DIABETES
PROBLEM
You have been diagnosed as having diabetes. Diabetes does not go away; you have to manage it every day. It is a condition in which your body cannot use the glucose from food properly. Some signs that your blood sugar is too high and too low are listed here:
A.Hyperglycemia (high blood sugar) signs/symptoms: Fruity breath odor; abnormal breathing pattern; rapid, weak pulse; confusion or stupor.
B.Hypoglycemia (low blood sugar) signs/symptoms: Hunger, weakness, sweating, headache, shaking, rapid heartbeat, paleness, fainting, seizures, or coma.
CAUSE
Your body has an organ close to the stomach called a pancreas. Your pancreas is not making enough insulin or your body is not using the insulin it is making properly.
TREATMENT/CARE
A.Lifestyle changes—exercise, stop smoking, follow your diet, and lose some weight—are necessary to control your diabetes:
1.Stop smoking. Smoking doubles your risk of developing heart or blood vessel disease. It’s never too late to quit smoking.
2.Weight loss of even 5 to 10 pounds helps to control your diabetes.
3.You need to wear an identification tag that tells others you have diabetes in case of an emergency.
B.Foot care is very important:
1.Check feet every day.
2.Wash with mild soap and lukewarm water.
3.Apply lotion.
4.File or clip nails after washing and drying.
5.Do not tear skin around calluses.
6.Wear clean socks daily.
7.Wear well-fitted shoes at all times: no bare feet. You may not be able to feel or detect damage.
8.Avoid crossing your legs.
9.Take your shoes off at every office visit.
C.Blood glucose monitoring: You will be instructed on how to check your blood sugar at home. Goals of glycemia control:
1.Fasting blood sugar: 80 to 120 mg/dL.
2.2-hour postprandial (after meal) glucose: less than 180 mg/dL.
3.Bedtime glucose: 100 to 140 mg/dL.
4.Hemoglobin A1c: less than 7%.
D.For low blood sugar you need to follow the 15:15 rule:
1.After having low blood sugar, you need to check your blood every 4 hours for the next 24 hours.
2.15:15 rule: Choose one to follow:
a.Take three glucose tablets.
b.Drink 1/2 cup orange juice.
c.Drink 1/2 cup apple juice.
d.Drink 1/3 cup grape juice.
e.Drink 6 oz of regular Coke.
3.If your blood sugar drops to less than 59, you need to follow the 15:15 rule, drinking juice or taking glucose tablets, followed with 1/2 cup of milk and a starch and 1 oz of protein.
4.If you have severe low blood sugar, you could pass out and go into a coma. You need to have glucagon for emergencies:
a.Glucagon is not glucose, but it helps the liver raise your blood glucose.
b.Glucagon is a prescription drug and is given by injection; it usually works within 15 minutes.
c.If you do not respond with the first shot of glucagon, your family needs to call 911.
d.A second dose of glucagon should be given by your family if you do not awaken in 15 minutes.
e.After receiving glucagon and you respond, you need to eat a snack.
REGULAR CARE
A.You will need to come to the office at regular times to have your diabetes checked and make sure you do not have any complications. Your provider will follow national standards of care, including:
1.Order a dilated eye examination every year.
2.Check your blood pressure and keep it less than 140/80.
3.Check your cholesterol at least once a year.
4.Do a special foot examination at least once a year.
5.Check your A1c every 3 months to see if your blood sugar is under control.
6.Check your urine for protein/kidney problems.
7.Give you a flu vaccine every year.
8.If you are older, you need a pneumonia vaccine, too.
SICK-DAY RULES
You will also need a special plan in the event you are sick or have a special occasion:
A.Test blood sugar more often, up to every 2 to 4 hours.
B.Increase your fluids, even if you do not feel like eating.
C.Follow a meal plan if you can.
D.Call your healthcare provider if your blood sugar is less than 70 or greater than 240 for two readings in a row that cannot be explained; if you are unable to retain food/fluids; and if you are spilling urine ketones.
E.Check your ketones if your blood sugar is greater than 240. If your ketones are negative, keep testing if your blood sugar stays up.
F.Continue to take your usual insulin dose.
G.Do not take Glucophage if you are dehydrated.
Activity: Exercise is very important in controlling your diabetes. It not only improves blood sugar by helping your insulin to work, but it also reduces your risk of heart attack and stroke, and helps with losing weight.
Talk with your health care provider before starting an exercise plan. If you are currently doing some form of exercise, please continue; however, avoid any strenuous exercise.
Moderate exercise (walking, cycling, and swimming) is the best exercise. Your goal will be to develop a consistent exercise activity three to four times a week for 20 to 45 minutes. Drink plenty of fluids before and after you exercise to prevent dehydration.
Exercise causes a decrease in your blood sugar for up to 24 hours. Do not exercise if your fasting blood sugar is greater than 250 or your sugar at any time is over 300. Exercise is not recommended if you have ketones (burning fat instead of sugar).
Diet:
A.You will be seeing a dietitian to develop a nutritional plan that is suited for you.
B.Consistency with meal times and amounts and food from all the six major food groups is important.
C.Even though we stress carbohydrate counting, diabetes has abnormalities in carbohydrate, fat, and protein metabolism that cause hyperglycemia.
D.Dietary control includes limiting fats such as cholesterol and saturated fat to help control blood lipid levels and prevent cardiovascular disease.
E.Eat a balanced diet, eat at regular times, and try not to skip meals; eat about the same amount of food at meal/snack times.
F.Use portion control, decrease the fats that you eat, and decrease fast simple sugars.
G.Decrease your alcohol consumption.
Medications:
A.You may need a combination of medications or insulin to help control your blood sugar to prevent complications.
B.If you use insulin injections or the insulin pump, the best place to give it is your stomach.
C.The American Diabetes Association recommends that you take an angiotensin-converting enzyme (ACE) inhibitor (blood pressure medicine) to help protect your kidneys.
D.You may be told to take an aspirin every day (if you are not allergic).
You Have Been Prescribed: ___________________________________________________________
You Need to Take: ___________________________________________________________
You Have Been Prescribed: ___________________________________________________________
You Need to Take: ___________________________________________________________
You Have Been Prescribed: ___________________________________________________________
You Need to Take: ___________________________________________________________
You Need to Notify the Office If:
A.You are sick and unable to keep foods/fluids down (vomiting) or have severe diarrhea.
B.You intend to take over-the-counter medications; they could react with your diabetes medication.
C.You are using metformin (Glucophage) and are going to have x-rays using any dyes. You must stop your medicine.
Phone: ____________________________
Remember to carry your ID and a carbohydrate source. Glucagon should be available for severe low blood glucose caused by risk of aspiration and/or inability to swallow.
RESOURCES
American Diabetes Association (ADA): http://www.diabetes.org/research-and-practice/we-support-your-doctor/patient-education-materials.html
Handouts from Academy of Nutrition and Dietetics: Diabetes Care and Education. https://www.dce.org/publications/education-handouts
You can build your own identification bracelets or neck chains from American Medical ID: https://www.americanmedical-id.com/customized-ids/customized-medical-id-jewelry.html.