Did you know that a shocking 9.4 percent of individuals in the U.S. live with diabetes type 1 or diabetes type 2 every day? While modern medicine (i.e., insulin shots) help many manage their condition safely and effectively, patients must be diligent to keep blood glucose levels within a safe range. This often means making several lifestyle changes as well as adhering closely to doctor-prescribed treatments. Here are five realities linked to living with diabetes:

1. Needles are no fun
Having diabetes type 2 or type 1 often requires numerous tests daily to monitor blood sugar levels. This means pricking your finger or jabbing yourself with a needle a few times a day (even up to 10 times daily) is a common occurrence. This can mean pain, bruising, tissue lumps, tender fingertips, and getting used to self administering injections multiple times per day to the point where you feel like a bit of a lab rat.

2. Insulin pumps
According to research from the American Diabetes Association, roughly 400,000 U.S. diabetes patients wear an insulin pump. The insulin pump is a device that automatically provides insulin on an as-need basis to prevent diabetic ketoacidosis. Pumps are often worn by patients with diabetes type 1, in which the body can’t produce adequate insulin levels. Diabetic ketoacidosis occurs when high levels of ketones, a type of blood acid, build up in the bloodstream, which can be fatal.

3. Associated health conditions
Diabetes is a seriously scary condition to live with and manage. For instance, the American Diabetes Association points to several health conditions that can crop up in patients with ill managed diabetes, such as vision and eye issues, skin conditions, kidney disease, high blood pressure, and nerve damage. However, with proper diligence for medication, diet, physical activity, and self care comes control over the disease.

4. Controlling the highs and lows takes planning
Life with diabetes is often described by patients as a carnival ride with ups and downs. They’re obviously referring to their spikes and dips in blood sugar, which can come on suddenly and often without much warning. And even though most patients do their part to keep blood sugars in a healthy, stable levels they often find themselves scrambling for something sweet if hypoglycemia hits (blood glucose drop to dangerous levels). This means eating on a strict schedule and having an emergency stash of carbs/sugar is not an option—it’s a necessity. Should you experience hypoglycemia, or low blood glucose on hand in case of a hypoglycemic episode.

5. Diabetes affects every aspect of your life
Every chronic health condition comes with many challenges, but diabetes type 1 or 2 can affect almost every aspect of a patient’s life including their emotions, their diet, their sleep schedule, and so much more. For instance, diabetic patients are considered at increased risk of clinical depression and anxiety due to the constant monitoring of their disease.