Diabetes Treatments

Highlights of Optimal Diabetes Management Measure at every visit for diabetes. Annual measurement Penn Diabetes Care © - 1998, The Trustees of the …

Diabetes
This information is at http://wwwndepnihgov/diabetes/diabeteshtm and is provided by the National Diabetes Information Clearinghouse NDIC, a service of the National Institute of Diabetes and Digestive and Kidney Diseases NIDDK The NIDDK is part of the National Institutes of Health under the US Department of Health and Human Services NIH Publication No 03-4016, April 2003 To obtain a free copy of this document, go to wwwmasterdocscom

Introduction
Diabetes is a serious chronic disease that can be managed through lifestyle changes and medication Over 18 million Americans have diabetes, and another 41 million adults ages 40 to 74 have pre-diabetes Whether you just found out you have diabetes or have been dealing with it for years, you can control your diabetes and live a long, active life If you are at risk or have pre-diabetes, you can take small steps to prevent the disease

What Is Diabetes?
If you just found out you have diabetes or want to know more about the disease, this section will help answer your questions Learn more about the different types of diabetes, including their causes, risk factors, symptoms, and complications

Diabetes Control
Diabetes is a serious
disease, but it is controllable Learn more about the disease, treatments, monitoring the ABCs of diabetes, and preventing severe complications

Diabetes Prevention
Diabetes prevention is proven, possible, and powerful Learn more about the risks for developing type 2 diabetes and the small steps you can take to delay or prevent the disease before it starts

Resources on Children and Adolescents
Children with type 1 and type 2 diabetes and their caregivers f ce special challenges a Take advantage of all of the NDEPs resources to equip children with diabetes, their caregivers, and school personnel with the tools they need to succeed

Diabetes Organizations
Diabetes may be difficult to manage, but you dont have to do it alone Learn about organizations in your community that can help

What Diabetes Is
Diabetes means that your blood glucose often called blood sugar is too high Your blood always has some glucose in it because your body needs glucose for energy to keep you going But too much glucose in the blood isnt good for your health

How do you get high blood glucose?
Glucose comes from the food you eat and is also made in your liver and muscles Your blood carries the glucose to all
the cells in your body Insulin is a chemical a hormone made by the pancreas The pancreas releases insulin into the blood Insulin helps the glucose from food get into your cells If your body doesnt make enough insulin or if the insulin doesnt work the way it should, glucose cant get into your cells It stays in your blood instead Your blood glucose level then gets too high, causing pre-diabetes or diabetes

What is pre-diabetes?
Pre-diabetes is a condition in which blood glucose levels are higher than normal but are not high enough for a diagnosis of diabetes People with pre-diabetes are at increased risk for developing type 2 diabetes and for heart disease and stroke The good news is if you have pre-diabetes, you can reduce your risk of getting diabetes With modest weight loss and moderate physical activity, you can delay or prevent type 2 diabetes and even return to normal glucose levels

What are the signs of diabetes?
The signs of diabetes are

being very thirsty urinating often feeling very hungry or tired losing weight without trying having sores that heal slowly having dry, itchy skin losing the feeling in your feet or having tingling in your feet having blurry
eyesight

You may have had one or more of these signs before you found out you had diabetes Or you may have had no signs at all A blood test to check your glucose levels will show if you have pre-diabetes or diabetes

What kind of diabetes do you have?
People can get diabetes at any age There are three main kinds Type 1 diabetes, formerly called juvenile diabetes or insulin-dependent diabetes, is usually first diagnosed in children, teenagers, or young adults In this form of diabetes, the beta cells of the pancreas no longer make insulin because the bodys immune system has attacked and destroyed them Treatment for type 1 diabetes includes taking insulin shots or using an insulin pump, making wise food choices, exercising regularly, taking aspirin daily for some, and controlling blood pressure and cholesterol Type 2 diabetes, formerly called adult-onset diabetes or noninsulin-dependent diabetes, is the most common form of diabetes People can develop type 2 diabetes at any age–even during childhood This form of diabetes usually begins with insulin resistance, a condition in which fat, muscle, and liver cells do not use insulin properly At first, the pancreas keeps up with the added
demand by producing more insulin In time, however, it loses the ability to secrete enough insulin in response to meals Being overweight and inactive increases the chances of developing type 2 diabetes Treatment includes using diabetes medicines, making wise food choices, exercising regularly, taking aspirin daily, and controlling blood pressure and cholesterol Some women develop gestational diabetes during the late stages of pregnancy Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin

Diabetes can start at any age

This guide is for people who have either type 1 diabetes or type 2 diabetes

If you use insulin, look at the white boxes for Action Steps If you dont use insulin, look at the gray boxes for Action Steps

Why do you need to take care of your diabetes?
After many years, diabetes can lead to serious problems in your eyes, kidneys, nerves, and gums and teeth But the most serious problem caused by diabetes is heart disease When you have diabetes, you are more than twice as likely as people
without diabetes to have heart disease or a stroke If you have diabetes, your risk of a heart attack is the same as someone who has already had a heart attack Both women and men with diabetes are at risk You may not even have the typical signs of a heart attack You can reduce your risk of developing heart disease by controlling your blood pressure and blood fat levels If you smoke, talk with your doctor about quitting Remember that every step toward your goals helps Later in this guide, well tell you how you can try to prevent or delay long-term problems The best way to take care of your health is to work with your health care team to keep your blood glucose, blood pressure, and cholesterol in your target range

Whats a desirable blood glucose level?
Everyones blood has some glucose in it In people who dont have diabetes, the normal range is about 70 to 120 Blood glucose goes up after eating, but returns to the normal range 1 or 2 hours later Ask your health care team when you should check your blood glucose with a meter Talk about whether the blood glucose targets listed below are best for you Then write in your own targets Blood Glucose Targets for Most People When Before meals 1
to 2 hours after the start of a meal Target levels 90 to 130 less than 180 My target levels _____________ _____________

Printer-friendly version of Glucose Targets form

It may be hard to reach your target range all of the time But the closer you get to your goal, the more you will reduce your risk of diabetes-related problems and the better you will feel Every step helps

Taking Care of Your Diabetes Every Day
Do four things every day to lower high blood glucose:

Follow your meal plan Get regular exercise Take your diabetes medicine Check your blood glucose

Experts say most people with diabetes should try to keep their blood glucose level as close as possible to the level of someone who doesnt have diabetes The closer to normal your blood glucose is, the lower your chances are of developing damage to your eyes, kidneys, and nerves Check with your doctor about the right range for you The chart in chapter one shows target blood glucose ranges Your health care team will help yo u learn how to reach your target blood glucose range Your main health care providers are your doctor, nurse, diabetes educator, and dietitian

When you see your health care provider, ask lots of
questions Before you leave, be sure you understand everything you need to know about taking care of your diabetes

A diabetes educator is a health care worker who teaches people how to manage their diabetes Your educator may be a nurse, a dietitian, or another kind of health care worker A dietitian is someone whos specially trained to help people plan their meals For more information about these health care providers and for help in finding them, see chapter six The next sections of this guide will tell you more about the four main ways you take care of your diabetes: Follow your meal plan, get regular exercise, take your diabetes medicine, and check your blood glucose

Follow Your Meal Plan
People with diabetes dont need to eat special foods The foods on your meal plan are good for everyone in your family Try to eat foods that are low in fat, salt, and sugar and high in fiber such as beans, fruits, vegetables, and grains Eating right will help you

Reach and stay at a weight thats good for your body Keep your blood glucose in a desirable range Prevent heart and blood vessel disease

Your daily meal plan should include foods from these groups:

Source: US Department of
Agriculture/US Department of Health and Human Services

People with diabetes sho uld have their own meal plan Ask your doctor to give you the name of a dietitian who can work with you to develop a meal plan Your

dietitian can help you plan meals to include foods that you and your family like to eat and that are good for you too Ask your dietitian to include foods that are heart-healthy to reduce your risk of heart disease ACTION STEPS If you use insulin

Follow your meal plan Dont skip meals, especially if youve already taken your insulin, because your blood glucose may go too lo w See chapter 3 for information on how to handle hypoglycemia, also called low blood sugar

ACTION STEPS If you DONT use insulin

Follow your meal plan Dont skip meals, especially if you take diabetes medicine, because your blood glucose may go too low It may be better to eat several small meals during the day instead of one or two big meals

Get Regular Exercise
Exercise is good for your diabetes Walking, swimming, dancing, riding a bicycle, playing baseball, and bowling are all good ways to exercise You can even get exercise when you clean house or work in your garden Exercise is especially good for
people with diabetes because

Exercise helps keep weight down Exercise helps insulin work better to lower blood glucose Exercise is good for your heart and lungs Exercise gives you more energy

Before you begin exercising, talk with your doctor Your doctor may check your heart and your feet to be sure y have no special problems If you have high ou blood pressure or eye problems, some exercises like weightlifting may not be safe Your health care team can help you find safe exercises Try to exercise almost every day for a total of about 30 minutes If yo u havent exercised lately, begin slowly Start with 5 to 10 minutes, and then add more time Or exercise for 10 minutes, three times a day

If you havent eaten for more than an hour or if your blood glucose is less than 100 to 120, have a snack before yo u exercise See chapter 3 for snack ideas

Being active helps you feel better

When you exercise, carry glucose tablets or a carbohydrate snack with you in case you get hypoglycemia low blood sugar Wear or carry an identification tag or card saying that you have diabetes The groups listed in chapter six have more information about diabetes and exercise ACTION STEPS If you use
insulin

See your doctor before starting an exercise program Check your blood glucose before, during, and after exercising Dont exercise when your blood glucose is over 240 or if you have ketones in your urine see below Dont exercise right before you go to sleep, because it could cause hypoglycemia low blood sugar during the night

ACTION STEPS If you dont use insulin

See your doctor before starting an exercise program

Take Your Diabetes Medicine Every Day
Insulin and diabetes pills are the two kinds of medicines used to lower blood glucose If You Use Insulin You need insulin if your body has stopped making insulin or if it doesnt make enough Everyone with type 1 diabetes needs insulin, and many people with type 2 diabetes do too Insulin cant be taken as a pill Youll give yourself shots every day or use an insulin pump Insulin pumps are small machines that connect to narrow tubing, ending with a needle just under the skin near the abdomen Insulin is delivered through the needle Keep extra insulin in your refrigerator in case you break the bottle youre using Dont keep insulin in the freezer or in hot places like the glove compartment of your car Also, keep it away from bright
light Too much heat, cold, and bright light can damage insulin If you use a whole bottle of insulin within 30 days, you can keep that bottle at room temperature If you dont use a whole bottle of insulin within 30 days, then store it in the refrigerator

You may need insulin to control your blood glucose

If You Take Diabetes Pills If your body makes insulin, but the insulin doesnt lower your blood glucose, you may need diabetes pills Some pills are taken once a day, and others are taken more often Ask your health care team when you should take your pills Be sure to tell your doctor if your pills make you feel sick or if you have any other problems Remember, diabetes pills dont lower blood glucose all by themselves Youll still want to follow a meal plan and exercise to help lower your blood glucose Sometimes, people who take diabetes pills may need insulin shots for a while If you get sick or have surgery, the diabetes pills may no longer work to lower your blood glucose You may be able to stop taking diabetes pills if you lose weight Always check with your doctor before you stop taking your diabetes pills Losing 10 or 15 pounds can sometimes help you reach your target blood glucose
level

Many people with type 2 diabetes take pills to help keep blood glucose in their target range

If You Dont Use Insulin or Take Diabetes Pills Many people with type 2 diabetes dont need insulin or diabetes pills They can take care of their diabetes by using a meal plan and exercising regularly

Check Your Blood Glucose as Recommended
Youll want to know how well youre taking care of your diabetes The best 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, exercise plan, or medicine Ask your doctor how ofte n 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 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 insurance or Medicare may pay for the supplies and equipment you need

Checking your blood glucose will help you see if your diabetes treatment plan is working

Take Other Tests for Your Diabetes
Urine Tests You may need to check your urine if youre
sick or if your blood glucose is over 240 A urine test will tell you if you have ketones in your urine Your body makes

ketones when there isnt enough insulin in your blood Ketones can make you very sick Call your doctor right away if you find ketones when you do a urine test You may have a serious condition called ketoacidosis If it isnt 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 You can buy strips for testing ketones at a drug store Your doctor or diabetes educator will show you how to use them The A1C Test Another test for blood glucose, the A1C, also called the hemoglobin A1C test, shows what your overall blood glucose was for the past 3 months It shows how much glucose is sticking to your red blood cells 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 under 7 usually means that your diabetes treatment is working well and your blood glucose is under control If your A1C is 8 or above, it means that your blood
glucose may be too high Youll then have a greater chance of getting diabetes problems, like kidney damage You may need a change in your meal plan, exercise plan, or diabetes medicine A1C Results Target for most people with diabetes under 7

Time to change my diabetes care plan 8 or above My last result My target __________ __________

Talk with your doctor about what your target should be Even if your A1C is higher than your target, remember that every step toward your goal helps reduce your risk of diabetes problems Keep Daily Records Print and make copies of the daily diabetes record page Then 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 youre 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 in your meal plan If you dont know what your results mean, ask your health care team Things to write down every day in your record book are

results of your blood glucose checks your
diabetes medicines: times and amounts taken if your blood glucose was very low see chapter three if you ate more or less food than you usually do if you were sick if you found ketones in your urine what kind of exercise you did and for how long

ACTION STEPS If you use insulin Keep a daily record of

Your blood glucose numbers The times of the day you took your insulin The amount and type of insulin you took Whether you had ketones in your urine

ACTION STEPS If you DONT use insulin Keep a daily record of

Your blood glucose numbers The times of the day you took your diabetes pills

Sample of a record page for a person who doesnt use insulin or diabetes pills

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, its too high or too low Blood glucose thats too high or too low can make you very sick Heres how to handle these emergencies

What You Need to Know About High Blood Glucose
If your blood glucose stays over 180, it may be too high Go back to the chart It means you don t have enough insulin in your body High blood glucose can happen if you miss taking your diabetes medicine, eat too much,
or dont 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 or being sick or under stress can also make your blood glucose too high Thats why its very important to check your blood glucose and keep taking your insulin or diabetes pills when youre sick For more about how to take care of yourself when youre sick, see chapter five

If youre 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 insulin or diabetes pills, or a change in your meal plan

What You Need Hypoglycemia

to

Know

About

Low

Blood

Glucose

Hypoglycemia happens if your blood glucose drops too low It can come on fast Its caused by taking too much diabetes medicine, missing a meal, delaying a meal, exercising more than usual, or drinking too much alcohol Sometimes, medicines you take for other health problems can cause
blood glucose to drop Hypoglycemia 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 70 or below, have one of the following right away:

2 or 3 glucose tablets 1/2 cup 4 oz of any fruit juice a piece of fruit or a small box of raisins 1/2 cup 4 oz of a regular not diet soft drink 5 or 6 pieces of hard candy 1 or 2 teaspoons 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 that its no longer too low Once your blood glucose is stable, if it will be at least an hour before your next meal, have a snack If you take insulin or a diabetes pill that can cause hypoglycemia, always carry food for emergencies Its a good idea also to wear a medical identification bracelet or necklace If you take insulin, keep a glucagon kit at home and also at a few other places where you go often 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 hypoglycemia You can prevent hypoglycemia by eating regular meals, taking your diabetes medicine, and checking your blood glucose often Checking will tell you whether your glucose level is going down You can then take steps, like eating some fruit, crackers, or other snacks, to raise your blood glucose

When you have hypoglycemia, have a snack to bring your blood glucose back to normal

ACTION STEPS If you use insulin

Tell your doctor if you have hypoglycemia often, especially at the same time of the day or night several times in a row Tell your doctor if youve passed out from hypoglycemia Ask your doctor about glucagon Glucagon is a medicine that raises blood glucose If you pass out from hypoglycemia, someone should call 911 and give you a glucagon shot

ACTION STEPS If you DONT use insulin

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

Why Its
Important to Take Care of Your Diabetes
Taking care of your diabetes every day will help keep your blood glucose in your target range and help prevent other health problems that diabetes can cause over the years This part of the guide describes those problems We tell you ab out them not to scare you, but to help you understand what you can do to keep them from happening Do what you can every day to keep your blood glucose in the range thats best for you

Follow your meal plan every day Get regular exercise every day

Take your every day

diabetes

medicine 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 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 He or she 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 fat and salt Keep your blood glucose on track Know your A1C The target for most people is under 7 If you smoke, quit Exercise regularly Lose weight if you need to Ask your health care team whether you should take an aspirin every day Keep your blood pressure on track The target for most people is under 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 under 100 If needed, take medicine to control your blood fat levels

Whats a desirable blood pressure level? Blood pressure levels tell how much 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 beats and the second is the pressure as your heart relaxes If your blood pressure is higher than your target, talk with your health care team about changing your meal plan, adding exercise, or taking medicine Blood Pressure Results Target for most people with diabetes My last result under 130/80 ____________

My target What are desirable blood
fat levels?

____________

Cholesterol, a fat found in the body, appears in different forms If your LDL cholesterol 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 good cholesterol protects you from heart disease, so the higher it is, the better Its best to keep triglyceride another type of fat levels under 150 All of these target numbers are important for preventing heart disease Target Blood Fat Levels for People With Diabetes Total cholesterol LDL cholesterol HDL cholesterol under 200 under 100 above 40 men above women Triglycerides under 150 My last My result_____ target_____ My last My result_____ target_____ My last My result_____ target_____

50 My last My result_____ target_____ My last My result_____ target_____

Rose is 55 years old and teaches at a junior high school on an American Indian reservation in New Mexico Rose has had type 2 diabetes for almost 10 years When she first found out she had diabetes, she weighed too much and didnt get much exercise After talking it over with her doctor, Rose began an exercise program She
lost weight, and her blood glucose began to come down She felt better too Now Rose teaches an exercise class in her spare time

Diabetes and Your Eyes
Have your eyes checked once a year You could have eye problems that you havent noticed yet It is important to catch eye problems early when they 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 as close to normal as possible If your eyes are already damaged, an eye doctor may be able to save your sight with laser treatments or surgery The best way to prevent eye disease is to have a yearly eye exam In this exam, the eye doctor puts drops in your eyes to make your pupils get bigger dilate When the pupils are big, the doctor can see into the back of the eye This is called a dilated eye exam, and it doesnt hurt If youve never had this kind of eye exam before, you should have one now, even if you havent had any trouble with your eyes Be sure to tell your eye doctor that you have diabetes Here are some tips for taking care of your eyes:

For people with type
1 diabetes: Have your eyes examined when you have had diabetes for 5 years and every year after that first exam Children should have an eye exam in their early teens For people with type 2 diabetes: Have an eye exam every year For women planning to have a baby: Have an eye exam before becoming pregnant If you smoke, quit Keep your blood glucose and blood pressure as close to normal as possible

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

See your eye doctor for an eye exam with dilated pupils every year Early treatment of eye problems can help save your sight

Diabetes and Your Kidneys
Your kidneys help clean waste products from your blood They also work to keep the right balance of salt and fluid in your body Too much glucose in your blood is very hard on your kidneys After a number of years, high blood glucose can cause the kidneys to stop working This condition is called kidney failure If your kidneys stop working, youll need dialysis using a machine or special fluids to clean your blood or a kidney transplant Have a urine test once a year for signs of kidney damage The test
measures how much protein is in your urine A blood pressure medicine called an ACE inhibitor can help prevent kidney damage Ask your doctor whether this medicine could help you Other ways to help prevent kidney problems are to

Take your medicine if you have high blood pressure Ask your doctor or your dietitian whether you should eat less meat, cheese, milk, and fish or fewer eggs See your doctor right away if you get a bladder or kidney infection Signs of bladder or kidney infections are cloudy or bloody 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 Keep your blood glucose and blood pressure as close to normal as possible If you smoke, quit

Mike is a migrant farm worker with type 2 diabetes and high blood pressure Mike, 47, is married, and he and his wife have three children The family is often on the move, depending on where the work is Mike has his blood pressure and kidneys checked at clinics in migrant worker camps Some of the clinics also offer diabetes classes Whenever they can, Mike and his wife attend these classes They especially like the cooking classes because
they learn how to prepare low-cost, healthy meals for the whole family

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 It can also cause pain in your legs, arms, or hands or cause problems with eating, 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 your nerves at least once a year Part of this exam should include tests to check your sense of feeling and the pulse in your feet Tell the doctor about any problems with your feet, legs, hands, or arms Also, tell the doctor if you have trouble eating, going to the bathroom, or having sex, or if you feel dizzy sometimes Nerve damage to the feet can lead to amputations 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 cant heal and might become infected If the infection isnt treated, it could lead to amputation Ask your doctor whether you already have nerve damage in your feet If you do, it is especially
important to take good care of your feet To help prevent

complications from nerve damage, check your feet every day see Foot care tips below

Joe is a 65-year-old retired letter carrier with type 2 diabetes Every time he visits his doctor, he takes his shoes and socks off so the doctor can check his feet for sores, ulcers, and wounds The doctor also checks the sense of feeling in Joes feet Joe and his doctor talk about ways to prevent foot and nerve problems Since Joe has lost some feeling in his toes, the doctor also talks to him about the importance of good foot care and keeping his blood glucose in a good range

Here are some ways to take care of your nerves:

Keep your blood glucose and blood pressure as close to normal as possible Limit the amount of alcohol you drink Check your feet every day If you smoke, quit

Foot Care Tips You can do a lot to prevent problems with your feet Keeping your blood glucose in your target range and taking care of your feet can 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 dont 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 Dont put lotion or cream between your toes File your toenails straight across with an emery board Dont leave sharp edges that could cut the next toe Dont try to cut calluses or corns off with a razor blade or knife, and dont 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 Dont wear mended stockings or stockings 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 Dont wear flip-flops, shoes with pointed toes, or plastic shoes Never go barefoot Wear socks if your feet get cold at night Dont 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 This will remind the doctor to check
your feet See a podiatrist for help if you cant 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 To help prevent damage to your gums and teeth,

See your dentist twice a year Tell your dentist that you have diabetes Brush and floss your teeth at least twice a day If you smoke, quit Keep your blood glucose as close to normal as possible

Keeping your blood glucose in your target range, brushing and flossing your teeth every day, and having regular dental checkups are the best ways to prevent gum and teeth problems when you have diabetes

James runs a bookstore in California Hes 35 years old and has had type 1 diabetes for 15 years James takes good care of his teeth and sees his dentist twice a year He makes his appointments in the morning, after breakfast, so he wont get hypoglycemia while at the dentist He also carries glucose tablets and wears an identification bracelet that has the name and the telephone number of his doctor on
it

Taking Care of Your Diabetes at Special Times
When Youre Sick
Take good care of yourself when you have a cold, the flu, an infection, or other illness Being sick can raise your blood glucose When youre sick,

Check your blood glucose every 4 hours Write down the results Keep taking your insulin and your diabetes pills Even if you cant keep food down, you still need your diabetes medicine Ask your doctor or diabetes educator whether to change the amount of insulin or pills you take Drink at least a cup 8 ounces of water or other calorie-free, caffeine -free liquid every hour while youre awake If you cant eat your usual food, try drinking juice or eating crackers, popsicles, or soup If you cant eat at all, drink clear liquids such as ginger ale Eat or drink something with sugar in it if you have trouble keeping food down Test your urine for ketones if o your blood glucose is over 240 o you cant keep food or liquids down

Call your health care provider right away if o your blood glucose has been over 240 for longer than a day o you have moderate to large amounts of ketones in your urine o you feel sleepier than usual o you have trouble breathing o you cant think
clearly o you throw up more than once o youve had diarrhea for more than 6 hours

ACTION STEPS If you use insulin

Take your insulin, even if youve been throwing up Ask your doctor about how to adjust your insulin dose, based on your blood glucose test results

ACTION STEPS If you DONT use insulin

Take your diabetes pills, even if youve been throwing up

When Youre at School or Work
Take care of your diabetes when youre at school or at work:

Follow your meal plan Take your medicine and check your blood glucose as usual Tell your teachers, friends, or close co-workers about the signs of hypoglycemia 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 hypoglycemia Tell your company nurse or school nurse that you have diabetes

Sally, a 12-year-old with type 1 diabetes, loves her gymnastics class She practices every day for an hour Before Sally exercises, she checks her blood glucose to make sure its okay to start her workout If her blood glucose is too low, she eats a snack before beginning to practice Sally has told her coach that she has diabetes She knows that if she has a problem with
hypoglycemia, her coach will be there to help her

When Youre Away From Home
Taking care of your diabetes, even on vacation, is very important Here are some tips:

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 If youre 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 soda in the car in case your blood glucose drops too low Ask ahead of time for a diabetes meal if youre traveling by plane Most airlines serve special meals for people with health needs Carry food like crackers or fruit with you in case meals are late Carry your medicines insulin, insulin needles, and diabetes pills and your blood testing supplies with you Never put them in the suitcase you dont carry with you on the plane or train

Ask your health care team how to adjust your medicines, especially your insulin, if youre traveling across time zones Take
comfortable, well-fitting shoes on vacation Youll probably be walking more than usual, so you should take extra care of your feet If youre going to be away for a long time, ask your doctor for a written prescription for your diabetes medicine and the name of a doctor in the place youre going to visit Dont count on buying extra supplies when youre traveling, especially if youre going to another country Different countries use different kinds of insulin, needles, and pills

When traveling by plane, find out if and when a meal will be served Then decide when to take your insulin shot or diabetes pills You may need to bring healthy snacks for the trip

ACTION STEPS If you use insulin When you travel,

Buy special insulated bags to carry your insulin and to keep it from freezing or getting too hot Take extra needles, insulin, and blood glucose test strips in case of loss or breakage If youre going to another country, ask your doctor for a letter saying that you have diabetes and need

insulin shots If asked, show the letter to the customs people

When Youre Planning a Pregnancy
Planning ahead is very important if you want to have a baby High blood glucose can be harmful to
both a mother and her unborn baby Even before you become pregnant, your blood glucose should be close to the normal range Keeping blood glucose near normal before and during pregnancy helps protect both mother and baby Your insulin needs may change when youre pregnant Your doctor may want you to take more insulin and check your blood glucose more often If you take diabetes pills, your doctor will switch you to insulin when youre 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 See a doctor who has experience in taking care of pregnant women with diabetes Have your eyes and kidneys checked Pregnancy can make eye and kidney problems worse Dont smoke, drink alcohol, or use harmful drugs Follow the meal plan you get from your dietitian or diabetes educator to make sure yo u and your unborn baby have a healthy diet

If youre already pregnant, see your doctor right away Its not too late to bring your blood glucose close to normal so that youll stay healthy during the rest of your pregnancy

Maria, a 25-year-old woman with type 1 diabetes, wanted children Her doctor told Maria and her husband
that before she got pregnant, her blood glucose should be close to normal and her kidneys, eyes, and blood pressure should be checked Maria began to watch her diabetes very carefully She checked her blood glucose four times a day, ate healthy meals, began to walk a lot, and checked her blood and urine often to make sure that her body was healthy enough to carry a baby Once Maria became pregnant, she spent a lot of time taking care of her diabetes Her hard work paid off After 9 months, she gave birth to a healthy baby boy

Where to Get More Help With Your Diabetes
People Who Can Help You

Your doctor He or she may be your doctor at the clinic where you go for health care, your family doctor, or someone who has special training in caring for people with diabetes A doctor with that kind of special training is called a n endocrinologist or diabetologist Youll talk with your doctor about what kind of medicine you need and how much you should take Youll also agree on a target blood glucose range and blood pressure and cholesterol targets Your doctor will do tests to be sure that your blood glucose, blood pressure, and cholesterol are staying on track and that youre 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, exercise, how to check your blood glucose, and how to fit diabetes care into your everyday life Dont be shy about asking your doctor or diabetes educator about the information in this guide Ask questions if you dont understand something After all, its your health

Your family and friends Keeping your blood glucose at your target level 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 sometimes 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 make you feel bad, you can talk to a counselor or mental health worker Your doctor or
diabetes educator can help you find a counselor if you need one

Organizations That Can Help You

How to find a diabetes educator

To find a diabetes educator near you, call the American Association of Diabetes Educators toll-free at 1-800-832-6874, or look on the Internet at wwwdiabeteseducatororg and click on Find a Diabetes Educator

How to find a dietitian

To find a dietitian near you, call the American Dietetic Association toll-free at 1-800-366-1655, or look on the Internet at wwweatrightorg and click on Find a Dietitian

How to find programs about diabetes To find programs about diabetes or for additional information, contact American Diabetes Association 1701 North Beauregard Street Alexandria, VA 22311 Phone: 1-800-342-2383 Internet: wwwdiabetesorg Juvenile Diabetes Research Foundation International 120 Wall Street, 19th Floor New York, NY 10005 Phone: 1-800-533-2873 Internet: wwwjdrforg Both these organizations have magazines and other information for people with diabetes They also have local groups in many places where you can meet other people who have diabetes

How to get more information about diabetes To get more information about taking care of diabetes,
contact National Diabetes Education Program 1 Diabetes Way Bethesda, MD 20892-3600 Phone: 1-800-438-5383 Fax: 301 907-8906 Internet: http://ndepnihgov

National Diabetes Information Clearinghouse
1 Information Way Bethesda, MD 20892-3560 Email: ndic@infoniddknihgov The National Diabetes Information Clearinghouse NDIC is a service of the National Institute of Diabetes and Digestive and Kidney Diseases NIDDK The NIDDK is part of the National Institutes of Health under the US Department of Health and Human Services Established in 1978, the clearinghouse provides information about diabetes to people with diabetes and to their families, health

care professionals, and the public NDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about diabetes Publications produced by the clearinghouse are carefully reviewed by both NIDDK scientists and outside experts This e-text is not copyrighted The clearinghouse encourages users of this e-pub to duplicate and distribute as many copies as desired

NIH Publication No 03-4016 April 2003

This document is provided as a service to
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Source:peidiabetes.pe.ca