Managing your diabetes

Transcription

1 Managing your diabetes A nonprofit independent licensee of the Blue Cross Blue Shield Association National strength. Local focus. Individual care. SM

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3 Table of contents You and your doctor...2 Understanding diabetes...3 Keeping diabetes in check...3 Meal planning...6 How to read nutrition labels....8 Diabetes and exercise....9 Diabetes medicines...10 General guidance for treating hypoglycemia Possible long-term problems...14 What to know about blood pressure...15 Diabetes and the risk of heart disease or stroke General health care...17 You are in control...18 When someone you care about has diabetes...19 Diabetes resources Your diabetes care team...20

4 2 You and your doctor How often should I see my doctor? People with diabetes who are treated with insulin shots generally should see their doctor at least every three to four months. Those who are treated with pills or who are managing diabetes through diet should be seen at least every four to six months. More frequent visits may be necessary if your blood glucose is not controlled or if complications of diabetes are worsening. What information should I give my doctor? Generally, your doctor needs to know how well your diabetes is controlled and whether diabetic complications are starting or getting worse. Therefore, at each visit, provide your doctor with your home blood glucose monitoring record and report any symptoms of hypoglycemia (low blood glucose) or hyperglycemia (high blood glucose). Your doctor also should be informed of any changes in your diet, exercise or medicines and of any new illnesses you may have developed. Tell your doctor if you have experienced any symptoms of eye, nerve, kidney or cardiovascular problems such as: Blurred vision. Numbness or tingling in your feet. Persistent hand, feet, face or leg swelling. Cramping or pain in the legs. Chest pain. Shortness of breath. Numbness or weakness on one side of your body. Unusual weight gain. What lab tests should I have? Lab tests should include: Hemoglobin A1C Urine Cholesterol Nine questions for your diabetes care team 1. When was the last time my A1C was tested? A1C measures diabetes control over the past three months. 2. What were the results of my last lipid profile? This test determines your blood fat levels, meaning your cholesterol and triglycerides. 3. How often should I be checking my blood glucose? How often you test depends on what kind of medication you take to control diabetes. 4. What kind of dietary guidelines should I be following? Find a nutrition plan that is right for you. 5. How do my feet look? Your doctor should examine your feet at every visit. 6. What were the results of my last dilated eye exam by an ophthalmologist? Diabetes causes most new cases of blindness in adults each year. Most of the time, there are no early warning signs. 7. What s my blood pressure? Keeping blood pressure at 140/80 or less is essential if you have diabetes. 8. When was my last test for microalbuminuria? This is the best way to determine if there has been any damage to your kidneys from the presence of diabetes. 9. Any other concerns you may have about how diabetes is affecting your health!

5 Understanding diabetes Diabetes is not like other health problems you may have had in the past. For one thing, it doesn t go away like a cold or the flu. For another, you are just as responsible as your doctor for treating your diabetes. Because so much of your day-to-day treatment is in your hands, you must learn as much about diabetes as you can. This book is the first step in that process. The basic facts about diabetes Diabetes is: Common At least one in every 14 people has diabetes. Controllable Though there is no cure for diabetes, it can be managed by keeping blood sugar close to normal. This is done with proper meal planning, exercise, and possibly medicines. Lifelong Your blood sugar levels should improve with treatment. However, this does not mean that your diabetes has gone away. It just means your blood sugars are in control. Self-managed Your health care team will advise and support you, but control depends on you. The choices you make help determine what your blood sugar level will be. Always changing It is common for your doctor to change your medicine or treatment plan over time because your diabetes changes over time. Keeping diabetes in check - know your blood sugar numbers Taking control of your diabetes can help you feel better and stay healthy. Keeping blood sugar close to normal reduces your chances of having heart, eye, kidney and nerve problems that can be caused by diabetes. To control your diabetes, you need to know your blood glucose numbers and your target goals. There are two different tests to measure your blood glucose. 1. The A1C (pronounced A-one-C) test 2. The blood glucose test you do yourself also called self-monitoring of blood glucose (SMBG) You and your health care team need to use both the A1C and SMBG tests to get a complete picture of your blood glucose control. What is the A1C test? The A1C test is a simple lab test that measures average blood glucose levels over the past three months. A small blood sample to check your A1C can be taken at any time of the day. Why should I have an A1C test? The A1C test is the best test for you and your doctor or health care provider to know how well your treatment plan is working over time. The test shows if your blood glucose levels have been close to normal or too high. The higher the amount of glucose in your blood, the higher your A1C result will be. A high A1C test result will increase your chances for health problems. What is a good A1C goal? You and your doctor or health care provider should discuss an A1C goal that is right for you. For most people with diabetes, the A1C goal is less than 7. An A1C higher than 7 means that you have a greater chance of eye disease, kidney disease, heart disease, or nerve damage. Lowering your A1C by any amount can improve your chances of staying healthy. If your number is 7 or more, or above your A1C goal, ask your doctor or health care provider about changing your treatment plan to bring your A1C number down. Level of control Normal A1C number 6 or less Goal Less than 7 Take Action 7 or more 3

6 Also, ask whether your meter gives the results as plasma or whole blood glucose. Most new meters provide the results as plasma glucose. What is a good self-testing blood glucose goal? One of your main goals of treating diabetes is to control your blood sugar level by keeping it as close to normal as possible. Set your goals with your doctor or health care provider. Blood and plasma glucose goals for most people with diabetes are on these charts. 4 How often do I need an A1C test? Ask for an A1C test at least twice a year. Get the test more often if your blood glucose stays too high or if your treatment plan changes. Why should I check my blood glucose? Self-monitoring of blood glucose, or SMBG, with a meter helps you see how food, physical activity, and medicine affect your blood glucose levels. The readings you get can help you manage your diabetes day by day or even hour by hour. Keep a record of your test results and review it at each visit with your doctor or health care provider. How do I test my own blood glucose? To do SMBG, you use a tiny drop of blood and a meter to measure your blood glucose level. Ask your doctor or health care provider to show you how to use the meter. Blood sugar control Test* Level for people Goal for people with diabetes without diabetes ADA 1 ACE 2 Blood sugar <100 mg/dl mg/dl <110 mg/dl Blood sugar after meals <110 mg/dl <180 mg/dl <140 mg/dl (peak) (2 hr. post meal) A1C <6% <7% <6.5 mg/dl (patients in general) The American Diabetes Association (ADA) recommends the following blood sugar goals for people with diabetes: Before meals: mg/dl 1-2 hours after meals: less than 180 mg/dl These guidelines apply to many people, but not to everyone. Your goals may be higher or lower than these guidelines. Your healthcare team will help you set the blood sugar target range that is right for you. * Do not use these values if you are pregnant. Work with your health care provider to determine your target values. 1 American Diabetes Association. Standards of medical care in diabetes. Diabetes Care. 2006;29 (suppl 1): S4-S42. 2 American College of Endocrinology. Consensus statement on guidelines for glycemic control. Endocr Pract. 2002;8 (suppl 1): 5-11.

7 How often should I check my blood glucose? Self-tests are usually done before meals, after meals, and/or at bedtime. People who take insulin usually need to test more often than those who do not take insulin. Ask your doctor or health care provider when and how often you need to check your blood glucose. The benefits of staying in control Maintaining a near normal blood sugar level may help protect you from many of the serious problems that are related to diabetes. You ll feel much better if you keep your blood sugar close to normal. When your blood sugar is higher or lower than normal, you will probably feel tired, sick, and/or uncomfortable. Controlling your diabetes will keep it from controlling you. It will have less power to disrupt your life. Tracking your A1C Know your numbers! The American Diabetes Association (ADA) A1c Goal: Less then 7% You and your doctor will set a A1C goal. This goal may change over time. Work with your doctor to reach a final goal less then 7%. Get your A1C checked every three to six months* Keep track of your A1C numbers on the chart below In the chart below, write down the date and your test result. Write down when you should have your next test. Place a check in the appropriate box on the graph closest to your test results. Track your progress over time. My A1C goal Date: Next Test: A1C Number: % % % % % % 11.5% 11.0% 10.5% 10.0% 9.5% 9.0% 8.5% 8.0% 7.5% 7.0% 6.5% 6.0% * Ask your doctor how often you should get an A1C test. 5

8 Meal planning In spite of what you might have heard, having diabetes does not mean you have to give up all the foods you enjoy. However, learning to eat healthy, satisfying meals is an important part of your treatment. The healthy plate This plate shows an easy way to choose foods for good health. 6 Good diabetes meal planning includes: Understanding how different foods and the amount eaten affect your blood sugar. Choosing healthy foods. Eating regular meals at the right times. Choose healthy food Good nutrition is a very important part of diabetes management. People with diabetes should work with their diabetes health care team to develop an eating plan that meets their personal food preferences while keeping blood glucose in a healthy range. By choosing nutritious foods and balancing what and how much you eat with activity level, blood sugar levels can be kept as close to normal as possible. Here are a few tips on making healthy food choices for the entire family. Eat lots of vegetables and some fruit. Try picking from the rainbow of colors available to add variety to your meals. Choose more non-starchy vegetables that have lots of vitamins and minerals such as spinach, carrots, broccoli or green beans with meals. Discuss with your diabetes care team how many servings of fruit you should eat each day. Choose whole grain foods instead of processed grain products like white bread, white rice or regular pasta. Try brown 1/2 Plate Fruit and Vegetables rice with your stir-fry or wholewheat spaghetti with your favorite pasta sauce. Include fish in your meals two to three times a week and choose lean meats like chicken and turkey without the skin. To prepare meats and fish with less fat, trim any visible fat and use low-fat cooking methods such as broiling, grilling, roasting, poaching or stir-frying. Include dried beans (like kidney or pinto beans) and lentils in your meals. Choose low fat dairy products such as milk, yogurt and cheese (1 percent fat or less). 1/4 Plate Protein 1/4 Plate Carbohydrates Choose liquid oils such as canola, olive or peanut oil for cooking, instead of solid fats such as butter, lard and shortening. Remember that all fats are high in calories. If you re trying to lose weight, cut back on portion sizes of added fats. Choose fruit that is in-season for dessert you ll get more flavor and pay less too! Try to cut back on high-calorie dessert and snack foods such as chips, cookies, cakes and ice cream that give you and your family little nutrition. Choose water and calorie-free diet drinks instead of regular soda, fruit punch, sweet tea and other sugar-sweetened drinks.

9 Control your portion sizes. Remember that the amount of food you eat is important in getting to and staying at a healthy weight. Understanding how different foods and amounts affect blood sugar Starches and sugars (carbohydrates) have more effect on blood sugar than protein or fat. Carbohydrates include foods such as bread, pasta, cereal, beans, milk, fruit and fruit juices, and sweets. Keeping track of the carbohydrate foods you eat is a key factor in controlling your blood sugar. Carbohydrates have the greatest impact on your blood sugar after meals, and your blood sugar level can go too high when you eat more carbohydrates than your body can use. By keeping track of the carbohydrates you eat and spreading them throughout the day, you can help control your blood sugar. In order to count carbohydrates, it s helpful to have a meal plan and know the average carbohydrate values of various food groups. Talk to your doctor about how many carbohydrates you should have at each meal. Most of the carbohydrates we eat come from three food groups: starch, fruit and milk. Vegetables also contain some carbohydrates, but foods in the meat and fat groups contain very little carbohydrates. This list shows the average amount of carbohydrates in each food group per serving: Carbohydrate Grams Starch 15 Fruit 15 Milk 12 Vegetable 5 Meat 0 Fat 0 To make things easy, many people begin carbohydrate counting by rounding the carbohydrate values: One serving of milk, starch, or fruit = 15 grams of carbohydrates or one carbohydrate serving. 3 servings of vegetable = 15 grams of carbohydrates. One or two servings of vegetables do not need to be counted. Each meal and snack will contain a total number of grams of carbohydrates. Counting carbohydrates allows flexibility in your meal plan, but you can t abandon your meal plan and eat as many carbohydrates as you desire. Remember to consult your health care team before making any of the changes discussed here. 7

10 How to read a nutrition label Serving size First look at the serving size and the number of servings in the package. All the information on this label is based on this serving or portion size. So, if you eat double the serving, you will consume double the calories, carbohydrate, fat and other nutrients. Calories Calories provide a measure of how much energy you get from a serving of this food. This gives the total calories per serving. The portion of the total calories that comes from fat is also given. A good rule of thumb is to look for foods that show one-third or fewer of the total calories coming from fat. Total carbohydrate and sugars This shows the amount of Carbohydrate per serving that comes from sugar. This includes both natural sugar and added sugar. Vitamins and minerals Eating enough of these nutrients can improve your health and help reduce the risk of some diseases and conditions Nutrition Facts Serving Size 1 cup (228g) Servings Per Container 2 Amount per Serving Calories 250 Calories from Fat 118 % Daily Value* Total Fat 12g 18% Saturated Fat 3g 15% Trans Fat 3g Cholesterol 30mg 10% Sodium 470mg 20% Total Carbohydrate 31 10% Dietary Fiber 0g 0% Sugars 5g Protein 5g Vitamin A 4% Vitamin C 2% Calcium 20% Iron 4% * Percent Daily Values are based on a 2,000 calorie diet. Your Daily Values may be higher or lower depending on your calorie needs. Calories 2,000 2,500 Total Fat Less than 65g 65g Sat Fat Less than 20g 25g Cholesterol Less than 300mg 300mg Sodium Less then 1,500mg Potassium 3.500mg Total Carbohydrate 300g 375g Dietary Fiber 25g 30g Limit these nutrients Sodium This shows the amount of sodium (salt) in one serving. This is important if you are on a lowsodium diet or if you have high blood pressure. Dietary fiber This shows the portion of the total carbohydrate per serving that is fiber. Eating a diet high in dietary fiber promotes healthy bowel function. Protein This shows the total grams of protein in one serving. Protein is an essential nutrient for growth and health. Total fat This gives the total grams of fat in one serving of that food. 8 Saturated, trans fat and cholesterol Eating too much fat may increase your risk of certain chronic diseases, such as stroke, and some types of cancers. Unsaturated fat You can find the amount of unsaturated fat by subtracting the amount of saturated and trans fats from the total fat. Eating more unsaturated fats than saturated fats can help lower blood cholesterol levels. Most unsaturated fats come from plant sources and include canola, vegetable and olive oil.

11 Diabetes and exercise Work up to at least 30 minutes of exercise a day, most days of the week. Regular physical activity helps to manage diabetes. People with diabetes should talk to their doctor or health care provider before starting any exercise plan. Some good ways to get exercise are to: Take a brisk walk (outside or inside on a treadmill). Go dancing. Take a low-impact aerobics class. Swim or do water aerobic exercises. Ice-skate or roller-skate. Play tennis. Ride a stationary bicycle indoors. Here are some ideas for being more active every day: Park the car farther away from your destination. Get on or off the bus several blocks away from your stop. Take the stairs instead of the elevator or escalator. Exercise while watching TV. Walk around while you talk on the phone. Play with the kids. Take the dog for a walk. Get up to change the TV channel instead of using the remote control. Work in the garden or rake leaves. Clean the house. Wash the car. Stretch out your chores. For example, make two trips to take the laundry downstairs instead of one. Park at the far end of the grocery store lot and walk to the store. At work, walk over to see a co-worker instead of calling or ing. Stretch or walk around instead of taking a coffee break and eating. A pre-workout diabetes checklist It s important to keep in mind that if you have diabetes, you always need to be prepared before exercising. Always speak with your diabetes care team prior to starting a new fitness routine. Once you ve been given the all clear for your workout regimen, ask yourself these questions prior to each workout. What s my blood glucose level? Before exercising, it s very important that you check your blood glucose to determine if it is low, high, or in a normal range. If it is low, have a snack with 15 grams of carbohydrate and wait 15 minutes for your glucose to return to normal. Check your glucose again in 15 minutes to make sure your glucose is rising. If it isn t, continue to follow the 15/15 rule (15 grams of carbohydrate for hypoglycemia and check glucose again in 15 minutes) until it is in a normal range. If your glucose is high (240 or more), check for ketones; if ketones are present, don t exercise. 9

12 Do I have fast-acting snacks in case of hypoglycemia (low glucose)? Always be prepared for these situations when you re about to work out. Many drugstores carry fast-acting glucose snacks that rapidly increase your blood sugar and many of them are small enough to take to the gym or outside (depending on where you work out). Do I have my glucose meter with me? Bring your glucose meter, since you ll want to check your glucose after every 30 minutes of exercise. Is there something I am wearing that identifies me as a person with diabetes? Wear a necklace, bracelet, or carry something that identifies you as a person with diabetes. Also, indicate whether or not you take insulin and list an emergency contact as well. Are my shoes comfortable? When you have diabetes, finding comfortable footwear that s also supportive is key to avoiding foot problems in the future. It s also part of a healthy program for caring for your body. If you re going outdoors for an extended period of time, you must be sure to bring extras of all of your supplies and also be sure to bring an emergency glucagon kit. Let the people you re with know that you have one, and show them how to use it. Lastly, make sure all of your insulin stays cool during outdoor activities because insulin that gets too hot will spoil. Diabetes medicines You have learned that diabetes is a disease in which the body does not make or fully use insulin. Insulin is a hormone that is needed to change sugar, starches and other food into energy needed for daily life. Diabetes cannot be cured, but it can be managed. People with type 1 diabetes must take insulin shots to live because their bodies cannot produce insulin. Although most people with type 2 diabetes take either diabetes pills, insulin, or both, a few can keep their blood sugar in control with careful meal planning and regular activity. Taking more medicine or different medicine doesn t always mean your diabetes has gotten worse. Remember, the key is controlling blood sugar levels and changing medicines may help you do that. All diabetes medicines work to lower blood sugar. Each kind of diabetes medicine works in a different way. Sometimes more than one medicine is needed. Talk with your doctor to learn more about your medicines. Insulin If pills alone don t work, your doctor may have you take insulin injections. Over the last decade, several new insulin options have been developed that make it easier to use. Your diabetes care team now has more choices when it comes to creating a treatment plan just for you. Other diabetes medicines (taken by shots): Amylin agonists: work with your body s own insulin to control your blood sugar, especially after meals. Your medicine: 10

13 Incretins help the body release more of its own insulin. Your medicine: Remember: All medicines can have side effects. Do not start or stop taking any medicine without talking to your doctor first. Over time, your doctor may ask you to: Take more of the same medicine. Change your medicine to a new one. Add another medicine. Talk with your doctor about what medicine is best for you. Taking your medicine the way your doctor tells you can help you stay healthy. Be informed Some things you should know about your medicine: The name of each medicine and why you should take it. When and how much medicine you should take. If you should take them with food or on an empty stomach. Any side effects medicines may cause and what you should do about them. If you should stay away from some foods, other medicines, or alcohol. What to do if you miss a dose. How to store the medicine. How long your supply will last and how to get more. Make a list of your medicines Keep track of how to take your medicines and take it with you when you see your doctor. Tips to help you remember Ask family or friends to help. Use a pill box organizer. Set an alarm clock. Take your pills at the same time you do something else, such as brushing your teeth. Make a chart to check off when you have taken your medicine. Tell your doctor if you take other over-the-counter medicines you get at a pharmacy or vitamin store. Always talk to your doctor before you stop taking any medicine or start taking a new one. Low blood sugar (hypoglycemia) When your blood sugar falls below 70 mg/dl, you may have low blood sugar (hypoglycemia). When this happens, most people don t feel well and can have physical and emotional symptoms. These symptoms can come on quickly. Hypoglycemia is usually easy to treat. However, if it is not dealt with right away, the symptoms can get worse, including passing out or having convulsions. Talk with your doctor about what steps to take in case of a low blood sugar emergency and most importantly, how to avoid one. Hypoglycemia can happen when a person eats too little food, takes too much insulin or diabetes medicine, or is more physically active than usual. Often hypoglycemia happens suddenly and sometimes there is no explanation for why it occurs. When this happens, a person may have some, or all of these symptoms: Shaking Fast heartbeat Sweating Dizziness Feeling anxious Hunger Vision problems Weakness or feeling very tired Headache Feeling irritable Since hypoglycemia can be lifethreatening, it must be treated immediately! People with diabetes should work with their doctor or health care provider to develop a plan to treat hypoglycemia. 11

14 General guidance for treating hypoglycemia 12 If you have any of the symptoms of hypoglycemia, check your blood glucose. If the level is 70 or below, have one of the following quick acting sources of sugar right away: Three or four glucose tablets One serving of glucose gel (equal to 15 grams of carbohydrate) 1/2 cup (4 ounces) of any fruit juice One cup (8 ounces) of fat-free milk 1/2 cup (4 ounces) of a regular (not diet) soft drink Five or six pieces of hard candy One tablespoon of sugar or honey After 15 minutes, check your blood glucose again to make sure your level is 70 or above. Repeat these steps as needed. Once your blood glucose is stable, if it will be at least an hour before your next meal, have a snack. If you take diabetes medicines that can cause hypoglycemia, always carry a quick acting source of sugar for emergencies. It s a good idea also to wear a medical identification bracelet or necklace.you can usually prevent hypoglycemia by eating regular meals, taking your diabetes medicine, and checking your blood glucose often. Checking will tell you whether your glucose level is going down. You can then take steps, like drinking fruit juice, to raise your blood glucose. Most hypoglycemic reactions are mild and can be resolved within 10 to 15 minutes of receiving the treatments listed above. Sometimes, hypoglycemia can happen rapidly and may progress to a more serious stage where a person becomes unconscious, has a seizure, or is unable to swallow. If this happens, nothing should be given by mouth. This is an emergency situation and 911 should be called immediately. What is glucagon? Glucagon is a medicine that raises blood sugar and is important therapy for hypoglycemia. It is given as a shot just like insulin. If your blood sugar level gets so low that you pass out or can t swallow, you will need a glucagon shot. If you take insulin, your family, friends, co-workers, and exercise partners should learn how to give you a shot of glucagon. When you need glucagon, you may not be able to give it yourself. Ask your doctor about glucagon, because you will need a prescription for it. When others should inject you with glucagons Family, friends, co-workers, or exercise partners should give you glucagon if: You are unconscious. You are unable to eat sugar or a sugar-sweetened product. Whenever possible, it is important to test blood sugar before giving glucagon Glucagon is a safe drug. There is no danger of taking too much. However, it is for emergencies and should be used only under the direction of your doctor. As with hypoglycemia, nausea and vomiting may occur. Generalized allergic reactions have also been reported with glucagon use. Hyperglycemia (high blood glucose) If your blood glucose stays over 180, it may be too high. High blood glucose means you don t have enough insulin in your body. High blood glucose, or hyperglycemia, can happen if you miss taking your diabetes medicine, eat too much, or don t get enough exercise. Hyperglycemia can happen when diabetes medicine or activity level is not balanced with food intake. It

15 can also happen because of stress or illness. When this happens, a person may have some, or all of these symptoms: Extreme thirst Having to urinate often Dry skin Hunger Blurred vision Wounds that are slow to heal Sometimes, the medicines you take for other problems cause high blood glucose. Be sure to tell your doctor about other medicines you take. Having an infection, being sick, or under stress can also make your blood glucose too high. That s why it s very important to check your blood glucose and keep taking your diabetes medicines when you re sick. If you re very thirsty and tired, have blurry vision, and have to go to the bathroom often, your blood glucose may be too high. Very high blood glucose may also make you feel sick to your stomach. If your blood glucose is high much of the time, or if you have symptoms of high blood glucose, call your doctor. You may need a change in your diabetes medicines or a change in your meal plan. It s important to treat hyperglycemia as soon as you detect it. If you fail to treat hyperglycemia, a condition called ketoacidosis (diabetic coma) could occur. Ketoacidosis develops when your body doesn t have enough insulin. Without insulin, your body can t use glucose for fuel. So, your body breaks down fats to use for energy. When your body breaks down fats, waste products called ketones are produced. Your body cannot tolerate large amounts of ketones and will try to get rid of them through the urine. Unfortunately, the body cannot release all the ketones and they build up in your blood. This can lead to ketoacidosis. Ketoacidosis is life-threatening and needs immediate treatment. Symptoms include: Shortness of breath Breath that smells fruity Nausea and vomiting A very dry mouth Talk to your doctor about how to handle this condition Often, you can lower your blood glucose level by exercising. However, if your blood glucose is above 240 mg/dl, check your urine for ketones. If you have ketones, do NOT exercise. Exercising when ketones are present may make your blood glucose level go even higher. You ll need to work with your doctor to find the safest way for you to lower your blood glucose level. Cutting down on the amount of food you eat might also help. Work with your dietitian to make changes in your meal plan. If exercise and changes in your diet don t work, your doctor may change the amount of your medication or insulin or possibly the timing of when you take it. 13

16 Possible long-term problems Many long-term problems with diabetes are strongly related to high blood sugar levels. By keeping your blood sugar as close to normal as possible, you may lower your chances of having the following: Eye problems Sexual problems Kidney disease Frequent infections Surgical loss of a foot or leg A heart attack or stroke Nerve damage Kidney disease Diabetes can also damage the small blood vessels in the kidneys. This kind of kidney damage is called nephropathy, and has no early symptoms. When this condition occurs: Waste products are kept in the body instead of leaving with the urine. Important nutrients like protein that should stay in the body are flushed away. Wastes continue to build up in the bloodstream. If the damage continues, the kidneys may fail completely. If your kidneys fail, you must depend upon a special filtering machine to remove impurities from your bloodstream. However, kidney damage can be found at an early and treatable stage with a simple office test that detects small amounts of protein in the urine. This test is called a microalbumin screen. You should have this test done at least once a year. With diabetes, you can have nerve damage Having high blood sugar for a long time can damage your nerves and lead to a number of problems. Nerve damage in your feet and hands may cause: Tingling Pain Numbness Weakness Nerve damage in other parts of the body may cause: Bladder problems Problems with sexual function Feeling dizzy or faint Too much or too little sweating Throwing up, diarrhea, or constipation Feeling full or sick to your stomach Skin problems are more common for people with diabetes Some of the skin problems include: Itchy skin Styes on eyelids Boils or infections at hair roots Infections deep under the skin or at nails Jock itch, athlete s foot, ringworm, and vaginal infections Yeast infections vaginal or between pads of skin Mouth and tongue sores (thrush) Things you can do to help avoid nerve damage and skin problems Control your blood sugar Keep skin clean and dry Keep your home more humid in Do not smoke Treat cuts right away cold, dry weather Limit how much alcohol Don t take very hot baths you drink and showers Take care of your feet Don t let your skin get dry 14

17 What to know about blood pressure High blood pressure (hypertension) makes your heart work harder and can damage blood vessels. This makes it more likely that you could have a heart attack, a stroke, eye problems, or kidney problems. Two out of three adults with diabetes may have high blood pressure. High blood pressure is a silent problem There may be no signs of high blood pressure. You may not know you have it until your doctor checks your blood pressure. Keep blood pressure below the goal to help lower the chance of heart problems Ask your doctor how you can control your blood pressure. What the numbers mean Blood pressure is measured with two numbers, such as 140/80 mmhg. The first number ( 140 ) is the pressure of blood coming out of the heart into the blood vessels, known as systolic pressure The second number ( 80 ) is the pressure of the blood in the vessels between heartbeats, known as diastolic pressure The American Diabetes Association and the National Institutes of Health say: The blood pressure goal for people with diabetes should be below 140/80 mmhg Some ways to help lower blood pressure include: Make healthy food choices and use less salt Try to lose weight Get physical activity Stop smoking If your blood pressure is high, your doctor may have you take blood pressure medicine to lower your blood pressure and help prevent heart problems. Talk to your doctor about a blood pressure plan that is right for you. What to know about cholesterol There are good and bad kinds of cholesterol Cholesterol is made by your body and comes from food you eat. LDL cholesterol Bad cholesterol that can narrow or block your blood vessels and may lead to heart attack or stroke. HDL cholesterol Good cholesterol that helps keep your blood vessels from being blocked. Triglycerides are like cholesterol and can also raise your chance of a heart attack or stroke. You can control your 15 cholesterol.

18 American Diabetes Association goals: MEN Women My Goal Bad LDL cholesterol under 100 mg/dl under 100 mg/dl Bad triglycerides under 150 mg/dl under 150 mg/dl Good HDL cholesterol above 40 mg/dl above 50 mg/dl Your doctor will help you set goals that are right for you. Be good to your heart! Reach your Make good choices to help con- To lower your risk for heart cholesterol goals. Try to: trol blood sugar, blood pressure, disease and stroke: Keep your bad cholesterol low and cholesterol Take medicines as your doctor Keep your good cholesterol Eat less fatty foods tells you high Use less salt Ask your doctor if taking aspirin, Learn what foods are better or Eat five servings of fruits and such as low-dose aspirin, is right worse for you vegetables a day for you Be more activefind an activity Cook the low-fat or no-fat way Ask your doctor about how that is right for you Be active other changes in the way you Take cholesterol-lowering Get to and stay at a healthy live can help medicines if your doctor tells weight you to Quit smoking Stop smoking 16 Talk to your doctor before starting an exercise plan. Diabetes and the risk of heart disease or stroke If you have diabetes, you are more likely to have: Heart disease Heart attack Stroke You could even die from heart disease or stroke. But you can do things to help prevent heart disease! Meeting your goals The American Diabetes Association says you should try to reach these goals. Work with your doctor to set your own goals. A1C test goal: Below 7% My goal: % Test at least twice a year, or every three months if you are not meeting your goals. Blood pressure goal: Below 140/80 mmhg My goal: mmhg Check at every regular diabetes visit. LDL cholesterol goal: Below 100 mg/dl My goal: mg/dl Check at least once a year, or more often if your doctor tells you to.

19 General health care Taking extra good care of yourself is important when you have diabetes. Dental care High blood sugar increases your risk for tooth and gum problems. To help prevent these problems, you should: Brush and floss every day. See your dentist at least every six months. Tell your dentist you have diabetes. Sexual dysfunction and diabetes Sexual problems (sexual dysfunction) are common among people with diabetes, particularly in older men who have had diabetes for years. In addition, many medical experts believe that women with diabetes experience sexual difficulties as a result of complications from the disease. Tips for foot care when you have diabetes For people with diabetes, practicing proper foot care is an important step toward successful diabetes management. One in four people with diabetes will develop foot complications. Make foot care a part of your daily routine to avoid serious problems such as neuropathy, vascular disease, and injury. Check. Check your feet in the morning and at night before you go to bed. Look for anything out of the ordinary, such as areas of redness, blisters, or cuts. If you discover a wound, pay close attention to be sure it is healing properly. Report any problems to your health care provider. Protect. Wash your feet every day with mild soap in tepidnot hotwater. Cut your toenails straight across, not into corners. Prevent. You can help prevent the risk of injury to your feet by selecting comfortable footwear. Wear socks and shoes. Consult. Take your shoes and socks off at every doctor visit to remind your health care provider to check your feet. Patients with diabetes must have a foot exam at least once a year. People who experience sexual difficulties can lead more enjoyable, fulfilling sexual lives by learning about common causes and symptoms of sexual difficulties, treatment options, and how to talk it over with a doctor or mate. 17

20 Sick days: Special Information Sick day rules Always take your insulin or diabetes pills. Test your blood sugar before each meal and at bedtime. Test your urine for ketones if blood sugars are greater than 240 mg/dl. Follow your meal plan if you can eat. If you can t eat, you should try to take in at least 4 oz. of a sugar-containing beverage every hour to keep your blood sugar from falling too low. Call your doctor when: You are vomiting and unable to keep down foods, liquids, or diabetes pills. Your illness lasts longer than 24 hours. Ketones are present in your urine. All blood sugars are higher than 240 mg/dl for more than one day. When the above symptoms occur, insist on speaking to your doctor or nurse to let them know something is wrong. You are in control The more you know about diabetes and act upon that knowledge, the healthier you can be. We hope that you ll make good use of this important information. This information will help you to manage your diabetes. It is good to catch problems early Tell your doctor if you have any signs of nerve damage and skin problems. Repeated infections High blood sugar levels can reduce the body s ability to fight off many kinds of infections, including the flu. Check with your doctor about getting a flu vaccine. People with diabetes are more prone to developing: Skin infections Bladder infections Vaginal yeast infections Tooth and gum infections Tips for dealing with diabetes Learning to deal with diabetes can be difficult. At first, you may feel angry, afraid, frustrated, guilty, or depressed. These feelings are quite normal. Expressing how you feel may help you to work through these emotions. Some people feel most comfortable talking with family and friends about their feelings. Others find comfort in talking with their health care team or a diabetes support group. The important thing is to talk about how you are feeling. Remember that you re not alone. You re part of a team committed to managing your diabetes. Never forget that diabetes is challenging. Celebrate your successes instead of striving for perfection. Keep track of your successes and work to repeat them. When things don t turn out the way you planned, ask yourself, What can I learn from this? By learning and using your knowledge to meet each new challenge, you ll gain confidence in your ability to take care of yourself. One day, instead of simply coping with your diabetes, you ll find that you truly are Managing Your Diabetes. 18

21 When someone you care about has diabetes Diabetes can be hard for people who have it. Here are some ways you can help make it easier for a family member or friend with diabetes. Learn about diabetes Ask the doctor or nurse how you can learn more. Go to a diabetes class. Read pamphlets containing diabetes information. Ask what you can do Find out what your loved one needs and ways you can help. You might offer to: Go along to the doctor. Go walking or dancing with him/ her. Cook a good, healthy meal. Watch out for other problems with diabetes, such as not seeing clearly, foot or skin problems, or depression. Talk about how you may feel so it can help both of you. If your family member gets very sick, you might be able to take time off from work to help. Ask your employer if you are covered by the Family and Medical Leave Act. Get help You don t have to do this alone. See if there is a diabetes support group where you live. Talk to the doctor if your loved one has problems or gets depressed. You can also get help from these groups: Diabetes resources Use these resources for more information about diabetes, including treatment, blood sugar monitoring, and the importance of healthy living. National organizations American Diabetes Association* DIABETES National Institute of Diabetes and Digestive and Kidney Diseases National Diabetes Education Program of the National Institutes of Health Centers for Disease Control and Prevention (CDC) CDC-DIAB Books by the ADA American Diabetes Association Complete Guide to Diabetes, 4th Edition 101 Tips for Simplifying Diabetes 101 Tips for Coping with Diabetes 101 Medication Tips for People with Diabetes 101 Nutrition Tips for People with Diabetes 101 Tips for Improving Blood Sugar, 2nd Edition 101 Foot Care Tips for People with Diabetes American Heart Association* AHA-USA *These organizations offer information on support groups and/or local resources. 19

22 Your diabetes care team People with diabetes work with an extensive diabetes care team, which may include a primary doctor, dietitian, diabetes educator, eye doctor, foot doctor, dentist and possibly an exercise trainer. But remember, you are the most important member of your diabetes care team. Your health care team is available to help you manage your diabetes and maintain your good health. Who s on your diabetes care team? According to the American Diabetes Association, your diabetes care team should include: You: You are the most important member of your diabetes care team. Only you know how you feel. Your diabetes care team will depend on you to talk to them honestly and supply information about your body. Monitoring your blood glucose is an important part of effective therapy. It tells your doctors whether your treatment is working. Primary doctor: Your primary care doctor is the doctor you see for general checkups and when you get sick. This person is usually an internist or family medicine doctor who has experience treating people with diabetes. Endocrinologist: An endocrinologist/diabetologist should also be seen regularly. An endocrinologist is a doctor who has special training and experience in treating people with diabetes. Dietitian: A registered dietitian is trained in the field of nutrition. Because food is a key part of your diabetes treatment, a dietitian is very important. Your dietitian helps you figure out your food needs based on your weight, lifestyle, medication and other health goals (such as lowering blood fat levels or blood pressure). Nurse educator: A nurse/diabetes educator or diabetes nurse practitioner is a registered nurse with special training and background in caring for and teaching people with diabetes. Nurse educators often help you learn the day-to-day aspects of diabetes self-care. Eye doctor: This doctor is another key member of your diabetes care team because diabetes can affect the blood vessels in the eyes. The eye doctor will be either an ophthalmologist (doctor who can treat eye problems both medically and surgically) or an optometrist (someone who is trained to examine the eye for certain problems, such as how well the eye focuses; optometrists are not medical doctors). You should see your eye doctor at least once a year. Podiatrist: This health professional is trained to treat feet and problems of the lower legs. For anyone with diabetes, foot care is important. Podiatrists have a Doctor of Podiatric Medicine degree from a college of podiatry. They have also done a residency (hospital training) in podiatry. Dentist: People with diabetes are at somewhat greater and earlier risk of gum disease. The excess blood glucose in your mouth makes it a nice home for bacteria, which can lead to infection. You should see your dentist every six months. Be sure to tell your dentist that you have diabetes. 20

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