Skills To Help Manage Your Diabetes
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How you eat can significantly impact blood sugar levels. When developing a meal plan for someone with diabetes, focus on providing regular meals throughout the day. Avoid skipping meals. Eating small regular meals can keep blood sugars from rising too high after eating.
As part of regular meals, it is important to look at the kinds of foods you eat. A well balanced diet includes managing portion size. Eat a variety of foods that contain a regular intake of vegetables, whole grains, fruits, low fat dairy foods, and lean meats. Try not to eat too much of one type of food.
The good news is that what you eat is flexible and still can include some of your favorite foods. What has the greatest impact on managing diabetes is considering what you eat, how much you eat, and the times you eat.
A nutrient in foods called “carbohydrates” is what primarily impacts blood sugar control. Carbohydrates are typically highest in foods that are part of the food groups listed below:
Trying to figure out how much to eat can be challenging. Focus on a well balanced diet, lower in carbohydrates, with controlled portions. A good place tool called the “Divided Plate Method” can help you balance your diet. The tool makes it easy because you do not need to count grams of carbohydrates. Instead, fill your plate with less high carbohydrate foods and replace them with more non-starchy vegetables.
Imagine drawing a line down the center of a medium 9-inch plate. Half your plate should be covered with non-starchy vegetables like salad greens, broccoli, green beans, cauliflower, cabbage, or tomatoes. On the other side of the plate, cut the section evenly in half again. There should be a total of 3 sections on the whole plate. In one of these sections, equal to one 1/4 of your plate, add a lean meat or protein such as fish, chicken without skin, lean pork or eggs. The remaining 1/4 of the plate should be used for a starchy food such as pasta, rice, corn, peas or potatoes. An 8 ounce glass of low fat milk and a small piece of fresh fruit can complete the meal. Half a cup of canned fruit (packed in juice) can be used as a substitute for the fresh fruit.
If you are overweight and want to lose weight or your doctor ha recommended you lose weight to better manage your diabetes, the divided plate method can be an easy way to get started without becoming overwhelmed by tracking calories. Covering half of your plate with non-starchy vegetables is a good way to “bulk” meals with lower calorie, higher fiber foods. Higher fiber foods can help you feel full longer and make meals more satisfying when trying to cut back on food portions.
Losing weight can help improve your blood sugar (glucose), blood pressure, lower cholesterol and help with self-esteem. Just a 5-10% loss in your body weight can have positive health benefits. The key to losing weight is to set short-term goals for gradual healthy weight loss, typically only 1-2 pounds per week. Avoid “fad diets” or diets that eliminate basic food groups. If you are having trouble losing weight, talk with your doctor about a referral to a registered dietitian to help with an individualized structured weight loss meal plan.
Leading an active lifestyle is another important choice to help control your diabetes. Being active can help lower your blood sugar level, increase energy levels, and lose weight. Exercising or increasing daily physical activity has many heath benefits.
If you do not currently maintain an active lifestyle, or exercise on a regular basis, getting motivated can be difficult or seem impossible. Make a plan for what types of exercise you enjoy and set goals for how often and how long you want to exercise each week. You should start slowly and build your endurance. Having exercise scheduled into your weekly routine makes you more likely to take the steps needed to get moving!
FREQUENTLY ASKED QUESTIONS (FAQ)
What types of exercise can I choose from?
There are three basic types of exercise – aerobic, strength, and flexibility exercises.
Aerobic exercise is exercise that makes your heart rate increase, raising your breathing rate while working muscles of the body. A good goal to aim for is 30 minutes of aerobic exercise 5 days a week. The time can be broken into 2 or 3 separate 10-15 minute exercise times if you are unable to get 30 minutes all at once. If you are trying to lose weight, it is recommended to aim for more than 30 minutes of aerobic exercise every day.Examples of aerobic exercise include:
- Tennis, golf or ice-skating
- Use of exercise equipment such as elliptical machines or rowing machines
Strength training exercise along with aerobic exercise helps keep you strong and helps maintain muscle mass that tends to be lost over the years as we grow older. Having more muscle makes everyday jobs like lifting and everyday chores easier. When you have more muscle on your body, you burn more calories than people who do not strength train which helps manage your weight. Lift weights at home, purchase exercise rubber bands or join a strength training class at your local gym.
Flexibility exercises or stretching keeps aging joints limber. Always do gentle stretching before any aerobic exercise to help your body warm and become flexible. Yoga or Pilates classes or videos can also be alternatives to improve flexibility and muscle tone.
How do I be more active if I cannot find the time to exercise?
Finding small ways to be more active in your daily routine can be easy if you look for opportunities to move. Even these small, short burst of activity can make a long-term difference in your blood sugar and weight.
- Go for a short walk after getting the mail or newspaper
- Get off the bus one stop early
- Doing yard work like raking leaves or planting flowers
- Play basketball or go for a bike ride with your kids
- Park a distance away from stores or take a walk at the mall when shopping
- Get up from your desk at work to stretch and walk the hallways
- Take the stairs instead of the elevator when able
- Find a friend or support person to encourage you to be more active – it becomes easier if others provide encouragement and support!
Self Blood Glucose Monitoring
Talk with your doctor about the benefits of using a home blood glucose meter to help monitor your daily blood sugars. Using a personal meter at home to check your own blood sugars helps you know how your diet, medications, and activity patterns affect your blood sugars. It also helps you know if your blood sugars are too low or too high when you are not feeling well. Then you are able to take actions to correct these blood glucose values outside of an acceptable range.
Blood glucose meters are available in most drug stores or at super centers that have a pharmacy anywhere diabetes supplies are sold. You could also ask your doctor or diabetes educator to help you obtain a meter by prescription that might be covered by your insurance. Many insurance companies have “preferred” brands of blood glucose meters that have the best coverage for supplies needed for the meter. Your doctor or diabetes educator would be able to assist you in choosing the best meter for you.
When should I test?
Talk to your doctor about the best times of day for you to test your blood sugars. Typical times to test might be first waking up in the morning, before meals, 1-2 hours after meals, or at bedtime. Likely, you do not need test more than a few times a day -- unless your blood sugars are variable and often outside of your target levels. Your doctor can guide the number of times of day to test and what times of day are best for you. Many insurance companies will provide only a certain amount of supplies per month to test your blood sugars, so be sure to communicate with your doctor about your testing schedule to make sure you won’t run out of lancets and testing strips.
It is suggested to keep a log book or list of all of your blood sugars that include date and time of the test. Your doctor and diabetes care team can use this information to make decisions about medication dosages and times, meal planning, and physical activity guidelines. Be sure to take your log book to all of your doctors and diabetes education appointments.
What blood glucose ranges for me?
It is suggested that blood glucose ranges be individualized based on your needs and diabetes control. Your doctor may consider certain variables when choosing your target range such as:
- How long you have had diabetes
- Your age, older individuals often have less stringent ranges
- Frequent episodes of low blood sugars, called hypoglycemia
- Your level of diabetes related health complications
- Personal lifestyle factors and goals
The American Diabetes Association provides people with diabetes suggested targets for blood glucose testing if your doctor has not suggested a different target. Check with your doctor to verify these targets are appropriate for your best blood sugars control and lower risk of diabetes related complications.
|Pre-prandial plasma glucose (before meals)||70-130 mg/dl|
|Post-prandial plasma glucose (usually 1-2 hours after meals)||Less than 180 mg/dl|
|A1c (3 month average blood sugar)||Less than 7%|
What is hypoglycemia?
A low blood glucose number, usually less than 70 mg/dl, can make you feel bad. This reaction is called hypoglycemia, or low blood glucose. When you are becoming hypoglycemic, common symptoms include:
- Sweating, even when not overheated
- Irritability or moodiness
- Tingling sensations around the mouth
- Seizures, if blood glucose level is extremely low
How do I treat a low blood sugar reaction or hypoglycemia? The fastest way to raise blood glucose levels is to eat sugar or another form of quickly absorbed carbohydrates. It is advised when you are diagnosed with diabetes to carry glucose tablets with you at all times. You never can predict when a low blood glucose level may occur. Glucose tablets can be purchased at any drugstores or supermarkets that carry diabetes supplies.
A simple and easy rule to remember to treat a low blood sugar reaction is the “Rule of 15”. The “Rule of 15” or commonly called the 15/15 rule for hypoglycemia is three easy steps:
Step 1: If you are feeling symptoms of hypoglycemia, test your blood sugar level
Step 2: If your blood sugar is below 70 mg/dl or you have multiple symptoms of hypoglycemia, eat about 15 grams of sugar or carbohydrates such as 3-4 glucose tablets, 4 ounces fruit juice, or regular soda, 4 teaspoons of sugar, 1 tablespoon of honey, or 3-5 hard candies. Stick with choices that are mostly sugar, avoiding foods with a high fat content like chocolate or cookies, which do not work as quickly to raise blood sugars normal again.
Step 3: Wait 15 minutes, and retest your blood sugar level. If your blood sugars are still low, repeat step 2, and retest your blood sugar again in 15 additional minutes. Once levels have returned to a normal range, consider eating a small snack if no meal is planned in the next 1-2 hours.
If your hypoglycemia continues to get worse, you could become confused or pass out. Seek immediate medical attention for any worsening symptoms of hypoglycemia by calling 911 or be taken to the nearest emergency room. You may also use an injectable alternative called glucagon available by prescription from your doctor. Glucagon is an injectable hormone that works on the liver to raise blood glucose levels.
What is hyperglycemia?
Hyperglycemia is the medical term used when blood sugars levels go too high. Hyperglycemia can often happen when the pancreas does not make enough insulin or insulin does not work properly. Blood sugars levels may also rise too high in response to poor dietary choices, forgetting to take diabetes medications, or due to illness or excessive stress.
What are the signs of hyperglycemia?
- Frequent urination
- Extreme thirst
- Increased hunger
- Dry, itchy skin
- Increased drowsiness or lethargy
- Slow to heal wounds
- Blurry vision
- High levels of sugar in the urine
If you are experiencing any of the symptoms and have not been diagnosed with diabetes, visit your doctor to determine if they are related to undiagnosed diabetes. If you are diabetic and having signs/symptoms of hyperglycemia, test your blood sugar level using a blood glucose meter. If your level is significantly outside of your normal range, call your doctor, and drink plenty of water.
High blood sugar values may be related to a lifestyle factor that is within your control such as food choices and portions, missed diabetes medication, or lack of exercise. Cutting down of food volumes of high carbohydrate foods may help. Talk with a dietitian to make changes in your food choices. Work with your diabetes educator or support people around you to help to remember to take your medication as ordered by your doctor. Or consider exercise as another alternative to help lower blood sugars. It is advised by the American Diabetes Association to check your blood sugars before exercise. If your blood glucose level is above 240 mg/dl, check your urine for ketones using urine strips you can obtain by prescription from your doctor. If ketones are present in your urine, DO NOT EXERCISE. Exercise may make your blood glucose level go higher if ketones are present in your urine. Talk to your doctor about the safest way to lower your blood glucose level, potentially by changes to your medication or they may advise going to your nearest emergency room.
Checking for Ketones
What are ketones? If ketones are present in your urine, it can be a sign that the body is breaking down fat stores for energy instead of sugars/glucose due to the lack of insulin.
How do I test for ketones? Get a sample of urine in a clean container. Put a ketone test strip in the urine sample. (Ketone testing strips can be obtained by prescription from your doctor). Follow the directions on the container of ketone strips, typically waiting for the strip pads to change color. Compare the strip to the color chart on the side of strip container for the range of ketones in your urine.
What do my test result mean? Moderate to larger amounts of ketones present in the urine can be a danger sign in a person with diabetes. High levels of ketones can cause an imbalance in blood that alters body chemistry and affects how the body functions. Typically high levels of ketones in the urine is a sign that diabetes is out of control. Talk to your doctor as soon as possible about your results for guidance on managing your diabetes.
When should I test my urine for ketones? Any of these warning signs can be an indication or cause high ketone levels:
- When blood glucose is greater than 250-300 mg/dl
- You are sick with cold or flu, have uncontrolled nausea or vomiting
- You have difficulty breathing
- Your breath has a “fruity” odor
- Confusion or disorientation
Diet and exercise alone may not be enough to help keep your blood glucose level in your target range. Medication may be the next step to get better control over your diabetes to prevent long-term health problems related to poorly controlled diabetes. Diabetes medications can be a pill, injecting insulin or wearing an insulin pump. The best type of diabetes medication for you should be determined by doctor who can evaluate blood sugar control and Lifestyle factors.
Many people with diabetes can control their diabetes with oral pill(s) without the use of injectable forms of insulin. People with type 1 diabetes typically have to depend on injectable insulin to control their diabetes. Diabetes pills often work well for individuals with type 2 diabetes, but may lose their effectiveness or stop working over years of having diabetes. It may mean you need more than one type of oral diabetes medication or a combination of oral pills and insulin to best control blood sugars.
There are many different types of oral diabetic pills to choose from, so talk to your doctor about options that can work best for you. Talk to your pharmacist or doctor about when to take your medication, considering your meal plan, exercise patterns and lifestyle.
Insulin – Is it for me?
Insulin can be an effective way to get tight control of blood sugars and can be dosed based on food intake. Insulin is not a pill. It is delivered by injection using an insulin needle or pen device. Insulin is available in different types based on the length of time it takes to reach the blood stream, when the strength peaks and how long it continues to work in minutes or hours.
Rapid-acting – begins to work about 5 minutes after it is injected, peaks at about 1 hour and full action is lost after about 2-4 hours.
Regular or short-acting – takes about 30 minutes to begin working, peaks at about 2-3 hours and last for about 3-6 hours.
Intermediate-acting – reaches the blood stream in about 2-4 hours, peaks 4-12 hours and last for 12-18 hours
Long-acting – takes 6-10 hours to reach blood stream and lasts for 20-24 hours
Insulin types can be mixed to optimize peak and duration for better blood sugar control. Mixed insulins are available already pre-mixed by the manufacturer. Talk to your doctor or pharmacist for more specific information how insulin can help better control your diabetes. If you are already on insulin, be sure to talk with your doctor or pharmacist about correct dosages, administration, and timing of insulin with meals to get the best control of blood sugars.
Insulin pump – Is it for me?
An insulin pump is a small external device that is linked to catheter placed below the skin to deliver insulin to help eliminate the need for multiple daily injections of insulin using a syringe or insulin pen. An insulin pump allows you more freedom to adjust your insulin based on your lifestyle. Insulin can be delivered 24 hours a day, set at different rates throughout the day, based on time of meals, activity levels, sleep schedules and work schedules.
The advantages of an insulin pump can overcome some of the disadvantages of insulin pump use. Some advantages of using an insulin pump include eliminating daily injections of insulin, increased flexibility in what you eat, reduction in extremes in blood glucose, and often improved A1c or average blood glucose levels. The disadvantages are small to using an insulin pump, but they can be expense if not covered by your insurance, potential for weight gain, and the need for extended training on use and care of the pump. Be sure to talk with your doctor and/or diabetes educator about if an insulin pump would work for you.
Management of Needles/Sharps
Storage of Insulin:
- Follow the manufacturer guide for storage of your insulin.
- Do not store insulin in extreme heat such as sunlight or cold such as in the freezer.
- Always check the expiration date. DO NOT use if past the marked date.
- Visually check the bottle or pen contents to make sure it looks normal before use.
- Store unused bottles of insulin or insulin pens in the refrigerator.
- Many manufacturers recommend keeping the insulin bottle or pen currently in use at room temperature to help reduce pain during injection due to being cold. Most insulin will last approximately a month at room temperature, but check with your pharmacist because it can vary depending on the type of insulin.
Reuse of Needles or Lancets
- Reusing needles or lancets may help save money, but does increase the risk for infection and pain during injection due to dull needles or lancets.
- If you have open wounds, a lowered immune system or poor resistance to infection, it is recommended by the American Diabetes Association to not reuse needles or sharps. There is no guarantee of a sterile needle or lancet once it has been used.
- If you have discussed reusing needles with you doctor and they feel it safe, be sure to use sanitary practices. Keep the needle or lancet capped when not in use. Never let the needle touch anything but clean skin. DO NOT share needles or lancets with anyone else. Cleaning the skin with alcohol before each use can help keep the skin clean, but can be drying to the skin.
Disposal of Needles or Lancets
- With an insulin syringe, if you can do it safely, clip the needles off with a needle clipping device to prevent anyone else from using the syringe. Do not use scissors.
- Or put the entire insulin syringe, pen needle that you have unscrewed from the top of the pen, or lancet into a medical grade waste container. A heavy duty plastic bottle with a screw cap may also be used if approved by your waste disposal company. Check with your local waste authority for your state, city, or town for the best methods that meets safe and acceptance disposal of hazardous waste. Click here to read the Delaware Solid Waste Authority's disposal of hazardous waste guidelines.