Understanding Diabetes

Transcription

1 Understanding Diabetes

2 We re here for you If you have diabetes, you are not alone. Over 29 million 1 people in the United States have diabetes. The good news is that, by carefully following the advice of your healthcare professional and with regular testing, healthy food choices, and physical activity, you can help to control and manage your diabetes. The trained diabetes-care pharmacists at Walmart want to be your partners in diabetes management. We look forward to working with you to help you meet your blood sugar control goals. 1 Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, GA: U.S. Department of Health and Human Services; 2014.

3 Table of contents Diabetes Fitness What is diabetes? Why test? 04 Get active Healthy tips 36 Health Tips for better balanced meals Care + 14 Healthcare coverage 41 Food facts 20 Resources 42 Label-wise 26

4 What is diabetes? Diabetes is diagnosed when your blood sugar is too high. Did you know that your blood sugar levels change throughout the day? They are affected by food, activity, diabetes medications, and other factors like stress. To reduce the risk of serious complications, the goal of all diabetes treatment is to keep your blood sugar levels in a healthy range not too high and not too low. 04 Diabetes What is diabetes? What is diabetes? Diabetes 05

5 Why test? Testing with a meter at key times is an easy way to see: If your food choices are working to keep your blood sugar levels in range or not How well diabetes medications are working to keep your blood sugar levels under control How illness and emotions, like stress, affect your blood sugar levels Plus, knowing if your blood sugar level is high or low, and why, means you can take action to get it back in range. And knowing that your blood sugar is in range lets you get back to enjoying life. Always follow your healthcare provider s recommendations for testing and for blood sugar levels that are appropriate for you. Blood sugar level test results Guidelines My current readings My current readings MY BLOOD SUGAR RECORD A1C Level Before meals mg/dl* mg/dl Guidelines Less than 7%* % 1 2 hours after start of meals Less than 180 mg/dl* mg/dl If your A1C is 7% or higher, ask your healthcare professional what you can do to lower it. *American Diabetes Association. Glycemic targets. Sec. 6. In Standards of Medical Care in Diabetes Diabetes Care 2015;38(Suppl. 1):S33-S40. Are your meals and snacks working to keep your blood sugar levels in range? 06 Diabetes Why test? Why test? Diabetes 07

6 Try testing around a meal Test before and 1 2 hours after the beginning of a meal MEALTIME WORK SHEET 2 Today s date: Test before and after a meal: Breakfast Lunch Dinner What I ate/how much: TIP Use these work sheets to help you plan your meals and snacks that work to keep your blood sugar in range. Time: Before-meal blood sugar level: mg/dl Time: Blood sugar level 1 2 hours after start of meal: mg/dl Difference between results? Comments: MEALTIME WORK SHEET 1 MEALTIME WORK SHEET 3 Today s date: Today s date: Test before and after a meal: Breakfast Lunch Dinner Test before and after a meal: Breakfast Lunch Dinner What I ate/how much: What I ate/how much: Time: Time: Time: Time: Before-meal blood sugar level: mg/dl Blood sugar level 1 2 hours after start of meal: mg/dl Before-meal blood sugar level: mg/dl Blood sugar level 1 2 hours after start of meal: mg/dl Difference between results? Comments: Difference between results? Comments: 08 Diabetes Why test? Why test? Diabetes 09

7 Keep a logbook A logbook can help you see how food, medication(s), and exercise affect your blood sugar levels. Then you can make healthy decisions each day to better manage your diabetes. Here s how to work with a logbook: Fill in the date. When testing blood sugar levels before and after meals, write down the before-meal result in the Before column and the after-meal result in the After column. Fasting refers to your blood sugar reading before breakfast (when you wake up). Jot down how many carbs you ve eaten and any amount of insulin you ve taken. Day M T W Week of: 9/8 1 Breakfast Lunch Dinner Bedtime Carbs/ Carbs/ Carbs/ Fasting After Insulin Before After Insulin Before After Insulin N/3N ? 2 01? ? Comments: Comments: Comments: What are your blood sugar goals? Circle the result each time you re above or below your target. Add comments on diet, exercise, stress, illness, etc. 5 TIP 4 5 When your blood sugar level result is high or low, circle it so you can see it at a glance. Use the Comments section to remark on anything important like if you feel different, diet, exercise, illness, or stress. Test your blood sugar levels as recommended by your doctor or healthcare professional. 10 Diabetes Why test? Why test? Diabetes 11

8 Circle the result each time you re above or below your target blood sugar level. Add comments on diet, exercise, stress, illness, etc. Circle the result each time you re above or below your target blood sugar level. Add comments on diet, exercise, stress, illness, etc. Download a logbook at no charge at 12 Diabetes Why test? Why test? Diabetes 13

9 Tips for better balanced meals Eat at least one dark green vegetable, like collards or spinach, and one orange vegetable, such as peppers or carrots, each day Have vegetables and fruit more often than juice Consume fat-free milk or lowfat dairy every day Have meat alternatives, such as beans, lentils, and tofu, often Eat at least two servings of fish every week Include a small amount of unsaturated fat every day (like nuts, avocados, and olive oil) Satisfy your thirst with water instead of full-calorie soft drinks Make at least half your grain products whole grain every day (brown rice, oatmeal, 100% or sprouted whole-wheat bread) TIP If you find yourself feeling hungry with your meal plan for diabetes, try starting meals with a low-carb salad or a broth-based soup with plenty of non-starchy vegetables. You ll find a complete assortment of healthy vegetables at your local Walmart. 14 Health Tips for better balanced meals Tips for better balanced meals Health 15

10 Build a better meal Divide your plate into sections, like the plate below. Be sure your vegetable and starch and protein portions match with the example proportions below. Add a serving of lowfat dairy and fruit for dessert and enjoy! This will help you achieve a well-balanced meal. Visualize portion sizes Sometimes there are no food labels or scales to measure the carbohydrate in your meal, like when you re eating out. So here s an easy way to estimate portions of different kinds of food to help you keep track of your carbs. Non-Starchy Vegetables (at least two kinds) Palm of hand = 3-ounce serving of cooked meat, fish, or poultry Thumb = 1 ounce of cheese Starch (potato, rice, corn, peas) Protein (fish, lean meat, chicken, beans, eggs) Fist* = 1 cup of pasta or fruit Tennis ball = 1 serving of milk, yogurt, or fresh greens 16 Health Tips for better balanced meals Tips for better balanced meals Health 17 *Given that men s and women s hand sizes vary, amounts can vary.

11 Use in moderation: salt, fat, & sugar The less salt, the better Eating too much sodium may increase your risk of developing high blood pressure, heart disease, and stroke. Start by removing the salt shaker from the table. Then add salt sparingly, if at all, when cooking. The following foods are generally high in sodium: Canned vegetables and meats Processed snack foods Crackers, chips, cookies, pretzels Frozen entrees and snack foods Good vs. bad fat Bad fats can contribute to heart disease. Good fats are healthy for you and can actually protect your heart when consumed in appropriate amounts. You ll find good fats (monounsaturated and polyunsaturated fats) in nuts and seeds, olive and canola oils, and avocados. Bad fats (saturated fats and trans fats) are found in animal products, such as butter, bacon, sausage, meat, and cheese. A small amount of saturated fat each day is ok, but zero trans fat is best. The skinny on sugar Though it might be delicious, sugar may contribute a lot of calories and carbohydrate if consumed in excess. That s why no-calorie sweeteners are smart choices for replacing sugar in baking, cooking, or sweetening. Not all no-calorie sweeteners are heat-stable, so be sure to check with the manufacturer. Best of all, there are now more choices than ever before: Saccharin (no-calorie, artificial sweetener) Aspartame (no-calorie, artificial sweetener) Sucralose (no-calorie, artificial sweetener) Acesulfame potassium (also called Acesulfame K) (no-calorie, artificial sweetener) Stevia/Rebaudioside A (no-calorie, natural sweetener) Monk Fruit Extract/Luo Han Guo (no-calorie, natural sweetener) Source: Calorie-Free Sweeteners Offer Benefits, Diabetes Forecast Magazine. Accessed October 2012, through diabetes.org, website of the American Diabetes Association, ( 18 Health Tips for better balanced meals Tips for better balanced meals Health 19

12 Food facts FIND THE CARBS QUIZ Check the foods that contain carbohydrates. Of all the things that affect your blood sugar levels, food has one of the biggest effects. Especially foods with carbohydrate (carbs, for short). Your body uses carbs for energy, but they raise your blood sugar level higher and faster than other kinds of nutrients. What s more, diabetes is different for everyone, including the way various foods affect blood sugar levels. So the goal is to plan meals with the right amounts of carbs for your body. When you eat carbs, your body breaks them down into glucose. Glucose is absorbed into the bloodstream Insulin helps the blood sugar enter your cells, where it can be stored or used for energy Peach Toast Skim milk Sandwich bread Diet soda Oatmeal cookie Cheddar cheese Broccoli Potato Apple Cereal Plain tuna Raisins Pork chop Eating about the same amount of carbs at meals and snacks can help keep your blood sugar levels in your target range If you check your blood sugar level before meals and then again 2 hours afterward, you ll begin to get a picture of how your body responds to the amount of carbs you are eating and if changes are needed Soda cracker Butter Peanut butter Salmon Peach, toast, skim milk, sandwich bread, oatmeal cookie, soda cracker, broccoli, potato, apple, cereal, raisins, peanut butter. Answer: 20 Health Food facts Food facts Health 21

13 Most people use this method to keep track of carbs 15 grams CARBS = 1 CARB CHOICE Counting carbs Counting carbs is one way to create meals and snacks that will help you stay in your blood sugar level range. Food labels list the number of carbs in grams (g) per serving. Meal and snack planning guide Meal Generally, adults need 45 to 60 grams of carbs in each meal for energy, but it depends on how your body handles carbs. Consult a registered dietitian or other healthcare professional for the amount that s right for you. Snack grams grams CARBS = 3 4 CARB CHOICES grams grams CARBS = 1 2 CARB CHOICES 22 Health Food facts Food facts Health 23

14 Common carb counts The following chart gives you an idea of what 15 grams of carbs (1 carb choice) looks like for many of your favorite foods. So you ll have an idea of how many carbs you re consuming, even if there s no package handy. 15 GRAMS OF CARBS 34 DIFFERENT WAYS Starches/Grains/Sweets 1 slice bread or small roll ¼ of a 4-oz. bagel ½ English muffin ¾ cup dry, unsweetened cereal ½ cup unsweetened hot cereal ¹ ³ cup cooked pasta or rice ½ cup peas or corn ¼ large potato ½ cup beans/lentils 1 pancake (4-inch diameter) 1 frozen waffle (4-inch diameter) 6 saltine crackers 3 cups popcorn ¾ ounce pretzels 1 tablespoon sugar Dairy 1 cup milk 6 oz. artificially sweetened yogurt 1 cup plain, lowfat yogurt ½ cup ice cream Fruits 1 small apple 1 small banana 4 apricots ¾ cup blueberries ¹ ³ small cantaloupe ½ large grapefruit ¾ cup mandarin oranges ½ papaya 1 medium peach ½ large pear ¾ cup pineapple 2 tablespoons raisins 1¼ cup strawberries 1¼ cup watermelon ½ cup apple or orange juice Don t forget! The following are a couple of reminders to help you manage your diet and achieve optimal glycemic (blood sugar) control. Remember: variety, moderation, and balance are key to healthy eating. Eat lean proteins, as well as a variety of fruits and vegetables, nonfat and lowfat dairy products, and whole grains When you eat carbs, your body breaks them down into glucose. Glucose is absorbed into the bloodstream Insulin helps the blood sugar enter your cells, where it can be stored or used for energy Eating about the same number of carbs at your meals and snacks can help to keep your blood sugar levels in your target range Space your meals out consistently, and do not skip meals these are both important principles in diabetes management If you check your blood sugar level before meals and then again 2 hours afterward, you ll begin to get a picture of how your body responds to the number of carbs you are eating and if changes are needed 24 Health Food facts Food facts Health 25

15 Label-wise Nutrition labels on packaged foods can be a great help when you re counting the carbs in your meals or snacks. Zero in on the Serving Size and the Total Carbohydrate lines to see the total grams of carbs for one serving. The label shows you where to look. Want to see more? Check out the packages, cans, and bottles in your kitchen cupboard. TIP Is the serving size the same as your portion? If not, adjust the carb content as necessary. Nutrition Facts Serving Size 1 slice Servings per container 22 Amount per serving Calories 80 Calories from Fat 10 % Daily Value Total Fat 1g 2% Saturated Fat 0g 0% Cholesterol 0mg 0% Sodium 210mg 9% Total Carbohydrate 15g 5% Dietary Fiber less than 1g 4% Sugars 2g Protein 2g 4% 26 Health Label-wise Label-wise Health 27

16 Get active The proven positive effects of physical activity can t be overstated. On top of all the health benefits you might know of, like building up your heart health, getting more activity is a great way for people with diabetes to help improve blood sugar control. For people with type 2 diabetes, activity can help to boost your body s ability to use the insulin it makes, which helps lower your blood sugar levels. 28 Fitness Get active Get active Fitness 29

17 Getting started Working up to 150 minutes of moderate-intensity aerobic activity (like brisk walking) every week is suggested. Be sure to talk to your healthcare professional before you begin any physical activity or exercise program, especially since exercise can have an effect on blood sugar levels. Find an activity you enjoy, so you can stick with it. For example, walking at a brisk clip is popular because it s easy on your joints and you don t need any fancy equipment. Not keen on walking? Try riding a bike or check your local recreational center for aquatic programs. Even household chores like raking leaves, vacuuming, or washing the car count as activity. Keep track of your active time, and you ll be surprised how easy it can be to fit 20 minutes (or more) into your day. 30 Fitness Get active Get active Fitness 31

18 Exercising safely with diabetes It is not uncommon for people with diabetes to experience hypoglycemia, or low blood sugar levels, during or after exercise. If this happens, treat it immediately. Use the same process as you would at any other time of the day: Consume at least grams of fast-acting carbohydrate (sports drinks, regular soda, or glucose tabs are all effective) ACTIVITY WORK SHEET Before Wait minutes and check your blood sugar level again If it is still low and your symptoms don t go away, repeat the treatment If low blood sugar levels regularly interfere with your exercise routine, talk to your healthcare provider about adjusting your diabetes management plan. Your provider might suggest eating a small snack before you exercise, or they might make an adjustment to your medication(s). For people engaging in long-duration exercise, a combination of these two regimen changes is often necessary to prevent hypoglycemia (low blood sugar levels) during and after exercise. TIP After After you feel better, be sure to eat your regular meals and snacks as planned to keep your blood sugar level up Try testing your blood sugar levels before and after a brisk 30-minute walk. Time: Result: mg/dl Time: Result: mg/dl Before walking, I felt: My test result was: After walking, I felt: My test result was: Good High Better High Okay In range Good In range Sluggish Low Okay Low Edgy Other Comments: Sluggish Edgy Comments: Other 32 Fitness Get active Get active Fitness 33

19 Before After Time: Result: mg/dl Time: Result: mg/dl Before walking, I felt: My test result was: After walking, I felt: My test result was: Good High Better High Okay In range Good In range Sluggish Low Okay Low Edgy Other Comments: Sluggish Edgy Comments: Other Before After Time: Result: mg/dl Time: Result: mg/dl Before walking, I felt: My test result was: After walking, I felt: My test result was: Good High Better High Okay In range Good In range Sluggish Low Okay Low Edgy Other Comments: Sluggish Edgy Comments: Other 34 Fitness Get active Get active Fitness 35

20 Healthy tips Maintaining a healthy lifestyle day to day is important and can help to reduce your risk of developing complications from diabetes. HERE ARE SOME AREAS TO WATCH: Here are some areas to watch: A1C This blood test measures blood sugar control over the past 90 days. A1C should be tested two to four times a year, depending on how well your blood sugar levels are managed and/or whether you have had a recent change in your diabetes medications or management plan. The goal for A1C levels is less than 7.0 percent. Smoking Cessation If you smoke, quit! It is never too late to quit smoking. Cigarette smoking is a strong risk factor for developing heart and lung disease. Ask your healthcare provider to help you quit smoking. Oral Care When you re living with diabetes, you are more susceptible to gum inflammation and you re at a higher risk for developing the advanced stage of gum disease periodontitis. Maintaining a consistent oral care routine is crucial to your oral health. The basic steps of daily brushing, flossing, and rinsing are the same for you as for everyone who wants a cleaner, healthier mouth, but vigilance is key. Foot Care Diabetes increases your risk for foot problems. You should inspect your feet every day for signs of redness, warmth, swelling, or calluses. These are early warning signs of conditions that can lead to serious foot problems. Tell your healthcare provider if you have any of these symptoms. In addition, people with diabetes should have their feet inspected by their healthcare provider during each visit. You should also have a complete sensory foot exam done by your healthcare provider every year. Eye Exam People who have diabetes should have a dilated retinal (eye) examination every year. Early detection and treatment of changes in your eyes can often prevent blindness. Remember, this is a special eye exam and is different than having your vision checked for glasses. 36 Fitness Healthy tips Healthy tips Fitness 37

21 Skin Care Managing diabetes is about eating right, exercising, and following your doctor s recommendations. But there are other considerations. For instance, many people with diabetes don t realize the importance of skin care. Here are a few tips to keep in mind: HYDRATE Keeping skin hydrated with a moisturizing body lotion or cream helps relieve the itch associated with dry skin while preventing irritation and cracking. Dry skin thoroughly and moisturize with lotion or cream after a shower or bath. Be sure the lotion or cream is fully absorbed before getting dressed. Do not use creams or lotions on open wounds. CLEAN AND DRY Ensuring that skin is always clean and dry helps prevent fungal growth and harmful bacteria from developing into infections. CHECK AND TREAT Checking skin daily for cracks and treating problems straight away helps prevent infections. The American Diabetes Association recommends avoiding harsh antiseptics and talking to a doctor before using an antibiotic cream or ointment. AVOID very hot baths and showers. Hot water can remove natural oils from skin, making it dry and itchy. Try showering or bathing with warm water and limit your time in the water to 10 minutes or less. If your skin is dry, don t use bubble baths. Moisturizing soaps may help. ALWAYS DRINK PLENTY OF WATER It s wise to cut down on alcohol and caffeine, since these substances can dehydrate the body, robbing the skin of fluids. REMEMBER TO WEAR SUNSCREEN Sun exposure can damage your skin s ability to protect itself, so choose a broad-spectrum sunscreen with an SPF of 15 or higher. Also, apply a lip balm with an SPF of 15 to help moisturize and prevent chapped lips. Depression It s not uncommon for people with diabetes to develop depression. Trying to focus on doing the right thing all the time can be draining, and it can be disheartening when things don t go right. It s important to be alert for the signs and symptoms of depression. Just as diabetes can be diagnosed, monitored, and treated, so can depression. Feelings of sadness almost every day, throughout the day Not performing as well at school or work Changes in appetite or weight Problems sleeping Loss of interest in work, hobbies, people, or sex Withdrawing yourself from family or friends Feeling hopeless, guilty, or having low self-esteem Feeling agitated or sluggish Difficulty concentrating, remembering things, or making decisions Crying easily or wanting to cry, but not being able to Feeling out of touch with reality Having thoughts of suicide (these should always be taken seriously; reach out to those around you right away) Fitness Healthy tips Healthy tips Fitness 39

22 Eye Exam People who have diabetes should have a dilated retinal (eye) examination every year. Early detection and treatment of changes in your eyes can often prevent blindness. Remember, this is a special eye exam and is different than having your vision checked for glasses. Flu Vaccine The flu can be a serious illness for people with diabetes. It is important that you get a flu vaccine every year. You should plan to get your flu vaccine as soon as it is available, usually in September. Pneumonia Vaccine A pneumococcal vaccine is recommended for everyone with diabetes beginning at two years of age. A second dose is recommended when you are 65 years of age or older, as long as it has been at least five years since your last pneumococcal vaccine. Talk with your healthcare provider about getting a pneumococcal vaccine. Hepatitis Vaccine The hepatitis B vaccine is recommended for adults with diabetes who are years of age. Talk with your healthcare provider to see if the hepatitis B vaccine is right for you. Healthcare coverage Your Walmart Pharmacy accepts most kinds of insurance including Medicare, Medicaid, and commercial insurance. For more information about insurance coverage, ask your Walmart pharmacist, check with your insurance provider, or visit one of these websites: Medicare Medicaid Insurance Information Institute Commercial Insurance Care Fitness Healthcare Healthy coverage tips Healthcare coverage Care 41

23 Resources American Diabetes Association Their mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes. Diabetes Forecast The premier healthy living magazine for people with diabetes. Recipes for Health Living Free online recipes, meal plans, and tips for healthy cooking. Living With Type 2 Diabetes Insight and support for people new to diabetes. Tour de Cure The ADA s signature fundraising cycling event, with routes designed for all levels. Step Out: Walk to Stop Diabetes The ADA s signature fundraising walk with events in 125 cities nationwide. CDC Centers for Disease Control. Diabetes Research Institute The Institute s mission is to develop and rapidly apply the most promising research to treat and cure those now living with diabetes. Joslin Diabetes Center An organization dedicated to ensuring that people with diabetes live long, healthy lives and offers real progress in preventing and curing diabetes. Mayo Clinic Worldwide leader in medical care, research, and education for people from all walks of life. SPLENDA Diabetes-Friendly Recipes The SPLENDA brand wants to help you select recipes that are both delicious and easy to fit into a balanced meal plan for diabetes. Walmart Diabetes Wellness Center Information and supplies for people with diabetes. The third-party trademarks used herein are registered trademarks of their respective owners. Provided for informational purposes only. 42 Care Resources No endorsement or sponsorship is implied. Resources Care 43

24 Phone numbers of your healthcare professional team. Clinic Phone / Physician / Nurse Practitioner / Physician Assistant Phone / Diabetes Educator Phone / Endocrinologist Phone / Registered Dietitian Your partners in diabetes care. At Walmart, our goal is to help you better manage your diabetes. We hope you have found the information in this booklet useful. Please don t hesitate to visit our pharmacy and talk with us about any concerns you may have about your health. Phone / Ophthalmologist (eyes) Phone / Podiatrist (feet) Phone / Other Phone / Third-party trademarks used herein are trademarks of their respective owners. Johnson & Johnson Services, Inc. 2015

25 Johnson & Johnson Services, Inc. 2015