DIABETES - Part 2

Check Your Blood Glucose as Recommended

You'll want to know how well you're taking care of your diabetes. One way to find out is to check your blood to see how much glucose is in it. If your blood has too much or too little glucose, you may need a change in your meal plan, physical activity plan, or medicines.

Checking your blood glucose will help you see if your diabetes treatment plan is working. Ask your doctor how often you should check your blood glucose. Some people check their blood glucose once a day. Others do it three or four times a day. You may check before and after eating, before bed, and sometimes in the middle of the night. Your doctor or diabetes educator will show you how to check your blood using a blood glucose meter. Your health care team should also check your blood glucose levels with a lab test called the Hb A1C test. Contact us for more information about the A1C test. 

Take Other Tests for Your Diabetes

Tests for Ketones

You may need to check your blood or urine for ketones if you're sick or if your blood glucose is above 240. Your body makes ketones when you burn fat instead of glucose for energy. Ketones can make you very sick. If you have ketones, you are at risk for having a serious condition called ketoacidosis. If ketoacidosis isn't treated, it can cause death. Signs of ketoacidosis are vomiting, weakness, fast breathing, and a sweet smell on the breath. Ketoacidosis is more likely to develop in people with type 1 diabetes.
Your doctor or diabetes educator will show you how to test for ketones.

The A1C test

Another test for blood glucose, the A1C, also called the hemoglobin A1C test, shows what your average blood glucose was for the past 2 to 3 months. The doctor does this test to see what your blood glucose is most of the time. Have this test done at least twice a year. 
Ask your doctor what your A1C test showed. A result of below 7 usually means that your diabetes treatment is working well and your blood glucose is under control. If your A1C is higher, your blood glucose may be too high. You'll then have a greater risk of having diabetes problems, like kidney damage. You may need a change in your meal plan, physical activity plan, or diabetes medicines.
Talk with your doctor about what your target should be. Your personal target may be lower or higher than the target shown below. Even if your A1C is higher than your target, remember that every step toward your goal helps reduce your risk of diabetes problems.

A1C results
Target for most people with diabetes	below 7
Time to change my diabetes care plan	8 or above
My last result	__________
My target	below __________

 

Keep Daily Records

Write down the results of your blood glucose checks every day. You may also want to write down what you ate, how you felt, and whether you exercised.
By keeping daily records of your blood glucose checks, you can tell how well you're taking care of your diabetes. Show your blood glucose records to your health care team. They can use your records to see whether you need changes in your diabetes medicines or your meal plan. If you don't know what your results mean, ask your health care team.
                                                         Steps
                                            If You Use Insulin 

Keep a daily record of

• your blood glucose numbers
• the times of the day you took insulin
• the amount and type of insulin you took
• whether you had ketones in your blood or urine
• your diabetes medicines: times and amounts taken
• if your blood glucose was very low
• if you ate more or less food than you usually do
• if you were sick
• what kind of physical activity you did and for how long

                                                 Action Steps
                                            If You Don't Use Insulin

Keep a daily record of

• your blood glucose numbers
• the times of the day you took your diabetes medicines
• your physical activity

DAILY DIABETES RECORD PAGE Week starting Dec 20, 2011

	Other Blood Glucose	Breakfast Blood Glucose	Medicine	Lunch Blood Glucose	Medicine	Dinner Blood Glucose	Medicine	Bed Time Blood Glucose	Notes :Special events, sick days, physical activities
Mon		104				128		114
Tue				103				155	Missed Evening walk
Wed		120		144		132		120
Thu		110		126		124		248	Sick with Cold
Fri		128		114		102		150
Sat		127				164			Had  extra Big  snack in afternoon
Sun		115		120				140

When Your Blood Glucose Is Too High or Too Low

Sometimes, no matter how hard you try to keep your blood glucose in your target range, it will be too high or too low. Blood glucose that's too high or too low can make you feel sick. Learn how to handle these emergencies.

 What You Need to Know about High Blood Glucose

If your blood glucose stays above 180, it may be too high. See the Blood Glucose Targets table. High blood glucose means you don't have enough insulin in your body. High blood glucose, also called hyperglycemia, can happen if you miss taking your diabetes medicines, eat too much, or don't get enough exercise. Sometimes, the medicines you take for other problems cause high blood glucose. Be sure to tell your doctor about other medicines you take.

Having an infection, being sick, or being under stress can also make your blood glucose too high. When you're sick, be sure to check your blood glucose and keep taking your diabetes medicines. For more about how to take care of yourself when you're sick, see "When You're Sick."

If you're very thirsty and tired, have blurry vision, and have to go to the bathroom often, your blood glucose may be too high. Very high blood glucose may also make you feel sick to your stomach.

If your blood glucose is high much of the time, or if you have symptoms of high blood glucose, call your doctor. You may need a change in your diabetes medicines or your meal plan.

What You Need to Know About Low Blood Glucose

Low blood glucose, also called hypoglycemia, happens if your blood glucose drops too low. It can come on fast. Low blood glucose can be caused by taking too much diabetes medicine, missing a meal, delaying a meal, exercising more than usual, or drinking alcoholic beverages. Sometimes, medicines you take for other health problems can cause blood glucose to drop.

Low blood glucose can make you feel weak, confused, irritable, hungry, or tired. You may sweat a lot or get a headache. You may feel shaky. If your blood glucose drops lower, you could pass out or have a seizure.

If you have any of these symptoms, check your blood glucose. If the level is below 70, have one of the following right away:

• 3 or 4 glucose tablets
• 1 serving of glucose gel-the amount equal to 15 grams of carbohydrate
• 1/2 cup, or 4 ounces, of any fruit juice
• 1/2 cup, or 4 ounces, of a regular-not diet-soft drink
• 1 cup, or 8 ounces, of milk
• 5 or 6 pieces of hard candy
• 1 tablespoon of sugar or honey

Have one of these "quick fix" foods when your blood glucose is low.

After 15 minutes, check your blood glucose again to make sure your level is 70 or above. Repeat these steps until your blood glucose level is 70 or above. Once your blood glucose is stable, if it will be at least an hour before your next meal, have a snack.

If you take diabetes medicines that can cause low blood glucose, always carry food for emergencies. You should also wear a medical identification bracelet or necklace.

If you take insulin, keep a glucagon kit at home and at other places where you often go. Glucagon is given as an injection with a syringe and quickly raises blood glucose. Show your family, friends, and co-workers how to give you a glucagon injection if you pass out because of low blood glucose.

                                      

                                               Action steps if you use Insulin

When you have low blood glucose, have a snack to bring your blood glucose back to normal. You can prevent low blood glucose by eating regular meals, taking your diabetes medicines, and checking your blood glucose often. Checking will tell you whether your glucose level is going down. You can then take steps, like drinking fruit juice, to raise your blood glucose.

                                         

                                             Action steps if you Don't use Insulin

Tell your doctor if you have low blood  glucose often, especially at the same time of the day or night sevral times in a row. Be sure to tell your doctor about other medicines you are taking.Some diabetes pills can cause low blood glucose. Ask your doctor whether your tablets can cause low blood glucose.

Why Taking Care of Your Diabetes Is Important

• Diabetes and Your Heart and Blood Vessels
• Diabetes and Your Eyes
• Diabetes and Your Kidneys
• Diabetes and Your Nerves
• Foot Care Tips
• Diabetes and Your Gums and Teeth

Taking care of your diabetes every day will help keep your blood glucose, blood pressure, and cholesterol in your target range and help prevent other health problems that diabetes can cause over the years. You can do a lot to prevent diabetes problems.

• Follow your meal plan every day.

• Take your diabetes medicines every day.

• Be physically active every day.

• Check your blood glucose as recommended.  

Diabetes and Your Heart and Blood Vessels

The biggest problem for people with diabetes is heart and blood vessel disease. Heart and blood vessel disease can lead to heart attacks and strokes. It also causes poor blood flow, also called circulation, in the legs and feet.

To check for heart and blood vessel disease, your health care team will do some tests. At least once a year, have a blood test to see how much cholesterol is in your blood. Your health care provider should take your blood pressure at every visit. Your provider may also check the circulation in your legs, feet, and neck.

The best way to prevent heart and blood vessel disease is to take good care of yourself and your diabetes.

·        Eat foods that are low in sodium (salt). Check the amount of sodium by looking at the Nutrition Facts on food packages. Limit the amount of salt you use when you cook. Choose foods naturally low in sodium, such as vegetables, fruits, dry beans and peas, and unprocessed meats, poultry, and fish.

·        Limit how much you have of these kinds of fat:

• saturated fat, such as bacon, butter, cream, lard, and high-fat dairy products such as whole milk
• trans fat, found in processed foods with partially hydrogenated or hydrogenated oil
• cholesterol, found in high-fat dairy products, high-fat meats and poultry, egg yolks, and liver

·        Keep your blood glucose on track. Know your A1C. The target for most people is 
         below 7.

·        Keep your blood pressure on track. The target for most people is below 130/80. If   
         needed, take medicine to control your blood pressure.

·        Keep your cholesterol level on track. The target for LDL cholesterol for most people 
         is below 100. If needed, take medicine to control your blood fat levels.

·        If you smoke, quit.

·        Be physically active.

·        Lose weight if you need to.

·        Ask your health care team whether you should take an aspirin every day.

What's a desirable blood pressure level?

Blood pressure levels tell how hard your blood is pushing against the walls of your blood vessels. Your pressure is given as two numbers: The first is the pressure as your heart pushes blood out into your blood vessels and the second is the pressure as your heart rests. If your blood pressure is higher than your target, talk with your health care team about changing your meal plan, exercising, or taking medicine.

Blood Pressure Results
Target for most people with diabetes		below 130/80
My last result		____________
My target		below ____________

 What are desirable blood fat levels?

Cholesterol, a fat found in the body, appears in several forms. If your LDL cholesterol, also called "bad" cholesterol, is 100 or above, you are at increased risk of heart disease and may need treatment. A high level of total cholesterol also means a greater risk of heart disease. But HDL cholesterol, also called "good" cholesterol, protects you from heart disease, so the higher it is, the better. You should keep your triglyceride-another type of fat-levels below 150. All of these target numbers are important for preventing heart disease. But the most important target to reach first is for your LDL cholesterol.

Target Blood Fat Levels for People with Diabetes
	My Last Result	My Target
Total cholesterol   below 200	___________	below _____
LDL cholesterol   below 100	___________	below _____
HDL cholesterol   above 40 (men)	___________	above _____
above 50 (women)	___________	above _____
Triglycerides   below 150	___________	below _____

Diabetes and Your Eyes

Have your eyes checked once a year. You could have eye problems that you haven't noticed yet. Yearly exams may catch eye problems early so problems can be treated. Treating eye problems early can help prevent blindness.

High blood glucose can make the blood vessels in the eyes bleed. This bleeding can lead to blindness. You can help prevent eye damage by keeping your blood glucose and blood pressure as close to normal as possible. If you already have eye problems, your eye doctor may be able to suggest treatments that can help.

The best way to prevent eye disease is to have a yearly eye check up. In this check up, the eye doctor puts drops in your eyes to dilate your pupils. When the pupils are dilated, or big, the doctor can see into the back of the eye. This type of exam is called a dilated eye exam and it doesn't hurt. If you've never had this kind of eye exam before, you should have one now, even if you haven't had any trouble with your eyes. Be sure to tell your eye doctor that you have diabetes.

Follow these tips to take care of your eyes:

• For adults and adolescents-10 years old and older-with type 1 diabetes: Have your eyes examined within 5 years of being diagnosed with diabetes. Then have an exam every year.
• For people with type 2 diabetes: Have an eye exam every year.
• Have an eye exam before becoming pregnant or as soon as possible after becoming pregnant.
• If you smoke, quit.
• Keep your blood glucose and blood pressure as close to normal as possible.

See your eye doctor for a dilated eye exam every year. Early treatment of eye problems can help save your sight.

Tell your eye doctor right away if you have any problems like blurry vision or seeing dark spots, flashing lights, or rings around lights.

Diabetes and Your Kidneys

Your kidneys help clean waste products from your blood. They also work to keep the right balance of sodium and fluid in your body.

Too much glucose in your blood is hard on your kidneys. After a number of years, high blood glucose can cause the kidneys to stop working, a condition called kidney failure. If your kidneys stop working, you'll need dialysis-a treatment that does some of the work your kidneys used to do-or a kidney transplant.

Make sure you have the following tests at least once a year to make sure your kidneys are working well:

• a urine test for protein, called the microalbumin test
• a blood test for creatinine, a waste product made by your body

Some types of blood pressure medicines can help prevent kidney damage. Ask your doctor whether these medicines could help you. You can also help prevent kidney problems by

• taking your medicine if you have high blood pressure
• asking your doctor or your dietitian whether you should eat less high-protein foods, such as meat, poultry, cheese, milk, fish, and eggs
• keeping your blood glucose and blood pressure as close to normal as possible
• quitting smoking

You should visit your doctor right away if you get a bladder or kidney infection. Signs of bladder or kidney infections are cloudy or bloody appearance of urine, pain or burning when you urinate, and having to urinate often or in a hurry. Back pain, chills, and fever are also signs of kidney infection.

Diabetes and Your Nerves

Over time, high blood glucose can harm the nerves in your body. Nerve damage can cause you to lose the feeling in your feet or to have painful, burning feet. You may not feel pain from injuries or sore spots on your feet. If you have poor circulation because of blood vessel problems in your legs, the sores on your feet can't heal and might become infected. If the infection isn't treated, it could lead to amputation.

Nerve damage can also cause pain in your legs, arms, or hands or cause problems with digesting food, going to the bathroom, or having sex.

Nerve damage can happen slowly. You may not even realize you have nerve problems. Your doctor should check the nerves in your feet at least once a year. Your doctor should check your sense of feeling and the pulses in your feet.

Tell the doctor about any problems with your feet, legs, hands, or arms. Also, tell the doctor if you have trouble digesting food, going to the bathroom, or having sex, or if you sometimes feel dizzy.

Ask your doctor whether you already have nerve damage in your feet. If you do, you should take good care of your feet. To help prevent complications from nerve damage, check your feet every day. See Foot Care Tips.

You can prevent nerve problems by

• keeping your blood glucose and blood pressure as close to normal as possible
• limiting the amount of alcohol you drink
• checking your feet every day
• quitting smoking

Foot Care Tips

You can do a lot to prevent problems with your feet. Keep your blood glucose in your target range and follow these tips to take care of your feet and help protect them.

·        
     Check your bare feet every day. Look for cuts, sores, bumps, or red spots. Use a mirror or ask a family member for help if you have trouble seeing the bottoms of your feet.

·    Wash your feet in warm-not hot-water every day, but don't soak them. Use mild soap. Dry your feet with a soft towel, and dry carefully between your toes. After washing your feet, cover them with lotion before putting your shoes and socks on. Don't put lotion or cream between your toes.

·    File your toenails straight across with an emery board. Don't leave sharp edges that could cut into your toe. Don't try to cut hardened skin or corns off with a razor blade or knife, and don't use wart removers on your feet. If you have warts or painful corns or calluses, see a podiatrist, a doctor who treats foot problems.

·    Wear thick, soft socks. Don't wear mended socks or socks with holes or seams that might rub against your feet.

·    Check your shoes before you put them on to be sure they have no sharp edges or objects in them.

·    Wear shoes that fit well and let your toes move. Break new shoes in slowly. Don't wear flip-flops, shoes with pointed toes, or plastic shoes. Never go barefoot.

·    Wear socks if your feet get cold at night. Don't use heating pads or hot water bottles on your feet.

·    Have your doctor check your feet at every visit. Take your shoes and socks off when you go into the examining room to remind the doctor to check your feet.

·    See a podiatrist for help if you can't take care of your feet yourself.

Diabetes and Your Gums and Teeth

Diabetes can lead to infections in your gums and the bones that hold your teeth in place. Like all infections, gum infections can cause blood glucose to rise. Without treatment, teeth may become loose and fall out.

Help prevent damage to your gums and teeth by

• seeing your dentist twice a year
• brushing and flossing your teeth at least twice a day
• quitting smoking
• keeping your blood glucose as close to normal as possible
• having regular checkups with your dentist

Be sure to tell your dentist that you have diabetes.

Taking Care of Your Diabetes at Special Times

Diabetes is part of your life. You can learn how to take care of yourself and your diabetes when you're sick, when you're at work or school, when you travel, when you're thinking about having a baby or are pregnant, or when there's an emergency or natural disaster.

• When You're Sick
• When You're at School or Work
• When You're Away from Home
• When There's an Emergency or Natural Disaster
• When You're Planning a Pregnancy

When You're Sick

Having a cold, the flu, or an infection can raise your blood glucose levels. You can have serious health problems leading to a coma if your blood glucose levels are very high.

Be prepared for illness. Make a plan ahead of time for sick days. Ask your health care team

• how often to check your blood glucose levels
• whether you should check for ketones in your blood or urine
• whether you should change your usual dose of your diabetes medicines
• what to eat and drink
• when to call your health care provider

Action Steps
If You Use Insulin

• Take your insulin, even if you are sick and have been throwing up. Ask your doctor about how to adjust your insulin dose based on your blood glucose test results.

Your doctor may recommend the following:

·    Check your blood glucose level at least four times a day and write down the results in your record book. Keep your results handy so you can report results to your health care team.

·    Keep taking your diabetes medicines, even if you're not able to eat.

·    Drink at least 1 cup of water or other calorie-free, caffeine-free liquid every hour while you're awake.

• If you can't eat your usual food, try eating or drinking any of the following:
• juice
• saltine crackers
• dry toast
• soup
• broth
• popsicles or sherbet
• regular-not sugar-free-gelatin
• milk
• yogurt
• regular-not sugar-free-soda

Action Steps
If You Don't Use Insulin

Keep taking your diabetes medicines, even if you're sick and have been vomiting

Your doctor may say you should call right away if

• your blood glucose levels are above 240 even though you've taken your diabetes medicines
• your urine or blood ketone levels are above normal
• you vomit more than once
• you have diarrhea for more than 6 hours
• you have trouble breathing
• you have a high fever
• you can't think clearly or you feel sleepier than usual

You should call your doctor if you have questions about taking care of yourself.

When You're at School or Work

Take care of your diabetes when you're at school or at work:

• Follow your meal plan.
• Take your medicines and check your blood glucose as usual.
• Tell your teachers, friends, or close co-workers about the signs of low blood glucose. You may need their help if your blood glucose drops too low.
• Keep snacks nearby and carry some with you at all times to treat low blood glucose.
• Tell your company nurse or school nurse that you have diabetes.

When You're Away From Home

These tips can help you take care of yourself when you're away from home:

·    Follow your meal plan as much as possible when you eat out. Always carry a snack with you in case you have to wait to be served.

·    Limit your drinking of beer, wine, or other alcoholic beverages. Ask your diabetes educator how much alcohol you can safely drink. Eat something when you drink to prevent low blood glucose.

·    If you're taking a long trip by car, check your blood glucose before driving. Stop and check your blood glucose every 2 hours. Always carry snacks like fruit, crackers, juice, or soft drinks in the car in case your blood glucose drops too low.

·    Bring food for meals and snacks with you if you're traveling by plane.

·    Carry your diabetes medicines and your blood testing supplies with you. Never put them in your checked baggage.

·    Ask your doctor how to adjust your medicines, especially your insulin, if you're traveling across time zones.

·    Take comfortable, well-fitting shoes on vacation. You'll probably be walking more than usual, so you should take good care of your feet.

·    If you're going to be away for a long time, ask your doctor for a written prescription for your diabetes medicines and the name of a doctor in the place you're going to visit.

·    Don't count on buying extra supplies when you're traveling, especially if you're going to another country. Different countries use different kinds of diabetes medicines.

Action Steps
If You Use Insulin

When you travel,

• take a special insulated bag to carry your insulin to keep it from freezing or getting too hot
• bring extra supplies for taking insulin and testing your blood glucose in case of loss or breakage
• ask your doctor for a letter saying that you have diabetes and need to carry supplies for taking insulin and testing blood glucose

When There's an Emergency or Natural Disaster

Everyone with diabetes should be prepared for emergencies and natural disasters, such as power outages or hurricanes. Always have your disaster kit ready. Include everything you need to take care of your diabetes, such as

• a blood glucose meter, lancets, and testing strips
• your diabetes medicines
• a list of your prescription numbers
• if you take insulin-some insulin, syringes, and an insulated bag to keep insulin cool
• if you take insulin or if recommended by your doctor-a glucagon kit
• glucose tablets and other foods or drinks to treat low blood glucose
• antibiotic cream or ointment
• a copy of your medical information, including a list of your conditions, medicines, and recent lab test results
• phone numbers for the Hospitals, Red Cross and other disaster relief organizations

You also might want to include some nonperishable food, such as canned or dried food, along with bottled water.

Check and update your kit at least twice a year.

When You're Planning a Pregnancy

Keeping your blood glucose near normal before and during pregnancy helps protect both you and your baby. Even before you become pregnant, your blood glucose should be close to the normal range.

Your health care team can work with you to get your blood glucose under control before you try to get pregnant. If you're already pregnant, see your doctor right away. It's not too late to bring your blood glucose close to normal so that you'll stay healthy during the rest of your pregnancy.

Your insulin needs may change when you're pregnant. Your doctor may want you to take more insulin and check your blood glucose more often. If you take diabetes pills, you'll take insulin instead when you're pregnant.

If you plan to have a baby,

• work with your health care team to get your blood glucose as close to the normal range as possible before you get pregnant
• see a doctor who has experience in taking care of pregnant women with diabetes
• don't smoke, drink alcohol, or use harmful drugs
• follow the meal plan you get from your dietitian or diabetes educator to make sure you and your unborn baby have a healthy diet.
•   Be sure to have your eyes, heart and blood vessels, blood pressure, and kidneys checked. Your doctor should also check for nerve damage. Pregnancy can make some health problems worse.

 Where to Get More Help with Your Diabetes

• People Who Can Help You
• Organizations That Can Help You

People Who Can Help You

·    Your doctor. You may see your regular doctor for diabetes care or someone who has special training in caring for people with diabetes. A doctor with special training in diabetes is called an endocrinologist or diabetologist.

You'll talk with your doctor about what kind of medicines you need and how much you should take. You'll also agree on a target blood glucose range and blood pressure and cholesterol targets. Your doctor will do tests to be sure your blood glucose, blood pressure, and cholesterol are staying on track and you're staying healthy. Ask your doctor if you should take aspirin every day to help prevent heart disease.

·    Your diabetes educator. A diabetes educator may be a nurse, a dietitian, or another kind of health care worker. Diabetes educators teach you about meal planning, diabetes medicines, physical activity, how to check your blood glucose, and how to fit diabetes care into your everyday life. Be sure to ask questions if you don't understand something.

·    Your family and friends. Taking care of your diabetes is a daily job. You may need help or support from your family or friends. You may want to bring a family member or close friend with you when you visit your doctor or diabetes educator. Taking good care of your diabetes can be a family affair!

·    A counselor or mental health worker. You might feel sad about having diabetes or get tired of taking care of yourself. Or you might be having problems because of work, school, or family. If diabetes makes you feel sad or angry, or if you have other problems that worry you, you can talk with a counselor or mental health worker. Your doctor or diabetes educator can help you find a counselor.

Organizations That Can Help You

To find a doctor / diabetes educator or dietitian contact a government hospital / private hospital near your area.

How to Find a Dietitian

To find a dietitian near you, contact a government hospital / private hospital near your area.

Pronunciation Guide

A1C (A-VUN-SEE)

beta cells (BEE-ta) (selz)

cholesterol (koh-LESS-ter-ol)

diabetologist (DY-beh-TOL-o-jist)

endocrinologist (EN-doh-krih-NOL-o-jist)

gestational (jess-TAY-shuhn-uhl)

glucagon (GLOO-kuh-gon)

glucose (GLOO-koz)

hemoglobin (HEE-mo-GLO-bin)

hyperglycemia (HY-per-gly-SEE-mia)

hypoglycemia (HY-po-gly-SEE-mia)

immune (e-MYOON)

injection (in-JEK-shun)

insulin (IN-su-lin)

ketoacidosis (KEE-toh-ASS-e-DO-siss)

ketones (KEE-ton-z)

pancreas (PAN-kree-ASS)

podiatrist (poh-DY-a-trist)

syringe (suh-RINJ)

triglyceride (try-GLISS-r-eyed)