managing your diabetes - gbcs

Managing Your Diabetes

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Table of Contents

The Importance of Managing Your Diabetes 3 - 8

Risk Factors 9 - 12

Food Choices & Meal Plans 13 - 15

10 Diabetes Diet Myths 16 - 22

Where to Get Help 23

Diabetes Care Record 24 - 26

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If left untreated, Diabetes can result in serious complications. This is why it is very important to take all medications as prescribed by your physician, control your diet and get regular exercise. Some of the complications that can result from not managing your diabetes appropriately are as follows:

Heart Disease

Eye Disease

Foot Ulcers

Kidney Disease

The Importance of Managing Your Diabetes

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Step 1: Learn About Diabetes

Diabetes means that your blood glucose (blood sugar) is too high. There are two main types of diabetes.

Type 1 Diabetes The body does not make insulin. Insulin helps the body use glucose from food for energy. People with type 1 need to take insulin every day.

Type 2 Diabetes The body does not make or use insulin well. People with type 2 often need to take pills or insulin. Type 2 is the most common form of diabetes.

Gestational Diabetes This form of diabetes may occur when a woman is pregnant. Gestational diabetes raises her risk of getting another type of diabetes, mostly type 2, for the rest of her life. It also raises the child’s risk of being overweight and getting diabetes.

You may have heard people say they have “a touch of diabetes” or “your sugar is a little high.” These words suggest that diabetes is not a serious disease. That is not correct. Diabetes is serious, but you can learn to manage it!

All people with diabetes need to make healthy food choices, stay at a healthy weight, and be physically active every day. Taking good care of yourself and your diabetes can help you feel better.

It may help you avoid health problems caused by diabetes such as:

• Heart disease and stroke • Eye problems that can lead to trouble seeing or going blind • Nerve damage that can cause your hands and feet to feel numb (Some people may even lose a foot or a leg) • Kidney problems that can cause your kidneys to stop working • Gum disease and loss of teeth

When your blood glucose (blood sugar) is close to normal you are likely to:

• Have more energy • Be less tired and thirsty and urinate less often • Heal better and have fewer skin, or bladder infections • Have fewer problems with your eyesight, feet, and gums

Diabetes is Serious!

also

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Step 2: Know Your Diabetes ABCs

also

Talk to your healthcare team about how to manage your A1C (blood glucose or blood sugar), Blood pressure, and Cholesterol when you have diabetes. This will help lower your chances of having a heart attack, a stroke, or other diabetes problems. Here’s what the ABCs of diabetes stand for:

Patients with diabetes have an increased presence of cholesterol abnormalities, which contribute to their higher risk of cardiovascular disease, which can result in a heart attack or a stroke.

Ask your healthcare team:

• What your A1C, blood pressure, and cholesterol numbers are • What your ABC numbers should be • What you can do to reach your targets

Write down all your numbers on the record page at the back of this booklet.

A for the A1C test (A-one-C)The A1C test shows what your blood glucose (blood sugar) has been over the last three months. The A1C goal for most people with diabetes is below 7%. High blood glucose (blood sugar) levels can harm your heart and blood vessels, kidneys, feet, and eyes.

B for Blood pressureThe blood pressure goal for most people with diabetes is below 140/90 mmHg. High blood pressure makes your heart work too hard. It can cause heart attack, stroke, and kidney disease.

C for Cholesterol (ko-LES-ter-ol)Regardless of cholesterol levels, your doctor may prescribe cholesterol lowering therapy, such as “statins”, to lower your cardiovascular risk due to your diabetes.

(A1C, Blood Pressure & Cholesterol)

ABC

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Step 3: Manage Your Diabetes

Many people avoid the long-term problems of diabetes by taking good care of themselves. Work with your healthcare team to reach your ABC goals (A1C, Blood Pressure and Cholesterol). Use this self-care plan: • Use your diabetes meal plan. If you do not have one, ask your healthcare team about one. o Make healthy food choices such as fruits and vegetables, fish, lean meats, chicken or turkey without the skin, dry peas or beans, whole grains, and low-fat or skim milk and cheese. o Keep fish and lean meat and poultry portion to about 3 ounces (or the size of a deck of cards). Bake, broil, or grill it. o Eat foods that have less fat and salt. o Eat foods with more fiber such as whole grain cereals, breads, crackers, rice, or pasta. • Get 30 to 60 minutes of physical activity on most days of the week. Brisk walking is a great way to move more. • Ask for help if you feel down. A mental health counselor, support group, member of the clergy, friend, or family member who will listen to your concerns may help you feel better. • Learn to cope with stress. Stress can raise your blood glucose (blood sugar). While it is hard to remove stress from your life, you can learn to handle it.

Make Healthy Food Choices

Exercise Regularly

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Talk with your healthcare team about your blood glucose targets. Ask how and when to test your blood glucose and how to use the results to manage your diabetes. Use this plan as a guide to your self-care. Discuss how your self-care plan is working for you each time you visit your healthcare team.

Take Your Medicine Daily

Get Regular Eye Exams

• Stop smoking. Ask for help to quit. • Brush your teeth and floss every day to avoid problems with your mouth, teeth, or gums. • Take medicines even when you feel good. Ask your doctor if you need aspirin to prevent a heart attack or stroke. Tell your doctor if you cannot afford your medicines or if you have any side effects. • Check your feet every day for cuts, blisters, red spots, and swelling. Call your healthcare team right away about any sores that do not go away. • Check your blood glucose (blood sugar). You may want to test it one or more times a day. Use the card at the back of this booklet to keep a record of your blood glucose numbers. Be sure to take this record to your doctor visits. • Check your blood pressure if your doctor advises. • Report any changes in your eyesight to your doctor. Get regular eye exams.

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Step 4: Get Routine Care to Avoid Problems

If you have diabetes, at each visit be sure you have a: • Fasting blood sugar test (FBS) • Blood pressure check • Foot check • Weight check • Review of your self-care plan shown in Step 3

If you have diabetes, two times each year get: • A1C test - it may be checked more often if it is over 7

If you have diabetes, once each year be sure you have a: • Cholesterol test • Triglyceride test - a type of blood fat • Complete foot exam • Dental exam to check teeth and gums - tell your dentist you have diabetes • Dilated eye exam to check for eye problems • Flu shot • Urine and a blood test to check for kidney problems

If you have diabetes, at least once get a: • Pneumonia shot

Ask your healthcare team about these and other tests you may need. Ask what the results mean. Write down the date and time of your next visit. Use this booklet to keep a record of your diabetes care (pages 24-26). If you have Medicare, ask your healthcare team if Medicare will cover some of the costs for:

• Learning about healthy eating and diabetes self-care • Special shoes, if you need them • Medical supplies • Diabetes medicines

See your healthcare team at least twice a year to find and treat any problems early. Ask what steps you can take to reach your goals.

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Risk Factors for Pre-Diabetes

Screening for pre-diabetes is recommended for men and women whose body mass index (BMI) is 25 kg/m2 or greater; screening should be considered for younger individuals with BMI’s of 25kg/m2 or more who also have one or more risk factors (e.g., family history of diabetes, gestational diabetes or delivery of a baby weighing more than 9 pounds, race/ethnicity, presence of high cholesterol or high blood pressure). Screening should be done during a regular physician’s office visit, using either a fasting plasma glucose test or a 2-hour oral glucose tolerance test (75 gram glucose load).

Patients can take an online diabetes risk test located at www.diabetes.org/main/info/risk/risktest.jsp, the test asks a few simple questions about age, medical and family history, and lifestyle, and scores patients’ risk of diabetes as very low, low/medium, or high.

RACE/ETHNICITY African American, American Indian, Asian American, Pacific Islander, or Hispanic American/Latino heritage

OVERWEIGHT Body mass index 25 or higher (23 or higher if Asian American, 26 or higher if Pacific Islander)

HISTORY OF GESTATIONAL DIABETES Or giving birth to a baby weighing more than 9 pounds

AGE Risk increases

with age

INACTIVE LIFESTYLE Exercise fewer than three times a week

BLOOD PRESSURE 140/90 mm/Hg or higher

FAMILY HISTORY OF DIABETES Having a parent, brother, or sister with diabetes

CHOLESTEROL Abnormal lipid levels: HDL cholesterol < 40mg/dL for men and < 50mg/dL for women, triglyceride level 150 mg/dL or higher

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At-Risk Weight Chart

If you weigh the same as or more than the amount listed for your height, you may be at risk for diabetes.

6’4”

6’3”

6’2”

6’1”

6’0”

4’11”

4’10”

5’11”

5’10”

5’9”

5’8”

5’7”

5’6”

5’5”

5’4”

5’3”

5’2”

5’1”

5’0”

Height (In feet and Inches

without shoes)

133

129

193

188

182

177

172

167

162

157

152

147

143

138

221

216

210

204

199

Weight (In pounds

without clothing)

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You Could Have Diabetes & Not Know itWrite in the points next to each statement that is true for you. If a statement is not true, put a zero. Then add your total score.

Take our quiz to find out!

1. A woman who had a baby weighing more than nine pounds at birth.

Yes ____ = 1pt

2. I have a sibling with diabetes.

Yes ____ = 1pt

3. I have a parent with diabetes.

Yes ____ = 1pt

4. My weight is equal to or above that listed on the chart.

Yes ____ = 5pts

5. I am under 65 years of age, and I get little or no exercise.

Yes ____ = 5pts

6. I am between 45 and 64 years of age.

Yes ____ = 5pts

7. I am 65 years old or older.

Yes ____ = 9pts

TOTAL ______

Scoring 10 or more You are at high risk for having diabetes. Only your physician can check to see if you have diabetes. See yours soon and find out for sure.

Scoring 3 to 9 points You are probably at low risk for having diabetes now. Keep your risk low by losing weight if you are overweight, being active most days and eating low-fat meals high in fruits, vegetables and whole grain foods.

Source: The American Diabetes Association

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Is Your Child at Risk for Diabetes?

As the obesity epidemic continues to grow in the US, many children are developing type 2 diabetes. And overweight kids tend to become overweight adults, continuing to put them at greater risk for heart disease, high blood pressure and stroke.

If your child is at risk or shows signs of diabetes, talk to your doctor. Ask your doctor to perform a blood test to see if your child has type 2 diabetes.

Diabetes is a disease that occurs when the body doesn’t produce enough insulin or loses the ability to use insulin efficiently. Children are considered to be at high risk for developing type 2 diabetes if they have any of the high risk symptoms listed below:

HIGH RISKS TYPE

Overweight

Not very active

Have family members

with diabetes

Have high blood

pressure or high

cholesterol

American Indian,

African American,

Hispanic-Latino or

Asian-South Pacific Islander

TYPICAL SIGNS

Dark patches of skin that

look like dirt on their neck,

underarms or groin area

Eating or drinking

more than usual

Losing weight

for no reason

Frequent urination

Feeling tired

Sources: American Diabetes Association and the National Library of Medicine

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Eating Out with DiabetesJust because you are a diabetic doesn’t mean you have to give up eating out. It does mean you need to make better choices. The average fast food meal can run upwards of 1000 calories! The table below offers some healthier restaurant alternatives.

Today the talk is all about Glycemic Index. Glycemic index measures how a carbohydrate containing food raises your blood sugar. High GI foods raise blood sugar significantly while low GI foods have little effect on blood sugar.

Create a meal plan that:

A free food advisor is available at www.diabetes.org. They offer meal plans, recipes, and food & kitchen tips.

Bacon, sausage, biscuits, croissantsPlain bagel, English muffin, cold cereal with fruit, plain eggs, fat free yogurt

Fried foods, cheese, anything “double”Grilled or broiled meats, veggies, regular or junior size

Mayo, high fat dressings, bacon bits Mustard, vinaigrettes, lemon juice

Fried taco shells, salad shells Soft shell tacos, bean burritos, fajitas

Deep dish pizza with double meat Thin crust pizza with veggies

Foods with High Glycemic Index (white bread, pineapple, pretzels)

Foods with Low Glycemic Index (most fruits, pasta, sweet potato)

Milk shakes, full sugar sodas Sugar free soda, teas, water

LIMIT OR AVOID BETTER CHOICES

• Works with your schedule • Improves blood glucose, blood pressure, & cholesterol• Keeps your weight on track

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If you have diabetes you should follow a special diet. Here’s a sample diabetic meal plan that is about 1,600 calories and 220 grams of carbohydrates. Remember to drink two 8-ounce glasses of water with each meal.

Sample Meal Plan

Breakfast

1 slice toasted whole wheat bread with 1 teaspoon margarine 1/4 cup egg substitute or cottage cheese 1/2 cup oatmeal 1/2 cup skim milk 1/2 small banana

1 cup vegetable soup with 4-6 crackers 1 turkey sandwich (2 slices whole wheat bread, 1 ounce turkey and 1 ounce low-fat cheese, 1 teaspoon mayonnaise) 1 small apple

Lunch

360 calories / 52.5 grams carbs

535 calories / 75 grams carbs

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Dinner

Snack

4 ounces broiled chicken breast with basil and oregano sprinkled on top 2/3 cup cooked brown rice 1/2 cup cooked carrots 1 small whole grain dinner roll with 1 teaspoon margarine Tossed salad with 2 tablespoons low-fat salad dressing 4 unsweetened canned apricot halves or 1 small slice of angel food cake

(Pick two per day)

16 fat-free tortilla chips with salsa 1/2 cup artificially sweetened chocolate pudding 1 ounce string cheese plus one small piece of fruit 3 cups light popcorn

60 calories (ea) / 15 grams carbs

635 calories / 65 grams carbs

Remember to drink two 8-once glasses of water with each meal.

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10 Diabetic Diet Myths“Diabetes diet.” Simply hearing these words may be enough to make you feel overwhelmed or frustrated. Perhaps you have said, or heard someone else express, one of these thoughts:

• Eating too much sugar causes diabetes. • There are too many rules about choosing foods that are OK in a diabetes diet. • You have to give up all your favorite foods when you’re on a diabetes diet. These three statements are all myths about diabetes diets. Take a closer look at these and other myths to find out the facts about diabetes and dieting.

EATING TOO MUCH SUGAR CAUSES DIABETESHow does diabetes happen? The causes are not totally understood. What is known is that simply eating too much sugar is unlikely to cause diabetes. Instead, diabetes begins when something disrupts your body’s ability to turn the food you eat into energy.

To understand what happens when you have diabetes, keep these things in mind: your body breaks down much of the food you eat into glucose, a type of sugar needed to power your cells. A hormone called insulin, made in the pancreas, helps the cells in your body use glucose for fuel.

Here are the most common types of diabetes and what researchers know about their causes:

• Type 1 diabetes occurs when the pancreas cannot make insulin. Without insulin, sugar piles up in your blood vessels. People with type 1 diabetes must take insulin to help get the sugar into the cells. Type 1 diabetes often starts in younger people or in children. Researchers believe that it may occur when something goes wrong with the immune system. • Type 2 diabetes occurs when the pancreas does not make enough insulin, the insulin does not work properly, or both. Being overweight makes type 2 diabetes more likely to occur. It can happen in a person of any age. • Gestational diabetes occurs during pregnancy in some women. Hormone changes during pregnancy prevent insulin from working properly. Women with gestational diabetes usually need to take insulin. The condition may resolve after birth of the child.

Myth 1

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10 Diabetic Diet Myths

Beans Fiber & Protein

Dark green leafy vegetables (kale, greens, spinach) Low in calories & carbohydrates

Citrus fruit (oranges, grapefruits) Fiber & Vitamin C

Sweet potatoes, Berries, Tomatoes Vitamin A, C, E, & fiber

Fish (salmon; not fried or breaded) Omega 3 fatty acids (good fats)

Whole grains (oatmeal, barley) Omega 3 fatty acids & folate

Nuts (in small amounts) Healthy fats and fiber

Fat free milk & yogurt Calcium & vitamin D

THERE ARE TOO MANY RULES IN A DIABETES DIETIf you have diabetes, you will need to plan your meals, but the general principal is simple: following a “diabetes diet” means choosing food that will work along with your activities and any medications to keep your blood sugar levels as close to normal as possible.

Will you need to make changes to what you now eat? Probably, but perhaps not as many as you anticipate.

Some diabetes “super foods” are:

Myth 2

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CARBOHYDRATES ARE BAD FOR DIABETESIn fact, carbohydrates—or “carbs” as most of us refer to them—are good for diabetes. They form the foundation of a healthy diabetes diet or of any healthy diet.

Carbohydrates have the greatest effect on blood sugar levels, which is why you are asked to monitor how many carbohydrates you eat when following a diabetes diet.

However, carbohydrate foods contain many essential nutrients, including vitamins, minerals, and fiber. So choose those with the most nutrients, like whole-grain breads and baked goods, and high-fiber fruits and vegetables. You may find it easier to select the best carbs if you meet with a dietitian. Alcohol is very high in carbohydrates.

Myth 3

PROTEIN IS BETTER THAN CARBOHYDRATES FOR DIABETESBecause carbs affect blood sugar levels so quickly, if you have diabetes, you may be tempted to eat less of them and substitute more protein. But too much protein may lead to problems for people with diabetes.

The main problem is that many foods rich in protein, such as meat, may also be filled with saturated fat. Eating too much of these fats increases your risk of heart disease. In a diabetes diet, protein should account for about 15% to 20% of the total calories you eat each day.

Myth 4

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YOU CAN ADJUST YOUR DIABETES DRUGS TO “COVER” WHATEVER YOU EATIf you use insulin for your diabetes, you may learn how to adjust the amount and type you take to match the amount of food you eat. But this doesn’t mean you can eat as much as you want, then just use more drugs to stabilize your blood sugar level.

If you use other types of diabetes drugs, don’t try to adjust your dose to match varying levels of carbohydrates in your meals unless instructed by your doctor. Most diabetes medications work best when they are taken consistently as directed by your doctor.

YOU’LL NEED TO GIVE UP YOUR FAVORITE FOODSThere is no reason to give up your favorite foods on a diabetes diet. Instead, try:

• Changing the way your favorite foods are prepared • Changing the other foods you usually eat along with your favorite foods • Reducing the serving sizes of your favorite foods

A dietitian can help you find ways to include your favorites in your diabetes meal plans. See “Eating Out with Diabetes” in the previous section.

Myth 5

Myth 6

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YOU HAVE TO GIVE UP DESSERTS IF YOU HAVE DIABETESNot true! You can develop many strategies for including desserts in a diabetes diet. Here are some examples:

• Use artificial sweeteners in desserts. There are many to choose from and most can be used in baking • Make desserts more nutritious. For example, use whole grains, fresh fruit, and vegetable oil when preparing desserts. Many times, you can use less sugar than a recipe calls for without sacrificing taste or consistency. • Expand your dessert horizons. Instead of ice cream, pie, or cake, try fruit, a whole-wheat oatmeal-raisin cookie, or yogurt.

ARTIFICIAL SWEETENERS ARE DANGEROUS FOR PEOPLE WITH DIABETESArtificial sweeteners are much sweeter than the equivalent amount of sugar, so it takes less of them to get the same sweetness found in sugar. This can result in eating fewer calories than when you do use sugar.

The American Diabetes Association approves the use of several artificial sweeteners in diabetes diets, including:

• Saccharin (Sweet’N Low) • Aspartame (NutraSweet, Equal) • Acesulfame potassium (Sunett) • Sucralose (Splenda)

Many of these products contain “sugar alcohols” such as Xylitol or Sorbitol. Sugar alcohols do not contain sugar. Be sure to read labels on products labeled “sugar free”. Often to replace the sugar, the product will be higher in fat, sodium, and carbohydrates.

A dietitian can help you determine which sweeteners are best for which uses, whether in coffee, baking, cooking, or other uses.

Myth 8

Myth 7

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YOU NEED TO EAT SPECIAL DIABETIC MEALSThe truth is that there really is no such as thing as a “diabetic diet.” The foods that are healthy for people with diabetes are also good choices for the rest of your family. Usually, there is no need to prepare special diabetic meals.

The difference between a diabetes diet and your family’s “normal” diet is this: if you have diabetes, you need to monitor what you eat a little more closely. This includes the total amount of calories you consume and the amounts and types of carbohydrates, fats, and protein you eat. A diabetes educator or dietitian can help you learn how to do this.

DIET FOODS ARE THE BEST CHOICES FOR DIABETESJust because a food is labeled as a “diet” food does not mean it is a better choice for people with diabetes. In fact, “diet” foods can be expensive and no healthier than foods found in the “regular” sections of the grocery store, or foods you prepare yourself.

As with any food you choose, read the labels carefully to find out if the ingredients and amount of calories are good choices for you. If you have doubts, ask your diabetes educator or a dietitian for advice. Below are some common terms found on labels:

• Low calorie—less than 40 calories/serving • Fat free—less than .5gm of fat or saturated fat/serving • Low fat—3gms or less of total fat/serving • Salt free—less than 5gms/serving • Reduced sodium—at least 25% less salt • Sugar free—less than .5gm sugar/serving • High fiber—5gms or more/serving

Myth 9

Myth 10

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Moving Beyond Diabetes Diet MythsNow that you know the facts about diabetes diets, you can take steps to learn even more about making wise food choices. Together with exercise and medication, you can use what you eat as an effective tool for keeping your blood sugar levels within normal ranges. That is the best diabetes diet of all.

DIET & EXERCISE

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National Diabetes Education Program 1-800-438-5383 www.ndep.nih.gov

American Association of Diabetes Educators 1-800-TEAM-UP4 (800-832-6874) www.diabeteseducator.org

American Diabetes Association 1-800-DIABETES (800-342-2383) www.diabetes.org

American Dietetic Association 1-800-366-1655 www.eatright.org

American Heart Association 800-AHA-USA1 (800-242-8721) www.americanheart.org

Centers for Disease Control and Prevention 1-877-232-3422 www.cdc.gov/diabetes

Centers for Medicare & Medicaid Services 1-800-MEDICARE (800-633-4227) www.medicare.gov/health/diabetes.asp

National Institute of Diabetes and Digestive and Kidney Diseases / National Diabetes Information Clearinghouse 1-800-860-8747 www.niddk.nih.gov

Many of these groups offer items in English and Spanish.

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Where to get Help

DIET & EXERCISE

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My Diabetes Care CardRecord your targets and the date, time, and results of your tests. Take this with you on your healthcare visits. Show it to your healthcare team to remind them of tests you need.

A1C — At least twice each year. Usual goal: below 7. My Target: _______

Date

Result

Blood Pressure (BP) — Each visit. Usual goal: below 130/80. My Target: _______

Date

Result

Cholesterol (LDL) — Once each year. Usual goal: below 100. My Target: _______

Date

Result

Cholesterol (HDL) — Once each year. Usual goal: above 40. My Target: _______

Date

Result

Triglycerides — Once each year. Usual goal: below 150. My Target: _______

Date

Result

Weight — Each visit. My Target: _______

Date

Result

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managing your diabetes - gbcs

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