Living with Diabetes Disease Basics and Treatment

Living with Diabetes Disease Basics and Treatment TCBC-410_12ALM785.indd 1

Foreign Language Lines Call if you need help and need to speak with someone in one of these languages: (Arabic) 1-877-652-3046 Bosanski (Bosnian) 1-877-652-3069 (Kurdish-Badinani) 1-877-652-3046 (Kurdish- Sorani) 1-877-652-3046 Soomaali (Somali) 1-877-652-3054 Espanol (Spanish) 1-800-254-7568 (Vietnamese) 1-800-269-4901 CareSmart Disease Management Program - 1-888-416-3025 Call CareSmart for assistance in managing your disease. About your benefits: Your health plan may have limits on the care and services you receive. If you go over your plan s limits, you may have to pay for care or services yourself. Services, programs or therapies listed here are not always covered by your benefits. Always check your plan to learn what is covered or what you may have to pay for yourself. If you have questions, call the customer service number listed on your member ID card. TCBC-410_12ALM785.indd 2

Table of Contents Diabetes: what it all means. 2-4 Type 1 diabetes................................ 3 Type 2 diabetes................................ 3 Gestational Diabetes.............................4 Treating diabetes. 5-19 Know your blood sugar level....................... 5-7 Tests.................................... 8-11 Medicines................................. 11-19 Understand your role in living with diabetes. 20-24 Stop Smoking.............................. 20-21 Low blood sugar.............................. 22 High blood sugar.............................. 23 When you re sick.............................. 24 For more information on diabetes, see the booklet, Diabetes: Eating Plan and Physical Activity, from VSHP. The information in this booklet is not meant to take the place of your health care provider s advice. 1 TCBC-410_12ALM785.indd 1

Diabetes: what it all means If you have diabetes, your levels of blood glucose (called blood sugar) are above normal. People with diabetes have problems converting food to energy. Normally, after a meal, your body breaks food down into blood sugar. Blood carries blood sugar to cells all over your body. At the same time, your pancreas makes a hormone called insulin. Your body s cells use insulin to help change blood sugar into energy. If you have diabetes: Your pancreas may not make any or enough insulin Cells in your muscles, liver and fat do not use insulin the right way. As your blood sugar levels increase, your cells do not get enough energy. High blood sugar damages nerves and blood vessels. The complications from diabetes include: heart disease stroke kidney disease blindness nerve problems gum infections amputation Controlling your blood sugar levels can prevent or delay many of these diseases. 2 TCBC-410_12ALM785.indd 2

Type 1 diabetes Most Type 1 diabetics are diagnosed when they are children, teenagers or young adults. If you have Type 1 diabetes, your pancreas no longer makes insulin. You may have a higher chance of getting Type 1 diabetes if a close family member also has Type 1 diabetes. Type 2 diabetes If you have Type 2 diabetes, your body may not use insulin the right way. Over time the pancreas cannot make enough insulin to meet your body s needs. Most people with Type 2 diabetes are diagnosed when they are adults. But the disease can develop in children and teenagers. Type 2 diabetes has become a leading health problem in the United States. A person who is overweight and not physically active has a higher chance of getting Type 2 diabetes. You may have a higher chance of getting Type 2 diabetes if close family members also have Type 2 diabetes. Source: National Institute of Diabetes and Digestive and Kidney Diseases 3 TCBC-410_12ALM785.indd 3

Diabetes: what it all means... Gestational diabetes A woman who is pregnant may get gestational diabetes. The diabetes usually goes away after the baby is born. Women who develop diabetes while pregnant have a higher chance of getting Type 2 diabetes later in life. More information can be found in the brochure, Know the Facts about Gestational Diabetes, from VSHP. Talk with your health care provider to learn about the type of diabetes you have. All types of diabetics have similar health problems, diet restrictions, tests and treatments. Source: National Institute of Diabetes and Digestive and Kidney Diseases 4 TCBC-410_12ALM785.indd 4

Treating diabetes Know your blood sugar level Blood sugar levels go up and down throughout the day and night in people with diabetes. High blood sugar levels over time can result in serious health problems. Low blood sugar levels can make you feel shaky or pass out. But you can learn how to make sure your blood sugar levels stay on target not too high and not too low. You should measure and record your blood sugar level yourself. This includes: Following your health care provider s directions on when and how often you should test your blood. Pricking your finger or arm with a small, sterile needle for a tiny amount of blood. Using test strips and a meter to measure your blood sugar level. (You will need prescriptions for the needles, test strips and meter). Recording these levels to discuss with your health care providers. People who control their diabetes have found this can become a routine part of their day. You can quickly find out how your blood sugar changes after eating certain kinds of food or doing physical activity. Diabetics who must treat their disease with insulin often use these measures to decide how much insulin to take. (See more about insulin on pages 16-19). My Blood Sugar Record Make a habit of writing down your blood sugar levels. With a written record, 5 TCBC-410_12ALM785.indd 5

Treating diabetes... you can see how medicines, food and exercise affect your blood sugar levels. Take this record to appointments with your health care provider. You can copy the chart on the next page. Similar charts are available online at Web sites such as: National Institutes of Health - www.nih.gov/topic/diabetes Centers for Disease Control & Prevention - www.cdc.gov/diabetes Target Blood Sugar Levels for Most People With Diabetes Before meals 70 to 130 1 to 2 hours after the start of a meal less than 180 Target Blood Sugar Levels for Most Pregnant Women With Gestational Diabetes On Awakening Not Above 95 1 hour after a meal Not above 140 2 hours after a meal Not above 120 Talk with your health care provider about what your blood sugar numbers should be. Source: National Institute of Diabetes and Digestive and Kidney Diseases 6 TCBC-410_12ALM785.indd 6

Daily Diabetes Record My Target Blood Sugar Levels Before meals to 1 to 2 hours after the start of a meal less than Date Time Blood Sugar Medicine Notes (Special events, sick days, exercise, etc.) 7 TCBC-410_12ALM785.indd 7

Treating diabetes... Other Diabetes Testing Testing for ketones in your urine If you do not have enough insulin in your body, your body may use fat for energy instead of glucose. Signs of this problem include: A blood sugar of more than 240 Trouble breathing Stomach ache, vomiting or nausea Feeling hot Feeling thirsty or having a dry mouth Feeling confused Feeling tired all the time Having ketones in your urine (most common for Type 1 diabetics) Talk to your health care provider about how and when to test for ketones in your urine. You need to follow the directions carefully. You may be asked to keep a record of your ketone levels. Low amounts of ketones should be discussed with your health care provider. However, if your ketones are moderate to high, you should call your health care provider right away. Do not exercise. Exercising when you have high ketone levels could make your blood sugar go even higher. Sources for Pages 8-11 are listed on the back cover. 8 TCBC-410_12ALM785.indd 8

Hemoglobin A1c Test (HbA1c) Measures your average blood sugar over the last three months. Blood is taken and sent to a lab. The results return in a few days. An HbA1c level of 5 is normal. A level of more than 7 means your diabetes is not well-controlled. The test is usually done every three to six months, as directed by your health care provider Glomerular filtration rate (GFR) blood test Measures how much blood your kidneys filter each minute. This can show kidney disease which is a complication of diabetes. A GFR of 60 or higher is normal. A GFR below 60 may mean kidney disease is present. A GFR of 15 or lower may mean kidney failure. Blood is taken and sent to a lab. Finding kidney disease early can mean more successful treatment. If you have Type 2 diabetes, this test should be done every year. If you have Type 1 diabetes, this test should be done five years after you know you have the disease. After that, the test should be done every year. Please talk with your health care provider for more detailed information about what GFR means. 9 TCBC-410_12ALM785.indd 9

Treating diabetes... Urine test for protein Measures how much protein or albumin (a type of protein) is in your urine. If your kidneys are damaged, albumin can pass into the urine. The less albumin in your urine, the better. You will not know albumin is present without the test. The test is performed On a sample of urine you provide in your health provider s office. Or on urine you collect over a 24-hour period. The test should be done at least once a year. Dilated eye exam Detects early signs of retinopathy, a complication of diabetes that may cause blindness. You need this test at least once a year as part of a complete eye exam performed by an ophthalmologist. Your eyes will be dilated, the pupils widened with drops. You may have no signs of retinopathy before the doctor finds it. Vision loss can be prevented with other treatments if the disease is caught early. 10 TCBC-410_12ALM785.indd 10

Diabetic foot exam Detects early signs of complications of diabetes that include nerve damage, poor circulation and numbness. Your doctor should perform a complete foot exam once or twice a year. Take off your socks and shoes every time you visit your doctor. Point out hard-to-heal sores or other problems. Complications and amputation can be delayed with early treatment. Medicines for diabetes Medicines may have different names on your prescriptions than what is listed below. Ask your health care provider to explain all your medicines. All drugs may have side effects, so talk with your doctor on a regular basis. On your Blood Sugar Record (see pages 6-7), please write down the medicines you take and what time you take them. That can help your health care provider decide how your medicines are working. To keep a record of your Diabetes Medicines, turn to page 15. 11 TCBC-410_12ALM785.indd 11

Treating diabetes... Diabetes pills This list includes many of the most common types of diabetes pills. You may take one type of pill or take several pills together or at different times of the day. Combination pills are also available. Type of Medicine Sulfonylureas Meglitinides Biguanides What It Does Helps the pancreas produce more insulin Usually taken several times a day before meals Helps the pancreas produce more insulin Taken before three meals a day May cause blood sugar levels to drop quickly Can lower blood sugar levels by helping the liver make less glucose Includes metformin, a common diabetes drug. Usually taken twice a day Sources: National Institute of Diabetes and Digestive and Kidney Diseases, American Diabetes Association 12 TCBC-410_12ALM785.indd 12

Type of Medicine Thiazolidinediones Alpha-glucosidase inhibitors What It Does Can lower blood sugar levels by helping the liver make less glucose Also can help muscles and fat use insulin Can have good effect on hba1c levels Patients should be monitored for heart failure and liver problems Can lower blood sugar levels. Blocks or slows the body s breakdown of some foods such as sugar or starches Taken with meals Can cause gas and diarrhea DPP-4 inhibitors Can lower hba1c levels without causing blood sugar levels to drop too quickly Sources: National Institute of Diabetes and Digestive and Kidney Diseases, American Diabetes Association 13 TCBC-410_12ALM785.indd 13

Treating diabetes... Diabetes Medicines Taken by Shot (Not Insulin) These newer medicines are often prescribed in addition to diabetes pills. Pramlintide Exenatide Type of Medicines What It Does Helps lower hba1c levels. Taken at meals. Helps the pancreas release more insulin without causing sudden drops in blood glucose levels. Usually given to Type 2 diabetics. Taken at meals. Sources: National Institute of Diabetes and Digestive and Kidney Diseases, American Diabetes Association 14 TCBC-410_12ALM785.indd 14

My Diabetes Medicines Copy this chart to keep track of your current medicines. You can download a similar chart at www.diabetes.niddk.nih.gov. My Insulins Brand Name Generic Name Type of Insulin My Pills and Injected Medicines Brand Name Generic Name 15 TCBC-410_12ALM785.indd 15

Treating diabetes... Insulin As noted in the section, Diabetes: what it all means, insulin is important to your body s functions. Insulin is a hormone made by your pancreas. Insulin helps change blood sugar into energy. If you have Type 1 diabetes, your pancreas has stopped making insulin. The only way to get the insulin you need is to take insulin shots. If you have Type 2 diabetes, you may be able to control your disease through a combination of diet and physical activity, diabetes pills or other medicines taken by shot. However, you may need insulin, too. The only way to get insulin into your blood is to give it by needle under your skin. 16 TCBC-410_12ALM785.indd 16

Today, there are several methods for giving insulin that include: Pre-loaded pens with needles that let you to select or dial up the correct amount of insulin Syringes with needles that you fill with insulin to right level Insulin pumps worn outside your body, but attached to an infusion site under your skin. They can be set up to give you a steady dose of insulin all day or give extra amounts as needed. Your health care provider will help you decide how your insulin should be given. Diabetes educators may help you in learning how to give yourself insulin. (Always check with your health plan provider to see what kind of education services are covered in your benefits). Your health care provider will also help you understand how much insulin to take and what time of day to take it. 17 TCBC-410_12ALM785.indd 17

Treating diabetes... Types of Insulin: Each type of insulin has an onset, a peak and a duration time. The onset is how soon the insulin starts to lower your blood sugar after you take it. The peak is the time the insulin is working the hardest to lower your blood sugar. The duration is how long the insulin lasts the length of time it keeps lowering your blood sugar. 18 TCBC-410_12ALM785.indd 18

The times shown in the chart are estimates. Your onset, peak and duration times may be different. You ll work with your health care team to come up with an insulin plan that works best for you. Types of Insulin Type of Insulin Generic Name Onset Peak Duration Rapid-acting Insulin aspart 15 min. 30 to 90 min. 3 to 5 hrs. Insulin glulisine Insulin lispro Short-acting Regular (R) 30-60 min. 2 to 4 hrs. 5 to 8 hrs. Intermediateacting NPH (N) 1 to 3 hrs. 8 hrs. 12 to 16 hrs. Long-acting Insulin detemir Insulin glargine 1 hr. Peakless 20 to 26 hrs. There are also a number of pre-mixed combinations of insulin types. Keeping track of your blood sugar levels on the Blood Sugar Record (see pages 6-7) can be important to helping you take the right type and amount of insulin. Source: National Institute of Diabetes and Digestive and Kidney Diseases 19 TCBC-410_12ALM785.indd 19

Understand your role in living with diabetes The key to controlling your diabetes is controlling your blood sugar levels. You must balance your eating with physical activity and your diabetes medicines. Many people who have Type 2 or gestational diabetes are overweight. They may have a poor diet and a lack of physical activity. Type 1 diabetics must always take insulin. For Type 2 or gestational diabetics, however, losing weight and eating a healthy diet may help you cut down on the insulin or other medicines you take. For all diabetics, a balanced diet and exercise are keys to living a normal life. See the booklet, Living with Diabetes: Eating & Physical Activity Plan, published by VSHP. Stop Smoking Smoking helps narrow your blood vessels and drive up your blood pressure. Diabetes affects your blood circulation, too. Smoking and diabetes are an unhealthy combination. There is good news. If you stop smoking, you can stop some of the damage. Research has shown that your body will begin the healing process within 20 minutes of your last cigarette. 20 TCBC-410_12ALM785.indd 20

Within one year of quitting smoking, risk of coronary artery disease drops to half that of a smoker. Between 5 and 15 years of quitting, risk of coronary disease and stroke risk drops to that of nonsmokers. Get free help to quit smoking. Call the Tennessee Tobacco QuitLine at 1-800-QUIT-NOW or 1-800-784-8669. Deaf or hard-of-hearing Tennesseans call 1-877-559-3816. Hours for the QuitLine are Monday through Friday, 8 a.m. to 11 p.m., Saturday from 9 a.m. to 6 p.m. and Sunday from 11 a.m. to 5 p.m., Eastern Time. Counseling is available in English and Spanish. Find out more on the Web site: health.state.tn.us/tobaccoquitline. htm. 21 TCBC-410_12ALM785.indd 21

Understand your role in living with diabetes... When your blood sugar is too low Low blood sugar can make you feel shaky, weak, confused, irritable, hungry or tired. You may sweat a lot or get a headache. If you have these symptoms, check your blood sugar. If it is below 70, have one of the following right away: 3 or 4 glucose tablets 1 serving of glucose gel the amount equal to 15 grams of carbohydrate 1/2 cup (4 ounces) of any fruit juice 1/2 cup (4 ounces) of a regular (not diet) soft drink 1 cup (8 ounces) of milk 5 or 6 pieces of hard candy 1 tablespoon of sugar or honey After 15 minutes, check your blood sugar again. If it s still too low, have another serving. Repeat these steps until your blood sugar level is 70 or higher. If it will be an hour or more before your next meal, have a snack as well. Source: National Institute of Diabetes and Digestive and Kidney Diseases 22 TCBC-410_12ALM785.indd 22

When your blood sugar is too high Your blood sugar may be too high from: Eating too much Not getting enough physical activity Being sick with a cold, virus, flu or other infection Not taking enough insulin Not taking your other diabetes medicines A lot of stress at home, work or school If your blood sugar levels are high. You may need to: Increase or decrease your physical activity. Talk to your health care provider about what steps are right for you. Take more insulin or other medicine Change your eating plan Test for ketones in your urine (See page 8 for information on ketone testing). Always talk with your health care provider before making changes in your medicine or exercise plan. 23 TCBC-410_12ALM785.indd 23

Understand your role in living with diabetes... When you are sick Being sick can make your blood sugar go too high. You and your health care provider should make a plan about what to do when you are sick. According to the National Institute of Diabetes and Digestive and Kidney Diseases, some tips about what do when you are sick include: Check your blood sugar level every 4 hours. Write down the results. Keep taking your diabetes medicines. You need them even if you can t keep food down. Drink at least one cup (8 ounces) of water or other calorie-free, caffeine-free liquid every hour while you re awake. If you can t eat your usual food, try drinking juice or eating crackers, popsicles or soup. If you can t eat at all, drink clear liquids, such as ginger ale. Eat or drink something with sugar in it if you have trouble keeping food down, because you still need calories. If you can t eat enough, you increase your risk of low blood sugar, also called hypoglycemia. 24 TCBC-410_12ALM785.indd 24

Test your urine for ketones if: Your blood sugar is above 240 You can t keep water or food down Your health care provider may say you should call right away if: Your blood sugar levels are above 240 even though you ve taken your diabetes medicines Your urine ketones are above normal You vomit more than once You have diarrhea for more than 6 hours You have trouble breathing You have a high fever You can t think clearly or you feel sleepier than usual You should call your health care provider if you have questions about taking care of yourself. 25 TCBC-410_12ALM785.indd 25

Sources: Centers for Disease Control and Prevention, National Institutes of Health, American Heart Association, United States Department of Agriculture, American Diabetes Association, National Institute of Diabetes and Digestive and Kidney Disease BlueCross BlueShield of Tennessee 1 Cameron Hill Circle Chattanooga, TN 37402 vshptn.com Habla español y necesita ayuda con esta carta? Los miembros de BlueCare pueden llamar al 1-800-468-9698. Los miembros de TennCareSelect, pueden llamar al 1-800-263-5479. We do not allow unfair treatment in TennCare. No one is treated in a different way because of race, color, birthplace, religion, language, sex, age, or disability. Do you think you ve been treated unfairly? Do you have more questions or need more help? If you think you ve been treated unfairly, call the Family Assistance Service Center for free at 1-866-311-4287. In Nashville, call 743-2000. Need help in another language? You can call for language assistance. BlueCare members call 1-800-468-9698. TennCareSelect members call 1-800-263-5479. Interpretation and translation services are free to TennCare members. Volunteer State Health Plan, Inc. (VSHP) d/b/a BlueCare and BlueCross BlueShield of Tennessee, Inc. (BCBST) are independent licensees of the BlueCross BlueShield Association. VSHP is a licensed HMO affiliate of BCBST. TCBC-410 (5/12) TCBC-410_12ALM785.indd 26