Managing Your Diabetes®
Contents
1. Biguanide Blood Glucose Meters Bloodstream Blood Sugar Level Byetta exenatide injection Carbohydrates Charts Blood Sugar Control Calories Burned Common Steps in the Treatment of Diabetes Insulin Injection Areas MyPyramid Recommended Insulin Storage Time of Activity of Human Insulins Diabetes What iS Diabetes Checklist Diabetes Medicines Eye Problems Exercise Expiration Date Palo ae eee ee eee eee Glimepiride Glipizide 4 es aso amp ee G4 Glucagon Glucose Sugar 5 Glucose Tablets 42 Glyburide 23 Glycosylated hemoglobin test A1C 10 Healthcare Team 12 Heart Attack 49 High Blood Pressure 49 High Blood Sugar see also Hyperglycemia 44 Humalog insulin lispro injection rDNA origin 27 Humalog Mix75 25 75 insulin lispro protamine suspension 25 insulin lispro injection rDNA origin 27 Humalog Mix50 50 50 insulin lispro protamine suspension 50 insulin lispro injection rDNA origin 27 Humulin human insulin rDNA origin 27 Hyperglycemia see also High Blood Sugar 44 Hypoglycemia see also Low Blood Sugar 40 Immune System TA Incretin Mimetic 24 Insulin 25 Defic2. e are Still very 22 Diabetes Medicines Types of oral medication Check with your doctor to find out how your diabetes pills work Sulfonylureas and Meglitinides such as glyburide glipizide glimepiride repaglinide and nateglinide These medications help the pancreas produce extra insulin Sulfonylureas raise insulin levels for several hours Meglitinides are taken with food and increase insulin levels for a shorter time than the sulfonylureas Low blood sugar is a possible side effect of these medications Starch Blockers such as acarbose These medications slow down the digestion and absorption of starches and sugars Therefore blood sugars rise more slowly after eating Gas and bloating are among the common side effects of these medications but doses can be increased very slowly to lessen the side effects Biguanide drugs such as metformin This type of medication works mostly in the liver Mainly it stops the liver from making extra sugar when it is not needed Biguanide medications can cause side effects the most common being diarrhea upset stomach or nausea To minimize side effects take biguanides with food TZDs such as pioglitazone and rosiglitazone TZDs are medicines that treat insulin resistance a primary cause of diabetes Insulin resistance is a condition in which the body does not use its own insulin effectively By reducing insulin resistance a TZD allows your own insulin or the insulin y
3. Here are ways to cut down on salt e Choose foods close to nature Less processed foods have less salt e Avoid foods canned boxed or frozen with extra salt Try the no salt added varieties e Use herbs spices and salt free seasoning mixes for added flavor instead of salt m Use sugar in moderation High sugar foods should make up only a small part of the diet However small amounts of sweet foods can be a part of a healthy diet even for people who have diabetes Learn how to fit the sweets you enjoy into your overall plan Use alcohol in moderation Alcohol can dangerously lower blood sugar in people with diabetes who take insulin or diabetes pills If you choose to drink alcohol talk to your doctor or dietitian about how to drink safely Pregnant women should not drink alcoholic beverages 14 Meal planning 3 MyPyramid Ve GRAINS VEGETABLES FRUITS MILK MEAT amp BEANS The new MyPyramid shows the food group colored bands running from the tip of the pyramid to its base The different size bands show the proportion of food we should eat from each food group One pyramid does not fit all of us So the USDA created 12 pyramids depending on how many calories you need and how active you are A fun way to determine which pyramid is right for you is to visit the MyPyramid website http www mypyramid gov By typing in your age and activ
4. The date must allow enough time for you to use all the insulin in the vial or pen Do not buy or use insulin past its expiration date Make sure you re buying the right kind of insulin Using the wrong insulin can affect your diabetes control so check the box and label carefully before you buy In order to make sure you re getting the right kind you must know the exact kind and brand name of insulin your doctor wants you to take i e Humalog Humalog Mix75 25 Humalog Mix50 50 Humulin N Humulin 70 30 etc Any change of insulin should be made cautiously and only under medical supervision Make sure the contents are in good condition Regular insulin or Humalog m should be clear and have no color do not use if it looks cloudy thickened even slightly colored or has solid particles in it PreMixed Insulin or Humulin N m should have an even cloudy appearance after gentle mixing rolling do not use if there are clumps in the insulin after mixing do not use if particles on the bottom or wall give the vial a frosted appearance If any of these conditions appear call insulin manufacturer Humby Humby 25 pumas 50 75 insulin lispro protamine suspension 50 insulin lispro protamine suspension insulin lispro Injection rDNA origin 25 insulin lispro injection rDNA origin 50 insulin lispro injection rDNA origin Diabetes Medicines Insulin shots Choosing the site for an insul
5. immediately after a meal Its dosing schedule is flexible With Humalog your insulin dose doesn t determine when you eat you do This means you can manage your diabetes even when you run into unexpected delays or schedule changes Humalog in a convenient premix Based on your needs your healthcare team may pels aT 5 determine that a premixed insulin should be a part of your treatment plan This type of insulin offers you MU ee ee convenience by combining a longer acting insulin with a rapid acting insulin like Humalog 50 50 50 insulin lispro protamine suspension 90 insulin lispro injection rDNA origin Two kinds of premixed insulin are Humalog Mix75 25 and Humalog Mix50 50 They can provide blood sugar control at meals between meals and even at night depending on your treatment plan Humalog Mix75 25 and Humalog Mix50 50 can be taken anytime within 15 minutes before a meal so you can dose and eat This can help you manage your diabetes even with an unpredictable schedule Insulin Basics Recommended insulin storage Insulin Type Unopened Room Temperature Room Refrigerated or Refrigerated Temperature 36 F 46 F 36 F 86 F 56 F 86 F Humalog Humalog Mix75 25 Until Humulin R 28 days 28 days Expiration Humulin N Date Humulin 70 30 Humulin 50 50 Cardges es WA Humalog 3 0 mL 28 days 28 days Until Expiration Date Insulin Type In Use Not In Use unopened Room Temperature
6. Refrigerated below 86 F not frozen Pens _ Humalog 28 days Humalog Mix75 25 10 days Until Humalog Mix50 50 10 days Expiration Humulin N 14 days Date Humulin 70 30 10 days t Opened vials and cartridges are defined as when the stopper or seal has been punctured with a needle Opened cartridges should be stored in the Pen at room temperature and may be stored outside of the Pen in the refrigerator Pens in use should not be refrigerated but should be kept at room temperature below 86 F 80 C away from direct heat and light Humalog is a registered trademark of Eli Lilly and Company Humalog Mix75 25 and Humalog Mix50 50 are trademarks of Eli Lilly and Company Humulin is a registered trademark of Eli Lilly and Company Diabetes Medicines jinto insulin lispro injection rDNA origin L kaa 75 insulin lispro protamine suspension 25 insulin lispro injection rDNA origin H fumadi 50150 50 insulin lispro protamine suspension 50 insulin lispro injection rDNA origin 70 Humulin 30 70 human insulin isophane suspension 30 human insulin injection rDNA origin 50 Humulin 50 50 human insulin isophane suspension 50 human insulin injection rDNA origin Humulin R REGULAR insulin human injection USP rDNA origin Humulin M NPH human insulin rDNA origin isophane suspension 29 30 Diabetes Medicines Handling and storing insulin When insulin is not handled and s
7. an incretin mimetic See page 24 For others it may make more sense to start with insulin shots instead of pills It s common to change your level of therapy from time to time depending on the stage of your diabetes Meal planning and exercise are important parts of diabetes manage ment regardless of the type of medicine used Always talk with your physician before beginning an exercise program See chapter 4 The steps below are common ways to treat diabetes Your healthcare team will help you choose the best therapy for you DP Try different Begin exercising Begin therapy with A f pill d meal planning diabetes pills Ee A z together to control blood sugar and possibly peer Common steps in the treatment of diabetes Aa 5 Add incretin Add insulin shots j using insulin ae OR l increase dose mimetic along along with the ad PEES with pillst diabetes pillst ee of insulin shots t Using the type s of medication s and dose s prescribed by your doctor 21 Diabetes Medicines Oral medications Many people with type 2 diabetes are able to take diabetes pills to keep their blood sugar under control These pills are not insulin Instead these pills rely on the insulin your body makes That is why diabetes pills can t be used in type 1 diabetes Different types of oral medicines lower blood sugar in different ways The list on the next page shows the type of medications and how they work
8. be further from the truth Because diabetes changes over time you simply have to adjust your therapy to keep up with the need for good blood sugar control m Other people fear taking insulin because they think the shots will be painful However many people who take insulin say their initial worries about injections were actually worse than the shots themselves Modern technology has given us better tools for injecting insulin such as shorter and thinner needles Once you know how to use your supplies and develop a technique injecting insulin can be quite simple 1 ADA National Diabetes Fact Sheet 2005 Available at http www diabetes org diabetes statistics jsp Accessed March 3 2006 25 26 Diabetes Medicines The goal is control Remember controlling your blood sugar is far more important than the treatment you use whether it s pills insulin shots or both The number one goal is for your blood sugar to be controlled as well as possible Treatment plans are different for different people Your doctor or diabetes educator working with you will determine the best plan for you What types of insulin are available If you didn t have diabetes your body would make different amounts of insulin at different times It would give you smaller steady amounts between meals and overnight This is sometimes called basal or back ground insulin It would give you larger amounts when you ate That is sometimes
9. fruity smell on your breath notice that your breathing is fast ou are SICK and deep m have a fever e team about is They may have dations for you to Treatment of ketoacidosis This is not a condition you should try to treat yourself Call your doctor immediately if you are ill and you have ketones in your urine Your doctor will tell you what to do If you are unable to reach your doctor go to the nearest emergency room right away Section 8 Possible long term problems Managing Your Diabetes Many long term problems with diabetes are strongly related to high blood sugar levels By keeping your blood sugar as close to normal as possible you may lower your chances of having the following m eye problems m sexual problems m kidney disease m frequent infections m surgical loss of a foot or leg m a heart attack or stroke m nerve damage These are truly serious problems and are scary to hear about But knowing about possible damage from diabetes and taking positive action can help you cope with your fears Eye problems Diabetes can cause the very small blood vessels in the eye to become fragile or blocked resulting in damage that affects your ability to see This is called diabetic retinopathy With these eye problems at first Diabetic retinopathy you many notice no changes to your vision But over time diabetic ret in opa the often retinopathy may get worse and can cause vision loss That s why it s
10. insulin and supplies you need with you This way if anything is lost or damaged you ll have plenty of extras m Do not store your insulin in the trunk of your car or in checked luggage The extreme temperature variations can harm the insulin m With any type of travel always be prepared for delays Carry your insulin and supplies with you at all times in a cold pack not packed in your Suitcase along with healthy snacks that can also serve as meals in case of heavy traffic or delayed flights m Bring something to eat on the plane even if it s a short flight Delays could interfere with your meal schedule Inject your insulin before or after you eat as instructed Be careful not to inject too much air into your insulin vial The pressurized cabin makes this easier to happen How much insulin will receive Just as height is measured in inches insulin is measured in units A unit is a small amount of pure insulin The vial Vials of insulin sold in the United States have 100 units of insulin in each milliliter of fluid Such vials say U 100 on the label The amount of insulin in a milliliter U 100 is called the insulin s concentration Each vial contains 1000 units The Lilly Pen A box of 5 Lilly Pens contains the same amount of insulin as 1 5 vials 31 32 Diabetes Medicines Check the expiration date Always look at the expiration date printed on the insulin box before you buy it
11. sugar Check with your doctor or dietitian for help in learning how your blood sugar is affected by carbohydrate intake 13 Meal planning Choosing healthy foods MyPyramid is a good basic guide to choosing healthy foods It shows the kinds of foods everyone needs The best choices for the rest of the family are also the best choices for people with diabetes The foods in each section of MyPyramid provide some but not all of the nutrients needed for health It is important to eat servings from every group each day Choosing your foods according to MyPyramid will help you follow these guidelines for healthier eating m Eat a variety of foods from the different food groups m Eat plenty of fruits and vegetables All fruits and most vegetables contain carbohydrates but their high content of vitamins minerals and fiber make them great choices Choose a diet low in fat saturated fat and cholesterol For best health these should make up only a small portion of overall food choices Saturated fats animal fats and shortenings for example tend to raise blood cholesterol levels and are bad for the health of your heart m Use salt sodium in moderation Most people eat more salt than they really need For some people extra salt adds to their risk for high blood pressure High blood pressure is more common in people with diabetes Uncontrolled blood pressure greater than 130 85 greatly increases the risk for health problems
12. the industry leader in pioneering therapies to helo healthcare professionals improve the lives of people with diabetes and research continues on innovative medicines to address the unmet needs of patients For more information about Lilly s current diabetes products visit www LillyDiabetes com HI 40811 0506 2006 ELI LILLY AND COMPANY PRINTED IN USA ALL RIGHTS RESERVED Lilly Answers That Matter
13. the liver from making too much sugar especially after meals This helps you avoid high blood sugar levels Food breakdown BYETTA also helps slow down the rate at which food leaves the stomach so it slows sugar entering the bloodstream This effect helps you avoid high blood sugar spikes BYETTA may reduce your appetite the amount of food you eat and your weight BYETTA may give you better control of your blood sugar by helping your body manage its blood sugar levels It works when you need it not when you don t Diabetes Medicines Insulin You have learned that diabetes is a disease that changes over time Because of this your diabetes treatment may also need to change to keep your blood sugar level in good control Early in the treatment of type 2 diabetes pills may work just fine to control your blood sugar But over time the pills may not continue to work as well Here are some facts you need to consider Most people with type 2 diabetes will eventually need to take insulin to control their blood sugar levels m Nearly three out of every ten people with diabetes use insulin today with or without diabetes pills Some common misconceptions Even though insulin treatment may bring blood sugar levels under control many people with diabetes have some mistaken ideas about this important form of treatment For ekample m Some people believe that starting insulin means that they have failed Nothing could
14. therapy should be done cautiously and only under medical supervision Humalog insulins start lowering blood sugar more quickly than regular human insulin allowing for convenient dosing immediately before a meal within 15 minutes Humalog can even be taken immediately after your meal Because Humalog is a mealtime insulin you may also need a longer acting insulin to get the best blood sugar control except when using an insulin pump Please click here for Humalog Humalog Mix75 25 and Humalog Mix50 50 Patient Information 28 Advances in Insulin Mealtime insulin Over the last decade several new insulin options have been introduced to the market As a result your health care team has more options than ever before when it comes to creating a treatment plan just for you Your healthcare team may suggest that you use a mealtime insulin as part of your treatment plan Humalog is the brand name of one mealtime insulin Your healthcare team can help you determine if Humalog is right for you and your needs a insulin lispro injection rDNA origin Humalog can offer you convenience control and flexibility Its rapid action works similar to your body s own insulin action after meals Humalog is absorbed quickly and starts working within minutes to lower your blood sugar With Humalog you can enjoy improved blood sugar control with dose and eat convenience Humalog can be taken within 15 minutes before or
15. wrong Managing Your Diabetes The more you know about diabetes and act upon that knowledge the healthier you can be We hope that you ll make good use of the important treatment tools we ve discussed in these pages These tools will help you to accomplish your key goals for living successfully with diabetes Strategies for dealing with diabetes Learning to deal with diabetes can be difficult At first you may feel angry atraid frustrated guilty or depressed These feelings are quite normal Expressing how you feel may help you to work through these emotions Some people feel most comfortable talking with family and friends about their feelings Others find comfort in talking with their healthcare team or a diabetes support group The important thing is to talk about how you are feeling Here are some other things to keep in mind m The love and support of your family and friends is an endless source of strength Take advantage of It m Fear anger and confusion can stop you from taking care of yourself If you feel them gaining control get help m Learn to take an active role in your care m Continue to do the things you love Diabetes does not have to stop you from getting satisfaction and pleasure out of life 53 10 You are in control 54 Remember that you re not alone You re part of a team committed to managing your diabetes Never forget that diabetes is challenging Celebrate your successes instead of s
16. your thumb on the injection button and push firmly until the dose knob is pushed in completely Hold the injection button in and count slowly to 5 to deliver the full dose Make sure that you received a full dose by checking that the injection button has been completely pushed in and you can see a diamond or an arrow gt in the center of the dose window 36 Diabetes Medicines 8 Store the Pen Replace the outer needle shield Unscrew the capped needle and dispose of the needle as directed by your healthcare professional Place the cap back on the Pen for storage If you have any questions about Pens call Lilly at 1 800 LillyRx 1 800 545 5979 from 9am 5pm EST If you have any questions about pen needles please call Becton Dickinson and Company at 1 888 BDCARES 1 888 232 2737 from 9am 5pm EST or 1 800 LillyRx 1 800 545 5979 See Pen literature in Pen package for complete instructions and storage information Every time you inject m Use a new needle Prime to make sure the Pen is m Make sure you receive all m Remove the needle immediatel Using a vial and syringe Your doctor or diabetes educator will explain how to take your first insulin shot He or she will then watch you do the following steps Preparing a dose of insulin 1 m Wash your hands Gently mix the insulin by e Rolling the vial between the palms of your hands e Turning the vial over from end to end a few times 2 m
17. 50 insulin lisoro protamine suspension t fund 50150 50 insulin lispro injection rDNA origin Diabetes Medicines 5 Prime the Pen With the needle pointed up m lap the clear cartridge holder gently with your finger so that any air bubbles collect near the top m Push in the injection button completely Keep pressing and continue to hold firmly while counting slowly to 5 You should see either a drop or a stream of insulin come out of the tip of the needle m If insulin does not come out of the tip of the needle repeat the priming steps m Priming is complete when the insulin flow appears at the needle tip and a diamond 9 is seen centered in the dose window Set your dose and inject 6 Set your dose A diamond must be seen in the center of the dose window before setting your dose m f you do not see a diamond in the center of the dose window the Pen has not been primed correctly and you are not ready to set your dose Before continuing repeat the priming steps m Turn to the arrow gt m Pull to 0 m Set your desired dose m f the dose you have dialed is too high simply turn the dose knob backward until the correct dose is seen in the dose window 7 Injecting Do not inject a dose unless the Pen is primed just before the injection or you may get too much or too little insulin m Prepare the skin and use the injection technique recommended by your healthcare professional Insert the Needle Place
18. 6 a Lilly Partnership tn Diabetes Comprehensive Patient Education Program n Lilly Answers That Matter Managing Your Diabetes is a registered trademark of Eli Lilly and Company Table of Contents What is diabetes Basic facts about diabetes Types of diabetes What happens in the body when you eat Causes of type 1 and type 2 diabetes Taking control of your diabetes Normal blood sugar ranges Keeping blood sugars in range Blood sugar testing The benefits of staying in control Working with your healthcare team The importance of diabetes self education Meal planning The effect of food on blood sugar Choosing healthy foods Eating the right amount at the right time Exercise Benefits How to get started Staying motivated Safety tips Diabetes medicines Page 13 17 Page Low blood sugar Hypoglyce High blood sugar Hyperglyc Possible long term problems 48 Eye problems Kidney disease Nerve damage Freguent infections Heart attack or stroke General healthcare 51 Eye care Foot care Skin care Dental care Sick days special information Now it s up to you 54 Strategies for dealing with diabetes Maintaining a positive outlook Managing your diabetes checklist 56 Index 57 Section 1 What is diabetes Managing Your Diabetes Diabetes is not like other health problems you may have had in the past For one thing it doe
19. If this is anew vial remove the flat colored cap but not the rubber stopper or the metal band under the cap m Clean the rubber stopper with an alcohol swab 3 m Remove the cover from the needle Pull the plunger back to pull air into the syringe m Pull back until the tip of the plunger is at the line for the number of units required 4 m Push the needle through the rubber stopper Make sure the tip of the needle is not in the insulin Press the plunger to push air into the vial of insulin Diabetes Medicines Turn the vial and syringe upside down Now the tip of the needle should be in the insulin Holding the vial with one hand use the other to pull back on the plunger which will pull insulin into the syringe Stop when the plunger is at the line for your dose Look at the insulin in the syringe If you see any air bubbles e Use the plunger to push the insulin back into the vial e Then slowly pull the plunger back to the line for your dose of insulin e Repeat this until there are no large air bubbles in the syringe Make sure the tip of the plunger is at the line showing your dose of insulin Double check your dose Magnifiers are available if needed to help you see more clearly Pull the needle out of the rubber stopper If you need to lay the needle down before taking your shot put the cover back on the tip to protect it Injecting your insulin Choose an injection site Make sure the skin is clean Pin
20. ar if needed mg Stretch and warm up at the beginning of your activity This helps prevent injuries m Drink more liquids that contain no calories like water when exercising If you have leg or chest pains during exercise stop exercising and call your doctor m Avoid exercising if your blood sugar is above 300 mg dL or under 70 mg dL Sectic Di A t In Chapter 1 you learned that diabetes is caused by the body s inability to make insulin or to use it properly You also found that although diabetes cannot be cured it can be managed by various treatments including the use of diabetes medications These include several types of oral medications and the various types of insulin People with type 1 diabetes must take insulin shots to live because their bodies cannot produce insulin Although most people with type 2 diabetes take either diabetes pills insulin or both a few can keep their blood sugar in control with careful meal planning and regular activity sugar zs o that 20 Diabetes Medicines Common treatment stages for type 2 diabetes Diabetes is different for each person Depending on the stage of your diabetes and your body s response to certain therapies your healthcare provider may prescribe one or more treatments For example you may be able to control your diabetes with diabetes pills alone or you may need more than one pill to control your blood sugar Some people may use pills plus
21. ar levels can reduce the body s ability to fight off many kinds of infections including the flu Check with your doctor about getting a flu vaccine People with diabetes are more prone to developing m skin infections m bladder infections m vaginal yeast infections m tooth and gum infections Heart attack or stroke Heart attacks are a major cause of death in people with type 2 diabetes People with type 2 diabetes have an increased risk for heart attacks because of m abnormal levels of blood fats m high blood pressure m high blood sugar levels Talk to your doctor about how to reduce your risk of heart disease 49 Managing Your Diabetes Taking extra good care of yourself is important when you have diabetes Possible eye problems diabetic retinopathy glaucoma glaw ko ma and cataract kat a rakt caused by diabetes often have NO symptoms in the early most treatable stages Therefore you should have a complete dilated eye examination every year from an eye doctor optometrist or ophthalmologist A complete dilated eye exam must include eye drops that allow your eye doctor to see the blood vessels in your eyes more clearly In addition you should visit your eye doctor at the first signs of any of the following m blurred or double vision m feeling pressure or pain in the eyes m seeing dark spots m unusual difficulty seeing in dim light m narrowed field of vision To further reduce your risk of eye problems you sh
22. called bolus or mealtime insulin Together they would keep your blood sugar in control all day Because you can t make insulin or don t make enough for your body s needs you probably will need to use more than one type of manufactured insulin to get the same effect These different types of insulin work at different rates and for different amounts of time Rapid acting insulins start very quickly and work for a short time These are best for mealtime and should be used with a longer acting insulin which covers your background needs Which plan is right for me Insulin therapy is not one size fits all Different people need different insulins The insulin plan that s right for you will do two things Fit your life What do you do When do you do it Let your healthcare team know your usual routine Or tell them if you don t have one The details of your life will make some insulins a better choice than others Match your body s needs You need some insulin all the time more when you eat and less when you exercise If you have type 1 diabetes all of those needs will be met by your injected insulin If you have type 2 some of the needs may be met by your body s own insulin There are a lot of ways to combine insulins to meet those different needs Your healthcare team will help you figure out which is right for you Diabetes Medicines How much insulin do you need Here are some of the th
23. ch upa large area of skin Push the needle into the skin going straight in at a 90 degree angle Make sure the needle is all the way in Push the plunger all the way down to inject the insulin into your body Release the pinched skin count to five slowly and pull the needle straight out Do not rub the place where you gave your shot Safely dispose of used needles and syringes Your doctor pharmacist diabetes educator or state health authorities can tell you how 38 Diabetes Medicines Preparing a mixed dose of insulin Your doctor may want you to take more than one type of insulin For example you may need a combination of rapid acting and longer acting insulin to keep your blood sugar in the target range There are two ways to do this A Use a premixed insulin This method does not require you to mix insulin yourself B Mix the two types of insulin yourself Follow the procedure below if you are mixing insulin yourself Both insulins can be put in the syringe at the same time allowing you to take just one shot instead of two 1 m Clean the tops of both vials with an alcohol swab m Inject a units of air into the longer acting cloudy insulin bottle Do not pull insulin into the syringe m lake the needle out of the vial 2 m Inject b units of air into the rapid acting clear insulin vial m Turn the vial and syringe upside down m Hold the vial with one hand m Use the other hand to pull back on the plung
24. en in doubt it s safer to take something that will quickly raise your blood sugar than to risk having a serious low blood sugar reaction After eating or drinking something m Wait 15 minutes then test your blood sugar again Record the number in your log book Also be sure to write down that you had a low blood sugar reaction m If you don t feel better in 15 minutes repeat above steps How to treat hypoglycemia m f your blood sugar is still low call your doctor s office m f your next meal is more than an hour away follow the sugar with something that provides carbohydrate and protein like half a sandwich or some crackers and cheese m Be sure to eat your normal meal at the regular time even if you have previously used a low blood sugar treatment Important to do m learn your body s warning signs of falling blood sugar m when you notice symptoms test your blood and you may need to have a snack m always wear or carry diabetes identification m educate family members friends or coworkers on symptoms and 42 treatment for low blood sugar Low Blood Sugar Hypoglycemia 6 TFE Glucagon Emergency Kil for Low Blood Sugar What is glucagon Glucagon is a medicine that raises blood sugar and is important therapy for hypoglycemia It is given as a shot just like insulin If your blood sugar level gets so low that you pass out or can t swallow you will need a glucagon shot If you take insulin y
25. ension t Typical profiles of insulin activity based on glucose utilization from clinical trial data Patients may experience variations in timing and or intensity of insulin activity due to dose site of injection temperature and patient s physical activity Please click here for Humalog Humalog Mix75 25 Humalog Mix50 50 Patient Information 27 Diabetes Medicines Humalog Humalog Mix75 25 and Humalog Mix50 50 are for use in patients with diabetes to control high blood sugar Humalog should be used with a longer acting insulin except when used in combination with sulfonylureas in patients with type 2 diabetes Important Safety Information Humalog insulins are contra indicated during episodes of hypoglycemia and in patients sensitive to Humalog or one of its excipients The safety and effectiveness of Humalog in patients less than 3 years of age have not been established Safety and effectiveness of Humalog Mix75 25 and Humalog Mix50 50 in patients less than 18 years of age have not been established There are no clinical studies of the use of Humalog insulins in pregnancy or nursing mothers Potential side effects associated with the use of all insulins include low blood sugar weight gain low blood potassium changes in fat tissue at the site of injection and allergic reactions both general and local Humalog Mix75 25 and Humalog Mix50 50 should not be mixed with another insulin Starting or changing insulin
26. er until you have your required dose of rapid acting insulin in the syringe m Be sure to remove any large air bubbles m lake the needle out of the vial 3 m Gently roll or shake the longer acting insulin vial until it is mixed m Insert the needle into the vial of longer acting insulin m Turn the vial and syringe upside down m Hold the vial with one hand m Use the other hand to pull back on the plunger m Pull the plunger back until you have a total of both equaled to a b your total prescribed insulin dosage as recommended by your physician m Be careful not to push any of the rapid acting insulin into the longer acting insulin vial be F F _ b d j am rs ia Aa Wa rr a P 2H aS A 1 ar a bi E amp a im ji a i 4 m Remove the needle from the vial m Give your shot as described in the Injecting Your Insulin section a Units reflects your Doctors recommendation for units of longer acting insulin b Units reflects your Doctors recommendation for units of rapid acting insulin Note Please work with your healthcare professional if you are mixing insulin for guidance on the best way to manage this Your healthcare professional can help you understand more about mixing insulin 39 40 Section 6 Low Blood Sugar Hypoglycemia Managing Your Diabetes When your blood sugar falls below 70 mg dL you may have low blood sugar hypoglycemia When this hap
27. gar reading below 60 mg dL and aren t experiencing any of the symptoms described above you should immediately treat your low blood sugar level Even if you are feeling fine this situation still needs to be treated Make sure to notify your doctor of this event Low blood sugar feels different to different people Learn to recognize your own particular symptoms How to prevent hypoglycemia Low blood sugar can be prevented if you m eat your meals on time m don t skip meals or snacks m learn to adjust your food and diabetes medicine for exercise m test your blood sugar on schedule m do extra tests when you don t feel normal and write down the results in your log book 41 Low Blood Sugar Hypoglycemia 6 How to treat hypoglycemia You need to treat low blood sugar right away It will not get better on its own So be sure to keep foods that contain sugar or glucose products with you at all times When you feel your blood sugar might be low test your blood If your reading is less than 70 mg dL or the level set by your AA doctor take one of the following right away Each one contains about 15 grams of carbohydrate m 3 glucose tablets 5 grams glucose each wa AN m 1 2 cup of fruit juice or regular soda not sugar free i m 6 or 7 hard candies not sugar free S m 1 tablespoon of honey or sugar If you feel your blood sugar is low but cannot test take one of the above items anyway Wh
28. hat are related to diabetes You will learn more about problems linked to diabetes in Chapter 8 m You ll feel much better if you keep your blood sugar close to normal When your blood sugar is higher or lower than normal you will probably feel tired sick and or uncomfortable m Controlling your diabetes will keep it from controlling you It will have less power to disrupt your life 1 American Diabetes Association Standards of medical care in diabetes Diabetes Care 2006 29 suppl 1 84 842 2 American College of Endocrinology Consensus statement on guidelines for glycemic control Endocr Pract 2002 8 suppl 1 5 11 11 Taking control of your diabetes Working with your healthcare team Although the day to day management of your diabetes is very much up to you controlling diabetes is always a team effort So you need on going professional help such as visits to your doctor and lab tests to make sure that your treatment plan stays on track That way if problems do start they will be found early Don t forget that if you have a question or a problem your healthcare team members are always there to help you Your healthcare team includes m your doctor and office staff m diabetes educators such as a nurse dietitian or other professional m pharmacist gi other professionals such as an eye doctor dentist podiatrist foot doctor or an exercise specialist depending on your needs family friends and
29. iency see also Type 1 Diabetes 7 Handling of 30 Injection Areas See also Site Rotation 33 Insulin continued Mikingof Premixed Resistance see also Type 2 Diabetes Storingof Ketoacidosis Ketones Low Blood Sugar see also Hypoglycemia Meglitinides Metformin Microalbumin Screen Nateglinide Nephropathy Nerve Damage Neuropathy Pen insulin Pioglitazone Podiatrist Repaglinide Retinopathy Rosiglitazone Salt see also Sodium Saturated Fats Sexual Problems Sick Days Site Rotation see also Insulin Injection Areas Sodium see also Salt Starch Blockers 39 32 30 46 46 48 17 40 23 48 23 48 48 48 31 23 51 23 47 23 14 14 48 52 33 14 Stroke 49 Sulfonylureas 23 Syringe 37 Thiazolidinedione or TZDs 23 TIravelng 31 Type 1 Diabetes See also Insulin Deficiency 5 Type 2 Diabetes see also Insulin Resistance 5 Vial insulin 31 59 Lilly Partnership in Diabetes Through a long standing commitment to diabetes care Lilly provides patients with breakthrough treatments that enable them to live full and active lives since 1923 Lilly has been
30. important to have a comprehensive dilated exam every year These eye problems can be treated if they are discovered in their early stages Don t wait for symptoms Be sure to have a complete Scene viewed by a dilated eye exam at least person with severe has no early warning signs scene viewed by a person WA once a year with normal vision loss from J J vision diabetic retinopathy T zia National Eye Institute National Institutes of Health Eye Simulations Ref s EDS01 and EDS04 47 Available at http www nei nih gov photo sims Accessed on March 3 2006 Litt Possible long term problems Kidney disease Diabetes can also damage the small blood vessels in the kidneys This kind of kidney damage is called nephropathy ne frop a the and has no early symptoms When this condition occurs m Waste products are kept in the body instead of leaving with the urine m Important nutrients like protein that should stay in the body are flushed away m Wastes continue to build up in the blood stream m f the damage continues the kidneys may fail completely If your kidneys fail you must depend upon a special filtering machine to remove impurities from your bloodstream However kidney damage can be found at an early and treatable stage with simple office testing that detects small amounts of protein in the urine This test is called a microalbumin mi kro al bu min screen A second test to check kidney fu
31. in insulin deficiency Type 2 used to be called non insulin dependent diabetes People who have it can be treated with proper meal planning exercise and medications Type 2 diabetes is the most common form of diabetes and accounts for at least nine out of ten cases Although it can occur in younger people it most often begins when people are over 40 years of age The most important thing to remember is that getting diabetes is not your fault m The tendency to develop type 2 diabetes is inherited present at birth m It does not always come from being too heavy m It is not caused by eating too much sugar LI Ee amp Body cell in type 2 diabetes 2 ki P Insulin in the blood Sugar in the blood Sugar in the body cell What is diabetes Symptoms In its early stages type 2 diabetes often has no symptoms When symptoms do occur they may come on gradually and be very subtle They include m feeling tired m dry itchy skin m frequent infections m increased urination m blurred vision m problems with sexual function m slow healing of cuts or sores m increased hunger and thirst m numbness or tingling in hands or feet Causes of type 2 diabetes No one knows the exact cause of type 2 diabetes We do know that it is more likely to occur in people who are over 40 years of age are overweight have a family history of diabetes have high blood pressure have had diabetes during a preg
32. in shot Knowing exactly where on your body you should give your shot s each day is very important The chart below shows sites for your insulin shots in the red and white grid areas Each square is a place to give yourself a shot You may need help from a family member to give shots in some of the sites Front Insulin injection areas Ret HE HE UKI Rotating sites For your insulin to work best it s important to use a different location for each shot This is called site rotation and involves following a regular pattern as you move from site to site If you take more than one shot each day use a different area for each shot Different people use different patterns but the intent should always be to use all of the areas and the sites When you do this no one site will be used too often Overusing a site can cause tissue Changes that lower or change insulin absorption 33 34 Diabetes Medicines Insulin enters the blood more guickly from some areas than others So your blood sugar may be higher or lower depending on what area is used At times you may want to use a certain area because of how quickly or slowly insulin is taken up from that site For example when you ll be eating very soon after a shot you could use a site on your stomach Most insulin enters the blood m fastest from the abdomen stomach m alittle slower from the arms m even more slowly from the legs most slowly from the b
33. ings that affect your need for insulin m how much you weigh m how much you exercise m how fit you are how much m how sensitive your body fat and muscle you have cells are to insulin m how much you eat and m your emotions Such as the foods you choose your amount of stress m what other medicines you take Getting the right insulin dose is a lot like tailoring a suit You might start with a suit right off the rack Then the tailor nips and tucks until it s just right It doesn t matter how large or small the suit is What matters is that it fits you Your blood sugars tell you when you ve got the right fit Different actions of insulin Knowing an insulin s type will tell you how fast it starts to work and how long its action continues The chart below shows the activity of some insulins Time of activity of human insulinst hours 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 Rapid acting tele VM ET TL LTE LELLEL Onset The start of the curve Premixed left side shows when the ge ee A insulin starts to work insulin lispro injection rDNA origin NON PA Peak The peak is the highest DATT when the insulin usually has o its strongest effect ia P O OO OO O O Duration The end of the curve Premixed 50 right side shows how long the o insulin may work Short acting Humulin REGULAR insulin human injection USP DNA origin Intermediate un N n NI n human insulin rDNA origin isophane susp
34. ity level the Pyramid Planner automatically calculates the number of servings from each food group and total number of calories you need each day Is your blood sugar often over 180 mg dL one to two hours after eating If so a change in your treatment plan may be needed Ask your healthcare team how to improve your numbers 1 United State Department of Agriculture MyPyramid gov Available at www mypyramid gov Accessed March 3 2006 Meal planning Eat the right amount of food for you at the right times Several factors affect how much food you need each day One of them Is how much you weigh in relation to how tall you are Another is how much exercise you get People who exercise a lot or whose jobs involve heavy labor use more energy than people who are less active Most people eat better feel better and have more energy if they eat regular meals Spacing food throughout the day also seems to help you stay at a healthy weight and get the vitamins and minerals you need 3 Skipping or delaying 16 kai AA ss Managing Your Diabetes Exercise is good for everyone But it can be especially good for people with diabetes It can reduce stress Increase your energy and just make you feel better When you exercise movement becomes easier and your muscles are strengthened It s also a good way to control your blood pressure and blood fats lipids If you are insulin resistant it ma
35. n both types of diabetes sugar builds up in your bloodstream because it cannot enter the cells m Without sugar for fuel in the cells your body lacks energy m Sugar stays in your blood and you have high blood sugar levels m High blood sugar levels can damage your blood vessels and over a long period of time can result in serious problems Type 1 diabetes As we discussed before in type 1 diabetes the body makes little or no insulin called insulin deficiency People with this type of diabetes must take insulin shots to live That s why you sometimes hear it referred to as insulin dependent diabetes Less than one in ten people with diabetes have type 1 Although it usually begins when people are young it may occur at any age Symptoms The symptoms of type 1 diabetes usually come on suddenly They include m increased thirst m increased urination m increased hunger m sudden weight loss m feeling very tired Whatis diabetes Causes of type 1 diabetes At this time no one knows the eract cause of type 1 diabetes Butitis related to A possible history of type 1 diabetes in the family m A problem with the body s defense immune system that causes it to destroy the insulin making cells in the pancreas Type 2 diabetes In type 2 diabetes your body may still make insulin but is unable to correctly use the insulin it does make insulin resistance Eventually the body doesn t make enough insul
36. nancy have given birth to a baby weighing over 9 pounds have the stress of an illness or injury are African American Hispanic Latino American American Indian Asian American or Pacific Islander Since the tendency to develop type 2 diabetes may be inherited any member of your family mother father sister brother children who has three or more of the above symptoms should be tested for diabetes Also regular exercise and managing your weight may help prevent or delay some cases of type 2 diabetes Whether you have type 1 or type 2 diabetes you have an important role in your own care Read on for more information on the things you can do to manage your diabetes It s important to keep learning The more you know the better you can manage 2 ADA National Diabetes Fact Sheet 2005 Available at http www diabetes org diabetes statistics jsp Accessed March 3 2006 ort pied ao Pa i oie ee Section 2 Taking control of your diabetes Managing Your Diabetes In Chapter 1 you learned about diabetes its symptoms its causes and what happens in your body In this chapter we will examine the tools you can use to manage your diabetes Your goal do your level best One of your main goals of treating diabetes is to control your blood sugar level by keeping it as close to normal as possible People without diabetes normally have blood sugar levels less than 100 mg dL milligrams of sugar for eve
37. nction is a blood test called serum creatinine You should have both of these tests done at least once a year Nerve damage is also called neuropathy nU rdp a the When blood sugar is high nerve cells swell and scar In time the nerves lose their ability to send signals through the body the way they should This can lead to symptoms which may come and go Some examples are m burning pain numbness tingling or loss of feeling in the feet or lower legs especially at night m problems in sexual function in both men and women m changes in stomach and bowel function The following can happen to your feet m when nerves are damaged an injury to the foot may not cause pain m with no pain to warn of the injury the foot can become badly infected before the problem is discovered m because of poor blood flow and high blood sugar the body is less able to fight the infection and heal the injury m in very serious cases it may be necessary to surgically remove the foot 48 or the limb Possible long term problems In most cases proper care of your feet can prevent the need for any surgery This is why it s so important to protect your feet especially when you exercise and check them daily for any sign of a problem See Chapter 9 for some important tips There are new treatments for neuropathy so be sure to tell your doctor or diabetes educator if you have any of the above symptoms Frequent infections High blood sug
38. ning m more regular exercise m more frequent blood testing and a plan for acting on the results 45 46 High Blood Sugar Hyperglycemia Ketoacidosis ke to a si do sis is a serious condition that usually occurs only in people with type 1 diabetes When your body does not have enough insulin it cannot use sugar as fuel even though your blood sugar level may be high Instead your body starts to burn fat for fuel and ketones are produced as a result As ketone levels rise in the bloodstream they cause a serious illness called ketoacidosis If you don t take extra insulin when your body begins to make ketones three things may happen m Your blood sugar level will keep increasing m Ketones may build up in the blood and make your body tissues too acidic m The body cells may be damaged which can lead to severe illness and even death Ketoacidosis can develop very quickly especially when you re sick with a cold flu or any other kind of infection or during periods of severe stress That s why it s so important to check your blood sugar and urine ketone levels several times a day when you are sick Symptoms of ketoacidosis There are several warning signs that you may be in ketoacidosis Do not ignore them Check your blood sugar and urine ketone levels when you m feel more hungry and thirsty than usual have to urinate more often than usual throw up or feel sick to your stomach have stomach pain have a
39. o your healthcare provider about any side effect that bothers you or that does not go away Please click here for BYETTA patient information BYETTA is a registered trademark of Amylin Pharmaceuticals Inc 24 An incretin mimetic is a unique kind of type 2 diabetes drug that mimics many of the actions of naturally occurring hormones from the intestines and can help the body make more of its own insulin BYETTA is the first incretin mimetic approved for the treatment of type 2 diabetes yetta exenalide injection BYETTA is an injectable medicine used to improve blood sugar control in adults with type 2 diabetes BYETTA is not insulin and is not a substitute for insulin BYETTA actually helps your body make more of its own insulin How to take BYETTA BYETTA should be taken twice daily at any time within the 60 minutes before the morning and evening meals BYETTA comes in a prefilled pen for simple fixed dosing How BYETTA works BYETTA works when used with metformin and or a sulfonylurea Common oral medications for the treatment of diabetes It helps with blood sugar problems in several ways m Insulin production During meals BYETTA signals the pancreas to make the right amount of insulin at the right time This helps lower blood sugar closer to normal levels After blood sugar levels get closer to normal BYETTA stops signaling the pancreas to produce insulin Sugar production BYETTA helps prevent
40. or in pain A number of medicines including over the counter medicines may increase your blood sugar Talk to your healthcare provider to find out what is safe for you Blood sugar levels are considered to be above normal when they nse above 120 mg dL before meals or above 180 mg dL after meals This happens to everyone with diabetes at certain times However if this happens often it is a problem that needs attention AA High Blood Sugar Hyperglycemia F Symptoms of hyperglycemia The tricky thing about hyperglycemia is that you can feel just fine even though your blood sugar is too high When symptoms of hyperglycemia are present they may be mild or come on so slowly you don t notice them So this is why it is important to test your blood sugar regularly Watch for the following symptoms m more hunger or thirst than usual m dry or itchy skin m feeling tired or sleepy m blurred vision m frequent infections m slow healing of cuts or sores m having to urinate often especially at night How to treat hyperglycemia If you have hyperglycemia it should be treated Although there may be no short term symptoms there are long term health risks related to hyperglycemia Talk with your doctor or diabetes educator about hyperglycemia Discuss your desire to improve control and ask what your options are for reaching your goals The following options may include m achange in medicines or doses m more careful meal plan
41. ou take to work more effec tively to help reduce the harmful increase in blood sugar level Side effects of the TZDs may include weight gain and edema swelling 23 5 Diabetes Medicines Important Safety Information for BYETTA exenatide injection BYETTA improves blood sugar control in adults with type 2 diabetes It is used with metformin a sulfonylurea or both BYETTA is not a substitute for insulin in patients whose diabetes requires insulin treatment BYETTA has not been studied in children Before using BYETTA tell your healthcare provider about all of your medical conditions including if you have severe problems with either your stomach or food digestion if you have severe kidney disease or if you are pregnant plan to become pregnant or are breastfeeding When BYETTA is used with a medicine that contains a sulfonylurea low blood sugar hypoglycemia is a possible side effect The dose of your sulfonylurea medicine may need to be reduced while you use BYETTA Other common side effects with BYETTA include nausea vomiting diarrhea dizziness headache feeling jittery and acid stomach Nausea is most common when first starting BYETTA but decreases over time in most patients BYETTA may reduce your appetite the amount of food you eat and your weight No changes in your BYETTA dose are needed for these side effects These are not all the possible side effects from use of BYETTA Talk t
42. ould have your blood pressure checked often and avoid smoking xam every year will 50 General health care Foot care Poor circulation nerve damage and trouble fighting infections can make foot problems very serious Have your doctor or podiatrist a foot doctor test your feet at least once a year for loss of feeling Visit a podiatrist regularly if you need help with routine nail or callus care Here are some other things you can do to help keep your feet in top condition m Check your feet every day for redness swelling corns calluses ingrown toenails or breaks in the skin Use a mirror if necessary Report any problems to your doctor immediately m Cut your toenails straight across not into the corners and smooth with an emery board m Wear only comfortable well fitting shoes If your shoes are uncomfortable get rid of them m Check inside your shoes for foreign objects or rough spots every time you put them on m Wear socks and shoes at all times m Be especially careful with your feet when weather is very hot or very cold Taking your shoes and socks off at every office visit will remind your doctor to check your feet Skin problems related to diabetes range from bothersome itching to painful infections but there is a lot you can do to keep from having these problems Basic skin care should include the following m Bathe every day with mild soap and lukewarm water using a small amount of lo
43. our family friends coworkers and exercise partners should learn how to give you a shot of glucagon When you need glucagon you may not be able to give it yourself Ask your doctor about glucagon because you will need a prescription for it When others should inject you with glucagon Family friends coworkers or exercise partners should give you glucagon if m You are unconscious m You are unable to eat sugar or sugar sweetened product Whenever possible it is important to test blood sugar before giving glucagon Glucagon is a safe drug There is no danger of taking too much However it is for emergencies and should be used only under the direction of your doctor As with hypoglycemia nausea and vomiting may occur Generalized allergic reactions have also been reported with glucagon use Click here for Lilly Glucagon Patient Information for the User 43 Managing Your Diabetes You have high blood sugar or hyperglycemia when your blood sugar level has risen and stayed well above normal When this happens often your diabetes is said to be out of control Blood sugars will change depending upon a number of factors What causes hyperglycemia Here are some things that will cause your blood sugar to increase m food m not taking enough diabetes medicine m emotional stress m not taking the right diabetes medicine m extra sugar made by the liver m getting less exercise than usual m physical stress being sick
44. our pancreas an organ in your body that helps to keep your blood sugar in the normal range m Intype 1 diabetes your body makes little or no insulin m Intype 2 diabetes your body makes insulin but your cells cannot use it well This is called insulin resistance Also your ability to make insulin gradually decreases as time goes by insulin deficiency What happens when you eat Some of the food in the stomach breaks down into sugars one of these sugars is glucose the body s main fuel Sugar enters the bloodstream and the level of sugar in your blood begins to rise When your body senses an increase in sugar it sends a signal to your pancreas The pancreas makes insulin and sends it into the bloodstream Insulin lowers the level of blood sugar by acting as a key to unlock 05 the body s cells and allows sugar to pass from the bloodstream into the cells QO The level of sugar in the bloodstream falls as the sugar passes into the cells The body s cells use the sugar for fuel Q 221 How sugar enters the cell P Insulin in the blood Sugar in the blood y Sugar in the body cell a e Food i Sugar enters through _ e amp the cell membrane What is diabetes What is diabetes What happens when you have diabetes m Intype 1 diabetes your body doesn t make enough insulin In type 2 diabetes your cells cannot use the insulin your body makes m I
45. p track of your results in a diary and take it with you for your office visits so your doctor can check for any trends 2 Have a glycosylated hemoglobin test A1C m This can give a clearer picture of whether your diabetes is in control since it shows your average blood sugar level over a 2 3 month period m Depending on your treatment and level of diabetes control an A1C test should be done in your doctor s office every 3 6 months m The ADA recommends that your ATC be less than 7 for patients in general Your healthcare team will set the target that is right for you 10 ACCU CHEK and ACCU CHEK AVIVA are trademarks of Roche 2006 Roche Diagnostics Taking control of your diabetes 2 Blood Sugar Control Testt Level for people Goal for people without diabetes with diabetes ADA ACE Blood sugar lt 100 mg dL 90 130 mg dL lt 110 mg dL Blood sugar lt 110 mg dL lt 180 mg dL lt 140 mg dL after meals peak 2 hr post meal ATC lt 6 lt 7 lt 6 5 patients in general t Do not use these values if you are pregnant Work with your healthcare provider to determine your target values A1C test values may be different for different test labs The values used in this chart refer to a range of 4 6 for people without diabetes mean 5 standard deviation 0 5 The benefits of staying in control m Maintaining a near normal blood sugar level may help protect you from many of the serious problems t
46. pens most people experience unpleasant symptoms that can be both physical and emotional These symptoms can come on quite suddenly Hypoglycemia is usually easy to treat However if it is not dealt with quickly serious reactions may result including passing out or having convulsions Talk with your doctor about what steps to take in case of a low blood sugar emergency and most importantly how to avoid one What causes hypoglycemia The most common causes of hypoglycemia are m getting more exercise than usual taking too much diabetes medication eating at the wrong time for the medicine you take skipping or not finishing meals or snacks drinking alcoholic beverages Skipping or delaying meals can cause low blood sugar in people who take sulfonylureas meglitinide or insulin These drugs increase the body s insulin level Unless insulin in the blood is balanced by food it can cause your blood sugar level to fall too low Before you drink alcoholic beverages discuss with your healthcare provider whether some use of alcohol may be included in your meal plan Low Blood Sugar Hypoglycemia 6 Symptoms of hypoglycemia When blood sugar gets too low you may m feel shaky m be sweaty m feel tired m be hungry m have a fast heartbeat m become ill tempered or confused m have blurred vision or a headache m have no symptoms at all Having no symptoms of hypoglycemia at all is a dangerous situation If you have a blood su
47. ry 100 milliliters of blood The American Diabetes Association ADA recommends the following blood sugar goals for people with diabetes m before meals 90 130 mg dL m 1 2 hours after meals less than 180 mg dL These guidelines apply to many people but not to everyone Your goals may be higher or lower than these guidelines Your healthcare team will help you set the blood sugar target range that is right for you 1 American Diabetes Association Standards of medical care in diabetes Diabetes Care 2006 29 suppl 1 84 842 9 Taking control of your diabetes Now it s up to you Managing your diabetes is hard work but it s worth the effort You feel your best when your blood sugar is normal or close to normal Controlling your blood sugar may take some time but if you work at it you will see improvements in your blood sugar levels Keeping blood sugars in range There are two good ways to find out if your diabetes is in control You should do both 1 Test your blood sugar m Work with your doctor or diabetes educator to learn how to use one of the many types of blood glucose meters that are available for personal use m Ask your doctor or diabetes educator what your testing schedule should be You may be asked to test before meals and at bedtime Also research suggests that occasionally testing your blood sugar after meals is a good way to find out how well you are controlling your diabetes m Kee
48. sn t go away like a cold or the flu For another you are just as responsible as your doctor for treating your diabetes Because so much of your day to day treatment is in your hands you must learn as much about diabetes as you can This book is the first step in that process The basic facts about diabetes Diabetes is Common At least one in every fourteen people has diabetes m Controllable Though there is no cure for diabetes it can be managed by keeping blood sugar close to normal This is done with proper meal planning exercise and possibly medicines m Life long Your blood sugar levels should improve with treatment However this does not mean that your diabetes has gone away It just means your blood sugars are in control m Self managed Your healthcare team will advise and support you but control depends on you The choices you make help determine what your blood sugar level will be Constantly changing It is common for your doctor to change your medicine or treatment plan over time because your diabetes changes over time 1 ADA National Diabetes Fact Sheet 2005 Available at http www diabetes org diabetes 4 statistics prevalence jsp Accessed March 3 2006 There are two main types of diabetes type 1 and type 2 When you have diabetes your body can t properly use the energy from the food you eat This problem is closely tied to how your body makes and uses insulin Insulin is a substance made in y
49. ssible to an enjoyable and healthy level of activity Potential calories burned during common activities Activity Cal Min Cal Hr Walking 3 mph Golf pulling cart 4 5 240 300 Cycling 6 mph Bowling Cycling 8 mph Volleyball Tennis doubles 5 6 300 360 Golf carrying clubs Walking 4 mph Ice or Roller Skating 6 7 360 420 Cycling 10 mph Walking 5 mph Cycling 11 mph 1 8 420 480 Water Skiing Tennis singles Jogging 5 mph Cycling 12 mph 8 10 480 600 Downhill Skiing Running 5 1 2 mph Cycling 13 mph 10 11 600 660 Aerobics Running 6 mph 11 or more 660 or more Remember to check with your healthcare team before beginning an exercise routine 1 Coleman E Nelson Steen S Strategies for weight gain The Ultimate Sports Nutrition Handbook 1996 Reprinted with permission Exercise Staying safe Check with your doctor before beginning to exercise Start slowly Five or ten minutes a day is a good beginning if you have been inactive m Wear comfortable supportive shoes and cotton socks Check your feet after exercise for any signs of poor shoe fit or injury Wear diabetes identification jewelry Check your blood sugar before and after exercise This is especially important for anyone who takes insulin a sulfonylurea or a meglitinide These medicines may create risk for low blood sugar Carry something to eat that contains glucose Use it to prevent or treat low blood sug
50. supporters Learn needed information and skills This book is a good start in learning what you need to know Many hospitals and clinics have diabetes education programs where you can learn more They teach important skills like testing your blood sugar planning your meals and how to take your medication Now let s move on to learn more about the basics of good diabetes control 12 Managing Your Diabetes In spite of what you might have heard having diabetes does not mean you have to give up all the foods you enjoy However learning to eat healthy satisfying meals is an important part of your treatment Good diabetes meal planning includes m understanding how different foods and the amount eaten affect your blood sugar m choosing healthy foods m eating regular meals at the right times Understanding how different foods and amounts affect blood sugar Starches and sugars carbohydrates have more effect on blood sugar than protein or fat Carbohydrates include foods such as bread pasta cereal beans milk fruit and fruit juices and sweets Keeping track of the carbohydrate foods you eatis a key factor in controlling your blood sugar Carbohydrates have the greatest impact on your blood sugar after meals and your blood sugar level can go too high when you eat more carbohydrates than your body can use By keeping track of carbohy drates you eat and spreading them throughout the day you can help control your blood
51. tion afterward to keep skin soft Take extra care to avoid scratches or bruises Wear gloves when you do work that may cause injury Use a sunscreen and common sense to avoid sunburn Dress warmly and avoid long exposure in very cold weather Wash cuts and scrapes with soap and water then cover with a sterile bandage m Treat askin injury quickly and call your doctor if it doesn t heal 51 52 General health care Dental care High blood sugar increases your risk for tooth and gum problems To help prevent these problems you should m Brush and floss every day m See your dentist at least every 6 months m Tell your dentist you have diabetes Sick Days Special information Sick day rules m Always take your insulin or diabetes pills m lest your blood sugar before each meal and at bedtime m Test your urine for ketones if blood sugars are greater than 240 mg dL m Follow your meal plan if you can eat If you can t eat you should try to take in at least 4 oz of a Sugar containing beverage every hour to keep your blood sugar from falling too low Call your doctor when m You are vomiting and unable to keep down foods liquids or diabetes pills m Your illness lasts longer than 24 hours m Ketones are present in your urine m All blood sugars are higher than 240 mg dL for more than one day When the above symptoms occur insist on speaking to your doctor or nurse to let them know something is
52. tored properly it may not work right so be sure to read the directions that are packaged with your insulin vials or pens To keep insulin in good condition you must do the following m Keep your extra supply of insulin in the refrigerator m Never let your insulin freeze m f you use a vial keep the vial you are currently using in the refrigerator whenever possible m Your unused pens should be stored in the refrigerator m The pen you are currently using should not be stored in the refrigerator m Keep unrefrigerated insulin as cool as possible below 86 F and away from heat and light m Never shake your insulin hard or let it get tossed around Insulin that s handled roughly is more likely to clump or frost Diabetes Medicines Traveling with insulin When you travel maintaining your regular schedule for insulin injections and blood sugar checks can be challenging But with careful planning any trip can go smoothly Discuss your plans with your healthcare professional before you go m Changing time zones can impact your regular insulin schedule Your healthcare professional can help you figure out how to adjust your dosage before you travel m f you re flying have your healthcare professional write a letter stating that you have diabetes and need to use syringes and insulin Make sure your supplies are clearly labeled This will help you get through security without delay m Bring 2 3 times the amount of
53. triving for perfection Keep track of your successes and work to repeat them When things don t turn out the way you planned ask yourself What can learn from this By learning and using your knowledge to meet each new challenge you ll gain confidence in your ability to take care of yourself One day instead of simply coping with your diabetes you ll find that you truly are Managing Your Diabetes Managing Your Diabetes Checklist Here are some key things you need to do Keep this list handy and refer to it often Things to do every day Test your blood sugar and write it down in your logbook Take your medicines as directed Check your feet Follow your plan for meals and exercise Take care of teeth and skin Things to do at each doctor s visit Take your blood sugar logbook with you Your logbook will help your doctor help you m Ask about your ATC level and determine your goal for your next visit m Have your doctor check your feet Taking off your shoes and socks will help you remember Have your blood pressure checked Things to do at least once a year Have your blood fats checked total cholesterol LDL HDL triglycerides m Have your urine checked for protein microalbumin screen and a serum creatinine m Visit an eye doctor for a comprehensive dilated eye exam m Visit your doctor for a foot exam 595 56 SA 58 Index Acarbose Alcohol
54. uttocks Note Humalog insulin lispro injection rDNA origin is absorbed very quickly from all injection sites mm n tools used to give insulin shots are oth methods r or diabetes Using the Lilly Pen If you treat your diabetes with Humalog Humalog Mix75 25 Humalog Mix50 50 Humulin N or Humulin 70 30 you can take your injections with the easy to use insulin Pen It takes only a few quick and easy steps to use the Lilly Pen Please see the user manual in your Pen package for complete instructions Preparing and priming 1 Remove Pen cap 2 Check your insulin m Correct type m Within expiration date m Correct appearance For cloudy insulin e Roll the Pen gently 10 times e Also gently turn the Pen up and down 10 times until the insulin is evenly mixed 3 Attach needle m Clean the rubber seal with alcohol swab m Push capped needle straight onto Pen m Screw on shielded needle until secure 4 Set the prime dose m Turn the dose knob clockwise to the right until you see an arrow gt in the center of the window and the raised notches on the Pen and dose knob are in line m Pull out the dose knob in the direction of the arrow until a 0 is seen in the dose window m Turn the dose knob clockwise until a 2 is seen in the dose window Diabetes Medicines Hinata injection rDNA origin mix 75 insulin lispro protamine suspension Hunat 15125 25 insulin lispro injection rDNA origin mix
55. y even make your insulin work better Before you begin m Have a medical check up This is especially important if you are 35 or older It is also important if you have any health problems besides diabetes m Talk with your healthcare team about an exercise plan that is right for you Since exercise can lower blood sugar you may need to change food choices medicine doses or timing How to get started m Look for an activity that you enjoy m Make sure it s right for your current level of fitness m Walking may be a good way to get started It is convenient and low in cost All you need to get started are cotton socks and a pair of supportive shoes that fit well 4 Exercise 18 A complete exercise plan will address m flexibility such as stretching done before walking m strengthening such as lifting light weights to build calorie burning muscle mass m aerobic activity such as walking dancing swimming or biking to burn calories and reduce risk of heart problems How to keep going m Make walking or your other exercise activities a part of your daily routine m Finding someone to walk or exercise with can help make your workout more enjoyable When exercise is enjoyable and social it is its own reward This may help you stay motivated m Know that everyone s exercise plans lapse occasionally Instead of being discouraged use this time as an opportunity to review your goals Try to recommit as soon as po
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