Living Well With Diabetes A Self-Management Guide

Transcription

1 Living Well With Diabetes A Self-Management Guide Table of Contents What is Diabetes?...1 Risk Factors for Diabetes.2 Diagnosis of Diabetes..2 Effects of Diabetes..3 General Healthcare...6 Nutrition Therapy.8 Physical Activity and Exercise..10 Diabetic Medications/Drugs..11 Insulin 12 Resources Available to Me Self-management guide.13

2 What is Diabetes? Diabetes is a long-term disease where the pancreas of the body produces ineffective insulin and blood sugar levels are high. Most often associated with diabetes is the topic of carbohydrates. Carbohydrates are made up of sugars. Therefore, sugars are carbohydrates and carbohydrates are sugars. When we eat foods with carbohydrates in them the body takes them and breaks them down for energy. Carbohydrates are an important nutrient for energy, especially nerve cells, including those in the brain. After a meal, as the blood sugar levels go up, insulin is turned on. Insulin is a hormone released by the pancreas in response to high blood sugar and assists cells in drawing sugar from the blood. Type 1 Diabetes is the type of diabetes where the pancreas produces little to no insulin. Type 2 Diabetes is the type of diabetes where the pancreas makes plenty of insulin but the body s cells resist insulin s action. Gestational Diabetes is the type of diabetes first diagnosed during pregnancy. Prediabetes is the when blood glucose levels are higher than healthy levels but not high enough for a diagnosis of diabetes. Prediabetes is warning sign for diabetes. In 2012, 29.1 million Americans, or 9.3% of the population, had diabetes. Type 1 diabetes accounts for 5-10% of all diagnosed cases of diabetes and often is diagnosed in children and adolescents but may still be diagnosed later in life. Type 2 diabetes accounts for 90-95% of all diagnosed cases of diabetes in the United States and is often diagnosed in adults but may still be diagnosed in children and adolescents. 1

3 About half of women diagnosed with gestational diabetes will go on to have Type 2 diabetes later in life. In addition, 86 million adults have prediabetes and 9 out of 10 people with prediabetes don t even know they have it. Diagnosis of prediabetes means a person is at high risk for developing type 2 diabetes, as well as for stroke and heart disease. In 2010, diabetes was the 7th leading cause of death in the United States. Risk Factors for Diabetes Risk Factors for getting diabetes include Being 40 or older Being overweight, obese or morbidly obesity Lack of physical activity Close family members with diabetes Being African American, Latino, Native American, Asian American, or Pacific Islander Women with polycystic ovary syndrome (PCOS) Hypertension- Blood pressure >140/90 or are taking medication for hypertension Having a history of heart disease Diagnosis of Diabetes Ways that you can be diagnosed is by your doctor testing your A1C levels, fasting blood glucose levels, giving you can oral glucose tolerance test or sometimes using a random blood glucose test. A1C% is a blood test of glucose levels over the past 2-3 months. A1C% of % means prediabetes and more than 6.5% is diabetes. 2

4 Fasting blood glucose test is a test of blood sugar levels when you have not eaten in 8 or more hours. A fasting blood glucose of mg/dL means prediabetes and greater than 126 mg/dl means diabetes. Oral Glucose Tolerance Test is a measure of blood sugar levels after taking a 75-g sugar (drink). A result of mg/dl means prediabetes and greater than 200 mg/dl means diabetes. A random plasma glucose test is taken at an undetermined time and is usually used in combination with the other tests. A result of greater than 200 mg/dl means diabetes. Glucose challenge test is used for women at risk for having gestational diabetes. 50g of sugar is taken and a result of greater than 180 mg/dl measured one hour later means diabetes. Effects of Diabetes Short term effects: Hypoglycemia: Low blood sugar below 50 mg/dl. Common causes of hypoglycemia include injection of too much insulin, bad insulin timing in relation to eating, not eating enough, missing snacks or meals and drinking alcohol without food. Signs and Symptoms of Hypoglycemia: Sweating a lot Feeling very hungry Fainting Fatigue, lightheadedness, or shakiness Nausea or vomiting 3

5 Mental confusion or unresponsiveness Dry mouth or tingling lips Hypoglycemia treatment should be started when blood sugar falls below 70 mg/dl. If your blood sugar levels drop be sure to eat or drink 15g carbohydrate tablets Carbohydrate gel ½ cup of fruit juice or soft drink 6 saltine crackers 1 tbsp. of honey or syrup Or any food or drink with carbohydrates in it. Eat the 15g of carbohydrates, wait 15 minutes and then check blood sugar levels again. If they are not within normal range, then eat another 15g of carbohydrates. Hyperglycemia and Diabetic Ketoacidosis (DKA): DKA happens when there not enough insulin in the body for sugar to use. With DKA the body uses fat for energy instead of carbohydrates. DKA is when blood sugar levels are mg/dL. Be sure to see a doctor if this happens. Signs and symptoms of DKA: Constant urination Constant eating Gasping for air Dehydration Smelling fruity odors Fatigue 4

6 Sick-Day Guidelines for Persons with Diabetes: 1. When you have to stay home because of you are sick, be sure to take regular amounts of insulin and other blood sugar lowering medications. 2. Four times a day (before each meal and before bedtime) blood sugar levels should be checked. Blood sugar above 250 mg/dl can be fixed by taking some insulin. 3. Every hour drink one glass of water. If experiencing diarrhea, vomiting or fever take small sips of water. 4. If regular texture foods don t feel good to eat, then try liquid or soft carbohydrate containing foods such as soft drinks, juices and ice cream. Have 10-15g of carbohydrates every 1-2 hours (or 50g of carbohydrates every 3-4 hours). 5. If the illness lasts more than a day, a doctor should be contacted. Long term effects: Dyslipidemia: This is defined as high levels of fat in the blood. Individuals with diabetes have an increased chance of having dyslipidemia and lead to higher rates of heart disease. The recommendation is eating less foods with saturated fats, trans-fatty acids and cholesterol in them such as Red meats- like beef, lamb or pork. Packaged or frozen dinners- like pot pies or pizzas Chips Candy bars Try and eat healthy fats instead from fish, canola and olive oils and nuts. In addition, increasing physical activity, weight loss and stopping smoking should be attempted. 5

7 Hypertension: This is defined as high blood pressure, a blood pressure above 140/90 mmhg. Currently, 73% of diabetics have hypertension. People with a high blood pressure should contact their Certified Diabetes Educator (CDE) or a Registered Dietitian. Neuropathy: This is a disease of one or more nerves, typically causing numbness or weakness. This disease can also affect the feet, so foot care is important. Retinopathy: This is when the eyes are made weaker and can lead to loss of vision. Glaucoma, cataracts, and other problems of the eye can occur earlier and are more common in diabetics. Type 1 diabetics should have an eye exam by an eye doctor within five years of being diagnosed with diabetes. Type 2 diabetics should be checked shortly after the diagnosis of diabetes. Nephropathy: This is kidney disease or kidney damage which if left untreated will result in kidney failure. Regular doctor s visits where lab work is taken is suggested. Always check your blood sugar levels and have your blood pressure checked. General Healthcare Foot Care: Diabetes can affect the feet, so foot care is important. Some tips to make sure you have healthy feet is to See your podiatrist (foot doctor) once a year. Check feet every day for redness, swelling, corns, calluses or ingrown toenails or breaks in the skin. Using a mirror is suggested. Cut toenails straight across, not into the corners, and smooth with an emery board. Wear comfortable, well-fitting shoes. Diabetic shoes are available for purchase in most places that sell footwear. 6

8 Check the inside of your shoes for foreign objects or rough spots each time before putting them on. Always wear socks with your shoes. Diabetic socks are available for purchase in most places that sell footwear. Be careful with feet when weather is very hot or cold. Long exposure is not ideal. Eye Care: Individuals with diabetes should see their eye doctor at the first signs of Seeing dark spots Feeling pressure or pain in the eyes Unusual difficulty seeing in dim light Blurred or double vision Narrowed field of vision Skin Care: Skin problems may be as minor as itching or as severe as painful infections. Basic skin care should include Bathe every day with mild soap and lukewarm water, using a small amount of lotion afterward to keep the skin soft. Wear gloves when you do work that may cause injury. Dress warmly and avoid long exposure in very cold weather. Take extra care to avoid scratches and bruises. Treat a skin injury quickly and call your doctor if it does not heal. Dental Care: Diabetes may affect risk for tooth and gum problems. Tips and tricks include Brushing and flossing every day. Seeing your dentist every six months. Informing your dentist of your diabetic condition. 7

9 Nutrition Therapy Goals Keep normal blood sugar levels by balancing eating with insulin or blood sugar medications and activity levels. Keep A1C levels less than 7%, blood sugar before a meal mg/dl and blood sugar after a meal (after 2 hours) less than 180 mg/dl Keep blood pressure <130/<80 mmhg to lower risk of heart disease and kidney issues. Sources of Carbohydrates Breads, crackers, and cereals Pasta, rice, and grains Starchy vegetables, such as potatoes, corn, and peas Beans and legumes Milk, soy milk, and yogurt Fruits and fruit juices Sweets, such as cakes, cookies, ice cream, jam, and jelly Healthy Plates Follow the myplate guidelines and eat healthy amounts of all of the food groups every day. o Grains- 6 servings for women and 7 servings for men o Fruits- 2 cups for women and men o Vegetables- 2 ½ cups for women and 3 for men o Protein- 5 to 6 ounces for women and men 8

10 o Dairy- 3 cups for women and men Include plenty of fiber from rice, vegetables, beans, fruits, oat bran and barley. Carbohydrate Counting 15g of carbohydrate from a food item = one carbohydrate choice Most women can have about three to four (45g-60g) carbohydrate servings per meal and men generally can have about four to five (60g-75g) carbohydrate servings per meal. Use one or two (15g-30g) carbohydrate choices for snacks. Check serving sizes with measuring cups and spoons or a food scale. Read the Nutrition Facts on food labels to find out how many grams of carbohydrate are in foods you eat. Meal Timing Spread meals and eating of carbohydrates evenly throughout the day. Eat breakfast every day and avoid skipping meals. Women with gestational diabetes need three meals and three snacks a day. These snacks should try and be eaten last 2 to 3 hours between feedings and should have some carbohydrates. Other Tips Always combine carbohydrates and protein during any meal and snack. Moderate weight loss can help lower cholesterol levels, blood pressure and blood sugar levels. However, weight loss during pregnancy is not advised. For women with gestational diabetes breastfeeding is encouraged, this may help reduce the risk of developing Type 2 diabetes. 9

11 For a personalized meal and nutrition plan make an appointment with your local Registered Dietitian, Certified Diabetes Educator. Physical Activity and Diabetes Recommendation: At least 150 minutes a week of easy physical activity or At least 90 minutes a week of challenging exercise. Try to do physical activity at least three days a week. Diabetic individuals should monitor blood sugar levels before, during and after all physical activity to prevent blood sugar levels becoming too low. All diabetics should talk with their physician and Certified Diabetes Educator before beginning an exercise program. Insulin Tips: Insulin users should add 15g of carbohydrates for 30 to 60 minutes of activity. Decrease insulin (of approx. 1 or 2 units) during the period of exercise. For longer, more challenging exercise (more than 45 minutes) a larger decrease in the total daily insulin may be needed. 10

12 Diabetic Medications/Drugs There are many types of medications for diabetes used to assist healthy lifestyles in achieving blood sugar control. Diabinese, Glucotrol, Glucotrol XL, Micronase, DiaBeta and Glynase Purpose: Increases insulin by activating the pancreas. Possible Side Effects: May cause skin rash or itching, lower blood sugar levels, sensitivity to light, upset stomach and weight gain. Prandin and Starlix Purpose: Activates the release of more insulin to help control blood sugar. Potential Side Effects: May cause low blood sugar and weight gain. Glucophage Purpose: Lowers liver s production of sugar and makes muscle more sensitive to insulin. Potential Side Effects: May cause development of high body acid levels, metallic taste in mouth and diarrhea. Avandia and Actos Purpose: Lowers liver s production of sugar and makes muscle more sensitive to insulin Potential Side Effects: May cause heart failure, weight gain, fatigue, swelling of legs or ankles; increased risk for heart attack (Avandia) and fractures in females. Precose and Glyset Purpose: Slows down high blood sugar levels after a meal. Potential Side Effects: May cause nausea, gas and bloating. Januvia 11

13 Purpose: Stops increased insulin release and lowers liver s production of glucose. Potential Side Effects: May cause serious sore throat, upper respiratory infection and headache. Byetta Purpose: Triggers insulin to be made. Potential Side Effects: Increases risk of inflammation of the pancreas. Not for use by type 1 diabetics. Symlin Purpose: Controls sharp increases in blood sugar levels after meals. Potential Side Effects: May cause nausea. Insulin Insulin is a hormone released by the pancreas in response to a high blood sugar and assists cells in drawing sugar from the blood. There are different types of insulin for diabetics and each serves a different purpose. Insulin may be injected in the abdomen, thigh or arm. Insulin injections must be coordinated with sleep cycles, physical activity and meals. The types of insulin include Rapid-acting o Begins to work in minutes and works for 3-5 hours Short-acting o Begins to work in 30 minutes - 1 hour and works for up to 12 hours Intermediate- acting o Begins to work in 1 ½ - 4 hours and works for up to 24 hours Long-acting 12

14 o Begins to work in 1-4 hours and works for up to 24 hours Resources Available to Me Note: All resources will be provided by HealthQuest. Self-Management Guide Note: All content for the self-management guide will be provided by HealthQuest. References: Escott-Stump, S. (2015). Nutrition and Diagnosis-Related Care (8th ed.). Philadelphia: Wolters Kluwer. Nahikian-Nelms, M. N., Sucher, K. P., & Lacey, K. (2016). Nutrition Therapy and Pathophysiology (3rd ed.). Boston, MA: Cengage Learning. Sizer, F. S., & Whitney, E. (2012). Nutrition: Concepts & Controversies (12th ed.). Belmont, CA: Cengage Learning. Statistics About Diabetes. (n.d.). Retrieved July 01, 2017, from 13