Controlling Your Diabetes

Controlling your Diabetes

• Weight Control – If you are overweight, losing some pounds will help you better manage your diabetes. A reduction in weight will help reduce glucose production and insulin resistance, improving blood sugar control. A body mass indicator BMI Calculator will help you determine if you are overweight.  It uses your height and weight to assess your weight status. Keep track of the carbohydrates you eat. Cut down on fatty foods – bake, broil or grill lean meats and cut away any fat on them.  Measure the foods you eat- know the serving sizes. Choose fruits, vegetables, and whole grains. Reach and stay at a healthy weight.
• Diet – Make wise food choices. Eat a balanced diet high in fruits, vegetables, fish, poultry, and whole grains.  Eating a balanced diet that spreads carbohydrates throughout the day will help prevent high blood sugar levels after meals
• Blood Sugar Control – Monitor your blood sugar at home. Your blood sugar test results can tell you if you are taking the right amount of medicine, eating the right amount and the right kinds of food, eating when you should, exercising as you need to, and managing your stress. It is important to monitor your blood sugar and take action to keep it in a normal range.
  • Hypoglycemia – When your blood sugar drops to 70 or below you are likely to experience symptoms such as shakiness, sweating, irritability, light headedness or confusion, and rapid heart rate. Causes of hypoglycemia include delaying meals, too much diabetes medication, not eating enough food, and too much exercise. To correct low blood sugar, eat or drink something with fast acting carbohydrates such as ½ cup orange juice, 6 ounces of regular soda, or 2-4 pieces of hard candy.  Wait 15 minutes and check your blood glucose. If it is still low, eat or drink another 10-15 grams of carbohydrate. Once your blood glucose returns to your normal range, eat a snack containing protein and carbohydrates.  Crackers with peanut butter or cheese are good choices.
  • Hyperglycemia - Anytime your blood sugar is above your target range, you may experience symptoms such as fatigue, excessive thirst, blurred vision, and frequent urination.  Causes of hyperglycemia include forgetting to take diabetes medication, overeating, stress, inactivity, or infections and illness. When your blood sugar is high, drink plenty of non-caloric fluids and check your blood sugar and ketones until your levels stabilize. Ketones are measured in urine, often during sick days, to detect ketosis, an acute and dangerous complication. Follow your diabetes management plan to adjust your meal plan and activity level.  Keep a record of your blood sugars and show it to your health care team.   Ask what to do if your blood glucose is often higher or lower than it should be. Ask your health care team to define when you should call for an appointment.
  • Sick Day Rule – When you are sick, stress causes your blood sugars to increase. It is important to discuss sick day rules with your health care team. You will need to continue to take your diabetes medications and monitor your blood sugar and ketones.  Drink plenty of fluids and eat meals and snacks even if you are not hungry.
• Physical Exercise – Getting regular physical exercise helps the body respond to insulin. Exercise also helps with weight control.  Try to exercise for at least 30 minutes on 3 or more days a week.  Aerobic exercises are the best.  Brisk walking, bike riding, or swimming are some examples. Always talk with your health care team before you begin an exercise program. You may need an exercise program tailored to your tolerance and health status.
• Blood Pressure Control – High blood pressure makes your heart work too hard.  If your doctor has prescribed a medication to lower your blood pressure, take it as prescribed. Discuss your blood pressure target with your health care team and write it down.  Discuss what you need to do to reach your target.  Ask if you need to test your blood pressure yourself.  If so, find out how, when, and what supplies you need.
• Cholesterol Control – LDL is the “bad” cholesterol that builds up in your blood vessels.  It causes the vessels to narrow and harden, which can lead to a heart attack.  Have your cholesterol checked at least once a year.  A diet low in saturated fat and regular exercise may help control your “bad” cholesterol.  If medication to lower your cholesterol is prescribed by your doctor, take it as prescribed.
• Regular Medical Checkups - Screening tests and examinations need to be done regularly to look for complications from diabetes, such as eye, kidney, cardiovascular, and nerve diseases. Early detection and treatment can help prevent progression of the disease. Talk to your health care team about ways to improve your diabetes management and make sure you schedule and follow through with these preventive care recommendations. Every 3 to 6 months
  • A1C- to measure your average blood glucose over the last three months. The target A1C for most people with diabetes is less than 7. Every 6 months
  • Dental Exams - to prevent gum disease and loss of teeth. Annually
  • Urine Micro albumin - to screen for kidney problems.
  • Fasting Lipid Profile- to measure “good” (HDL) and “bad” (LDL) cholesterol and fats in your blood.
  • Dilated Eye Exam – to check for eye problems caused by high blood sugar.
  • Comprehensive Foot Examination- to evaluate the circulation and nerves in the feet and any cuts, bruises, or infections.
  • Flu Vaccine - preventive

                Every Visit

• • Blood Pressure
  • Weight
  • Foot Exam - Visual
• Medication Adherence – You may need to take one or more medications to control your blood sugar.  If oral medications do not control your blood sugar, you may require insulin.  It is important to take these medications exactly as your doctor has prescribed. If you have questions, talk to your pharmacist or doctor about your medicines.
• Self Care – Take extra care of your feet and teeth and gums to prevent problems that may develop because of high blood sugar. Look at your feet and wash and dry them well each day.  Tell your podiatrist or health care team about any changes with your feet.  Check your mouth daily for gum or tooth problems.  Call your dentist right away if you have problems with your teeth or gums.
• Manage your stress- Stress from strong emotions or illness can cause your blood sugar to go up or down.  Usually, it will go up.
• Do Not Smoke – Smoking can aggravate problems that people with diabetes already face, such as heart and blood vessel disease.  People with diabetes who smoke are three times as likely to die of cardiovascular disease as are other people with diabetes. Smokers get respiratory infections more easily. Smoking makes your blood sugar go up.  If you currently smoke, it is never too late to quit. Talk to your health care provider about a plan that is right for you.  Your disease management nurse can help you set a goal to quit smoking and support you during the process.

   
   Sources:  DoD/VA Clinical Practice Guidelines
               American Diabetes Association
                National Institues of Health