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Living Well With Diabetes

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Table of ContentsIntroduction..............................................................................4

What Is Diabetes? ......................................................................5

Take Charge ..............................................................................5

Healthy Living ..........................................................................6 • Know Your ABCs and Your Numbers ..............................6 • My Diabetes Care Record ...............................................7 • Self-tests for Blood Glucose ............................................8 • Hypoglycemia ................................................................9 • Medication .....................................................................9 • Healthy Food Choices ..................................................10 • Diabetes and Exercise ...................................................11

Coping With the Emotional Effects of Diabetes .......................12 • Denial ..........................................................................12 • Stress ...................................................................... 12-13 • Depression ...................................................................13

Planning for Health ................................................................14 • Diabetes Wheel ............................................................14 • Wellness Plan Tool .......................................................16 • Weekly Tracker and Review Tool ..................................17

Resources ................................................................................18

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IntroductionHearing the news that you have a chronic medical condition such as diabetes may seem overwhelming. You probably have questions like:

• What is it?• How, or why, did I get it?• How will it affect my life?• How can I live with it?

This booklet will help answer these and other questions, and lay to rest fears you may have about diabetes.

Read about the definition of diabetes and the changes that happen inside your body. Learn about the methods to measure your blood sugar numbers and what those numbers mean. Find tips to keep track of the food you eat and your physical activity as well as tips to manage emotions that may occur along with diabetes such as depression.

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What Is Diabetes?Diabetes is a condition in which the body either does not produce insulin or cannot use it properly. In diabetes, blood sugar (glucose) is at abnormally high levels because cells don’t absorb enough insulin.

The different types of diabetes Type 1 diabetes

• the body cannot produce insulin • must inject insulin daily

Type 2 diabetes

• most common form of diabetes • the body either does not make enough insulin or does not use it properly

Gestational diabetes

• occurs in about 4 percent of pregnancies • a temporary disease

Treating diabetesTreatment aims to keep blood sugar near normal levels, and self-management plays a crucial role. You can live well with diabetes with special attention to:

• nutrition • exercise • home blood glucose testing • medications, including insulin

Adapted from “Diabetes: Frequently Asked Questions” by Tom Gray, © 2000-2011 Lifescape

Take ChargeYou may feel overwhelmed or discouraged about the diagnosis of diabetes. Taking time to work through this booklet will help you gain a sense of control over the illness. Take action to be healthy and control your diabetes for life. Write down the following:

One or more reasons I have to manage my diabetes: ––––––––––––––––––––––––––––––––––––––––––––––– ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––

People who can help me do these things are: –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––

Adapted from “Tips to Help You Stay Healthy” by the National Diabetes Education Program

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Healthy Living Although diabetes may be with you for the rest of your life, that doesn’t mean you’ll always be sick. You can learn to manage this chronic condition. Put the following steps into practice and live a healthy life with diabetes.

Know Your ABCs and Your NumbersTalk with your health care provider about what things you need to monitor. It is important to know your diabetes ABCs.

• A stands for A1C test. This test measures your average blood glucose levels for the past 3 months. Your doctor should test your A1C at least twice a year. For most people with diabetes, the goal is to have an A1C “score” of less than 7.

• B stands for blood pressure, a measurement of how hard your heart needs to work to keep your blood circulating. For most people with diabetes, the goal is to keep blood pressure below 130/80.

• C stands for cholesterol, a type of fat found in your blood. There are 2 kinds of cholesterol: LDL, or “bad” cholesterol, and HDL, or “good” cholesterol. For most people with diabetes, the goal is to keep:

• LDL cholesterol below 100 • HDL cholesterol above 40 for men and above 50 for women

Ask your doctor what you can do to reach your targets for A1C, blood pressure, and cholesterol. Use the Diabetes Care Record to help keep track of your numbers and other aspects of self-care.

Adapted from “Tasty Recipes for People with Diabetes and Their Families” by the National Diabetes Education Program

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My Diabetes Care RecordDate Result Date Result Date Result

EACH vIsIT

Blood pressureMy target is:

Foot check

Review self-care plan

Weight checkMy target is:

AT LEAsT TWICE A YEAR

A1CMy target is:

ONCE A YEAR

Cholesterol-LDLMy target is:

Complete foot exam

Dental exam

Eye exam (with drops in your eyes)

Flu shot

Kidney check

AT LEAsT ONCE

Pneumonia shot

From “Tips to Help You Stay Healthy” by the National Diabetes Education Program

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self-tests for Blood GlucoseSelf-tests can help you learn how being active, having stress, taking medicine and eating food can make your blood glucose go up or down.

Talk with your health care team about the best blood glucose target range for you. Keep a record of your results. Look for times when your blood glucose is often too high or too low. Talk about your results with your health care team at each visit. Ask what you can do when your glucose is out of your target range.

Adapted from “Know Your Blood Sugar Numbers,” National Diabetes Education Program

Blood Glucose TrackersuNDAY MONDAY TuEsDAY WEDNEsDAY THuRsDAY FRIDAY sATuRDAY

Before Breakfast

After Breakfast

Before Lunch

After Lunch

Before Exercise

After Exercise

Before Dinner

After Dinner

Bedtime

Other:

Other:

My blood glucose is often out of range when: ————————————————————————————————————————————————————————————————————————————————————————

Steps I can take when my blood glucose is out of range: ————————————————————————————————————————————————————————————————————————————————————————

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HypoglycemiaKeep in mind that your blood glucose can get too low. Hypoglycemia, also called low blood glucose or low blood sugar, can happen suddenly and occurs when blood glucose drops below normal levels. If you feel shaky, sweaty, or hungry, do a check to see if your blood glucose is below your target range.

Treatment and PrecautionsIf your blood glucose level is low, treat the problem right away. Let your health care team know if this happens often.

To treat hypoglycemia, you should have a serving of a quick-fix food, wait 15 minutes, and check your blood glucose again. Repeat the treatment until your blood glucose is 70 or above.

Quick-fix food ideas: • 4 ounces of any fruit juice or regular soft drink • 5 or 6 pieces of hard candy • 1 tablespoon of sugar or honey

Adapted from “Know Your Blood Sugar Numbers” and “Hypoglycemia” by the National Diabetes Information Clearinghouse

Quick-fix foods that I will have on hand: ———————————————————————————————————————————————————————————————————————————————————————————————————————————————————

Places I will store quick-fix foods (work, car, during exercise, etc.): ——————————————————————————————————————————————————————————————————————————————————————————————————————————

MedicationIf your doctor prescribes medicine to treat your diabetes, take it exactly as instructed, even when you feel good. The medicine works only if you take it as prescribed. Tell your doctor if you have any side effects. If you have trouble paying for it, ask about a “medication assistance program.” Ask your doctor if you need aspirin to help prevent a heart attack or stroke.

Name of meDiciNe Dosage to take How ofteN to take it

Adapted from “Healthy Living With Diabetes” by Tom Gray, © 2010-2011 Achieve Solutions®

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Healthy Food ChoicesThe recommended diabetic diet, in general, isn’t much different from the kind of healthy diet that everyone should have—low-fat and high-fiber, with limited alcohol. You can stick with a normal diet as long as you keep your intake moderate.

Ask your doctor to refer you to a registered dietitian or a diabetes educator who can help you create a meal plan for you and your family. The dietitian will work with you to come up with a meal plan tailored to your needs. Other healthy steps you can take are to:

• Never skip meals. Stick to your meal plan as best you can. • Eat more fiber by eating more whole-grain foods. • Eat a variety of fruits and vegetables every day. • Eat fewer foods that are high in sugar. • Use less salt in cooking and at the table and eat fewer foods that are high in salt. • Record what you eat and drink to help know where you can improve your nutrition.

Adapted from “Common Misconceptions About Diabetes: Learn the Facts, Take Action” by Tom Gray © 2010-2011 Achieve Solutions® and “Tasty Recipes for People with Diabetes and Their Families” by the National Diabetes Education Program

time of Day Name offooD/DRiNk seRviNg amouNt

amouNt offat, sugaR

aND soDiumcaloRies

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Diabetes and Exercise Exercise is as important as medicine for managing your diabetes. It can help you: • lose weight, if you are overweight

• prevent weight gain

• lower your blood sugar without medicines

• reduce your risk for heart disease and stress

Be sure to talk to your doctor first, to make sure your exercise program is safe for you. If you take medicines that lower your blood sugar, exercise can make your blood sugar go too low. Talk to your doctor about how to take your medicines when you exercise.

Exercise tips • Start slowly with walking. If you are out of shape, walk for 5-10 minutes.

• Try to set a goal of fast walking or other aerobic exercise for 30- 45 minutes at least 5 days a week.

• Wear a bracelet or necklace that says you have diabetes.

• Always have “quick-fix” foods with you.

• Drink plenty of water. Do this before, during, and after exercising.

• Try to exercise at the same time of day, for the same amount of time, and at the same level. This will make your blood sugars easier to control.

Use the Weekly Tracker Tool found on page 17 to help keep track of your exercise.

Your feet and exerciseYou might not feel pain in your feet because of your diabetes. You may not notice a sore or blister on your foot. Call your doctor for any changes on your feet. Small problems can become serious if they go untreated.

Adapted from “Diabetes and Exercise” by MedlinePlus, National Institutes of Health

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Coping With the Emotional Effects of DiabetesAs you try to come to terms with the diagnosis of diabetes, it is normal to feel a variety of emotions. It is vital for you to find healthy ways to cope with the stress and other feelings that may impact your blood sugar levels and your self-care. The good news is that, even if the physical ups and downs of the disease continue, you can keep them from getting you down emotionally.

DenialDenial is a natural reaction to bad news—such as a diagnosis of diabetes. Just as an angry person says, “Why me?” a person in denial says, “Not me,” when told he has diabetes and must learn to live with it. Denial can become destructive if it doesn’t go away and prevents people with diabetes from looking at their situation clearly. To manage diabetes effectively, you must take it seriously. Taking it seriously means facing it honestly—and not lulling yourself into complacency as time goes on.

signs of denial The American Diabetes Association says denial shows up in “catch phrases” such as these:

• “One bite won’t hurt.”

• “I’ll go to the doctor later.”

• “My diabetes isn’t serious. I only have to take a pill, not shots.” If you find yourself or a loved one saying or thinking this, stay on guard.

• Write down your care plan and your health goals so that you fully understand them and have a reminder of what you must do.

• Get family or friends to help you, perhaps by encouraging you to stay on your care plan when you may feel tempted to let it slide.

stressStress can make diabetes worse, but diabetes itself can become a source of stress when you’re having trouble keeping it under control. At times, people with diabetes have difficulty controlling blood sugar levels even when they’re doing things right. It may help to know that this is normal.

Then there’s the stress of day-to-day living with diabetes, a disease that doesn’t allow you to lower your guard and forget about it for a while. Managing this stress in healthy ways is a big part of managing the disease itself. Consider using this chart to plan ways to manage stress.

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stress reduction planactivity wHeN? witH wHom? How ofteN? moRe Details?

Spending time with loved ones

Exercise

Spending quiet time alone

Hobby time

Meditation or prayer

Sharing your concerns with someone you trustRelaxing with a book, movie, bath, etc.

Deep breathing exercises

DepressionPeople with chronic diseases often experience depression, and diabetes is no exception. Sadness and worry about things related to diabetes are normal. But a constant state of the “blues” is not. It can trigger personal neglect.

Completing the screening tool for depression below is a useful first step. Talk to your care provider if you suspect that you are depressed.

ALMOsT NEvER sOMETIMEs OFTEN ALMOsT

ALWAYs

I feel sad.I feel less pleasure doing things I used to enjoy.My sleep has changed.My appetite has changed.I feel tired.I feel nervous.I have trouble concentrating.I feel hopeless or worthless.I have thoughts of suicide.

You may have some of these signs and not have depression. Blood sugar levels that are poorly controlled sometimes create depression-like symptoms, such as fatigue, anxiety or trouble sleeping.

If depression is the diagnosis, you can get treatment in the form of either psychotherapy or medication. If you take an antidepressant drug, the American Diabetes Association advises you to talk to both your psychiatrist and primary care provider about its side effects, including its possible effects on blood glucose levels.

Adapted from “Diabetes and Denial” and “Coping With Stress From Diabetes” by Tom Gray, © 2000-2011 Lifescape

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Planning for HealthDiabetes WheelUse this wheel to help manage your health habits and self-care.

1. Blood sugar monitoring: How often are you checking your blood sugar levels? Do you have adequate supplies? Are your blood sugar measurements within normal limits? Do you follow a protocol for abnormal blood sugar levels?

2. Medication: Are you taking your medication as prescribed? Do you understand the dosing and when to take medication?

3. Diet: Are you adhering to your diabetic diet recommendations? Do you understand the recommendations? Are you satisfied with your current eating plan? Learning what to eat, how much to eat and when to eat is a key part of learning to take care of your blood sugar levels.

4. Physical activity: Are you exercising regularly? What percent of your day is spent sitting? How satisfied are you with your exercise routine? Do you incorporate aerobic exercise, strength training and stretching in your routine? Note regular exercise improves blood sugar control.

5. Weight: Do you know your BMI? Is it within normal limits? If not, are you taking steps toward a normal BMI? Excess fat interferes with your body’s ability to effectively use insulin, which can lead to high blood sugar levels.

6. Support: What or who do you turn to for support? Support is important when making lifestyle changes. Do you need to increase your resources in this area?

7. Stress: What is your stress level? Do you utilize stress reduction techniques? Stress hormones may alter blood glucose levels directly.

8. Healthy habits: Are you practicing good habits to stay healthy? Are you practicing good eye and foot care? Are you getting enough sleep? Do you have routine visits with your primary care physician and other health care specialists?

Blood sugar monitoringHealthy habits

MedicationStress

DietSupport

Physical activityWeight

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Wellness Plan ToolUse the Wellness Plan Tool to set goals and plan for your best health.

All aspects of our lives are connected and affect one another. As we work on our relationships the workplace feels the positive outcomes. As we build strength at the gym we also build confidence and inner fortitude to complete a job. Use the Wellness Map Form to chart your own success. It is the agreement with yourself that brings clarity to what you desire to accomplish and creates a reference for you. Use your Well Life Vision to guide the way.

DATE: NAME:

Focus Area / Change Desired How ready are you?

Action Steps Indicators of Success Who will support you?

CompletionDate

1. 1.

2. 2.3. 3.

Focus Area / Change Desired How ready are you?

Action Steps Indicators of Success Who will support you?

CompletionDate

1. 1.2. 2.3. 3.

Focus Area / Change Desired How ready are you?

Action Steps Indicators of Success Who will support you?

CompletionDate

1. 1.2. 2.3. 3.

Focus Area / Change Desired How ready are you?

Action Steps Indicators of Success Who will support you?

CompletionDate

1. 1.2. 2.3. 3.

How to use this chart:

Focus Area: What do you want to change or accomplish? How ready are you? How ready are you to make the changes you have identified? Rate your readiness on a 1-5 scale with 5 being the most ready. Action Steps: The steps that will walk you to your desired change. Indicators of Success: These are the mile markers along your path to reaching your desired changes and Well Life Vision.

©2011 Real Balance Global Wellness Services LLC

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©2011 Real Balance Global Wellness Services LLC

Weekly Tracker & Review Toolweek:

1. Focus Area / Desired Change: 2. Focus Area / Desired Change:

Action Steps - What I agree to do this week

Focus Area

Mon. Tues. Wed. Fri. Sat. Sun. Did you Progress Notes

Step 1

Notes

Step 1

Notes

Step 1

Notes

What have you accomplished this week?

What have you accomplished this week?

What worked well for you this week?

Action Steps: Action steps walk you toward accomplishing your desired life change. Write down the Action Steps you committed to accomplish this week. Make each step small and specific. Focus Area: These are the areas in your life that you decided to focus on and the lifestyle changes you desire. In this section, write down the focus area the Associated Step is moving you toward. Days of the Week: When you complete an action step write it down under the day it was completed. Be specific and give yourself credit due. Weekly Review: Answer the questions and review your week. Use what you learned this week to help plan for the upcoming week. What will you change? What will you add?

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ResourcesAmericAn DiAbetes AssociAtionwww.diabetes.org

DiAbetes PhysiciAn recognition ProgrAmhttp://recognition.ncqa.org

Joslin DiAbetes centerwww.joslin.harvard.edu

Juvenile DiAbetes reseArch FounDAtion internAtionAlwww.jdf.org

nAtionAl DiAbetes eDucAtion ProgrAmwww.ndep.nih.govFor recipes: http://ndep.nih.gov/media/mqc_recipebook_english.pdf

nAtionAl DiAbetes inFormAtion cleAringhousehttp://diabetes.niddk.nih.gov

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