EDUCATION BOOKLET - Healthy Transitions Colorado
Contents
1. Cholesterol My current lab values Individual farget Alc Less than 7 Blood Pressure Less than 130 80 Cholesterol Total Less than 200 HDL Women greater than 50 Men greater than 40 LDL Less than 100 What is the Alc test It is a blood test done in the lab that measures your average blood sugar level for the past 3 months e t should be checked every 3 to 6 months e The higher your Alc the higher your risk for getting complications e Atc goal should be less than 7 Knowing both your Ale and your daily blood sugars gives a heiter total picture of your diabetes control Alc Average Blood Sugar mg dl 13 330 12 soo High risk for complications 11 2 0 10 240 9 210 8 180 7 150 E 120 Low risk for 5 90 complications 4 60 Normal is 5 7 or below Aim for an Alc below 7 Date My Mec Managing Diabetes AADE Self Care Behaviors These 7 things can help make sure you stay healthy You can work with your diabetes care team to decide how to fit them into your daily life 1 Healthy Eating e Do not skip meals o Eat when you are hungry Stop when you feel satisfied e Eat meals and snacks at regular times every day o Eat 3 balanced meals a day plus snacks if you are hungry o Spread meals out over the day e Eat a variety of foods o Add lots of color to meals with fresh fruits and lots of vegetables o Enjoy plenty of whole grains O Make sure you get enough fiber every day e2. www centura org Centura Health complies with the Civil Rights Act of 1964 and Section 504 of the Rehabilita tion Act of 1973 and no person shall be excluded from participation in be denied benefits of or otherwise be subjected to discrimination in the provision of any care or service on the grounds of race religion color sex national origin sexual preference ancestry age familial Status disability or handicap Copyright O Centura Health 2011 Fe E Broadcast Yourself What is Diabetes Taking good care of yourself can seem overwhelming when you have diabe tes whether you ve just learned you have the disease or you ve had it for a long time The right tools and support can make diabetes self care very man ageable in your everyday life What is diabetes e When you eat some of your food is broken down into sugar Sugar travels in your blood to all your body s cells Insulin is a hormone that is made by the beta cells in your pancreas It works to move sugar from your blood into your cells e Diabetes means your blood sugar glucose is too high because your body is not able to use the sugar for energy This happens because insulin does not work right You can think of diabetes as an insulin prob lem and not a sugar problem e When you have type 2 diabetes your body is not able to use the insulin correctly and your body often doesn t make enough insulin When you have type 1 diabetes y
3. Watch portion sizes e Slow down and enjoy the flavor of each bite of food e Limit sweets and regular soda 2 Being Active e Aim for 30 minutes of non stop activity each day e Start slowly if you haven t exercised for awhile and talk to your doctor about activity guidelines e Choose activities that you enjoy 3 Monitor and record your blood sugar levels e Check your blood sugars with your meter every day e You may check when you wake up in the morning before you eat or 2 hours after eating e Record your blood sugars in a logbook and bring it to all your medical appointments Instructions for checking your blood sugar After washing your hands insert a test strip into your meter Use your lancing device on the side of your fingertip to get a drop of blood Gently squeeze or massage your finger until a drop of blood forms Re quired sample sizes vary by meter Touch and hold the edge of the test strip to the drop of blood and wait for the result Your blood glucose level will appear on the meter s display Note All meters are slightly different so always refer to your user s manual for specific instructions Other tips for checking With some meters you can also use your forearm thigh or fleshy part of your hand There are spring loaded lancing devices that make sticking yourself less painful If you use your fingertip stick the side of your fingertip by your fingernail to avoid h
4. and cholesterol are staying within your target range e You are seeing your doctor every 3 months for ongoing checkups Call your doctor in the NEXT 24 HOURS if You notice you have a blister sore or another abnormality in your feet and it is getting larger or seems infected e You are not sick and you are taking your medicines but your blood sugar levels seem to have suddenly changed e You have questions or want to know more about diabetes O Call your doctor RIGHT AWAY when e You are sick and your blood sugar stays over 300 mg dL for more than 24 hours Do not take over the counter medications without first consulting your doctor e You have been throwing up or have severe diarrhea for more than 6 hours e You have moderate or large amounts of ketones in your urine if you have been told to check this and they won t come down after several hours of treatment If you develop abdominal pain If you often have problems with high or low blood sugar levels If you have trouble knowing when your blood sugar is dropping low Call dale or other emergency services right away if you are Unconscious or you suddenly become very sleepy or confused and difficult to awaken e You cannot think clearly your breathing becomes fast and you have a high fever that won t come down e You have a low blood sugar that will not come up after multiple treatments with carbohydrate The best way to prevent diabetic emergencies is to
5. aving sore spots on the frequently used part of your finger Call the 800 on the back of your meter for questions customer service 4 Take your medications as directed e Know how your medicines work and when you should take them e Know which medicines can cause blood sugar to drop too low e Keep alist of all your medications and carry it with you ol Reducing Risks e Schedule doctor appointments at least every 3 months e Follow sick day rules when you are feeling sick e Keep your blood pressure and cholesterol at a healthy level e Check your feet daily for redness sores or cuts o Wash your feet every day and make sure you dry feet amp toes well o Cut toenails straight across regularly See a foot doctor if you have toenail problems Reducing Risks continued o Wear comfortable shoes o Do not go barefoot always wear shoes that protect your feet and slippers with a hard sole o Use lotion to keep skin soft but not between your toes e Visit your eye doctor every year for a dilated eye exam e Take good care of your skin o Avoid very hot baths or showers o Moisturize skin with non alcohol based lotion o Treat cuts right away see your doctor right away if you get a major cut burn or infection e Take good care of your teeth o Brush amp floss your teeth and gums every day o Change your toothbrush every three months o Have your teeth examined and cleaned every 6 months O See your dentis
6. od sugar acetate Used with insulin Nausea Vomiting Helps lower after meal blood sugars Lantus must not be mixed in a syringe with any other insulin What about insulin safety Check the expiration date and do not use it if it has expired An open vial is only good for 30 days Look at the bottle and be sure regular insulin is clear NPH insulin should be cloudy but should not be clumped or have floating pieces in it If it does do not use It When should take insulin Try to take Insulin at about the same time every day How should store insulin Most people store their insulin in the refrigerator The door of the refrig erator is best Insulin can be kept at room temperature If insulin gets too hot or cold it breaks down and does not work Do not keep it in very cold places such as the freezer or in hot places such as by a window or in the car s glove box Your Action Plan Use this guide to help you report changes to your doctor or other healthcare provider For most medical problems you should first call your primary care doctor Your doctor can answer your questions and guide you to make an ap pointment if needed al are doing WELL when You have no symptoms of high or low blood sugar e You are checking your blood sugar levels and they are staying within your target range most ofthe time e You are eating right staying active and maintaining a healthy weight e Your blood pressure
7. our pancreas makes very little or no insulin When you have diabetes Your pancreas makes little or no insulin Your body prevents the insulin you do make from working right Sugar can t get into your cells so it stays in your blood Symptoms of Diabetes The common signs of high blood sugar are Feeling tired Going to the bathroom frequently Being thirsty more than usual Being hungry more often than usual Possible weight loss Having an infection that does not go away Having wounds or sores that do not heal well Numbness or tingling in your hands or feet Some people experience other symptoms And some people may have no symptoms at all If type 2 diabetes rarely causes symptoms why should care about it Even though type 2 diabetes may not make you feel sick it can cause serious problems over time if it is not treated The disorder can lead to Heart attacks strokes Kidney disease Vision problems or even blindness Pain or loss of feeling in the hands and feet The need to have fingers toes or other body parts removed amputated What is high blood sugar also called hyperglycemia e High blood sugar is a blood sugar level that stays over 250 mg dl e High blood sugar usually starts slowly e High blood sugar may lead to diabetic coma if not treated What causes high blood sugar e Eating too much food e Not taking enough diabetes medicine e Having the flu or being sick e Having stress in yo
8. r made by the nal problems XR Glumetza liver may cause lactic Riomet acidosis Precose acarbose Slows digestion of Stomach or intesti miglitol carbohydrates nal problems pioglitazone Helps cells use Weight gain insulin better liver problems may cause heart attack sitagliptin Increases release of Headach upper insulin in response respiratory infection to a meal sore throat runny linagliptin or stuffy nose saxagliptin Some medications for diabetes are combinations of medicines Brand Name Generic Name ACTOplus met pioglitizone and metformin Glucovance glyburide and metformin Metaglip glipizide and metformin Jentadueto linagliptin and metformin Janumet sitagliptin and metformin Kombiglyze saxagliptin and metformin e Because the drugs listed above act in different ways to lower blood glucose levels they may be used together e Though taking more than one drug can be more costly and can in crease the risk of side effects combining oral medications can improve blood glucose control when taking only a single pill does not have the desired effects e You should know that alcohol and some diabetes pills can interact and cause vomiting flushing or sickness Ask your doctor if you are concerned about any of these side effects The medication am taking is Insulin What is Insulin e Insulin is a hormone that is made in the pancreas an organ in your body How does it work e Insulin lo
9. regularly check your blood sugar levels take your medications as prescribed eat well exercise learn to cope with your stress and keep all appointments with health care providers My Personal Plan would like to work on the following areas to manage my diabetes 4 Healthy Eating Mm Being Active Monitoring my blood sugar E Taking medications E Reducing health risks I Problem Solving 4 Healthy Coping What about this area do you find to be the most challenging What are 3 things that keep you from making this behavior part of your day to day activities How can you partner with your doctor to reach this goal How can you partner with your friends family and loved ones to reach this goal My confidence in being able to meet my GOAL 0 1 2 3 4 5 6 7 8 9 10 Not confident Very confident m How can have the best care for my diabetes Ask to have these tests done and work to get your results in target range How often Target My Result Blood Pressure Below 130 80 a i Fam Complete Foot Yearly Exam Aic Blood Test Every 3to 6 Below 7 months Below 200 Cholesterol Triglycerides S Below 150 HDL Good Over 45 cholesterol LDL Bad Below 100 cholesterol Blood Sugar Log Before first meal of the day Breakfast Before mid day meal Lunch Before evening meal Dinner Before bedtime Comments
10. s Avoid foods high in sugar and fat Do not skip meals e Exercise Start slow and work towards getting at least 30 minutes of extra activity at least 4 days each week Examples of extra activity can be walking climbing stairs dancing mowing grass or vacuuming Talk to your care provider before starting an exercise program Choose activities you enjoy e Medicines Take diabetes pills or insulin if prescribed by your caregiver e Stress Learn to problem solve and use healthy coping methods e Monitor your blood sugar It is important to check your blood sugars to know how well you are managing your diabetes Ask your care provider about how often you need to do this You can also e Control your weight If you are too heavy losing even a few pounds can make a difference e Stop smoking e Learn as much as you can about diabetes Attend diabetes classes Read or view videos from trusted sources What should my blood sugar be The general guidelines for your target blood sugar are e Before meals 80 120 mg dl Your goal is e 2 Hours after meals Below 160 mg dl Your goal is e Before bed 100 140 mg dl Your goal is Why is controlling blood sugar important e Inthe short term it will help you feel better and have more energy e Inthe long term it will help prevent problems with eyes kidneys nerves and blood vessels As part of your care plan be sure to keep track of your ABC S Atc B Blood pressure C
11. t if you have unusual pain swelling or bleeding e Geta flu shot every year and ask your doctor about a pneumonia vaccine e Stop smoking 6 Problem Solving e Know the signs of low hypoglycemia and high hyperglycemia blood Sugar and take action re Healthy Coping e Having diabetes can make you feel discouraged stressed or even de pressed Learn healthy coping methods to deal with your feelings e Get support from your friends family or a Support group with others who also have diabetes e Go to education sessions where you can learn more about managing your diabetes e Set small goals that will help you take steps to being the healthiest you can be What is a Sick Day A sick day is when you have a cold the flu or a fever Blood sugar tends to go up when you are sick What should do if am sick Keep taking your diabetes medicines Pills and or Insulin Check your blood sugar every 4 hours Check your urine for ketones every 4 hours If you have Type diabetes Drink 1 cup of sugar free liquid every hour like water broth caffeine free diet soda or tea Eat your usual diet if you can e lf you can t eat your usual diet choose 1 of these foods or liquids every hour sick day foods and liquids 1 2 cup regular Jell O not sugar free 1 4 cup applesauce not sugar free 6 saltine crackers 1 cup soup 1 2 cup non fat fruit yogurt not sugar free 3 graham crackers 1 cup sports drink 1 2 Cup s
12. ugar free pudding 1 slice toast or bread 1 2 cup regular soda not sugar free 1 4 cup sherbet 1 3 cup cooked rice 1 fruit juice bar not sugar free 1 2 cup ice cream 1 2 cup mashed potatoes 1 2 cup fruit juice 5 vanilla wafers 1 2 cup hot cereal Each has about 15 grams of carbohydrate When should call my doctor e You have been sick for 1 2 days and you are not getting better e You have been throwing up or having severe diarrhea for more than 6 hours e You cannot think clearly your breathing becomes fast or you have a fever over 101 F e Your blood sugar stays over 250 mg dl on 2 checks 4 hours apart e You have moderate or large amounts of ketones in your urine If you have been told to check this e You are not sure what to do to take care of Medications for Diabetes If you cannot manage your diabetes with diet and exercise you may need medi cine Diabetes medicine can be taken by mouth or injected through the skin You may be on more than one medicine You may also be on a medication to keep your cholesterol at a healthy level Oral Medications Brand Name Generic Name How It Works Side Effects Amaryl glimepiride Stimulates release Low blood sugar of insulin from weight gain Glucotrol Glucotrol XL glipizide pancreas Diabeta Glynase glyburide Micronase Starlix nateglinide Prandin repaglinide Fortamet Gluco metformin Reduces amount of Stomach or intesti phage Glucophage suga
13. ur life What are symptoms of high blood sugar E DROWSINESS DECREASED HEALING BLURRED VISION HUNGER e How do treat high blood sugar 1 Check your blood sugar 2 Drink 8 10 glasses of water per day If you are not on a fluid restriction 3 If blood sugar stays over 250 mg dl for 2 days call your care provider What is low blood sugar also called hypoglycemia e Low blood sugar is a blood sugar below 70 mg dl e Low blood sugar can come on very fast e Low blood sugar may lead to coma if not treated What causes low blood sugar e Not eating enough food e Too much insulin or diabetes pills e xtra exercise or activity WEAKNESS DIZZINESS FATIGUE ANXIOUS How do treat low blood sugar 1 Take 15 grams of carbohydrates Here are some examples choose one e 3 4 glucose tablets e 4 6 ounces regular soda e 4 6 ounces fruit juice e 1 cup skim or 1 milk Wait 15 minutes Recheck blood sugar should be above 70 mg dL Repeat if blood sugar has not increased Once your blood sugar returns to normal eat a meal or snack This can helo keep low blood sugar from coming back Tell your diabetes care team if you often have low blood sugar You and your team may need to change your diabetes care plan Ae ey O Whether you have type 1 or type 2 diabetes managing diabetes is a balancing act How do manage my diabetes You need to balance e Food Eat healthy food
14. wers blood sugar by moving sugar from the blood into the cells of your body Once inside the cell sugar provides energy e Insulin lowers your blood sugar whether you eat or not You should eat at regular times if you take insulin Can insulin be taken as a pill e No Insulin can only be taken as a shot because insulin would be de stroyed in the stomach What are the types of insulin Insulin Brand Name When to Use Side Effects Generic Name How It Works Rapid acting insulin Humalog insulin Given before you eat Low blood sugar lispro Apidra insulin Starts working within weight gain glulisine Novolog 5 15 minutes insulin aspart Short acting insulin Regular Given before you eat Low blood sugar Starts working within weight gain 1 2 to 1 hour Intermediate acting NPH Given in the morning Low blood sugar insulin or evening Lasts for weight gain 10 20 hours Long acting insulin Lantus insulin Once or twice a day Low blood sugar glargine Levemir dosing Provides cov weight gain insulin determir erage over 24 hours Pre mixed insulins 70430 50 50 75 25 Usually given before Low blood sugar breakfast amp dinner weight gain Other injectable Victoza Liraglitude Given once a day Nausea Vomiting Other injectable Byetta exenatide Given before morning Nausea Vomiting and evening meals Helps increase insulin production Other injectable Symlin pramlintide Given at mealtime Low blo
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