Colorado Diabetes Prevention and Control Program Rocky Mountain Association of Diabetes Educators National Diabetes Information Clearinghouse (NDIC) …
Step-by-step guide to controlling your blood glucose around meals
Use this workbook for one week and see how much you can learn about diabetes, food, and self-testing with a blood glucose monitor
This workbook is designed mainly for people with type 2 diabetes who are having trouble controlling their blood glucose, or who may want to learn more about self-testing It is not a substitute for treatment by a physician Talk to your physician or diabetes educator before making any changes to the self-care routine that has been recommended for you 2005 American Association of Diabetes Educators Developed with editorial assistance and an educational grant from LifeScan, Inc
Step-by-Step Guide to Controlling Your Blood Glucose Around Meals
Type 1 diabetes means the pancreas stops making insulin, so it must be injected
Diabetes can be overwhelming Theres a lot to learn and so many changes to make But millions of people with type 2 diabetes, like you, live healthy, happy lives And theres no reason why you shouldnt, too This workbook is designed to teach you practical things that will help you take control of your diabetes
Type 2 diabetes means that your body cant keep your glucose at a
healthy level Thats because your pancreas isnt making enough insulin The result? Glucose from food stays in your bloodstream instead of being used for energy Many factors contribute to a diagnosis of type 2 diabetes Some, like your age or family history, are out of your control Other factors, like being overweight or not being active, can change
Type 2 diabetes means your body is unable to use insulin properly Eventually, the pancreas stops producing adequate amounts of insulin to control glucose
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Step-by-Step Guide to Controlling Your Blood Glucose Around Meals
The goal of your treatment is to keep your blood glucose levels as close as possible to the normal range found in people who dont have diabetes 80140 mg/dL If your blood glucose levels are too high greater than 200 mg/dL you can damage blood vessel walls — and that can lead to serious complications, like heart disease, blindness, and kidney failure
Keeping blood glucose levels within a target range can prevent, delay, or slow progression of complications and improve overall health and well-being
A blood glucose monitor will allow you to check your blood glucose level It shows you if your blood sugar is in range or
not If your glucose is out of range, your test results can also help you figure out what you need to do Its not hard to monitor your glucose, once youve learned some basics
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Step-by-Step Guide to Controlling Your Blood Glucose Around Meals
Your primary care physician is the first diabetes healthcare professional you see Visit your physician regularly every 3 to 4 months to monitor your progress Your physician will examine you, arrange lab tests, and may refer you to a diabetes
Its important to work closely with your physician, diabetes educator, and other healthcare providers to set a routine for your care
educator, dietitian, or other diabetes specialist Diabetes educators are nurses, dietitians, pharmacists, doctors, exercise physiologists, and social workers who specialize in the care and education of people with diabetes A diabetes educator can help you incorporate lifestyle changes such as blood glucose testing, adjustments to food, and physical activity into your diabetes management plan
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Step-by-Step Guide to Controlling Your Blood Glucose Around Meals
Your physician and diabetes educator use an A1C test result to assess your diabetes control Your A1C is directly
related to your blood glucose number, which is the result you get when you test with a monitor
your to i Circlekind ofA1C resultyou see what control have
A1C is a test that measures your average blood glucose levels over 2 to 3 months
If your A1C is:
Your average blood glucose level is:
6 7 8 9 10 11 12
135 mg/dL 170 mg/dL 205 mg/dL 240 mg/dL 275 mg/dL 310 mg/dL 345 mg/dL
Non-diabetic range: Good control: Fair control: Poor control:
4 to 6 7 7 to 8 8 to 10
Very poor control:
10 to 12
Definite risk of long-term health problems: 12
Mean plasma glucose The correlation between A1C level and mean plasma glucose levels as published by the American Diabetes Association Clinical Practice Recommendations, Diabetes Care 28, Jan 2005, suppl 1, S11
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Step-by-Step Guide to Controlling Your Blood Glucose Around Meals
What else should you do? Your physician will arrange these tests for you If you have not had these tests, or do not understand what the results mean, talk to your physician
What needs to be done?
A1C test glycosylated hemoglobin test
Why?
To check your long-term glucose control To check for sores or infections, pressure points, swelling, in-grown toenails, etc A
blood pressure reading above 130/80 should be treated
How often?
Every 3 months
Goals
65 see the chart on page 5 for more information
Complete foot exam
Every office visit daily at home
Healthy tissue and normal circulation
Because of the risk of diabetes-related complications, its important to closely monitor your health
Blood pressure
Every visit
130/80 mm Hg
Lipid profile
Cholesterol and other lipids fats in your blood may increase your risk of heart disease
At least once a year
LDL 100 mg/dL bad cholesterol Triglycerides 150 mg/dL HDL 40 mg/dL good cholesterol Total cholesterol 200 mg/dL normal
Kidney function microalbumin test
To check for early signs of kidney problems To check for changes in blood vessels in your retina To check for tooth decay and gum disease
At least once a year
Dilated eye exam
At least once a year
normal
Dental exam
At least twice a year
Healthy teeth and gums
This A1C goal is consistent with the goals published by the American Association of Clinical Endocrinologists Medical Guidelines for the Management of Diabetes Mellitus: The AACE System of Intensive Diabetes Self-Management — 2002 Update Endocrine Practice 2002;8Suppl
1:4082 Suggested target levels are consistent with the goals published by the American Diabetes Association Clinical Practice Recommendations, Diabetes Care 28, Jan 2005, suppl 1, S10
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Step-by-Step Guide to Controlling Your Blood Glucose Around Meals
How often should you test? There is no one recommendation for people with type 2 diabetes It really depends on how your diabetes is being treated, and how well your glucose is in control Ask your physician and diabetes educator for direction For example, if your A1C is too high, your physician may ask you to check more often and log the results That log can help you see trends in your glucose You may also need to check more often if you take certain medications In this workbook, youll learn how to read the results of your tests and how to use them to make health decisions Over a week, youll check around mealtimes And each day, youll get tips to help you better understand diabetes Read the explanations on the next three pages Once youre ready, begin the workbook
People with diabetes should have and know how to use a blood glucose monitor
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diabetes and food
Step-by-Step Guide to Controlling Your Blood Glucose Around
Meals
Blood glucose is mainly affected by food, especially carbohydrates The easiest way to understand the effects of food is to check your blood glucose before and after meals Using the worksheets on the following pages to record your results and comments will help you see how your food choices affect your blood glucose
Youll be surprised how much you can learn in just a week Start by recording your current test results, weight, and how much you exercise Ask your healthcare professional to help you set goals for improvement
Blood glucose test results
Weight
Exercise
Guidelines
Before meals: 110 mg/dL After meals: 140 mg/dL
Consult your physician
My current readings:
i
Before meals:
After meals:
lbs
These are the ideal goals for people with diabetes, so it may take some time for you to get there A good way to start is to make sure that your blood glucose result 2 hours after beginning a meal is no more than 30-40 mg/dL higher than your before-meal result If you have tried to reduce your portions of carbohydrate foods and your post-meal blood glucose is still out of range, consult with your primary caregiver or diabetes educator An adjustment in medication or treatment
may be necessary
These suggested target levels are consistent with the goals published by the American Association of Clinical Endocrinologists Medical Guidelines for the Management of Diabetes Mellitus: The AACE System of Intensive Diabetes Self-Management — 2002 Update Endocrine Practice 2002;8 Suppl 1:4082 Children, older people, pregnant women, and people with certain health problems may have different results Check with your healthcare professional for the target range that is best for you
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diabetes and food
Step-by-Step Guide to Controlling Your Blood Glucose Around Meals
Heres an example of a food log:
Check your blood glucose just before your meal Check your blood glucose 2 hours after your meal
BEFORE BREAKFAST
coffee, hard boiled egg, two slices of toast with butter, and a glass of orange juice
145 105
AFTER BREAKFAST
215 180
My result shows a 70-point increase I was more than full Maybe cut the orange juice?
COMMENTS
What did you eat? Its the carbohydrates that count
If your result shows more than a 40-point increase, see if you can figure out why
WORKING WITH YOUR TEST RESULTS
What do your results tell you? If your result is less than a 30 to 40 point
increase, your food choices and blood glucose are in balance If your result shows more than a 30 to 40 point increase, dont worry The exercises in this workbook will help you find out why
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diabetes and food
Step-by-Step Guide to Controlling Your Blood Glucose Around Meals
Keeping blood glucose in range around mealtimes has a lot to do with your eating habits Use this guide to help spot easy ways to improve your eating habits
Do You:
Have regularly scheduled mealtimes? Plan your snacks? Adjust portion sizes to your blood glucose levels? Eat 3 meals every day? Stop eating when your hunger is satisfied? Make meals last more than 15 minutes? Get some physical activity after meals?
Answer YES?
5 or more: Youre on the right track Keep reading for more healthy eating and activity tips 3 or more: Youre doing well, but try using this workbook to improve your eating habits Less than 3: Think about improving your eating habits The tips in this workbook can help
i
10
Yes
No
Sometimes
workbook day one
Step-by-Step Guide to Controlling Your Blood Glucose Around Meals
Select at least 2 meals to check, and test before and after these meals consistently for the next 7 days
i
105
BEFORE BREAKFAST
AFTER BREAKFAST
COMMENTS
i
BEFORE LUNCH
AFTER LUNCH
i
BEFORE DINNER
AFTER DINNER
Carbohydrates are in starchy foods, grains, fruit, milk products, and sweets
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what is a carb?
Step-by-Step Guide to Controlling Your Blood Glucose Around Meals
Whats up with carbohydrates? Carbohydrates carbs are the starches and sugars in food They are digested and converted into glucose Carbs are essential in a diet because they act as fuel for your body, but they also raise your blood glucose higher and faster than other kinds of food The challenge with diabetes is to eat the right portion size that allows you to stay in range
Plate of spaghetti and a roll 2 hours later
foods that count i Circle thecarbohydrate as a Peach Toast Skim milk Sandwich bread Diet soda Oatmeal cookies Cheddar cheese Crackers Sausage Broccoli Potatoes Apple
FINDING THE CARBS QUIZ
Cereal Tuna Raisins Porkchop Peanut butter Salmon
See below for answers
200 mg/dL
vs
Plate of pork chops, peas, and carrots
2 hours later
140 mg/dL
Answers: Peach, Toast, Skim milk, Sandwich bread, Oatmeal cookies, Crackers, Potatoes, Apple, Cereal, Raisins
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workbook day two
Step-by-Step Guide to
Controlling Your Blood Glucose Around Meals
i
Now, circle all the foods in your log that are carbs If your after-meal result is high, can you link it to a specific food or portion size? Can you reduce and adjust the amount of carbs in your next meal?
i
BEFORE BREAKFAST
AFTER BREAKFAST
COMMENTS
i
BEFORE LUNCH
AFTER LUNCH
How many carb choices at lunch?
i
BEFORE DINNER
AFTER DINNER
A kitchen scale is another way to measure portions
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carb counting
Step-by-Step Guide to Controlling Your Blood Glucose Around Meals
The amount of carbs is listed on a food label in grams A gram is a tiny unit of weight So counting carbs is easier when you use a bigger unit of
measure The one used most often is a 15-gram unit — its referred to as a carb choice You can also think of a carb choice as a basic portion size
15 grams of carbs 1 carb choice 34 choices 4560 grams of carbs 1 meal 12 choices 1530 grams of carbs 1 snack
i
Learn to visualize portion sizes for different kinds of food Even if you cant find a food label, you can estimate portion sizes
Handful 1 or 2 ounces of snack food Palm 3 ounces of meat
Fist 1 cup
Thumb 1 ounce
Tip of your thumb 1 teaspoon
A
tennis ball 1 serving of fruit
This number can vary according to your weight and height Check with your physician or diabetes educator for the carb servings that are right for you
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workbook day three
Step-by-Step Guide to Controlling Your Blood Glucose Around Meals
Test before you eat to fine-tune the carb content of your meal
i
BEFORE BREAKFAST
AFTER BREAKFAST
COMMENTS
i
BEFORE LUNCH
AFTER LUNCH
i
BEFORE DINNER
AFTER DINNER
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how to adjust meals
Step-by-Step Guide to Controlling Your Blood Glucose Around Meals
How to stay on target
Avoid large portions of carbs all at once Try to spread carbs throughout the day In fact, between-meal snacks are allowed Adjusting a meal to leave room for a light snack 1530 grams of carbohydrates every 3 to 4 hours helps keep you from getting too hungry, which is what often leads to overeating at meals
How to adjust a meal
BEFORE 1 small bag of chips 15 grams 1 portion 1 6 oz cup of fruit yogurt 30 grams 2 portions 1 12 oz cola 45 grams 3 portions Tuna salad sandwich 30 grams 2 portions 1 small bag of chips 15 grams 1 portion AFTER Switch for 1 diet cola 0 grams 0 portions Tuna salad sandwich 30 grams 2 portions Total: 45
grams 3 portions Check results 2 hours after lunch: 138 mg/dL SNACK 1 6 oz cup of fruit yogurt 30 grams 2 portions
Total: 120 grams 8 portions Check results 2 hours after lunch: 238 mg/dL
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workbook day four
Step-by-Step Guide to Controlling Your Blood Glucose Around Meals
your results past 2 days See any i Look atyou can adjustover the between-meal snack?high-carb meals with a
i
BEFORE BREAKFAST
AFTER BREAKFAST
COMMENTS
i
BEFORE LUNCH
AFTER LUNCH
Any surprises on your food label?
i
BEFORE DINNER
AFTER DINNER
No Added Sugar doesnt
mean its carb-free
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food labels
Step-by-Step Guide to Controlling Your Blood Glucose Around Meals
i 1 Find the Serving Size
Look at the Food Labels in Your Cupboard
2 Find the Total Carbohydrate of one serving Sugars are included in this number Dont count them separately 3 Count the carbohydrates in your meals 1 carb choice 15 carb grams
Loaf of Whole Grain Bread
Nutrition Facts
Serving Size 1 slice 31g Servings per container 22
Amount per serving
Compare the serving size of the label to your portion
Calories 80 Total Fat 1g
Calories from Fat 10
Daily Value
2 0 0 9 5 4
Saturated Fat 0g Cholesterol 0mg Sodium 210mg Total
Carbohydrate 15g Dietary Fiber less than 1g Sugars 2g Protein 2g
Look for the TOTAL CARBOHYDRATE line on food labels to determine the carbohydrate count for that food item
Ingredients on packages are listed in order of weight, and the ingredient used most is listed first
Shop smart
Use the food label to find healthy snacks
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workbook day five
Step-by-Step Guide to Controlling Your Blood Glucose Around Meals
Use Food Labels to Help You Count Carbs
i
BEFORE BREAKFAST
AFTER BREAKFAST
COMMENTS
i
BEFORE LUNCH
AFTER LUNCH
Time for a walk during lunch?
i
BEFORE DINNER
AFTER DINNER
Walk after meals to aid digestion and lower blood glucose
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using activity
Step-by-Step Guide to Controlling Your Blood Glucose Around Meals
Did you know that regular activity has been shown to lower blood glucose?
If the idea of exercise is a turn-off, consider this: A workout doesnt have to be work It doesnt require special equipment And the best part is, you may already be doing more than you think After all, even vacuuming is considered moderate exercise 30 minutes of activity each day is a good goal Great news You get the same health benefits from 10 minutes of activity three times
a day as from 30 minutes all at once The more you enjoy your activity, the better However, your body doesnt care how or where you exercise And even small increases can make a difference in how you feel To sneak more activity into your day without making it a chore: Park farther away to get in a brisk walk Get a pedometer to measure your progress Use half your lunch break to stretch your legs Get up and walk around the office or house every 30 minutes
20
workbook day six
Step-by-Step Guide to Controlling Your Blood Glucose Around Meals
typical day and down i 1 Thinkaabout your all the exercise writeget in a the times ayou canbitadd some activity 2 Keep record of you day Add little more each day
i
BEFORE BREAKFAST
AFTER BREAKFAST
COMMENTS
i
BEFORE LUNCH
AFTER LUNCH
i
BEFORE DINNER
AFTER DINNER
Consider splitting a meal with a friend
or taking leftovers home
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eating out
Step-by-Step Guide to Controlling Your Blood Glucose Around Meals
your past i Look athidden meals from theto high5 days See any carbs that connect results?
By now you should be paying more attention to what you eat at home The same guidelines apply when you eat out It takes a little planning to
avoid meals that are high in fat, sodium, calories, and carbohydrates, but if you ask, most fast food restaurants will provide a menu that includes nutrition content to help you make healthy decisions
Watch out for hidden carbs
Some drinks have as many or more carbs than a meal You may be surprised by these carb counts
Starbucks drinks, 16 oz, no sugar added
grams of carbohydrates carbohydrate choices
Jamba Juice fruit smoothies, 24 oz
grams of carbohydrate carbohydrates choices
Cappuccino Hot chocolate Caffé latte Mocha Frappuccino
13 44 21 61
1 3 1 4
Banana BerryTM Mango-A-Go-GoTM Strawberries Wild Aloha PineappleTM
112 104 105 117
7 7 7 75
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workbook day seven
Step-by-Step Guide to Controlling Your Blood Glucose Around Meals
i
BEFORE BREAKFAST
AFTER BREAKFAST
COMMENTS
i
BEFORE LUNCH
AFTER LUNCH
i
BEFORE DINNER
AFTER DINNER
Write down your shopping
list before you go to the store
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whats next?
Step-by-Step Guide to Controlling Your Blood Glucose Around Meals
i
This is a good time to review what youve learned over the past week
Has checking your blood glucose around mealtimes helped you stay in range? J Yes J No Have you found foods or portion sizes
that can push your glucose too high? J Yes J No Do you know how to identify and count carbs? J Yes J No Can you plan meals that you still enjoy? J Yes J No Has your shopping list changed? J Yes J No If you answered no to any of these, you may benefit from meeting with a diabetes educator
HOW DO I FIND A DIABETES EDUCATOR?
Go to this Web site: wwwdiabeteseducatororg Ask your physician for a recommendation, or call your insurance company Will my insurance cover the visit? Call your insurance plan and ask if you are covered for diabetes self-management training Often, you are covered if your physician refers you If the answer is no, ask if your insurance covers visits with a dietitian instead Many diabetes educators are also registered dietitians
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Source:direct-ms.org
