Managing Diabetes

Managing Diabetes

Valerie M. Turner, MSN, RN, CNS, CDE.

Diabetes Connections 4 Life

 

You can manage your diabetes and live a long and healthy life by taking care of yourself each day.

Diabetes can affect almost every part of your body. Therefore, you will need to manage your blood glucose levels, also called blood sugar within the range recommended by your health care provider.  This can be challenging, because many things make your blood glucose level change, sometimes unexpectedly.

 

Managing your blood glucose, as well as blood pressure, and cholesterol can reduce the risks of developing several health problems. With the help of your health care team, including a Certified Diabetes Educator (CDE), you can create a diabetes self-care plan to manage your diabetes. Your self-care plan should include these steps:

Manage your diabetes ABCs

 

Knowing your diabetes ABCs will help you manage your blood glucose, blood pressure, and cholesterol. Stopping smoking, if you smoke, will also help you manage your diabetes. Working toward your ABC goals can help lower your chances of having a heart attack, stroke, or other diabetes problems.

 

A B C
A1C Blood Pressure Cholesterol
Average blood glucose.  This blood test shows glucose control over the past few months.  A normal A1C is below 5.7%.

 

Goal: Based on the individual.  In general, for a non-pregnant person with diabetes: less than 7%.

Force of the blood flow in your blood vessels.

 

Goal: Less than 140/90mmHg

 

Tip: 2 out of 3 people with diabetes report having high blood pressure.  Be sure to have yours checked at every health visit.

A waxy, fatlike substance in all body cells.

 

Total Cholesterol

Goal: Less than 200mg/dl

 

LDL (Bad Cholesterol)

Goal: Less than 100md/dl

 

HDL (Good Cholesterol)

Women  greater than 50mg/dl

Men greater than 40mg/dl

 

Triglycerides: A type of fat that circulates in the blood.  Elevated levels increase the risk for heart disease.

Goal: Less than 150mg/dl

 

S for Stop smoking

Not smoking is especially important for people with diabetes because both smoking and diabetes narrow blood vessels. Blood vessel narrowing makes your heart work harder. E-cigarettes aren’t a safe option either.

If you quit smoking, it will:

  • Lower your risk for heart attack, stroke, nerve disease, kidney disease, diabetic eye disease, and amputation.
  • Your cholesterol and blood pressure levels may improve.
  • Your blood circulation will improve.
  • You may have an easier time being physically active.

If you smoke or use other tobacco products, stop. Ask for help so you don’t have to do it alone. You can start by calling the national quitline at 1-800-QUITNOW or 1-800-784-8669. For tips on quitting, go to SmokeFree.gov .

Keeping your A1C, blood pressure, and cholesterol levels close to your goals and stopping smoking may help prevent the long-term harmful effects of diabetes. These health problems include heart disease, stroke, kidney disease, nerve damage, and eye disease. You can keep track of your ABCs with a diabetes care record (568 KB). Take it with you on your health care visits. Talk about your goals and how you are doing, and whether you need to make any changes in your diabetes care plan.

Healthy Eating

Healthy eating is the cornerstone of healthy living with or without diabetes.  However if you have diabetes, you need to know how food effects your blood glucose (sugar) levels.  Learning to eat regular meals, controlling the amount you eat and making healthy food choices can help you manage your diabetes, and help prevent other health problems.

The good news is, you can still enjoy your favorite foods.  It’s the amount that matters.  Ask your health care provider for a referral to attend Diabetes Self-Management Education where a Certified Diabetes Educator or Registered Dietician who specializes in diabetes can help you develop a meal plan that can help you reach your goals.

The following is a list of skills the diabetes educator or registered dietician will help you develop.  Some are more complex.

  • Counting carbohydrates
  • Reading food labels
  • Measuring the amount of a serving
  • Developing a practical meal plan
  • Preventing high or low blood sugar
  • Setting goals for healthy eating.

There are only three types of nutrient in food; carbohydrates, proteins, and fats.  A healthy meal will include all three.  Foods from the carbohydrate group (also known as carbs) will have the greatest effect on your blood glucose level.  Therefore, choosing the right amount of carbs will help you control your blood glucose level.

 

WHAT ARE CARBS?
1.     Sugars

2.     Starches

3.     Fiber

·         Sugars and starches make glucose rise.

·         Some fibers slow the absorption of sugar after a meal.

Women: Meal 45-60gm; Snack 15gm

Men: Meal 60-75gm; Snack 15-30

 

Foods in the carbohydrate group include; bread, tortillas, rice, crackers, cereal, fruit, juice, milk, yogurt, potatoes, corn, peas, and sweets.  Keep the amount of carbs in your meals and snacks about the same day to day to help you reach your blood glucose goals.

 

Healthy Eating and Blood Pressure Control

According to the ADA, the combination of hypertension (high blood pressure) and type 2 diabetes is particularly lethal and can significantly raise your risk of having a heart attack or stroke. Having type 2 diabetes and high blood pressure also increases your chances of developing other diabetes-related diseases, such as kidney disease and retinopathy. Diabetic retinopathy may cause blindness.

 

There is also significant evidence to show that chronic hypertension can speed the arrival of cognitive problems associated with aging, such as Alzheimer’s disease and dementia. That is because the blood vessels that supply the brain can weaken just like the heart.

 

Limiting the amount of sodium (salt) you eat can help control your blood pressure.  There are several ways to decrease the amount of salt in your diet. A Certified Diabetes Educator (CDE) or Registered Dietician will assist you with developing a meal plan that will help you reach and maintain your blood pressure goals.

 

 

Healthy eating and Lipids (Fats)

Lipid refers to the cholesterol and triglycerides in the blood.  Abnormal lipid levels increase the risk of heart disease.  Choose foods low in saturated fats.  This will help you lower your cholesterol and decrease your chance of developing heart disease.  Foods high in saturated fats include; meats, butter, whole milk, cream, cheese, lard, shortening, many baked goods, and tropical oils such as palm and coconut oil.

Eat More Fiber

The average person should eat between 20-35 grams of fiber each day. Most Americans eat about half that amount. There are two types of fiber: insoluble and soluble. Insoluble fiber keeps your digestive tract working well. Whole wheat bran is an example of this type of fiber. Soluble fiber can help lower your cholesterol level and improve blood glucose control if eaten in large amounts. Oatmeal is an example of this type of fiber.

Another benefit of fiber is that it adds bulk to help make you feel full. Given these benefits, fiber is important to include in the daily diet for people with diabetes, as well as those who don’t have diabetes. You can add fiber by eating whole grain products, fruits, vegetables, and legumes. Leave the skin on fruits and vegetables, as it is high in fiber. Eat whole grain breads and crackers. And be sure to increase your fiber intake gradually, and remember to drink 6-8 glasses of water per day to avoid constipation.   Of course, most of the foods that contain fiber (fruits, vegetables, whole grain breads, cereals, and pastas) also contain other types of non-fiber carbohydrate (sugar, starch) that must be accounted for in your meal plan.

Read Food Labels

By law, the US Department of Agriculture has required that Nutrition Facts labels be placed on most packaged foods for sale.  The label has a great deal of information on it.  You can use the label to help you make better food choices.  A Certified Diabetes Educator or Registered Dietician can help you develop this skill.

Lower Portion Size

The amount of food you eat is called a portion.  The portion you eat may actually be several serving sizes, based on the serving size on the Nutritional Facts panel of the food label.  Cutting back on food portions at meals and snacks can help with weight loss.

Healthy Eating Weight

For people with prediabetes and those in the early stages of type 2 diabetes, moderate weight loss can help the body use insulin better.  A moderate weight loss means losing 5% – 10% of body weight.  Weight loss also helps to control blood pressure and lowers the risk of getting certain kinds of cancer.

Physical activity should always be a part of any weight loss effort, along with a helpful eating plan.  Studies show that slow weight loss of ½ to 2 pounds per week is kept off more easily than rapid weight loss.  Rapid weight loss is usually regained.  Also, losing more than 3 pounds per week for more than a few weeks increases the risk of gallstones.

HYPOGYCEMIA HYPOGLYCEMIA
Low blood glucose.  Occurs when blood glucose is lower than normal, generally less than 70mg/dl.

 

Signs

·         Hunger

·         Shaking

·         Nervousness

·         Sweaty

·         Dizzy

·         Tired

·         Confused

·         Risk of Diabetic Shock

When blood glucose is above target range.

·         Fasting: 80-130mg/dl

·         Before a meal: 80-130mg/dl

·         1-2 hours after a meal: Less than 180mg/dl

Signs:

·         Blurry vision

·         Frequent urination

·         Thirst

·         Fatigue

·         Headache

Advanced Signs:

·         Fruity breath

·         Dry mouth

·         Breathless

·         Stomach pain

·         Nausea

·         Vomiting

·         Weakness

·         Confusion

·         Risk of Diabetic Coma

 

 

Physical Activity

Physical activity is not just about losing weight.  Physical activity:

  • Helps keep your blood glucose (sugar), blood pressure, and cholesterol levels on target.
  • Lowers your risk of heart disease and stroke.
  • Relieves stress.
  • Helps insulin work better.
  • Strengthens your heart, muscles, and bones.
  • Improves your blood circulation and tones your muscles.
  • Keeps your body and your joints flexible.

It can be difficult to find the time or the motivation to start an exercise program.  However, even if you’ve never exercised before, you can find ways to add physical activity to your day.  You’ll get benefits, even if your activities aren’t hard to do.  The important thing to remember is to choose activities that you enjoy doing; whether it’s walking to work, doing chair exercises, or working out at the gym. Remember to set realistic goals.  Once physical activity is a part of your routine, you’ll wonder how you did without it.

If I Haven’t Been Very Active Lately, What Should I do First?

Before beginning an exercise plan, visit your health care provider.  Your provider will check your heart, blood vessels, eyes, kidneys, feet, and nervous system.  If you have health problems, your provider can recommend physical activities that will help you but won’t make your conditions worse.

What Kinds of Physical Activity are Best?

Being active helps burn calories.  Get up and move every 90 minutes if sit for long periods of time.  A complete physical activity routine includes 3 different kinds of activities:

  1. Activity
  2. Aerobic exercise
  3. Strength training

Activity

Activity is, activities that get your body moving.  Here are some ways to become active:

  • Walking
  • Taking stairs
  • Moving around throughout the day.

Aerobic Exercise

Aerobic exercise makes your heart and bones strong, relieves stress, helps your insulin work better, and improves blood circulation.  It also lowers your risk for heart disease by keeping your blood glucose (sugar), blood pressure, and cholesterol levels on target.

For most people with diabetes, it’s best to aim for a total of about 30 minutes a day, at least 5 days  a week (a total of at least 150 minutes each week).  If you haven’t been active recently start with 5 or 10 minutes a day, and work up to more time each week.  You can also split up your activity for the day.  Try a brisk 10-minute walk 3 times a day.  Your health care team can show you how to warm up, stretch, and how to cool down afterward.

Here are some ways to get aerobic exercise:

  • Take a brisk walk every day.
  • Go dancing or take an aerobic dance class.
  • Swim or do water aerobic exercises.
  • Take a bicycle ride outdoors or use a stationary bicycle indoors.

Strength Training

Strength training helps build strong bones and muscles and makes everyday chores like carrying groceries easier for you.  With more muscle, you burn more calories, even at rest.  Strength training also helps your insulin work better.

Do your strength training routine 3 times per week.  Here are some things to try:

  • Lift light weights at home.
  • Join a strength training class that uses weights, elastic bands, or plastic tubes.
  • When you travel, make time to use the hotel fitness center.

How to Keep a Record of Your Progress:

Keep track of your efforts to be active.  You might find that writing everything down helps keep you on target.  Think about what works for you:

  • Keep a small notebook with you all day. Write down what kind of physical activity you’ve done and for how long.
  • Mark your activity program on a calendar or daily planner and chart your progress.
  • Find an Internet-based exercise-tracking log and record how you are doing on-line.

How a Support System can Help:

You might find it helpful to meet on a regular basis with people who are trying to be active.  Think about joining a group for exercise or general support.  Find a walking buddy, and work together to reach your goals.

Taking Medication

There are several types of medications recommended for people with diabetes.  Insulin and oral medication that lower your blood glucose (sugar), aspirin, blood pressure medication, cholesterol –lowering medication, and a number of others medications.  Several medications may work together to help you lower your blood glucose levels, reduce your risk of complications, and help you feel better.

Take your medication for diabetes and any other health problems, even when you feel good or have reached your blood glucose, blood pressure, and cholesterol goals.  The medications help you manage your ABC’s.  If you are not taking aspirin, ask your health care provider if you need to take it, to prevent a heart attack or stroke.

Your medications come with specific instructions for use, and they affect your body differently depending on how and when you take them.  It may take a while to figure out which medicines work best with your body.  Therefore, it is important for you to pay attention to how you feel and how your body reacts to each medicine or treatment.  It’s up to you to tell your health care provider, diabetes educator, or pharmacist if you’ve noticed any side effects.  A side effect is an effect that a drug has on your body that it is not intended (i.e. diarrhea, nausea, headache).  It is important to know the names, doses, and instructions for the medications you are taking, as well as the reasons they are recommended for you.

Why is Medication Necessary?

In type 1 diabetes, insulin is always needed to replace what the pancreas no longer produces.  Type 2 diabetes is a progressive condition.  It starts with insulin resistance.  This means that the body is unable to respond properly to its own insulin.  Physical activity and eating healthy can help reverse insulin resistance, but only to a point.  There comes a time when medicine is needed to help your body cells become more sensitive, and less resistant to insulin.

The next thing that happens in type 2 diabetes is a decline in insulin production.  This decline continues as long as you live.  When your pancreas cannot make enough insulin, medication is needed to help control your blood glucose level.  In the earliest stages of type 2 diabetes, oral medication can often help you make more insulin.  If your body doesn’t respond to the oral medication, insulin can be taken.

Many people feel that taking medication is proof that they didn’t do a good enough job with their efforts to change lifestyle.  This is not entirely true.  Your efforts to eat healthy and be physically active are very important.  You should continue to do your best with meal planning and activities to control your weight, and help prevent other health problems caused by type 2 diabetes.  It’s just the natural progression of things.

Oral Diabetes Medication (Pills)

For each main problem in diabetes, there is a medication that can help.  Sometimes, it takes more than one medicine to control your glucose level.  Your health care provider won’t know which medicine is effective until you try it.  It takes time to learn how your body responds to each medicine.  That means your provider may try one medicine first adjust the dose after a while, then perhaps change you to another medicine, or add another one.  It’s important to be patient while your provider discovers the right combination of medicines for you.  Knowing what side effects to watch for is crucial.  Contact your diabetes educator whenever, you have a change in medication.

Insulin

Normally the pancreas releases a small amount of insulin in a slow, steady stream throughout the day.  When a meal is eaten, the food breaks down into glucose which is fuel for the body.  The glucose gets into the bloodstream as the food is digested.  When you begin to eat, a burst of insulin is released from the pancreas into the bloodstream.  Insulin moves the glucose from the bloodstream into the cells.  Once glucose is inside the cells, energy is released.  This is how the body gets the energy it needs.

In type 1 diabetes, insulin production stops completely.  Insulin therapy is always needed to maintain life and regulate the blood glucose level. In type 2 diabetes, there is a continued decline in the amount of insulin produced.  In most people with type 2 diabetes, the time will come when their pancreas can no longer make enough insulin to meet their needs.  At that point, insulin therapy is needed to regulate the blood glucose level.

Currently, insulin is only available by injection or by way of an insulin pump.  An insulin pump can deliver a steady amount of insulin constantly throughout the day and night.  At mealtime, it can deliver a larger burst of insulin. In this way, it mimics the normal action of the pancreas.  Insulin cannot be taken in pill form because the digestive juices will destroy it.

  • Side Effect: Because insulin lowers blood glucose, there is always a possibility the glucose level could drop to low.  This is called hypoglycemia.  To keep hypoglycemia from occurring you should balance your food and activity with insulin’s action.  You should check your glucose level to see how you respond to insulin.

Non-Insulin Injectable Medication

Non-insulin injectable medication is for people with type 2 diabetes who take one or more oral diabetes medicines, but whose glucose levels remain above target.  These medications are not replacements for insulin, are not intended for use with type 1 diabetes.  This class of injectable medicine, is becoming more popular for several reasons, not the least of which is, they result in weight loss.

This class of medication is called incretin memetics, meaning they mimic the hormones (incretin hormones) that tell the body to release insulin after eating.  These medicines work by enhancing insulin secretion, slowing stomach emptying, reducing food intake, and enhancing the production of bête cells (cells that make insulin).  Some are taken as infrequently as once per week.

Do you Know?

Some over-the-counter medications, supplements, or natural remedies can interfere with the effectiveness of your prescribed medication.  Some liquid medications are sweetened with sugar to cover their taste.  Sometimes an alternate medication may be recommended.  Always check with your health care provider and your diabetes educator before taking any new over-the counter.  They will inform you about the impact it may have on your blood glucose level.

Be Your Own Advocate

The more you know about how to take your medicines and how to take all of your doses as prescribed, the better it will work for you, and the healthier you’ll stay. Here are some pointers to get the most from your medicines:

  • Know the names of your medicines, what they do and how and when to take them.
  • Keep a current list of all your medicines with you at all times, including the name, strength and directions. An example would be “Aspirin 81mg, Take once daily.”
  • Always ask for clarification if you have any doubts about your medicines.
  • Bring a list of the questions you have about your medicines to each visit with your diabetes care team.
  • If you have problems fitting your medicines into your everyday life (work schedule, meals, activities) ask for help or suggestions to make your medication routine simpler to follow.

Strategies for Remembering to Take your Medication

  • Take your medicines the same time each day. Set a daily routine.
  • Link your medicines with a current activity. For example:
    • Place your medicines (or reminder) next to your tooth brush.
    • Put a glass of water next to your medicines so they are ready for your morning dose.
    • Place your prescription vials on the counter next to your toaster or breakfast plate.
  • Schedule reminders on your phone or have family or friends remind you. (You can do the same for them!)
  • Use pill boxes with daily compartments that you fill each week.
  • Place sticky notes on the refrigerator or in other strategic locations.