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BASIC INFORMATION FOR PATIENTS WITH TYPE 2 DIABETES Your doctor has recently told you that you have type 2 diabetes, which means that your blood sugar is high We understand that being given a new diagnosis is disturbing and even frightening, at least in the beginning Your health care team at PAMF will work with you to make sure you understand diabetes, help you to manage it and insure your long term health To get you started, we are providing some introductory guidelines to help you maintain good health Please read and think about the following information contained in this packet: a brief review of what causes diabetes how to manage diabetes long and short-term diabetes complications blood sugar goals basic diet guidelines It is very important that you understand as much as possible about diabetes To begin your education, we strongly encourage you to take our classes and schedule individual counseling with a dietitian/diabetes educator Included in this packet are fliers for our many programs including information how to register for our classes and individual counseling sessions What Is Type 2 Diabetes? Sugar glucose that you eat must enter your bodys cells in order to
produce energy Insulin is a hormone produced by the pancreas that allows glucose to enter cells Type 2 diabetes makes it harder for the glucose that you eat to enter your bodys cells, for several reasons 1 your cells may be resistant to the insulin you produce, and 2 your pancreas may not produce enough insulin The result is a high level of sugar in the blood High blood sugar levels can cause symptoms and damage to body organs What Are Symptoms Of Type 2 Diabetes? High blood sugar hyperglycemia may cause NO symptoms It may cause: blurry vision, increased thirst, increased urination, itchy dry skin, fatigue, increased infections and slow healing from wounds What Do We Do For Type 2 Diabetes? How Is It Treated? Controlling diabetes means keeping your blood sugar level in balance This is done through diet and exercise and often prescription medications Better control means feeling better and limiting serious problems in the future Learning About Diabetes And How You Can Manage This Condition PAMF has various programs and classes to teach you about diabetes with the help of our specialized Diabetes Educators and Registered Dietitians
Revised 11-06
We very strongly encourage you to
take the group classes and individual appointments that are recommended for you as listed below Call the Nutrition-Diabetes Education Department for scheduling in: Palo Alto and Redwood City: 650-853-2961 Fremont: 510 498-2184 When you call, the coordinator will discuss fees and insurance coverage with you PAMF Diabetes programs include: 1 Introduction To Diabetes: A two-session course, each session lasting 3 hours, offered in small group setting both at the Fremont and Palo Alto sites 2 Individual Sessions With A Diabetes Educator: An introductory one-on-one appointment and follow up visits as necessary Offered at both the Palo Alto and Fremont sites 4 Healthy Eating With Type 2 Diabetes: A one-session 3 hour course, offered in small group setting both at the Fremont and Palo Alto sites 5 Diabetes Drop-In Group: On-going one hour group meeting offered twice a month at the Palo Alto site only to address questions in a group setting Offered at no charge 6 Pre-Diabetes Class: A one-session 2 hour course offered in small group setting both at the Fremont and Palo Alto sites 4 Diabetes Support Group: This is for patients and their families, led at PAMF by a licensed therapist Our
Diabetes Educators can give you more details Offered at no charge PAMF classes and information will focus on the following topics: Healthy Eating Exercising regularly Achieving and maintaining body weight close to your goal Testing your blood sugar regularly Checking your body to prevent complications Following schedules for check ups and tests Taking recommended medications and insulin as directed
BEYOND CLASSES: THE REST OF YOUR DIABETES CARE Primary Care Visits: You should see your primary care provider PCP within one month of your diabetes diagnosis and then at regular intervals as necessary, at least twice a year and sometimes more often Endocrinology Visits: You may be asked to see a specialist in endocrinology to help manage your diabetes Your PCP will arrange this Eye Specialty Visits: You should have your eyes checked at least ONCE A YEAR, including a dilated examination of the back of your eyes the retinas
Revised 11-06
Foot Care: Good foot care is very important in diabetes You should inspect your own feet daily and let us check any skin or nail problems Your PCP should inspect your feet at least twice yearly You may be asked to see a foot care specialist, a
podiatrist Dental Care: You should see your dentist at least twice a year and practice good dental hygiene: tooth brushing at least twice daily, and flossing once daily We hope that the classes and appointments you have over the next few months will help you understand diabetes and how you can manage this condition As you learn more, please let us know how we at PAMF can help you further
Sincerely, PAMFs Diabetes Task Force: Physicians, registered dietitians, nurses, and certified diabetes educators working together to improve the care of people with diabetes
Revised 11-06
Blood Glucose Goals
Time of Blood Glucose Test Fasting and Pre-meal One Hour After Meals Two Hours After Meals Ideal Range 90 to 110mg/dl 160mg/dl or less 140mg/dl or less
If you are controlling your diabetes with diet alone, or are taking only Glucophage metformin, Actos, Avandia, Precose, or Glycet, it is safe for fasting or pre-meal blood glucose levels to be lower than the ranges recommended above However, if you are taking insulin or oral diabetes medications other than those listed above, you can experience hypoglycemia low blood sugar In these cases, it is important to keep fasting and pre-meal blood
glucose levels within the recommended range For various medical reasons, some people with diabetes are advised to keep their blood glucose levels higher Consult with your physician or diabetes educator regarding the safest blood glucose levels for you Ask them fill out the section below if your blood glucose goals are different than the ranges listed above
Time of Blood Glucose Test Fasting and Pre-meal One Hour After Meals Two Hours After Meals
Ideal Range _______ mg/dl _______ mg/dl _______ mg/dl
2005
Diane Lesnick, MPH, RD, CDE
Palo Alto Medical Foundation
650 321-4121
Basic Dietary Guidelines for Type 2 Diabetes
The nutritional goals of meal planning for the diabetic diet are to achieve and maintain at least a 5 to 10 percent weight loss if an individual is overweight, to control blood sugar and lipids cholesterol and triglycerides, and to prevent or delay the complications associated with diabetes Below are tips to control your diabetes Limit foods high in sugar They can dramatically increase your blood glucose levels Limit added sugar in the diet, including granulated, brown, powdered and raw sugar Honey, syrup and molasses are also sugar, and consumption should be
reduced Limit foods high in sugar, such as cake, cookies, candy, pie, pastries, ice cream, frozen yogurt, sherbet, pudding, jam/jelly, donuts, sweet rolls, sweet muffins, flavored gelatin and sweetened canned fruit Avoid soft drinks diet soda is OK, fruit juices and fruit drinks Read food labels and look out for added sugar, such as corn syrup, sucrose, dextrose, fructose, honey, invert sugar, etc You may use artificial sweeteners in moderation, such as aspartame Nutrasweet or Equal, saccharine Sweet n Low or Sucralose Splenda Include carbohydrate foods in moderation Blood sugar is affected primarily by foods containing carbohydrates The main sources of carbohydrates in the diet are starch, fruit and milk Although these foods do not contain refined sugar, they can still have a dramatic effect on the blood sugar Examples of starch include bread, pasta, rice, tortillas, cereal, crackers and starchy vegetables such as potatoes, corn, beans, peas and lentils However, most other vegetables are non-starchy and have only a minimal effect on blood sugar Choose high-fiber, whole grain starches Replace refined grains such as white rice, bread and pasta with whole grains such as brown
rice, whole wheat pasta, whole grain bread and crackers, barley or buckwheat Include legumes such as beans, peas and lentils Do not eliminate carbohydrates Eating fruits, starch and milk are part of a healthy diet, and eating these foods in moderation should not cause your blood glucose to rise too high Spread out carbohydrates into three small meals and three carbohydrate snacks Every time you eat carbohydrates, your blood glucose begins to rise reaching its peak approximately one hour after you start your meal The
2005 Diane Lesnick, MPH, RD, CDE Palo Alto Medical Foundation 650 321-4121
more 
carbohydrates you eat at a meal or snack, the higher your blood glucose will rise Therefore, you should spread out your carbohydrates into small, frequent amounts Choose fruit for snacks One small to medium piece of fruit the size of a tennis ball or one-half to three-fourth a cup of cut-up fruit can be used as a quick and easy snack Choose fresh fruit whenever possible Try to include three servings of fruit a day Increase your consumption of vegetables Be liberal with your intake of vegetables Most vegetables are low in calories and carbohydrates, and can be used whenever you are
hungry between meals and to help fill you up at mealtime Include at least three servings a day One serving equals one-half a cup of cooked or 1 cup of raw vegetables Keep the amount of carbohydrates consistent at each meal and snack Keeping the quantity of carbohydrates consistent at each meal and snack will keep your blood glucose consistent Work with your registered dietitian to determine how much carbohydrate your body will tolerate to normalize blood sugar levels Meal timing Space meals and snacks evenly Optimally, meals should be eaten five hours apart Meals and snacks should be eaten two to three hours apart Meals and snacks should be consumed at consistent times, especially if you are taking insulin or certain diabetes medications to lower your blood glucose Do not skip meals If you are taking certain diabetes medications to lower your blood glucose or are on insulin, do not skip meals Otherwise, you are at risk of a low blood sugar reaction hypoglycemia Maintain acceptable weight for your age and height If you are overweight and have type 2 diabetes, weight loss can not only improve your blood glucose dramatically, but also decrease or eliminate your need for diabetes
medication or insulin Even a modest weight loss of 10 to 15 pounds can have a major benefit on improving blood glucose levels Eat less fat and cholesterol This will help you manage your blood cholesterol and triglyceride levels, and achieve or maintain desirable body weight
2005
Diane Lesnick, MPH, RD, CDE
Palo Alto Medical Foundation
650 321-4121
Eat smaller portions of meat Choose lean cuts of red meat, fish and skinless poultry Healthy meat substitutes include low-fat or non-fat cottage cheese, egg whites and tofu products Limit use of cold cuts, hot dogs, sausage, bacon, egg yolks, cheese and organ meats Reduce your consumption of added fats, particularly saturated sources such as butter, stick margarine, shortening, cream sauces, cream cheese, sour cream, meat drippings, whole milk or cheese based salad dressings and coconut Substitute non-fat or low-fat milk or yogurt for high-fat dairy products Substitute monounsaturated fats for saturated fats, including olive, canola and peanut oils; avocado; nuts; and natural peanut butter or other nut butters As a second choice, you can also replace saturated fats with polyunsaturated fats such as corn, sunflower and
safflower oils; trans fatfree margarine; mayonnaise; and commercially prepared oil based salad dressings Use less fat in cooking Bake, broil, boil or simmer instead of frying or sautéing Remove all skin from poultry, and fat from meat, prior to cooking Alcohol consumption can significantly increase your triglyceride levels If you do drink alcohol, please discuss with your physician to determine if this is appropriate
2005
Diane Lesnick, MPH, RD, CDE
Palo Alto Medical Foundation
650 321-4121
Hemoglobin A1C
The hemoglobin A1c blood test shows your average blood glucose level over the past three to four months This test, along with your home blood glucose tests and the tests performed during your clinic visit, can give you a better picture of your diabetes care Hemoglobin is one part of a red blood cell It carries oxygen throughout your body The glucose sugar in your blood attaches to the hemoglobin, where it stays for the life of the red blood cell The combined hemoglobin molecule and attached glucose is called hemoglobin A1c HbA1c This test measures the percentage of total hemoglobin that has glucose attached to it Because red blood cells live for 120 days, this test reflects
your glucose levels for the previous three to four months What you did the day before the test has very little effect on the result The chart below shows how the hemoglobin A1c result corresponds to the average blood glucose levels over the previous 3-4 months
Hemoglobin A1c Measurements
Hemoglobin A1c percent 4 5 6 7 8 9 10 11 12 13
Average blood glucose level mg/dl 70 100 135 170 205 240 275 310 345 380
Normal HbA1c is 4-6 percent HbA1c of 65 percent or less is goal for diabetes This test should be repeated every three to six months so you and your health care team can assess your overall diabetes care
______________________________________________________________________________________ 2005 Diane Lesnick, MPH, RD, CDE Palo Alto Medical Foundation 650 321-4121
Introduction to Diabetes
TWO SESSION PROGRAM COVERS: What is diabetes and its causes Diet/weight management overview Insulin and oral medications Interpretation of blood glucose patterns and making management decisions Exercise guidelines Diabetic emergencies and sick-day management Preventing long-term complications Foot Care Guidelines Stress and Diabetes Blood Glucose Monitoring Instruction Alternate
Wednesdays 2:30-5:30pm and Fridays 1:30-4:30pm Please call 650853-2961 for dates Palo Alto Medical Foundation 795 El Camino Real, Palo Alto 50 for 2 sessions
Copayment for PAMF HMO/POS patients with physician referral
Times: Location: Fee: Instructor: To Register:
Diabetes Educator/Dietitian Please call 650853-2961 for availability and then mail the completed form with your payment
Please register me for Introduction to Diabetes on Name Address Referred by Insurance Enclose check to PAMF and mail to: Education Division, 795 El Camino Real, Palo Alto, CA 94301 Daytime Phone
Diabetes Self Management and Support Resources
Newly diagnosed patients with type 2 diabetes are advised to register for the Introduction to Diabetes class series Physician referral is required for all classes and individual appointments
Introduction to Diabetes: A Two Session Program Palo Alto and Fremont sites Two 3-hour sessions offered weekly All new patients are advised to register for this program Program topics include: Causes and types of diabetes Diet/weight management introduction Insulin and oral diabetes medications Exercise guidelines and precautions Diabetic emergencies and sick-day management
Coping with stress and relapse prevention Preventing long-term complications Foot care Self blood glucose monitoring instruction Healthy Eating with Type 2 Diabetes: A Single Session Class Palo Alto and Fremont site Single 3-hour session offered monthly, covering: meal planning, carbohydrate counting, weight management, cholesterol and blood pressure management, label reading, dining out and much more Living Well with Pre-Diabetes: A Single Session Class Palo Alto and Fremont sites Single 2-hour session offered monthly, covering: Causes and consequences of insulin resistance and metabolic syndrome, prevention of diabetes and heart disease, dietary and exercise guidelines Individual Counseling Sessions Palo Alto, Fremont and Redwood City sites Appointments focus on individualized needs including: Meal planning for blood glucose sugar control and weight management Oral diabetes medication management Insulin instruction and management Insulin pump therapy training and management Other specialized needs that cannot be addressed in a group setting Diabetes Drop-In Group Palo Alto site On-going one-hour group meeting offered twice a month A certified diabetes educator will addressing
patients questions through group discussion Location: SMA room, first floor, Palo Alto Clinic Time: Second Monday of each month, 11:00 am to noon and Forth Monday of each month, 4 to 5 pm Will not be held on major holidays Please contact the Education Division at 650 853-2961 for questions and confirmation of meeting times Support Groups: Free Monthly Meetings Palo Alto site At the Palo Alto site, the first Wednesday of each month, 7 PM - 9 PM For questions, call Marcie Heft 650 856-0838 No referral is necessary Provides support to people with diabetes and their families Videotapes, Internet access and Books about Diabetes Palo Alto and Fremont sites Available for on-site review or checkout at The Community Health Resource Centers in Palo Alto and Fremont Palo Alto: Call 650-614-3200 Fremont: Call 510-623-3221 For more information, please visit our diabetes website at wwwpamforg/diabetes To schedule individual counseling and register for diabetes classes, call: Nutrition-Diabetes Education in Palo Alto and Redwood City 650 853-2961 510 498-2184 Nutrition-Diabetes Education in Fremont
Updated 11-06
Source:healthierus.gov
