Congratulations! You have taken the first step to living a full life with diabetes. By enrolling in a diabetes self-management class and using the materials provided to you by your diabetes educator, you are taking control of your diabetes instead of letting it manage you. This Resource Guide contains chapter summaries of the DVD, helpful links to online information, and an index at the back showing where specific topics are covered in both the Resource Guide and DVD. It also has an important Emergency Contact card where you can record your medications and the contact information for your diabetes healthcare team. Be sure to complete that card, tear it out and keep it with you. The American Association of Diabetes Educators is proud to be making this educational information available to you. We welcome your feedback, which you can provide by completing the survey at atozhealth.com/ diabetes/survey.
Sincerely,
Donna Tomky MSN, RN, C-NP, CDE, FAADE AADE President
This Resource Guide is for information purposes only and is not to be used for medical advice, diagnosis or treatment. Always consult with your healthcare providers before implementing any information in the Resource Guide. All Images are for illustrative purposes only and any person depicted in the image is a model.
Table of Contents Chapter 1 Understanding Diabetes
3
Chapter 2 Healthy Eating
5
Chapter 3 Being Active
13
Chapter 4 Monitoring
15
Chapter 5 Taking Medications
21
Chapter 6 Problem Solving
25
Chapter 7 Reducing Risks
27
Chapter 8 Healthy Coping
29
Index
35
AADE and A to Z Health have made this DVD and Resource Guide available to you at no charge. We only ask that you give us your feedback on it by completing a short online survey at www.atozhealth.com/diabetes/survey.
Congratulations! You have taken the first step to living a full life with diabetes. By enrolling in a diabetes self-management class and using the materials provided to you by your diabetes educator, you are taking control of your diabetes instead of letting it manage you. This Resource Guide contains chapter summaries of the DVD, helpful links to online information, and an index at the back showing where specific topics are covered in both the Resource Guide and DVD. It also has an important Emergency Contact card where you can record your medications and the contact information for your diabetes healthcare team. Be sure to complete that card, tear it out and keep it with you. The American Association of Diabetes Educators is proud to be making this educational information available to you. We welcome your feedback, which you can provide by completing the survey at atozhealth.com/ diabetes/survey.
Sincerely,
Donna Tomky MSN, RN, C-NP, CDE, FAADE AADE President
This Resource Guide is for information purposes only and is not to be used for medical advice, diagnosis or treatment. Always consult with your healthcare providers before implementing any information in the Resource Guide. All Images are for illustrative purposes only and any person depicted in the image is a model.
Table of Contents Chapter 1 Understanding Diabetes
3
Chapter 2 Healthy Eating
5
Chapter 3 Being Active
13
Chapter 4 Monitoring
15
Chapter 5 Taking Medications
21
Chapter 6 Problem Solving
25
Chapter 7 Reducing Risks
27
Chapter 8 Healthy Coping
29
Index
35
AADE and A to Z Health have made this DVD and Resource Guide available to you at no charge. We only ask that you give us your feedback on it by completing a short online survey at www.atozhealth.com/diabetes/survey.
Get your coupon book for more than
$70 in savings!
Chapter 1 Understanding Diabetes You need to know the type of diabetes you have because your treatment and lifestyle will vary depending on which you have: TYPE 1 Your body does not make insulin. Type 2 Your body might not make enough insulin and/or it might
not properly use the insulin it makes. Many people have diabetes but do not know it, so it’s important to know the Signs and Symptoms: Type 1 Frequent urination, extreme thirst and hunger, unusual weight loss, extreme fatigue, and irritability. Type 2 The type 1 symptoms, as well as frequent infections, blurred vision, slow-healing cuts and bruises, tingling or numbness in the hands or feet, and recurring skin, gum, or bladder infections.
Look for the coupon book that came with this Resource Guide for more than $70 in savings from:
Someone in your own family might be at increased risk for developing diabetes, and they might not even know about this serious risk. These people can often help prevent diabetes or delay the onset through a few lifestyle changes. Risk factors for diabetes can be found at atozhealth. com/diabetes/resources. With the help of your Diabetes Healthcare Team, you will be able to make good decisions that will allow you to participate in the activities you enjoy. YOUR DIABETES HEALTHCARE TEAM doctor/healthcare provider PHONE email/FAX DIABETES EDUCATOR PHONE email/fax DIETITIAN PHONE email/fax
Links to additional information
• Finding a diabetes educator: www.diabeteseducator.org/DiabetesEducation/Find.html • Gestational diabetes: diabetes.niddk.nih.gov/dm/pubs/gestational • This Resource Guide and the DVD are for adults with diabetes. Resources for children with diabetes are at atozhealth.com/diabetes/resources atozhealth.com/diabetes
3
Get your coupon book for more than
$70 in savings!
Chapter 1 Understanding Diabetes You need to know the type of diabetes you have because your treatment and lifestyle will vary depending on which you have: TYPE 1 Your body does not make insulin. Type 2 Your body might not make enough insulin and/or it might
not properly use the insulin it makes. Many people have diabetes but do not know it, so it’s important to know the Signs and Symptoms: Type 1 Frequent urination, extreme thirst and hunger, unusual weight loss, extreme fatigue, and irritability. Type 2 The type 1 symptoms, as well as frequent infections, blurred vision, slow-healing cuts and bruises, tingling or numbness in the hands or feet, and recurring skin, gum, or bladder infections.
Look for the coupon book that came with this Resource Guide for more than $70 in savings from:
Someone in your own family might be at increased risk for developing diabetes, and they might not even know about this serious risk. These people can often help prevent diabetes or delay the onset through a few lifestyle changes. Risk factors for diabetes can be found at atozhealth. com/diabetes/resources. With the help of your Diabetes Healthcare Team, you will be able to make good decisions that will allow you to participate in the activities you enjoy. YOUR DIABETES HEALTHCARE TEAM doctor/healthcare provider PHONE email/FAX DIABETES EDUCATOR PHONE email/fax DIETITIAN PHONE email/fax
Links to additional information
• Finding a diabetes educator: www.diabeteseducator.org/DiabetesEducation/Find.html • Gestational diabetes: diabetes.niddk.nih.gov/dm/pubs/gestational • This Resource Guide and the DVD are for adults with diabetes. Resources for children with diabetes are at atozhealth.com/diabetes/resources atozhealth.com/diabetes
3
Chapter 2 Healthy Eating Healthy eating helps control blood glucose and weight. Changing eating habits can be difficult at first but you can eat your favorite foods if you control how often and how much you eat. All food and beverages are made up of carbohydrates, proteins and fats. Many foods also contain important vitamins and minerals. Your body uses Carbohydrates for energy and to help your cells function. There are three types: Starches, Fibers and Sugars. Carbohydrates are found in fruits and vegetables, grains, sugars, and foods with fiber. Fiber is an important part of your meal planning, and should be included in every meal. In most situations, carbohydrates that are absorbed slowly are better than those absorbed quickly, e.g., eat the fruit instead of drinking the juice. Try to limit your intake of simple sugars, found in cakes, candy, and fruit juice, because they raise your blood glucose immediately. Proteins usually come from animals and animal products, but are also found in beans, peas and lentils. Choose lean meats and plenty of vegetables in your protein choices. Fats should be the smallest part of your meal plan. Mono-unsaturated and poly-unsaturated fats and omega-3 fatty acids are good for you, and are found in olive oil and canola oil. Saturated fat and trans fats are not good, and they usually come from meat, dairy and animal products like lard. While fats do not raise your blood glucose, saturated fats are not good for your heart. Beverages can make a big difference in your calorie and glucose
intake. Choose diet drinks instead of sweetened ones. Limit your alcohol consumption and avoid sweet drinks. Make sure you eat something if you drink alcohol.
atozhealth.com/diabetes
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Chapter 2 Healthy Eating Healthy eating helps control blood glucose and weight. Changing eating habits can be difficult at first but you can eat your favorite foods if you control how often and how much you eat. All food and beverages are made up of carbohydrates, proteins and fats. Many foods also contain important vitamins and minerals. Your body uses Carbohydrates for energy and to help your cells function. There are three types: Starches, Fibers and Sugars. Carbohydrates are found in fruits and vegetables, grains, sugars, and foods with fiber. Fiber is an important part of your meal planning, and should be included in every meal. In most situations, carbohydrates that are absorbed slowly are better than those absorbed quickly, e.g., eat the fruit instead of drinking the juice. Try to limit your intake of simple sugars, found in cakes, candy, and fruit juice, because they raise your blood glucose immediately. Proteins usually come from animals and animal products, but are also found in beans, peas and lentils. Choose lean meats and plenty of vegetables in your protein choices. Fats should be the smallest part of your meal plan. Mono-unsaturated and poly-unsaturated fats and omega-3 fatty acids are good for you, and are found in olive oil and canola oil. Saturated fat and trans fats are not good, and they usually come from meat, dairy and animal products like lard. While fats do not raise your blood glucose, saturated fats are not good for your heart. Beverages can make a big difference in your calorie and glucose
intake. Choose diet drinks instead of sweetened ones. Limit your alcohol consumption and avoid sweet drinks. Make sure you eat something if you drink alcohol.
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5
PORTION CONTROL
FOOD DIARY
You can eat almost anything if you eat the right amounts. Smaller, more frequent meals are better than a few big meals because your body can process small portions more easily. The Plate Method: fill half of a 9-inch plate with one cup of non-starchy vegetables; a quarter of the plate with high-protein foods; and a quarter of the plate with starchy foods. Add a small serving of fruit and a serving of dairy.
A food DIARY enables a diabetes educator or dietitian to help you plan.
6
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Day/Time
Food
Food Preparation
Amount You Ate
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PORTION CONTROL
FOOD DIARY
You can eat almost anything if you eat the right amounts. Smaller, more frequent meals are better than a few big meals because your body can process small portions more easily. The Plate Method: fill half of a 9-inch plate with one cup of non-starchy vegetables; a quarter of the plate with high-protein foods; and a quarter of the plate with starchy foods. Add a small serving of fruit and a serving of dairy.
A food DIARY enables a diabetes educator or dietitian to help you plan.
6
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Day/Time
Food
Food Preparation
Amount You Ate
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Day/Time
Food
Food Preparation
Amount You Ate
FOOD LABELS
Label reading is important. You should get in the habit of reading the label on every food product you buy. Look at the label below:
Nutrition Facts Serving Size 2 oz (56g/1/2 cup) Dry Servings Per Container: About 6.5
The label shows you the serving size (How much you should eat). Many packages contain more than one serving size.
Amount Per Serving
Calories 190 Calories from Fat 10 % Daily Value* Total Fat 1g 2% 0% Saturated Fat 0g Trans Fat 0g Polyunsaturated Fat 0.3g Monounsaturated Fat 0.1g Cholesterol 0mg 0% Sodium 10mg 1% Total Carbohydrate 41g 14% Dietary Fiber 5g 20% Soluble Fiber 3g Insoluble Fiber 2g Sugars 1g Protein 7g 14%
The number of calories per serving The total amount of fat per serving (look for the types of fat)
Cholesterol (limit this for heart health) Sodium (sometimes “NA”; this is salt) Carbohydrates (the key number) Dietary fiber (fiber is good!)
Sugars are immediately absorbed Proteins
When you read the label you may ask yourself, “Is this food worth eating?” Tips for Eating Out
• • • •
Look or ask for nutrition information. Avoid fried foods and rich gravies. Order small or half portions. Ask for a take out box when you get your meal and put half the meal in it for tomorrow’s lunch.
You can download a complete food diary from atozhealth.com/ diabetes/resources 8
atozhealth.com/diabetes
atozhealth.com/diabetes
9
Day/Time
Food
Food Preparation
Amount You Ate
FOOD LABELS
Label reading is important. You should get in the habit of reading the label on every food product you buy. Look at the label below:
Nutrition Facts Serving Size 2 oz (56g/1/2 cup) Dry Servings Per Container: About 6.5
The label shows you the serving size (How much you should eat). Many packages contain more than one serving size.
Amount Per Serving
Calories 190 Calories from Fat 10 % Daily Value* Total Fat 1g 2% 0% Saturated Fat 0g Trans Fat 0g Polyunsaturated Fat 0.3g Monounsaturated Fat 0.1g Cholesterol 0mg 0% Sodium 10mg 1% Total Carbohydrate 41g 14% Dietary Fiber 5g 20% Soluble Fiber 3g Insoluble Fiber 2g Sugars 1g Protein 7g 14%
The number of calories per serving The total amount of fat per serving (look for the types of fat)
Cholesterol (limit this for heart health) Sodium (sometimes “NA”; this is salt) Carbohydrates (the key number) Dietary fiber (fiber is good!)
Sugars are immediately absorbed Proteins
When you read the label you may ask yourself, “Is this food worth eating?” Tips for Eating Out
• • • •
Look or ask for nutrition information. Avoid fried foods and rich gravies. Order small or half portions. Ask for a take out box when you get your meal and put half the meal in it for tomorrow’s lunch.
You can download a complete food diary from atozhealth.com/ diabetes/resources 8
atozhealth.com/diabetes
atozhealth.com/diabetes
9
Chapter 3 Being Active
Download your FREE diabetes recipe book at www.atozhealth.com
Talk with your healthcare provider or diabetes educator before you start any activity program. Always have the Contact Card from the back-cover of this Resource Guide with you when you go out to be active. Anything that gets you up and moving can help to lower your blood glucose, increase your feeling of well being, and improve your blood pressure. Cardio Do some activity 5 days/week for 30 minutes. It does not have to be 30 consecutive minutes. Examples: walking, swimming. Resistance Training 3 days/week. Examples: lifting light weights, yoga.
For both cardio and resistance, start slowly and build up levels of activity. Keep an Activity Log for a three day period. Remember to use it, be honest about what you did, and take it with you to your next healthcare provider or diabetes educator visit. You can download the log at atozhealth.com/diabetes/resources. You might want to answer the following questions and then discuss the answers with your diabetes educator or healthcare provider: 1 2 3 4 5 6 7 8 9 10
Yes I exercise 3 times a week for 30 minutes I play a sport once or twice a week I have a job that requires physical activity I often walk my dog I often play physical games like golf or bowling I often go dancing, swimming or walking I live in an area where I could walk year round I think I need to join a gym to exercise I have talked to my doctor about exercising I think it is too hard for me to exercise or move more
No
Monitor your blood glucose before — and if it is a strenuous activity, during — your activity. If it is below 100 mg/dl, eat a snack and do not exercise until it is back to a normal level. If it is above the target given you by your healthcare provider or diabetes educator, check for ketones. Do not exercise if you have ketones. 8
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Chapter 3 Being Active
Download your FREE diabetes recipe book at www.atozhealth.com
Talk with your healthcare provider or diabetes educator before you start any activity program. Always have the Contact Card from the back-cover of this Resource Guide with you when you go out to be active. Anything that gets you up and moving can help to lower your blood glucose, increase your feeling of well being, and improve your blood pressure. Cardio Do some activity 5 days/week for 30 minutes. It does not have to be 30 consecutive minutes. Examples: walking, swimming. Resistance Training 3 days/week. Examples: lifting light weights, yoga.
For both cardio and resistance, start slowly and build up levels of activity. Keep an Activity Log for a three day period. Remember to use it, be honest about what you did, and take it with you to your next healthcare provider or diabetes educator visit. You can download the log at atozhealth.com/diabetes/resources. You might want to answer the following questions and then discuss the answers with your diabetes educator or healthcare provider: 1 2 3 4 5 6 7 8 9 10
Yes I exercise 3 times a week for 30 minutes I play a sport once or twice a week I have a job that requires physical activity I often walk my dog I often play physical games like golf or bowling I often go dancing, swimming or walking I live in an area where I could walk year round I think I need to join a gym to exercise I have talked to my doctor about exercising I think it is too hard for me to exercise or move more
No
Monitor your blood glucose before — and if it is a strenuous activity, during — your activity. If it is below 100 mg/dl, eat a snack and do not exercise until it is back to a normal level. If it is above the target given you by your healthcare provider or diabetes educator, check for ketones. Do not exercise if you have ketones. 8
atozhealth.com/diabetes
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Chapter 4 Monitoring Monitoring your blood glucose is important if you have diabetes, and helps you know if your medication is working, which foods raise your blood glucose, and which activity affects your blood glucose. Usually, recommended blood glucose ranges are as noted below, however you should always check with your own health care professional: • When fasting or not eating: 70 - 130 mg/dl • Two hours after the first bite of a meal: Below 180 mg/dl When To Test
Talk with your healthcare provider or diabetes educator about the right testing plan for you. Common guidance includes: • Test your levels at the same times each day. • For type 2, check your blood glucose before meals, at bedtime, and two hours after the first bite of each meal. • For type 1, check before meals, at bedtime, two hours after the first bite of each meal, and also during the night if necessary. Choosing A Meter
Key questions to consider and discuss with your healthcare provider or diabetes educator before choosing a meter include: • What size and shape of meter is easiest for me? • Do I want to download results onto a computer? • What is the cost of the meter and its testing strips? • Which meters are covered by my insurance? Recording Your Results
Be sure to record your glucose test results in a logbook or on a computer. If you get a very high or low reading, make a note of any recent activity or food you consumed. Date
Time
Glucose Level
Food and/or Activity Notes
You can find logbook forms at atozhealth.com/diabetes/resources atozhealth.com/diabetes
15
Chapter 4 Monitoring Monitoring your blood glucose is important if you have diabetes, and helps you know if your medication is working, which foods raise your blood glucose, and which activity affects your blood glucose. Usually, recommended blood glucose ranges are as noted below, however you should always check with your own health care professional: • When fasting or not eating: 70 - 130 mg/dl • Two hours after the first bite of a meal: Below 180 mg/dl When To Test
Talk with your healthcare provider or diabetes educator about the right testing plan for you. Common guidance includes: • Test your levels at the same times each day. • For type 2, check your blood glucose before meals, at bedtime, and two hours after the first bite of each meal. • For type 1, check before meals, at bedtime, two hours after the first bite of each meal, and also during the night if necessary. Choosing A Meter
Key questions to consider and discuss with your healthcare provider or diabetes educator before choosing a meter include: • What size and shape of meter is easiest for me? • Do I want to download results onto a computer? • What is the cost of the meter and its testing strips? • Which meters are covered by my insurance? Recording Your Results
Be sure to record your glucose test results in a logbook or on a computer. If you get a very high or low reading, make a note of any recent activity or food you consumed. Date
Time
Glucose Level
Food and/or Activity Notes
You can find logbook forms at atozhealth.com/diabetes/resources atozhealth.com/diabetes
15
Keys When Testing Blood Glucose
• When testing on a finger, hold it below your heart to let the fingertips fill with blood, and stick around the edge of the pad of your finger, as it is less sensitive (see left). • Always wash your hands before testing. • Alternate which fingers you use for testing, and if supported by your meter, you may be able to use alternative testing sites like the palm of your hand or the inside of your forearm. Check with your healthcare professional to determine if alternate testing sites are appropriate for you. • Discard the strip in a safe container away from pets and children. The A1C Test
You should have an A1C test at least twice a year. The A1C test estimates your average blood glucose over the previous 2-3 months. The ADA recommends that people with diabetes keep their A1C below 7%. Your health care team will recommend an A1C goal for you. There is now a home kit that will let you do this test in your own time at your own home. This is available for you to use between tests at your healthcare provider’s office. Hypoglycemia
You have Hypoglycemia, low blood glucose, when your blood glucose falls below 70. This is a serious condition, and if left untreated can be fatal. Symptoms include hunger, cold sweat, confusion, lightheadedness, and tremors. If your blood glucose is below 70, apply the Rule of 15: • Take 15 grams of carbohydrates, such as (one of the following): 4-5 saltine crackers, ½ cup apple juice, 1 cup milk, or three to four 5-gram glucose tablets. • Wait 15 minutes, then test your blood. If still below 70, consume another 15 grams of carbohydrates. • Wait 15 minutes. Test again. If still below 70, call the doctor. 16
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Keys When Testing Blood Glucose
• When testing on a finger, hold it below your heart to let the fingertips fill with blood, and stick around the edge of the pad of your finger, as it is less sensitive (see left). • Always wash your hands before testing. • Alternate which fingers you use for testing, and if supported by your meter, you may be able to use alternative testing sites like the palm of your hand or the inside of your forearm. Check with your healthcare professional to determine if alternate testing sites are appropriate for you. • Discard the strip in a safe container away from pets and children. The A1C Test
You should have an A1C test at least twice a year. The A1C test estimates your average blood glucose over the previous 2-3 months. The ADA recommends that people with diabetes keep their A1C below 7%. Your health care team will recommend an A1C goal for you. There is now a home kit that will let you do this test in your own time at your own home. This is available for you to use between tests at your healthcare provider’s office. Hypoglycemia
You have Hypoglycemia, low blood glucose, when your blood glucose falls below 70. This is a serious condition, and if left untreated can be fatal. Symptoms include hunger, cold sweat, confusion, lightheadedness, and tremors. If your blood glucose is below 70, apply the Rule of 15: • Take 15 grams of carbohydrates, such as (one of the following): 4-5 saltine crackers, ½ cup apple juice, 1 cup milk, or three to four 5-gram glucose tablets. • Wait 15 minutes, then test your blood. If still below 70, consume another 15 grams of carbohydrates. • Wait 15 minutes. Test again. If still below 70, call the doctor. 16
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• If you cannot reach your doctor or take oral food, you may need a glucagon injection. If you are Type 1 you should have such a kit nearby at all times, and should train people likely to be nearby how to give it to you. They should also call 911. HYPERGLYCEMIA Hyperglycemia is high blood glucose. You can have hyperglycemia with-
out being aware of it. It can cause serious complications, including ketones and Hyperosmolar Hyperglycemic NonKetotic Syndrome (HHNS). High Ketone levels can lead to ketoacidosis, which is very serious. Early symptoms of ketoacidosis include high blood glucose, increased thirst or a very dry mouth, and frequent urination. Later symptoms include feeling tired; dry or flushed skin; difficulty breathing; a fruity odor on the breath; confusion or difficulty paying attention, and nausea, vomiting, or abdominal pain. Ask your healthcare provider or diabetes educator when to test for ketones. Contact your doctor immediately if the results are moderate or high, and do NOT exercise. You can test for ketones either by a finger stick blood test or urine sample. More info: diabetes.org/livingwith-diabetes/complications/ ketoacidosis-dka.html. With HHNS, the body starts passing glucose into the urine, which may become very dark and concentrated. Symptoms include extreme thirst, dehydration, and a fever of a hundred and one or more. Usually, blood glucose is above 600. This is an emergency situation and you should get to your healthcare provider or hospital as soon as possible. If you’re alone, call 911. More info: diabetes.org/livingwith-diabetes/complications/hyperosmolar-hyperglycemic.html.
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• If you cannot reach your doctor or take oral food, you may need a glucagon injection. If you are Type 1 you should have such a kit nearby at all times, and should train people likely to be nearby how to give it to you. They should also call 911. HYPERGLYCEMIA Hyperglycemia is high blood glucose. You can have hyperglycemia with-
out being aware of it. It can cause serious complications, including ketones and Hyperosmolar Hyperglycemic NonKetotic Syndrome (HHNS). High Ketone levels can lead to ketoacidosis, which is very serious. Early symptoms of ketoacidosis include high blood glucose, increased thirst or a very dry mouth, and frequent urination. Later symptoms include feeling tired; dry or flushed skin; difficulty breathing; a fruity odor on the breath; confusion or difficulty paying attention, and nausea, vomiting, or abdominal pain. Ask your healthcare provider or diabetes educator when to test for ketones. Contact your doctor immediately if the results are moderate or high, and do NOT exercise. You can test for ketones either by a finger stick blood test or urine sample. More info: diabetes.org/livingwith-diabetes/complications/ ketoacidosis-dka.html. With HHNS, the body starts passing glucose into the urine, which may become very dark and concentrated. Symptoms include extreme thirst, dehydration, and a fever of a hundred and one or more. Usually, blood glucose is above 600. This is an emergency situation and you should get to your healthcare provider or hospital as soon as possible. If you’re alone, call 911. More info: diabetes.org/livingwith-diabetes/complications/hyperosmolar-hyperglycemic.html.
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Chapter 5 Taking Medications Your doctor will decide which medication is right for you. Make sure your doctors, diabetes educator and pharmacist know about any other medications you may be taking, including over-the-counter drugs, vitamins, herbal supplements, cough medicine and cough drops. If you have Type 1 you will immediately start on insulin.You may take other non-diabetes medications along with insulin. If you have Type 2 diabetes you might be prescribed a non-insulin diabetes medication. You might eventually start taking insulin too. Keys to Remember for all Medications
• Unless otherwise directed by your doctor, take your medications at the same time and in the same dosage each day. • Make sure you always have access to your medications. • Use the cut-out card on the back cover of this Resource Guide to record your medications and keep the card on you at all times. This could be needed in an emergency. type 2 medications
If you have Type 2 diabetes, you may need to take one or more medications. You may need to take more than one medicine because they work in different ways on different tissues and organs, such as: • Slowing the production and release of glucose in the liver so that you need less insulin. • Stimulating the pancreas to release more insulin. • Increasing insulin sensitivity in muscle tissue. • Delaying the breakdown of carbohydrates, like bread and pasta, in the stomach and intestine, which helps slow the release of glucose into the blood stream after a meal. Most Type 2 medications are taken as pills, though some are injected.
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Chapter 5 Taking Medications Your doctor will decide which medication is right for you. Make sure your doctors, diabetes educator and pharmacist know about any other medications you may be taking, including over-the-counter drugs, vitamins, herbal supplements, cough medicine and cough drops. If you have Type 1 you will immediately start on insulin.You may take other non-diabetes medications along with insulin. If you have Type 2 diabetes you might be prescribed a non-insulin diabetes medication. You might eventually start taking insulin too. Keys to Remember for all Medications
• Unless otherwise directed by your doctor, take your medications at the same time and in the same dosage each day. • Make sure you always have access to your medications. • Use the cut-out card on the back cover of this Resource Guide to record your medications and keep the card on you at all times. This could be needed in an emergency. type 2 medications
If you have Type 2 diabetes, you may need to take one or more medications. You may need to take more than one medicine because they work in different ways on different tissues and organs, such as: • Slowing the production and release of glucose in the liver so that you need less insulin. • Stimulating the pancreas to release more insulin. • Increasing insulin sensitivity in muscle tissue. • Delaying the breakdown of carbohydrates, like bread and pasta, in the stomach and intestine, which helps slow the release of glucose into the blood stream after a meal. Most Type 2 medications are taken as pills, though some are injected.
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insulin
Insulin enables glucose to enter your cells. Having to take insulin does NOT mean that you’re sicker than someone else with diabetes who does not take insulin. Insulin delivery devices
Insulin can be taken by Insulin Pen, Syringe or Pump. Your healthcare provider or diabetes educator will teach you how to inject your medication.
Insulin pen and syringe with needle.
keys to remember for insulin
• Never use insulin beyond its expiration date. • Insulin impacts blood glucose at different speeds depending on where it’s injected (abdomen is fastest). • Try to inject insulin in the same area at the same time each day, but don’t inject it in exactly the same spot each time. • Syringes should be disposed of immediately after they are used, or if they have a dull or bent needle or are unclean. Dispose of syringes by placing the needle or syringe in a glass or hard plastic bottle or box that closes firmly. Links to more info
• diabetes.niddk.nih.gov/dm/pubs/medicines_ez • atozhealth.com/diabetes/resources 22
atozhealth.com/diabetes
insulin
Insulin enables glucose to enter your cells. Having to take insulin does NOT mean that you’re sicker than someone else with diabetes who does not take insulin. Insulin delivery devices
Insulin can be taken by Insulin Pen, Syringe or Pump. Your healthcare provider or diabetes educator will teach you how to inject your medication.
Insulin pen and syringe with needle.
keys to remember for insulin
• Never use insulin beyond its expiration date. • Insulin impacts blood glucose at different speeds depending on where it’s injected (abdomen is fastest). • Try to inject insulin in the same area at the same time each day, but don’t inject it in exactly the same spot each time. • Syringes should be disposed of immediately after they are used, or if they have a dull or bent needle or are unclean. Dispose of syringes by placing the needle or syringe in a glass or hard plastic bottle or box that closes firmly. Links to more info
• diabetes.niddk.nih.gov/dm/pubs/medicines_ez • atozhealth.com/diabetes/resources 22
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Chapter 6 Problem Solving addressing financial challenges Costs to be covered (by you or by insurance)
• Visits to your health care team, e.g., healthcare provider, podiatrist, ophthalmologist and other specialists. • Blood glucose meter, test strips and lancets. • Medications and diabetes supplies to administer medications. How to cover the cost
• If you have private insurance, such as through your employer, find out what benefits you have and what is not covered. • If you do not have private insurance, you may be eligible for Medicare, Medicaid, or other government programs. To find out what government programs are available to you, visit www.healthcare.gov. • If you take insulin, Medicare will reimburse for 100 strips a month. If you do not take insulin, Medicare will reimburse for 100 strips every 3 months. To make sure you get the right number of strips covered, your healthcare provider must write on the prescription form how often you test your blood glucose. • Programs may be offered by pharmacy retailers and pharmaceutical manufacturers for patients who cannot afford their medications or devices. Check their web sites. Addressing Other Challenges
• Do not leave a diabetes class or doctor’s office until all of your questions are answered. • Patient materials are often available in languages other than English. Be sure to ask if materials are available in your first language. • Make sure to talk to your family about your concerns and let them help you with your tasks.
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Chapter 6 Problem Solving addressing financial challenges Costs to be covered (by you or by insurance)
• Visits to your health care team, e.g., healthcare provider, podiatrist, ophthalmologist and other specialists. • Blood glucose meter, test strips and lancets. • Medications and diabetes supplies to administer medications. How to cover the cost
• If you have private insurance, such as through your employer, find out what benefits you have and what is not covered. • If you do not have private insurance, you may be eligible for Medicare, Medicaid, or other government programs. To find out what government programs are available to you, visit www.healthcare.gov. • If you take insulin, Medicare will reimburse for 100 strips a month. If you do not take insulin, Medicare will reimburse for 100 strips every 3 months. To make sure you get the right number of strips covered, your healthcare provider must write on the prescription form how often you test your blood glucose. • Programs may be offered by pharmacy retailers and pharmaceutical manufacturers for patients who cannot afford their medications or devices. Check their web sites. Addressing Other Challenges
• Do not leave a diabetes class or doctor’s office until all of your questions are answered. • Patient materials are often available in languages other than English. Be sure to ask if materials are available in your first language. • Make sure to talk to your family about your concerns and let them help you with your tasks.
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Chapter 7 Reducing Risks People with diabetes are at risk for a variety of serious complications. Let’s look at some specific things you can actively do to prevent complications and avoid problems. You need to take special care of your heart, kidneys, feet, eyes and teeth. Heart. People with diabetes are more likely to develop heart disease. Keep
your blood pressure and cholesterol under control, and take medications you have been prescribed for that purpose. Your target blood pressure is less than 130/80, unless otherwise determined by your healthcare provider. Your blood pressure should be checked at all routine diabetes visits. Have your blood cholesterol and lipids tested at least once a year. Keep your weight under control. Determine with your healthcare provider and diabetes educator what your ideal weight is and set goals to meet that target. Kidneys. Lower risks to your kidneys by reducing salt intake. Inform every health care provider that you have diabetes so they avoid prescribing medications that may be damaging to your kidneys. Feet. Diabetes can cause pain and reduced sensation in the feet. Be aware of your safety to prevent injuries and infection. Never walk barefoot. If the circulation in your feet is impaired you might step on something sharp and never know it.
Always wear water shoes at the beach or pool. Avoid open toe shoes and sandals. A cut in the sand can be dangerous, as live bacteria can get under the skin from the smallest opening and cause infection. Watch water temperatures and always check bath water with your wrist before sticking your feet in the water. Serious burns have occurred from not checking for hot water. Make sure you examine your feet daily and check for bruises, blisters and cuts. Toenails should be cut straight across, and visiting a podiatrist is a great idea. Shoes should be well fitting to avoid blisters, and socks should be high enough to avoid cutting off or decreasing circulation at the ankle. Make sure they are the right size to avoid folds or ridges that might cause irritations. atozhealth.com/diabetes
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Chapter 7 Reducing Risks People with diabetes are at risk for a variety of serious complications. Let’s look at some specific things you can actively do to prevent complications and avoid problems. You need to take special care of your heart, kidneys, feet, eyes and teeth. Heart. People with diabetes are more likely to develop heart disease. Keep
your blood pressure and cholesterol under control, and take medications you have been prescribed for that purpose. Your target blood pressure is less than 130/80, unless otherwise determined by your healthcare provider. Your blood pressure should be checked at all routine diabetes visits. Have your blood cholesterol and lipids tested at least once a year. Keep your weight under control. Determine with your healthcare provider and diabetes educator what your ideal weight is and set goals to meet that target. Kidneys. Lower risks to your kidneys by reducing salt intake. Inform every health care provider that you have diabetes so they avoid prescribing medications that may be damaging to your kidneys. Feet. Diabetes can cause pain and reduced sensation in the feet. Be aware of your safety to prevent injuries and infection. Never walk barefoot. If the circulation in your feet is impaired you might step on something sharp and never know it.
Always wear water shoes at the beach or pool. Avoid open toe shoes and sandals. A cut in the sand can be dangerous, as live bacteria can get under the skin from the smallest opening and cause infection. Watch water temperatures and always check bath water with your wrist before sticking your feet in the water. Serious burns have occurred from not checking for hot water. Make sure you examine your feet daily and check for bruises, blisters and cuts. Toenails should be cut straight across, and visiting a podiatrist is a great idea. Shoes should be well fitting to avoid blisters, and socks should be high enough to avoid cutting off or decreasing circulation at the ankle. Make sure they are the right size to avoid folds or ridges that might cause irritations. atozhealth.com/diabetes
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Eyes. Diabetes can hurt your eyes because of damage to blood vessels
in the retina. Get an annual eye exam by an ophthalmologist. Teeth. Gum disease and other oral health problems, like thrush and dry
mouth, can be brought on by diabetes. You should brush your teeth at least twice daily and floss at least once daily. While smoking is dangerous for everyone, for people with diabetes it doubles your risk of heart disease. Nicotine raises your blood pressure and increases your cholesterol. You should do everything you can to avoid tobacco products. There are now lots of methods to help you quit. Find one that you think will work for you. Alcohol should be limited to two glasses a day for men and one glass for women. In terms of alcohol content, one beer is equal to one ounce of “hard liquor” or 4 ounces of wine. Most glasses of wine served in restaurants and at home are at least 6 ounces. For mixed drinks use diet soda as the mixer and avoid drinks with umbrellas (as most of them are full of sugar).
These preventative measures will help you continue leading the life you want. Regular contact with your diabetes educator is important because it reminds you to take care of yourself. Your annual physical and regular visits with your physician are very important because diabetes is a progressive disease and you want to slow down that process as long as possible.
Chapter 8 Healthy Coping Diabetes is a chronic disease. You will have it the rest of your life. Many people reach a point where they are frustrated or depressed. Here are some tips to help you cope: • Find someone or a support group that you trust and talk to them about how you feel. • Communicate openly with your family and tell them what you want from them and what you don’t want them to do. • Try physical activity if you’re feeling stressed. • Find things that are fun to do but do not involve eating. For example, play cards instead of going out to dinner. You may need professional counseling if you have any of the following: • • • • •
You are no longer interested in your favorite activities. You avoid talking about your diabetes with family or friends. You sleep more or less than usual. You don’t see the benefit in taking care of yourself. You feel like diabetes is conquering you.
If you feel any of these you should talk to your healthcare professional or diabetes educator. Remember, there are lots of ways to deal with stress, and they may have great suggestions that you have not thought of to help. Avoid Sickness and Manage Sick Days
• The ADA recommends a flu shot once a year, and a pneumonia shot at least once and then as directed by your doctor. A one-time revaccination is recommended for individuals over 64 years old who were previously immunized when they were less than 65 if the vaccine was administered over 5 years ago. Be sure to ask your doctor which vaccinations are right for you. If you are sick, • Keep your body hydrated by drinking 8 ounces of calorie-free fluid every hour you are awake. • Check your blood glucose and ketones more than usual. • Call your doctor if you vomit or have diarrhea more than 4 hours. 28
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Eyes. Diabetes can hurt your eyes because of damage to blood vessels
in the retina. Get an annual eye exam by an ophthalmologist. Teeth. Gum disease and other oral health problems, like thrush and dry
mouth, can be brought on by diabetes. You should brush your teeth at least twice daily and floss at least once daily. While smoking is dangerous for everyone, for people with diabetes it doubles your risk of heart disease. Nicotine raises your blood pressure and increases your cholesterol. You should do everything you can to avoid tobacco products. There are now lots of methods to help you quit. Find one that you think will work for you. Alcohol should be limited to two glasses a day for men and one glass for women. In terms of alcohol content, one beer is equal to one ounce of “hard liquor” or 4 ounces of wine. Most glasses of wine served in restaurants and at home are at least 6 ounces. For mixed drinks use diet soda as the mixer and avoid drinks with umbrellas (as most of them are full of sugar).
These preventative measures will help you continue leading the life you want. Regular contact with your diabetes educator is important because it reminds you to take care of yourself. Your annual physical and regular visits with your physician are very important because diabetes is a progressive disease and you want to slow down that process as long as possible.
Chapter 8 Healthy Coping Diabetes is a chronic disease. You will have it the rest of your life. Many people reach a point where they are frustrated or depressed. Here are some tips to help you cope: • Find someone or a support group that you trust and talk to them about how you feel. • Communicate openly with your family and tell them what you want from them and what you don’t want them to do. • Try physical activity if you’re feeling stressed. • Find things that are fun to do but do not involve eating. For example, play cards instead of going out to dinner. You may need professional counseling if you have any of the following: • • • • •
You are no longer interested in your favorite activities. You avoid talking about your diabetes with family or friends. You sleep more or less than usual. You don’t see the benefit in taking care of yourself. You feel like diabetes is conquering you.
If you feel any of these you should talk to your healthcare professional or diabetes educator. Remember, there are lots of ways to deal with stress, and they may have great suggestions that you have not thought of to help. Avoid Sickness and Manage Sick Days
• The ADA recommends a flu shot once a year, and a pneumonia shot at least once and then as directed by your doctor. A one-time revaccination is recommended for individuals over 64 years old who were previously immunized when they were less than 65 if the vaccine was administered over 5 years ago. Be sure to ask your doctor which vaccinations are right for you. If you are sick, • Keep your body hydrated by drinking 8 ounces of calorie-free fluid every hour you are awake. • Check your blood glucose and ketones more than usual. • Call your doctor if you vomit or have diarrhea more than 4 hours. 28
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managing diabetes at work
• Keep hydrated by drinking lots of fluids without glucose. • Carry healthy snacks. Avoid high carbohydrate and fatty meals. • Always carry your medications and supplies with you and have an extra set of your medications available where you work or play. • Speak to your employer about anything special you need at work. • Excellent information about your rights in the workplace (and at school and in access to public services) can be found at www.diabetes.org/living-with-diabetes/know-your-rights. managing travel
• If you are traveling carry your supplies as hand luggage and never include them in checked baggage. • Carry your blood and ketone testing supplies when travelling. • Always carry 10 days of extra supplies when leaving the country. • Never leave home without your emergency contact card. managing physical complications Sexual health
• People living with diabetes can enjoy a healthy sex life. • For women, diabetes can cause vaginal dryness, painful intercourse, menstrual changes, and yeast infections. • Men may experience erectile dysfunction. Remember, erectile dysfunction is a common problem and nothing to be ashamed of. • There are many successful treatments now available for these conditions. Be sure to discuss the potential side effects and safe use of any treatment with your physician. Skin Health
• There are a number of skin conditions commonly associated with diabetes. You should create and maintain a daily skin care routine. • Talk with your diabetes educator or physician about any skin problems you have. You need to rotate your insulin injection sites to help improve glucose control and prevent skin infections and damage. 30
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managing diabetes at work
• Keep hydrated by drinking lots of fluids without glucose. • Carry healthy snacks. Avoid high carbohydrate and fatty meals. • Always carry your medications and supplies with you and have an extra set of your medications available where you work or play. • Speak to your employer about anything special you need at work. • Excellent information about your rights in the workplace (and at school and in access to public services) can be found at www.diabetes.org/living-with-diabetes/know-your-rights. managing travel
• If you are traveling carry your supplies as hand luggage and never include them in checked baggage. • Carry your blood and ketone testing supplies when travelling. • Always carry 10 days of extra supplies when leaving the country. • Never leave home without your emergency contact card. managing physical complications Sexual health
• People living with diabetes can enjoy a healthy sex life. • For women, diabetes can cause vaginal dryness, painful intercourse, menstrual changes, and yeast infections. • Men may experience erectile dysfunction. Remember, erectile dysfunction is a common problem and nothing to be ashamed of. • There are many successful treatments now available for these conditions. Be sure to discuss the potential side effects and safe use of any treatment with your physician. Skin Health
• There are a number of skin conditions commonly associated with diabetes. You should create and maintain a daily skin care routine. • Talk with your diabetes educator or physician about any skin problems you have. You need to rotate your insulin injection sites to help improve glucose control and prevent skin infections and damage. 30
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Notes
Notes
Notes
Index for Resource Guide and DVD Keyword
Resource Guide
DVD Chapter
A1C test Activity log Alcoholic beverages ADA - American Diabetes Association Blood glucose Blood glucose meters & logbook Blood glucose monitoring Blood pressure Calories Carbohydrates Cardio activity Children with diabetes Cholesterol Cuts and bruises Depression, Stress Discount programs (meds, supplies) Eating out, Restaurants Emergencies (CALL 911) Erectile dysfunction Eye exam, Opthalmologist Fatigue, extreme Fats Feet Fiber Flu shots Food diary Gestational diabetes, Pregnancy Glucagon emergency kit Glucose tablets Gums Heart disease Hydration Hyperglycemia Hyperosmolar Hyperglycemic NonKetotic Syndrome - HHNS
16 13 5, 28 16 5, 15 15 13, 15, 16 27 9 5, 9 13 3 9, 27 3, 27 29 25 9 19 30 28 3 5 27 5 29 7 3 19 16 28 27 30 19 19
Monitoring Active, Risks Eating, Risks Monitoring Eating, Monitoring Monitoring Monitoring, Active Risks Eating Eating Active Understanding Eating, Risks Understanding, Risks Coping Problem Solving Eating Monitoring Coping Risks Understanding Eating Risks Eating Coping Eating Understanding Monitoring Monitoring Risks Risks Coping Monitoring Monitoring
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Notes
Index for Resource Guide and DVD Keyword
Resource Guide
DVD Chapter
A1C test Activity log Alcoholic beverages ADA - American Diabetes Association Blood glucose Blood glucose meters & logbook Blood glucose monitoring Blood pressure Calories Carbohydrates Cardio activity Children with diabetes Cholesterol Cuts and bruises Depression, Stress Discount programs (meds, supplies) Eating out, Restaurants Emergencies (CALL 911) Erectile dysfunction Eye exam, Opthalmologist Fatigue, extreme Fats Feet Fiber Flu shots Food diary Gestational diabetes, Pregnancy Glucagon emergency kit Glucose tablets Gums Heart disease Hydration Hyperglycemia Hyperosmolar Hyperglycemic NonKetotic Syndrome - HHNS
16 13 5, 28 16 5, 15 15 13, 15, 16 27 9 5, 9 13 3 9, 27 3, 27 29 25 9 19 30 28 3 5 27 5 29 7 3 19 16 28 27 30 19 19
Monitoring Active, Risks Eating, Risks Monitoring Eating, Monitoring Monitoring Monitoring, Active Risks Eating Eating Active Understanding Eating, Risks Understanding, Risks Coping Problem Solving Eating Monitoring Coping Risks Understanding Eating Risks Eating Coping Eating Understanding Monitoring Monitoring Risks Risks Coping Monitoring Monitoring
atozhealth.com/diabetes
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Keyword
Resource Guide
DVD Chapter
Hypoglycemia Immunizations Infections Insulin Insurance Irritability Ketones Ketoacidosis Kidneys Meal planning Medicare, Medicaid Nutrition labels Opthalmologist Oral medications (pills) Pain Plate Method Podiatrist Portion control Protein Resistance training Salt intake Sexual health Shoes Smoking Socks Starches Sugars Support groups Symptoms of diabetes Thirst, extreme Tingling, numbness in hands/feet Tobacco use Urination, frequent Vaginal dryness Vision, blurred Vomiting Weight Workplace issues, rights
16 29 27 3, 21, 22 25 3 13, 19 19 27 5 25 9 28 21 27 6 27 6 5 13 27 30 27 28 27 5, 6 5, 9 29 3 3 3 28 3 30 3 19, 29 5, 27 30
Monitoring Coping Risks Understanding, Medications Problem Solving Understanding Active, Monitoring, Coping Monitoring Risks Eating Problem Solving Eating Risks Medication Risks Eating Risks Eating Eating Active Risks Coping Risks Risks Risks Eating Eating Coping Understanding Understanding Understanding Risks Understanding Coping Understanding Monitoring Coping Risks Coping
36
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See us online!
Recipes, Videos and More at atozhealth.com/diabetes
medical information Name DOB Diabetes type
Blood type
Emergency Contact Name Ph Doctor/Primary Care Contact Name Ph Diabetes Educator Contact Name Ph
Keyword
Resource Guide
DVD Chapter
Hypoglycemia Immunizations Infections Insulin Insurance Irritability Ketones Ketoacidosis Kidneys Meal planning Medicare, Medicaid Nutrition labels Opthalmologist Oral medications (pills) Pain Plate Method Podiatrist Portion control Protein Resistance training Salt intake Sexual health Shoes Smoking Socks Starches Sugars Support groups Symptoms of diabetes Thirst, extreme Tingling, numbness in hands/feet Tobacco use Urination, frequent Vaginal dryness Vision, blurred Vomiting Weight Workplace issues, rights
16 29 27 3, 21, 22 25 3 13, 19 19 27 5 25 9 28 21 27 6 27 6 5 13 27 30 27 28 27 5, 6 5, 9 29 3 3 3 28 3 30 3 19, 29 5, 27 30
Monitoring Coping Risks Understanding, Medications Problem Solving Understanding Active, Monitoring, Coping Monitoring Risks Eating Problem Solving Eating Risks Medication Risks Eating Risks Eating Eating Active Risks Coping Risks Risks Risks Eating Eating Coping Understanding Understanding Understanding Risks Understanding Coping Understanding Monitoring Coping Risks Coping
36
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Recipes, Videos and More at atozhealth.com/diabetes
medical information Name DOB Diabetes type
Blood type
Emergency Contact Name Ph Doctor/Primary Care Contact Name Ph Diabetes Educator Contact Name Ph
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