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Diabetes Inpatient Booklet

AdventHealth Waterman

Table of Contents 2 3

Table of Contents Diabetes

Normal Anatomy and Physiology

Types of Diabetes

Do you know what kind of diabetes you have? What Went Wrong?

7 8 8

Testing Blood Glucose When should I test? What should I do if glucose levels are too high?

10 Hypoglycemia 11 The most common causes of hypoglycemia 11 Symptoms of low glucose 11 What if Blood Sugars are Too Low? 12 Diabetes Pills 12 These are several commonly used medicines for diabetes: 14 Injected Medications for Glucose Control 15 Insulin Action

25 Skin Care 26 Diabetes and How It Affects the Feet 28 Stress 29 Dental Care 30 Goal Setting 31 Take Control 32 Glossary 34 34 34 35 36 37 37 38 39

Community Resources Diabetes Education Classes Clinics Health Departments Behavioral Health Food Banks National Organization Resources Disabilities Medication Assistance

41 Support Groups

16 A1C (Glycohemoglobin Test)

41 Transportation

17 A1C: Know Your Number

42 Weight Loss

18 Goals for Healthy Lipid Levels

43 Index

19 The Benefits of Exercise with Diabetes

44 Patient Resource Materials

20 20 20 20

Getting Started with Exercise How to get started Choosing an activity Aerobic Exercise

21 Making an Exercise Plan 21 When making an exercise plan… 22 My exercise program begins with… 23 Sick Day Care 24 Food for Sick Days

24 Complications of Diabetes

45 Notes

Diabetes Diabetes is a chronic disease that takes time and knowledge to control. This booklet has been developed to help you have a better understanding of the disease and hopefully help you feel a little more comfortable about taking care of yourself. Diabetes is different from most chronic diseases where the doctor controls the treatment. A patient with diabetes must participate in their care. That means when you have been diagnosed with diabetes, you are given a lot of the responsibility. You need to test your blood glucose and help control it by exercising, eating the right foods and taking your medicine at the right time. This may cause you to be nervous, afraid and even angry. We, at AdventHealth Waterman, are here to help you through the process. The nurses, dietitians and diabetes educators will help you to understand your diabetes, assist you with your meal planning and make you more comfortable testing your blood glucose. Together, we hope you will feel more confident with this diagnosis, and have a better understanding of diabetes and how to treat it.

Normal Anatomy and Physiology Diabetes is a serious disease that prevents your body from being able to control your blood sugar or metabolize fats appropriately. There is no known cure. When not cared for, it can lead to life- threatening complications. Diabetes is the leading cause of blindness, lower limb amputations, and kidney failure in the U.S. It is a major risk factor for heart disease. Fortunately, keeping blood sugars as close to normal as possible has been found to greatly reduce these complications. It is our hope that by understanding your body and how diabetes affects it, you will take an active part in working toward controlling your blood sugar. Controlling your blood glucose level requires balancing food, exercise and, sometimes, medication. Food is fuel for the body. Normally, carbohydrates are broken down into glucose molecules and used as fuel. If there is more glucose than needed in the blood, the extra glucose is stored as glycogen in the liver and muscle cells. This can be used later when the body needs an extra supply of energy, such as when you exercise. The body prefers to keep the blood sugar level between 70-140 mg/dL. An organ in the body that helps you to store and use glucose is called the pancreas. Insulin, a hormone that is produced in the pancreas, allows sugar from the blood to move into the cells of the body to use as fuel or store it as glycogen or fat.

Types of Diabetes Normal blood glucose is 70-140 mg/dL for people without diabetes. The diagnosis of diabetes can be made when one of these is true: 1. Fasting glucose (before eating or drinking) is 126 mg/dL or more, and 2. You have an A1C of 6.5 percent or higher (this is a 3 month test for glucose average. Normally this is about 5 percent.) There are three (3) types of diabetes. The first is type 1, sometimes called “juvenile diabetes.” Often the person diagnosed with type 1 is:

1. Under 30 years old 2. Usually normal weight 3. Can be quite ill very quickly 4. Needs insulin every day from the time of diagnosis (because they make no insulin of their own).

Do you know what kind of diabetes you have? HIGH BLOOD SUGAR High blood sugar (hyperglycemia) occurs when glucose builds up in the blood. This can be caused by: • not enough insulin; • the liver releasing too much glucose (glycogen); • when your cells are not able to use insulin appropriately; and medications. • sometimes steroids can increase blood glucose.

Type 2 diabetes is the most common, with 95 percent of people with diabetes diagnosed with type 2. It is a slow progressive disease and is controlled with diet, exercise and sometimes, medication. Usually this person: 1. Is over 40 years old 2. Often has a family member with diabetes 3. Is frequently overweight 4. May be less active than normal Gestational Diabetes is the first time a woman has an elevated glucose during a pregnancy. Mom and baby are usually fine after delivery, but strict control of glucose is needed for a healthy baby and delivery. Mom is at high risk of Type 2 diabetes later in life.

You may not experience any signs of hyperglycemia, but symptoms of high blood sugar (B/S) (over 200 mg/dL) are: 1. Thirst, dry mouth, dry and itchy skin; 2. Hunger, which often includes craving sweets or other carbohydrates; 3. Frequent urination; 4. Lack of energy, exhaustion, falling asleep after meals; 5. Frequent infections, esp., urinary, skin, or yeast infections; 6. Blurred or cloudy vision that comes and goes; 7. Numbness, tingling or burning feet; and 8. Weight gain or loss.

Not controlling your glucose may cause: 1. Blindness, 2. Kidney Disease, 3. Heart Disease, 4. Nerve Damage, 5. Stroke or Heart Attack, and/or 6. Loss of circulation in arms and legs, which may lead to amputation.

What Went Wrong Type 1 diabetes, (juvenile diabetes), is caused from a lack of insulin being made by the pancreas. In a young person, who develops type 1, the child’s own immune system begins to destroy the fragile beta cells in the pancreas that make insulin. This causes the pancreas to not make enough insulin. In adults, type 1 diabetes is often caused by an injury to the pancreas like pancreatitis, chemotherapy, cancer, or surgery.

Type 2 diabetes, (mature onset), is caused by insulin resistance, when the body cells become resistant to the insulin the body produces. Insulin resistance is most often inherited, but aggravated by extra weight, inactivity, and progressing age; all these increase insulin resistance. As we age, gain weight or become less active, our pancreas must make more insulin to keep blood sugar within normal limits. However, insulin is a growth hormone. Since most of us have reached our full height by this time, the extra insulin has a tendency to stimulate hunger, urging us to eat more. We now have a greater chance of gaining weight, especially around the middle. The increased weight slows us down. The extra weight and decreased activity increases our insulin resistance, meaning more insulin must be produced. More insulin means more hunger, more weight gain, and more inactivity. This cycle of insulin resistance eventually leads us to the point where our pancreas cannot keep up with the demand for insulin. We have overworked our pancreas for many years by the time we reach this stage. If our body cannot produce enough insulin, the blood sugar levels cannot be maintained for good body functioning. This leads to type 2 diabetes. The insulin resistance that evolves into type 2 diabetes also is related to the high blood pressure and heart disease that often happens to many people with diabetes. Heart disease is the leading cause of death for those with diabetes. Have you noticed a tendency to gain weight and exercise less in the past several years? This makes your blood sugar more difficult to control. What things can you do to help lower your glucose level?

The Dangers of Over-the-Counter Medications and Supplements: Herbal supplements and alternative substances can change the way your prescription medicines work. For your safety, be sure to ask your healthcare provider before taking anything that is not prescribed.

Testing Blood Glucose Testing blood sugar is an important part of controlling your diabetes. Most people cannot feel if their glucose is high. The only way to know for sure is to test it. There are many kinds of glucose meters on the market. Your choice may be limited by your insurance company and your finances. Testing can be expensive if you choose the wrong meter. When your doctor says, it is time to start testing, call your insurance company to find out if they pay for a certain brand of supplies. If you do not have insurance, or you have no coverage, Walmart offers a very inexpensive meter called ReliOn. The strips cost as little as $9 for a 50-count package. All meters require sticking yourself for a little sample of blood and putting it on a small strip for a meter to test. Results are available in several seconds. Having your supplies ready will help prevent errors. Store your supplies properly: Do not allow to overheat or get damp. Always start with a clean dry finger. Alcohol is unnecessary. Try sticking your finger on the side up near the tip for good blood supply and less pain. 7

When should I test? 1. When your doctor tells you. Usually it’s recommended first thing in the morning before food, medicine or even coffee. 2. When you “feel” high or low, or when you are sick. 3. If you have to take mealtime insulin, two hours after meals. 4. Sometimes at bedtime, esp., if you are having “low sugars” at night. 5. Pregnant women usually test one hour after meals.

Blood Glucose Target Ranges Your doctor may have glucose specific targets that he wants you to meet. As a rule of thumb: • Before meals: usually 70-120 mg/dL • Two hours after meals: under 140 mg/d • Bedtime: under 140 mg/dL • If you are ill, your physician may allow your glucose levels to be higher than usual.

What should I do if glucose levels are too high?

1. Drink plenty of water or sugar free liquids to dilute the sugar in your blood. 2. Test glucose more frequently, maybe every four hours, to see if the blood sugar level is going up or down. 3. Always record your glucose level and the time you took it. 4. Do not stop eating to lower glucose, but you can pick options that are lower in carbohydrates. 5. Continue taking your medications. 6. You may try some light exercise, if you are feeling well. 7. If glucose levels are over 180 mg/dL for one week or over 300 mg/dL all day, call your doctor.

Disposing of Sharps LAKE OR SUMTER COUNTY:

1. Lake County Department of Health: 249 East Collins Street, Umatilla 352-771-5500 2. Sharps Disposal Program: $15 disposal fee. *Residents will receive a new replacement sharps disposal container. 3. Leesburg Fire Stations. They ask that sharps not just be “dropped” at the location, they ask that individuals come in to the location and be directed to disposal. a. Admin: 201 S. Canal Street, Leesburg b. 2014 Griffin Road, Leesburg c. 9400 Veterans Road, Leesburg d. 3014 Rogers Ind. Pk. Rd., Okahumpka 4. Individual Doctor offices MAY accept sharps from patients. Residents need to check with provider. 5. LAST RESORT: Laundry Detergent Bottle (thick plastic container) • Used sharps such as needles or lancets must be placed in a puncture-proof, leak proof container that has a lid, such as an empty bleach, detergent or softener bottle. • When the bottle is full, put on the lid and tape the lid with duct tape. • Label the container as “SHARPS.” • Put the bottle in the regular trash container.

DO NOT PUT UNPROTECTED SHARPS IN THE TRASH CAN!

Hypoglycemia Hypoglycemia, or low blood sugar, is the most common complication of diabetes. The most likely people to suffer from hypoglycemia are those with type 1 diabetes, and those with type 2 who take insulin or medications that cause the pancreas to make more insulin, such as glyburide, glipizide or glimepiride.

The most common causes of hypoglycemia are: 1. Delayed or skipped meals and snacks, or too few carbohydrates at a meal; 2. Too much diabetes medication; and 3. Exercising more than usual without increasing food intake.

Hypoglycemia occurs when blood sugar drops below 70 mg/dL. As blood sugar drops, adrenaline is secreted and causes glucose to be released from the liver and muscle cells. This hormone, adrenaline, is responsible for many of the feelings we get with low glucose levels. Although, most people will have symptoms when their blood sugar level falls, some do not have the same signs every time, and some have no symptoms at all. The body’s safety system to prevent hypoglycemia may not work as well in individuals with type 1 or in someone with poor glucose control. These are the people most at risk for a severe low blood sugar reaction, because they have no warning signs.

Symptoms of low glucose may include: • Anxiety • Difficulty concentrating • Dizziness • Uncoordinated movements • Hunger/Nausea • Shaking/trembling • Numbness or tingling in

extremities • Cold sweats • Dimmed/blurred vision • Faintness • Headache • Pounding heart • Weakness • Fast pulse

Low blood sugar happens most often when a meal or snack is missed or delayed. If meals are irregular or eating is difficult, plan ahead to have a snack. Nutrition bars or crackers are easy to carry. Preplanning can prevent a potentially dangerous situation. Those taking insulin, and/or medications that produce more insulin, are at higher risk for having a low glucose. Measure medicines carefully and take them at the correct time to lower risk. If low glucose happens more than twice a week, see your physician. You may need a change in your diabetes treatment plan. Hypoglycemia can also occur during and after exercise, especially, if it is a period of long or strenuous exercising. It often happens in the middle of the night. An extra snack may help if bedtime blood sugar levels are low, or if exercise was heavier than usual for the day. Carefully check glucose levels following exercise and, especially at bedtime, to help prevent a nighttime low.

What if Blood Sugars are Too Low? 1. If you are having low blood sugar symptoms take one of the following: The following are equal to 15 grams of carbohydrate: • 3-4 hard candies (sour balls, butterscotch, or mints); • 3-4 ounces of any juice or 4 ounces of regular soda; • 4 glucose tablets or 1 tube of glucose gel; • 8 ounces of skim milk; or • A small piece of fruit. * Try not to fix with chocolate, cake and cookies, as the fat in them will slow the “fix”. 2. If possible, check your blood sugar. 3. Wait 15 minutes. 4. Recheck sugar, if glucose levels are still under 70 mg/dL, repeat #1. 5. When glucose is above 70 mg/dL, eat ½ sandwich, 3 peanut butter crackers or an early snack/meal.

Do not ignore repeated lows; they are a signal that your management plan needs adjusting. If symptoms of hypoglycemia occur, test blood sugar, if possible. The symptoms you are feeling may not always be due to low blood sugar. Testing is the only way to be sure of your blood sugar level. If you cannot test, treat as though it is a low. Low blood sugar should be treated with 15 grams of simple carbohydrate.

Diabetes Pills Often you will be taken off your diabetes pills when you are in the hospital and placed on insulin. There are a number of reasons for this. Some pills may combine with other medications and increase your risk of low blood sugars. Most people will have a much higher blood sugar in the hospital because stress increases glucose. It is much easier to control glucose with insulin than pills. High glucose levels increase your risk of infection, slow down healing and cause a longer hospital stay.

These are several commonly used medicines for diabetes: A. SULFONYLUREAS Examples: Glucotrol, Amaryl, glyburide, glipizide, glimepiride 6. Dose may differ, but should be taken before breakfast and sometimes, before supper. 7. Action: Tells the pancreas, to make more insulin. 8. Side effects: Low blood sugar, hunger, weight gain.

B. GLUCOPHAGE, FORTAMET, GLUMETZA,METFORMIN (GENERIC) 1. Dosage: 500 mg, 850 mg, or 1000 mg to 5. Appropriate use: Cannot be taken with total no more than 2500 mg per day. some kidney problems and you may need to have kidney function tests. This drug does 2. Action: Decreases the sugar released by the not cause kidney damage, but is filtered out liver and helps muscles store sugar. by the kidney. 3. May cause weight loss: 8-12 pounds in the 6. Takes 10-14 days to work. first 3 months. 7. Usually not taken the day before surgery 4. Side effects: Nausea, diarrhea, anorexiaor dye test, and not started until you have less if taken after meals; not recommended urinated. for underweight individuals.

C. ALPHA-GLUCOSIDASE INHIBITORS: PRECOSE, GLYSET 1. Dosages: Start at 25 mg and increase. 2. Action: Slows absorption of starches into sugar in blood. 3. Side effects: Gas and bloating.

D. THIAZOLIDINEDIONES (TZDS): ACTOS (PIOGLITAZONE HYDROCHLORIDE), AVANDIA (ROSIGLITAZONE): 2, 4 AND 8 MG. 1. Dosage: Actos 15, 30, and 45 mg. Avandia: 2, 4 and 8 mg. 2. Action: Decreased insulin resistance may take 30 days to work. 3. Side effects: Weight gain, fluid retention, may cause liver enzymes to elevate. 4. Precautions: Liver function tests regularly. 12

E. MEGLITINIDES: PRANDIN, STARLIX 1. Dosage: Taken before meals that contain carbohydrates. 2. Action: Releases insulin from pancreas. 3. Side effects: Gastrointestinal (GI) upset, rare hypoglycemia.

F. DPP-4 INHIBITORS: JANUVIA, ONGLYZA, TRADJENTA, NESINA 1. Dosage: (100 mg, 50 mg, 25 mg), Onglyza: saxagliptin (5 mg), Tradjenta (5 mg), and Nesina (5 mg). 2. Action: Enhances the body’s own ability

to make more insulin with the rise in blood sugar. Decreases release of sugar by liver. 3. Side effects: Few side effects. Possible skin and upper respiratory or sinus infections.

G. WELCHOL: COLESEVELAM HCI 1. Binding agent used to treat cholesterol. Also binds to glucose molecules which are wasted through the stool. 2. Stays in the gut and is not absorbed in the blood. 3. May reduce absorption of medications, esp., birth control, glyburide, and thyroid.

Vitamins and these medications should be taken at least 4 hours prior to Welchol. 4. Should be used with caution by patients with gastric bypass, gastroparesis, irritable bowel syndrome (IBS). May cause constipation, nausea, gas, bloating. Pills or powder should be taken at each meal.

H. CYCLOSET: BROMOCRIPTINE (ALSO USED TO TREAT PARKINSON’S) 1. Dopamine receptor agonist. 2. Action: Lowers insulin resistance by using biorhythms. Pills must be taken early in A.M. 3. Side effects: Nausea, vomiting, fatigue, dizzy, low blood pressure headache. It should not be used in pregnant/nursing mothers.

I. FARXIGA (DAPAGLIFLOZIN), INVOKANA (CANAGLIFLOZIN); JARDIANCE (EMPAGLIFLOZIN); STEGLATRO (ERTUGLIFLOZIN) 1. Dosages: 100 mg starting dose, may increase to 300 mg1. 2. Action: Allows kidneys to dump extra sugar through the urine. Not to be used by someone with severe kidney disease, or with high potassium. 3. Side effects: May increase creatinine and lower GFR. May increase urination. May cause yeast infection in women or uncircumcised men. May lower blood pressure.

J. COMBO MEDS- WRITTEN AS TWO DOSES (2/500) 1. Glucovance (Glucophage and glyburide) 2. Metaglip (metformin and glipizide) 3. Actoplusmet (Actos and metformin) 4. Janumet (Januvia and metformin)

5. Prandimet (Prandin and metformin) 6. Kombiglyze (Onglyza and metformin) 7. Jentadueto (Tradjenta and metformin) 8. Kazano (Nesina and metformin)

Injected Medications for Glucose Control 1. GUT HORMONE:

Byetta (exenatide), Victoza (liraglutide), and Bydureon (exenatide extended release), Trulicity (duglalutide); Tanzeum (albiglutide), Ozempic (semaglutide) Gut hormones are types of diabetes medication that slow the way that sugar enters the blood. Incretin mimetics are injections that mimic normal gut hormones and help to regulate blood glucose. a. Byetta: Take daily before breakfast and dinner, starting dose is 5 mcg two times a day and after 1 month, dosages are increased to the maximum of 10 mcg two times a day. b. Victoza: Starting dose 0.6 mg once a day, increase up to 1.2 mg, then 1.8 mg taken one time daily. c. Bydureon: 2 mg dose once weekly. d. Trulicity: once weekly dosing. e. Side effects include nausea, vomiting, diarrhea, jittering, weakness, headache, possibly pancreatitis. f. Should not be used in type 1, severe kidney disease or severe gut disorders. g. Often causes weight loss, as much as 3-5 pounds a month. 2. SYMLIN: INJECTION TAKEN WITH MEALS, TYPE 1S AND INSULIN USING TYPE 2S.

a. Works with insulin to lower blood sugar after meals. b. Rarely, but may cause severe low sugar after meals – if so, reduce insulin. c. Most common side effect is nausea. d. Not needed if meal is skipped, less than 250 calories or less than 30 grams of carbohydrates. 14

Insulin Action ONSET — The onset of insulin means the time that it takes that insulin to begin to work after injection. PEAK — The peak is when the insulin reaches the highest level of action, when it is at its strongest (most likely time for a low blood sugar reaction). DURATION — The duration is how long the insulin works. INSULIN

TYPE

ONSET

DURATION

Humalog Novolog Apidra

Very rapid acting

As little as 5-15 minutes

These insulins are used to cover food and correct high glucose levels. Strongest action in the first 2 hours, may last for 4.

1 -2 hours

Regular (R)

Rapid acting

From 3045 minutes

Strongest action in 2-4 hours; but lasts 5-8 hours.

2-4 hours

NPH (N) Lente (L)

Intermediate acting

2 hours

Strongest action in 4-8 hours may last 16.

4-6 hours

1-3 hours

Action is 24 hours. They DO NOT cover food.

Equal action throughout the day

Lantus Levemir

Peakless

PEAK

NOTE: There are several insulins that are pre-mixed. They contain a combination of insulin. For example, 75/25 is a mix of 75% intermediate analog and 25% Humalog (instant), 50/50 is 50% long term basal and 50% short term. The action is a combination of both. Insulin must be injected into fat. Most often it is placed into belly, upper thigh, buttocks and upper arm if there is enough fat tissue. If injected into muscle, it may bruise, hurt or seep out. If you can “pinch an inch” there is probably enough fat to use in that area. DO NOT PINCH while injecting. Today’s insulin needles are so thin and so short, they cannot be felt and do not require pinching while injecting. Always remember to rotate sites, meaning injections should be two inches apart. With long term insulin such as Levemir and Lantus, it is important not to reuse a site for at least three days. It is important to understand that insulin may work a little differently on each individual and even differently from day-to-day on the same person.

Content courtesy of The Academy of Nutrition and Dietetics.

Do you know the name of your medication? Do you know the dosage and correct time to take it? Always have a copy of your medicines with you.

A1C (Glycohemoglobin Test) GUMMY BEARS AND GUM DROPS The glycohemoglobin test or A1C is a test that gives an average of blood glucose levels over a period of 8-12 weeks. It does not need to be a fasting sample and is not affected by food eaten the day before. It is an important test that helps determine if your diabetes treatment is working. It is done every three months. Hemoglobin cells carry oxygen from the lungs to all the cells of the body. They need a clean surface and to be very flexible (like gummy bears). Unfortunately, as hemoglobin cells travel through the blood, they attract sugar. The more sugar in the blood, the more it sticks to the cells. Eventually the cells

become sticky, covered with sugar, and inflexible (like gum drops), making it difficult to do their job. Obtaining an A1C level of under 7 percent will greatly decrease your risk of diabetes complications. It is recommended that when an A1C level is over 7 percent, a change of treatment may be needed to prevent eye disease, kidney disease and nerve damage that result from high glucose levels. Damage to nerves and kidneys occurs when glucose levels reach 180 mg/dL or higher. The elderly and chronically ill may safely have a higher A1C goal. A1C levels or glycohemoglobin values are written in a percentage, unlike what you are used to seeing on your meter. They may be confusing, but the following chart may help you correlate the A1C to corresponding blood glucose AVERAGES.

Do you know your A1C?

Content courtesy of The Academy of Nutrition and Dietetics.

A1C: Know Your Number 4.0%= 68

4.1%= 71

4.2%= 74

4.3%= 77

4.4%= 79

4.5%= 82

4.6%= 85

4.7%= 88

4.8%= 91

4.9%= 94

5.0%= 97

5.1%= 100

5.2%= 103

5.3%= 106

5.4%= 108

5.5%= 111

5.6%= 114

5.7%= 117

5.8%= 120

5.9%= 123

6.0%= 126

6.1%= 129

6.2%= 132

6.3%= 135

6.4%= 137

6.5%= 140

6.6%= 143

6.7%= 146

6.8%= 149

6.9%= 151

7.0%= 154

7.1%= 157

7.2%= 160

7.3%= 163

7.4%= 165

7.5%= 168

7.6%= 171

7.7%= 174

7.8%= 177

7.9%= 180

8.0%= 183

8.1%= 186

8.2%= 189

8.3%= 192

8.4%= 194

8.5%= 197

8.6%= 200

8.7%= 203

8.8%= 206

8.9%= 209

9.0%= 212

9.1%= 215

9.2%= 218

9.3%= 221

9.4%= 223

9.5%= 225

9.6%= 228

9.7%= 231

9.8%= 234

9.9%= 237

10.0%= 240

10.1%= 243

10.2%= 246

10.3%= 249

10.4%= 251

10.5%= 254

10.6%= 357

10.7%= 260

10.8%= 263

10.9%= 266

11.0%= 269

11.1%= 272

11.2%= 275

11.3%= 278

11.4%= 280

11.5%= 283

11.6%= 286

11.7%= 289

11.8%= 292

11.9%= 295

12.0%= 298

12.1%= 301

12.2%= 304

12.3%= 307

12.4%= 309

12.5%= 312

12.6%= 315

12.7%= 318

12.8%= 321

12.9%= 324

13.0%= 327

13.1%= 330

13.2%= 333

13.3%= 336

13.4%= 338

13.5%= 341

13.6%= 344

13.7%= 347

13.8%= 350

13.9%= 353

14.0%= 356

14.1%= 359

14.2%= 362

14.3%= 365

14.4%= 367

14.5%= 370

14.6%= 373

14.7%= 376

14.8%= 379

14.9%= 382

15.0%= 385

15.1%= 388

15.2%= 391

15.3%= 394

15.4%= 396

15.5%= 399

15.6%= 402

15.7%= 405

15.8%= 408

15.9%= 411

Content courtesy of The Academy of Nutrition and Dietetics.

Goals for Healthy Lipid Levels • Total Cholesterol: <200. • HDL cholesterol (High density lipoprotein) “happy, healthy” lipid level it should be over 50. This is light, fluffy ‘popcorn’ cholesterol that carries bad cholesterol back to liver. • LDL cholesterol (Low density lipoprotein) “lousy”, “lethal” lipid level it should be under 100. This is stiff, sticky ‘tar-balls’ cholesterol which forms plaque in vessels. • VLDL (Very low density) “very lousy” lipid level it should be under 25. • LDL and VLDL may be written combined as non-HDL, and should be <130. • Triglycerides <150. These are often high when your glucose levels are out of control or you are eating too many carbohydrates.

My Goal Weight: ___________________ How Often to Weigh: □ Daily □ Weekly □ other: ________________

The Benefits of Exercise with Diabetes Exercise can play an important role in the health of everyone, but is especially important for patients with diabetes. Regular exercise will improve blood sugar, lower blood pressure, and decrease blood fat levels. It is also important in helping weight loss, helping in the loss of fat tissue while saving muscle. Exercise is free, and convenient, and not too difficult to do. It is considered to be part of the foundation of diabetes management. EXERCISE

• Increases muscle strength. • Helps with balance and coordination. • Decreases the loss of bone density as we age, lowering our risk of osteoporosis. • Increases the strength of the heart, allowing it to pump more blood with each beat and making it stronger. • Lowers the rate of colon, breast, and prostate cancer. • Increases our ability to deal with stress. • Improves the quality of our sleep. • Decreases the risk of heart disease, common in those with diabetes. • Reduces blood pressure, lowering risks for eye and kidney damage, stroke, and heart attack. • Lowers bad cholesterol and increases good ones. • Lowers insulin resistance, helping the body use its own insulin. • Lowers blood sugar quickly. Thirty minutes of exercise can cause a blood sugar drop of 60 points or more within a short period of time. • Helps to maintain normal weight and, when used with a reduction in calories, results in weight loss. 19

Getting Started with Exercise HOW TO GET STARTED:

• Visit your doctor for a physical exam. Your current health will help determine your exercise program. • Set exercise goals. • Start slowly and build gradually. • Choose activities that you like. • Keep track of your progress. • Choose an activity that is right for you. CHOOSING AN ACTIVITY

Just like your meal plan, your exercise must be planned for what activities you may do and enjoy. Your activity plan will change as you become more fit, along with your needs and abilities. When you choose your activity, consider convenience, cost, skills, safety, equipment and rewards. Will you be alone? A buddy system helps to encourage you to stick to a plan. AEROBIC EXERCISE

The kind of exercise that provides the greatest benefits is aerobic exercise. Aerobic exercise gives your heart a workout, as well as your muscles. It makes you breathe faster and feel warmer. Walking at a brisk pace, running, swimming, cycling, and vigorous dancing are forms of aerobic exercise. You should work up to 20 to 30 minutes of aerobic exercise per week. If you are not in good shape now, you may have to begin with as little as five minutes, and add one to two minutes every day, until you reach your goal.

The aerobic portion of your workout should begin with a warm-up, including doing your exercise slowly (like walking slowly for 5 to 10 minutes). Stretching may be done after warming up. This will help avoid cramps, injuries, and feeling “sore” afterwards. You need to exercise at your level of intensity. Walking – Walking is easy on the feet and legs and cheap to incorporate into your daily life. All you need is a pair of good walking shoes and a safe place to walk. If the weather is bad, walk in the mall. Some malls even have special hours and clubs for their walkers. There are video tapes available that develop a walking program right inside your own home. If you have hip, knee or foot problems you can walk in water, relieving the stress on your joints. Swimming – A good choice if you are overweight, or have foot, knee, ankle, or hip problems. There is 80% less weight on your bones in water! Aerobic dancing – Look for a class or a videotape that includes stretching, warm-up, and cool-down. Running and jogging – These are intense aerobic activities and not for people with foot or knee problems. Racquet sports – Tennis and racquetball can give you a great workout. If this is new for you, start slowly. Even ping pong is healthy. Cycling – Riding a bike is an excellent workout for your heart and does not stress feet. You can ride a regular or stationary bicycle. Increase the tension to increase intensity of the workout.

Making an Exercise Plan WHEN MAKING AN EXERCISE PLAN, CONSIDER:

• Having you had a checkup to make sure exercise is safe for you? • Making sure you have the skills needed to do the exercise. • Having the right equipment (shoes, swimsuit, safety helmet, etc.). • Doing a 5 to 10 minute warm-up and cooldown of slow walking or slowing your activity. • Adding a five-minute cool-down period of stretching or walking slowly with deep breaths. • Be aware that exercise can lower blood sugar and always carry a glucose-source when exercising. Always begin slowly, increasing length and intensity gradually. Try to exercise every day. Exercise can give you more energy if you can just get yourself to do it. Once you become fit, you will have more stamina. If you want to lose weight, you may want to try exercising first thing in the morning. Then you may not be too tired to exercise, and the energy boost you get will help you get through the rest of the day.

ENJOY!!! Being able to move is a blessing!

My exercise program begins with: WEEK 1 Morning: ____________________________________ for ______minutes Late afternoon or evening: _____________________ for ______minutes

WEEK 2 Morning: ____________________________________ for ______minutes Late afternoon or evening: _____________________ for ______minutes

WEEK 3 Morning: ____________________________________ for ______minutes Late afternoon or evening: _____________________ for ______minutes

WEEK 4 Morning: ____________________________________ for ______minutes Late afternoon or evening: _____________________ for ______minutes

WEEK 5 Morning: ____________________________________ for ______minutes Late afternoon or evening: _____________________ for ______minutes

WEEK 6 Morning: ____________________________________ for ______minutes Late afternoon or evening: _____________________ for ______minutes

Sick Day Care Getting sick is a fact of life and we have all experienced it at some time or another. When you have diabetes, getting sick can get complicated if you do not remember a few important points. • The person with diabetes has a less-active immune system, making it harder to fight off invading germs. • Blood sugar levels often elevate when you are sick. • It is easy to become dehydrated when you are sick because the body tries to rid itself of extra sugar by frequent urination. • Maintaining a blood sugar, as near normal as possible, will help you get better faster. • Exercising, when blood sugar is over 250 mg/dL, can actually increase B/S, esp., type 1’s. • When there is not enough insulin present to utilize the glucose in the blood, fats are used instead, producing ketones. This may be a sign that your blood sugar has been too high for too long. In Type 1 diabetes, ketones should be tested when B/S levels are over 300 high three times in a row for type 1’s or in severe infections in type 2’s.

Using the previous information, develop some sick day rules that could speed up your recovery. 1. _________________________________ _________________________________ 2. _________________________________ _________________________________ 3. _________________________________ _________________________________ 4. _________________________________ _________________________________ 5. _________________________________ _________________________________ 6. _________________________________ _________________________________

I need to call the doctor when: __________________________________ __________________________________ __________________________________ __________________________________ A list of foods is next to help you choose alternative meals/snacks to eat on those days when illness prevents you from following your normal meal plan.

Food for Sick Days When you are sick and unable to follow your normal meal plan, it is important that you continue to take in food to give your body what it needs to fight off the infection. If nausea and vomiting prevent eating, rest for 20-30 minutes after the episode of vomiting. Try to take a few sips of fluid and rest for 20 minutes. If it stays down, try again to take several sips, with about 20 minutes in between. If you can keep down fluids for an hour, gradually increase the amount you are taking. The stomach is less likely to give it back if you do not overfill it. Often warm, slightly sweet or salty fluids are better tolerated than plain water. If using soda, shake gently to disperse some of the bubbles. If nothing stays down for 24 hours, call your doctor. When nausea and vomiting stop, try to take in at least four ounces of fluid per hour. Also, try to keep carbohydrate intake to the equivalent of about 15 grams per hour of being awake. ¹⁄³ cup milkshake

6 saltines or 3 graham crackers

3-4 oz. juice

½ cup reg. gelatin

½ cup of soup

½ Popsicle

½ cup custard

½ cup oatmeal

4-5 oz. reg. soda

¹⁄³ cup sherbet or ½ cup ice cream

1 slice toast

1 TBS. honey

Complications of Diabetes Diabetes greatly affects the health of your heart and blood vessels. This includes heart attack, coronary artery disease (CAD), strokes, poor circulation to legs and feet (peripheral vascular disease or PVD). The greatest cause of death to those with diabetes is heart disease. Diabetes also affects the small blood vessels of the body. Red blood cells become coated with sticky sugar and are unable to do their job of taking oxygen to the cells. Small vessels are affected first: in the eyes (retinopathy), in the kidneys (nephropathy) and the long twisted blood vessels of the legs and hands (peripheral vascular disease). High blood glucose levels in the blood (glucose of 180 and higher) coat the ends of the nerve fibers with sugar. Nerves die from lack of oxygen (neuropathy), causing numbness, tingling and pain. Controlling glucose is important for controlling the complications of diabetes. Regular medical care from your diabetes team will help you to avoid complications. Team members include: your primary care physician, foot doctor, eye doctor, dietitian, heart doctor, nurse educator, and YOURSELF! It takes a team to take of your diabetes! 24

Skin Care Preventing skin infections is very important for those with diabetes. The skin is the largest organ of the body and is your best defense against germs. Following these basic health guidelines can help protect you and your skin from infections. • Adequate fluid intake. Eight glasses of water are needed daily, more if you are sweating a lot or blood sugars are over 180mg/dL. • Proper nutrition. Follow a daily diet that has lots of fresh vegetables, lean meat/chicken, fresh fruit and whole grains. • Wash with a mild soap with cool or warm water daily to reduce harmful germs. Hot water and harsh deodorant or perfumed soaps may be irritating to skin. • Carefully pat skin dry with soft, absorbent towel. Rubbing may tear thin skin. Dry skin folds carefully, especially between toes. Cornstarch or powder may be used to keep damp areas dry, but stop if there is any irritation. • Moisturizers should be applied to dry skin areas, but not between toes. Lotions with alcohol should not be used, as they are drying to the skin. • Avoid sunburn and use sunscreen. Sun damages the skin. • Have skin over all your body examined yearly by your doctor. Any wound, rash, or crack in the skin is an invitation for germs to enter and should be treated quickly. Broken skin should be open to air, as much as possible. Moisture promotes further breakdown of tissue. Wash with antibacterial soap and apply an antibiotic cream. Contact your physician immediately if redness, warmth, tenderness, or drainage appears. 25

Diabetes and How It Affects the Feet Diabetes causes problems and deformities that put the diabetic foot at risk. High blood sugar levels lead to nerve damage and loss of feeling. Diabetes causes damage to blood vessels, leading to poor peripheral circulation to the feet. The person with diabetes is at higher risk of infection and has a lowered immune response. This combination of problems makes the diabetic foot at high risk for ulcers, wounds that do not heal, gangrene, and amputation. Daily care and inspection of your feet will help reduce your risk of foot problems. Foot care should include: • Washing feet daily to remove bacteria that are always there. • Dry carefully, do not forget between toes. • Apply lotion to dry areas, but be careful to avoid between toes, as this may help bacteria to grow and cause an infection. • Examine feet daily. Note any red areas or broken skin. ANY foot wound is serious for those with diabetes. If you cannot see your feet, use a long handled mirror or have someone else check them. • Cut toenails evenly across. File any corners and rough edges. If you cannot see your toes or if you have nerve damage so you cannot feel your feet or toes, do NOT try to do your own nail care. • DO NOT PERFORM BATHROOM SURGERY. Never try to remove corns, calluses, or blisters. Cutting into the skin opens the body to infection. Rough areas can be gently buffed with pumice stone. • Medicare and medical insurance will usually cover the cost of foot care if you have diabetes. • Do not use over-the-counter corn and callus treatments. Most contain acid that can hurt healthy skin, leaving it open to infection. • Wear supportive, comfortable shoes. Leather, canvas, or cotton shoes are best as they allow feet to “breathe.” Socks should be of an absorbent material such as cotton. • Try new shoes on in late afternoon or evening. Feet are bigger late in the day. Buy shoes with plenty of toe room. Shoes should be cushioned and have a low heel. • NEVER GO BAREFOOT. Always wear protective footwear at the beach and pool. • Rub your hand along the inside of your shoe to check for any irregularity such as loose linings, threads, or bumps that could hurt feet. • Take shoes off at every doctor visit, even if the doctor forgets to ask. • See your foot doctor regularly; he will tell you how often you need to see him. Everyone with diabetes should have a thorough foot exam every year. Feet should be checked for fungus, blood supply, and bone problems. Loss of feeling is tested with a monofilament, a very fine, plastic tool that resembles a straw from a plastic broom. Sensitivity to touch and pressure is checked on several places of the foot.

Have you had your feet examined by a foot doctor? Did you know Medicare and most insurance will cover that exam, if you have diabetes? Foot deformities are common in diabetes. Nerve damage and poor circulation cause muscle damage. This may lead to a high arch and toes that form a “claw” when the shoe is removed. This change causes the fat pads of the foot to shift and no longer protect the bones when walking. Continuing to use an injured foot can lead to wounds that do not heal. These are easily ignored when the sensation of pain is gone from nerve damage. Prevention of foot ulcers is important to stop amputations. • Stop smoking. Smoking slows blood flow, causes vessel damage, and prevents oxygen from getting to cells. • Keep blood sugar levels as near normal as possible. High blood sugar is the leading cause of nerve damage. • Wear special shoes, if needed. • Avoid use of alcohol. Drinking alcohol makes nerve damage worse. Did you know last year 86,000 feet and legs were amputated? 90% of those amputations could have been prevented!

Stress Stress can make blood glucose levels hard to control. When you are under stress, certain hormones are released. The most common are adrenaline and cortisol. These hormones travel through the blood to the liver, which responds by releasing sugar into the blood. A stressful event can lead to a large rise in blood sugar, sometimes hundreds of points! There are many kinds of stressors: illness, infection, lack of sleep, surgery, and emotional stress such as anger, frustration and grief.

Can you think of some things that are stressing you now?

It is impossible to prevent stress in our lives. So it is important for you to develop a strategy of stress relievers. These are things you can do to help to lower your stress level and help you to cope with life’s daily stresses.

What kinds of things do you do to help yourself cope when you are having a bad day? __________________________________________________________________________

Can you name a couple of new things that you would like to try?

Dental Care People with diabetes have an increased risk for cavities and gum disease. High blood sugar levels may increase glucose in the saliva, causing more bacteria to grow. Gums may become red, painful and swollen. They may bleed easily even with gentle brushing. Teeth may become loose and discolored. All of these are signs of periodontal disease, or gum disease. Gum disease often goes unnoticed as there are often no symptoms. HOW TO PREVENT GUM DISEASE

Thorough, daily dental care and regular examinations by the dentist are helpful in preventing gum disease. • KEEP BLOOD SUGAR UNDER CONTROL. • Brush and floss daily using a soft toothbrush. • Use an antibacterial mouth rinse, or a mixture of hydrogen peroxide and baking soda. • Report any painful, swollen, receding, or bleeding gums to the dentist. • Visit your dentist every six months, or as recommended by your dentist. • Some dentists recommend a vibrating toothbrush and/or a water device to decrease risks of dental/gum disease. Seek advice of your dentist.

Goal Setting WHAT GOALS DO YOU WANT TO ACHIEVE?

Choose 2 or 3 goals. 1.

I will

What could prevent you from achieving those goals? 1. 2. 3. 4.

What steps could you take to overcome those barriers? 1. 2. 3. 4.

Take Control Only you have the power to make the changes in your lifestyle that will impact the course of this disease. Only you can control those factors in your life that can prevent permanent disabilities. Diabetes is a demanding disease. If you don't take control of your diabetes, diabetes will take control of your life. Don't let diabetes win. TAKE CONTROL. TAKING CARE OF YOU MEANS:

1. A dilated eye exam every year. 2. A foot exam at each physician visit. 3. Daily foot exams. 4. Blood pressure measurement at each visit. 5. Urine protein (microalbumin) test every year. 6. Blood cholesterol (fat) levels every year. 7. Nutrition education every year. 8. Updated diabetes self-management training every year. 9. Maintaining a healthy weight. 10. Taking medication properly. 11. Healthy eating. 12. Exercising daily.

GLOSSARY Angiotensin-converting enzyme (ACE) Inhibitors - A group of medicines that lower blood pressure; especially useful in diabetes because it helps to prevent kidney damage. Angioplasty - Opening up a blocked vessel, either with surgery or by using a balloon to expand the inside opening. Antihypertensive - A medicine to prevent or treat high blood pressure. Arteriosclerosis - A disease where blood vessels become thick, hard, and lose their flexibility. Atherosclerosis - A form of arteriosclerosis where vessels are filled with fat. Autonomic neuropathy - Damage to nerves that go to organs. Cardiovascular Disease - Disease of the heart and blood vessels. Cerebral Vascular Disease - Disease where blood vessels in the brain become small, hardened, or filled with fatty deposits. Cholesterol - A fat found in animal products, such as cheese, meats, and milk. Also, made by the liver. High levels of LDL (low-density lipoproteins) have been linked to heart disease. Coronary Artery Disease (CAD) - Vessel damage in the heart. Cardiometabolic Syndrome - Disease process with increasing glucose, cholesterol, blood pressure, expanding waistline, and cardiac disease. Dilated - Pupils wide open for examination. Erectile dysfunction - Inability of a man to obtain or maintain an erection. Fasting - Without eating. Floaters - A speck that passes across the field of vision. They vary in size and shape and have a variety of causes. Hammer toe - Where the 2nd or 3rd toe curl over the great toe. High-density lipoprotein (HDL) - Healthy cholesterol. Higher HDL levels decrease cardiac risk. HDL levels should be over 50. Hemodialysis - A treatment used in kidney failure where a machine filters the wastes from the body. Hyperglycemia - High blood sugar. Hypertension - High blood pressure. Hypoglycemia - Low blood sugar. Incontinence - Inability to control the bladder and flow of urine. 32

Insulin - Hormone made in the beta cells of the pancreas. It is necessary to move sugar out of the blood and into the cells for energy. Insulin Resistance - Inability of cells to use insulin appropriately. It is the cause of type 2 diabetes. Ketones - The by-products of broken down fatty acids in the body, too much in your blood is really bad for health. Ketones levels in urine are developed in your body when fats, instead of glucose are utilized to produce energy. It is an acid. The measuring range is 0 to 160 mg/dL. Low-density lipoprotein (LDL) - Cholesterol that clogs arteries; becomes very sticky in those with diabetes. LDL levels should be under 100 with diabetes, under 70 with heart disease. Lipid - Fat. Macrovascular - Large blood vessels, usually those of the heart. Microalbumin - Urine test to determine small amounts of protein. Microaneurysm - Rupture of tiny blood vessel, usually in the eye. Microvascular - Pertains to small blood vessels, usually relating to those vessels in the eyes and kidneys. Myocardial Infarction - Heart attack. Nephropathy - Disease of the kidney. Neuropathy - Disease of the nerves could be numbness, burning, tingling. Ophthalmologist - Doctor who specializes in diseases of the eye. Orthotics - Specially-made devices that fit into the shoe to correct foot problems. Pancreas - Fat, pancake-shaped organ behind and below the stomach in the abdomen. Contains beta cells where insulin is made. Peripheral neuropathy - Damage to nerves that are in the feet, legs, hands, and fingers. Peripheral Vascular Disease (PVD) - Disease of the blood vessels in the extremities. Platelets - Cells in the blood that aid in clotting. Proliferative Retinopathy - Latter stage of eye disease, where abnormal blood vessels are formed in the retina of the eye. Retinopathy - Disease of the eye. Stent - A device surgically placed in a narrow vessel to widen it. Triglycerides - Fatty substance in the blood.

COMMUNITY RESOURCES LAKE COUNTY COMMUNITY RESOURCES

DIABETES EDUCATION CLASSES ADVENTHEALTH WATERMAN CREATION HEALTH CENTER -TAVARES

CONTACT: 352-253-3965 SERVICES: A comprehensive, five session class for patients who are prediabetic, those newly diagnosed, and those having trouble controlling blood glucose. Mondays from 5-7 pm. Registration is necessary. SERVICES: Prediabetes Class: A 3-week, 2-hour class, held every Tuesday throughout the year. Registration is required. SERVICES: Lake County Gestational program. Must be referred by physician. Meets Thursday mornings.

CLINICS ADVENTHEALTH WATERMAN COMMUNITY PRIMARY HEALTH CLINIC - EUSTIS

CONTACT: 352-589-2501 2300 Kurt Street Eustis, FL 32726 SERVICES: Provides non-emergent, primary care services to eligible adults in Northeast Lake County. Serves ages 18-65 HOURS: M, W: 8:30 am – Noon, and 1:00 - 4:00 pm; Tu-Th: 8:30 am – Noon, and 1:00 am – 6:00 pm; F: 8:30 am – Noon FEES: None REQUIREMENTS: Northeast Lake County resident. No insurance. Meet Federal Poverty Guidelines. LEESBURG REGIONAL MEDICAL CARE - TAVARES

CONTACT: 352-323-2373 URGENT CARE 8 am - 8 pm daily 3631 W. Burleigh Boulevard Tavares, FL 32778 SERVICES: Treats non-life-threatening health needs, no appointment needed. HOURS: Daily: 8 am - 8:00 pm, staffed by Nurse Practitioners. FEES: Vary—accepts all types of Medicaid except Amerigroup. All commercial insurances welcomed that cover Urgent Care Groups.

SOUTH LAKE HEALTH CLINIC - CLERMONT

CONTACT: 352-243-6280 835 7th Street Building B, Suite 4 Clermont, FL 34711 SERVICES: Free clinic provides primary care only for South Lake County residents without insurance. Patients must meet by Federal Poverty Guidelines. AGE GROUPS: 18 Up. HOURS: M, T, W 7 am - 5:30 pm, by appointment only. FEES: NONE

HEALTH DEPARTMENTS FLORIDA DEPARTMENT OF HEALTH FLORIDA KIDCARE

CONTACT: 1-888-540-5437 WEB: www.healthykids.org SERVICES: Florida health insurance program for uninsured children. Four levels: MediKids, Healthy Kids, Children's Medical Services and Medicaid. Florida KidCare will assess which program your child may be eligible for based on age and family income. AGE GROUPS: Under 19. REQUIREMENTS: Submit an application and qualify medically and financially. FLORIDA DEPARTMENT OF HEALTH-LAKE COUNTY WOMEN, CHILDREN AND INFANTS (WIC) M-F 8 AM - 6 PM, BY APPOINTMENT ONLY.

CONTACT: 352-394-3464 560 DeSoto Street Clermont, FL 34711 SERVICES: Nutritional support for low income women, infants and children. For WIC appointments at the Clermont office, call 352-771-5559 (English) and 352-394-3464 Ext. 2002 (Spanish). CLERMONT HEALTH CENTER

CONTACT: 352-989-9001 875 Oakley Seaver Drive Clermont, FL 34711 HOURS: M-F, 8 am - 5 pm, by appointment only SERVICES: Immunizations, Dental, and Vital Statistics 35

LAKE COUNTY HEALTH DEPARTMENT - LEESBURG WOMEN'S WELLNESS CENTER

CONTACT: 352-360-6548 2113 Griffin Rd Leesburg, FL 34788 HOURS: M-F: 8 am - 5 pm, by appointment only. SERVICES: Maternity, Postpartum, Family Planning, Immunizations, and STD (testing and treatment). LAKE COUNTY HEALTH DEPARTMENT - LEESBURG WIC (WOMEN, CHILDREN AND INFANTS)

CONTACT: 352-771 5559 225 North First Street Leesburg, FL 34748 HOURS: M-F, 8 am-5 pm, by appointment SERVICES: Nutritional support for low-income women, infants, and children. LAKE COUNTY HEALTH DEPARTMENT - UMATILLA

CONTACT: 352-771-5500 249 E. Collins Street Umatilla, FL 32746 HOURS: M-F, 8 am - 5 pm, appointment preferred. SERVICES: Breast and Cervical Cancer early detection, Pediatrics, WIC, Maternity, Family Planning, Primary Care, Quick Care, Immunizations, Foreign Travel, Epidemiology/Disease control, STD (testing and treatment), HIV testing, Dental Van, and other services.

Behavioral Health LIFESTREAM BEHAVIORAL CENTER COMMUNITY MENTAL HEALTH INPUT AND OUTPATIENT CENTERS

CONTACT: 352-315-7500 Various locations throughout Lake County WEB: www.lsbc.net HOURS: M-F: 8:30 am - 5:00 pm SERVICES: Input and Outpatient mental health and medication management services are provided at clinics for all ages in Leesburg (352-315-3913), The Villages (352-259-5762), Eustis (352-357-1550), Clermont (352-394-5922), and Bushnell (352-793-4126). AGE GROUPS: All FEES: Sliding scale, private insurance, Medicaid and Medicare. 36

Leesburg Food Bank CONTACT: 352-326-5463 503 N. 13th Street Leesburg, FL 34748 HOURS: M-F: 10 am - Noon REQUIREMENTS: Must have a Social Security Card, picture identification, and live in Leesburg.

Food banks in surrounding areas: Benevolence Center

1308 W Main St, Leesburg

352-787-5289

Clermont Neighborhood Center

630 W Desoto Street, Clermont

352-394-2278

Dayspring Ministries

2434 Old Dixie Hwy, Apopka

407-814-4996

8698 Hillside Dr., Orlando

407-814-4996

First Baptist Church

124 N. Joanna Ave., Tavares

352-343-7131

Groveland Neighborhood Center

7432 SR 50 Suite 114, Groveland

352-429-3822

Lake Community Action Agency

501 North Bay St., Eustis

352-357-5550

Leesburg Neighborhood Center

1010 E. North Blvd., Leesburg

352-787-1156

Operation Homebound

975 Rolling Acres Rd., Lady Lake

352-753-8484

Real Life Christian Church

1501 Steves Rd, Clermont

352-394-3553

Salvation Army

Leesburg

352-365-0079 or 352-568-2284

National Organization Resources AMERICAN DIABETES ASSOCIATION

1-800-DIABETES (1-800 342-2382) www.Diabetes.org Local – Chapter 2290 Lucien Way, Suite 230 Maitland, FL 32751 407-660-1926 Provides information on the disease and local diabetes services.

DISABILITIES DEAF AND HEARING SERVICES OF LAKE AND SUMTER COUNTIES - LEESBURG

CONTACT: 352-323-0757(Voice); 352-323-9106(TTY) 220 South 9th Street Leesburg, FL 34748 WEB: www.deafandhearing.org SERVICES: Case Management, advocacy, interpreters and services to hearing-impaired, Sign Language classes and counseling. Provide phones FREE to Florida residents. Also, sponsors a “Hear Again” program which provides FREE, refurbished hearing aids to those who cannot afford them. AGE GROUPS: All HOURS: M-F, 9 am - 3 pm. DISABILITY DETERMINATION SOCIAL SECURITY

CONTACT: 1-800-772-1213 WEB: www.SocialSecurity.gov SERVICES: Call Social Security to begin your "Disability Determination" application, or visit a local office in person. FEES: None NEW VISION FOR INDEPENDENCE, INC. (NV) - LEESBURG

CONTACT: 352-435-5040 Lake-Sumter State College 9501 U.S. Highway 441 Leesburg, FL 34788 SERVICES: Free training for visually impaired and blind adults. Classes include: independent living skills, orientation and mobility, assistive technology, and braille. Computer programs: ZoomText (screen magnification for those with some usable vision) and JAWS (speech output for those without sight), Window Eyes, Open Book and Typing. NV's Family Workshops offer information, visual simulations and experiential activities for clients, family members and friends. Seven support groups. AGE GROUPS: All HOURS: M-Th, 8 am - 5 pm. FEES: None REQUIREMENTS: Recent eye report must be submitted to Florida Division of Blind Services by NV.

SOCIAL SECURITY – DISABILITY ADVISOR

CONTACT: 352-821-1041 101 E. Berckman Street Fruitland Park, FL 34731 SERVICES: Non-Attorney representative for Social Security Disability. HOURS: M-F, 9 am - 5 pm STATE OF FLORIDA, DEPARTMENT OF EDUCATION DIVISION OF VOCATIONAL REHABILITATION SERVICES

CONTACT: 352-742-6100 8112 Centralia Ct Suite 102 Leesburg, FL 34748 HOURS: M-F, 8 am - 5 pm. SERVICES: Help individuals with physical or mental disabilities that prevent them from being able to acquire employment. REQUIREMENTS: Stable living conditions; and must provide documentation of physical or mental medical condition. STEP BY STEP SPEECH THERAPY

CONTACT: 352-742-7837 2760 Dora Avenue Tavares, FL 32778 WEB: www.stepbysteptherapy.com AGE GROUPS: All HOURS: By appointment FEES: Private pay and insurances. UNITED WAY

Marion County 352 732 9696 Lake and Sumter Counties 352-787-7530

MEDICATION ASSISTANCE EXPRESS SCRIPTS

PHONE: 314-996-0900 WEB: www.express-scripts.com SERVICES: Coordinator between pharmaceutical companies and patient to help provide assistance to uninsured and low income families.

FAITH NEIGHBORHOOD CENTER

CONTACT: 352-429-1200 7432 Hwy 50, Suite 114 Groveland, FL 34736 SERVICES: Serves south end of Lake County only. Provides assistance for housing referrals, rent, prescription medication, clothing, food, and small appliances. Mortgage and utilities assistance, as funds are available. HOURS: M, Tu, W, F: 9 am - Noon; Th: 1 pm - 4 pm. FEES: None NEEDYMEDS

CONTACT: 800-503-6897 WEB: www.needymeds.org HOURS: M-F, 9 am - 5 pm. SERVICES: Applications for medication assistance from pharmaceutical companies. PARTNERSHIP FOR PRESCRIPTION ASSISTANCE

CONTACT: 1-888-477-2669 WEB: www.pparx.org HOURS: M-F: 9:00 am - 5:00 pm Eastern Standard Time SERVICES: Assistance is available to finding ways to acquire medication. Call or visit website for information for how to qualify for assistance. PFIZER RXPATHWAYS

CONTACT: 866-706-2400 for Enrolled patients, 866-989-7284 for New patients WEB: www.pfizerrxpathways.com SERVICES: Comprehensive assistance program that provides eligible patients with a range of support services, including insurance counseling, co-pay assistance,* and access to medicines for free or at a savings. *Terms and conditions Publix: Some antibiotics and metformin given free; monthly, 30-day supply. Walmart: 70/30, Reg and NPH insulin. ReliOn Brand $24.88/vial.

SUPPORT GROUPS ADVENTHEALTH WATERMAN - TAVARES CREATION HEALTH DIABETES SUPPORT GROUP

CONTACT: 352-263-3539 Conry CREATION Health Center 1000 Waterman Way Tavares, FL 32778 HOURS: 3rd Wednesday of each month, from 5-6 pm.

TRANSPORTATION CENTRAL AIR AMBULANCE

CONTACT: 1-866-910-6744 WEB: www.centralairambulance.com SERVICES: If non-ambulatory and on medical equipment, you may be eligible for this service. AGE GROUPS: Any HOURS: 24/7 FEES: Vary ANGEL FLIGHT SOUTHEAST

CONTACT: 352-326-0761 8864 Airport Blvd Leesburg, FL 34788 WEB: www.AngelFlightSE.org SERVICES: Non-profit organization provides free air transportation for any legitimate, charitable or medically-related need. LAKE COUNTY CONNECTION

CONTACT: 352-326-2278 SERVICES: Provides a variety of transportation services for the elderly, disabled and low-income citizens, such as to medical appointments, jobs, senior centers, hair/barber appointments, nail appointment, going out to dinner, shopping, etc. Determination of eligibility is made by Lake County Connection. Transportation Disadvantaged (TD), American Disability Act (ADA) (must live on a City bus route to have ADA services) and Medicaid service is provided for those who qualify. Customers may schedule trips 2 to 14 days ahead of time. AGE GROUPS: All HOURS: M-F, 6 am - 6 pm, must call for reservations FEES: ADA - $2, Medicaid - $1, and TD riders - $2 REQUIREMENTS: Written application.

LAKEEXPRESS

CONTACT: 352-762-1940 WEB: www.ridelakexpress.com SERVICES: Fixed route bus service provides hourly transportation, from Monday-Friday starting at 6 am and ending at 7 LakeExpress offers two bus routes: One travels to The Villages and the other towards Eustis and AdventHealth Waterman, past shopping malls, on a fixed route. AGE GROUPS: All HOURS: M-F, 6 am - 7 pm FEES: $1.00/ride, $3.00/day pass, or $30/month pass, half fare for seniors and disabled. Lake County School children and college students with school ID ride free.

WEIGHT LOSS TOPS – (TAKE OFF POUNDS SENSIBLY)

CONTACT: 941-524-5069 Jim Ferri, coordinator, jimferri711@gmail.com Leesburg: First Presbyterian Church, 200 S. Lone Oak Dr. Leesburg FL 34748; Wednesdays, 8:30 am weigh-in, 10a. meeting Eustis: First Church of God, 1550 N. Hwy 19, Eustis FL 32726; Thursdays, Noon weigh- in, 1 pm meeting. Mount Dora: Congregational Church, 650 Donnelly St., Fellowship Hall, Mount Dora, FL 32757; Thursdays, 6:15 - 7 pm. SERVICES: Nutritional information and support regarding weight loss. FEES: $32 a year, which is a national fee plus you receive a magazine. $5 month

Index

Diabetes . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

Goals for Healthy Lipid Levels. . . . . . . . . . . 20

Normal Anatomy and Physiology . . . . . . . . . 2

The Benefits of Exercise with Diabetes. . . . 21

Types of Diabetes . . . . . . . . . . . . . . . . . . . . . . 3

Getting Started with Exercise. . . . . . . . . 22-23

High Blood Sugar. . . . . . . . . . . . . . . . . . . . . . . 4

Making an Exercise Plan. . . . . . . . . . . . . . . . 24

What Went Wrong . . . . . . . . . . . . . . . . . . . . . . 5

My exercise program begins with: . . . . . . . 25

Testing Blood Glucose . . . . . . . . . . . . . . . . . . 6

Sick Day Care. . . . . . . . . . . . . . . . . . . . . . 26-27

Blood Glucose Target Ranges. . . . . . . . . . . . 7

Food for Sick Days. . . . . . . . . . . . . . . . . . . . . 28

Disposing of Sharps. . . . . . . . . . . . . . . . . . . . . 8

Complications of Diabetes. . . . . . . . . . . . . . 29

Hypoglycemia. . . . . . . . . . . . . . . . . . . . . . . . . . 9

Skin Care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

Symptoms of low glucose may include. . . . 10

Diabetes and How It Affects the Feet. . . 31-33

What if Blood Sugars are Too Low? . . . . . . . 11

Stress. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34-35

Diabetes Pills . . . . . . . . . . . . . . . . . . . . . . . 12-14

Dental Care. . . . . . . . . . . . . . . . . . . . . . . . . . . 36

Injected Medications for Glucose Control. . 15

Goal Setting . . . . . . . . . . . . . . . . . . . . . . . . . . 37

Insulin Action. . . . . . . . . . . . . . . . . . . . . . . . 16-17

Take Control. . . . . . . . . . . . . . . . . . . . . . . . . . 38

A1C (Glycohemoglobin Test). . . . . . . . . . . . . . 18

GLOSSARY . . . . . . . . . . . . . . . . . . . . . . . . . 39-41

A1C: Know Your Number. . . . . . . . . . . . . . . . . 19

COMMUNITY RESOURCES . . . . . . . . . . 42-49

Patient Resource Materials Medication List MEDICATION

DOSAGE

FREQUENCY

REASON FOR TAKING

Notes

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