control diabetes and prevent its serious complications, as well as endocrinologists, diabetes nurse educators, registered dietitians, exercise physiologists, …
wwwbdcom/diabetes_makeover
BD Diabetes
MAKEOVER MANUAL
Inspiring Better Diabetes Care
Do You Need a Diabetes Makeover?
Diabetes–whether type 1 or type 2–is a serious, chronic, and progressive condition That means that each person needs to monitor their health to ensure that they are doing what is necessary to keep their disease in check A regimen established when you were first diagnosed may need to be adjusted over time to keep your blood-glucose level in your target range Each year, we are learning more and more about how to better control diabetes and prevent its serious complications, as well as developing new treatment options and tools to help us manage diabetes with ease and comfort So what exactly is a diabetes makeover? A diabetes makeover is a top-to-bottom check with tailored recommendations for better diabetes control The BD Diabetes Makeover shows us that with the help of a comprehensive care team and the right information and tools, people with diabetes can improve their diabetes management and, hopefully, live healthier lives We are the BD Diabetes Dream Team We are experts in diabetes clinical care, nutrition, fitness, and lifestyle organization In your own
neighborhood, there are dedicated endocrinologists, diabetes nurse educators, registered dietitians, exercise physiologists, and professional organizers–people just like us–to whom you can turn to create your own dream team In the following pages we offer some tips on managing your diabetes After you read the articles, talk to your doctor to see if you need a makeover or to ask for help with assembling your own personal Diabetes Dream Team You can also visit the American Diabetes Association Web site, wwwdiabetesorg, for a list of ADA-recognized diabetes education programs in your community To your health,
wwwbdcom/diabetes_makeover
Table of Contents:
Do You Need a Diabetes Makeover? Patients and Doctors: Partners in Diabetes Care
Harvey L Katzeff, MD
Taking Aim at Your Blood-Glucose Target
Andrea Zaldivar, MS, ANP, CDE
Eating Right Means Eating Healthy
Ann Fittante, MS, RD, CDE
Harvey L Katzeff, MD Andrea Zaldivar, MS, ANP, CDE Ann Fittante, MS, RD, CDE Paul Frickman Pamela Kelly
Exercising to Control Your Blood Glucose
Paul Frickman
Organizing Your Life and Your Diabetes Care
Pamela Kelly
Do Your Homework When It Comes to Your Child and
Diabetes
TREATMENT
Patients and Doctors: Partners in Diabetes Care
By Harvey L Katzeff, MD Diabetes can be overwhelming, since it affects every aspect of your life–when and what you eat, when you sleep, when you travel, and when and how you exercise, for example However, your diabetes does not have to control you when you have the resources you need to control it Good diabetes care starts with a visit to your doctor–your endocrinologist, internist, or family physician He or she should be your partner in helping you determine the strategy and resources you need to manage your diabetes care and live a healthy life First, your doctor can determine the treatment that is right for you– diet and exercise, oral medication, insulin, or a combination of these approaches Your doctor can also identify your target bloodglucose levels and help you build your own Diabetes Dream Team to ensure you have the knowledge, skills, and support you need to manage your diabetes care The next time you visit your doctor about your diabetes, ask for referrals to a dietitian and a fitness expert who specialize in diabetes care, and a diabetes nurse educator With your doctor taking the lead, these
specialists can help you overcome the obstacles on your path to better health Whether its determining an exercise regimen, planning your meals, managing your blood glucose, or starting insulin see sidebar Getting FIT, your own Dream Team can help you gain control of your diabetes so you can get on with the important stuff–like living your life For information on insulin therapy, visit www bddiabetescom to download and print these resources: Drawing and Injecting Insulin, Mixing Insulins, and Site Selection
Taking Aim at Your Blood-Glucose Target
By Andrea Zaldivar, MS, ANP, CDE People with diabetes can greatly reduce the risk of serious complications by controlling their blood-glucose levels According to the Diabetes Control and Complications Trial DCCT, one of the largest type 1 diabetes studies ever conducted in the US, people can reduce the risk of the complications associated with diabetes–including the ones leading to blindness, kidney failure, and amputation–by as much as 76 by lowering their blood glucose to normal or near-normal levels Other studies have shown reductions in complications of 25 to 70 for people with type 2 diabetes You and your doctor should work
together to determine what your target blood-glucose range should be Target blood-glucose is the range that your blood glucose should fall into most of the time Many doctors use the guidelines developed by the American Diabetes Association as a starting point Your doctor or diabetes nurse educator can help you figure out how many times a day you should test your blood glucose to make sure you are reaching your target To help people with diabetes manage their disease, the American Association of Diabetes Educators AADE recently identified seven essential self-care behaviors: Eating healthy Being active Monitoring blood glucose regularly Taking medications as directed by your physician Solving problems related to your diabetes care Coping with diabetes in a healthy way Reducing risks associated with diabetes
Harvey L Katzeff, MD,
is chief of the Division of Endocrinology at Long Island Jewish Medical Center, program director of the Endocrinology Training Program, and medical director of the Obesity Management Program at North Shore Long Island Jewish Medical Center, New York He is also an adjunct associate attending at the Rockefeller University Hospital and associate
professor of medicine at Albert Einstein College of Medicine, New York Dr Katzeff has significant experience treating people with diabetes
Ask your doctor to refer you to a diabetes educator in your community who can help you learn to better manage your disease You can also visit the AADE at wwwaadenetorg For more information, visit wwwbddiabetescom to download and print: Self-Monitoring of Blood-Glucose and Know the Difference: High Blood Sugar and Low Blood Sugar
GETTING
FIT
Some people with diabetes practice Flexible Insulin Therapy FIT Its a different way of thinking about your diabetes care if you take insulin injections before each meal FIT allows you to adjust the timing and amount of insulin to meet your needs For example, you may adjust your meal-time insulin dose up or down to match your current blood-glucose level, the carbohydrates you plan to eat, and the exercise you plan to do Hypoglycemia low blood glucose and other risks are associated with FIT, so this type of insulin therapy is not for everyone Ask your doctor if FIT is right for you
KNOWLEDGE
Andrea Zaldivar, MS, ANP, CDE, is director of clinical services of the North General Diagnostic and Treatment
Center, NY Ms Zaldivar is currently a member of the American Diabetes Association, and serves on the Hispanic Education Committee for the National Diabetes Education Program Ms Zaldivar has had extensive experience in treating people with diabetes
ADA RECOMMENDED TARGET BLOOD-GLUCOSE LEVELS
Plasma blood values Average pre-meal glucose mg/dL Average post-meal glucose mg/dL Normal Less than 100 Less than 110 Target Range for People With Diabetes 90-130 Less than 180
Source: 2004 American Diabetes Association Diabetes Care, Vol 27, Supplement 1, January 2004 Measurement of capillary blood glucose Note: The above values are for non-pregnant adults and are averaged for the entire population of people with diabetes Patients with other diseases, as well as the very young, older adults, and people with unusual conditions or circumstances, may need a different target
NUTRITION
Ann Fittante, MS, RD, CDE, is a registered dietitian
and a certified diabetes educator at the Joslin Diabetes Center Education Affiliate at Swedish Medical Center in Seattle Ms Fittante has worked for the Joslin Diabetes Center for 10 years, both in New York and Seattle She counsels patients and teaches group
classes on meal planning, exercise, and diabetes management
Eating Right Means Eating Healthy
By Ann Fittante, MS, RD, CDE Contrary to what many people believe, there is no such thing as a diabetic diet People with diabetes should be eating a healthy, well-balanced diet, just like everyone else A healthful diet is one that is high in fiber and includes a balance of carbohydrates, protein, and fat It also includes lots of fruits and vegetables, more whole foods than processed foods, and good fats like olive oil, canola oil, and nuts Following are a few tips on healthy eating: Eat fruits and vegetables every day They are low in calories and provide important nutrients and fiber, which will help keep you healthy Legumes such as lentils, split peas, and black or kidney beans are loaded with vitamins, fiber, and protein Try to eat them at least once a week A high-fiber diet can help lower your cholesterol Foods high in fiber include: oatmeal, oat bran, legumes, fruit, vegetables, popcorn, whole-wheat pasta, and grains, such as brown rice Try not to skip meals Eating meals and snacks at regular times prevents overeating and can keep your blood glucose in better control You can
usually eat more if you exercise Exercise will lower your blood glucose and help keep it in balance Also, if you are active and fit, your body will metabolize food more efficiently There is room in everyones diet for a treat now and then Because sweets are often high in calories and concentrated with carbohydrates and unhealthy fats, it is best to eat them in moderation As you can see, people with type 1 or type 2 diabetes can eat the same foods as people without diabetes Whats important is that you keep your blood-glucose level as close to normal as possible Many people with diabetes use a tool called carbohydrate counting to help them plan their meals For more information on Carb Counting and meal planning, visit wwwbddiabetescom to download and print Fast Food Guide and Carb Counting–Eat to Win
A R E C I P E F O R H E A LT H Y L I V I N G
Visit the American Diabetes Association Web site at wwwdiabetesorg for a list of recipes for meals, snacks, or desserts
Exercising to Control Your Blood Glucose
By Paul Frickman Everyone should exercise But for people with diabetes, exercise has extra health benefits: it helps to control weight and lower blood glucose In fact, 30 to 60
minutes of moderate activity can lower your blood glucose for 24 to 72 hours Regular exercise also increases energy, lowers cholesterol, and decreases stress Before you start any exercise program, talk to your doctor and get a thorough medical exam Walking, dancing, bicycling, swimming, skating, lifting weights, stretching, or doing yoga are some of the many exercises you can do You can also see an exercise professional at your local wellness center to help you get started These experts can identify the exercises that are right for you and within your limits Moderate exercise each day can improve your health and make you feel better If you havent exercised in a while, start with 10 minutes and gradually increase your time to 30 minutes Warm up by starting slowly, or by gentle stretching, and gradually increase your activity to a moderate intensity Then, slow down for the last five minutes or do some post-exercise stretching Remember, it is important to build up to at least 30 minutes of continuous activity, since that is the point when exercise will help lower your blood glucose For more information on exercise and its effect on blood glucose, visit
wwwdiabetesmakeovercom/support_materials to download and print the resource Exercise and Diabetes
FITNESS
Paul Frickman is the exercise
coordinator at the Florida Hospital Diabetes Center in Orlando He operates a fitness center for people with diabetes, designing and monitoring individualized exercise programs Paul teaches exercise in the Centers diabetes education classes and writes a bimonthly exercise column read by 180,000 central Florida seniors He is a member of the American College of Sports Medicine
GET MOVING
While exercise is good, it can lower your blood glucose too much It is important to monitor your blood glucose before and after any physical activity To make sure you are making the most of your exercise routines, follow these tips: Exercise 1 to 2 hours after a meal, when your blood-glucose level is highest If your blood-glucose level drops below 70 after exercise, eat a snack to increase it If your blood-glucose level is consistently low after exercise, call your doctor You may need to adjust your insulin or oral medication Proper support as well as heat and cold therapy can help prevent and treat minor strains that can result from excercise Remember to call
your doctor if you experience pain regularly during or after excercise You do not have to do high-intensity exercise–like running–to receive benefits Mod 
erate-intensity exercise–like walking or biking–5 to 7 days a week, accompanied by upper-body exercise–like lifting weights or swimming–2 to 3 days a week, is the key
LIFESTYLE
Pamela Kelly is a professional organizer and redesigner for her own company, Pam Kelly Interiors, Chicago Ms Kelly helps her clients organize their homes so their living spaces accommodate their unique daily needs and serve as beautiful oases from the pressures of life She is a member of the National Association of Professional Organizers, Glenview, Ill, and chairs the Midwest Redesign Association, Chicago
Organizing Your Life and Your Diabetes Care
By Pamela Kelly Monitoring your blood glucose several times a day Keeping track of your blood-glucose levels Taking your pills Injecting insulin Counting carbohydrates For individuals with diabetes, theres a lot to remember–and even more to forget How do you keep track of it all? Write it down, keep a record of it, and develop a routine Write it down: Keep a detailed calendar of all your medical
appointments, and place it in clear view Also, keep a log of your blood-glucose readings and other important information related to your diabetes for quick reference when visiting your doctor Keep records: Every insurance claim and medical report related to your condition should be well-organized and kept in an easily accessible place Expandable legal-sized folders are good tools Develop a routine: Create a daily schedule that includes when to monitor your blood glucose, inject insulin if appropriate or take medications, exercise, eat meals or snack, and any other repetitive activities related to your diabetes
PREPARE FOR THE UNEXPECTED
If you have a severe hypoglycemic low blood glucose or hyperglycemic high blood glucose reaction, you may pass out and be unable to explain your medical condition to first responders Consider getting a medical identification bracelet or necklace that identifies you as someone with diabetes and an insulin user
For information on preparing for a disaster, visit
wwwbdcom/diabetes_makeover
Do Your Homework When It Comes to Your Child and Diabetes
Coping with diabetes can be difficult for adults, let alone for children or teens For children with
diabetes, school can simply add to the stress of managing a chronic disease Taking insulin and monitoring blood glucose during school hours can be worked into the school day If you have a school-aged child with diabetes, work with your healthcare provider and school personnel to establish a care plan that is right for your child and addresses, among other things, meal planning, snacking, exercising, blood-glucose monitoring, injecting insulin, and addressing hyperglycemia or hypoglycemia in the school setting Parents of young children need to be especially aware of signs of high or low blood glucose, since young children may not be able to communicate how they are feeling You should also make sure that teachers, school nurses, babysitters, and other caregivers know these signs and know how to respond For more information on helping your child manage diabetes, visit the National Diabetes Education Program Web site at wwwndepnihgov to download and print the booklet Helping Students with Diabetes Succeed
with diabetes, I had immediate I consider myself lucky When I was diagnosed my diabetes to allow me to access to a team of specialists to help manage etition; however, many people
continue swimming at the highest level of comp BD recognized the need to with diabetes are not this lucky Because of this, ed the BD Diabetes Makeover provide access to diabetes resources and creat program help is not easy to do; some Taking that first decisive step to admit you need process of good diabetes care would argue that its the hardest step in the over participants come together Recognizing this need in themselves, the Make on their diabetes management Like from all over the country to get a better grip somewhere in a busy, often hectic so many others, they have lost the motivation s Some dont have access to the life to give their diabetes the attention it need ion of diabetes was met with a right tools and information For others, the ment needed to start monitoring their groan and a mental acknowledgment that they blood glucose level back where it diabetes in a more aggressive way to get their belonged was immediately overwhelmed by When I met the first Makeover participants, I ted reminded me of the team their enthusiasm The teamwork they demonstra pic level Everyone, including Olympic attitude I was accustomed to at the Olym and this effort provides plenty of athletes,
needs encouragement and support, over participants encourages and it Meeting people like the BD Diabetes Make when I dont feel like it, to give motivates me to test my blood glucose levels an extra lap in training myself that extra shot of insulin, and to swim easier for everyone living with Im also impressed with BDs effort to make life adapted by those willing to diabetes by creating a program that can be easily tes make a change and take charge of their diabe unity since I was diagnosed, and I have been very active in the diabetes comm challenge to manage their disease I often meet people who feel alone in their of other people struggling with Its important for them to know there are a lot tes Makeover can provide diabetes and that programs like the BD Diabe a sense of community and a support system people, Im lucky to be part of such a great group of with this program The and I enjoy helping them and participants stories are a source of inspiration to initiate your own will hopefully encourage you know BD Diabetes Makeover program Im proud to on board these people, and Im proud to be Gary Hall, Jr, Ten-Time Olympic Medalist in Swimming
PREPARING
AN
EMERGENCY
KIT
In case of
an emergency, students with diabetes may need to stay at school later than usual The Centers for Disease Control and Prevention and the National Institutes of Health recommend that parents or guardians prepare an emergency supply kit for school-age children to protect against such an event The kit should contain diabetes supplies for 72 hours and include the following: Blood-glucose meter, batteries for meter, testing strips, lancets Urine ketone strips Insulin and supplies, including syringes or pen needles Other medications Antiseptic wipes Fast-acting source of glucose, such as glucagons tablets Carbohydrate-containing snacks Hypoglycemia food supplies enough for three episodes: quick-acting sugar and snacks with carbohydrates and protein
BD Diabetes Products
It is important for people with diabetes to have the right care products Products can make a difference when it comes to closely managing diabetes Products like BD Ultra-FineTM Insulin Syringes, BD Ultra-FineTM Pen Needles, BD Logic Blood Glucose Monitor, and for pump users, the Paradigm Link Blood Glucose Monitor help people manage their diabetes with comfort and control
BLOOD
GLUCOSE
MONITORING
BD Logic Blood
Glucose Monitor
Paradigm Link Blood Glucose Monitor
BDTM Test Strips
BD Ultra-FineTM 33 Lancets
BDTM Diabetes Software
INSULIN
DELIVERY
BDTM Insulin Syringes
BD Ultra-FineTM Pen Needles
SHARPS
DISPOSAL
Diabetes Resources
General
American Diabetes Association ADA
Phone: 800-342-2383 wwwdiabetesorg
Nutrition
American Dietetic Association ADA
Phone: 800-877-1600 wwweatrightorg
American Association of Diabetes Educators AADE
Lifestyle Organizations
Pam Kelly Interiors
service fees apply wwwpamkellyinccom
BDTM Home Sharps Container BD Safe-ClipTM Device BD Sharps Disposal by Mail System
TM
Phone: 800-338-3633 wwwaadenetorg
Florida Hospital Diabetes Center
Phone: 407-303-1700 or 407-303-2822 wwwflhosporg
National Association of Professional Organizers NAPO
Phone: 847-375-4746 wwwnaponet
EXCERCISE
AIDS
Joslin Diabetes Center, Swedish Medical Center
Phone: 206-215-2440 wwwswedishorg/1556cfm
Children with Diabetes
Juvenile Diabetes Research Foundation International JDRF
Phone: 800-533-2873 wwwjdrforg
Long Island Jewish Medical Center
Phone: 718-470-7240 wwwlijedu
ACE Brand Heat Therapy
ACE Brand 3 Elastic Bandage with ACE E-Z Clips
National Diabetes Education
Program
Phone: 800-438-5383 wwwndepnihgov
To download a copy of the brochure, Planning Your Diabetes Care During Disaster Conditions, visit
Diabetes Care Products
BD Diabetes
Phone: 888-232-2737 wwwbddiabetescom
wwwbdcom/diabetes_makeover or call 18003411167
Exercise
ACE Brand Reuseable Cold Compress ACE Brand TekZoneTM Antimicrobial Wrist Brace with Gel Support
Diabetes Exercise and Sports Association
Phone: 800-898-4322 wwwdiabetes-exerciseorg
For further information, or to order any of these products, call 1-888-BD CARES 1-888-232-2737
90-Second Makeover
The BD Diabetes Makeover can be applied to anyone who has diabetes Our team of experts–the BD Diabetes Dream Team–created a 90-second makeover based on techniques used in BDs two-month program that anyone with diabetes can incorporate into daily life The following 10 tips take 90 seconds and can be done on a daily basis to help you makeover your diabetes care regimen: 1 Prepare a daily schedule detailing when you will take your oral medication or inject insulin, check your blood glucose, and plan your meal times; incorporate at least a half hour for exercise 2 Prepare a daily travel kit with extra diabetes supplies,
including insulin syringes and pen needles, blood glucose monitor, lancets, test strips, glucose tablets to combat lows, and water 3 Check your blood glucose levels frequently with a blood glucose meter that includes a software program, like BD Logic Monitor with BD InterActivTM Diabetes Software, so you can upload your data and track your readings 4 Get moving; plan an exercise routine–either cardio brisk walk, run, bicycling, aerobics class or weight training 5 Keep track by filing your latest insurance claim or medical report from your doctor in a filing cabinet at home 6 Block your schedule by filling out a monthly calendar with your doctor appointments for the next three months 7 Plan a healthy meal that is high in fiber and includes a balance of carbohydrates, protein, and fat 8 Eat a healthy snack such as a piece of fruit, popcorn, or yogurt if you are feeling hungry 9 Count your carbs before ordering or eating a meal to keep blood glucose levels in target; and if you take insulin, adjust your dosing accordingly 10 Check your local American Diabetes Association chapter Web site to see if there are any diabetes events, like a walk, that you can get involved in and have
fun
Diabetes is a potentially devastating disease Globally, more than 180 million people–at least 400,000 of them children–have this condition, which prevents the body from producing or properly using insulin Insulin is a hormone necessary to convert sugar, starches, and other foods into the energy we need for daily life Diabetes can lead to blindness, amputation, heart disease–even death Fortunately, in many cases it can be managed
Partnering for a cure
The number of people with diabetes will nearly double in the next 25 years1 BD has formed partnerships worldwide with various organizations to take the broad, global actions needed today if we are to avoid the prospect of caring for more than 350 million projected victims of this debilitating disease The leadership of BD in diabetes care began in 1924 with the production of the first syringe designed for injecting insulin Today, BD has the worlds most complete array of insulin delivery and monitoring products In addition to donating millions of dollars to research and discovering ways to increase the availability of cells for researchers, BD develops comprehensive educational programs to help patients manage their disease BD
also supports camps for children with diabetes, donating educational materials, products, and equipment for camp activities BD is a medical technology company serving healthcare institutions, life sciences researchers, clinical laboratories, industry, and the general public every day BD–selected as one of Americas Most Admired Companies by FORTUNE magazine2–is privileged to fight diabetes and address other fundamental healthcare issues in every corner of the world BD–Helping all people live healthy lives
To learn more about the comprehensive BD Diabetes Makeover program or how you can form your own Dream Team, visit wwwbdcom/diabetes_makeover or call 18003411167
wwwbdcom/diabetes_makeover
1 2
Please visit wwwbdcom Screening for Type 2 Diabetes: Report by the World Health Organization and the International Diabetes Federation 2003 World Health Organization Americas Most Admired Companies annual survey, 2005; FORTUNE magazine, March 7, 2005 BD and BD Logo are trademarks of Becton, Dickinson and Company 2005 BD
Photo Marianne Smith/BD
For more information on the
BD Diabetes Makeover
program, visit us at
wwwbdcom/diabetes_makeover
or call
18003411167
Paradigm Link is a
trademark of Medtronic Minimed BD, BD Logo, and all other trademarks are the property of Becton, Dickinson and Company 2005 BD PR102 11/05
1 Becton Drive Franklin Lakes, NJ 07417
Source:bd.com
