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Fresh View Diabetes Book Eng (Superior HealthPlan)

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A
ON
YOUR
DIABETES
TINY
PARTICLES,
BIG
IMPACT
Most people don’t think about what’s floating
around in their bloodstream. Or the fact that
the blood is essentially the river of life, bringing
nutrients and oxygen to all the cells of the
body. Most of the time, that’s OK. But when
you’re diagnosed with diabetes, that all changes.
Suddenly, what’s in your blood is the most
fascinating subject of the day.
If you have diabetes, understanding how to best
care for yourself is most important. Learning
what changes you’ll need to make in your life
will be key to controlling your diabetes. You may
be currently feeling overwhelmed. This book is
designed to give you answers to your questions
about diabetes and a whole lot more.
DISCLAIMER. The information contained in this A Fresh View on Your Diabetes book is for
informational purposes only. The information does not constitute medical advice and is not
intended to be used for the diagnosis or treatment of a health problem or as a substitute for
consulting a licensed health professional. Consult with a qualified physician or health care
practitioner to discuss specific individual health needs and to professionally address personal
medical concerns.
1
A Fresh View
on your Diabetes
TABLE OF
CONTENTS
WORD UP: Basic Diabetes Definitions
2
BREAK IT DOWN:
The Journey of a Bite of Food
4
WHAT’S GOING ON IN THERE?:
Causes of Diabetes
6
A SNEAKY DISEASE:
Diabetes Symptoms and Warning Signs
8
CONTROL YOURSELF!:
Getting a Handle on Your Diabetes
10
MENTAL STRESS: Letting off the Steam
20
TIME TO GET TO WORK:
Three Jobs Key to Your Diabetes Management
24
STEADY AS SHE GOES:
Control Your Blood Glucose Level!
25
SNIFFLE COUGH:
Taking Care when You’re Sick
28
OPEN WIDE: Take Your Medicine
30
FEELING GOOD, LOOKING GOOD:
Adopt a Healthier Lifestyle
32
ALL IN GOOD TASTE:
Nutrition and Diabetes
33
IN THE ZONE: Diabetes and Exercise
43
SNUFF THE PUFF: Smoking and Diabetes
50
NONE FOR THE ROAD:
Diabetes and Alcohol
53
YOUR DIABETES: A Change for Life
54
CREDITS AND SPECIAL THANKS
55
NOTES
56
RESOURCES
2
A Fresh View on your Diabetes
WORD UP
BASIC
DIABETES
DEFINITIONS
Before we get too far into this discussion, it’s important to define the
common words you’ll hear now that you’re learning about diabetes. Here
are some basic terms to know and understand.
DIABETES:
A condition in which your body is unable to use glucose (sugar)
as energy. There are different types of diabetes:
PREDIABETES: This is what you can get before you develop type
2 diabetes. When you’re in this stage, your blood sugar levels are
higher than normal, but not so out of the range that you have
diabetes. You have a chance to change your behaviors before you
get type 2 diabetes.
TYPE 1: This diabetes type used to be called “juvenile diabetes,”
“early-onset” or “insulin-dependent.” This type usually develops in
the early child or teen years, although it can show up in adults.
People with type 1 must take insulin every day, since their pancreas
doesn’t make enough or makes none at all.
TYPE 2: This is the most common form of diabetes and generally
shows up in adulthood, although teens and even children have been
diagnosed with type 2 in recent years. Obesity is often the biggest
cause of type 2 diabetes.
GESTATIONAL: This type can happen to pregnant women and
usually goes away after the baby is born. Women who have this
when they’re expecting have a higher risk of getting type 2 diabetes
within five to 10 years after giving birth.
3
A Fresh View on your Diabetes
GLUCOSE (GLU-kose):
A simple sugar created as carbohydrates (kar-
bo-HY-drates) are digested. All cells in the
body require glucose to live. Because glucose travels in the bloodstream, it’s
called Blood Glucose. You may also hear the term “blood sugar.”
GLUCOSE MONITOR :
A device that measures the amount of
glucose in your blood. Also known as a
blood glucose monitor or meter.
HYPOGLYCEMIA
(hy-po-gly-See-me-uh):
A state in which you have too little glucose
in your blood.
INSULIN RESISTANCE:
A state in which your body can’t use the
insulin being produced by the pancreas. It’s
also a factor of metabolic syndrome.
PANCREAS:
A small gland behind the stomach that
produces insulin and digestive juices. In
type 1 diabetes, the pancreas produces
little to no insulin. In type 2, the pancreas
produces insulin, but the body is unable
to use it as well as it should.
HYPERGLYCEMIA
(hi-per-gly-SEE-me-uh):
A state in which you have too much glucose
in your blood.
INSULIN (IN-suh-lin):
A hormone made in the pancreas that
allows glucose to enter cells.
DIABETES
BY THE NUMBERS
90-95
Percent of those with diabetes in
the U.S. who have type 2.
American Diabetes Association:
Common Terms:
diabetes.org/diabetes-basics/
common-terms
4
A Fresh View on your Diabetes
BREAK IT DOWN
THE JOURNEY OF A BITE OF FOOD
MISSION: DEFINITION
CARBOHYDRATE (kar-boh-HY-drate)
One of the three main nutrients in all food.
Starches, fruits, vegetables, dairy products and
sugars are all carbohydrates, or carbs for short.
You might not give a lot of thought as to what happens to food when you eat
it. It’s actually pret
ty cool. This is what happens when you put a bite of food
into your mouth all the way to its final destination.
You take a big bite of a ripe red juicy apple and begin chewing. Digestion is already
happening in your mouth as saliva mixes with the apple to begin breaking it down.
After chewing, you swallow the now mushy apple and it travels to your stomach.
Your stomach continues the digestion process by breaking down the apple into
usable bits. Since the apple is mostly carbohydrate, it breaks down easily into a
simple sugar called glucose.
The stuff formerly known as “apple” travels into the small intestine where the apple
nutrients are absorbed and shuttled into the blood supply.
The new glucose moves into your bloodstream and provides food to every cell in your body.
This is, at least, what happens if you don’t have diabetes. When you have
diabetes, this process doesn’t work as planned.
KNOCK, KNOCK. CAN I COME IN?
In order for glucose to enter a cell, it needs permission. Insulin, made by the pancreas, is what
allows glucose to get in. Think of glucose as a visitor bringing a gift of food to a hungry cell and
insulin as the kindly butler who opens the door.
When you have diabetes, the butler (insulin) can’t open the door (as in type 2), or isn’t even
around to do so (as in type 1). Glucose, unable to get into the cells, continues to float through
your bloodstream. As you eat more food that’s changed into glucose, your blood glucose level
rises. Your bloodstream is getting crowded with all that glucose floating around! At a certain
point, you become hyperglycemic, meaning you have too much sugar in your blood.
5
A Fresh View on your Diabetes
When glucose levels stay too high for too long, diabetes develops. If not taken care of, diabetes
can cause all sorts of problems, including:
Fatigue Heart damage Loss of feet and legs
Vision issues Stroke Nerve damage
Kidney
problems
And more.
It’s impor
tant to take care of yourself by eating right, taking medications as ordered by your doctor and
monitoring your blood glucose levels all as a daily habit.
DIABETES
BY THE NUMBERS
Less than 1
Percentage of U.S. population with diabetes
in the late 1950s
More than 8
Percentage of U.S. population with diabetes
today
25.8 million
Number of children and adults in the U.S. who have diabetes.
79 million
Number of people in the U.S. who have prediabetes.
1 in every 400
Children and teens have diabetes.
WebMD: Diabetes Basics:
diabetes.webmd.com/
diabetes-basics
6
A Fresh View on your Diabetes
WHAT’S GOING ON IN
THERE?
CAUSES
OF
DIABETES
There are a number of ways a person can
develop diabetes. Some are under your control and others aren’t.
The key is taking care of yourself once you are diagnosed to
lower the chance of the diabetes causing other problems.
Type 1 diabetes happens when the pancreas doesn’t work right. It might make insulin,
but not enough or it might not make it at all. There are many possible reasons why
this happens, but people with type 1 can control this form with daily insulin shots
and regular blood glucose testing.
Type 2 diabetes develops later in life, usually after age 45. This has been changing,
however, as children, teens and young adults have been diagnosed in recent years.
DID YOU KNOW?
The first known record of diabetes-
like problems was in ancient Egypt
in 1552 BC.
RISK FACTORS FOR TYPE 2 DIABETES
Risk Factors are lifestyle habits or traits that may make it more likely for you to
develop type 2 diabetes. The more risk factors you have, the greater the chance
of getting type 2 diabetes. Some are within your control, such as physical activity
levels. Others are outside of your control, like your family history.
7
A Fresh View on your Diabetes
Being older than age 45
Having a family background that is Asian American, African American,
American Indian, Hispanic/Latino or Pacific Islander
Having a parent or sibling with diabetes
Having a baby that weighed more than nine pounds
Having gestational diabetes
Being diagnosed with prediabetes
Having a history of polycystic ovary disease (PCOS)
Being overweight
Having high blood pressure
Reporting high cholesterol levels
National Diabetes Clearinghouse: Causes of Diabetes
diabetes.niddk.nih.gov/dm/pubs/causes/
American Diabetes Association: Diabetes Basics
diabetes.org/diabetes-basics/?loc=gsa-GlobalNavDB
8
A Fresh View on your Diabetes
A SNEAKY DISEASE
DIABETES SYMPTOMS AND WARNING SIGNS
Although it might seem like it, diabetes doesn’t just show up one day. Diabetes often
gives you clues that it’s there. The symptoms might seem harmless, unimportant
and unrelated. Paying attention to what your body is telling you is a good step
toward controlling your diabetes.
Here’s what to look for:
Symptom/Warning Sign In Type 1 In Type 2
Urinating (peeing) often
X X
Thirsty all the time
X X
Hungry all the time
X X
Unusual weight loss
X X
Extremely tired
X X
Very cranky or crabby, or other mood changes
X X
Many infections
X
Blurry vision
X
Cuts or bruises that take a long time to heal
X
Numbness or tingling in the hands and/or feet
X
Persistent bladder, gum or skin infections
X
Now the Bad News
Sometimes type 2 diabetes is sneaky and doesn’t show any symptoms. That’s right.
You can have it and have no idea. That’s why it’s important to see your doctor and
get regular testing, especially if you have any of the risk factors listed earlier.
9
A Fresh View on your Diabetes
DIABETES MESSES WITH
MORE THAN YOUR BLOOD
People with diabetes often have an increased chance of having other
serious health issues. There is good news – by taking care of your
diabetes and making necessary lifestyle changes, you may be able to
avoid or slow down possible complications. Here are some of the areas
affected by diabetes and a few of the possible health issues.
HEART DISEASE
AND STROKE –
Too much glucose in the
blood can create sticky
messes on the walls of
blood vessels and arteries.
This increases your
chances of developing
high blood pressure, high
cholesterol, heart disease
and suffering a stroke.
EYES –
People with diabetes are at greater risk for
developing glaucoma, cataracts and retinopathy,
a disease of the retina located in the back of the eye.
FEET –
Diabetes can damage the nerves in your feet
making it difficult for you to feel pain, heat or
cold. This increases your risk for infection if you have an
injury that goes untreated. Diabetes can also narrow the
blood vessels in your legs. This reduces the amount of
blood that can get to your feet easily and makes healing
from injuries harder.
SKIN –
Your skin is the largest organ on your body and can take a beating.
It’s the part of you that faces the world each day and, when you have
diabetes, your skin can develop problems more quickly. Problems with recurring
bacterial or fungal infections are common among people with diabetes. You can
also have itchy skin. Cuts and scrapes that are slow to heal or don’t ever totally
heal may be a sign that your blood glucose level is too high.
American Diabetes Association: Diabetes Complications
diabetes.org/living-with-diabetes/complications/?loc=DropDownLWD-complications
Centers for Disease Control (CDC): Keeping Your Feet Healthy
cdc.gov/Features/DiabetesFootHealth/
10
A Fresh View on your Diabetes
CONTROL
YOURSELF!
GETTING A HANDLE
ON YOUR DIABETES
You now have some very good
reasons to take charge of your
health and your diabetes. When
your diabetes is controlled you:
Feel better
Have more energy
Are less thirsty
Have fewer infections
Have healthier skin, eyes,
feet and heart
Visit the bathroom less
often to pee
IT CAN BE HARD,
BUT WORTH IT
Sometimes dealing with a health issue like
diabetes can get you down. You know you should
follow the doctor’s orders, but it can seem like a
real hassle. When you feel this way, it’s good to remember your “WHY” for taking care
of yourself. Sometimes that can be as simple as, “I want to feel better.” Many times,
it’s bigger than that, such as, “I want to see my daughter graduate from college” or “I
want to go on a cruise with my partner.”
What’s your BIG WHY?
My BIG WHY for taking care of me and my diabetes is:
11
A Fresh View on your Diabetes
IN IT TOGETHER: YOU AND YOUR
HEALTHCARE TEAM
Controlling your diabetes and its effects is a group
effort. Having a supportive and knowledgeable
medical team makes the process of managing your
diabetes much easier. It also keeps you healthier.
So besides you, who’s on your team?
Your doctor – to manage your overall health
and make sure you do the proper tests to
track your progress
Your dentist – to monitor your gum and teeth health
Your eye doctor – to alert you to any changes
in your eyes
Your foot doctor – to inspect your feet for
any possible injuries, infections or other
issues that could cause serious problems
Depending upon how you’re feeling currently,
you may need additional people on your team to
help manage your kidney health, mental health
and heart health. Other people could include a
dietitian to help you learn how to make healthier
eating choices and a personal trainer to get you
moving.
All glucose meters use strips to
catch the drop of blood. Be sure
to have plenty of test strips on
hand so you don’t run out!
TESTING, TESTING
When you have diabetes, tests are a way of
life. Each is important for different reasons.
Put together, they create a picture of your
health and help you know if you’re on track
or off in left field.
BLOOD GLUCOSE TEST
Q:
What is it?
A:
This self-test uses a small drop of
blood and a glucose meter to measure
the amount of glucose (sugar) in your
blood. You should test before meals
and/or one to two hours after meals.
Q:
How often should I test?
A:
At least once per day, sometimes more
often. Talk with your doctor about
how often you should do this test.
Q:
What results am I hoping for?
A:
These are the target glucose levels for
most adults with diabetes.
Before meals:
70 to 130 mg/dl (milligrams per deciliter)
After meals:
Less than 180 mg/dl (milligrams per deciliter)
12
A Fresh View on your Diabetes
KEEPING TRACK
Keep track of your Blood Glucose test numbers using
this page. The instructions for using this page are easy:
Take a reading using your glucose meter
Write it down under the correct column
Take your pages with you when you visit your healthcare team
If this page is helpful in
keeping up with your blood
sugars, copy this page!
You might not need to put a number into each column. Only test as often as your doctor advises.
Date
Before
Breakfast #
After
Breakfast #
Before
Lunch #
After
Lunch #
Before
Dinner #
After
Dinner #
Bedtime
#
Example: 2/25 99 103 96 105 91 10 0 118
13
A Fresh View on your Diabetes
ABC
TESTS
The next three tests are called the “ABC Tests” to help
you remember them more easily. Each is very important
in helping you manage your diabetes.
A1C TEST
What it is:
The A1C test measures how well you’re able to manage your diabetes. Sugar
attaches to the red blood cells, and the more sugar in the blood the higher the A1C
value. Since a red blood cell lives for about three months, this test measures the average amount
of glucose in your blood over that time. The A1C test gives you and your doctor a quick look at
your diabetes control.
HOW Often
If you have just been diagnosed, your doctor will probably want to do this
test every three months. Once you’ve been successfully taking care of your
diabetes for a while, you may only need to have this test done twice a year. The amount of
time between tests really depends on how well your body is handling diabetes.
RESULTS
Test results are also given as an Estimated Average Blood Glucose (eAG). Most
adults with diabetes want to see a score of 7% or less, which equals an eAG of
140 mg/dl or less.
Here’s how to understand just what that percentage means.
What Your A1C Results Mean
A1C Results eAG What Your Doctor Might Say
6%
126 mg/dl
“Great job!”
7%
154 mg/dl
“Great job!”
7.5%
169 mg/dl
“Good job! Let’s keep working at it.”
8%
183 mg/dl
“This is too high. We need to look at what’s going on.”
8.5%
197 mg/dl
“This is too high. We need to look at what’s going on.”
9%
212 mg/dl
“We need to work harder to get your diabetes under control.”
10%
240 mg/dl
“We need to work harder to get your diabetes under control.”
14
A Fresh View on your Diabetes
MISSION: DEFINITION
HYPERTENSION
(hi-per-TEN-shun):
Also called High Blood Pressure. This occurs when blood pressure stays
higher than normal levels over time.
SYSTOLIC (sis-TALL-ic):
The measure of how hard the heart must work in order to pump blood
through your arteries. The number represents the amount of pressure
inside the arteries as the heart pumps. It is the first number (130/80) reported in a blood pressure result.
DIASTOLIC (dy-ah-STOL-ic):
This measures the pressure in the arteries at the point the heart
is relaxing between beats. It is the second number in a blood pressure reading (130/80).
BLOOD PRESSURE
CHECK
What it is:
This test measures how hard your heart has to pump in order to move blood through
your body. You’ve probably heard the result “120 over 80” in TV medical shows.
That’s considered a normal blood pressure for adults without diabetes. The goal for
people with diabetes is 130 over 80. When you have high blood pressure (also called
hypertension), your heart must work harder to circulate your blood. It can lead to
problems in many areas of your body, like eyes, kidneys and blood vessels. It can
also lead to heart disease, stroke and kidney disease. High blood pressure isn’t good
for anyone, but if you have diabetes, you are more at risk of developing it.
15
A Fresh View on your Diabetes
HOW Often
You should have your blood pressure checked each time you visit your doctor.
In some cases, you may be asked to have it checked more often.
RESULTS
High blood pressure is nothing to ignore. The chart below explains how you
know when high is too high. A single high reading doesn’t mean you have high
blood pressure. It serves to warn your doctor that something might be going
on. Your doctor will monitor you more closely and take several readings over
time before giving you a high blood pressure diagnosis.
Systolic
Reading
Diastolic
Reading What Your Doctor Might Say
Less than 120
and
Less than 80 “Congratulations! You’re in the normal range.”
120-139
or
80-89 “You could be developing high blood pressure.”
140-159
or
90-99 “You have Stage 1 high blood pressure.”
160-179
or
100-109 “You have Stage 2 high blood pressure.”
180 or higher
or
110 or higher “Your heart is in a state of emergency. We need to
admit you to a hospital NOW.”
Q:
Can your blood
pressure be too low?
A:
Yes! If this happens, your doctor
will want to investigate further.
16
A Fresh View on your Diabetes
CHOLESTEROL TEST
What it is:
This is a simple test to measure the amount of certain fats in your
blood. It can also be called a lipoprotein (LIE-poe-pro-teen) or lipid
profile. High cholesterol competes for space in your arteries and blood vessels with
the added glucose that’s floating around. Too much of either spells trouble. But not
all cholesterol is bad. In fact, our bodies need cholesterol to work right. But too much
of the LDL or “bad” cholesterol and you could be in trouble.
TOTAL CHOLESTEROL
As the name suggests, this is a measurement of all the cholesterol, good and bad.
It’s an important number to know, but it doesn’t tell you the whole picture. It’s also
worth noting that you can’t add the HDL and LDL numbers together to get your Total
Cholesterol number.
HDL CHOLESTEROL
HDL cholesterol, the “good” kind, is the cleaning crew in your bloodstream.
HDL sweeps through your arteries, blood vessels and veins scrubbing “bad” LDL
cholesterol off the walls. It then takes LDL for a trip to the liver, where this important
organ processes LDL into something more user-friendly. Our bodies are the ultimate
recyclers. A healthy level for HDL is over 40 mg/dl for men and over 50 mg/dl for
women. An unhealthy level, and one that puts you on the path to heart disease, is
less than 40 mg/dl.
17
A Fresh View on your Diabetes
What does it all mean?
LDL CHOLESTEROL
LDL cholesterol is the uninvited guest who shows up at a party and leaves a mess
behind. Too much LDL and arteries, blood vessels and veins become sticky with fatty
deposits that begin to narrow your blood pathways increasing your risk for a heart
attack. A healthy measure of LDL for adults with diabetes is less than 100 mg/dl.
TRIGLYCERIDES
Triglycerides give energy to the body, so they are a good cholesterol. Triglycerides
turn bad when too much is stored by the body with the hope of using it one day.
When this happens, triglycerides act more like LDL cholesterol, clogging things up
and generally wreaking havoc. A healthy amount of triglycerides measures less than
150 mg/dl.
HOW Often
Doctors recommend you have your cholesterol checked at least once a year.
Your doctor may decide to check it more often, depending upon how healthy
you are and your risk factors.
RESULTS
Remember, a Total Cholesterol number doesn’t really tell you anything. You need to
know your HDL, LDL and triglycerides numbers to understand your cholesterol levels
completely. Just because you might have a low HDL or a high LDL number doesn’t
mean you cannot change them. Diet, exercise, and possibly medication can help.
18
A Fresh View on your Diabetes
A FINAL WORD ON TESTS (FINALLY!)
There are other helpful tests that can
tell you the state of your body:
Dental exams – Having your teeth and gums looked at, twice a year if possible,
will keep your pearly whites intact and reduce the chance of gum disease. Be
sure to tell your dentist you have diabetes.
Eye exam – At least once per year, visit your eye doctor for a complete exam
including a test where they dilate (DIE-late) your eyes to look at your retinas in
the back of your eyes.
Foot exam – While you’ll want to inspect your feet daily for any issues, you
should also visit a foot doctor—also called a podiatrist (poe-Die-A-trist)—at
least once a year. If you have had foot problems, you’ll want to visit more often.
Your primary doctor can check your feet during regular visits, too. Be sure to
take your shoes and socks off to remind the doctor to check your feet.
Kidney function tests – To know if your kidneys are working well, a urine
(pee) test and blood test will look for specific properties that can cause kidney
malfunction or failure. Your doctor will recommend a timeframe for these tests.
PLANNING THE WORK AND WORKING THE PLAN
You’ll go over your test results with your healthcare team. Your team may create
or change your treatment plan depending upon your symptoms and what the
tests say. These changes may include:
Your medicine schedule
Your meal plan
Your exercise plan
19
A Fresh View on your Diabetes
SO MUCH PAPER, SO LITTLE TIME…
If your head is swimming with all the tests and numbers
you’ll need to understand and manage your diabetes,
you’re not alone! Here’s a quick and easy solution.
Get a binder or notebook
Write everything in it about your diabetes
Include your daily blood glucose monitoring pages
Keep doctor reports and test results in it, too
Take the notebook with you when you visit a member of
your healthcare team
That was easy!
WebMD: Medical Tests You Must Have
diabetes.webmd.com/features/three-medical-tests-for-diabetes-patients
CDC/NIH: National Diabetes Education Program
U.S. Department of Health and Human Services
ndep.nih.gov/i-have-diabetes/KnowYourABCs.aspx
American Diabetes Association: Your Healthcare Team
diabetes.org/living-with-diabetes/treatment-and-care/whos-on-your-
health-care-team/your-health-care-team.html
20
A Fresh View on your Diabetes
MENTAL STRESS...
LETTING OFF
THE STEAM
Whoa. This is a life-changer. Getting a diagnosis of diabetes can affect the way you
think about yourself or how you view life. You might feel sad or even depressed that
you have this new health issue to deal with – one that you will need to manage the
rest of your life. You might even deny there’s a problem, at least for a while. It can
certainly increase your stress level, which can make controlling your diabetes harder.
MISSION: DEFINITION
FIGHT OR FLIGHT RESPONSE:
An automatic physical response in our bodies that releases cortisol (COR-tuh-sawl)
and epinephrine (eh-pin-NEH-fren). Epinephrine is also known as adrenalin (uh-
DREN-uh-lin). These two hormones give us strength to fight or run away from
a perceived threat. In today’s society, fighting or running away is usually not an
option, which leads to chronic stress.
STRESS DOESN’T ALWAYS DO A BODY GOOD
Stress is a normal part of being human. Stress can be good and it can be bad. Good
stress, like planning a wedding or learning a new job can be fun and is usually
temporary. Bad stress can cause a lot of problems, especially if you have diabetes.
You might have heard of the fight or flight response. This is how our bodies
learned to adapt to challenges back in the caveman days. When we’re always
feeling stressed, we’re in a constant state of fight or flight called chronic stress. If
you feel anxious a lot, have trouble sleeping, have an upset stomach a lot and feel
you have no control over your life, you may have chronic stress. And chronic stress
can raise your blood sugar.
21
A Fresh View on your Diabetes
Being stressed out all the time and having diabetes is a dangerous
combination. Chronic stress can raise your blood sugar. Too much
cortisol means blood glucose levels are harder to control. Other
negative effects can be…
Higher blood pressure
Chest pain
Making other conditions you might
have, such as heart disease, even worse
Getting a diagnosis of diabetes can add more stress to your life as you try
to understand your disease and take care of yourself. It can be scary. This is
normal. But if you’re feeling sad or blue more than usual, you could be suffering
from depression. Depression is a serious mental health condition that can affect
how you view life. It can bring feelings of hopelessness and make it hard for you
to concentrate on other things. You might feel like your brain is “foggy” and that
thinking is hard. You might not want to move. If this sounds like you, talk with
your doctor about it right away.
DID YOU KNOW?
Breathing deeply is a great way to reduce stress? Here’s a simple exercise
you can do just about anywhere.
DEEP BREATHING EXERCISE
Find a quiet space where you won’t be bothered by people, telephones, TV, etc.
Sit in a comfy chair with your feet flat on the floor
Place your hands on your thighs with the palms facing up
Before you begin, take a moment to notice where your body is achy,
tight, painful, etc.
Now, focus on your breath
22
A Fresh View on your Diabetes
DEEP BREATHING EXERCISE Continued
Bring a deep breath of air into your lungs
Hold it for just a second and let it all out
Take in a second deep breath – this time, hold it for 10 seconds
Before letting that breath go, put your mouth into the shape of an “O” as if
you were going to blow up a balloon or whistle.
Now, to the count of 10, let that breath go
Empty your lungs as much as you can
Continue doing this for at least 10 minutes
When you finish, focus again on your body. Do you notice any changes? Are you feeling
more relaxed? Are any tight places looser?
Taking time for this and other stress buster exercises will have great health benefits for you!
YOU’RE NOT ALONE!
While you might feel like the only person
in the world with diabetes, you’re not.
Consider joining a support group for
people with diabetes. It can really help
to talk with people who understand
what you’re going through. Check your
local area for in-person groups and
search on the Internet for online ones.
There’s a link at the end of this section
to help with your search.
Support groups not your thing? Then talk
with someone you trust. This could be
a friend, relative, clergy member or co-
worker. You might find that talking about
what’s going on helps relieve the pressure
you’re feeling so you can begin to work
toward solutions.
SHIMMY, SHIMMY, SHAKE
When was the last time you danced
around your house to music? Or took
a walk in your neighborhood? Moving
around can make you feel better
and lower stress levels. When you’re
dancing around, it’s hard to focus on
a problem. You’re too busy being silly
and having fun. So – move it! (Within
your ability level, of course.)
SOOTHING SOUNDS
If you love music, then let it be a part of your
stress reduction team. Here’s what you do:
Find a comfortable place where you
can lie down with no distractions
Take off your shoes
Lie down and be sure your arms and
legs are stretched out and that your
legs aren’t crossed
Focus on your music – let it fill your
body with its melody
Try not to think about anything else
You might fall asleep and that’s OK!
Just 15 minutes of music can lift your
spirits and lower your stress level
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A Fresh View on your Diabetes
GO THE EXTRA SMILE
The act of smiling can change your mood,
even when you don’t feel like smiling. Try
this challenge. Smile at everyone you meet
– people on the street, in stores, at work, at
home. Smile even if you’re faking it because
you’re in a bad mood. The funniest thing
happens. The more you smile, the more
people will smile back. And that just feels
good. Before you know it, you’ll be smiling
FOR REAL. And a positive outlook reduces
stress. It’s a true win-win.
ARE YOU GAME?
Are you ready to lower the stress in your
life? Yes? Explore things that will help
reduce your stress. Try different things.
You never know what might work. And
what works one day, might not work the
next day. It’s always great to have options!
WebMD: 10 Stress Reduction Techniques
webmd.com/balance/guide/blissing-out-10-relaxation-techniques-reduce-stress-spot
National Institute of Mental Health: Depression and Diabetes
National Institute of Health
nimh.nih.gov/health/publications/depression-and-diabetes/complete-index.shtml
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A Fresh View on your Diabetes
TIME TO
GET TO
WORK
THREE JOBS
KEY TO YOUR
DIABETES
MANAGEMENT
It’s difficult, if not impossible to maintain the same lifestyle (eating, activity level, smoking) after
learning you have diabetes. In most cases, your doctor (and anyone else who cares about you) will tell
you that you shouldn’t keep doing the same things. It does take some effort on your part to manage
your diabetes and make changes in your life. It might not be the easiest thing you’ve ever done. But the
rewards for making changes can be the difference between living a full, happy life…and not.
When you have diabetes, you have three important jobs:
Control your blood glucose level
Take your medicine(s)
Lead a healthier lifestyle
We’ll explore what each of these means in the next few pages.
DID YOU KNOW?
Dr. Thomas Willis, a 17th century
doctor in London, tested if his patients
had diabetes or not by tasting their
urine. A sweet taste would warrant a
diagnosis of diabetes mellitus, also
known as “honeyed” diabetes. This
method of monitoring blood sugars
was common until the 1900s.
National Diabetes Education Program:
I Have Diabetes:
ndep.nih.gov/i-have-diabetes
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A Fresh View on your Diabetes
STEADY AS SHE GOES
CONTROL YOUR
BLOOD GLUCOSE LEVEL
You know your blood glucose levels can get too
high. But did you know they can get too low, too?
KEYS TO KEEPING CONSTANT
Try to eat the same amount of food every day.
Don’t skip meals.
Eat around the same time each day – that
includes snacks.
Take your medicines about the same time
every day.
Pretty easy, right? Maybe not. Sometimes things
happen that throw you off. Traveling can affect your
eating and medicine schedule, and so can holiday
gatherings. Working long hours or dealing with a
family crisis can also knock your meal plan for a loop.
If you do get off track, you may experience a blood
glucose spike or drop.
You may not have any symptoms and be unaware that
your blood glucose level is high. Or, you might experience
one or more of these:
Dry mouth, very thirsty
Dizziness when you stand
Hard to breathe
Mental confusion
Sleepiness
Ask your doctor for goals for your blood glucose. If your
blood glucose level stays high for several hours, contact your
doctor. Left untreated, hyperglycemia can lead to increased
problems including coma and, in the worst case, death.
WHEN
YOUR BLOOD
GLUCOSE LEVEL
IS TOO HIGH
If your blood glucose level
reaches above 180 mg/dl, it’s
too high. At this range, you’re
in a state of hyperglycemia.
Your level will go too high for
lots of reasons:
Battling infections or illness
Living with a high stress level
Taking of other medicines
Forgetting to take your diabetes
medicine or taking it late
Eating certain foods –
desserts, sodas, candy, too
many carbohydrates or too
much of any type of food
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A Fresh View on your Diabetes
WHEN YOUR BLOOD GLUCOSE LEVEL IS TOO LOW
If your blood glucose level sinks below 70 mg/dl, you’re in a state of hypoglycemia.
Your level will go too low for lots of reasons:
Failing to eat before injecting insulin
Not injecting insulin soon enough after eating
Taking medicines incorrectly or taking too much
Drinking too much alcohol
Not eating enough before doing a physical activity
Effects of other medicines
Waiting too long to eat or skipping meals or snacks
Keeping track of your blood glucose level is a
MUST! When your blood glucose level is low,
you might experience one or more of these:
Shaking
A cold sweat or clammy skin
Faster-than-normal heart rate
Mental confusion
Anxious or crabby behavior
Extreme hunger
Headache
Dizziness
DID YOU KNOW?
When your blood glucose level is
low, a hormone called epinephrine
is released. This is what causes most
of the symptoms experienced when
you’re in a hypoglycemic state.
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A Fresh View on your Diabetes
HOW TO RAISE YOUR BLOOD GLUCOSE LEVEL SAFELY
Before taking any action, check your blood glucose level to be certain it’s too low. Ask
for help, especially if you feel woozy, dizzy or don’t feel like you’re thinking clearly.
If your blood glucose is less than 70 mg/dl, you can
eat or drink the following:
3 or 4 glucose tablets
1 serving of glucose gel – this equals 15 grams of carbs
½ cup (4 ounces) of any fruit juice
½ cup (4 ounces) of regular (not diet!) soda
1 cup (8 ounces) of milk
5 or 6 pieces of hard candy
1 tablespoon of sugar or honey
WARNING!
Tell others what to do if you
become unable to care for yourself.
If you pass out, you won’t be able
to tell them how to treat you. Let
them know that if you can’t talk
or swallow, they shouldn’t put any
drinks or candy into your mouth
because you could choke. Glucose
gel is fine, but it should be squeezed
between your cheek and gums to
avoid it going into your throat and
causing you to choke.
Just as with hyperglycemia, if a low
blood glucose level isn’t fixed it can
lead to more problems, including coma
and possibly death.
Mayo Clinic:
Blood Sugar Care
mayoclinic.com/health/blood-
sugar/DA00007
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A Fresh View on your Diabetes
SNIFFLE
COUGH!
TAKING CARE WHEN YOU'RE SICK
Being sick is no fun. When you have diabetes, you must be extra careful in
monitoring your blood glucose level because being sick can really do a number on
it. Follow these steps to safeguard your health:
Check your blood glucose level every four hours, without fail. Write
down the results.
Keep taking your diabetes medicines, even if you can’t keep food down,
unless your doctor tells you something different.
Drink at least one cup (8 ounces) of water or other calorie-free, caffeine-free
liquid every hour you’re awake.
If you can’t eat your usual food, try eating crackers, popsicles or soup.
You can also try drinking juice.
If you can’t eat anything, drink clear liquids like ginger ale. You still
need to get calories into your body. If you don’t, your blood glucose
level might drop too low.
DOCTOR, DOCTOR
Call your doctor if you have any of
these symptoms:
Your blood glucose has been over 240 mg/dl
for more than a day
You’re sleepier than usual
You’re having trouble breathing
You’re not thinking clearly
You throw up more than once
You’ve had diarrhea for more than six hours
MISSION: DEFINITION
KETONES (KEE-tones)
Ketones are made when the body
starts burning fat for energy instead of
glucose. It’s a warning that something
isn’t right. Ketones are toxic acids
that build up in the blood and appear
in the urine when the body doesn’t
have enough insulin. Ketones appear
when blood glucose levels are too
high in people with type 1 diabetes.
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A Fresh View on your Diabetes
Extra steps if you have Type 1 diabetes
If you have type 1 diabetes, test your
blood or urine for ketones if:
You can’t keep food
or liquids down
Your blood glucose
level is above 240 mg/dl
If ketones are present, call
your doctor right away.
SICK DAY PREP KIT
Having an emergency sick day kit put together in advance is a smart way to be ready
when the flu bug hits. Here are some suggested items for your kit:
Blood glucose recording sheet for monitoring your blood every four hours
Ketone recording sheet to monitor your ketones every three to four hours
Blood glucose strips and ketone strips (check the expiration dates and keep
your kit stocked with fresh strips)
Drinks with sugar
Thermometer
Your doctor’s emergency contact info
Sugar-free cough drops or cough medicine
Prescribed meds to treat nausea, diarrhea or vomiting
WebMD: Managing Sick Days
diabetes.webmd.com/managing-sick-days
American Diabetes Association: When You’re Sick
diabetes.org/living-with-diabetes/treatment-and-care/
whos-on-your-health-care-team/when-youre-sick.html
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A Fresh View on your Diabetes
OPEN
WIDE
TAKE YOUR MEDICINE
This might seem obvious, but it can
be easy to forget or put off, especially
if you take several medicines. The best
thing you can do for yourself, and for
those who care about you, is take your
medicine as prescribed.
KEEPING TRACK
A simple way to keep track is to use a pill container. It can be as large or small and
as detailed as necessary to help you remember. Using a watch or other device with
an alarm can alert you to the right times to take your medicine.
When you have many medicines, remembering what they all are for and when to
take them can be challenging, even with a handy pill box.
You can use the form on the next page to write in this critical information – be sure
to copy it a few times first so you can put it into the notebook you’re keeping. You
are keeping a notebook, right?
Be sure to write down any problems you have with any of your medicines. Your doctor
will want to know this. If you have any bad reactions, call your doctor right away.
Mayo Clinic: Managing Diabetes with Insulin
mayoclinic.com/print/diabetes-treatment/DA00010/METHOD=print
American Diabetes Association: Insulin Basics
diabetes.org/living-with-diabetes/treatment-and-care/medication/insulin/insulin-basics.html
American Diabetes Association: Oral Medicines
diabetes.org/living-with-diabetes/treatment-and-care/medication/oral-medications/
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A Fresh View on your Diabetes
Name
How Much
Take
When Take It Description
Example:
Med 1 1 pill
1 morning,
1 before bed
Small white pill
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A Fresh View on your Diabetes
FEELING GOOD, LOOKING GOOD
ADOPT A HEALTHIER LIFESTYLE
WHAT IS A LIFESTYLE CHANGE?
Most people don’t like change and altering a lifestyle can be a big one. But what
exactly does “lifestyle” mean? Well, it means changing habits and ways of doing
things so keeping your diabetes under control is easier. It’s easy to fall into bad
habits that don’t support a healthy lifestyle. Changing them takes time, but the
rewards in how much better you’ll feel and how much easier it is to control your
diabetes will be worth it.
You don’t have to do it alone, either. Remember your healthcare team? A few other
people are a dietitian, a health coach and a personal trainer. A dietitian’s time may
be covered by your insurance plan. You can find plenty of guidelines in this book.
As for training, you can find free workouts online, buy DVDs or rent them from
a library. Or just get out and walk! Keep reading for ideas on how you can make
positive changes to look better, feel better and be healthier.
In the following sections, you’ll read about how to
make changes so you are:
Eating a healthier diet
Being more active
Working toward quitting smoking
Ready? Set? Go!
Diabetic Lifestyle:
diabeticlifestyle.com/
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A Fresh View on your Diabetes
ALL IN GOOD TASTE
NUTRITION AND DIABETES
The Good News.
Eating a balanced diet doesn’t mean you have to give up things that actually taste
good. You might be surprised at how flavorful and filling food that’s really good for
your body can taste.
WHERE TO START
Learning how to eat in a healthy
way can seem daunting. A good
place to start is your doctor or
dietitian/health coach. You’ll
want to discuss your current
eating habits and concerns you
have about changing the way
you eat. They will be able to
give you some guidelines as to
what you can do to start down
the road of healthy eating for
diabetes. These guidelines
will include:
When you can eat
What you can eat
How much you can eat
There are many plusses to eating a
balanced diet. Here are five key ones:
Eating a healthy diet…
Helps you feel better
Helps you l
ose weight
Lowers your risk for heart
disease, stroke and other
health problems
May prevent or delay long
term complications
Keeps your blood glucose
levels, blood pressure and
cholesterol in healthy ranges
That last point is important because
keeping those three things in check
will make taking care of your
diabetes a whole lot easier.
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A Fresh View on your Diabetes
REMEMBER…
No habits change overnight. Be patient with yourself and go slow. You don’t need
to change everything at once. Trying things one at a time is OK. Your taste buds
will need to adapt to new flavors, textures and cooking styles that may seem
foreign at first. Over time, you’ll discover things you like (or love) and become
more comfortable with making different eating choices. Soon it will become
second nature.
WHAT TO EAT
When you begin your new eating journey, it will help to keep the letters V, B and M in mind.
V = Variety - No one food will give you all the nutrients you need. You need a good
mix (and your mouth won’t get bored, either).
B = Balance - Choosing foods from different food groups means you won’t be
overloading in one area and forgetting another. Balance is the key!
M = Moderation - Limiting
the amounts you eat will
keep you in balance and help
you keep from over-eating.
This might mean eating
smaller portions than you’re
used to.
When you have diabetes,
it’s the quality of the foods
you’re eating that’s most
important, not quantity. It’s
also important that you not
skip meals and eat about the
same time every day.
A diabetes-friendly diet plan includes:
Healthy carbohydrates: Fruits, vegetables, whole
grains, legumes (beans, peas and lentils), low fat
or non-fat milk products
Heart-healthy meats: Lean meats such as white
meat chicken and turkey and fish such as cod,
tuna, halibut, salmon, mackerel and herring
Healthy fats: Foods containing monounsaturated
and polyunsaturated fats, such as avocados, almonds,
pecans, walnuts, olives and canola, olive and peanut oils
Fiber-rich foods: Vegetables, fruits, legumes, whole-
grain flour and wheat bran
FIBER FACTS
Fiber comes in two types: Soluble and Insoluble.
Soluble means it can be dissolved. Fiber that’s in beans, oatmeal and
fruits is soluble. This helps lower your cholesterol.
Insoluble fiber (you guessed it) can’t be dissolved. Examples of insoluble
fiber are whole grains, brown rice and vegetables. Insoluble fiber helps
you digest your food, aids in keeping you “regular” and makes you feel
fuller faster when you eat.
Recommended amount of fiber per day: 25-35 grams
How much people usually eat: 15 grams per day
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A Fresh View on your Diabetes
A CONVERSATION
ABOUT CARBS
Q:
Are carbs good
for me or not?
A:
Yes.
OK, let’s clear up the confusion. Carbs are in foods like
pasta, bread and rice. They’re also in starchy veggies like
potatoes, corn and peas. There are even carbs in fruits and
dairy products such as milk and yogurt.
The good news is, you don’t have to say no to them
completely. You do, however, need to be careful how
many you eat because…
Your body breaks down carbs to make glucose for energy
When you have diabetes, too many carbs can cause
your blood glucose level to rise.
Be smart about your carb choices. Ones high in fiber are
better for you. The added fiber helps keep your blood
glucose levels more steady. Carefully monitor your portion
sizes for all foods.
HIGH-FIBER CARBS
Here’s a short list of good high-
fiber carbs for your diet:
100% whole grain bread,
tortillas and pasta
Brown rice
Fresh fruits
Oatmeal
Non-starchy vegetables
Whole-grain cereals
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A Fresh View on your Diabetes
JUST A LITTLE STARCH
It can be confusing as to what vegetables make the most sense for your new diet. If
you’re used to eating “starchy” veggies, like potatoes, you’ll be eating them less and
eating low-starch (low-sugar) veggies more. The list below gives lots of options for
vegetables that will work well in your new diet. Remember that raw or steamed is best.
Asparagus
Brussels sprouts
Carrots
Celery
Green beans
Mushrooms
Onions
Radishes
Spinach
Tomatoes
Broccoli
Cabbage –
green, purple, red
Cauliflower
Cucumbers
Greens –
collard, mustard, turnip
Okra, not fried
Peppers –
green, red, yellow
Lettuce
Summer squash –
green, yellow
Turnips
A PRIMER ON PROTEIN
Everyone needs protein. Protein is found in animal products such as meat,
eggs and dairy. You can also find protein in beans and tofu. When choosing
animal sources of protein, be sure to select lean meats and non-fat and low-
fat dairy options.
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A Fresh View on your Diabetes
LEAN MEATS
Here’s a short list of lean meats for your table:
White meat chicken and turkey with the skin taken off
Most fish
Lean cuts of beef, pork, veal and wild game with the fat removed
DAIRY
Good choices include:
Fat-free (skim) or 1% milk
Reduced fat cheese
Non-fat or 1% cottage cheese
Non-fat or low-fat yogurt with
no added sugar or syrup
FACTS ABOUT FRUIT
Just because you have diabetes doesn’t mean
you still can’t enjoy fruit. In fact, ALL fruits
are good for you. You just need to watch the
portions. When you eat the whole fruit (think
apples or grapes), you get all the benefits of the
fiber in the skin. So, eat the entire fruit when it
makes sense.
Fruit juice doesn’t provide the fiber and can
contain lots of added sugars. If you drink fruit
juice, read the labels and choose 100% pure
fruit juice, which does not contain added sugars
or syrups.
Fruits
Apples, Apricots, Bananas, Berries (a ll
kinds including blackberries, blueberries,
raspberries, strawberries), Melons (a ll
kinds including cantaloupe, honeydew,
watermelon), Cherries, Citrus fruits (a ll
kinds, including oranges, tangerines,
grapefruit), Grapes, Kiwi, Mango,
Nectarines, Papaya, Peaches, Pears,
Pineapple and Plums
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A Fresh View on your Diabetes
FOODS/DRINKS TO WATCH OUT FOR
Some fats are good for you in moderation. Other fats are just plain bad for you. They
can increase your risk for heart disease, high blood pressure and chance of stroke.
Other things to limit are sodium (salt), sweet treats, sweet drinks and alcohol.
A diabetes-friendly diet plan does not include or limits:
Fats: limit or avoid fried foods, gravies, or creamy sauces
Saturated fats: High-fat animal proteins, like fatty cuts of beef and pork,
hot dogs, sausage and bacon and high-fat dairy products. Saturated fat tends
to be solid at room temperature.
Trans fats: Processed snacks, baked goods, shortening and stick
margarines. You’ll want to take these out of your diet completely.
Cholesterol: This includes high-fat animal proteins, egg yolks, high-fat
dairy products, liver and other organ meats and shellfish. Eat at most
200 milligrams (mg) of cholesterol per day.
Sodium: Eat less than 1,500 mg of sodium per day (about 3/4 teaspoon).
Sweets, sodas: These may have added sugar or syrup, which will raise
your blood glucose levels.
Alcohol: Ask your doctor about specific limits on drinking alcohol
(wine, beer and hard liquor).
DID YOU KNOW?
The chemistry to develop hydrogenated oils, also known as trans fats, was
invented in the 1890s. When hydrogen is added to oil, it changes the properties,
making the oil solid. The first product developed in the U.S. with this new
process was 1911.
39
A Fresh View on your Diabetes
READING FOOD LABELS
Part of the puzzle of learning how to shop for, buy and cook new foods is
understanding food labels. They’re designed to tell you a lot about what’s in
the food product you’re about to buy.
In the Nutrition Facts box on the food label, you’ll find lots of information.
But you only need to read a few areas to know if a product is good for your
diabetes or not. We’ll just focus on those.
First things first – Serving size. This important piece of information may not
actually match the amount of food you actually eat. The serving size is used
as a basis for all the other information you see on the food label. If you eat
a half-cup of food when the serving
size i
s one cup, you’ll need to cut the
other numbers on the label in half.
Here are the numbers to look for:
DIABETES
BY THE NUMBERS
2,000 - 2,500
FDA (U.S. Food and Drug Administration)
recommended amount of calories per day for a man.
1,800 - 2,300
FDA (U.S. Food and Drug Administration) recommended
amount of calories per day for a woman.
For those needing to lose weight, the daily calories
may not need to be this high.
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A Fresh View on your Diabetes
Calories
This is the number of calories you get if you eat the listed serving size.
If you’re trying to lose weight, you need to eat fewer calories than your
body uses each day. To learn how many calories you should eat each
day, talk with your doctor or dietitian.
Total fat
Total fat includes good and bad fats. Fat has twice the calories as
carbohydrates or protein. For a healthy weight, fat must be eaten in
moderation, no more than 20-30% of your daily total calories.
Saturated fat
This fat raises your LDL (bad) cholesterol, and you’ll want to avoid it as
much as possible. It’s found in things like fatty meat, butter and cheese.
Cholesterol
This also increases your LDL cholesterol. Limit this to 200 mg per day at most.
Sodium (Salt)
Limit this to 1,500 mg or less per day.
Total carbohydrate
This number includes sugar, complex carbs and fiber. Sugar and fiber are
listed separately, too. To understand how much carbohydrate is actually in
a food, subtract half of the total fiber number from the total carb number.
Example: Total fiber = 6, Total carbs = 12 , so take 12 minus 3 (half the
total fiber number) = 9. This food contains 9 grams of carbs. A place
to start is 30-60 grams of carbohydrate per meal and 15—30 grams of
carbohydrate per snack. Ask your doctor or dietitian health coach.
Dietary fiber
Eat at least 25 grams every day.
Sugar alcohols
These include sorbitol, sylitol and mannitol and have fewer calories than sugars and
starches. Use of these doesn’t always make the product low carb or low calorie.
Even if the package says “sugar-free,” always check the carbohydrates and calories.
Half of sugar alcohols can be subtracted from the Total carbs, just like fiber.
Ingredient list
Ingredients are listed in the order of weight in the product, so the first
ingredient makes up the largest portion of the food. Stay away from
products with coconut oil or palm oil, which are saturated fats. Say no to
trans fats, also called hydrogenated oils. Look for olive, peanut or canola
oils and whole grains, for a healthy heart.
Nutrition experts suggest that shopping the outside edges of your grocery store
is where you need to focus most of your attention. It’s the edges that provide
fresh fruits and vegetables, meats, dairy and breads. It’s the inner aisles that
contain processed foods that may not be part of your new diet. That’s where
reading labels will come in very handy.
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A Fresh View on your Diabetes
COOKING FOR HEALTH
Part of learning to live with diabetes is experimenting with new ways of cooking.
High-fat oils, creamy sauces and dressings are replaced with low fat, low-carb
alternatives. Using a grill and steamer is the new normal. Here are some tips on
ways to cook that give an overall boost to your health.
TIPS FOR VEGGIES
Buy fresh or frozen vegetables. Canned veggies
tend toward higher salt content, which isn’t good
if you also have high blood pressure. Look for
veggies labeled “No Added Salt.”
Steam or grill your vegetables. Boiling takes
away the vitamins and cooking in heavy oil
makes them less healthy. You can also try gently
cooking them in a non-stick pan with a touch of
olive or canola oil or baking them in the oven.
To give your veggies more flavor, drizzle them with
low-fat salad dressing, lemon juice, vinegar or herbs.
Stay away from cream- or cheese-based sauces.
TIPS FOR MEATs
Bake, grill, roast or
broil your meats
Avoid frying
THE DINING OUT DILEMMA
If you dine out a lot, you know that many times portion sizes are big.
Food comes drenched in calorie-rich sauces and desserts are a mile high.
Staying on a stricter, healthier diet may seem impossible, but it’s not.
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A Fresh View on your Diabetes
FOUR WAYS TO WIN:
1
Select places to eat that offer
the chance to switch out one
food choice for another. Say,
green beans instead of fries.
2
If you’re eating at a restaurant
that has big portion sizes, try
splitting your dinner with a
friend or asking the server to
wrap half of your dinner to go
before you’re served.
3
To stop mindless munching before
dinner, ask the server not to bring
free bread, crackers or chips to the
table until dinner, if at all. If others
with you want to eat these things
before dinner, ask that they be
kept out of your reach.
4
Arrange your dinner date around
the time you would normally
eat so you don’t risk becoming
hypoglycemic. Be sure to eat
something to maintain your
blood glucose level, if you end up
having to wait for a table.
TIPS FOR THE TABLE:
Here are some quick tips to keep in mind:
Choose foods that are baked, broiled or
steamed instead of fried
Substitute vegetables for fries or potatoes
Have salad dressings and sauces served on the
side so you control the quantity you eat
Dip your fork points in the dressing or sauce
before you spear your bit of food
Ask for olive oil or margarine instead of butter
Trim visible fat from meat and remove the
skin from poultry
For salad bar visits, take a pass on the bacon
bits, cheeses and croutons
For dessert, choose fresh fruits or order one
dessert for the table and share with your dining
companions. Or wait until you get home
to enjoy a treat allowed on your meal plan.
Limit your alcohol intake
Academy of Nutrition and Dietetics:
Diabetes and Diet
eatright.org/food
Mayo Clinic: Dietary Fiber
mayoclinic.com/health/fiber/NU00033
U.S. Food and Drug Administration:
Reading Food Labels
www.fda.gov/food/resourcesforyou/
consumers/ucm274593.htm
Food Network:
Diabetes-Friendly Recipes
foodnetwork.com/topics/diabetic/
index.html
43
A Fresh View on your Diabetes
IN THE ZONE
DIABETES
AND EXERCISE
MISSION: DEFINITION
Obesity (oh-BEE-sitty):
a range of weight that is greater than what is considered healthy for a given height.
WHY EXERCISE?
Exercise does more than work your muscles. It helps your body in invisible ways,
such as improving your mood. It generally gets things moving all around and is
an important part of a healthy lifestyle. Obesity is one of the main causes for the
increase in type 2 diabetes in the U.S. By developing an exercise habit, you can shed
pounds, feel better and potentially lower your need for diabetes medicine.
THE BENEFITS OF EXERCISE
Improves your body’s use of insulin
Provides greater control over blood glucose levels
Reduces body fat, helping you lose weight
and control your diabetes better
Promotes muscle strength
Lowers your blood pressure
Improves your circulation
Lowers your risk of heart disease
Can lower your bad cholesterol and
increase your good cholesterol
Reduces stress
Increases bone density and strength
Improves your energy level
Helps you sleep better
DIABETES
BY THE NUMBERS
169 - 202
The weight in pounds at which
a five-foot nine-inch adult is
considered overweight.
203 +
The weight in pounds at which
a five-foot nine-inch adult is
considered obese.
Source: Centers for Disease
Control and Prevention
44
A Fresh View on your Diabetes
WHERE TO START?
The best place to begin is with your doctor. Your doctor will advise you on the following:
Exercises right
for you
Those based on your current health, physical stamina and that meet your exercise goals
Discus
s the exercises you should stay away from
Heart health
Your doctor may order a stress test to see how well your heart is working
Exercise
frequency
How often and for how long you should exercise in your current health state
Blood glucose
monitoring
Your blood glucose level can go up right after intense exercise
You may be told to test your level before, during and after exercise to understand
how your body responds and to keep your blood glucose at a safe level
What actions to take if your blood glucose level changes drastically
Insulin dosing
This may need to be changed depending upon the type of exercise, how long and its intensity
Equipment
needed
Properly fitting shoes protect the feet from added stress and blistering
The right socks protect the feet from rubbing and wick away sweat
An ID bracelet lets others know you have diabetes in case of an emergency
Other equipment may be needed, depending upon exercise plan
Fast-acting carbohydrates such as glucose tablets or gel
MAKE EXERCISE "NO HASSLE"
Choose activities that you enjoy – this makes it easier to stay with a program
Make it convenient – pick locations to exercise close to home or work
Exercise with a friend so you don’t get bored and so you have someone nearby in case of an emergency
Pick an activity you can easily afford – walking around your neighborhood is free
Exercise at the same time each day to support stable blood glucose levels
Decide on a routine and don’t change those times
Use an exercise journal or log like the one below to keep track of your progress (put it in
your notebook with all your other diabetes information)
45
A Fresh View on your Diabetes
EXERCISE LOG
Date Activity Done for
how long?
How I felt afterwards
Example:
2/25
Walked around the block 30 minutes Energized!
46
A Fresh View on your Diabetes
COMMON CONCERNS ABOUT EXERCISING
If it’s been a long time since you’ve exercised, you may have concerns. In fact, the
thought of exercising might be more than you want to think about. There are so
many benefits to exercising and few downsides.
“I don’t like to exercise!”
Many things can be thought of as “exercise” in your everyday life. These won’t replace
a formal exercise program, but are a simple way to support your activity goals. They’re
also easy to do because they can happen during the normal course of a day!
Walking around your house or up and down stairs when you’re talking on the phone
Taking the stairs instead of the elevator
Walking instead of driving
Working in the yard, gardening, or doing a bit of housecleaning every day
Parking far away from the door at a shopping center lot and walking briskly to the store
Walking with your significant other/child/grandchild/dog
Chasing toddlers around for ½ an hour
You can probably think of many other activities in your
normal day that can be considered exercise. It just takes a
little creativity. Now that you’re thinking, consider those
activities that you really enjoy. Do you like to dance?
Swim? Lift weights? Walk? It’s a fact that if you pick things
you like to do, you’re more likely to actually do them.
“I don’t know how to start.”
It’s ea
sy to feel overwhelmed, especially if you haven’t exercised in a long time – or
have never exercised. The hardest part is deciding to get moving. The next hardest
part? Actually doing it.
Consider this: Begin where you are. If you’ve been inactive for years, your body won’t
become athletic overnight. You’ll need to slowly ease your body into exercising. This might
mean exercising for 10 minutes once per day for several weeks. As you begin to notice
changes in your stamina, you can increase the amount of time you exercise. As you continue
to improve and feel better, you may decide to add other activities into your routine.
“I don’t have time.”
47
A Fresh View on your Diabetes
Remember the list of everyday activities? That counts as exercise. Suddenly, you have time
to exercise as you go through your normal day. There’s also a misconception that exercise
must be done all at one time. There is scientific evidence to suggest exercising for shorter
spurts twice or more a day is better for you than busting it out in one session. Break it up.
Even if something comes up and you can’t get all of your minutes in for a day, you will still
have done some exercising – and that’s way better than nothing!
“Exercising is expensive, and I’m on a budget.”
Actua
lly… exercising doesn’t have to be expensive. Sure, you could join a fancy gym or buy
tons of equipment for your home, but you don’t have to do that. Exercising is as easy as:
Taking a walk with a friend
Borrowing an exercise video from the library or a friend
Participating in free exercise classes at your local community center
Buying a used treadmill or stationary bike and using it at home
Dusting off your old bicycle and tooling around the neighborhood
Using two equally sized cans of soup as weights for strength training
Incorporating “body weight” exercising – all you need is…you!
“I could get hurt or my blood glucose level could drop.”
Working with your doctor to figure out the best exercise plan for you will help you
stay off t
he disabled list. Your doctor will also advise you on how to manage your
blood glucose level best. Here are some additional points to remember before and
after you exercise:
“I could get hurt or my blood glucose level could drop.” continued
48
A Fresh View on your Diabetes
Before exercising
Check your blood glucose level if your doctor says you should.
Bring glucose tablets or a snack so you’re prepared to treat low blood glucose if it happens.
Drink plenty of water before, during and after exercise – especially in warm weather.
Carry identification including information that you have diabetes.
After exercising
Check your blood glucose level. If it’s always lower than your goal, talk with your doctor
about what to eat before you work out. Your doctor may also need to adjust your medication.
Keep track of your activity level by using your exercise log or journal.
“I have trouble sticking with exercise programs.”
This is a common problem. An easy fix is to invite a friend to work out with you.
Having s
omeone else to share the experience will make you more likely to stick with
it. You motivate each other and share in the successes you’ll each have. You both win.
FIT AND FABULOUS
Now that you’ve learned how to take care of yourself and what exercise can do for
you, there are just a few more things to keep in mind that haven’t been mentioned yet.
KEEP EXERCISING.
If you have a good routine going, keep at it.
You can’t start and stop exercising and expect
to maintain your fitness level. Consistent
workouts are what will have you (and everyone
else) seeing results. So keep going!
USE THE “TALK TEST”
WHEN EXERCISING.
You should be able to carry on a
conversation while exercising without
gasping for air. If you’re straining to
talk, you could be working too hard.
49
A Fresh View on your Diabetes
TIRED, NOT EXHAUSTED
AFTER EXERCISE.
Exercise should leave you feeling nicely tired,
not exhausted. When you exercise to tiredness,
your endorphins should kick in and give you a
wonderful sense of happiness. If you’re exhausted
and too tired to move, you may have overdone it.
Lesson learned. Dial it back a bit next time.
EXERCISING WHEN YOU’RE SICK
COULD MAKE YOU SICKER.
Not to mention infecting everyone around you.
Hold off on exercise until you feel better. You
can exercise with a cold (runny nose, nasal
congestion, sneezing and/or a bit of a sore
throat) but you might feel better staying in
bed. If you have anything else, such as chest
congestion, cough, upset stomach, don’t
exercise. Absolutely hold off on exercising if
you have a fever, fatigue or body aches.
TEMPERATURE MATTERS.
You may need to exercise indoors when
the temperature outside is too hot, too
cold, or if it is too humid. Wear a medical
ID bracelet or necklace and carry a cell
phone when you exercise outdoors or
away from home. Always let someone
know when you plan to be back. And
don’t forget to stay well hydrated!
PAT YOURSELF ON THE BACK
Everyone likes to be recognized for a job
well done. The same is true for you. Give
yourself little rewards for staying with your
exercise goals. Having a reward in mind is a
subtle way to keep you motivated. Have a new
outfit you’ve been eyeing? What about that
new gadget you’ve been wanting? Figure out
your reward and what it will take to reach it.
Celebrate your success!
WebMD: Exercising with Type 2 Diabetes
diabetes.webmd.com/guide/exercise-guidelines
National Diabetes Information Clearinghouse (NDIC)
Department of Health and Human Services
diabetes.niddk.nih.gov/dm/pubs/physical_ez
Diabetes Education Online: Exercising with Type 1 Diabetes
University of California – San Francisco
dtc.ucsf.edu/living-with-diabetes/activity-and-exercise/
exercise-guidelines-faqs/exercise-guidelines-faqs
50
A Fresh View on your Diabetes
SNUFF THE PUFF
SMOKING AND
DIABETES
Seriously? You’re still smoking? There really isn’t a good
reason to be smoking these days. After all, there are so
many health issues, most of them pretty scary. If you
have diabetes, it’s more important than ever that you
snuff the puff – QUIT SMOKING.
FOUR FANTASTIC REASONS
TO QUIT SMOKING
1
Lower your risk of other diseases…
Smoking raises the chance of
having heart disease, kidney and
foot problems.
2
Reduce circulation problems…
Nicotine affects both the large
and small blood vessels, reducing
blood flow throughout the body.
3
Look better…
Smoking causes facial wrinkles
and dull skin.
4
Improve your health overall…
Smoking can cause coughing,
reduce lung capacity and cause
sore throats.
51
A Fresh View on your Diabetes
CHOOSING HEALTH OVER HABIT
There’s no question that quitting smoking is hard. It can be difficult to make the
decision to quit. In this case, however, the benefits far outweigh the difficulty of
quitting. It helps to have a plan of attack so you set yourself up for success. But
remember, anytime is a great time to quit, but it helps a lot if you’re not under stress
or dealing with other conflicts or problems at the same time.
Think about putting these steps in place before you actually stop smoking.
Step 1:
Set your quit date. Consider calling it something positive such as “My
New Life Day.” This helps focus on the fact that you’re making a wise
and healthy new lifestyle choice.
Step 2:
Write your reasons for quitting. They could be like the reasons
above, or additional ones, such as “smell better,” “protect my
kids from secondhand smoke”.
Step 3:
Toss out all your cigarettes, matches, lighters and
ashtrays, preferably in a place where you can’t get
them back.
Step 4:
Tell people what you’re doing. Some smokers
become more emotional when they quit, so
letting others know what you’re doing will
aid in their understanding if you’re cranky,
weepy or quieter than usual.
Step 5:
Decide how to quit. Some people just
stop “cold turkey.” Others taper off
gradually. Still others need some extra
help through cigarette replacements like
nicotine gum or smokeless alternatives.
Talk with your doctor about what
makes the most sense for you.
52
A Fresh View on your Diabetes
FIGHTING THE URGE
It’s going to happen. You’ll have an almost uncontrollable desire to smoke, likely more
than once. That’s just your body trying to feel “normal.” It doesn’t matter if you smoked
for months or years. Smoking changes how the body feels – and when you quit, it will
fight you mightily to get its “fix.” Fight the urge with the suggestions below.
Take in a deep breath and hold it for 10 seconds when the urge to smoke hits
you. Then, release it slowly. Continue breathing in this way until the urge passes.
This mimics smoking, except you’re breathing in air, not cigarette smoke.
Chew sugarless gum, suck on a sugar-free hard candy, eat a bit of beef
jerky. In other words, keep your mouth busy.
Hang out in places where smoking isn’t allowed.
Exercise to take your mind off smoking.
Take up a hobby to keep your hands busy.
When the urge to smoke hits, take a drink of water.
Change your habits. People tend to smoke during certain times: on a
break, when studying, a night out. Understanding when you might be
triggered to smoke can help you either stay away from those situations or
give you a chance to plan to do something other than smoke.
Quitting smoking is serious business and it isn’t easy.
Over time, once you quit, you’ll be amazed at how
different you feel, how good food tastes and, possibly,
how much easier it is to control your diabetes.
DIABETES
BY THE NUMBERS
7
The ranking of diabetes in the Centers
for Disease Control and Prevention’s
TOP 10 CAUSES OF DEATH IN THE
U.S. Smoking with diabetes makes the
risk all the more deadly.
American Diabetes Association: Smoking
diabetes.org/are-you-at-risk/lower-your-
risk/smoking.html
WebMD: Diabetes and Smoking
webmd.com/diabetes/diabetes-smoking-
cessation-tips
53
A Fresh View on your Diabetes
NONE FOR THE ROAD
DIABETES AND ALCOHOL
HEAD FOR THE MONITOR
Remember how we said sweets and foods high in carbs or too much of most any
kind of food can send your blood sugar into the clouds? Alcohol can also affect your
blood sugar. Alcohol contains “empty” calories, and almost as many calories as fat.
Monitor your blood glucose levels whenever you drink alcohol.
LIMIT ALCOHOL TO OCCASIONAL TIMES WHEN YOUR BLOOD SUGAR IS WELL CONTROLLED
Ways alcohol can affect diabetes:
Alcohol can lower blood sugar, causing it to drop to dangerous levels
Alcohol increases appetite, making you want to overeat, which can raise blood sugar
Alcohol can lessen the effects of diabetes meds taken by mouth
Alcohol can increase triglycerides and blood pressure
Alcohol can raise blood sugar over time
Have diabetes and like to drink alcohol? Remember these Do’s and Don’ts.
DO
Drink only when your blood glucose
level is under control.
Drink alcohol only with food.
Drink slowly.
Mix alcohol with water or diet soda to dilute it.
Sip slowly to make it last longer.
DON’T
Drink more than two drinks of alcohol a day
for men or more than one a day for women.
Drink sugary mixed drinks, sweet wines or cordials.
Forget to wear your medical alert ID stating
that you have diabetes.
Drive for several hours after drinking.
Mayo Clinic: Alcohol and Your Body:
mayoclinic.org/diseases-conditions/diabetes/in-depth/diabetes-management/art-20047963?pg=2
54
A Fresh View on your Diabetes
YOUR DIABETES
A CHANGE FOR LIFE
Living with diabetes will change your life. You’ll
have to adopt new habits such as monitoring your
blood glucose levels regularly, eating a healthier
diet and exercising. You’ll have to leave old habits
behind like smoking.
For many, especially those who develop diabetes
later in life, it’s a wake-up call. And a second
chance to live life to the fullest.
DIABETES
BY THE NUMBERS
1
Where you rank as a team member on your Diabetes
Management Team. If you haven’t yet started your
diabetes treatment plan, this is it. Step up to the plate
and swing for the fences. The rest of the team is
counting on you.
55
A Fresh View on your Diabetes
CREDITS AND
SPECIAL
THANKS TO:
Centene’s Diabetes Management Team:
Mary Mason, M.D., MBA
Amy Poole-Yaeger, M.D.
Contributors:
Monica Arter, R.N.
Cathie Krueger, R.N., B.SN.
Cathleen McDaniel
Patty Vickers, MS, RD, LD, CDE, BC-ADM
Pamela Neff, RD, LD, CDE
56
A Fresh View on your Diabetes
NOTES
RESOURCES
American Diabetes Association
1-800-DIABETES or 1-800-342-2383
diabetes.org
Academy of Nutrition and Dietetics
1-800-877-1600 or 1-800-877-0877
eatright.org
U.S. Food and Drug Administration:
Food Safety for People with Diabetes
Department of Health and Human Services
www.fda.gov/Food/
FoodborneIllnessContaminants/
PeopleAtRisk/ucm312706.htm
Centers for Disease Control and Prevention:
Diabetes Public Health Resource
cdc.gov/diabetes
National Diabetes Information
Clearinghouse (NDIC)
Department of Health and Human Services
diabetes.niddk.nih.gov
Diabetes Health Hotline
1-800-342-2383
National Diabetes Education Program
ndep.nih.gov/
MedicineNet: Diabetes Supplies:
What Medicare Covers
medicinenet.com/script/main/art.
asp?articlekey=21534
USDA
ChooseMyPlate.gov
President’s Council on Fitness,
Sports & Nutrition
fitness.gov
Smoke Free
smokefree.gov
© 2014 Centene Corporation. All rights reserved. All materials are exclusively owned by Centene
Corporation and are protected by United States and international copyright law. No part of this
publication may be reproduced, distributed, displayed, stored in a retrieval system, or transmitted
in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise,
without the prior written permission of Centene Corporation. You may not alter or remove any
trademark, copyright or other notice. v.2
MCARE14-00013E
A
on your
Diabetes
Diabetes can happen to anyone,
especially if you have a family history
of it. This book offers insightful
information to help you manage your type 1 or type 2 diabetes. And if you’re
Prediabetes, you’l
l learn how to care for yourself now, so you don’t develop type 2
diabetes later. You’ll learn:
WHAT DIABETES IS
WHAT CAUSES IT
SYMPTOMS TO BE AWARE OF
NECESSARY TESTS
NUTRITION AND COOKING
EXERCISE
REDUCING STRESS
QUITTING SMOKING
MORE
ISBN: 978-0-9857750-9-4
MADE IN THE
U.S.A.
Because Where’s It
@? Media
cares about the environment,
this book was printed on
recycled paper.
Created by MICHELLE BAIN
Design by SAM WASHBURN
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