xperts say most people with diabetes should try to keep their
blood glucose
level as close as possible to the level of someone who doesn't 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 you learn how to reach your target blood glucose range. Your main health care providers are your doctor, nurse, diabetes educator, and dietitian.
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| 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 who's 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.
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People with diabetes don't 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 that's 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: U.S. Department of Agriculture/U.S. Department of Health and Human Services
People with diabetes should 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.
- Don't skip meals, especially if you've already taken your insulin, because your blood glucose may go too low. (See chapter 3 for information on how to handle hypoglycemia, also called low blood sugar.)
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ACTION STEPS
If you DON'T use insulin
- Follow your meal plan.
- Don't 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.
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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 you have no special problems. If you have high 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 you haven't 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 haven't eaten for more than an hour or if your blood glucose is less than 100 to 120, have a snack before you exercise. (See chapter 3 for snack ideas.)
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. Don't exercise when your blood glucose is over 240 or if you have ketones in your urine (see below).
- Don't exercise right before you go to sleep, because it could cause hypoglycemia (low blood sugar) during the night.
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ACTION STEPS
If you don't use insulin
- See your doctor before starting an exercise program.
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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 doesn't make enough. Everyone with
type 1 diabetes
needs insulin, and many people with
type 2 diabetes
do too.
Insulin can't be taken as a pill. You'll 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 you're using. Don't 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 don't use a whole bottle of insulin within 30 days, then store it in the refrigerator.
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| You may need insulin to control your blood glucose. |
If You Take Diabetes Pills
If your body makes insulin, but the insulin doesn't 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 don't lower blood glucose all by themselves. You'll 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.
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| Many people with type 2 diabetes take pills to help keep blood glucose in their target range. |
If You Don't Use Insulin or Take Diabetes Pills
Many people with type 2 diabetes don't need insulin or diabetes pills. They can take care of their diabetes by using a meal plan and exercising regularly.
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You'll want to know how well you're 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 often 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.
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| Checking your blood glucose will help you see if your diabetes treatment plan is working. |
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Urine Tests
You may need to check your urine if you're 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 isn't 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 isn't 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. You'll 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 you're 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 don't 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.
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ACTION STEPS
If you DON'T use insulin
Keep a daily record of
- Your blood glucose numbers.
- The times of the day you took your diabetes pills.
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