Understanding Your Diabetes: A Basic Guide

Transcription

1 Understanding Your Diabetes: A Basic Guide Table of Contents First Steps to Managing Your Diabetes at Home When Your Blood Sugar is Too High (Hyperglycemia) Blood Sugar Targets and Blood Sugar Log How to Choose a Blood Sugar Meter How to Discard Sharps Diabetes Medicines Used to Treat Type 2 Diabetes X40123bc (1/2016) AHC

2 First Steps to Managing Your Diabetes at Home (A basic guide until you see a registered dietitian and a diabetes educator) What is diabetes? To understand diabetes, you must first understand the role of glucose (sugar) and insulin in your body. Glucose comes from the food you eat. Your blood carries glucose to all the cells in your body. These cells use the glucose for energy. Insulin is a hormone made by the pancreas. It enters the blood and acts as a key to open the body s cells so glucose can enter. Why did I get diabetes? We don t know what causes type 1 diabetes. If you have type 2 diabetes, you could have a combination of risk factors. The more risk factors a person has, the higher the risk for type 2 diabetes. Diabetes means that your blood sugar or blood glucose is too high. If your body doesn t make enough insulin, or if the insulin doesn t work the way it should, glucose can t get into your cells. Instead, glucose stays in your blood. Type 1 diabetes means that the pancreas no longer makes insulin. Therefore, people with Type 1 diabetes need insulin. Type 2 is the most common form of diabetes. The body s cells no longer use insulin the right way. Eventually, the pancreas may lose its ability to make enough insulin. It can be treated with healthy eating, exercise and medications. There are other types of diabetes. What are the symptoms of high blood sugar? Not everyone will have or notice symptoms of high blood sugar. Symptoms may include: Extreme thirst or hunger Blurred vision Feeling tired Frequent urination Risk factors that can be controlled include: Obesity Lack of physical activity High blood pressure High cholesterol Risk factors that cannot be controlled include: Family history of diabetes Increasing age Being in a higher risk ethnic group Having diabetes while you were pregnant or a baby bigger than 9 pounds Can diabetes be cured? There is no cure, but there are a number of ways to help control diabetes. Healthy eating, exercise, losing weight and prescribed medication can help you lead a longer life with fewer health problems. Many cases of diabetes can be linked to two things that can be controlled too much weight and too little physical activity. Taking care of your diabetes every day will help keep blood sugar levels in an acceptable range. It will help to prevent health problems that diabetes can cause over time. Continued X13517bc (2/2016) AHC

3 First Steps to Managing Your Diabetes at Home, Page 2 Healthy eating for diabetes: what you can do now Why learn about healthy eating? You can make a difference in your blood sugar control by making good food choices. The food that is healthy for you is the same as the food that is healthy for people without diabetes. A meal plan can help you decide what, when and how much to eat. You do not need special or diet foods. When you learn how food affects your diabetes, you will be able to fit most of your favorite foods in your meal plan. When can you eat? Eat at least 3 small-to-medium meals a day. Space meals 4 to 5 hours apart, especially if you are taking diabetes pills or insulin. Eat meals at about the same time every day. Avoid skipping meals. If you snack between meals, keep the portion small. What can you eat? Eat small-to-medium-sized portions. Eat about the same amount of food each day. Cut down on foods and drinks with a lot of added sugar (candy, regular soft drinks, rich desserts and sweet baked goods) until you learn how to fit them into your meal plan. Be aware of foods that contain natural sugars, like fruit and fruit juices. These foods cause your blood sugar to rise just like foods that have added sugar. Limit fruit juice to ½ cup (4 oz.) a day. Avoid drinking alcohol until the dietitian shows you how to fit it into your meal plan. Keep track of your eating Keep a record of everything you eat and drink for 3 days before you see the dietitian. Write down what and how much you had right after you eat (don t wait and try to remember). Bring the food record with you to help your dietitian figure out the best meal plan for you. How much can you eat? Your dietitian will help you with portion sizes that are right for you. Imagine a standard size (9-inch) dinner plate divided as shown here. Fill one quarter of the plate with starchy foods, such as bread, potato, rice, pasta, cereal, peas and corn. Fill another quarter of the plate with your meat or meat substitute serving. On the remaining half of your plate, put lots of low-calorie, low-fat vegetables prepared without fat, sauce or frying, such as salad, greens, asparagus, green or wax beans, broccoli, carrots, tomatoes, cucumbers or cauliflower. A small piece of fruit or a small glass of milk serving can be on the side. Vegetables Starches (Potatoes, rice or noodles) Meat (Red meat, poultry or fish) 8 oz. Milk X13517bc (2/2016) AHC

4 First Steps to Managing Your Diabetes at Home, Page 3 Exercise Exercise is an important part of diabetes control. Regular exercise can lower blood sugar, improve blood flow and help control weight. Talk with your doctor before starting an exercise program. Controlling your type 2 diabetes Medication You may need pills or shots (insulin or other diabetes shots) if your diabetes is not controlled with meal plans and exercise. Take your medicine exactly as told. Never skip or stop taking your pills or shots. Talk to your doctor if you have questions or concerns. Check with your doctor or pharmacist before taking over-the-counter medicines (medicine or supplements you can buy without a prescription) Preventing complications Taking care of your diabetes every day will help keep blood sugar levels in your target range. It will also help prevent health problems that high blood sugar can cause, such as: Damage to blood vessels over time, which may lead to a heart attack or stroke. Damage to blood vessels in the eyes, which may lead to blurred vision or blindness. Nerve damage that can lead to a loss of feeling or pain in your feet. A cut or sore can become infected before you know it. Damage that causes the kidneys to stop working (kidney failure). Infections in your gums and teeth, which could cause your teeth to become loose or fall out. The best way to prevent these problems is to take care of yourself and your diabetes. Your diabetes educator will help you learn about the things you can do every day to keep your blood sugar in the range that s best for you. You will also learn how to test your blood sugar at home to help you manage your diabetes and prevent the damaging effects of high blood sugar. There are many types of blood sugar meters to choose from. The diabetes educator or clinic staff can help you choose the meter that is best for you. The needles (sharps) you use with your meter cannot go into the regular trash. Ask the diabetes educator, clinic staff or pharmacist what to use and how to dispose of your sharps. Can blood sugars become too low? Low blood sugar can happen as a result of: Too much insulin or diabetes medication Too little food Extra exercise or activities Late or skipped meals Drinking alcohol Symptoms of low blood sugar can include: Dizzy, lightheaded or not thinking clearly Anxious or irritable Hungry (a panic to eat) Weak, shaking, Sweaty especially upper body Your heart pounding or beating fast Trembling What to do if you have these symptoms Drink or eat a fast-acting sugar source, such as: ½ cup regular soda or juice (not sugar-free) 1 cup milk Candy (4 to 5 Lifesavers or small gumdrops, or 2 to 3 pieces of hard candy) Honey (2 teaspoons) Sugar (2 to 3 cubes or 2 teaspoons granulated) Glucose tablets or gels, which can be bought in your pharmacy. Take as shown on the package as a rule, take 3 tablets or 1 tube of gel. Always carry one of these fast-acting sugar sources with you. Continued X13517bc (2/2016) AHC

5 First Steps to Managing Your Diabetes at Home, Page 4 Final tips and resources Call your doctor if you: Are sick for 1 or 2 days and not getting better Are not able to eat or drink Have a before meal blood sugar reading of over 240 for two readings in a row Are not sure what you need to do to take care of yourself Cannot see a diabetes educator and need more information You have the most important role in managing your diabetes By taking control, you will increase your chances for a long and healthy life. Control starts with learning and we recommend you see a diabetes educator and/or a registered dietitian to help you learn what you need to know to stay well with diabetes. If a referral is made, it will help if you contact your insurance company to find out what coverage you have for diabetes education. My questions: Write down any questions you have for the diabetes educator or your provider and bring this form to your appointment. Diabetes educators at Aurora For the most current list of diabetes educators and dietitians at Aurora, call The operator will help you find an educator near you. Other resources You may also find helpful information by contacting the organizations listed below or by visiting their websites on the Internet: Aurora Health Care American Association of Diabetes Educators diabeteseducator.org American Diabetes Association diabetes.org 800-DIABETES ( ) American Dietetic Association eatright.org National Diabetes Education Program ndep.nih.gov The information presented is intended for general information and educational purposes. It is not intended to replace the advice of your health care provider. Contact your health care provider if you believe you have a health problem. X13517bc (2/2016) AHC

6 When Your Blood Sugar is Too High (Hyperglycemia) Causes Not taking enough insulin or diabetes pills Infection, fever, injury, or other illness Severe emotional stress Eating too much food, or the wrong kind of food Not enough exercise Your body is not making enough insulin Onset Gradual (hours to days) Symptoms may include: Extreme thirst Blurred vision Feeling tired Frequent urination Treatment 1. Call your doctor and be ready to report: Your blood sugar test results Your temperature Any signs of infection Types of foods and liquids you have eaten Medications you have taken Your allergies, if any The telephone number of your pharmacy 2. Rest and keep warm. 3. Drink plenty of sugar-free liquids (for example, a glass of water each hour). 4. Test your blood sugar as explained by your doctor or diabetes educator. Keep a record of the results. 5. Have someone check on you. Symptoms may progress to: Nausea and vomiting Abdominal pain Unexplained weight loss Points to keep in mind Test your blood sugar more often if you are not feeling well or have increased amounts of sugar in your blood. Call your doctor if your blood sugar is higher than 240 for two readings in a row, or if you are ill. Stay on your diet. Keep appointments with your doctor, even if you have been feeling good. Never omit your medication without talking to your doctor. Pregnant women with diabetes should have stricter blood sugar goals. Ask your doctor about blood sugar goals during pregnancy. The information presented is intended for general information and educational purposes. It is not intended to replace the advice of your health care provider. Contact your health care provider if you believe you have a health problem. X13521bc (1/2016) AHC \CM

7 Before meals Two hours after meals Levels for people without diabetes Less than 100 mg/dl Blood Sugar Targets Levels for people with diabetes Target goal ranges 80 to 130 mg/dl Less than 120 mg/dl Less than 180 mg/dl Your provider may take action if: Frequently over 140 or under 70 Frequently over 180 or under 100 A1C Less than 6% Less than 7% 8% or greater 2016 American Diabetes Association recommendations Your blood sugar target may be different than above. Talk with your doctor or diabetes educator about what your goals should be. Enter your blood sugar (blood glucose ) readings on the chart below. Checking your blood sugar is your main way of knowing if your diabetes is in control. Use the comments section to keep track of things that might have affected your blood sugar (food you ate, medicines you took, exercise, being sick) or any other thoughts or questions you have. Take this chart with you when you visit the diabetes educator, the dietitian or your doctor s office. Date Breakfast Lunch Supper Before After Before After Before After Bedtime Comments X27586bc (1/2016))

8 Blood Sugar Targets, Page 2 Enter your blood sugar (blood glucose ) readings on the chart below. Checking your blood sugar is your main way of knowing if your diabetes is in control. Use the comments section to keep track of things that might have affected your blood sugar (food you ate, medicines you took, exercise, being sick) or any other thoughts or questions you have. Take this chart with you when you visit the diabetes educator, the dietitian or your doctor s office. Date Breakfast Lunch Supper Before After Before After Before After Bedtime Comments The information presented is intended for general information and educational purposes. It is not intended to replace the advice of your health care provider. Contact your health care provider if you believe you have a health problem. X27586bc (1/2016) AHC

9 How to Choose a Blood Sugar Meter There are many types of blood sugar meters available. It can be confusing when trying to buy one. Here are some tips to help you choose the best blood sugar meter for your needs. Insurance Most health insurance companies will cover meters and strips for testing your blood sugar. But they may only cover certain brands. Before you buy a meter, check with your insurance company to see which brands they will cover. You will need a prescription from your doctor to have insurance cover the meter, strips, and lancets. Cost The cost of strips varies with each meter. If your insurance does not specify a certain meter or if you don t have insurance, you will want to know how much the strips cost. There are many less expensive strips that work well. Which meter to choose There are many types of meters. Talk with your diabetes educator about the type that will work best for you. For example: Some meters are very basic with few options while others have memory, and downloading and data-management options. Some meters have large number displays that are good for people with vision problems. Some meters are small and easy to fit in a purse while others are larger and work well for people whose fingers are a little stiff. Some meters let you test on your arm instead of your finger. Support Most meters have customer support phone numbers. Make sure the brand of meter you choose has customer support and that you have the support phone number available. Ask your insurance company about what is covered for a blood sugar meter and blood sugar testing. The following are the most common makers of blood sugar meters: Abbott (Medisense) Asencia (Bayer) Diagnostic Devices, Inc. Johnson & Johnson Nova Biomedical Nipro Roche Remember Choosing a meter can be confusing. The diabetes educators are here to help. Ask your diabetes educator to help you choose a meter that fits your budget and your needs. The information presented is intended for general information and educational purposes. It is not intended to replace the advice of your health care provider. Contact your health care provider if you believe you have a health problem. x27617 (1/2016) AHC Diabetes Care

10 How To Discard Sharps (Used Needles, Syringes, Lancets) Should used needles be thrown out with the household trash? No. Unfortunately, needles, syringes and lancets are often being mixed in with household garbage and recyclables. These sharps pose a risk to those who have to handle them. Why is this risky? A person handling the trash could receive an accidental needlestick injury. He or she then could be exposed to infectious disease and would need a blood test. How can you avoid these risks? The state of Wisconsin has rules for the safe packaging, treatment and disposal of sharps. Sharps must be placed in a puncture-resistant, leak-proof sharps container. These containers can be purchased at most pharmacies. When your container is full, it must be taken to a sharps collection station. Where can I find a Sharps Collection Station? Aurora Pharmacy sites are registered sharps collection stations. Ask your local pharmacy if they are registered as a sharps collection station. Ask your diabetes educator for the nearest location. Call your local Public Health Department for sites and regulations within your city. (Registered sharps collection stations may charge fees to cover the costs of containers, disposal and treatment. Some sites offer the service for free.) The information presented is intended for general information and educational purposes. It is not intended to replace the advice of your health care provider. Contact your health care provider if you believe you have a health problem. X17141bc (3/2016) AHC

11 Diabetes Medicines Used for Type 2 Diabetes There are many types of diabetes medicines: Pills, non-insulin shots and insulin People with Type 1 diabetes always take insulin. People with Type 2 diabetes try to control their diabetes with meal planning, exercise and weight loss. If meal planning and exercise do not lower blood sugar, your doctor may want you to take diabetes medication. Diabetes is a progressive disease. It is common for your medications to suddenly not work as well as they did, so medication changes may be made. The different types of diabetes medication all help to lower your blood sugar but might work in different parts of the body. People with both type 1 and type 2 diabetes may need more than one type of diabetes medicine. How do diabetes medicines work? Diabetes medicines work in these places in your body. - Pancreas - Liver - Fat cells - Intestines - Brain - Muscle cells - Kidneys - Stomach See the Diabetes Medicine Chart for more details on your specific medicine. Muscle cells Kidneys Important points about taking medicine Don t stop taking your medications without talking with your doctor. Carry a list with you of all your medicines, both prescription and medicines you buy over the counter. If you have trouble remembering to take your medicines use a pill planner or talk to your pharmacist, doctor, or diabetes educator. Show your list of medicines to your doctor, nurse, pharmacist, diabetes educator and family. Ask questions Why do I take this? How much do I take? When and how do I take this? What if I forget a dose? What are the side effects? What should I do if I get the side effects? Concerned about medication costs? Your insurance company is a good place to start: Ask if your medications are in the health plan and the expected costs. Talk with your pharmacist or doctor: Ask if there are similar medications that may be more affordable or if discounts are available. Websites like goodrx.com, rxassist.com and needymeds.org may be helpful or call several pharmacies to ask the price of your medication. Medicare D enrollment is offered once a year. During the 6 - week period, Medicare patients may choose a plan with the best benefits for your medicine costs. Never stop taking your diabetes medications because you cannot afford them. Contact your insurance company, your pharmacist or your doctor to ask for help. Fat cells Continued X26912bc (2/2016) AHC Diabetes Care

12 Diabetes Medicine Chart Diabetes Medicines Used for Type 2 Diabetes, Page 2 Trade Generic Where and how it works Possible side effects Information Micronase Diabeta Glynase Glucotrol Glucotrol XL Amaryl Prandin Starlix Glucophage Glucophage XR Riomet (liquid) Glumetza Fortamet Actos Avandia Precose Glyset Invokana Farxiga Jardiance Januvia Onglyza Tradjenta Nesina Cycloset glyburide glipizide glimepiride repaglinide nateglinide metformin metformin XL pioglitazone rosiglitazone acarbose miglitol canagliflozin dapagliflozin empagliflozin sitagliptin saxagliptin linagliptin alogliptin bromocriptine mesylate Pancreas: Causes the pancreas to make and release more insulin Pancreas: Causes the pancreas to make and release more insulin Pancreas: Causes the pancreas to make and release more insulin Liver: Reduces the amount of sugar the liver makes Muscle and fat cells: Helps the body make better use of insulin in muscle and fat cells Muscle and fat cells: Helps the body use insulin better in the muscle and fat cells (decreases insulin resistance) Low blood sugar Low blood sugar Low blood sugar Diarrhea, nausea, bloating, loss of appetite Weight gain, swelling in lower legs, feet or hands, heart disease, liver dysfunction, anemia, bone loss Intestines: Slows the absorption Gas, diarrhea, stomach pain of carbohydrate foods (starches) Kidneys: Decreases Female genital infections, reabsorption of blood sugar and urinary infections causes it to be removed in urine. Rare: diabetic ketoacidosis Pancreas:Increases insulin release and decreases glucose production Upper respiratory infection, headache, low blood sugar Brain: Increases dopamine Nausea, weakness, headache, activity in the brain. It is uncleardizziness, fatigue, runny or how it helps lower blood sugar. stuffy nose Take 30 minutes before meals Tell your doctor if you are allergic to sulfa Take before or with meals Tell your doctor if you are allergic to sulfa Take before or with meals Tell your doctor if you are allergic to sulfa Take with a meal Your doctor may check your kidney and liver function before you start taking this medicine You will need to stop this medicine for a short time if you have an X-ray with dye You should not drink alcohol in excess while taking this medication You can take with or without a meal Your doctor may check your liver function before you start taking this medication You may need to stop this medication if you have congestive heart failure or serious liver problems May take up to 6 weeks to work in your body Take with the first bite of a meal You should not take this medicine if you have ongoing problems with diarrhea or constipation Take with first meal of the day Your doctor may check your kidney function before you start taking this medication Take with first meal of the day Take within 2 hours of waking Take this medication with food X26912bc (2/2016) AHC Diabetes Care Continued

13 Diabetes Medicine Chart, continued Diabetes Medicines Used for Type 2 Diabetes, Page 3 Trade Generic Where and how it works Possible side effects Information Non-insulin injections Byetta exenatide Pancreas: increases insulin release Stomach: slows digestion Liver: decreases glucose production Brain: reduces appetite Nausea, vomiting, low blood sugar, stomach pain. Rare: pancreatitis Inject Byetta up to 60 minutes before breakfast and up to 60 minutes before supper You should not take this medication if you skip a meal You will need to eat at least 30 grams of carbohydrates after taking this medicine Rotate injection sites Bydureon exenatide XR Inject Bydureon once a week Victoza Tanzeum Trulicity liraglutide albiglutide dulaglutide Pancreas: increases insulin release Stomach: slows digestion Liver: decreases glucose production Brain: reduces appetite Nausea, vomiting, reduced appetite, slight weight loss, low blood sugar Rare: pancreatitis In animal studies: medullary thyroid cancer Inject Victoza one time a day Rotate injection sites Inject Tanzeum once a week Rotate injection sites Inject Trulicity once a week Rotate injections sites Symlin pramlintide Liver: decreases glucose production Stomach: slows digestion Brain: reduces appetite Nausea, low blood sugar Inject before meals This medication is taken in combination with rapid acting insulin. Symlin can also be used in people with type 1diabetes Rotate injection sites A pill that combines two medicines may be prescribed. Examples of combination pills: Glucovance (glyburide and metformin), Invokamet (Invokana and metformin),metaglip (glipizide and metformin), Kombiglyze XR (saxagliptin and metformin), ActoplusMet (pioglitazone and metformin), Avandamet (rosiglitazone and metformin), Avandaryl (rosiglitazone and glimepiride), Oseni (alogliptin and piogliazone), Kazano (alogliptin and metformin), Prandimet (prandin and metformin), Janumet (Januvia and metformin), ), Janumet XR (Januvia XR and metformin), Jentadueto (Tradjenta and metformin), Glyxambi (Jardiance and Tradjenta),Xigduo XR (Farxiga and metformin) and Duetact (Actos and Amaryl). See the Diabetes Medicine table to learn how each medicine works and its possible side effects. The information presented is intended for general information and educational purposes. It is not intended to replace the advice of your health care provider. Contact your health care provider if you believe you have a health problem. X26912bc (2/2016) AHC Diabetes Care