Living WITH TYPE 2 DIABETES

Transcription

1 Living WITH TYPE 2 DIABETES S TAY H E A LT H Y A N D F E E L B E T T E R B Y M A N A G I N G Y O U R D I A B E T E S B R O U G H T TO YO U BY T H E O DS H E A LT H CO A C H I N G P R O G R A M

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3 W H AT S I N S I D E Chapter 1: Facts about type 2 diabetes Chapter 2: Who is on your team? Chapter 3: High and low blood glucose Chapter 4: Complications of uncontrolled diabetes Chapter 5: Diet for type 2 diabetes Chapter 6: Physical activity Chapter 7: Medication Chapter 8: Staying on track Chapter 9: Have a plan for sick days Chapter 10: Dental care, eye care and foot care Chapter 11: Your action plan Notes This workbook is meant to be a reference to help you live better with type 2 diabetes. It is not meant to be used in place of consultation from your healthcare provider.

4 Chapter 1: Facts about type 2 diabetes W H AT Y O U L L L E A R N I N T H I S C H A P T E R : > What is type 2 diabetes? > Symptoms of type 2 diabetes WHAT IS TYPE 2 DIABETES? Type 2 diabetes is a condition in which your body s cells become resistant to insulin. Insulin is a hormone produced by your pancreas and is needed to get glucose (sugar) into the cells of your body to provide fuel. The pancreas produces increasing amounts of insulin as the body becomes more and more resistant to the effect of insulin. Eventually, the pancreas becomes exhausted and cannot make enough insulin to keep up with the demand. Without insulin, glucose stays in your blood and does not get used. Over time, the excess glucose that is not removed can cause damage to your blood vessels. The unused glucose is removed from your body through the kidneys in the urine. This robs your body of energy. To correct this, people with type 2 diabetes may need to change their diets, take oral medication and/or inject insulin to help move glucose into the cells. Type 2 diabetes usually occurs in people over the age of 40. You can work to help control it through diet, physical activity, stress reduction and medication. MY BLOOD GLUCOSE LEVEL Diabetes is diagnosed when your fasting plasma glucose is 126 mg/dl or above and is confirmed by repeating the test on a different day. Blood glucose levels of 100 mg/dl to 125 mg/dl are indicators of pre-diabetes. M Y FA S T I N G G L U C O S E L E V E L I S : This level indicates: Diabetes THE MOST COMMON SYMPTOMS OF TYPE 2 DIABETES INCLUDE: Frequent urination Excessive thirst Extreme hunger but loss of weight Blurred vision Nausea and vomiting Irritability and mood change Pre-diabetes PRE-DIABETES In pre-diabetes, blood glucose levels are higher than normal, but not high enough to be diagnosed as diabetes. Many people with pre-diabetes develop type 2 diabetes within 10 years, unless they properly manage their pre-diabetes. Modest weight loss and moderate physical activity can delay or prevent type 2 diabetes. 4

5 Chapter 2: Who is on your team? W H AT Y O U L L L E A R N I N T H I S C H A P T E R : > Who makes up your diabetes healthcare team > How to communicate with your healthcare providers YOUR HEALTHCARE TEAM You are not alone in dealing with diabetes. Your diabetes management team is here to help you. This group of professionals will work closely with you and your family as you learn how to get your diabetes under control. MY TEAM List the names and contact information of your healthcare providers below: Primary care provider: Profession Primary care provider Diabetes educators Ophthalmologist Podiatrist Dentist Social worker Description Your main doctor (a general practice or family physician, internist or pediatrician) who provides general medical care for you, including annual physicals and checkups. This doctor manages your overall care and will provide referrals as needed. Nurses and dietitians who teach you about diabetes and how to manage it with meal planning and medications (if needed). A doctor who specializes in eye care and diseases of the eyes. Some people with diabetes have problems with their eyes (including glaucoma, retinopathy and cataracts). A doctor who provides foot care and treats foot problems. Diabetes causes decreased circulation and feeling in the feet. This can lead to sores and blisters that may lead to a foot ulcer. A doctor who provides regular dental care and diagnoses and treats gum disease. Diabetes can cause dental cavities, which may lead to tooth decay and possible infections. A person who specializes in finding and giving information on diabetes-related services. Diabetes educators: Ophthalmologist: Podiatrist: Dentist: Social worker: Other specialists: Your primary care provider may recommend other specialists, including an endocrinologist or orthopedist. FLIER: C O M M U N I C AT I O N W I T H Y O U R P R O V I D E R S You will receive a flier in the mail that includes questions to ask your provider about your care. Take it with you the next time you have an appointment. It s important to work with your healthcare provider to create a treatment plan that feels right for you. You can find more questions for your healthcare team on page 26. 5

6 Chapter 3: High and low blood glucose W H AT Y O U L L L E A R N I N T H I S C H A P T E R : > What you need to know about hypoglycemia > What you need to know about hyperglycemia WHAT IS HYPOGLYCEMIA? Glucose (sugar) is the body s main source of energy. You get most of the glucose you need from the carbohydrates (sugars and starches) you eat. As you digest your food, glucose is absorbed into your blood and sent to your cells. Sometimes, the level of glucose in your blood gets too low. This is called hypoglycemia, or low blood glucose. It can happen when you don t manage your diabetes. With low blood glucose, you don t have enough energy. Hypoglycemia occurs when the level of glucose in the blood drops to 70 mg/dl or lower. WHAT CAUSES LOW BLOOD GLUCOSE? Extra physical activity or unplanned activity An insulin dose that is too high Missing a meal or snack or eating less than usual Eating a meal or snack later than usual HOW YOU MIGHT FEEL Low blood glucose can happen fast. Know and teach others around you the following signs. P H Y S I C A L C H A N G E S : Shakiness Fatigue Dizziness Nervousness Slurred speech Sweatiness Hunger Weakness Headache B E H AV I O R A L C H A N G E S : Confusion Unusual or inappropriate actions Combative actions Passing out (in severe cases) Irritability WHAT TO DO: 1. Check blood glucose. 2. If it is low (70 mg/dl or lower), take some form of sugar right away. Each of the following provides 15 grams of fast carbohydrates: 4 ounces of juice or soda pop 3-4 glucose tablets 8 ounces of milk 1 tablespoon of honey or sugar 3. Wait 15 minutes and then recheck blood glucose. If it is still low (70 mg/dl or lower), take another 15 grams of fast carbohydrates. Check your blood glucose level again after 15 more minutes. If you still don t feel better, call your healthcare provider. Following your diabetes management plan closely is the best way to prevent low blood glucose. If you are taking insulin, you may have occasional low blood glucose. To avoid problems: Know what lowers your blood glucose Know your symptoms Have snacks on hand Know your target blood glucose range 6

7 My healthy blood glucose range is: Before meals: to Two hours after meals: to At bedtime: to WHAT IS HYPERGLYCEMIA? Your body uses insulin to help glucose (sugar) get into your cells to be used for energy. When you have diabetes, your body does not have enough insulin or has trouble using the insulin it has (insulin resistance). When glucose builds up in your blood rather than going into your cells, you experience hyperglycemia (high blood glucose). WHAT CAUSES HIGH BLOOD GLUCOSE? Eating too much Irregular timing of meals Stress, both physical and emotional Less physical activity or more activity than usual Not taking oral medication insulin or taking less than you need Sickness or infection Taking other medicines that affect your blood glucose levels (antibiotics and steroids) HOW YOU MIGHT FEEL Being familiar with the signs of high blood sugar will help you know when to take action. Know and teach others around you these signs: PREVENTING HIGH BLOOD GLUCOSE Maintain a balanced lifestyle and take precautions to prevent a spike in your blood glucose. Follow your meal plan and eat on time Don t skip meals or overeat Check your blood glucose as needed (before and after physical activity) Take your medication as prescribed by your diabetes management team Keep a regular physical activity routine Know your target blood glucose range Teach others who spend time with you to recognize hypoglycemia and hyperglycemia signs and symptoms HEMOGLOBIN A1C The A1c test reflects average blood glucose levels for the past two or three months. Check with your healthcare provide to see what the recommendations are for how often you should have your A1c checked and what level is desired. A1c Level Average glucose numbers Self-test Being very thirsty Having to urinate often Feeling very tired or sleepy Stomach pains or nausea 7

8 Chapter 4: Complications of uncontrolled diabetes W H AT Y O U L L L E A R N I N T H I S C H A P T E R : > The complications of uncontrolled diabetes > How you can prevent these complications Diabetes is a life-long condition with serious associated complications. With proper care, you can prolong the development of these complications. HEART DISEASE AND STROKE Two out of three people with diabetes die from heart disease and stroke. 1 In addition to controlling blood glucose, people with diabetes should also manage their blood pressure and cholesterol to reduce their risk. You can help reduce your risk by making healthy lifestyle choices, such as eating a healthy diet and regular physical activity. Taking medication also can help. If you smoke, get help to quit. Talk with your health coach or provider about resources. develop cataracts. 1 Glaucoma occurs when pressure builds in the eye and damages the retina and nerve. The risk of glaucoma increases the longer you have diabetes, as well as with age. People with diabetes tend to get cataracts at a younger age and have them progress faster. With cataracts, the eye s clear lens gets cloudy, blocking light. Diabetic retinopathy refers to disorders of the retina caused by diabetes. Your blood sugar level, blood pressure, how long you have had diabetes and your genes can all affect whether you develop retinopathy. Most people with type 2 diabetes develop nonproliferative retinopathy, which often does not exhibit any symptoms. Your retina can be badly damaged even before you notice any change in vision. KIDNEY DISEASE Your kidneys contain millions of tiny blood vessels that remove waste from your blood. High levels of blood sugar can damage these blood vessels and cause the kidneys to fail, losing their ability to filter out waste products. This results in kidney disease and possibly kidney failure a very serious condition that requires dialysis or transplant. Keeping blood sugar levels in the target range will help prevent kidney disease. EYES AND VISION LOSS Diabetes can cause eye vessel damage and may lead to blindness. People with diabetes have a higher risk of blindness than people without diabetes. It is important that people with diabetes get routine eye exams. Early detection and regular eye exams (every year) can save your sight. People with diabetes are 40 percent more likely to suffer from glaucoma and 60 percent more likely to 8 1 American Diabetes Association

9 TEETH AND GUM PROBLEMS People with diabetes have a higher risk of gum problems. To reduce your risk, first control your blood glucose level. You also should brush your teeth twice a day, floss every day, look for early signs of gum disease and visit your dentist at least twice a year. Read more about dental care in Chapter 10. NERVE DAMAGE One of the most common complications of diabetes is diabetic neuropathy. Neuropathy is damage to the nerves that run throughout the body, connecting the spinal cord to muscles, skin, blood vessels and other organs. Generally, your extremities (such as arms and legs) are affected, but you may experience problems with digestion as well. About half of all people with diabetes have some form of nerve damage. Neuropathy is more likely the longer you have diabetes. You can help prevent or delay nerve damage by keeping your blood glucose levels within the target range and by following a healthy diet, getting regular physical activity and taking your medications. FOOT PROBLEMS Nerve damage, poor blood flow and changes in the shape of your feet or toes can cause a variety of foot problems. Some of the more serious complications may even lead to amputation. You can reduce your risk of complications by inspecting your feet every day and seeking care early if you suffer a foot injury. For more information, see Chapter 10. GASTROPARESIS Gastroparesis occurs when the stomach takes too long to empty its contents. This happens when nerves to the stomach are damaged or stop working and the movement of food is slowed or stopped. Diabetes can damage the stomach nerves if blood glucose levels remain high over a long period of time. High blood glucose causes chemical changes in nerves and damages the blood vessels that carry oxygen and nutrients to nerves. DEPRESSION Feeling a sadness and hopelessness that won t go away for most of the day for two weeks or more is a sign of serious depression. Studies show that people with diabetes have an increased risk of depression. Managing diabetes may cause you to feel overwhelmed or alone because of the extra work involved. You might feel out of control when trying to keep blood sugar levels in the normal range or when dealing with complications such as nerve damage. Depression can prevent you from taking good care of yourself. Below is a list of symptoms that might indicate depression. Take a look at the list and check the boxes that apply to you. Recently, I have experienced: A loss of pleasure in the things I used to enjoy A change in my sleep patterns A change in my appetite Trouble concentrating A loss of energy Nervousness Guilt or a feeling of burden to others Morning sadness Suicidal thoughts If you have three or more of these symptoms or if you have just one or two but have been feeling bad for two weeks or more, seek help. Talk with your healthcare provider to see if there s a physical cause for your depression, such as thyroid problems or side effects from medications. Your healthcare provider may refer you to a mental health professional or try antidepressant medications. Make sure you discuss how antidepressants might affect your blood sugar levels. 9

10 STRESS Stress is your body s response to change, and everyone experiences this differently. One person might find a situation stressful that is enjoyable to someone else such as driving or rock climbing. Most people cannot avoid stress completely. We have busy lives, full of challenges and unexpected events that can be difficult. Some stress is actually good for us, such as when we work to overcome fears or accomplish goals speaking in public, for example. And some stress is actually fun like riding a roller coaster or watching a scary movie. However, some stress makes your heart work harder. It can raise blood pressure and cholesterol. It s important to learn healthy ways of coping with stressful situations. Some people deal with stress by smoking a cigarette or binge eating. Neither of these approaches is good for your heart. Other people respond to stress with anger; these people tend to have more heart attacks. Here are some tips for reducing the effects of stress: Balance work and play every day. Don t stuff your emotions talk to a friend or family member about how you feel. Laugh more. Be physically active. Meditate or breathe deeply for 15 minutes each day, thinking about peaceful things. Look for the positive side in all situations. Limit your time spent in situations that, or with people who, upset you. Don t take on more than you can handle. Learn to say no to requests that you know will be stressful or that will cause you to be too busy. Limit alcohol, don t overeat and don t smoke. How can you tell if your body is stressed? This might seem like an obvious question, but sometimes stress sneaks up on us. Stress can affect you in a variety of ways: You might feel angry, afraid, excited or helpless. You might have trouble sleeping. It can give you aches and pains in your head, neck, jaw and back. It can lead to excessive eating, drinking, smoking or drug use. You may feel no effects at all, even though your body is experiencing it. While you cannot change the outside forces that make you feel stressed, you can change the way you react to them. Try to accept the things you cannot change instead of worrying about how to fix them. 10

11 SLEEP Getting a good night s sleep is important for overall good health, diabetes and heart health in particular. New research is showing that poor-quality or not enough sleep may negatively affect your blood sugar and put you at a higher risk for heart disease. Here are some tips for how you can improve you sleep patterns. 1. Don t go to bed unless you are sleepy. Read a book, listen to soft music or browse through a magazine if you re not sleepy at bedtime. Find something relaxing, but not stimulating, to take your mind off of worries about sleep. This will relax your body and distract your mind. 2. If you are not asleep after 20 minutes, get out of bed. Do something else that will make you feel relaxed in another room. Your bedroom should be where you go to sleep, not a place to go when you are bored. Once you feel sleepy again, go back to bed. 3. Begin rituals that help you relax each night before bed. Try a warm bath, light snack or a few minutes of reading. 4. Get up at the same time every morning. Do this even on weekends and holidays. 12. Do not go to bed hungry, but don t eat a big meal near bedtime either. 13. Avoid any tough physical activity just before bedtime. It's important to get physical activity on a regular basis, but do it earlier in the day. (Talk to your healthcare provider before you begin a physical activity program.) 14. Avoid sleeping pills, or use them cautiously. Most healthcare providers do not prescribe sleeping pills for periods of more than three weeks. Do not drink alcohol while taking sleeping pills. 15. Take time during the day to deal with things that make you worry. Discuss your concerns with a family member or friend. Express your feelings by writing in a journal. If your worries are a constant problem, then talk to a therapist. 16. Make your bedroom quiet, dark and a little bit cool. It should remind you of a cave. While this may not sound romantic, it seems to work for bats. Bats are champion sleepers. They get about 16 hours of sleep each day. 5. Get a full night s sleep on a regular basis. Get enough sleep so that you feel well-rested nearly every day. 6. Avoid taking naps if you can. If you must take a nap, try to keep it short (less than one hour). Never take a nap after 3 p.m. 7. Keep a regular schedule. Regular times for meals, medications, chores and other activities help keep your body s internal clock running smoothly. 8. Use your bed only for sleep and sex. 9. Do not have any caffeine after lunch. 10. Do not have a beer, a glass of wine or any other alcohol within six hours of your bedtime. 11. Do not have a cigarette or any other source of nicotine before bedtime. 11

12 Chapter 5: Diet for type 2 diabetes W H AT Y O U L L L E A R N I N T H I S C H A P T E R : > What carbohydrates are and how much of them to eat at a meal or as a snack WHAT ARE CARBOHYDRATES? Diabetes is often described as having too much sugar. Carbohydrates (starches), no matter what form, break down to sugar. Insulin is the key that unlocks the door to your cells, allowing sugar to enter the cell and be used by the cell to make energy. The following are examples of carbohydrate sources. Each portion has approximately 15 grams of carbohydrates: 1 slice of bread 1/2 cup of cereal, grits, oats, shredded wheat or sugar-frosted cereal 1 Tbsp of sugar, honey, jam or jelly, or syrup 1/3 cup cooked pasta or rice 1/2 cup starchy vegetables, such as corn, peas and yams 1/2 cup mashed or diced potato 3 cups popcorn (popped, no fat added) 3/4 oz. pretzels 3/4 cup blackberries, blueberries or fresh pineapple 1/2 large grapefruit or pear 1/2 cup apple, grapefruit or orange juice 1/3 cup grape or prune juice 1 cup milk 2/3 cup of reduced-fat yogurt, plain, or flavored with an artificial sweetener DIETARY PLANNING Your healthcare provider may refer you to a dietitian or nutritionist for dietary planning. Follow the food plan for breakfast, lunch, dinner and snacks. Eat meals at regular times. Counting carbohydrates is a great way to control your blood glucose levels each day. M Y D I E T I T I A N / N U T R I T I O N I S T I S : H E R / H I S C O N TA C T I N F O R M AT I O N I S : 1/3 cup baked beans 1/2 cup cooked beans (black garbanzo, kidney, pinto, white) 1 biscuit (2 1/2 inches across) 1 3/4 inch cube of cornbread 1 waffle or pancake (4-inches) 1/4 cup low-fat granola 1 small apple, banana or orange Recommended carbohydrates Breakfast, lunch and dinner Morning, afternoon and evening snacks grams per meal grams per snack 12

13 Work with your health coach or healthcare provider to fill in your specific guidelines: List additional instructions from your healthcare team in the space below: Carbohydrates for each meal/snack For breakfast, I will eat grams of carbohydrates. For lunch, I will eat grams of carbohydrates. For dinner, I will eat grams of carbohydrates. For morning. afternoon and evening snacks (circle which ones are in your meal plan), I will eat grams of carbohydrates. Food suggestions for everyday meal planning: Incorporate 20 to 35 grams or more of fiber into your diet every day. Fiber is in bran, whole grain breads, cereals, fresh fruits, oats, vegetables, beans, peas and seeds. Limit saturated fats and avoid trans fats. Choose nonfat dairy products and very lean meats. Eat only small amounts of animal fat. Avoid all hydrogenated fats as margarine and shortening. Use healthy oils such as olive and canola oil. Limit your cholesterol to 300 mg a day (200 mg if your cholesterol is high). Limit or avoid alcohol. Plan a low-sugar dessert alternative such as fruit. Monitor sodium intake 13

14 Chapter 6: Physical activity W H AT Y O U L L L E A R N I N T H I S C H A P T E R : > The benefits of physical activity > Safe physical activity > Special precautions while exercising PHYSICAL ACTIVITY AND YOUR HEALTH Physical activity can help control diabetes. It can help you feel good today and improve your health tomorrow. Physical activity can help you: Feel better about yourself Lower your blood glucose Lower your blood pressure Reduce or maintain weight Increase strength, energy and flexibility Reduce your need for oral or injected medications Improve your cholesterol Reduce stress Physical activity helps reduce the blood glucose in your body. Physical activity helps get the glucose into your cells to be used for fuel. In turn, this process may reduce your need for medication or insulin. Consult your healthcare provider before starting a new physical activity program. Ask if there are any specific precautions you should take. Physical activity can lower your glucose too much, which can be dangerous. Your healthcare provider also will advise you about when to check your blood glucose, how to take medication and whether you should take a sugar supplement with your physical activity routine. Check your blood glucose before and after being active. When you are active, bring a carbohydrate source (such as glucose gel, 6 7 hard candies or fruit juice). Ask your healthcare provider if you should have a glucagon emergency kit with you when you work out. If you work out with a buddy, both of you should know how to use this kit and how to check your blood glucose. Always carry identification or a medical alert bracelet while exercising. Once you talk to your healthcare provider and you are ready to begin, your ODS health coach can help you design a physical activity program if you do not have access to a trainer or other professional. DETAILS ABOUT YOUR PHYSICAL ACTIVITY ROUTINE Work with your healthcare provider or health coach to fill in the following information about your physical activity routine. My healthcare provider advises these precautions during physical activity: CALL YOUR DOCTOR IMMEDIATELY if you experience severe exhaustion, severe or prolonged shortness of breath, or chest pain during or after physical activity. 14

15 When exercising, I need to check my glucose: ( frequency) I need to take the following medication or sugar supplement when exercising: GENERAL GUIDELINES Warm up before exercising and cool down after exercising. Your goal is 150 minutes of moderate physical activity or 90 minutes of vigorous physical activity every week. Spread your activity over at least three days, going no more than two days in a row without being active. Try to include strength training three times a week. Good forms of aerobic physical activity for you may include: Walking Swimming Biking Dancing Special precautions: Drink plenty of water throughout the day. Stay hydrated during physical activity. Additional details about my physical activity program: Wear footwear that fits properly. Check for redness, cuts or sores on your feet after exercising. Learn what to eat, or do, if your blood glucose becomes too low or high after exercising. Know how to adjust your diet or medication on days when you are more or less active. Avoid exercising when the weather is too hot, humid or cold. Work with your health coach to list physical activities, such as walking, that you enjoy doing: 15

16 Chapter 7: Medication W H AT Y O U L L L E A R N I N T H I S C H A P T E R : > How to manage your prescriptions > How to keep track of your medications and how to use them If you take medication to help manage your diabetes, your doctor will schedule visits to monitor weight, blood pressure and pulse; discuss side effects; conduct laboratory tests; and answer your questions. Diabetes drugs approved by the Food and Drug Administration (FDA) should be used only as part of a program that includes diet, physical activity and behavioral changes. TAKE AN ACTIVE ROLE Prevent problems with drug interactions and misuse by following these tips: Fill all your prescriptions at the same pharmacy Make sure you understand how to take each medicine. Talk your doctor or your pharmacist Tell your doctor and pharmacist about all prescription and nonprescription medicines you take, including vitamins Tell your doctor and pharmacist if you have any medical conditions or allergies to any medicine or food, or if you are pregnant or breastfeeding Keep a list of all your medicines and their dosages and carry it with you. The list should include the name of the medicine, its purpose, when to take it and how to take it (i.e., with water or food, or on a full or empty stomach) Many types of medication are available to help control diabetes. Managing multiple medications can be difficult. Your health coach can help you with questions you might have. MEDICATION NAME DIRECTIONS 16

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18 Chapter 8: Staying on track W H AT Y O U L L L E A R N I N T H I S C H A P T E R : > What tests and exams you need > How often you need these tests and exams > Normal levels for these tests RECOMMENDED TESTS Once you are diagnosed with diabetes, your healthcare provider will want you to complete additional tests. The list below shows what tests are needed and the frequency of each. Every 3 months Regular office visit Hemoglobin A1C test (if your blood sugar is not stable) Blood pressure check Weight check Foot check Every 6 months Hemoglobin A1C test (if your blood sugar is stable) Dental exam Every year Physical exam Comprehensive foot exam Blood fats and cholesterol (if your levels are normal) Kidney tests Dilated eye exam Flu shot These recommendations are based on American Diabetes Association guidelines. Talk with your diabetes care team about what s right for you. YOUR CARDIOMETABOLIC HEALTH Your cardiometabolic health is a measure of your risk for diabetes and heart disease and is a good gauge of your overall health. Learn to recognize the following cardiometabolic health terms: Cardiometabolic risk is a set of factors that indicate your risk for heart disease and diabetes. Cholesterol is a collection of fat-like substances found in all your body s cells, including the blood. Cholesterol is also found in some foods you eat. Your body needs cholesterol to make some hormones and vitamins and to help you digest. Your body makes all of the cholesterol it needs. HDL (high-density lipoprotein) cholesterol is also known as good cholesterol. HDL helps remove cholesterol from your body, so the higher your HDL, the lower your chance for getting heart disease. LDL (low-density lipoprotein) cholesterol can lead to a buildup of cholesterol in your arteries and is sometimes called bad cholesterol. The higher your LDL level, the greater your risk for heart disease. Triglycerides are another form of fat in your blood. High triglyceride levels can increase your risk for heart disease. BMI: Body Mass Index is the measure of body fat based on height and weight that applies to adult men and women. To calculate your BMI, log on to your member site, myods at 18

19 Fasting plasma glucose (FPG) is the amount of sugar (glucose) in your blood after you haven t eaten for eight to 12 hours (usually overnight). A fasting plasma glucose test is used to diagnose pre-diabetes and diabetes. It also is also used to monitor people with diabetes. Blood pressure is the force of blood pushing against blood vessel walls. High blood pressure raises your risk for heart disease and stroke. The standard for blood pressure is 120/80. mg/dl (milligrams per deciliter) is the unit of measurement indicating the amount of a particular substance, such as cholesterol or glucose, in a specific amount of blood. Cardiometabolic health is determined by a set of conditions known as cardiometabolic risk factors. Keep track of your cardiometabolic risk factors and set goals for each category to prevent diabetes and heart disease. Risk factor Healthy range How am I doing? My goal Overweight/ obese BMI between 19 and 25 High LDL cholesterol Less than 100* Low HDL cholesterol Men more than 40 Women more than 50 Total cholesterol Less than 200* Triglycerides Less than 150* Physical inactivity At least 30 minutes of moderate activity, most days High blood pressure Less than 120/80 High blood glucose Fasting plasma glucose (FPG) less than 100* Smoking No safe level! *Cholesterol, triglycerides and blood glucose levels as measured in mg/dl. Other risk factors include age, race, gender and family history. Talk to your healthcare provider about how you can lower your cardiometabolic risk. 19

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21 HEALTH MONITORING Use this chart to keep track of important health statistics. With help from your healthcare provider or health coach, list your current results in the spaces below, and then talk with your healthcare team about where you should be headed in each category. Test Goals Date of visits Blood glucose Hemoglobin A1C % Fasting lipid profile (mg/dl) Total cholesterol HDL LDL Triglycerides Blood pressure (mmhg) Height Weight Microalbuminuria 21

22 Chapter 9: Have a plan for sick days W H AT Y O U L L L E A R N I N T H I S C H A P T E R : > How illness affects blood glucose control > What to do when you are sick BLOOD GLUCOSE AND ILLNESS Being sick with a cold, the flu or other illness puts stress on the body. When you are sick, your body releases stress hormones into your bloodstream. These hormones can cause blood glucose levels to rise and can interfere with how insulin lowers blood glucose. It also can lead to: A buildup of poisons (called ketones) in blood and urine from too little insulin A need to urinate too much, so the body ends up having too little fluid These problems can lead to severe illness, coma and even death. Work out a plan with your primary care provider or endocrinologist to prevent serious problems. WHAT TO DO WHEN YOU ARE SICK 1. Check blood glucose every three to four hours, or as directed by your healthcare provider. Write down how often you need to check your blood glucose on sick days: B L O O D G L U C O S E : 2. Keep sick-day foods on hand. Follow your meal plan as much as possible. But if you don t feel like eating, try: Mild foods, such as rice, crackers, toast and cooked cereal Foods with lots of liquid, such as soup, broth, applesauce, regular (non-diet) gelatin, frozen juice bars, sherbet, custard and yogurt Ask your healthcare provider or dietitian which foods are best for you, how much to eat and how often. 3. Drink extra fluids. You may need some fluid at least every hour. Choose drinks without caffeine. If you are able to follow your meal plan, stick to drinks without calories. Good choices include water and caffeine-free herbal tea. If you cannot follow your meal plan, you may also need some fluids with sugar or carbohydrates. These include juice and milk. 4. Follow medication instructions exactly. For insulin and oral diabetes medications: Take your normal dose unless your healthcare provider says to change it. Be sure you understand instructions for any changes. For example, if you take insulin, you may need to take more than usual. Or you may need to take insulin even if you normally don t. Tell your healthcare provider about all medications you take. Ask before taking any over-the-counter 22

23 medications, remedies or supplements. Some, such as certain cold medicines, may have ingredients that can raise your blood sugar or cause other problems. List medicines and instructions here: You feel sleepier than normal, have trouble breathing or have trouble thinking clearly Ask about other signs and when to seek emergency care. MORE INSTRUCTIONS Ask your provider what else you should do, including how to get enough rest and how to prepare a family member or friend to help you on sick days. Your healthcare provider also may recommend shots to prevent the flu and pneumonia. 5. Keep a record while you are sick. This helps if you need to call your healthcare provider. He or she may ask: What is your blood sugar level? How long you have been sick? Have you lost weight? What is your temperature? What are your other symptoms? What you have been eating and drinking? Write everything down. Ask what else to include. KNOW WHEN TO CALL Know when to call your healthcare provider. For example, he or she may tell you to call if: You don t improve after one or two days You have had vomiting or diarrhea for more than six hours You are taking insulin and your blood sugar level is more than 240 mg/dl or less than 60 mg/dl Your ketone levels are too high (ask your healthcare provider what level is too high) 23

24 Chapter 10: Dental care, eye care and foot care W H AT Y O U L L L E A R N I N T H I S C H A P T E R : > Why dental care matters > Why an eye exam is important > How to care for your feet DIABETES HURTS TEETH AND GUMS Poor glucose control makes gum problems, such as gingivitis and periodontitis, more likely. A sticky film full of germs (called plaque) builds up on your teeth. High blood glucose helps bacteria grow. Periodontal disease can damage the gum and bone that hold your teeth in place and may lead to painful chewing problems. Some people with serious gum disease lose their teeth. Not only is there an increased rate of gum disease among people with diabetes, but in turn, serious gum disease may have the potential to affect blood glucose control and contribute to the progression of diabetes. When you have diabetes, you generally have a decreased ability to fight bacteria that invade your gums. Other problems diabetes can cause are dry mouth and a fungal infection called thrush. Dry mouth happens when you do not have enough saliva. Diabetes may also cause the glucose level in your saliva to increase. Together, these problems may lead to thrush, which causes painful white patches in your mouth. Red, sore and bleeding gums are the first sign of gum disease. This can lead to periodontitis. Periodontitis is an infection in the gums and the bone that holds the teeth in place. If the infection gets worse, your gums may pull away from your teeth, making your teeth look long. SIGNS OF DAMAGE If you have one or more of these problems, you may have tooth and gum damage from diabetes: Red, sore, swollen gums Bleeding gums Gums pulling away from your teeth so your teeth look long Loose or sensitive teeth Bad breath A bite that feels different Dentures that do not fit well Remember, good blood glucose control can help prevent mouth problems. SEE YOUR DENTIST You can prevent problems by controlling your blood glucose level and taking good care of your teeth and gums. But you should also make sure that you see your dentist at least once every six months to catch any problems early. Your dentist can help you take care of your teeth and gums by: Cleaning and checking your teeth and gums twice a year Helping you learn the best way to brush and floss your teeth and gums Telling you if you have problems with your teeth or gums and what to do about them Making sure your dentures fit well 24

25 Telling you if you have a fungal infection in your mouth and treating it EYE EXAMS People with diabetes have a much higher likelihood of developing glaucoma, cataracts and diabetic retinopathy (see Chapter 4). These eye complications can lead to blindness. You may not notice any symptoms of these eye conditions until it is too late to treat the problem. This is why it is extremely important to have regular, annual eye exams. Early detection of these problems can save your sight. DIABETIC FOOT CARE People with diabetes need to be especially careful about foot care. Even minor injuries can cause major problems, such as leg and foot infections some even leading to amputation. Diabetic nerve damage can lessen your ability to feel pain, heat and cold. Loss of feeling often means you may not notice a foot injury, even until the skin breaks down and becomes infected. Nerve damage also can change the shape of your feet and toes. Special therapeutic shoes may help you deal with this problem. Diabetes can cause numbness and reduced blood flow to the legs and feet. Poor circulation can weaken your foot s ability to fight infection and to heal. Improve blood flow by not smoking and by keeping your blood pressure and cholesterol under control. People with diabetes are far more likely to have a foot or leg amputated because of to artery disease that reduces blood flow to the feet or nerve disease. These problems make it easy to get ulcers and infections that may lead to amputation. Most amputations are preventable with regular care and proper footwear. See your healthcare provider right away about all foot problems, and always follow his or her advice. 1. Take steps to prevent foot problems. Wear shoes that fit properly as well as clean socks. Discuss shoe and sock selection with your healthcare provider based on your specific needs and activities. Change socks if they become wet or sweaty. Look in each shoe for objects before putting it on. Don t let your feet get too hot or too cold. Protect them from the sun and hot surfaces. Wear warm socks and shoes when it s cold. Don t go barefoot (indoors or outdoors) or wear open footwear, such as sandals. Stop smoking. Smoking causes one of the greatest threats to your feet, since it affects small blood vessels and causes decreased blood flow to the feet, making wounds heal slowly. Get regular physical activity for good health and better blood flow. Walking is generally considered a safe choice. Check with your healthcare provider before beginning a physical activity program. 2. Check your feet every day. Inspect each foot for cuts, bruises or other signs of injury. (Check after exercising too.) Use a hand-held mirror, or ask a family member or caregiver to check for you. Look for corns, warts, calluses, bunions or sores. Check for hot or cold spots on your feet. These could indicate an infection (hot) or poor blood flow (cold). Never cut calluses or corns yourself or remove them with chemical agents this can lead to ulcers, infections or burns. Ask your healthcare provider to cut your calluses. If you get a foot ulcer, see your healthcare provider immediately. Neglecting ulcers can result in infections, which can lead to the loss of a limb. 25

26 3. Wash your feet every day. Use warm water and mild soap. Do not soak your feet or use hot water. Test the temperature before putting your feet in. Dry your feet carefully. Make sure you dry between your toes. Apply a mild moisturizer, such as plain petroleum jelly or an unscented hand cream, if your skin seems dry. Avoid products with a fragrance. Do not use moisturizer between your toes it can build and lead to infection. 4. Trim your toenails regularly. When you trim your toenails: Do it after washing your feet. Cut or file your toenails straight across. Use a file or emery board to remove rough or sharp edges. Call your healthcare provider if a toe appears red or feels tender. You may have an ingrown toenail. If you have poor eyesight or have a hard time cutting your toenails, get help from a healthcare provider. Talk with your healthcare provider about any foot problems. Do not try to treat problems yourself. Have him or her check your feet at least once a year and at each visit. Prompt treatment can make a big difference. Ask for suggestions about keeping your feet clean and safe, and write further instructions below: WEAR THE RIGHT SHOES Because diabetes can cause foot problems, you should choose shoes that fit your feet. Here are some general guidelines for getting the right shoes. D O : Wear athletic or walking shoes for everyday use. Wear shoes or slippers to keep your feet safe. Always wear socks so you won t get blisters. Make sure shoes fit if your feet have changed shape. Shop for shoes at the end of the day when your feet are bigger. Break in new shoes slowly. Wear them only one to two hours a day for the first week or two. D O N T: Wear shoes that don t fit right. Get shoes that don t support your feet. Choose shoes that don t match the shape of your feet. Wear pointed-toe shoes. Wear high heels. Wear knee-high socks that are too tight. My healthcare provider suggests: 26

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28 Chapter 11: Your action plan W H AT Y O U L L L E A R N I N T H I S C H A P T E R : > How to prepare for your annual visit > Routine care guidelines > A list of questions to ask your healthcare team YOUR ANNUAL DOCTOR VISIT Ask your healthcare provider how often he or she wants to see you in a year. When you go to your appointment, follow the guidelines below: 1. Bring a list of your questions. 2. Ask for your test results and what they mean for you. 3. Take notes at your visit. 4. Ask Why? before agreeing to any medication, medical tests or treatment. TAKE ROUTINE CARE OF YOURSELF It may seem like there s a lot to remember when taking care of your diabetes. Work with members of your healthcare team to stay informed, and use this workbook to help stay in control. Know what blood glucose levels your healthcare provider wants you to have when you get up in the morning (fasting) and before or after meals. Know how often you should check your blood glucose. Know how to correct low and high blood glucose. Know what medications you are taking, what they do, any side effects and when to take them as directed by your healthcare provider. Ask about your blood test results and what they mean for you. Ask whether there are other medications you need because of the blood test results. Have your blood pressure and feet checked at every healthcare provider visit. See your dentist twice a year for an exam and dental cleaning. See your eye doctor every year for a dilated eye exam. See your healthcare provider every fall for a flu shot. Inspect your feet every day for any problems. Inspect your skin (entire body) every day for problems. Be physically active most days of the week. Be aware of, and monitor, your daily food intake. Try to maintain a healthy weight. For some people, this could mean losing five to 10 percent of their current weight. Have a plan for when you are sick. (See Chapter 4 for more information.) Know what blood tests need to be done and how often. 28

29 QUESTIONS FOR YOUR HEALTHCARE TEAM Here are some other questions to ask members of your healthcare team, if appropriate: How can I get help to stop smoking? Do I need a pneumonia vaccine? What are my restrictions, if any, on alcohol use? How should I start a physical activity routine, and what kind of physical activity should I be doing? What are my best options for birth control and family planning? How will diabetes affect my pregnancy? TYPE 2 DIABETES RESOURCES Contact the organizations below for more information, educational programs and other services. A M E R I C A N D I A B E T E S A M E R I C A N D I E T E T I C I N T E R N AT I O N A L A S S O C I AT I O N A S S O C I AT I O N D I A B E T E S F E D E R AT I O N / Oregon Affiliate: J U V E N I L E D I A B E T E S N AT I O N A L C H O L E S T E R O L N AT I O N A L D I A B E T E S R E S E A R C H F O U N D AT I O N E D U C AT I O N P R O G R A M E D U C AT I O N P R O G R A M CURE hin.nhlbi.nih.gov/ncep.htm ( ) N AT I O N A L D I A B E T E S P R E V E N T I N G A N D T R E AT I N G A M E R I C A N H E A RT H I G H B L O O D P R E S S U R E A S S O C I AT I O N

30 Notes After reading each section, use this space to write any questions you may have for your health coach or notes for yourself. 30

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32 6 0 1 S. W. S E C O N D AV E N U E P O RT L A N D, O R D I A B E T E S C A R O D S C O M PA N I E S. C O M W W W.O DS CO M PA N I E S.CO M (10/10) 2010 ODS