Every day without exception, I find myself discussing the many ways in which my patients can lower their blood sugar. Did you know that over one third of adults have pre-diabetes, and that 13% of adults suffer from diabetes? 

The body normally manages blood sugar levels by producing insulin. Insulin is a hormone that helps control your body's blood sugar level and metabolism - the process that turns the food you eat into energy. However, a number of things can hamper the body’s ability to do this, resulting in either too much sugar in the blood (hyperglycemia), or too much insulin being produced.  Either condition can lead to so many serious complications.

For those with pre-diabetes or diabetes, it is critical to manage blood sugar. Here is a list of things you can do:

• Regular exercise helps in many ways. It can help you reach and maintain a moderate weight and increase insulin sensitivity, which will allow your cells to more effectively use the available sugar in your bloodstream. Exercise helps the muscles to use blood sugar for energy and muscle contraction. Take small exercise breaks during the day, including light walking or simple resistance exercises like squats or leg raises. For regular exercise, almost anything will work, as long as it gets you up and moving. 

• Drink plenty of water and stay hydrated. Drinking enough water helps the kidneys to flush out excess sugar through urine. Note that an added benefit is that water is a zero-calorie drink, and can take the place of high sugar drinks. 

• Maintain a proper body weight. This promotes healthy blood sugar levels, and even a 5% drop in body weight can make a significant difference.

• Exercise portion control. You might measure and weigh portions, use smaller plates, avoid buffets, read food labels, keep a food journal, and eat more slowly.

• Consume small frequent meals and snacks. Several studies suggest that having smaller, more frequent meals throughout the day improves insulin sensitivity and lowers blood sugar levels. 

• The food that most strongly influences your blood sugar level is carbohydrates. Problem carbs are the simple ones like sugar, and highly processed white foods like pasta, bread, and rice, which easily break down into sugars. Insulin then helps to use and store these sugars for energy. When you eat too many carbs or have insulin-function problems, this process fails, and blood glucose levels rise. The American Diabetes Association recommends that people with diabetes count carbs every day. Note that a low carb diet is not a no carb diet. It is still important to eat complex carbs like fruits, vegetables, and whole grains.

• Eat more fiber. Fiber slows carb digestion and sugar absorption. Of the two types of fiber, soluble and insoluble, soluble fiber is most important. Foods high in soluble fiber include vegetables, fruits, legumes, and whole grains. Your goal should be about 25 grams of fiber per day for women, and about 35 grams for men. 

• Choose foods with a low glycemic index. The glycemic index measures how quickly carbs break down during digestion and how rapidly they are absorbed. Choose whole grains like steel-cut or rolled oats, brown rice, quinoa, and barley instead of flour products like breads, pastas and crackers. Try beans, legumes and starchy vegetables like sweet potatoes and squash.  

• Eat foods rich in chromium and magnesium. High sugar levels have been linked to deficiencies in these minerals. Foods rich in chromium include meats, whole grains, fruit, vegetables, and nuts. Foods rich in magnesium include dark leafy vegetables, squash and pumpkin seeds, tuna, whole grains, dark chocolate, bananas, avocados, and beans. 

• Control stress. Stress releases the hormones glucagon and cortisol, which lead to a rise in blood sugar. Exercise, meditation, yoga, and relaxation can help to significantly reduce stress and lower blood sugar levels. 

• Get enough quality sleep. In addition to helping us feel better, there is a direct connection: Sleep deprivation raises levels of cortisol, mentioned above. Some suggestions: Follow a sleep schedule, avoid caffeine and alcohol late in the day, get regular exercise, cut down on computer screen time before bed, keep your bedroom cool, limit daytime naps, create a bedtime routine, use soothing and calming scents, avoid working in your bedroom, take a warm bath or shower before bed, and try meditation and guided imagery.

• Monitor blood sugar levels. Feedback is a great tool. Use a home glucose meter or a continuous glucose monitor. 

• If you drink alcohol, practice moderation. In addition to so many other problems which come with the excessive consumption of alcohol, alcohol breaks down into sugar. 

• Quit smoking cigarettes. Quit smoking cigarettes. Quit smoking cigarettes. Smoking can contribute to insulin resistance, among so many other health issues. Quitting has been shown to reduce the risk of type 2 diabetes. 

Medication is effective for many diabetics, but there are so many ways to either maintain or improve blood sugar levels that do not require medication. Lifestyle changes focused on managing weight, stress, sleep quality, exercise, diet, and hydration have an enormous impact. If you are concerned about your blood sugar levels, then in addition to talking to your physician, I urge you to use today’s column as your homework assignment!

Dr. Alan Frischer is former chief of staff and former chief of medicine at Downey Regional Medical Center. Write to him in care of this newspaper at 8301 E. Florence Ave., Suite 100, Downey, CA 90240.