How is Diabetes Diagnosed? -What is a Normal Blood Sugar? Your Game Plan For Preventing Type 2 Diabetes. (Available Online: …
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Am I at Risk?
Questions and Answers Diabetes and You
PartnerSHIP for a Healthy Community
Erie Countys State Health Improvement Plan Partnership
Northwest Pennsylvania Guide to Prevention and Control of Diabetes
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Contents
-Risk Test -What is the Next Step? -How is Diabetes Diagnosed? -What is a Normal Blood Sugar? -Why Should I Try to Keep my Blood Glucose on Target? -Who Should Have the Fasting Blood Sugar Test?
39 Continued-Sources
14 United States Department of Health and Human Services 2003
What is Diabetes? I Risk Factors of Diabetes
Small Steps Big Rewards Your Game Plan For Preventing Type 2 Diabetes
Available Online: wwwbscgwuedu/dpp/manualshtmlvdoc 15 United States Department of Health and Human Services 2002
Small Steps Big Rewards Am I at Risk for Type 2 Diabetes? Taking Steps to Lower the Risk of Getting Diabetes Available Online: wwwniddknihgov
under Health Information
II Prevention of Diabetes
-What is a Healthy Weight and Why Does it Matter? -BMI Chart -Why is Physical Activity Important for People at Risk for Developing Diabetes? -What is a Healthy Diet? -Lets Look Inside the Food Pyramid
III Types of Diabetes
-What is Pre-Diabetes? -What is Insulin
Resistance? -Can Insulin Resistance be Reversed? -What are the Risk Factors for Insulin Resistance? -What is Type 2 Diabetes? -What is Type 1 Diabetes? -What are the Symptoms of Diabetes? -What is Gestational Diabetes?
IV Diabetes Care
-What Can I do to Develop a Foundation for Healthy Living? -What are the Standards of Diabetes Care? -What Do These Tests Mean?
V Complications
-What are the Short-Term and Long-Term Complications of Diabetes?
VI Prescription Help VII Community Resources
38 Continued-Diabetes Websites
United States Department of Agriculture Nutrient Data Laboratory wwwnalusdagov/fnic/cgi-bin/nut_searchpl
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What is Diabetes?
Weight Control Information Network wwwniddknihgov/health/nutrit/winhtm World Health Organization wwwwhoint/en
Sources
1 American Diabetes Association 2006 wwwdiabetesorg
Diabetes is a disease in which the body does not produce or properly use insulin Insulin is a hormone that is needed to convert sugar, starches, and other foods into the energy needed for daily activities The exact cause of diabetes is unknown, although both genetics and environmental factors, such as obesity and lack of exercise, appear to play serious roles in the
diagnosis of type 2 diabetes Diabetes is the sixth leading cause of death in Pennsylvania and fifth in the nation Nearly 8 of Pennsylvanians, 660,000 adults and 4,800 children, have diabetes It is estimated that 208 million 7 Americans already have Diabetes, making Pennsylvanias rate higher than the national average 3
2 American Heart Association 2006 wwwamericanheartorg 3 BD UPdate Winter 2006 MyPyramid: Your foundation for healthy living
Available online: wwwbdcom/us
4 Centers for Disease Control and Prevention 2005 National Diabetes Fact Sheet, 2005 wwwcdcgov/diabetes 5 Erie County Diabetes Association 2006 What is a Normal Blood Sugar
Level? Available online: wwwdiabeteserieorg
6 Erie County Diabetes Association 2006 Who Should Have the Fasting Blood Sugar Test? Available online: wwwdiabeteserieorg 7 Medical News TODAY Nov 10, 2005 Establishing diabetes plan for Pennsylvania wwwmedicalnewstodaycom 8 National Heart, Lung, and Blood Institute 2006 Body Mass Index
Are you at risk?
Table
9 National Institute of Diabetes and Digestive and Kidney Diseases and National Diabetes Information Clearinghouse 2006 wwwniddknihgov 10 National Heart, Lung, and Blood Institute 2006
wwwnhlbinihgov 11 Novo Nordisk 2005 Avoiding Diabetes Complications wwwkwwdcom 12 Rite Aid Pharmacy 2004 You can manage your diabetes I can Help
Living With Diabetes A Handbook
13 United States Department of Agriculture Inside the Pyramid 2006 Available Online: wwwmypyramidgov
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37 Continued-Diabetes Websites
I Risk Factors of Diabetes
Check each box that relates to you
I am age 45 or older I am overweight See Body Mass Index, pg 9 I am physically inactive, or exercise less than 3 times per week I have a parent, brother, or sister with diabetes I am a member of a high risk ethnic population ex African American, Latino, Native American, Asian American, or Pacific Islander I have been diagnosed with high blood pressure, or currently have blood pressure equal to or greater than 140/90 mm/Hg I have high cholesterol, or I have normal cholesterol, but my HDL good cholesterol is less than or equal to 35 mg/dl and/or triglycerides are equal to or greater than 150 mg/dl I have been previously diagnosed with pre-diabetes I have had gestational diabetes or have given birth to a baby weighing equal to or greater than 9 pounds
Adapted from Am I at Risk for Type 2 Diabetes? NIH publication
No 02-4805 June 2002
Diabetes 4 Patients wwwdiabetes4patientscom Diabetes Type II 2 Mellitus Diet wwwpulsemedorg/qnadiabetesdiethtm Dietary Guidelines wwwhealthgov/dietaryguidelines Dole 5 A Day wwwdole5adaycom Emedicine Diabetes Mellitus wwwemedicinecom/EMERG/topic134htm Food Guide Pyramid–Nutrtion wwwmypyramidgov Food and Nutrition Center wwwnalusdagov/fnic Healthier US Initiative wwwhealthierusgov Help for Type 2 Diabetes http://outreachmissouriedu/hesfn/diabetes/helptype2htm Juvenile Diabetes Research Foundation, Northwestern PA Chapter wwwjdrforg/northwestpa National Diabetes Education Program 1-800-438-5383 or wwwndepnihgov and click on the Small Steps logo National Heart, Lung, and Blood Institute 301-592-8573 or wwwnhlbinihgov National Institute of Diabetes and Digestive and Kidney Diseases and National Diabetes Information Clearinghouse 1-800-860-8747 or wwwniddknihgov National Institutes of Health wwwnihgov PA Advocates for Nutrition and Activity wwwpanaonlineorg PA Department of Health wwwhealthstatepaus Penn State University–Nutrition http://nirccaspsuedu
36 Continued-Other Resources
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University of Pittsburgh Medical Center, Horizon Hospital 2200 Memorial St,
Farrell, PA 16121 724 589-6163 110 N main St, Greenville, PA 16125 800 533-8762 University of Pittsburgh Medical Center, Northwest 100 Fairview Dr, Seneca, PA 16346 814 676-7600 Diabetes Support Groups wwwnorthwestupmccom Warren General Hospital 2 Crescent Park West, Warren, PA 16365 814 723-3300 wwwwghorg
What is the Next Step?
The risk factors listed are meant to increase your awareness of diabetes If you are age 45 or older and overweight, testing for diabetes and pre-diabetes is strongly recommended If you are younger than 45 years, overweight, and checked any other items, consider your risk and discuss with your physician the need for further testing
I am physically inactive, or exercise less than 3
Diabetes Websites
How is Diabetes Diagnosed?
Your doctor will order a blood test to determine whether or not you have diabetes or pre-diabetes The following tests are used to diagnose diabetes Fasting Plasma Glucose Test–measurement of glucose in the blood after you have not eaten for 8 hours Random Plasma Glucose Test–measurement of glucose in the blood taken at any time, that if elevated requires the presence of symptoms to diagnose Oral Glucose Tolerance Test–measurement
of glucose in the blood taken after consumption of a drink containing 75 grams of glucose dissolved in water 100 grams are used to test for gestational diabetes
American Assistance for Retired Persons AARP Wellness Information wwwaarporg American Association of Diabetes Educators 1-800-832-6874 or wwwaadenetorg American Cancer Society wwwcancerorg American Diabetes Association 1-888-342-2383 or wwwdiabetesorg American Dietetic Association, Heart and Stroke Information 1-800-877-1600 or wwweatrightorg American Heart Association 1-800-242-8721 or wwwamericanheartorg American Heart Association, Womens Health 1-888-694-3278 or wwwamericanheartorg Centers for Disease Control and Prevention 1-800-323-4636 or wwwcdcgov/diabetes Childrens Hospital of Pittsburgh 412-692-5171 or wwwchpedu Children with Diabetes wwwchildrenwithdiabetescom Diabetes Footcare wwwniceorguk/pageaspx?o101518
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35 Continued-Special Help
What is a Normal Blood Sugar Level? 13
A fasting blood sugar should be ordered by your doctor and done after you have fasted for 8–10 hours Results Normal Blood Sugar Pre-Diabetes Diabetes Less than 100 100–125 126 or higher on two different occasions
Special Kids Network
Information Referral Hotline
800 986-4550 wwwkidstogetherorg
The Special Kids Network: 814 833-3881 Community Systems Development 877 986-4550 3745 West 12th St, Erie, PA 16505 wwwkidstogetherorg Assist with local planning and developing special programs
Check your local yellow pages: Shuttle Transportation Services and Home Health Services
Other Regional Resources
Bradford Regional Medical Center 116 Interstate Pkwy, Bradford, PA 16701 814 362-8200 wwwbrmccom 814 362-8717 wwwbrmccom 814 375-6135 wwwdrmcorg
Why Should I Try to Keep my Blood Glucose on Target? 1
The closer your blood glucose stays to your target range, the more youll lower your risk of blindness or diabetic eye disease, kidney disease, foot problems, nerve damage, tooth and gum disease, and skin problems You may also lower your risk for heart attack or stroke
Center for Diabetes Nutrition 199 Pleasant St, Bradford, PA 16701 DuBois Regional Medical Center: Diabetes Weight Management Center 100 Hospital Ave, DuBois, PA 15801
Great Lakes Home Healthcare Services, Bradford 600 Chestnut Street 814 362-8141 Bradford, PA 16701 Great Lakes Home Healthcare Services, Meadville 303 Chestnut Street 814 337-6900
Meadville, PA 16335 Mind-Body Wellness Center 814 333-5060 Meadville Medical Center 18201 Conneaut Lake Rd, Meadville, PA 16335 Weight management classes, diabetes management , cardiovascular prevention services, and empowering services Sharon Regional Health System 740 E State St, Sharon, PA 16146 724 983-5518 wwwsharonregionalcom
34 Continued-Special Help
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Community Resources for Independence 2222 Filmore Ave, Erie, PA 16506 Services for deaf and advocacy for disabilities
814 838-7222 wwwcrinetorg
Who Should have the Fasting Blood Sugar Test? 13
Dr Barclays Camp for Children with Diabetes 814 877-2123 1700 Peach St, Erie, PA 16501 wwcampfitchcom Integrated camp with education sessions Dr Gertrude A Barber Center 136 East Ave, Erie, PA 16507 814 453-7661 wwwbarberinstituteorg 814 459-4581 wwwgecacorg
GECAC Greater Erie Community Action Committee 18 West 9th St, Erie, PA 16501 Ask for Intake Hispanic American Council 554 East 10th St, Erie, PA 16503 International Institute 517 East 26th St, Erie, PA 16504 Juvenile Diabetes Research Foundation 1030 State St, Erie, PA 16501
814 455-0212 wwweriehispaniccouncilorg 814 452-3935 wwwinterinsterieorg 814 452-0635
wwwecpajdrforg
If you are age 45 or older Overweight Get little or no exercise Family history of Diabetes If you are under age 45, overweight and any of the following are true: Blood pressure of 140/90 or higher Cholesterol higher than 200 Triglycerides higher than 150 Family history of diabetes History of gestational diabetes Get little or no exercise In one of the ethnic groups African American, Hispanic American, Native American Indian, Latino American with a higher risk of developing diabetes
MHEDS 814 453-6229 Multicultral Health Education and Delivery Systems 2928 Peach St, Erie, PA 16508 Northwestern Legal Services 814 452-6957 1001 State St, Erie, PA 16501 800 665-6957 Free legal representation to low-income clients Community education programs Pennsylvania Department of Health 877 PA-HEALTH Northwest District Office wwwhealthstatepaus 19 McQuiston Drive, Jackson Center, PA 16133 Office of Vocational Rehabilitation 1600 Peninsula Dr, Erie, PA 16505 814 871-4551
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II Prevention of Diabetes
It is important to take action with pre-diabetes Type 2 diabetes, the most common type, develops gradually over a period of 7-10 years, beginning as pre-diabetes Efforts to
lose weight and get more exercise will make a big difference By taking action, you can reduce your risk of developing diabetes by 50 Healthy life style changes can delay or prevent type 2 diabetes by 50 by simply doing the following:
33 Continued-Preventing Problems
Erie County Diabetes Association 1128 State St, Suite 302, Erie, PA 16501
814 454-0715 wwwdiabeteserieorg
Assistance with testing supplies, prescription drug assistance program applications, and additional information
Pennsylvania Dental Association Information and referral St Martins Center 1701 Parade St, Erie, PA 16503
800 692-7256 814 452-6113
Reach and maintain a healthy weight Moderate physical activity Modest changes to your diet
St Pauls Neighborhood Free Clinic 814 454-8755 1608 Walnut St, Erie, PA 16502 wwwstpaulsfreeclinicorg Free medical care for uninsured, if eligible Second Harvest Food Bank of NW Pennsylvania 814 459-3663 1703 Ash St, Erie, PA 16051 wwweriefoodbankorg Tri-State Dental Hygiene Clinic 5757 W Ridge Road, Erie, PA 16506 Cleanings, Evaluations, X-Rays 814 838-4317
What is a Healthy Weight and Why Does it Matter?
Reaching a healthy body weight will decrease your risk of developing
diabetes Healthy body weight is defined as a Body Mass Index or BMI range of 19-25 among individuals ages 20 years and older Obesity is defined as a BMI of 30 or higher, which is about 30 pounds of excess weight Excess weight places you at risk for developing many serious health problems, including diabetes Please refer to the BMI chart If your BMI is above 25, choose sensible ways to get in shape Avoid crash dieting and make a plan to increase your activity level Set reasonable weight loss goals Aim for a long-term goal of losing 5-7 of total body weight For example, a person weighing 200 pounds would need to lose 10-15 pounds to achieve a 5-7 weight loss
Ask your doctor and about prescription drug assistance programs and your pharmacist for prescription discount cards
Special Help
Blindness Visual Services 3100 Lowell Place, Erie, PA 16503 814 871-4401
Caregivers Coalition of Erie County 814 459-2245 1272 Top Rd, Erie, PA 16505 wwweriecountycaregiverorg Information on resources and services to caregivers City Mission New Life Center 814 725-4300 1023 French St, Erie, PA 16501 wwweriecitymissionorg An emergency shelter that provides food, housing, and clothing Community
Nursing Services 7 Park St, North East, PA 16428 814 725-4300 wwwnortheastnursescom
32 Continued-Preventing Problems
9
BMI Chart
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Metabolic Disease Associates Inc 240 W 11th St, 2nd Floor, Erie, PA 16501 Northwest Physicians Associates 333 State St, Erie, PA 16507 Vision USA Free eye exam and eye wear, if eligible
814 452-2218 wwwyourmdcom 814 454-8886 814 454-6497 800 766-4466
BMI kg/ m2
To use the table, find the appropriate height in inches in the left column and move across to a given weight in pounds The number at the top of the column is the BMI at that height and weight Pounds have been rounded off
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For additional diabetes care, check local yellow pages: Physicians for all areas of care
Ht in 58 59 91 94 97 96 99
Weight lb 100 105 110 115 119 124 129 134 138 143 167 191 104 109 114 119 124 128 133 138 143 148 173 198
On A Budget
Services/Low Income
American Dietetic Association Consumer Hotline Booker T Washington Center 1720 Holland St, Erie, PA 16503 Charles Ray Foundation PO Box 792, Apex, NC 27502 Community Health Net 1202 State St, Erie, PA 16503 Medical and dental care Community Nursing Services 7 Park
St, North East, PA 16428 Department of Public Welfare 1316 Holland St, Erie, PA 16503 Erie County Department of Health Eat Smart-Move More Campaign 606 West 2nd St, Erie, PA 16507 800 366-1655 wwweatrightorg 814 453-5744 wwwbtwcenterorg 919 303-6949 wwwcharlesrayg12com 814 454-4530 wwwcommunity-healthnetcom 814 725-4300 wwwnortheastnursescom 814 461-2000 wwwdpwstatepaus 814 451-6700 wwwecdhorg
60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76
102 107 112 118 123 128 133 138 143 148 153 179 204
100 106 111 116 122 127 132 137 143 148 153 158 185 211 104 109 115 120 126 131 136 142 147 153 158 164 191 218 107 113 118 124 130 135 141 146 152 158 163 169 197 225 110 116 122 128 134 140 145 151 157 163 169 174 204 232 114 120 126 132 138 144 150 156 162 168 174 180 210 240 118 124 130 136 142 148 155 161 167 173 179 186 216 247 121 127 134 140 146 153 159 166 172 178 185 191 223 255 125 131 138 144 151 158 164 171 177 184 190 197 230 262 128 135 142 149 155 162 169 176 182 189 196 203 236 270 132 139 146 153 160 167 174 181 188 195 202 207 243 278 136 143 150 157 165 172 179 186 193 200 208 215 250 286 140 147 154 162 169 177 184 191 199 206 213 221 258 294 144 151 159 166 174 182
189 197 204 212 219 227 265 302 148 155 163 171 179 186 194 202 210 218 225 233 272 311 152 160 168 176 184 192 200 208 216 224 232 240 279 319 156 164 172 180 189 197 205 213 221 230 238 246 287 328
Diabetes education for homebound patients only Doctor referral needed
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Shopping for Supplies
Check Your Local Pharmacy for Diabetes Supplies
Why is Physical Activity Important for People at Risk for Developing Diabetes? 1
What physical activity can do for you: Lower blood glucose, blood pressure, and cholesterol Lower risk for heart disease, stroke, and diabetes Relieve stress Help insulin work better Strengthen bones, muscles, and heart Tone muscles Improve blood circulation Keep joints and body flexible Improve mental outlook Even if you have never exercised before, you can find ways to add physical activity into your daily routine Once physical activity is part of your routine, you will wonder how you did without it If you have not been very active lately, what should you do first? Start with a checkup from your doctor to check your heart, blood vessels, eyes, kidneys, nervous system, and feet Your doctor can recommend physical activities that will help you if
you show signs of disease Practical Activities to Add Throughout the Day: Walk instead of drive whenever possible Take stairs instead of elevator Walk when on the phone Work in the garden, rake leaves, wash the car Play with the kids Carry things upstairs in two trips instead of one
The following suppliers carry a variety of diabetes products and provide instruction on use May bill directly to some insurance provider for supplies
Great Lakes Diabetes Institute 1700 Peach St, Erie, PA 16501 Great Lakes Home Health Care Certified Pedorthist/Orthotist 1647 Sassafras St, Erie, PA 16502 814 877-6121 wwwgreatlakesdiabetescom 814 877-6121 wwwhamotdiabetescom
Check your local yellow pages: Hospital Equipment Supplies or Shoes-Orthopedic
Preventing Problems
Complications: Prevention Care
American Heart Association 823 Filmore Ave, Erie, PA 16505 Blindness Visual Services 3100 Lowell Place, Erie, PA 16506 Corry Memorial Hospital 612 W Smith St, Corry, PA 16407 Foot care specialist Erie Center on Health Aging 406 Peach St, Erie, PA 16507 Medical Podiatry Care Eye Care American
Senior Eye Care Free eye exam, if eligible
814 836-0013 wwwamericanheartorg 814 871-4401 814 663-3668
wwwcorryhospitalorg 814 453-5072 wwwhealthyagingerieorg 800 222-3937 wwweyecareamerica,org 814 456-4241 wwwerieretinalcom 814 455-0995 wwwpablindorg
Erie Retinal Surgery 300 State St, Suite 201 Erie, PA 16507 Vision Blindness Resources Center 2402 Cherry St, Erie, PA 16502
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Getting Fit
Exercise
Booker T Washington Center 1720 Holland St, Erie, PA 16503 Gym and some equipment available Cardiac Fitness Center Phil Hardesty, Clinical Coordinator 3330 Peach St, Erie, PA 16508 Erie Center on Health Aging 406 Peach St, Erie, PA 16507 Fitness, Tai Chi, Community Walking Gertrude Barber Center 136 East Ave, Erie, PA 16507 Swimming Pool Hamot Wellness Center 300 State St, Erie, PA 16507 Diabetes WellFit Program Kid Shape Mercy Center on Aging 444 East Grandview Erie, PA 16504 814 453-5774 wwwbtwcenterorg 
814 868-9674
What is a Healthy Diet?
Healthy eating includes watching portion sizes and eating a wide variety of foods including vegetables, whole grains, fruits, low-fat dairy products, beans, lean meats, poultry, and fish Dietary Guidelines describe a healthy diet as one that: Focuses on fruits, vegetables, whole grains, skim milk and low-fat dairy products; Includes lean
meats, poultry, fish, beans, eggs, and nuts; Low in saturated fat, trans fats, cholesterol, salt, and added sugars
814 453-5072 wwwhealthyagingerieorg 814 453-7661 wwwbarberinstituteorg 814 877-7030 wwwhamotorg
814 824-2214 wwwmercycenteronagingcom
Pennsylvania Advocates for Nutrition and Activity Listing over 140 parks and trails wwwkeystoneactivezoneorg
Check your local yellow pages: Health Fitness Program Consultants; Health Clubs Gyms; or Exercise and Physical Fitness Programs Consultation with a registered dietitian is very important in the management of Diabetes They can be reached at most local Hospitals
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29 Continued-Eat Right-Cook Right
Community Nursing Services 7 Park St, Northeast, PA 16428 Dial A Dietitian Erie Center on Health Aging Health Educator 406 Peach St, Erie, PA 16507
814 725-4300 wwwnortheastnursingcom 814 877-6142 814 453-5072 wwwhealthyagingerieorg
Diabetes education for homebound patients only Doctor referral needed
Lets Look Inside the Food Pyramid
7
Erie County Cooperative Extension 814 825-0900 850 E Gore Rd, Erie, PA 16509 http://erieextensionpsuedu Erie County Department of Health 606 W 2nd St, Erie, PA 16507 Talk to a Public Health
Educator or nurse Erie County Diabetes Association 1128 State St, Suite 302 Erie, PA 16501 Great Lakes Diabetes Institute Diane Harbaugh, RN, CDE 1700 Peach St, Suite 220 Erie, PA 16501 Hamot Heart Institute Dr Dean Ornish Program Sterling Square, Suite 211 3330 Peach St, Erie, PA 16508 Highmark Blue Cross Blue Sheild 717 State St, Erie, PA 16501 8 Wellness Programs Offered Locally 814 451-6700 wwwecdhorg 814 454-0715 wwwdiabeteserieorg 814 877-6130 800 765-0655 wwwgreatlakesdiabetescom 814 868-6437 wwwhamotorg
1 Grains–Make Half Your Grains Whole Grains Eat at least 3 ounces of whole grain bread, cereal, crackers, rice, or pasta every day Look for whole before the grain name on the list of ingredients 2 Vegetables–Vary Your Vegetables Eat more dark green vegetables Eat more orange vegetables Eat more dry beans and peas 3 Fruits–Focus on Fruit Eat a Variety of Fruit Choose fresh, frozen, canned, or dried fruit Go easy on fruit juices; limit to 4-6 oz a day, if any 4 Milk–Get Your Calcium Rich Foods Go low fat or fat free If you dont or cant consume milk, choose lactose free products or other calcium sources 5 Meat Beans–Go Lean on Protein Choose low fat or lean
meats and poultry Bake it, broil it, or grill it Vary choices–with more focus on fish, beans, peas, nuts, and seeds 6 Oils–Know Your Fats Make most of your fat sources from fish, nuts, and vegetable oils Limit solid fats like butter, stick margarine, shortening, and lard
800 879-2217
Saint Vincent Diabetes Resource Center 814 864-0038 3413 Cherry St, Erie, PA 16508 wwwsaintvincenthealthcom
Check your local yellow pages for Nutritionist and weight loss programs
28 Continued-Education Support
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Erie County Diabetes Association 1128 State St, Suite 302, Erie, PA 16501 Schedule of support groups/newsletter
814 454-0715 wwwdiabeteserieorg
III Types of Diabetes
What is Pre-Diabetes?
Pre-diabetes is diagnosed when an individual has a blood glucose sugar level that is higher than normal but not yet high enough to be diagnosed as diabetes Pre-diabetes may also be called impaired glucose tolerance or impaired fasting glucose An individual with pre-diabetes has a fasting blood glucose sugar level between 100 and 125 mg/dl Pre-diabetes increases an individuals risk for developing type 2 diabetes and heart disease Pre-diabetes usually has no symptoms or warnings Some long-term
damage to the body, especially the heart and circulatory system, may already be occurring during pre-diabetes If you have pre-diabetes, you can reduce the risk of developing type 2 diabetes if you:
Great Lakes Diabetes Institute 814 877-6130 1700 Peach St, Suite 220, Erie, PA 16501 800 765-0655 Talk to a Certified wwwgreatlakesdiabetesorg Diabetes Nurse Educator Saint Vincent Diabetes Resource Center 814 864-0038 3413 Cherry St, Erie, PA 16508 wwwsaintvincenthealthorg Talk to a Certified Diabetes Educator Sanofi-Aventis Medical Information Veterans Affairs Medical Center 135 E 38th St, Erie, PA 16504 Talk to a Certified Diabetes Educator 800 633-1610 814 868-8661 wwwvagov
Support groups are available at various sites Call Erie County Diabetes Association
Eat Right-Cook Right
Food and Nutrition
Adagio Health 1611 Peach Street, Suite 455, Erie, PA 16105 American Dietetic Association Consumer Hotline
Corry Memorial Hospital
814 453-4718 wwwadagiohealthorg 800 366-1655 814 664-4641
Cut back on calories and fat Increase physical activity through moderate exercise such as walking, 30 minutes a day, 5 days a week Lose weight, 5-7 of body weight, which is 10-15 pounds for a
person that weighs 200 pounds
Dietary Department 612 West Smith St, Corry, PA 16407
It is important to do something about pre-diabetes An individual can delay or prevent the progression of type 2 diabetes through wise choices in both diet and increased activity
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What is Insulin Resistance?
Insulin resistance is a condition that increases your chances of developing type 2 diabetes and heart disease When you have insulin resistance, your body has difficulty responding to insulin Eventually, your blood glucose levels will rise above normal
Now What Do I Do?
General Information and Referral
814 664-4641 wwwcorryhospitalorg
Corry Memorial Hospital 612 W Smith St Corry, PA 16407 Talk to a Certified Diabetes Educator Erie County Diabetes Association 1128 State St, Suite 302, Erie, PA 16501
Can Insulin Resistance be Reversed?
Insulin resistance can be reversed and lessen your chance of developing type 2 diabetes and heart disease by:
814 454-0715 wwwdiabeteserieorg
Cutting calories Adding/increasing daily physical activity Losing weight Taking medications as directed
Great Lakes Diabetes Institute 814 877-6130 1700 Peach St, Suite 220, Erie, PA 16501 800 765-0655 Talk
to a certified wwwgreatlakesdiabetescom Diabetes Nurse Educator Pennsylvania Department of Health Northwest District Office 19 McQuiston Drive Jackson Center, PA 16133 Access Hamot Hotline Call for family physician information Saint Vincent Ask-A-Nurse Call with Questions about any health topic 724 662-6068 1-877-PA HEALTH wwwhealthstatepaus 814 877-5678 wwwhamotorg 814 452-5500 7am to 11pm
What are the Risk Factors for Insulin Resistance?
You are more likely to have insulin resistance if you are:
Overweight Physically inactive Over 45 years of age A woman with a waist measurement over 35 inches or a man with a waist measurement over 40 inches Or have:
Saint Vincent Diabetes Resource Center 814 864-0038 3413 Cherry St, Erie, PA 16508 wwwsaintvincenthealthcom
Education Support
Diabetes Education
Community Nursing Services 7 Park St, North East, PA 16428 wwwnortheastnursingcom Corry Memorial Hospital 612 W Smith St, Erie, PA 16407 Talk to a Certified Diabetes Nurse Educator 814 725-4300
A parent, brother, or sister with type 2 diabetes Polycystic ovary syndrome Blood pressure of 140/90 or higher HDL cholesterol levels of 35 or less Triglyceride levels of 150 or
higher
Diabetes education for homebound patients only Doctor referral needed
814 664-4641 wwwcorryhospitalorg
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Continued-Prescription Help
15
Rx Savings Access Card wwwrxsavingsaccesscom Sanofi-Aventis Patient Assistance Together Rx wwwtogether-rxcom
1-888-227-3479 1-800-221-4025 1-800-865-7211
What is Type 2 Diabetes?
Type 2 diabetes usually begins with insulin resistance, a condition in which body cells do not use insulin properly At first, the pancreas keeps up with the added demand by producing more insulin In time, however, the pancreas loses the ability to make enough insulin in response to meals Being overweight and inactive increases the chance of developing type 2 diabetes Treatment may include taking oral medications or using insulin, making wise food choices, exercising regularly and controlling blood pressure and cholesterol Type 2 diabetes may be controlled through losing weight, improved nutrition, and exercise Take steps now to lower your risk of getting diabetes
VII Community Resources
Finding Out
Information, Blood Sugar, Blood Pressure, and Cholesterol Testing
Erie Center on Health Aging Preventative Health Services at 40 Erie County Locations 406
Peach St, Erie, PA 16507 Fee: Free-600 depending on test Erie County Diabetes Association 1128 State St, Suite 302, Erie, PA 16501 Great Lakes Diabetes Institute Registered Nurse 1700 Peach St, Suite 220, Erie, PA 16501 814 453-5072 wwwhealthyagingerieorg
814 454-0715 wwwdiabeteserieorg 814 877-6130 800 765-0655 wwwgreatlakesdiabetescom
What is Type 1 Diabetes?
Type 1 diabetes is diagnosed when the body does not make any or enough insulin Type 1 diabetes most often develops in children and young adults Individuals diagnosed with type 1 diabetes need to take daily insulin injections or use an insulin pump The causes of this type of diabetes are unknown though a viral illness or an autoimmune disease may play a role
Millcreek Public Service Department 814 833-1111 ext 29 wwwmillcreekcommunityhospitalcom Northwest Area Health Education Center 1913 W 8th St, Erie, PA 16505 General Information and referral Services 814 453-6551
Talk with your family doctor for testing Check local pharmacies for screening
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What are the Symptoms of Diabetes?
One third of those who have diabetes do not know it Sometimes no signs or symptoms are noticed The signs and symptoms of high blood
glucose are:
VI Prescription Help
Diabetic Medication Assistance Programs
Partnership for Prescription Assistance 1-888-477-2669 wwwpparxcom Adult Basic Health Insurance for 1-800-462-2742 Pennsylvania Adults 1-800-GO-BASIC wwwcompassstatepaus Childrens Health Insurance Program 1-800-986-5437 wwwchipcoverspakidscom Diabetics Rx America 1-800-537-4881 wwwdiabetesrxamericacom Express-Scripts RX Outreach 1-800-769-3880 Freedrugcardus 1-866-410-4225 wwwfreedrugcardus Free Medicine Foundation 1-573-996-0125 wwwFreeMedicineFoundationcom Lilly Answers wwwlillyanswerscom MedCare Solutions 1-888-727-8633 wwwmedcaresolutionscom Medicine Bridge 1-877-667-6337 wwwmedicinebridgecom Merck Prescription Assistance Program 800-506-3725 wwwmerckhelpscom/uninsured/abouthtml Novo Nordisk Inc 1-800-727-6500 wwwnovonordisk-uscom Novo Nordisk Patient Assistance 1-866-310-7549 Orange Card 1-888-672-6436 http://usgskcom/card PACE 1-800-225-7223 Patient Assistant Programs 1-215-625-9609 wwwneedymedscom Pfizer Helpful Answers 1-866-706-2400 wwwpfizerhelpfulanswerscom
Blurred vision Increased infections, such as yeast infections in women Cuts and bruises that are slow to heal Frequent urination
Fatigue Increased hunger Unwanted weight loss Extreme thirst
If you have any of the symptoms listed above, contact your physician to discuss your concerns
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Long-Term Complications Continued Nerve Damage–Nerve damage, peripheral neuropathy, is a
common problem among individuals with diabetes There are two types of nerve damage With the first type, you might experience tingling or numbness in your hands or feet The second type damages the nerves that help control blood pressure You may feel dizzy when you stand up or your heart wont speed up when you exercise Other signs of nerve damage include dry skin, bladder and digestive problems, or sexual problems
What is Gestational Diabetes?
Gestational diabetes is a form of glucose intolerance diagnosed in some women during pregnancy Gestational diabetes occurs more frequently among African Americans, Hispanic/Latino Americans, and American Indians It is also more common among obese women and women with a family history of diabetes During pregnancy, gestational diabetes requires treatment to normalize maternal blood glucose levels to avoid complications in the infant After pregnancy, 5 to 10 of women with gestational diabetes are
found to have type 2 diabetes Women who have had gestational diabetes have a 20 to 50 chance of developing diabetes in the next 5-10 years 3 Gestational diabetes affects about 4 of all pregnant women
Tooth Decay and Gum Disease–Diabetes can increase the
glucose in your salvia Over time, high glucose levels can cause tooth decay and gum disease See your dentist at least every 6 months for a checkup
Skin and Foot Infections–High glucose levels increase the
risk of foot and skin infections Foot numbness, resulting from nerve damage, increases the risk of cuts and infections Severe problems with blood circulation can lead to toe, foot, or leg amputation Watch for signs of foot problems that include foot pain or numbness; swelling in the feet or legs; or sores that wont heal
How are You Diagnosed?
Gestational diabetes is first diagnosed in pregnancy It is typically diagnosed with a blood test during the 24th to 28th week of pregnancy and generally resolves after delivery It is controlled with a meal plan, exercise, and in some cases, insulin Women who develop gestational diabetes are at high risk for developing type 2 diabetes later in life
Foot Care Tips–Protect Your Feet
Clean feet well and often Dry them well Use lotion on outside of feet, not between toes Never go barefoot Wear comfortable socks and shoes Inspect feet daily for bruises, cuts, or swelling File toenails straight across with an emery board Call your doctor if you injure your feet in any way Take your shoes and socks off at every doctors appointment for examination
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IV Diabetes Care
What Can I do to Develop a Foundation for Healthy Living?
Long-Term Complications
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Cardiovascular Disease–Cardiovascular disease is the leading cause of diabetes-related death People with diabetes are 2-4 times more likely to develop cardiovascular disease due to: high blood pressure; lipid disorders including high LDL, or bad cholesterol; high triglycerides; and low HDL, or good cholesterol; smoking; obesity; and lack of physical activity 2 Heart disease occurs earlier in people with diabetes and is more often fatal High Blood Pressure–Controlling high blood pressure in people with diabetes is especially important because high blood pressure is a major risk factor for cardiovascular disease and increases the risk for heart attack, stroke, and other complications such as retinopathy
damage to the blood vessels in the retina and nephropathy damage to the blood vessels in the kidneys 2 High blood pressure doesnt usually have any symptoms, therefore you should have it checked regularly Blindness–Diabetes can cause damage to the tiny blood vessels that supply the retina, which is the light-sensing section of the inner eye Glaucoma is an eye disease caused by excess pressure buildup in the eyes, which can lead to blindness Kidney Disease–People with diabetes have a higher risk of developing kidney disease The tiny blood vessels in the kidneys that filter out waste in the blood can get blocked and leaky Tobacco use can also reduce blood flow to the kidneys
While managing diabetes, you can eat the same foods as your family and friends as long as you space meals evenly throughout the day and control portion sizes Remember to include a balance of carbohydrates, proteins, and fats with meals, which will help you control your blood glucose levels By monitoring your blood glucose levels often, you can fine-tune your meal planning 12 GRAINS–Make Half Your Grains Whole Grains, such as bread, cereal, and pasta are good sources of carbohydrates However, these foods can
raise blood sugar levels Limit these portions to 2–4 servings at a meal A 1/3 cup of rice or pasta equals 1 serving; a sandwich equals 2 servings
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V Complications
What are the Short-Term and Long-Term Complications of Diabetes?
Short-Term Complications Hypoglycemia–Low blood sugar levels
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Symptoms: Causes: Nervous or irritable Not eating or eating too Dizzy or shaky little Hungry Taking too much insulin or Headache diabetes medication Sweating Being too active without Fast heartbeat enough available energy Blurry vision source Treatment: Eat or drink fast acting carbohydrates such as: 3-4 glucose tablets 1/2 can regular soda not diet 4 oz of fruit juice 3-5 hard candies to quickly chew
Hyperglycemia–High blood sugar levels
Symptoms: Causes: Frequent urination Not taking enough insulin Extreme thirst or medication Dry skin/mouth Eating more than usual Hunger Not exercising Blurred vision Drowsiness Slow healing wounds Treatment: Follow your meal plan Do an activity in your exercise plan Take your medications as directed
Vegetables–Vary Your Veggies Vegetables are low in fat and calories, and high in vitamins, minerals, and fiber
Non-starchy vegetables are low in carbohydrates and can be eaten freely Non-starchy veggies include dark, leafy greens like spinach or broccoli, and orange veggies like carrots and sweet potatoes Fruits–Focus on Fruits Like vegetables, fruits contain carbohydrates, vitamins, minerals, and fiber You can have canned, dried, fresh, or frozen fruit and 100 fruit juices Aim for 1–3 servings of fruit per day, limit juices to 4oz–6oz since it is a concentrated source of carbohydrates Milk–Get Your Calcium-Rich Foods Dairy products are sources of nutrients Milk and yogurt are considered carbohydrates; cheese is protein; butter, cream cheese, and sour cream are fats Meats and Beans–Go Lean on Protein Meat, poultry, fish, dry beans and peas, eggs, nuts, and seeds are sources of protein, which your body needs to build and repair tissue, muscle, and bones Protein affects blood glucose levels much less than carbohydrates An adequate serving of protein is 3 oz, or the size of a deck of cards Oils–Know Your Fats Use oils from plants like olive and vegetable oils, which dont have any cholesterol and are usually low in saturated fats Limit use of hydrogenated products like stick margarine and
shortening High fat meals can slow absorption of carbohydrates and keep blood sugar levels higher for 3-5 hours after a meal Physical Activity–Food and Physical Activity Balancing food, activity, and medications is the key to managing diabetes Exercise, however, can cause hypoglycemia Monitoring blood sugar levels before and after exercise is recommended
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What are the Standards of Diabetes Care?
There are at least 7 important tests for a person with diabetes Ask your doctor about these tests
What Do These Tests Mean?
Hemoglobin A1C HbA1c test is a simple lab test showing the average amount of sugar in your blood over the last 2-3 months It is one of the best ways to find out if your blood sugar level is under control HbA1c Levels: Normal Goal Action Taken
At Every Visit:
Blood Pressure Check–to help prevent heart attack and stroke Foot Exam–to keep feet healthy to prevent infection or amputation Weight–to maintain a healthy weight
6 7 8 Goal 90–130 mg/dl 180 mg/dl
At Least Twice a Year:
HbA1c Blood Test–to check sugar control over the past 2-3 months Quarterly testing is recommended if your treatment changes or you are not meeting your goals
Plasma Blood
Values Average Before Meals Average After Meals
Lipid and Blood Pressure Lipid Profile: Total Cholesterol 200 mg/dL LDL 100 mg/dL HDL 40 mg/dL for Men HDL 50 mg/dL for Women Triglycerides 150 mg/dL Blood Pressure: Systolic 130 mm Hg Diastolic 80 mm Hg
Once a Year:
Dilated Eye Exam–to help prevent blindness Urine Test for Protein–to help prevent kidney failure Cholesterol Panel–to help prevent heart attack
