasizes vegetables, whole grains, fish, olive oil, and nuts. It tends to be easier to sustain long-term and carries additional benefits for heart health and inflammation. A low-carbohydrate diet restricts bread, pasta, rice, and sugary foods more aggressively, replacing those calories primarily with protein and healthy fats. The best diet is the one you can actually stick with for years, not weeks.
Fiber deserves special attention regardless of which pattern you follow. The CDC notes that adults should aim for 22 to 34 grams of fiber per day, depending on age and sex. Fiber slows the absorption of sugar into your bloodstream, which prevents the sharp spikes that make diabetes harder to control. Beans, lentils, oats, vegetables, and berries are particularly good sources.
How Exercise Improves Insulin Sensitivity
Physical activity makes your cells more responsive to insulin, which means your body needs less of it to move sugar out of your blood. Both aerobic exercise (walking, cycling, swimming) and resistance training (weights, bands, bodyweight exercises) improve insulin sensitivity. In a controlled trial of overweight individuals, both types of exercise produced significant improvements compared to a sedentary control group. You don’t have to choose one or the other.
The practical takeaway: aim for at least 150 minutes per week of moderate activity, spread across most days. Resistance training two to three times per week adds a separate benefit by building muscle, which acts as a larger “sponge” for absorbing blood sugar. Even a 15-minute walk after meals can noticeably blunt post-meal glucose spikes, something you can verify yourself if you use a continuous glucose monitor.
Sleep Is More Important Than You Think
Losing just 90 minutes of sleep per night for six weeks increased insulin resistance by nearly 15% in a Columbia University study of women. Fasting insulin levels rose by over 12% overall and by more than 15% in premenopausal women. Postmenopausal women saw insulin resistance climb by more than 20%. Notably, these changes were not caused by weight gain. The sleep loss itself was enough to shift metabolism toward diabetes.
If you’re doing everything else right but consistently sleeping six hours or less, poor sleep may be quietly undermining your blood sugar control. Prioritizing seven to eight hours is one of the simplest interventions available, and it costs nothing.
Weight Loss and Diabetes Remission
For people with type 2 diabetes, sustained weight loss is the single most powerful tool for improving blood sugar, and in some cases, achieving remission. The landmark DiRECT trial found high rates of remission among participants who lost more than 10 kilograms (about 22 pounds) and kept it off for 12 to 24 months. Remission means your HbA1c drops below the diabetes threshold without medication.
Not everyone will achieve remission, and the likelihood decreases the longer you’ve had diabetes, since the insulin-producing cells in your pancreas gradually lose function over time. But even modest weight loss of 5 to 7% of body weight produces clinically meaningful improvements in blood sugar, blood pressure, and cholesterol.
Medications That Make a Difference
Metformin remains the usual starting medication for type 2 diabetes. It works primarily by reducing the amount of sugar your liver releases into your bloodstream. Doses typically start low, around 500 mg once or twice daily, and are gradually increased over several weeks to reduce digestive side effects like nausea or diarrhea. Most people settle into a maintenance dose of 850 to 1,000 mg twice daily.
GLP-1 receptor agonists are a newer class of injectable or oral medications that have changed diabetes treatment significantly. They work on multiple fronts: they signal your pancreas to produce more insulin when blood sugar is high, slow the rate at which food leaves your stomach (which reduces post-meal spikes), and act on the brain’s appetite centers to increase feelings of fullness. On average, people taking these medications lose about 2.9 kg (roughly 6.4 pounds) more than those on placebo, along with improvements in blood pressure and cholesterol. They also appear to protect the insulin-producing cells in your pancreas from dying off, which could slow the progression of the disease.
SGLT2 inhibitors work differently. They cause your kidneys to excrete excess sugar through urine rather than reabsorbing it back into your blood. Beyond glucose control, these drugs have shown striking benefits for heart and kidney health. In a meta-analysis of 13 randomized trials, they reduced the risk of hospitalization for heart failure by 35%, cardiovascular death by 16%, and all-cause death by 14%. For people with diabetes who also have kidney disease or heart problems, these medications pull double duty.
Monitoring and Targets
Continuous glucose monitors (CGMs), small sensors worn on your arm or abdomen, have made it far easier to see how your body responds to specific foods, exercise, stress, and sleep in real time. The key metric with a CGM is “time in range,” which measures what percentage of the day your blood sugar stays between 70 and 180 mg/dL. The goal for most people with diabetes is to spend more than 70% of the time in that range, with less than 4% of readings below 70 mg/dL (which indicates low blood sugar).
Time in range gives you a much more detailed picture than HbA1c alone, which is just a three-month average. Two people can have the same HbA1c while having very different daily glucose patterns. One might have steady readings; the other might swing wildly between highs and lows. A CGM reveals those swings and helps you identify what triggers them.
Personalizing Your Targets
The American Diabetes Association’s 2025 guidelines recommend an HbA1c below 7% for most nonpregnant adults, but they emphasize that targets should be individualized. If you’re younger, recently diagnosed, and not at risk for dangerous low blood sugar episodes, aiming lower than 7% may offer extra protection against complications. If you’re older, managing multiple chronic conditions, or dealing with cognitive decline, a less aggressive target reduces the risk that treatment itself causes harm.
Factors that shape your personal target include how long you’ve had diabetes, whether you have cardiovascular disease or advanced kidney problems, your history of low blood sugar episodes, and your overall functional health. The right goal is one that reduces your long-term risk without making daily life harder than it needs to be.