Diabetes: An Owner`s Manual - NorthShore University HealthSystem
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1. 3 If your blood sugar is still below 70 mg dL after 15 minutes eat or drink another 15 grams of fast acting glucose wait 15 minutes and test your blood sugar again 4 Document all of your low blood sugar episodes on your log sheet and discuss them with your diabetes care team By recognizing the patterns that cause low blood sugar you can take steps to prevent them in the future 5 Untreated low blood sugar or low blood sugar that does not improve with the above treatment can become an emergency involving loss of consciousness or a seizure You also may faint Contact your doctor or 911 if your symptoms do not improve and your blood glucose remains below normal despite multiple attempts to treat it Preventing Low Blood Sugar Here are some tips to help prevent hypoglycemia and manage tt if it happens to you e Eat meals and snacks at consistent times such as breakfast at 8 a m lunch at 12 noon an afternoon snack at 4 p m and dinner at 6 p m Be sure not to skip meals e Follow directions carefully as to when to take insulin in relationship to eating meals The timing of insulin injections is very important Understand how carbohydrate containing foods and your insulin medication doses are connected The more you know about the foods you eat the more you can control your blood sugar by taking the correct amount of medication e Carefully measure your medication If you think your dose needs to be adjusted contac2. Highland Park IL 847 433 2508 NorthShore Skokie Hospital Outpatient Pharmacy 9600 Gross Point Road Skokie IL 847 933 6890 Outpatient Diabetes Education Diabetes Education at 847 926 5032 NorthShore Evanston Hospital 2650 N Ridge Avenue Evanston IL Diabetes Education at 847 926 5032 NorthShore Glenbrook Hospital 2000 Pfingsten Road Glenview IL Diabetes Education at 847 926 5032 NorthShore Highland Park Hospital 7 7 Park Avenue West Highland Park IL Diabetes Education at NorthShore Skokie Hospital 9600 Gross Point Road Skokie IL 847 926 5032 NorthShore Medical Group Endocrinology 9977 Woods Drive Skokie IL 847 663 3540 Here are other helpful diabetes websites NorthShore University HealthSystem northshore org diabetes Academy of Nutrition and Dietetics eatright org American Diabetes Association diabetes org Juvenile Diabetes Research Foundation jdrf org Diabetes An Owner s Manual Table of Contents Chapter 1 Chapter 6 What Is Diabetes 00 2 TAKING Insulin wo cece cette 24 CAUSES and SYMPLOMS ccecseeceeeeeeeeeeeeeeees 2 ASAE ma log is peeeerne tee cen nee eae nee ne 28 Type 1 Diabetes rrr ype a 3 Chapter 7 TPE DECI eee eer ee eer eee 3 7 er PEA OD Cleo escerai Reia 4 reating owe eas and HYPerGlVCEMIA cece 29 Gestational Diabetes 5 Chapter 8 Chapter 2 i l l Following Sick Day Guidelines 33 Planning Healthy Meals
3. e Always carry Sugar containing food or glucose tablets to treat low blood sugar e Warm up before and cool down after you exercise e Drink plenty of water l e gt 300 mg dL Do not exercise until your e Stop if you have any pain or discomfort and call blood glucose level returns to a normal range your doctor 100 250 mg dL e Do not exercise when insulin is peaking e Do not inject insulin into an area that you plan to exercise e Always have your blood glucose meter with you e Wear comfortable and supportive shoes and cotton socks Exercise one to one and a half hours after eating Diabetes An Owner s Manual Chapter 4 Monitoring Your Blood Glucose The only way to know how well your diabetes treatment plan is working is to check your blood sugar at different times during the day every day Monitoring your blood glucose level can help you understand how your meal planning exercise and medications are working to control your diabetes Information on how often and when you should check your blood sugar with your blood glucose monitor or meter will be part of your diabetes treatment plan You can choose from a variety of different types of blood glucose monitors Work with your diabetes care team to make the best choice for you It s also important to keep a logbook of your daily sugar levels so you can track your progress Your doctor will need to see the logbook to treat you effectively In ad
4. 7 FOO GrOUPS o eescceccseeeeeeeesteeestestestssterteatees 7 Chapter 9 Nutrition Labels sssssssssssscecsseeeeesseseseseessttee 9 Reducing Your Risk Serving S26 os aararancetenratecnntaaniarzarstsuetndestens 10 of Chronic Complications eo FOO i aes crs oe E eee eens 30 Chapter 3 Eye Cares ccecceccesecereseceecereceesenrecnreenreenreenee 36 Getting Exercise and Oral Health essissiiriiicesisnirireiniteisniinnina 36 Physical Activity vo cece 17 Chapter 10 Chapter 4 Coping With Stress voces 37 Monitoring Your Blood GIUCOSC n i 19 Chapter 11 Your Diabetes Care Checklist 38 Chapter 5 Learning About Medications Chapter 12 to Manage Diabetes 21 RESOUICES cccccecesccsesscteeteeeeseeseeeeeeen 39 Oral Medications ssnecssnsisacincnvechanndeennwerseapeatas 22 Important Phone Numbers ssseserseerrrrren 39 Injectable Medications cccceeeeeeeeeeeeeeeeeees Ze Safe Needle DISDOSAl cceceseeeseeeeeeeeeeees 40 Combination Medications cccseeeeeeeeeeees 23 New Apps to Manage Diabetes 42 z NorthShore University HealthSystem t Diabetes An Owner s Manual Chapter 1 What Is Diabetes Diabetes mellitus or diabetes is a group of diseases characterized by high blood glucose levels These high levels are the result of the body s inability either to produce or to use insulin properly Insulin deficiency means the body no longer makes insulin insulin resistanc
5. pregnancy During this time the placental hormones in the mother s blood increase her need for insulin Insulin the hormone produced by the pancreas helps keep blood sugar within normal levels When the body is unable to produce enough extra insulin or it s not working effectively high blood sugar or gestational diabetes develops In most cases the mother s blood sugar returns to normal levels after the baby is born However women who have had gestational diabetes are at high risk between a 35 to 60 percent chance of developing type 2 diabetes within 10 years following the pregnancy Gestational diabetes occurs in about 7 percent 7 out of 100 of all pregnancies Most women with gestational diabetes have no symptoms so a blood test is the only way to diagnose the condition The test usually is performed at the end of the second or beginning of the third trimester 24 28 weeks Women with the following risk factors may be tested earlier e 25 years of age or older e Being overweight BMI gt 25 kg m2 before becoming pregnant e Having a family history of diabetes e Previously giving birth to a baby weighing more than 9 pounds e Belonging to a particular ethnic group including African Americans Hispanic Latino Americans Asian Americans and Native Americans e Women with polycystic ovarian syndrome PCOS e Women with a prior history of gestational diabetes Untreated gestational diabetes can increase the risk of macro
6. Carb counting e Meal entry cose i e Medication log e Exercise log e Weight log a e Graphs and charts e Alarms to remind you to check your blood glucose For more information about these helpful tools be sure to talk with your certified diabetes educator or visit your app marketplace for more information We hope that this owner s manual has provided information to helo you successfully navigate your diabetes care and live your best life Please feel free to reach out to your care team at NorthShore University HealthSystem with any questions that you may Nave z NorthShore University HealthSystem
7. Carbo oeum ei S hydrate grams not Sugars and the Serving Size to Set t a 12g on determine how many grams of carbohydrate you re ee Aaa E a eating Sugars 1g Sugar Alcohol 3g Protein 24g 4 Look for foods that are Low in Total Fat Saturated ae E Fat Trans Fat Cholesterol and Sodium Vitamin A1 Vitamin C 2 Calcium 2 e iron 5 7 7 Percent Daily Values are based on a 2 000 calorie 5 Look for foods that are High IN Fiber Vitamin A diet Your daily values may be higher or lower Vitamin C Calcium and Iron Breads should a a _ p00 contain 3 grams of fiber or more per serving and eee aS 7 cereals should contain 5 grams of fiber or more Cholesterol Less Than 300mg 300mg f Sodium Less Than 2 400mg 2 400mg per serving Total Carbohydrate 300g 375g Dietary Fiber 25g 30g Calories per gram Fat9 e Carbohydrate 4 e Protein 4 6 Sugar alcohols have carbohydrates and may cause gas and bloating when eaten in excess continued gt gt Diabetes An Owner s Manual Planning Healthy Meals continued gt gt Starches Each serving of starch contains about 15 grams of carbohydrate Bread Serving Size Bagel large about 4 oz 4 1 oz Biscuit 2 1 Bread whole wheat white or rye 1 slice 1 oz Chapati 6 across 1 Cornbread 134 cube 1 oz Dosa plain 1 English muffin 1 2 Hot dog or hamburger bun 12 1 oz Idli plain 3 round Naan 1 4 Pancake 4 across 14 thick 1 Pita
8. Stress An important part of managing your diabetes is caring for your emotional health and learning how to cope with stressful situations Everybody has to manage stress in their lives and they handle it in different ways But when you have Things that affect your blood sugar level diabetes coping with stress is important because it helos keep your blood sugars in your target range Stress can increase blood glucose levels by activat Food 47 Increase ing the fight or flight hormones in the body These Variable Effect on Blood Sugar regulatory or stress hormones signal the liver and liness Increase muscles to release sugar into the bloodstream Stress 4 Increase which raises blood sugar levels Exercise Jb Decrease Here are some helpful tips to manage stress in your life e Be sure to get regular exercise or be physically Skipping Meals W Decrease active which are both natural stress relievers and can lower your blood sugar Diabetic Medication b Decrease Alcohol 4s Jb Increase OR Decrease e Jake time to enjoy life by spending relaxing time with your family friends or starting a hobby e Jalk to a counselor or close friend or join a support group to get the emotional support you need e alk with your doctor if you re in a stressful situation and are having trouble coping with it Diabetes An Owner s Manual Chapter 11 Your Diabetes Care Checklist Diabetes Care Checklist YOU can contro
9. a plan to help you recognize and treat high blood sugar when it happens to you continued gt gt Diabetes An Owner s Manual Treating Hypoglycemia and Hyperglycemia continued gt gt Here are some helpful tips if you experience hyperglycemia e Review your food choices You may be eating too much food or too many foods that are high in carbohydrates e Review your exercise habits If you re not as active as usual your body may not be using carbohydrates in the same way e Review your medications Make sure you re not skipping any medications and are taking them as prescribed Sometimes if your medications have been changed recently you also may experience hyperglycemia Additionally some over the counter non diabetes medications can affect your blood sugar e Stress also can impact your blood sugar levels so try to identify the sources of stress in your life and take steps to manage them as best as you Can Some ways to prevent hyperglycemia are to follow your treatment plan and keep your regular visits with your diabetes care team Call your doctor or diabetes care team if your blood sugar is higher than 240 mg dL or if there are ketones in your urine Ketones are the result of the body using stored fat instead of glucose for energy You can test for ketones by using a small plastic cup and Ketostix strios which you can purchase at your local pharmacy Ketone read at exactly 15 seconds NEGATIVE
10. can list of proper foot care eventually affect the nervous system and blood vessels throughout your body Do not walk barefoot Always wear comfortable fitting footwear Cut toe nails straight across and use emery board to Clean and inspect your feet daily gently shape sides of toe nails Do not use pocket knives or razors continued gt gt Diabetes An Owner s Manual Reducing Your Risk of Chronic Complications continued gt gt e Eye care High blood sugar affects the blood vessels and retina in the eyes and may cause blindness over time Make regular appointments with an ophthalmologist or optometrist to have a thorough dilated eye exam at least once a year Some people may not experience pain or early warning signs of trouble with their vision at the early stages Others may notice dark spots difficulty seeing in the dark or a feeling of pressure in their eyes Let your doctor know if you have any of these symptoms e Oral health Diabetes can lead to periodontal or gum disease which impacts the bones and gum that hold your teeth in place Periodontal disease is an infection that also can damage the heart Be sure to brush and floss your teeth daily and have regular checkups with your dentist Call your dentist if you have signs or symptoms of gum disease such as gums that bleed are red or swollen or have receded from your teeth Diabetes An Owner s Manual Chapter 10 Coping With
11. cottonseed flaxseed grape seed safflower soybean sunflower 1 tsp Salad dressing e Reduced fat 2 Tbsp e Regular 1 Tosp Saturated Fats Serving Size Bacon cooked regular or turkey 1 slice Butter stick 1 tsp Cream half and half 2 Tbsp Cream cheese e Reduced fat 172 Tbsp oz e Regular 1 Tosp oz Sour cream e Reduced fat or light 3 Tosp e Regular 2 Toso Palm oil palm kernel oil 1 tsp Coconut oil 1 tsp Free Foods Each food from this list has 5 grams or less of carbohydrate and less than 20 calories per serving Eat up to three servings per day of the free foods with a serving size noted without counting any carbohydrate Choices listed without a serving size noted can be eaten whenever you like For better blood glucose control soread your servings of these foods throughout the day Low Carbohydrate Foods Serving Size Cabbage raw 2 Cup Gelatin sugar free or unflavored Gum Jam or jelly light or no sugar added 2 tsp Salad greens Sugar substitutes low calorie sweeteners Modified Fat Foods with Carbohydrate Serving Size Cream cheese fat free 1 Tosp oz Creamers e Nondairy liquid 1 Tbsp e Nondairy powdered 2 tsp Salad dressing e Fat free or low fat 1 Tbsp e Fat free Italian 2 Tbsp continued gt gt Diabetes An Owner s Manual Planning Healthy Meals continued gt gt Free Foods continued Condiments Serving Size Barbecue sauce 2 tsp Cats
12. day This is especially important if you re taking certain diabetes medications Eat the right kinds of foods There are three major nutrients in food e Carbohydrates Carbohydrates or carbos raise blood sugar Choose whole grains fruit low fat milk and vegetables every day e Protein Protein does not have a major effect on blood glucose Choose lean beef pork chicken fish eggs egg whites reduced fat cheese and tofu e Fat Very little dietary fat turns to glucose but certain types of fat can increase the risk of heart disease Choose from at least three of the food groups ideally incorporating a fruit and or vegetable at each meal Healthy fats can be added in moderation Fruit Milk yogurt 1 serving 1 serving Starches 1 4 of a 9 plate Vegetables 1 2 of a 9 plate Meat protein 1 4 of a 9 plate e 9 plate continued gt gt Diabetes An Owner s Manual Planning Healthy Meals continued gt gt Eat the right amount of each nutrient type Carbohydrates provide energy fiber vitamins minerals and antioxidants so it s important to eat reasonable amounts of carbohydrates at each meal Here are some examples of one carbohydrate serving which equals 15 grams of carbohydrate 1 slice bread 1 small apple 1 cup milk 2 small cookies Carbohydrate foods include e Starches grains cereal starchy vegetables such as corn peas and pota
13. have a fever to get further instructions on how to reduce tt e Let a family member or friend know that you re ill and keep in regular contact with them Ask them to check on you during your illness e Keep track of your illness and record your blood sugar levels temperature and symptoms continued gt gt Diabetes An Owner s Manual Following Sick Day Guidelines continued gt gt Here are symptoms to watch for when you re sick Below is a list of the carbohydrate content of liquids If you experience any of them you need to call and soft foods for sick days your doctor for immediate medical attention Fooi Armour Gamesi e You can t keep liquids down for more than aida Se four hours Regular soda V2 Culp 15 TET 1 e You re vomiting or dehydrated ee ee Apple juice V2 CUP 15 e You have diarrhea or abdominal pain Milk 1 cup 40 e You have difficulty breathing or have fast Ice cream vanilla Ye cup 15 es nnd Cereal cooked V2 CUP 15 e Your blood glucose is over 300 mg dL on two Gelatin regular Ye cup 20 consecutive measurements that do not respond to increased fluids or food Also call your doctor ee if your blood sugar levels are too low Popsicle 1 serving e You have ketones in your urine oone Een i Coffee tea 1 Gup O e You have a temperature of 100 4 38C or above Soup creamy 1 cup 15 e You re confused or are unable to stay awake or Pudding regular Ye cup 20 pO Olen Pudding sugar free Yo Cup 15 e Yo
14. into your meal plan Entrees Serving Size Casserole type tuna noodle lasagna macaroni and cheese 1 cup 8 oz Count as 30 grams carbohydrate 2 medium fat meats Frozen Meals Entrees Serving Size Burrito beef and bean 1 5 oz Count as 45 grams carbohydrate 7 lean meat 2 fats Enchilada 1 11 oz Count as 45 grams carbohydrate Pizza cheese vegetarian thin crust of a 12 4 5 oz Count as 30 grams carbohydrate 2 medium fat meats Taco 1 5 6 oz Count as 30 grams carbohydrate Soups Serving Size Bean lentil or split pea 1 cup Count as 15 grams carbohydrate 1 lean meat Tomato made with water 1 cup Nonstarchy Vegetables One cup of raw vegetables a 1 2 cup cooked vegetables or a 1 2 cup tomato or vegetable juice has about 5 grams of carbohydrate Amaranth or Chinese spinach Bean sprouts Beans green wax Italian Broccoll Cabbage green bok choy Chinese Carrots Cauliflower Celery Cucumber Eggplant Greens collard kale mustard turnip Jicama Mushrooms all kinds fresh Okra Onions Pea pods Peppers all varieties Radishes Sauerkraut Spinach Squash Summer crookneck Zucchini Tomatoes fresh and canned Tomato sauce Tomato vegetable juice Water chestnuts continued gt gt Diabetes An Owner s Manual Planning Healthy Meals continued gt gt Meat and Meat Substitutes Meat and meat substitutes are rich in protein W
15. or other diabetes medication e Taking rapid acting insulin too early before the start of a meal e Drinking alcohol without eating e Being more physically active than usual If you re having any symptoms of low blood sugar you must test your blood sugar immediately Always carry your blood glucose meter with you If your blood sugar is less than 70 mg dL or 60 mg dL if you re pregnant you need to treat it immediately by eating or drinking 15 grams of fast acting carbohydrate If your blood sugar is less than 50 mg dL you need to double the portion size listed below and eat or drink 30 grams of fast acting carbohydrate continued gt gt Diabetes An Owner s Manual Treating Hypoglycemia and Hyperglycemia continued gt gt How to Treat Low Blood Sugar Use the The Rule of 15 1 The following examples contain approximately 15 grams of fast acting carbohydrate e 3 4 glucose tablets e cup of apple juice e 4 6 ounces of regular not diet soda e 1 tablespoon of sugar honey or syrup e 5 7 Lifesavers hard candy e 8 ounces of skim milk 2 Check your blood sugar 15 minutes after eating or drinking the fast acting carbohydrate food source Once your blood sugar is above 70 mg dL you can have a snack if your next meal is longer than one hour away In your snack or meal be sure to include foods with carbohydrate protein and fat An example of a snack may be half a sandwich with a piece of fruit
16. pocket bread 6 across 1 2 Roll plain small 1 1 oz Roti 6 across 1 2 Tortilla corn or flour 6 across 1 Waffle 4 square or 4 across 1 Cereals and Grains Serving Size Cereals cooked oats oatmeal grits 2 cup Cereals unsweetened ready to eat 34 cup Couscous 1 3 cup Granola low fat 1 4 cup Kasha cooked 1 2 cup Millett cooked 1 3 cup Quinoa cooked 1 3 cup Pasta cooked 1 3 cup Rice white or brown cooked 1 3 cup Rice vermicelli 1 2 cup starchy Vegetables Serving Size Breadfruit cup small cubes Corn cooked 1 2 cup Corn on cob large 2 cob 5 oz Dhal mung or toor cooked 2 cup Hominy canned 34 cup Peas green cooked 1 2 cup Plantain ripe 1 3 cup Potato e Baked with skin 1 4 large 3 oz e Boiled all kinds cup or medium 3 oz e Mashed with milk and fat 1 2 cup e French fried oven baked 1 cup 2 oz Spagheiti pasta sauce 2 Cup Squash winter acorn butternut 1 cup Yam sweet potato plain cup Yucca 3 cup Diabetes An Owner s Manual Planning Healthy Meals Crackers and Snacks Serving Size Crackers e Round butter type 6 e Saltines 6 Graham cracker 2 square 3 Matzoh 34 oz 2 square or 2 sheet Popcorn e With butter 3 cups e Lower fat or no fat added 3 cups Pretzels 94 oz Snack chips tortilla chips potato chips e Fat free or baked 15 20 amp oz e Regular 9 13 3
17. 4 oz Beans Peas and Lentils Count as 1 Starch 15 grams of carbohyarate 1 Lean Meat 7 grams of protein Serving Size Baked beans 3 Cup Beans cooked black garbanzo kidney lima navy pinto white 1 2 cup Dhal mung or toor cooked 2 cup Lentils cooked brown green yellow 2 cup Peas cooked black eyed split 1 2 cup Milk Each serving of milk yogurt contains about 12 grams of carbohydrate Milk buttermilk goats milk 1 Cup Evaporated milk 1 2 cup Yogurt plain 8 oz 1 Cup Yogurt Greek carbohydrate varies Soy milk regular or light 15 grams carbohydrate 2 5 grams fat Fruit Serving Size Each serving of fruit contains about 15 grams of carbohydrate Apple unpeeled small 1 4 oz Applesauce unsweetened 2 Cup Banana extra small 1 4 oz Berries e Blackberries 34 Cup e Blueberries 34 cup e Raspberries 1 cup e Strawberries 1 cup whole berries Cantaloupe small 1 3 melon or 1 cup cubed 11 oz Cherries sweet fresh 12 3 oz Dried fruits olueberries cherries cranberries mixed fruit raisins 2 Tbsp Grapefruit large 2 11 oz Grapes small 17 S oz Guava 2 cup Kiwi 1 8 oz Mandarin oranges canned cup Mango small 12 fruit 51 2 oz or 2 cup Orange small 1 6 oz Papaya 1 2 fruit or 1 cup cubed 8 oz Passion fruit 1 4 cup Peaches fresh medium 1 6 oz Pears fresh large 2 4 oz Pineapple fresh 34 cup Plums e Drie
18. Diabetes An Owner s Manual Your guide to successfully navigating your diabetes and living your best life z NorthShore University HealthSystem z NorthShore University HealthSystem Dear Patient Welcome to NorthShore University HealthSystem NorthShore where excellence is all around you Our outpatient programs in diabetes care are recognized by the American Diabetes Association ADA and our inpatient program at NorthShore Evanston Hospital achieved Advanced Certifica tion in Inpatient Diabetes through The Joint Commission At NorthShore we are committed to helping you manage your diabetes through our comprehensive education and support programs This booklet is designed to get you started with your diabetes care by providing important basic information while you re hospitalized or in the outpatient setting It also introduces you to our team of inpatient nurses and dietitians as well as our outpatient certified diabetes educators These team members are specially trained experts in the field of diabetes and are available to provide an individualized treatment plan for you Our educators also can assist you in planning for your diabetes care in the areas of diet exercise blood glucose monitoring and medication If your doctor has requested that you test your blood sugar levels our certified diabetes educators can provide you with a free blood glucose monitor and demonstrate how to use tt Use the following phon
19. Phone Numbers Keep this information in a safe place so It s available when you need tt Name Phone Primary Care Physician Endocrinologist Registered Dietitian Certified Diabetes Educator Pharmacist In addition the above information also is important to carry with you in case of an emergency Medic Alert ID bracelets are available for purchase and are recommended for people with diabetes This allows others including medical staff to provide appropriate treatment in case of an emergency If you need diabetes supplies please call the following numbers NorthShore Evanston Hospital 847 570 2210 Outpatient Pharmacy 2650 N Ridge Avenue Evanston IL NorthShore Glenbrook Hospital 847 657 1785 Outpatient Pharmacy 2050 Pfingsten Avenue Glenview IL NorthShore Highland Park 847 433 2508 Hospital Outpatient Pharmacy 7 7 Park Avenue West Highland Park IL NorthShore Skokie Hospital 847 933 6890 Outpatient Pharmacy 9600 Gross Point Road Skokie IL continued gt gt Diabetes An Owner s Manual Resources continued gt gt Outpatient Diabetes Education Diabetes Education at NorthShore Evanston Hospital 2650 N Ridge Ave Evanston IL 847 926 5032 Diabetes Education at 847 926 5032 NorthShore Glenbrook Hospital 2000 Pfingsten Road Glenview IL Diabetes Education at 847 926 5032 NorthShore Highland Park Hospital 7 7 Park Ave West Highland Park IL Diabetes Education
20. TRACE SMALL md dL 5 MODERATE 10 40 80 160 Diabetic Ketoacidosis In type 1 diabetes hyperglycemia high blood sugar may lead to a serious health condition called diabetic ketoacidosis or DKA Without insulin the cells of the body cannot get the energy that glucose provides As a result the cells use stored fat for energy instead As fat is broken down ketones are released into the bloodstream and eventually appear in the urine Here are some common signs and symptoms of diabetic ketoacidosis e Stomach pain e Increased urination leading to dehydration e Heavy breathing or trouble breathing e A dry mouth or fruity breath e Confusion e Coma e Vomiting or diarrhea If you experience any of these symptoms of diabetic ketoacidosis have a blood glucose reading that s greater than 240 mg dL have ketones present in your urine or have a fever of 101 degrees or above call your doctor It s important to continue to take your insulin check your blood sugar levels and your urine for ketones and drink eight ounces of water every hour lt LARGE Ketone testing strips change color to correspond with the amount of ketones present your urine The guide above shows the various readings you may see after you test for ketones Diabetes An Owner s Manual Chapter 8 Following Sick Day Guidelines When you re sick or have an infection or injury and your body is under stress it responds by releasing hor
21. ands and feet Diabetes also may lead to a serious health condition called diabetic ketoacidosis or DKA see page 32 With out insulin the cells of the body can t get the energy that glucose provides As a result the cells use stored fat for energy instead As fat is broken down ketones are released into the bloodstream and eventually appear in the urine 2 Diabetes An Owner s Manual What is Diabetes Understanding Type 1 Diabetes Type 1 diabetes formerly called juvenile onset diabetes is usually diagnosed Cell without diabetes in children and young adults although older adults may develop this disease as well Only 5 to 10 percent of people with diabetes have type 1 diabetes which occurs when the pancreas doesn t produce insulin With the help of insulin therapy and other treatments even very young children can learn to manage their condition and live a long healthy and happy life A Understanding Type 2 Diabetes Most people with diabetes more than 90 percent have type 2 diabetes which also may occur at any age In type 2 diabetes the pancreas produces insulin but either the body can t use it properly insulin resistance or the Cell with diabetes body isn t making enough insulin A gt Diabetes is a progressive disease So over time the pancreas will make A Q A b lt less and less insulin and eventually will stop making enough insulin insulin Q deficiency a gt gt
22. at NorthShore Skokie Hospital 9600 Gross Point Road Skokie IL 847 926 5032 NorthShore Medical Group Endocrinology 9977 Woods Drive Skokie IL 847 663 8540 A referral from your primary care physician is required Here are other helpful diabetes websites NorthShore University HealthSystem northshore org diabetes Academy of Nutrition and Dietetics eatright org American Diabetes Association diabetes org Juvenile Diabetes Research Foundation jdrf org Safe Needle Disposal Disposing of medical waste such as used insulin needles pen needles and lancets known as sharps in a safe and appropriate way is crucial to avoid injuring other people and keep the environ ment safe In the state of Illinois needle disposal programs are available outside of Chicago in northern Cook County and LaSalle County Residents in other areas of the state should follow state guide il lines for safe needle disposal gt which allow individuals to place used needles pen needles and lancets in household containers Acceptable containers include laundry bottles bleach bottles or other opaque plastic contain ers with screw top lids When the container is full it s placed in the regular garbage not the recycling bin for pickup he rot voy 4 Here are some helpful tips to remember when you re disposing of used needles and lancets e Label the container Do Not Recycle e Do not store sharps in glas
23. ate 11 fats Candy hard 3 pieces Cookies e Chocolate chip 2 cookies 2 across Count as 15 grams carbohydrate 2 fats e Vanilla wafer 5 cookies Count as 15 grams carbohydrate 7 fat Doughnut cake plain 1 medium 1 oz Count as 22 grams carbohydrate 2 fats Flan caramel custard 72 cup Count as 30 grams carbohydrate Fruit juice bars frozen 100 juice 1 bar 8 oz Gelatin regular 1 2 cup Granola or snack bar regular or low fat 1 bar 1 oz Count as 22 grams carbohydrate Jam or jelly regular 1 Tbsp Ice cream e Light and no sugar added 2 cup e Regular 2 cup Muffin 4 oz muffin 1 oz Count as 15 grams carbohydrate 12 fat Pie commercially prepared fruit 2 crusts 6 of 8 pie Count as 45 grams carbohydrate 2 fats Pudding e Regular made with reduced fat milk 1 2 Cup Count as 30 grams carbohydrate e Sugar free or sugar and fat free 2 cup made with fat free milk Sports drink 1 Cup 8 oz Sugar 1 Tbsp Syrup e Light pancake type 2 Tbsp e Regular pancake type 1 Tbsp Yogurt e Frozen fat free 1 3 cup Count as 15 grams carbohydrate 7 fat e Regular 2 cup Count as 15 grams carbohydrate 2 fats Diabetes An Owner s Manual Planning Healthy Meals Combination Foods Combination foods contain foods from more than one food list With the help of a registered dietitian and certified diabetes educator you can fit these foods
24. bedtime Bring your records and meter to each office visit so that you can review this information with your diabetes care team e If you have a history of severe hypoglycemia it s very important that family friends and co workers know how to recognize and treat your low blood sugar in case you need assistance What to Do in the Case of Severe Low Blood Sugar If symptoms of low blood sugar become serious and you re unable to swallow call 911 or have someone take you to the nearest emergency room for treatment Some people with diabetes have a family member or friend who has been trained to give a glucagon injection which is a medication that rapidly raises blood sugar For more information on how to receive this training please contact your doctor or certified diabetes educator Increased thirst can be a sign of high blood sugar Hyperglycemia High Blood Sugar Hyperglycemia means there s too much glucose or sugar in the bloodstream Some people may have no symptoms of hyperglycemia but typical signs and symptoms include the following e Increased thirst or hunger e Frequent urination e Feeling more tired than usual e Confusion e Cuts or infections that are slow to heal e Stomach pain e Nausea e Blurred vision e Dehydration e Tingling or numbness of the hands or feet e Hair loss These symptoms can vary from person to person so It s important to work with your diabetes care team and develop
25. d prunes 3 e Small 2 5 oz Tamarind 1 4 cup whole or 1 oz dried Watermelon 1 slice or 1 cups cubes 13 oz Fruit Juice Serving Size Apple grapefruit orange pineapple 2 cup Fruit juice blends 100 juice grape juice prune juice 1 3 cup continued gt gt Diabetes An Owner s Manual Planning Healthy Meals continued gt gt Sweets Desserts and Other Carbohydrates Each food from this list contains 15 grams of carbohydrate The amount of protein fat and calories varies You can substitute food choices from this list for other carbohydrate containing foods Such as those found on the Starch Fruit or Milk lists in your meal plan even though these foods have added sugars or fat The foods on this list do not have as many vitamins minerals and fiber Choose foods from this list less often if you re trying to lose weight Many sugar free fat free and reduced fat products are made with ingredients that contain carbohy drate so check the Total Carbohydrate information on the Nutrition Facts food label Food Serving Size Brownie small unfrosted 1 square 1 8 high about 1 oz Count as 15 grams carbohydrate 7 fat 5 grams of fat Cake e Frosted 2 square about 1 oz Count as 30 grams carbohydrate 7 fat e Unfrosted 2 square about 1 oz Count as 15 grams carbohydrate 7 fat Candy bar chocolate peanut 2 fun size bars 1 oz Count as 22 grams carbohydr
26. dition be sure to record other information e Wash and dry your hands and the area on your that could affect your blood sugars levels These skin where you ll use your lancing device include being sick getting more exercise than usual forgetting to take your medication or celebrating a special holiday e Use the lancing device to prick your skin surface and obtain a small drop or sample of blood for the testing strip to run your blood glucose test e These helpful hints will make it easier to obtain an adequate drop of blood Hold your hands under warm water if they Keeping track of your blood glucose readings helos you manage your blood sugar in two ways e t can identify patterns that tell you how your i feel cold Aa YOUr DIOS UCar Hang your hands down at your sides for e t can tell you if you need to make changes to your 30 seconds and gently milk the finger from diet activity level or other areas of yout life the palm of your hand to your fingertip before lancing Here are the basic steps for blood sugar monitoring After lancing hold hand on table or below e Gather all of your supplies These include your waist to get a drop of blood blood glucose monitor or meter test strips a Deliver the blood drop to the test strip lancing device a lancet a tiny needle a sharps e Write down the results in your blood sugar logbook container a heavy plastic bottle for used needles and lancets and yo
27. dy 24 hours a day Larger amounts of insulin called bolus can be administered by the pump before meals or snacks An insulin pump also can provide intensive insulin therapy This alternative to daily injections may be right for you if you have type 1 or type 2 diabetes take Insulin test your blood sugar at least four to six times a day and count carbohydrates Your doctor can help you decide if an insulin pump Is appropriate for you and provide a prescription if insulin pump therapy is right for you Diabetes An Owner s Manual Chapter 7 Treating Hypoglycemia and Hyperglycemia Hypoglycemia Low Blood Sugar A blood sugar reading below 70 mg dL is considered a lower than normal level of Sugar in the bloodstream In gestational diabetes a blood sugar reading below 60 mg dL is considered below normal Some people may have no symptoms but typical signs and symptoms of low blood sugar include the following e Sweating e Shakiness e Anxiety e Nervousness e Rapid heartbeat e Dizziness light headedness e Headache e Sudden hunger e Weakness e Impaired vision e Confusion e Numbness or tingling around the mouth or lips Low blood sugar is caused by several factors Below are some of the most common causes e Missing or delaying a meal e Eating a meal that s smaller than usual e Taking an insulin dose that s mismatched with the amount of carbohydrate you eat at a meal e Taking too much insulin
28. e means the body makes insulin but doesn t use it properly Here s what happens Every time you eat your food is broken down into a variety of nutrients including glucose or sugar which is used as fuel or energy in your cells for normal daily living Glucose needs the help of the hormone insulin which is made in the pancreas in order to move from your bloodstream into your cells so it can be used as energy The pancreas is a small organ located near the stomach When you eat your brain signals the pancreas to make insulin Insulin acts like a key to unlock your cells so glucose can pass from your bloodstream into your cells Insulin is important because it lowers your blood sugar and helps keep it within normal levels Without insulin glucose or Sugar stays in your bloodstream and cannot get into your cells This is what leads to high blood sugar readings You may experience several signs or symptoms of diabetes or you may not have any symptoms Stomach Following are the classic symptoms Liver e Frequent urination e Thirst Pancreas e Fatigue e Unusual weight loss e Frequent infections such as urinary tract S ugar infections yeast infections or gum skin and bladder infections Blood e Blurred vision stream Sometimes long standing undiagnosed diabetes can result in other symptoms such as e Erectile dysfunction impotence e Slow healing of cuts and sores e Numbness tingling and burning of h
29. e number for our outpatient Diabetes Education Centers if you have any questions or need to schedule appointments at any of our NorthShore Hospital locations 847 926 5032 e Evanston Hospital e Glenbrook Hospital e Highland Park Hospital e Skokie Hospital You may also access our program in Adult Endocrinology and Metabolic Diseases with a referral from your primary care physician We are located at 9977 Woods Drive in Skokie and can be reached by calling 847 663 8540 We invite you to visit us online at northshore org diabetes for additional information and resources to help you take charge of your diabetes care Inpatients can work with their healthcare team to assist with their diabetes education Again thank you for choosing NorthShore You are an important member of the NorthShore Diabetes Care Team and we re here to assist you in managing your care so you can live a healthy productive life A Teaching Affiliate of the University of Chicago Pritzker School of Medicine Hospitals Evanston Glenbrook Highland Park Skokie Helpful Information NorthShore Pharmacies Diabetes supplies are available at the following locations NorthShore Evanston Hospital Outpatient Pharmacy 2650 N Ridge Avenue Evanston IL 847 570 2210 NorthShore Glenbrook Hospital 847 657 1785 Outpatient Pharmacy 2050 Pfingsten Avenue Glenview IL NorthShore Highland Park Hospital Outpatient Pharmacy 11 Park Avenue West
30. eir bodies no longer produce insulin Most people with type 2 diabetes take diabetic pills insulin or both Some can keep their blood sugar in control with careful meal planning and regular activity If you take medicine and need to take either more of your medicine or a different type of medicine or insulin this does not mean your diabetes is getting worse Over time diabetes can change and your medications and treatment plan will change too Remember the key to managing your diabetes is to control your blood sugar levels and you can do this in different ways How Diabetes Medications Work Medications that treat diabetes affect different parts of your body including the pancreas liver intestines and muscles It s important to talk with your doctor certified diabetes educator or pharmacist about the particular medication you re taking and make sure all your questions are answered Be sure to ask about any side effects of the medications some medications increase insulin sensitivity or how insulin works in the cells while other medications prevent the liver from making and releasing too much glucose Some medications cause carbohydrates to break down more slowly while others work on the hormones your body secretes continued gt gt Diabetes An Owner s Manual Learning About Medications to Manage Diabetes Oral Medications Injectables and Combination Medications continued gt gt The following c
31. etitian or certified diabetes educator can show you how to test for ketones using a small plastic cup and Ketostix Strios purchased at your local pharmacy A1C Test The A1C test glycated hemoglobin measures a person s average blood glucose level over the last two to three months The A1C also can be reported as an estimated average glucose value eAG People with diabetes should get their A1C tested every 3 6 months The table to the right shows the relationship between A1C and eAG A1C eAG mg dL 5 F 55 m 6 18 65 140 7 154 o 75 T Average Amount of Glucose in Cells A oO N eN Non diabetes A1C Goal A1C High A1C range 4 6 less than 7 7 or greater Diabetes An Owner s Manual Chapter 2 Planning Healthy Meals Planning for a healthy diet and choosing healthy foods that best meet your needs and eating habits are important steps in managing your diabetes A balanced diet also helps you feel better You can make a difference in controlling your blood sugar levels and reducing your risk for the complications of diabetes by eating the right kinds of foods at the right time in the right amount Drinking alcohol also can affect your blood sugar levels so be sure to talk with your doctor or certified diabetes educator to learn the risks of drinking alcohol when you have diabetes Eat at the right time Eat three meals a day spaced four to five hours apart at about the same time each
32. h skin or fried 1 oz Ricotta cheese 2 oz or Cup Sausage with 4 7 grams of fat per 1 oz Tempeh 34 cup High Fat Meat and Meat Substitutes Each food from this list contains 0 grams carbohydrate 7 grams protein 8 grams fat and 100 calories Bacon e Pork 2 slices e Turkey 3 slices Cheese regular American bleu brie cheddar hard goat Monterey jack queso and Swiss 1 oz Hot dog beef pork or combination 1 Pork sparerib 1 oz Processed sandwich meats with 8 grams of fat or more per 1 oz bologna pastrami hard salami 1 oz Diabetes An Owner s Manual Planning Healthy Meals Fats Each food from this list contains 0 grams carbohydrate 0 grams protein 5 grams fat and 45 calories Choose heart healthy fats from the monounsatu rated and polyunsaturated groups more often In general a single serving of fat is e 1 teaspoon of regular margarine vegetable oil or butter e 1 tablespoon of regular salad dressing Unsaturated Fats Monounsaturated Fats Serving Size Avocado medium 2 Tbsp 1 oz Nut butters trans fat free 17 tsp Nuts e Almonds cashews 6 nuts e Macadamia 3 nuts e Peanuts 10 nuts e Pecans 4 halves Oil canola olive peanut 1 tsp Olives black ripe 8 large Olives green stuffed 10 large Polyunsaturated Fats Serving Size Margarine e _ower fat spread 1 Tbsp e Stick tub or squeeze 1 tsp Mayonnaise e Reduced fat 1 Tbsp e Regular 1 tsp Oil corn
33. hart shows how different medications work in your body and will help you discuss your medication with your healthcare team Oral Medications Sulfonylureas ae Lowers blood sugar by stimulating the pancreas to produce more insulin Side effects may include low blood glucose or hypoglycemia Glimepiride Amaryl Glipizide Glucotrol Glipizide Extended Release Glyburide Micronase Meglitinides Stimulates the pancreas to release insulin to lower blood sugar after meals Pancreas Side effects may include low blood glucose or hypoglycemia 2 Liver Repaglinide Prandin Nateglinide Starlix Biguanides 2 Body fat and muscles O Intestine liver and pancreas O Liver and pancreas Keeps the liver from releasing too much stored glucose QO Kidney Side effects may include GI disturbances such as gas bloating Intestine and liver diarrhea or upset stomach Metformin Glucophage Metformin Liquid Riomet Metformin Extended Release Glucophage XR Fortamet Thiazolidinediones Glumetza Increases insulin sensitivity or how insulin works in the muscle cells and fat cells Pioglitazone Actos Take once a day May cause weight gain and fluid retention swelling and increase potential for heart problems Check with your doctor before using if you have any heart condition Diabetes An Owner s Manual Oral Medications continued DPP 4 Inhibitors Impr
34. henever possible choose lean meats Portion sizes on this list are based on cooked weight after bone and fat have been removed The carbohydrate content varies among plant based proteins so read food labels carefully Lean Meats and Meat Substitutes Each serving from this list contains 0 grams carbohydrate 7 grams protein 0 3 grams fat and 45 calories Beeft Select or choice grades e Ground round roast chuck rib rump e Round sirloin steak cubed flank porterhouse T bone tenderloin 1 oz Canadian bacon 1 oz Cheeses with 3 grams of fat or less per 1 oz Cottage cheese 1 4 cup Egg whites 2 Fish fresh or frozen plain catfish cod flounder haddock halibut orange roughy salmon tilapia trout tuna 1 oz Hot dog with 3 grams of fat or less per 1 oz Pork lean 1 oz Rib or loin chop roast ham tenderloin 1 oz Poultry without skin 1 oz Processed sandwich meats with 3 grams of fat or less per 1 oz Tuna canned in water or oil drained 1 oz Medium Fat Meat and Meat Substitutes Each food from this list contains 0 grams carbohydrate 7 grams protein 4 7 grams fat and 75 calories Beef corned beef ground beef meatloaf prime grades trimmed of fat prime rib 1 oz Cheeses with 4 7 grams of fat per oz feta mozzarella pasteurized processed cheese spread reduced fat cheeses string cheese 1 oz Egg 1 Fish any fried product 1 oz Pork cutlet shoulder roast 1 oz Poultry wit
35. information at e Safe Needle Disposal Solutions by State safeneedledisposal org e Solid Waste Agency of Lake County swalco org Diabetes An Owner s Manual Sharps Disposal Resources in the Northwest Suburbs The Solid Waste Agency of Northern Cook County SWANCC provides a complete list of disposal sites on its website at swancc org In addition below is a list of suburbs that accept used sharps Sharps must be in a heavy plastic container such as a laundry detergent bottle bleach bottle or fabric softener bottle The container can be dropped off at the village hall Monday through Friday from 9 a m to 4 p m You must show identification to verify that you live in the suburb Check to see if they also have a used or old prescription drugs drop off service Arlington Heights Barrington Buffalo Grove Elk Grove Village Evanston Glencoe Glenview Hoffman Estates Inverness Kenilworth Lincolnwood Morton Grove Mount Prospect Niles Palatine Park Ridge Prospect Heights Rolling Meadows Skokie South Barrington Wheeling Wilmette Winnetka continued gt gt Diabetes An Owner s Manual Resources continued gt gt New Apps to Manage Diabetes New technology such as tablets and smartphones can help you manage your diabetes care with special applications or apps Some of these are free of charge while others include a small fee Diabetes apps include the following features e
36. ith your doctor about ways to reduce the risk of your blood sugar level rising after exercis ing In addition e Taking the stairs instead of the elevator e Walking a hallway several times 1 Make sure you get a stress test if recommended e Exercising to a video 2 Check your blood sugar before and after exercise Your doctor may recommend a stress test or an electrocardiogram test EKG if you e lt 100 mg dL Your blood sugar may be too low to exercise safely consume a snack 15 grams of carbohydrate before beginning your workout e Have heart disease e Are over the age of 35 e Have high blood pressure or elevated cholesterol 100 250 mg dL This is a e Use tobacco safe pre exercise blood e Have a family history of heart disease glucose range proceed with your workout 250 300 mg dL Check Physical activity may cause your blood sugar to drop more quickly than usual so be sure to ask your doctor how to avoid the risk of low blood sugar for ketones in your urine In addition Do not exercise with e Always wear your diabetes identification which you ketones they can can obtain with the helo of your certified diabetes cause ketoacidosis a educator If no ketones are present e Carry a cell phone with you begin your workout and e Check your blood sugar before and after exercise test blood glucose after i 5 10 minutes of activity Only continue to exercise if your blood glucose level begins to drop
37. l your diabetes Take this checklist when you see your doctor Know your numbers and discuss your goals at each visit Enter information below each time you visit your doctor How Often Target Level Your Result L A1C measures blood sugar control Lowering your A1C reduces Every 3 6 months Discuss with your diabetes complicatons physician L Blood pressure control Lowering your blood pressure Every visit Less than reduces the risk of strokes 130 80 mm Hg L Cholesterol LDL level Lowering your LDL level Every year Less than reduces the risk of heart attacks 100 mg dl L Depression screen Monitors your emotional health Every year L Diabetes kidney function tests Urinalysis and microalbumin ratio Treating early kidney damage Every year Less than may prevent dialysis 30 mg gm L Eye Exam Treating diabetic eye disease Every year early may prevent blindness L Foot exam e Observe the feet Every year e Check the pulses e Test sensation e Helos prevent serious foot infections and amputations L Immunizations e Influenza flu vaccine Every year e Pneumonia Pneumovax At least once Just ask for a referral to e Diabetes education classes Discuss with your physician e Nutritional counseling Call 847 926 5032 Levels are based on recommendations from the American Diabetes Association see Living With Diabetes at www diabetes org but may vary by patient Diabetes An Owner s Manual Chapter 12 Resources Important
38. lds and maintains muscle and bone mass and gives you the strength you need for daily activities Strength training also improves blood sugar levels by helping your body s cells use insulin more effectively You can do strength training by using small weights or weight machines or by using your own body weight with exercises such as push ups stretching and flexibility Stretching and flexibility exercises including yoga and Pilates keep your joints and muscles flexible and help prevent soreness from other activities If you have certain diabetes complications talk to your doctor about physical activities you should not include in your exercise routine such as high impact activities heavy lifting or strenuous exercises continued gt gt Diabetes An Owner s Manual Getting Exercise and Physical Activity continued gt gt Safety Guidelines S Guidelines for blood sugar Its important to have a medical exam before you range before exercise begin any exercise program and to exercise safely If your doctor encourages you to exercise start by being active for only 5 to 10 minutes a day and work up to longer exercise sessions over time You can begin with simple activities that include e Parking in the far corner of a parking lot and walking to your destination Blood sugar levels also can increase after you ve been physically active because your muscles need more glucose during exercise Be sure to talk w
39. mones These hormones can cause high blood sugar levels and make it harder for you to get well Here are some important tips to remember e Be prepared before you get sick Jalk with your diabetes care team about getting a flu shot every year Ask about a sick day menu liquid carbohy drates that you should have on hand if you have nausea or are vomiting and any extra diabetes supplies you should be sure to have Find out how frequently you should check your blood sugar levels Keep a list of telephone numbers that include your doctor your certified diabetes educator and your pharmacy Always have a list of your current medications available Drink plenty of liquids Drink 8 ounces of water or other calorie free beverages every hour You also can have ice chips sugar free popsicles sugar free soda sugar free jello and clear broth If you re unable to eat you ll need to drink liquids that contain sugar Choices include fruit juice regular soda and sports drinks Check your blood sugar frequently on average at least every four hours Check your urine for ketones if your blood glucose is greater than 240 mg dL e Continue to take your medication and insulin If you have nausea or diarrhea check with your doctor or certified diabetes educator to find out how to adjust your medication doses e Check your temperature A fever may dehydrate you so be sure to increase the amount of water you drink Call your doctor when you
40. n A The liver also may release stored glucose glycogen into the bloodstream at D gt b any time causing your blood sugar to rise in the morning after an overnight i fast When any of these factors happen glucose can build up in the blood stream causing high blood sugar or hyperglycemia Following are characteristics of people l Glucose at risk for developing type 2 diabetes Ba Receptor e Pre diabetes see page 4 insulin e Sedentary lifestyle e Body mass index BMI of gt 25 kg m2 e Family history of diabetes e High triglycerides or fat in your blood e High blood pressure e Excessive alcohol consumption continued gt gt Diabetes An Owner s Manual What is Diabetes continued gt gt In addition certain groups of people are at higher risk for type 2 diabetes including e African Americans Hispanic Latino Americans Asian Americans Pacific Islanders Native Americans and Native Alaskans e Women who have had gestational diabetes e Women who have given birth to a baby weighing more than nine pounds e Women with polycystic ovarian syndrome PCOS e Individuals with acanthosis nigricans a darkening of skin that appears around the neck elbows underarms and knuckles If type 2 diabetes is not well controlled through a healthy diet regular exercise and medications it can lead to serious complications Understanding Pre Diabetes Pre diabetes is a condition that occur
41. n Juvisync sitagliptin and simvastatin Jenadueto linagliptin and metformin Alpha Glucosidase inhibitors 7 Delays the absorption and breakdown of carbohydrates from the intestines Miglitol Glyset Acarbose Precose Bile acid sequestrants Works with other diabetes medications to lower blood glucose lowers low density lipoprotein LDL or bad cholesterol Cholesevelam Welchol Take once or twice May cause constipation diarrhea nausea gas and a day with a meal headache May interact with glyburide thyroid medica and liquid tion levothyroxine and contraceptives Dopamine 2 agonists Lowers blood glucose Bromocriptine Take with food within May cause hypoglycemia abdominal pain constipation 2 hours of waking diarrhea nausea and loss of appetite continued gt gt 23 Diabetes An Owner s Manual Chapter 6 Taking Insulin Insulin is divided into five different groups depending on its onset of action when it starts working peak action when it s working the hardest and effective duration when it stops working Insulin helos move glucose into your cells for your body to use as energy Learning how to prepare and administer insulin is an important part of your diabetes care plan Insulin Types Insulin Name Generic Name Rapid Acting Bolus Apidra Glulisine Humalog Lispro NovoLog Aspart Short Acting Regular Intermediate NPH Neutral Protamine Hagedo
42. out of the clear vial turn the clear vial and syringe upside down and pull the plunger down to draw the units of clear insulin you need into the syringe Check for air bubbles and push insulin back into the bottle if you see any sign of bubbles Pull the needle out of the vial of clear insulin and carefully push the needle containing the clear insulin into the cloudy insulin vial Without taking the needle out of the cloudy vial turn the cloudy vial and syringe upside down and pull the plunger down to draw the units of cloudy insulin you need into the syringe Make sure you draw the correct units of insulin because you can t push any insulin back into the cloudy vial Now you should have units of clear units of cloudy total units Pull the syringe out of the bottle You re now ready for your injection e Push the needle through the skin and push down the plunger e Count to 10 and pull the needle out of your skin Warning Never mix Lantus Glargine or Levemir Detemir with other insulins Below is a chart that provides information on different types of insulin their admin istration and the number of days they re good for after their first use or unopened if left at room temperature Number of days good for after first use Type of Insulin Administration or unopened at room temperature Apidra glulisine Cartridge vial 28 days Humalog lispro Cartridge 28 days disposable pen vial H
43. oves insulin level after a meal and lowers the amount of glucose or sugar made by your body Sitagliptin Januvia Take once a day May cause stomach discomfort diarrhea stuffy nose and upper respiratory infections Saxagliptin Onglyza Take once a day Same as above Linagliptin Tradjenta Nesina Take once a day Same as above SGLT2Class Inhibits reabsorption by reducing renal glucose reabsorption and increasing urinary glucose excretion Invokana canaglifozin tablets works with your kidneys and the natural process of urination to help remove excess sugar from the body is a sodium glucose transport inhibitor Injectible Medications GLP 1 Receptor Agonists Injectables O After you eat your intestines release incretins which work as messengers to signal insulin producing cells to make more insulin These medicines also help you feel full longer so you may eat less Exenatide Byetta Take 2 times a day at least 6 hours May cause nausea which may lead to weight loss apart 60 minutes or less before and increase potential for low blood glucose especially breakfast and dinner when taken with other diabetes medications Liraglutide Victoza Take once a day Same as above Exenatide XR Bydureon Take once a week Same as above Combination Medications Kazano alogliptin metformin Ozenc alogliptin and pioglitazone Kombiglyze XR metformin saxagliptin PrandiMet repaglinide and metformi
44. rn Long Acting Basal Levemir Detemir Lantus Glargine Onset 5 15 minutes 5 15 minutes 5 15 minutes 30 60 minutes 2 4 hours 2 4 hours 2 4 hours Plasma Insulin Levels Peak 1 2 hours 1 2 hours 1 2 hours 2 3 hours 4 10 hours None None Aspart lispro glulisine Regular Detemir Glargine Duration 3 4 hours 3 4 hours 3 4 hours 5 8 hours 10 16 hours Up to 24 hours Up to 24 hours Premixed insulin provides some coverage for both your background basal and mealtime bolus needs For many patients mixed insulin does not adequately control blood sugars Usually you take this before your breakfast and evening meal Rapid intermediate acting insulin e Humalog mix 75 25 e Humalog mix 50 50 e Novolog mix 70 30 Short intermediate acting insulin e Humulin 70 30 e Humulin 50 50 e Novolin 70 30 24 Diabetes An Owner s Manual Taking Insulin Before you begin taking any medication such as insulin be sure to talk with your certified diabetes educator about any side effects For instance some side effects may include the following e Low blood sugar e Weight gain e Low blood potassium e Changes in fat tissue at the site of injection e Allergic reactions Injecting Insulin The first time you do something new you may feel uncertain about how to do it correctly This is true for taking insulin to treat your diabetes But once you learn ho
45. rs Buttery Sauteed Fried or crispy Creamed or cream sauce Gravy Au gratin or escalloped Ala mode Hollandaise Alfredo B arnaise Prime e f you want your favorite dessert omit or reduce your portions of starches e Eat a small portion of dessert or split dessert with a companion Diabetes An Owner s Manual Chapter 3 Getting Exercise and Physical Activity Regular physical activity is an important part of managing your diabetes because it helps improve your body s ability to use insulin and reduces your risk of complications It also helps you e ower your blood sugar blood pressure and cholesterol levels e Strengthen your heart and lungs e Relieve stress and tension e Lose or maintain weight e Feel better mentally and physically The American Diabetes Association recommends 150 minutes of exercise each week which is about 20 to 30 minutes of physical activity most days of the week Here are some types of exercise that can help you stay healthy Aerobic exercise Aerobic exercise increases your heart rate works the large muscles in your arms and legs and makes you breathe harder It also can improve or lower blood sugar levels by helping your body s cells use insulin more effectively Some types of aerobic exercise include e Walking e Swimming e Running e Cycling e Dancing e Water aerobics e Chair aerobics strength training Strength training bui
46. s O after the safety test Then select your required dose Insert the needle into your skin and inject your dose by pressing the injection button all the way in Hold the button in that position and count to 10 the window should be back to O then withdraw the needle continued gt gt Diabetes An Owner s Manual Taking Insulin continued gt gt Be sure to store your unopened vials or pens For a single dose in the refrigerator Don t freeze or allow insulin to become warmer than 86 degrees and be sure to use it before the expiration date Open vials may e Take off the cap and be refrigerated or kept at room temperature for one pull the plunger down month Avoid heat and direct light to the units of insulin you need Pens cartridges and vials are good for a limited time after their first use Record the date you use them and store them at room temperature Store unopened vials pens and cartridges in the refrigera tor and be sure to check their expiration dates e Put the needle into i the vial and push Drawing Up Insulin the plunger down Single and Mixed Doses pushing air into Some patients take a single dose of insulin others the vial take a mixed dose which involves combining two different types of insulin medication in one injection It s important to talk with your certified diabetes educator about the steps you must follow to draw up Or prepare either a
47. s bottles soda bottles milk jugs aluminum cans or coffee cans e Always keep storage containers out of reach of children and pets e Always place needles in the container with the sharp end first e Screw the cap on tightly e Never place loose sharps in the garbage For a complete list of disposal sites check the program information about sharps on the Solid Waste Agency of Northern Cook County SWANCC website at swancc org or call 847 724 9205 Resources Other Disposal Options Available to Illinois Residents Below are some additional options to dispose of your used insulin needles pen needles and lancets Mail Back Programs Mail back disposal programs allow you to mail used sharps to a licensed disposal facility These programs charge a fee for their service Be sure to ask your healthcare provider or pharmacist for more information or search the yellow pages or Internet using the search term sharps mail back You also can find additional information at BD ecoFinity Life Cycle Solution bd com ecofinity Sharps Needle Destruction Devices These devices are designed to bend break melt or shear needles Once the needle is destroyed it may be safely disposed of in the garbage not the recycling bin Sharos needle destruction devices can be purchased from medical supply companies or found on the Internet using the search term sharps destruction devices You also can find additional
48. s when blood glucose levels are higher than normal but not yet high enough to be diagnosed as diabetes Pre diabetes also is called impaired fasting glucose or impaired glucose tolerance People with pre diabetes are at higher risk of developing type 2 diabetes than people with normal glucose levels Research shows that some long term damage to the body especially the heart and circulatory system may occur in people with pre diabetes Studies also show that the best way to control pre diabetes is to control your weight by losing 7 to 10 percent of your total body weight and exercising regularly Three blood tests can determine whether you have pre diabetes type 1 or type 2 diabetes Blood Test What It Measures Without Diabetes With Pre Diabetes With Diabetes Type 1 or 2 Fasting plasma Blood sugar levels lt 100 mg dL 100 125 mg dL gt 126 mg dL glucose fasting gt 8 hours Oral glucose Blood sugar levels 2 hours lt 140 mg dL 140 199 mg dL gt 200 mg dL tolerance test after eating often used to diagnose gestational diabetes Average blood glucose lt 5 7 average 5 7 6 4 average gt 6 5 estimated over 2 3 months blood glucose range blood glucose range glucose number lt 100 mg dL 117 137 mg dL 140 mg dL Diabetes An Owner s Manual What is Diabetes Understanding Gestational Diabetes Gestational diabetes is a common medical problem that usually occurs between the sixth and ninth month of
49. single or mixed dose Be sure to wash your hands thoroughly before you prepare your insulin doses If your insulin is cloudy in appearance roll it between the palms of your Turn the vial and hands and mix it well Never shake a bottle of insulin syringe upside down Wipe the top of the insulin bottle with an alcohol and pull the plunger swab down to draw the units of insulin you need into the syringe e Check for air bubbles and push insulin back into the bottle if you see any sign of bubbles e Push the needle through the skin and push down the plunger e Count to 10 and pull the needle out of your skin Diabetes An Owner s Manual Taking Insulin For a mixed dose It is more difficult to attain adequate blood sugar control using a mixed insulin regimen Discuss this with your doctor to determine the best insulin regimen for you Take off the cap and pull the syringe plunger down to the units of cloudy insulin you need Put the needle into the cloudy vial and push the plunger down pushing air into the vial Pull the needle out of the cloudy insulin bottle you should not draw out any cloudy insulin yet Pull the plunger down to the prescribed units of clear insulin you ll need these will be air units You need air in the syringe equal to the amount of clear insulin you ll take Push the needle into the clear vial and push the plunger down pushing air into the vial Without taking the needle
50. somia a baby weighing more than 9 pounds before birth the most common complication for women with this condition Babies of this weight may have problems during delivery as well as breathing problems and low blood sugar levels after birth Most women can control gestational diabetes with diet and exercise Those who cannot keep their blood sugar within a normal range through diet and exercise alone may need to take medication Your physician may refer you to an endocrinologist for follow up after the baby is born continued gt gt Diabetes An Owner s Manual What is Diabetes continued gt gt Here are some tips to manage gestational diabetes e Eat healthy and make appropriate food choices to provide good nutrition for you and your baby Meet with a registered dietitian or certified diabetes educator to develop a meal plan during pregnancy and after delivery Monitor blood sugar levels as directed to make sure they re within a normal range A registered dietitian or certified diabetes educator can show you how to test blood sugar levels daily Get regular physical exercise but check with your doctor first to learn the guide lines for safe exercise Check urine ketones each morning before breakfast to monitor adequate carbohydrate intake Ketones are the result of the body using stored fat instead of glucose for energy They re released into the bloodstream and eventually appear in the urine A registered di
51. t your doctor for help Do not adjust your medication yourself without talking to your physician f you exercise or are going to be physically active you may need to either eat additional snacks or have a plan to adjust your medica tion e Talk to your diabetes care team for instruc tions about the best way to use insulin when you exercise Always remember to check your blood sugar before during and after any physical activity lf you use insulin or take oral medication that can cause low blood sugar you should carry the following items with you o Your glucose monitor or meter o Fast acting glucose tablets o A snack that contains carbohydrate protein and fat o Always carry a Medical Identification or ID card or medical ID tag Such as a necklace or bracelet with your diabetes information listed This is especially important if you use insulin Diabetes An Owner s Manual Treating Hypoglycemia and Hyperglycemia e Carry a cell phone with you if possible e Always check your blood sugar before driving or operating heavy machinery especially if you use insulin Low blood sugar can limit your ability to drive and make decisions e Test your blood sugar as directed by your diabetes care team Vary the time of day at which you test your blood sugar so you can recognize patterns The most common times to check are when you re fasting before meals two hours after meals and at
52. toes e Fruits and fruit juices e Milk and yogurt e Desserts and sweets Nonstarchy vegetables have little effect on blood sugar and provide few calories They can help lower blood pressure and cholesterol and they have other health benefits so incorporate more vegetables into your diet Some examples of nonstarchy vegetables include green beans broccoli spinach and tomatoes Talk to your certified diabetes educator about how many grams of carbohydrate per meal or snack or how many servings of carbohydrate you need to manage your diabetes You also can learn about carb counting to keep track of how many carbohydrates you eat at each meal Diabetes An Owner s Manual Planning Healthy Meals Understanding Nutrition Facts Label 1 Start with Serving Size and Servings Per Container because the rest of the label is based on this informa N utrition E acts tion Measure foods to determine how many servings Serving Size 5 oz 144g you re consuming Servings Per Container 4 Amount Per Serving 2 If you re watching your weight look at Calories first Calories 310 Calories from Fat 100 If you re trying to maintain or lose weight your meals Daily Value should be between 500 and 700 calories depending Total Fat 15g 21 on your height weight physical activity and gender saturated Fat 2 6g 17 Snacks should be no more than 200 300 calories Mane PEt Cholesterol 118mg 39 289 3 When counting carbohydrates use the Total
53. umalog Disposable pen 10 days Mix 50 50 Humalog Vial 28 days Mix 50 50 Humalog Disposable pen 10 days MIX T325 Humalog Vial 28 days Mix 75 25 Humulin 70 30 Disposable pen 10 days Humulin 70 30 Vial 28 days Humulin N Disposable pen 14 days Humulin N Vial 28 days Lantus glargine Cartridge 28 days disposable pen vial Levemir detemir Disposable pen vial 42 days Novolin 70 30 Cartridge InnoLet 10 days Novolin 70 30 Vial 28 days Novolin N Cartridge InnoLet 14 days Novolin R Cartridge InnoLet 28 days NovoLog aspart Cartridge disposable pen 28 days Novolog Disposable pen 14 days Mix 70 30 continued gt gt Diabetes An Owner s Manual Taking Insulin continued gt gt Insulin Pump Therapy Insulin pumps can sometimes be used instead of giving multiple daily injections of insulin by an insulin syringe or pen You still need to learn how to inject insulin with a syringe or pen however you still need to learn how to inject insulin with a syringe or pen in the event the pump malfunctions or before deciding to use a pump The pump is a small battery operated device that s filled with fast acting insulin It s connected to a narrow plastic tube that s inserted just under the skin and taped in place There are also pumps available without tubing The pump site is changed every two to three days Small amounts of insulin called basal are deliv ered to the bo
54. up ketchup 1 Tbsp Mustard Pickles dill 1 2 medium Salsa Cup Taco sauce 1 Tbsp Vinegar Drinks Mixes Bouillon broth consomme Carbonated or mineral water club soda Coffee or tea Diet soft drinks or sugar free drink mixes Eating Out at Restaurants When you have diabetes ordering food from a menu takes careful planning Here are some important guidelines to remember so you can enjoy eating out while keeping your blood sugar levels under control e Keep your meal plan in mind when you eat out e Be sure to bring medications and or insulin with you and take as prescribed e Do not drink alcohol on an empty stomach Seasonings Flavoring extracts Garlic Herbs fresh or dried Nonstick cooking spray Spices Worcestershire sauce Meal Planning information has been adapted from the following sources Choose Your Foods Exchange Lists for Diabetes American Diabetes Association and Academy of Nutrition and Dietetics 2008 Beyond Rice and Beans by Lorena Drago American Diabetes Association 2006 AAPI Guide to Indian Foods e Give specific instructions to the waiter or waitress when you place your order e Send your food back if it s not what you ordered e Order a la carte or appetizers instead of large meal portions e Order dressings sauces gravy butter and sour cream on the side e f a meal serving is large eat half of the portion and take the rest home e Limit foods with these descripto
55. ur blood sugar logbook Be sure to check the expiration date on your test strips and do not use them if they ve expired e Always bring your meter with you to appointments continued gt gt Diabetes An Owner s Manual Monitoring Your Blood Glucose continued gt gt Recommended Glucose Target Ranges Leading organizations that helo people manage their diabetes prefer slightly different glucose target ranges or the healthy level of your blood sugar The measurement mg dL means how many milligrams mg of sugar for 100 milliliters dL of blood For example The American Diabetes Association ADA recommends glucose levels e Before meals 70 130 mg dL e After meals less than lt 180 mg dL The American Association of Clinical Endocrinologists AACE recommends glucose levels e Before meals less than lt 110 mg dL e 2 hours after meals less than lt 140 mg dL Be sure to talk with your diabetes care team about your glucose target range and record it here for future reference My glucose target e Before meals e After meals Diabetes An Owner s Manual Chapter 5 Learning About Medications to Manage Diabetes Oral Medications Combination Medications and Insulin Pumps Most people with diabetes need to take medication to keep their blood glucose within a target range For instance people with type 1 diabetes take insulin injections or use an insulin pump because th
56. ur breath smells fruity or smells like fingernail Yogurt fruit regular 1 cup AO POrSMIE OMEN Yogurt lite 1 cup 15 Diabetes An Owner s Manual Chapter 9 Reducing Your Risk of Chronic Complications Diabetes can lead to serious health complications so it s important to keep your blood sugar levels within your target range and to have regular checkups with your doctor Your physician will test your A1C blood test results Here are some tips to Keep your feet eyes and and help you learn how to keep your blood pressure gums healthy and cholesterol at healthy levels e Foot care Be sure to check your feet every day These are the ABCs of diabetes It s important to including the tops and bottoms and between the know your A1C levels blood pressure readings and toes Look for changes in skin color swelling cholesterol results So you can discuss your goals open sores ingrown or fungal toenails corns or with your doctor or certified diabetes educator calluses and cracks in the skin and talk with your certified diabetes educator to treat them promptly People with diabetes are at risk for heart disease stroke nerve damage and kidney disease as well Be sure to wear comfortable fitting footwear and as Complications with their feet eyes teeth and never walk barefoot Talk with your doctor or gums Wound healing can also be delayed or certified diabetes educator for a complete check impaired This is because high blood sugar
57. w to inject insulin you ll feel more confident in your ability to take this medication The injection technique is the same for those who use a needle or insulin pen some general instructions for taking injections are to choose an area of your body where you ll inject the insulin and change the site for each injection Use fatty tissue such as your belly the top of your thigh your hips or buttocks Arms should be used as a last site choice due to access and arm variabil ity Be sure to wash your hands before you begin Then clean the injection site with soap and water or use an alcohol wipe Using Insulin Pens and Injectables An insulin pen and pen needle which may be more expensive can be used instead of a syringe to inject insulin Several types of insulin pens are available for purchase Be sure to read the instructions carefully if you decide to use one of these devices and always check the label on the insulin to make sure you re using the correct insulin type Below are some general instructions for using insulin pens e Attach a new needle before each injection Never leave a needle on the insulin pen e Always prime your insulin pen before injecting by removing the needle cap and shooting two drops of insulin into the air If you don t see at least two drops after repeated priming don t use the pen because it may not administer the correct amount of insulin you need Be sure the dose window show
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