MANAGING YOUR DIABETES
SURVIVAL SKILLS GUIDE
*The American Diabetes Association Recognizes this education service as meeting the National Standards for Diabetes Self-Management Education and Support.
TABLE OF CONTENTS
Contact Information .................................................. Diabetes At-A-Glance ................................................ Steps For Health Living ............................................. Your Diabetes Care Team .......................................... Diabetes Basics .......................................................... Diabetes Types ........................................................... Blood Sugar & Diabetes ............................................. ABC’s Of Diabetes ...................................................... A1C ............................................................................. Checking Your Blood Sugar ....................................... Sharps Disposal ......................................................... Hyperglycemia & Hypoglycemia ............................... Healthy Eating ........................................................... Physical Activity ......................................................... Medication ................................................................. Illness ......................................................................... Resources ................................................................... Glossary .....................................................................
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WELCOME TO SOUTH COUNTY HEALTH
Welcome to the South County Health Diabetes Center. Our objective is to provide you with the tools, education and resources you need to live a healthy life. Within this booklet, you will find tips and information to help you better manage your diabetes and live well. We want you to be an informed participant in your healthcare and we encourage you and your family to ask questions. Personalized, quality care is our goal.
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MANAGING YOUR DIABETES Doctor/Medical Provider Contact Information Physician Name Physician Phone Number Diabetes Nurse Educator Name Diabetes Education Office Phone Registered Dietitian Name Dietitian Office Phone
Other Important Phone Numbers South County Health Diabetes Center Appointment Scheduling 401-788-1135 Diabetes Center Coordinator 401-788-1696 South County Hospital (Main) 401-782-8000 South County Home Health
401-782-0500
South County Health Diabetes Center www.southcountyhealth.org
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MANAGING YOUR DIABETES
If You Have Diabetes - We Can Help! •
Millions of people all over the world have diabetes.
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When you learn about diabetes, it will be easier to manage.
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It is normal to feel sad, mad, scared or guilty when you are diagnosed with diabetes or even if you have had it for awhile.
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South County Health has Diabetes Champions and Diabetes Educators along with your healthcare team who can help you take care of your diabetes and show you how to lead a healthy life. Support and education make life with diabetes easier.
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Our Diabetes Center will give you the tips, tools and techniques to optimize your health and empower you to make and keep healthy lifestyle choices.
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Make your appointment today!
Make life with diabetes easier by getting support & education.
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MANAGING YOUR DIABETES Taking Care of Your Diabetes By following the basic steps below, you’ll put yourself on the path toward living healthy with diabetes. • Choose what, how much and when to eat. • Check your blood sugar as directed by your doctor. • Get active. Any type of physical activity you do will help lower your blood sugar. • Take your medications every day if prescribed. • Join South County Health’s ‘Fit To Quit’ stop smoking program. (Call 401-782-8020 ext. 3368 for more information.) • Check your feet every day. Report any changes to your medical provider. Never walk barefoot. • Go to ALL your medical appointments. • Know when to call your doctor or medical provider for help. • Learn all you can about diabetes!
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YOUR DIABETES CARE TEAM
The South County Health Diabetes Management Team Diabetes can be managed with healthy eating, physical activity, weight loss if needed, and medications when necessary. The South County Health Diabetes Management Team will help you learn how to manage your diabetes step-by-step. We will work with you and your doctor to get you on your way to good health. Your Diabetes Care Team
Your diabetes care team may include • your doctor • diabetes nurse educator • registered dietitian • pharmacist • and other health care providers who will work with you. The South County Health Diabetes Champion Team is a specialized team of nurses, diabetes educators, dietitians, pharmacists and other clinicians who are dedicated to improving the quality of care for people with diabetes. They are here to assist you, using the latest information and best treatment practices in diabetes care. Along with the Diabetes Care Team, your family and friends are important members of your team too, offering help and support. Remember: YOU are the captain of your team.
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DIABETES BASICS Diabetes Basics • • • •
When you eat, your food is broken down into a sugar called glucose.
Glucose gives your body the energy it needs to work. To use glucose as energy, your body makes insulin. Insulin is like a key that “unlocks” your body’s cells so they can get the glucose they need.
Types of Diabetes There are three main types of diabetes: •
Type 1
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Gestational
•
Type 2
Each has unique characteristics. Your doctor will tell you which type of diabetes you have.
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TYPES OF DIABETES
Which Type of Diabetes Do I Have? Type 1 Diabetes The body stops making insulin. Without insulin to put blood sugar (glucose) into your cells for energy, the glucose builds up in the blood causing high blood sugar levels. Insulin injections are needed to bring blood sugar levels down to a healthy range. Type 2 Diabetes The body does not make enough insulin, or use the insulin well, or both. Without enough insulin to put the glucose into your cells for energy, the glucose builds up in the blood causing high blood sugar levels. A person may require pills, insulin or other injectable medication to bring blood sugar levels down to a healthy range. Gestational Diabetes Diabetes that happens only during pregnancy. There is a high risk for developing Type 2 diabetes in the future once you have had gestational diabetes. Make sure to have your blood sugar checked 6 to 8 weeks after delivery.
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MANAGING YOUR DIABETES Blood Sugar & Diabetes Diabetes is a condition that happens when your blood glucose, also called blood sugar, is too high. Why is it important to keep blood sugar in a healthy range?
Many people with diabetes live long and healthy lives. Having high blood sugar can put you at risk for eye, kidney, nerve, foot, dental and other health problems. People with diabetes are also at a higher risk for high blood pressure, heart disease and stroke. Keeping your blood sugar in a healthy range can help prevent or delay diabetes complications. Seeing your doctor, eye doctor, foot doctor, dentist and your diabetes nurse educator and dietitian regularly can give you the information you need to stay healthy and prevent or delay diabetes complications. How do I treat my diabetes?
Diabetes can be managed. Balancing the food you eat with physical activity and medications if needed will help you control your weight and keep blood sugar in a healthy range. If you are overweight just a 5-10 pound weight loss can make a difference. We will work with you and your doctor to find the plan that works best for you.
The Diabetes Care Team at the South County Health Diabetes Center will work with you and your doctor to design a lifestyle plan that will help you live well.
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ABCs OF DIABETES
ABCs of Diabetes
Things may be overwhelming when you find out you have diabetes. Small changes over time are usually the best way to get and stay healthy. Even small changes can give you big rewards! A1C, Blood Pressure, Cholesterol A1C* In general, by lowering the A1C by just one (1) percentage A point reduces the risk of eye, kidney and nerve complications by 40%.
B
C
Blood Pressure Control Reduces the risk of heart and kidney disease. Cholesterol Control Controlled cholesterol can reduce heart disease. *A1C is the estimated average blood sugar over a 2-3 month period of time.
South County Health Diabetes Center
surpasses the national average for lowering A1C!
People receiving diabetes education and nutrition counseling through South County Health’s Diabetes Center lowered their A1C by an average of 1.08%-2.9%.* * Data as of July 2017. The national A1C average reduction with diabetes education provided by a nationally recognized center is 0.57%.** ** Source: AADE 2017
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KNOW YOUR A1C Knowing Your A1C The A1C test measures your estimated average blood sugar level over the past 2 to 3 months. It’s like a “memory” of your blood sugar levels. It shows what your blood sugar levels have been over time. Both your FPG and PPG have to be at their targets most of the time in order for your A1C to be at your goal. Usually an A1C of 7% or below is a good goal to set. PPG Postprandial Plasma Glucose
FPG Fasting Plasma Glucose
This is your blood sugar number when you have been fasting (not eating) for at least eight (8) hours.
This is your after-meal blood sugar number that you check 1 to 2 hours after you eat. It measures the blood sugar spikes that occur after you eat.
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KNOW YOUR A1C A1C and Blood Sugar Your A1C and your blood sugar levels go up and down together. The chart below shows how A1C relates to the estimated average blood sugar level.
A1C Levels
Average Blood Sugar
6%
126 mg/dL
8%
183 mg/dL
10%
240 mg/dL
12%
298 mg/dL
7%
154 mg/dL
9%
212 mg/dL
269 mg/dL
11%
Adapted from the American Diabetes Association. Standards of medical care in diabetes - 2016. Diabetes Care. 2016;39 (suppl 1):S1-S112
Check with your doctor or diabetes nurse educator to see what A1C goal is right for you.
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CHECKING YOUR BLOOD SUGAR How Do I Check My Blood Sugar At Home? The best way to tell if your blood sugars are high or low is to check your levels with a blood glucose meter. You and your doctor will decide when and how often you need to check your blood sugar. These readings will show you how food, activity, stress, illness and medications affect your blood sugar every day. * Steps to check your blood sugar: 1. 2. 3. 4. 5. 6.
Wash your hands with soap and water Insert a new lancet into lancing device Place new strip into meter Prick side of finger to get drop of blood Apply drop of blood to strip Write down your blood sugar number in your log book or Blood Glucose Record sheet (see pages 16-17) 7. Bring your meter and blood sugar log with you to your appointments with your doctor, diabetes nurse educator and dietitian * Check your “Quick Start” guide in your meter kit for steps unique to your meter. If you have any problems with your meter, contact the meter company via the phone number included on the meter or the manufacturer’s website.
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PROPER SHARPS DISPOSAL Lancet, Syringes & Pen Needle (sharps) Disposal (Rhode Island Guidelines*)
After each blood sugar check, the lancet used to draw blood from your finger must be disposed of properly, as well as any used insulin/medication syringes or pen needles. For your safety, as well as those who may come in contact with the used lancets or needles, be sure to follow these important steps: •
Place the used lancets, syringes or pen needles into a puncture proof plastic bottle such as a laundry detergent or bleach bottle IMMEDIATELY AFTER USE.
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When the container is full, replace the cap and secure it with strong tape.
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Place container in your general trash.
DO NOT PLACE SHARPS CONTAINER IN RECYCLING BINS * If you live outside RI, check with your state Department of Health for state-specific sharps disposal guidelines.
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LIVING WELL WITH DIABETES Contact the Diabetes Care Team at the South County Health Diabetes Center if you want to: • Get control of your health.
• Get tips, tools & techniques to help manage your diabetes.
• Get professional support & coaching to help you make healthy lifestyle choices. South County Health Diabetes Center Appointment Scheduling Diabetes Center Coordinator
401-788-1135 401-788-1696
Contact the scheduling office for an appointment at any of our three locations:
EAST GREENWICH
WESTERLY
South County Health Medical & Wellness Center 3461 South County Trail (Rt. 2)
South County Health Medical & Wellness Center 268 Post Road (Rt. 1)
WAKEFIELD
South County Health Medical Office Building 100 Kenyon Ave. (Adjacent to South County Hospital)
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YOUR GLUCOSE LEVELS Hyperglycemia and Hypoglycemia The goal of diabetes management is to keep your blood sugar level in a healthy range. Too much blood sugar is called Hyperglycemia. Too little blood sugar is called Hypoglycemia.
What Should My Blood Sugar Numbers Be? Always discuss your personal blood sugar goals with your doctor or diabetes educator.
Time of test
Blood Sugar Range
Before a meal
80 mg/dL - 130 mg/dL
After a meal
Less than 180 mg/dL
Breakfast, Lunch, Dinner
1 - 2 hours after
Track Your Numbers Using the chart provided on the following pages, record your blood sugar levels after each check. Bring this blood glucose record with you to all your doctor, diabetes nurse educator and dietitian appointments.
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BLOOD GLUCOSE RECORD
Date
M T W Th F S Su M T W Th F S Su M T W Th F S Su M T W Th F S Su
Breakfast Before 2 Hours After
Lunch Before
ADA Targets for Blood Glucose - Before meal: 80 - 130 mg/dl
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BLOOD GLUCOSE RECORD
Lunch 2 Hours After
Before
Dinner 2 Hours After
Bedtime
1-2 hours after start of meal: below 180 mg/dl
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HYPERGLYCEMIA Hyperglycemia - High Blood Sugar Hyperglycemia High Blood Sugar
Blood Sugar Level 240 mg/dl or above
Causes • Too much food • Too little insulin or diabetes medicine • Being sick • After surgery or dental work • Stress
Onset May be gradual
Prevention • Eating healthy • Being active • Taking medications/ insulin as prescribed • Checking blood sugar regularly • Talk to your doctor and diabetes educator about your diabetes regularly
IMPORTANT!
Call your doctor if your blood sugar stays above 240 mg/dl for two readings.
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HYPERGLYCEMIA
Hyperglycemia - Signs & Steps If your blood sugar is HIGH, you may experience: • Increased thirst • Hunger • Feeling tired
• Slow healing wounds • Headache • Dry skin & mouth • Frequent urination • Weakness • Blurred vision
If you experience any of these signs, follow these steps: Step 1: CHECK Check your blood sugar. If you are 200 mg/dl or more, go to Step 2. Step 2: DRINK Drink 1-2 glasses of water and go to Step 3. Step 3: CHECK Check to make sure you are taking your diabetes medication or insulin as prescribed. Step 4: CALL Call your doctor if your blood sugar is 240 mg/ dl or above after two (2) readings.
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HYPOGLYCEMIA Hypoglycemia - Low Blood Sugar Hypoglycemia Low Blood Sugar
Blood Sugar Level Below 80 mg/dl
Causes • Too little food • • •
Onset Can be sudden
Prevention • Space meals no more than 4-5 hours apart
Too much insulin or diabetes medicine
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Extra physical activity
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Drinking alcohol
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Take medications or insulin as prescribed
Work with your diabetes educator to develop a physical activity plan
Discuss alcohol use with your doctor and diabetes educator
IMPORTANT!
Call your doctor if your blood sugar stays below 80 mg/dl for two readings.
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HYPOGLYCEMIA
Hypoglycemia - Signs & Steps If your blood sugar is LOW, you may experience: • • • •
Shaking • Sweating Dizziness • Blurred vision Anxiety • Irritability Lack of coordination
• • • •
Weakness or fatigue Headache Hunger Fast heartbeat
If you experience any of these signs, follow these steps: Step 1: CHECK Check your blood sugar. If you are at 80 mg/dl or less, go to Step 2. Step 2: TREAT Drink 4 ounces of juice or regular soda or eat 3-4 glucose tablets or 5-6 fruit candies. Go to Step 3.
Step 3: CHECK Re-check blood sugar after 15 minutes has passed. If sugar is below 80 mg/dl, repeat Step 2. If above 80 mg/dl, go to Step 4. Step 4: EAT Within 30 minutes, eat your regularly scheduled meal. If no meal is planned, eat 4-6 peanut butter crackers or a granola bar.
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HEALTHY EATING Creating Your Plate Balancing Your Plate A balanced plate contains: • 50% non-starchy vegetables • 25% starch (potatoes, pasta, etc.) • 25% protein (lean meat, chicken, fish) • A serving of fruit & milk For illustration only. Portions not to scale.
Effects of carbohydrates Carbohydrates raise your blood glucose levels after you eat.
This does not mean you should avoid carbohydrate foods. In fact, some of these foods are very healthy for you. But since they do turn into sugar (glucose) when you digest them, it is important to keep the portions of carbohydrate foods moderate at each meal and snack.
Watching the portions and spacing these foods throughout the day will help keep your blood glucose levels controlled.
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HEALTHY EATING What Can I Eat? Quick Tips Tip #1:
Know your carbs. Starches (pasta, rice, bread), starchy vegetables (potatoes, peas, corn), fruits, milk, yogurt and sweets.
Tip #3:
Eat whole grain, high fiber starches (brown rice, oatmeal, whole wheat bread, whole wheat pasta).
Tip #2:
Tip #4: Tip #5:
Tip #6: Tip #7:
Eat plenty of non-starchy vegetables (asparagus, broccoli, green beans, cauliflower, lettuce, kale, spinach, tomatos, zucchini).
Eat fresh fruits - be careful with juices that may contain added sugars. Keep meats and other proteins lean; go easy on added fats such as butter, oil, salad dressings.
Eat three (3) meals per day. Do not skip breakfast. You may have a small snack between meals. Drink plenty of water; sugar-free beverages in limited amounts. Do not drink fruit juices between meals.
We’ll help plan your meals Registered Dietitians at the South County Health Diabetes Center will help you create a meal plan that meets your needs. Schedule your appointment today, 401-788-1135.
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PHYSICAL ACTIVITY Get Active, Stay Active Physical activity is another part of living healthy and managing diabetes. Any type of physical activity you do will help lower your blood glucose. Other benefits include: • Improving your blood sugar, blood pressure, and cholesterol • Having more energy • Relieving stress • Burning calories to help you lose or maintain your weight • Keeping your joints flexible • Increasing your strength • Improving your balance to prevent falls • Lowering your risk for heart disease and stroke
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PHYSICAL ACTIVITY
How Should I Begin Physical Activity? Getting Started Before you begin your new active lifestyle, talk with your doctor. He or she will tell you what kind and level of activity is safe for you. Start slowly Aim for 30 minutes of activity each day. If you are short on time or just starting out, this can be done with 10 minutes of activity three times a day. Remember: • Start slowly • Make safety a priority
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DIABETES & MEDICATION Why Do I Need Medication? Medications help to lower blood sugar and keep blood sugar levels in a healthy range. If you are prescribed medication by your doctor, follow these tips: • • • • • •
Take all of your medications exactly as your doctor tells you. Forgetting to take your medications can cause your blood sugars to go too high. If you have side effects from your medication, contact your doctor immediately. Some diabetes medications can be taken by mouth and others are injected.
Keep an updated list of all your medications, how much and when you take them. Use a pill organizer.
Use a timer, alarm clock or phone alarm to remind you to take your medicine.
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DIABETES & MEDICATION Will I Need Insulin? People with Type 1 diabetes need insulin to lower blood sugar and keep it in a healthy range. Sometimes people with Type 2 diabetes also need insulin as time goes on. This is because the body makes less insulin over time. This does not mean you are doing anything wrong or your diabetes is worsening. If you’ve had diabetes for an extended length of time, your doctor may prescribe insulin to help maintain your blood sugar levels so you can feel better and stay healthy. Your doctor may also prescribe insulin if you become sick, are very stressed or are planning to have surgery. This may be temporary as blood sugar can go up to unhealthy ranges when you are not feeling well. Once you are feeling better your doctor will evaluate the need for continuing insulin.
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IF YOU GET SICK What If I Get Sick? Colds, flus and other illnesses When you are sick or recovering from surgery, remember to manage your diabetes. • It is important that you continue to take your diabetes medications and continue to check your blood sugars, even when you are sick. • You may need to check your blood sugars more frequently to make sure that your blood sugar does not go too high or too low. • It is important to drink lots of fluids when you are sick.
• Some illnesses can be prevented with vaccines. Check with your doctor to see which vaccines you may need to stay healthy.
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IF YOU GET SICK
What If I Get Sick?
Call your medical provider if: • Your blood sugar is less than 80 mg/dl or higher than 240 mg/dl for more than two (2) blood sugar checks. • You are vomiting or unable to keep fluids down.
• You are vomiting or have diarrhea for more than 6 hours. • You have a fever of 101°F or higher.
• You have an illness lasting more than 24 hours.
• You have severe pain in your stomach and/or are having a hard time breathing. • You have any questions at all about what to do.
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NAVIGATING YOUR DIABETES
You can live well with diabetes!
Call the South County Health Diabetes Center to learn more about your diabetes and get the support you need to succeed.
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RESOURCES Helpful Resources For additional information or support, these resources are available for you: American Diabetes Association – diabetes.org Type 2 diabetes programs, online support groups, recipes, books and much more! South County Health Diabetes Center Scheduling – 401-788-1135 Make living with diabetes easier! Make your appointment today with our Diabetes Nurse Educators and Dietitians. South County Health Diabetes Support Management and Support Group (FREE) Meets the 3rd Tuesday of March, June, September and November; 7 – 8:30 pm South County Health Website southcountyhealth.org Check for diabetes education class and support group schedules.
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GLOSSARY Glossary Of Terms A1C The estimated average blood sugar over a 2- 3 month period. American Diabetes Association (ADA) A not-for-profit organization whose mission is to prevent and cure diabetes and improve the lives of all people affected by diabetes. www.diabetes.org Blood glucose A type of sugar present in the blood. Blood glucose meter A device that tests the amount of glucose in the blood. Blood pressure The force created by blood flow as it presses against blood vessel walls. Blood vessels Tubes that carry blood throughout all parts of the body. Carbohydrate A nutrient in food that is broken down into glucose during digestion. Cardiovascular Pertaining to the heart and blood vessels. Cholesterol A waxy, fat-like substance used by the body to build cell walls. If too much is present, it can build up and block arteries. Complications Serious health problems that develop over time due to high blood glucose.
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GLOSSARY
Glossary Of Terms Glucose A simple form of sugar that is used to fuel the body’s cells. Heart disease A condition that affects the heart’s ability to function. High blood pressure Blood pressure that is higher than the normal range. Hormone A chemical released by special cells that tell other cells what to do. Insulin A hormone made naturally in the body by an organ called the pancreas that enables glucose to enter most cells. Insulin resistance A condition in which most cells do not respond properly to insulin. Lancet A device that uses a tiny needle to prick the skin for a drop of blood. Lipids A fatlike substance in the blood. Pancreas An organ that makes insulin and releases it into the bloodstream. Target range The level of blood glucose a patient is told to aim for as often as possible. Triglycerides Building blocks of fats.
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NOTES
NOTES
A member of South County Health, including: South County Home Health South County Medical Group South County Surgical Supply South County Hospital 100 Kenyon Avenue, Wakefield, RI 02879
401-782-8000 ~ www.southcountyhealth.org
Our vision is to forge extraordinary connections with our community that support health at every stage of life.