What Does That Mean?

“My Doctor Says Getting Resultsin Diabetes Care is Easier Than I Think...”

BD Getting Started™

Getting Results

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YOU Can Make the Differencein Your Diabetes Care!

This booklet is designed to teach you about your

diabetes and what you can do to get the best results

from your care. You will learn:

• What diabetes is all about

• How your Diabetes Team can help you

manage your diabetes

• The medical exams and lab tests you

will need to keep your diabetes under control

You will find out why it is important to work closely

with your diabetes health care team members as they

help develop a treatment plan especially for you. You

will also discover why you need to stay with your

treatment plan and follow up regularly with your team.

If your diabetes goes untreated, over time high levels of

blood glucose can damage your vital organs. This could

lead to heart disease and stroke; high blood pressure;

vision problems or blindness; kidney disease; nervous

system disease; problems with your teeth and gums;

amputations of feet or toes; and complications of

pregnancy. However, recent advances in diabetes

treatment that you will read about on these pages

have helped people to control their diabetes

successfully and live healthily.

Table of Contents

YOU Can Make the Difference in Your Diabetes Care! . . . . . . . . . . .2

What is Diabetes? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3

What are the Different Types of Diabetes? . . . . . . . . . . . . . . . . . . .4

Who Has Diabetes in the United States? . . . . . . . . . . . . . . . . . . . . .7

Why You Need to Take Care of Diabetes . . . . . . . . . . . . . . . . . . . . .8

What is a Diabetes Health Care Team? . . . . . . . . . . . . . . . . . . . . . . .10

Who is on a Diabetes Team? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

What is Included in a Diabetes Management Plan? . . . . . . . . . . .11

Lab Tests and Medical Exams . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13

Why You Need to Prevent Complications . . . . . . . . . . . . . . . . . . .13

Diabetes-Related Tests and Exams; When to Have Them . . . . . . .13

Follow-up with Your Diabetes Team Members . . . . . . . . . . . . . . .21

YOU are the Most Important Member

of Your Health Care Team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .22

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What is Diabetes?

Definition

Diabetes is a disease that changes the way your bodyuses glucose (sugar) for energy.

People without Diabetes Have Normal Blood GlucoseLevels: If you don’t have diabetes, your food isdigested in your stomach and changed into glucose(a kind of sugar). The glucose travels in yourbloodstream to your body cells. Insulin produced by your pancreas allows the glucose to enter yourbody cells and gives them energy.

People with Diabetes Have Blood Glucose LevelsThat Are Too High: Your pancreas is not makingenough insulin, or the insulin it makes does not work well. Either way, without insulinyour cells can’t get the glucose theyneed. Instead, the glucose builds up inyour bloodstream. When your bloodglucose level gets very high, your bodygets rid of the glucose and caloriesthrough your urine. As a result, your diabetes is out of control and you may have one or more of the following signs.

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Signs of diabetes: • Thirst• Urinating more than usual• Feeling very hungry• Feeling more tired than usual• Losing weight without trying• Sores that heal slowly• Dry, itchy skin• Losing feeling in your feet, tinglingin hands and feet

• Sexual dysfunction• Blurry eyesight

When your blood glucose is too high for too long, it isconsidered “out of control.” The goal in treatingdiabetes is to keep your blood glucose levels as close tonormal as possible. This will make you feel better andkeep you free of the signs of diabetes.

What are the Different Types of Diabetes?

Pre-diabetes – You have “pre-diabetes” if your bloodglucose is higher than normal, but not high enough fora diagnosis of diabetes. For example:

• Your “fasting” blood glucose may be 100 – 125 mg/dl(taken in the morning after not eating or drinkingovernight)1

• Your blood glucose taken two hours after a mealmay be 140 – 199 mg/dl

People with pre-diabetes are at risk to develop type 2 diabetes. If people with pre-diabetes lose

1 American Diabetes Association, Standards of Medical Care in Diabetes - 2010.Diabetes Care. 2010;33 (suppl 1): S13.

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2 American Diabetes Association, Standards of Medical Care in Diabetes - 2010.Diabetes Care. 2010;33 (suppl 1): S20.

Type 2 is treated by:• Making healthyfood choices

• Exercisingregularly

• Taking aspirin daily (if prescribed by your doctor)• Controlling your blood pressure and cholesterol• Checking your blood glucose

As times passes, your blood glucosemay still rise in spite of taking all of these steps. In this case you may need to add diabetes pills andinsulin to your treatment. For moreinformation about type 2 diabetes,diabetes pills and insulin, read theBD Getting Started™ booklet, “My Doctor Says I Need to TakeDiabetes Pills and Insulin…”What Do I Do Now?

Gestational Diabetes – GestationalDiabetes Mellitus (GDM) is a condition that can

happen during the late stages of pregnancy. High bloodglucose levels develop because some of the hormones of pregnancy act against insulin. Pregnant women withGDM will need more insulin to bring their blood glucoseto normal levels. After the baby is born, blood glucosereturns to normal 90 to 95% of the time. Women who have had GDM have a 40% to 60% chance ofdeveloping type 2 diabetes over the next 5 to 10 years.3

3 Centers for Disease Control and Prevention, National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2007.Atlanta, GA: U.S. Department of Health and Human Services, Centers for DiseaseControl and Prevention, 2008.

a moderate amount of weight and increase theirexercise, they are more likely to prevent type 2diabetes than people who do not. They may evenreturn blood glucose to normal levels!2

Type 1 diabetes – You have type 1 diabetes if yourpancreas can no longer make insulin and you mustinject insulin to meet your body’s needs. Type 1 usually

develops in children, teen-agers andyoung adults.

Treatment includes: • Taking insulin by injection with a

syringe, insulin pen or insulin pump• Making healthy food choices• Exercising regularly• Controlling blood pressure and

cholesterol• Taking aspirin daily (if prescribed by

your doctor)• Self Monitoring of Blood Glucose

(SMBG)

Type 2 diabetes – You have type 2 if the insulin madeby your pancreas does not work well enough to meetyour body’s needs. (Over time, it can’t make enoughinsulin to match the glucose released after a meal.)Type 2 can happen at any age, even childhood. It usually starts with insulin resistance (when fat,muscle, and liver cells stop using insulin properly). If you are overweight and not active you are morelikely to develop type 2 diabetes.

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The treatment for GDM includes:• Self Monitoring of Blood Glucose• Exercise• Healthy food choices• Insulin treatment may be necessaryin certain cases

For more information about GestationalDiabetes, read the BD Getting Started™

booklet, “My Doctor Says I HaveGestational Diabetes…” What Do I Do Now?

Who Has Diabetes in the United States?

More people in the U.S. are developing diabetes thanever before. From 1980 through 2002, the number of Americans with diabetes more than doubled. (It

is estimated that this number will doubleagain by 2050.) According to the Centerfor Disease Control, 23.6 million peoplehave diabetes, but 5.7 million of them do not know it!4

Children, Teens and Seniors: • About one in every 500 children and teens hastype 1 or type 2 diabetes. Type 2 diabetes isbecoming more common among children andteens, particularly in minority groups, such asNative Americans, African Americans andHispanics/Latino.

• More than 23% of people aged 60 years or olderhave diabetes.

Minorities:On average, people in certain race/ethnic groups are more likely to have diabetes than non-Hispanicwhites of similar ages.

Why You Need To Take Care of Diabetes

Diabetes is a chronic disease. It does not go away, even with treatment. It is also progressive,meaning that if left untreated, it can lead to difficultcomplications. The good news is that diabetes can becontrolled. However, it must be carefully monitoredto keep it in control. A treatment planthat works at first may need to beadjusted as time passes to keep yourblood glucose in its “target range”(where it should be most of the time).Your health care team will work withyou to decide the blood glucose goalsor target ranges that are right for you.

Non-Hispanic 6.6 %Whites

Non-Hispanic 11.8 %Blacks

Hispanics 10.4 %

American Indians and 16.5 %Alaska Natives

Asian Americans 7.5 %

MINORITY GROUP PERCENTAGE OFDIABETES INPOPULATION

4 Centers for Disease Control and Prevention, National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2007. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2008. 8

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The following table provides target blood glucoseranges recommended by the American DiabetesAssociation. It also tells you when you should takeaction to get your blood glucose back on track.

What is a Diabetes Health Care Team?

Who is on a Diabetes Team?

Your doctor may recommend that you meet with otherhealth care professionals to help you learn how tomanage your diabetes. Your diabetes teammay include diabetes educators such as:

• Registered dietitian• Nurse or nurse practitioner• Exercise specialist• Social worker• Physician assistant

Your health care providers may also becertified diabetes educators (CDE). CDEshave had special training to teach peoplehow to live with diabetes. Your teammembers combine their individual talentsand skills together to help you manageyour diabetes.

Extended Team Members

Your doctor may also want to call incertain medical specialists to find and treat problems early. They include:

• Endocrinologist – a diabetes medical specialist• Ophthalmologist – for eye problems• Nephrologist – for kidney problems• Urologist – to help with sexual function or urinary problems

• Podiatrist – to help with foot care

ADA RECOMMENDED TARGETS FOR BLOOD GLUCOSE CONTROL IN ADULTS WITH DIABETES

Normal Target When ToTake Action

Before eating Less than 100 70 to 130 If less than 70 or greater than 130

2 hours after Less than 130 Less than 180 If less than eating 70 or greater

than 180

A1C Less than 6 Less than 7 If greater than 7

RECOMMENDED TARGET BLOOD GLUCOSE LEVELS5

5 American Diabetes Association, Standards of Medical Carein Diabetes - 2010. Diabetes Care. 2010; 33 (suppl 1): S23.

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4. Taking MedicationIf diabetes medications are prescribed,your team will explain why you need to: • Take your medications to keep yourtreatment working

• Be aware that your treatment planwill change over time and that youmay need to have your medications or insulin doses changed

5. Problem SolvingYou will learn how to manage instancesof high or low blood glucose by:• Making adjustments to your treatment plan• Learning how to make temporary changes in yourdiabetes management for special events in your life

6. Reducing RiskYour team will teach you about sick day managementand possible complications of diabetes so you can: • Understand why diabetes control is so important.Poor diabetes control increases your risks for heartdisease and other diabetes complications

• Work with your health care teamto keep your blood pressure,cholesterol and blood glucoselevels under control

• Stop smoking if you are still doing so

7. Healthy CopingYou will discover why stress management skills are needed so you can:• Learn the coping skills you need to live with diabetes • Take best advantage of the support and educationprovided by your diabetes health care team

What is Included in a Diabetes Management Plan?

Your diabetes team will help you learn how to treat yourdiabetes by teaching what you need to do every day tohelp yourself. The American Association of DiabetesEducators (AADE) has identified seven key parts to yourtreatment, each a specific action you should take daily:

AADE 7 Self-Care Behaviors:™6

1. Healthy EatingYour diabetes team will help design a meal plan with you and teach you to:• Choose healthy foods• Select the correct serving sizes• Plan the right times to eat so that you can matchyour food to your medication or insulin and activity

2. Being ActiveYour team will develop an exercise plan with you sothat you can:• Stay fit• Keep your weight under control• Keep your blood glucose in your target range

3. Self Monitoring Blood Glucose (SMBG)Your diabetes nurse educator will show you how toself-monitor so you can:• Check your readings on your own to see if yourtreatment plan is working

• See if your values are signaling needed adjustmentsto your treatment

• Recognize when you need to call your health teamfor help

6 Mulcahy K, Maryniuk M, et al. Diabetes Self-Management Education CoreOutcomes Measures. The Diabetes Educator. 2003;29(5):768-796.

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working. For more information about theA1C test, read the BD Getting Started™

booklet, A1C What’s Your Number?

2. Weight (every visit)It is important for your weight to be checked every time you see yourdiabetes team. The following chartshows why your weight may havechanged and what you might need to do about the changes.

CHANGE IN POSSIBLE CAUSE POSSIBLE ACTIONWEIGHT

Weight gainrelated to alow bloodsugar reaction.

Extra food eatento treat lowblood glucosereaction.

May need LESS medicine.

Weight gainrelated toincreasedinsulin.

1. You are takinga diabetes pillthat makesyour pancreasproduce moreinsulin OR

2. You are new totaking insulin.

When diabetes is out ofcontrol, you lose caloriesthrough urine. Whenyou start taking insulin oryour pancreas makesmore insulin, you insteadabsorb these calories andgain weight. Developmeal plan that will matchthe insulin your bodyneeds to work.

Weight losswithoutcutting backon eating.

You may not bereceiving enoughmedication orinsulin to controlyour bloodglucose.

May need MORE medication or insulin .

Lab Tests and Medical Exams

Why You Need to Prevent Complications

Finding problems early is very important, so they can betreated right away before they become severe. As youlearned earlier, when left untreated, complications ofdiabetes can lead to heart disease and stroke; high bloodpressure; vision problems or blindness; kidney disease;nervous system disease; problems with your teeth and gums;amputations of feet or toes; and complications of pregnancy.

Diabetes-Related Tests and Exams; When to Have Them7

Record your results in the BD Getting Started™ PersonalDiabetes Care Card. Be sure to note how often each testis needed.

1. A1C blood test (every 3 months)Given in your doctor’s office, theA1C measures your average bloodglucose levelover a three-month

period. It givesyou the overall “big picture” to

tell you if your blood glucose is incontrol. When you check your bloodglucose at home you get a “snapshot”affected by factors such as time of day,meals eaten, activity, and sick days.An A1C result under 7% means thatyour diabetes treatment plan is

7 American Diabetes Association, Clinical Practice Recommendations - 2010: Standardsof Medical Care in Diabetes Position Statement. Diabetes Care. 2010;33(suppl 1):S19.

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7

8

9

10

11

12

126

154

183

212

240

269

298

A1c %

eAG (AverageGlucose)

mg/dl

through your body and against the walls of yourblood vessels. When blood pushes too hard, this is called high blood pressure (hypertension). Thisputs extra strain on your heart and blood vesselsand may result in heart disease. The best way totreat high blood pressure is to eat foods low in fat and salt and take medicine if needed.

ADA recommendation: Blood pressure less than 130/80.

Cholesterol tests — HDL/LDL - once a yearCholesterol is found in food and also made in thebody. Although your body needs some cholesterol,too much of the wrong type of cholesterol canclog your arteries and lead to heart disease.

ADA recommendation: Total cholesterol of less than 200 mg/dl.

There are 2 types of cholesterol:HDL (High-density lipoprotein cholesterol – once a year)HDL is considered “good” because it carries excess cholesterol out of the arteries so it can be removed from the body before it can build up on the artery walls.

ADA recommendation: Target HDL of >40 mg/dl for men and >50 mg/dl for women.

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3. Examinations Related to Heart DiseaseThe biggest problem for people with diabetes is heart and blood vessel disease, which can lead to heart attacks and strokes.8 Heart disease mayalso cause poor blood flow (circulation) to the legs and feet.• Smoking is a risk factor for heart disease. If you smoke you should quit.

• The American Diabetes Association (ADA)recommends aspirin therapy for people withdiabetes over 40 years of age to prevent heartattack and stroke.9 Talk to your doctor aboutwhether you should take aspirin every day andthe correct dose for you.

The ADA also recommends target levels for bloodpressure, cholesterol, and triglycerides for peoplewith diabetes. Check with your diabetes team to find out the target levels they recommend for you.

Blood Pressure [every visit]A large research studyfound that blood pressurecontrol is just as importantas blood glucose control in preventing diabetescomplications.10 Bloodpressure pushes blood

8 Haffner SM, Lehto S, Ronnemaa T, et al, Mortality from coronary heart disease insubjects with type 2 diabetes and in non-diabetic subjects with and without priormyocardial infarction. N Engl J Med. 1998;339:229-234.

9 American Diabetes Association. Standards of medical care in Diabetes–2010.Diabetes Care. 2010;33 (suppl 1): S32.

10 UKPDS Group. Tight blood pressure control and risk of macrovascular andmicrovascular complications in type 2 diabetes. Br Med J. 1998:317:703-13.

Microalbumineria (once a year)This urine test detects early signs of kidney damage.It measures the amount of albumin (protein) that“spills” into your urine. If small amounts aredetected, your diabetes team may recommend specialblood pressure medicine and a low protein meal planto prevent any further changes in kidney function.

ADA recommendation: If you smoke, quit and keepyour blood pressure in your target range.

5. Diabetes-related Foot ProblemsDiabetes foot disease occurs becauseof poor blood flow and nerve damage.Poor blood flow does not let enoughblood to reach the legs and feet. Ifthe feet or legs are injured, they willheal slower and are more open toinfection. Nerve damage in feetresults in a loss of feeling so the painfrom the injury is not felt. Leftuntreated, infection in your feet canlead to gangrene and amputation.

Foot Exam (every visit)Take your shoes and socks off when you go into theexam room. This will remind your doctor to check yourbare feet for sores, cracks, infection or other changesin the skin on your feet. Let your doctor know of anyproblems with your feet as soon as they occur.

ADA recommendation: It is important to examineyour own feet every day and wear socks and shoesthat fit well.

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LDL (Low-density lipoprotein cholesterol – once a year) LDL is considered “bad” because it stays in thebloodstream, sticking to the walls of blood vesselsand increasing the chance of heart disease.

ADA recommendation: Target LDL level of <100 mg/dl.

Triglycerides (once a year)Triglycerides are fats found in food and also producedin your body and stored for energy. Together withcholesterol, triglycerides can cause hardening of thearteries in some people. When blood glucose levelsare high, triglyceride levels are also high. When bloodglucose levels fall, triglyceride levels fall. This testmeasures the amount of triglycerides in your blood.Too high a level can put you at risk for heart disease.

ADA recommendation: <150 mg/dl.

4. Examinations-related to Kidney DiseaseYour kidneys clean waste products from your blood thatleave your body through your urine. They also keepthe right balance of minerals and fluid in your blood.High blood glucose levels over a number of years maydamage the small blood vessels that make up yourkidney, resulting in kidney failure. If this happens,dialysis is needed to clean your blood or a kidneytransplant may be required. If damage is detectedearly, treatmentcan be started andkidney failure maybe avoided.

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6. Diabetes-related Eye DiseaseChanges in blood glucose levels may causeblurred vision. High blood glucose levels over a number of years can affect the small bloodvessels in the eye. Retinopathy, early cataracts,and glaucoma are the main types of eyecomplications related to diabetes. High bloodglucose can make the blood vessels in your eyesvery delicate and cause them to bleed. Thebleeding can cause blindness. It is critical to catch eye problems early when they can betreated easily and blindness can be prevented.

Eye Exam (once a year)Be sure that your eye doctor knows you havediabetes. In this exam drops are put in your eyes todilate your pupils (make them bigger). This allows

your retina (back of youreye) to be examined forany changes. Your vision isalso checked and testedfor glaucoma.

ADA recommendation:Keeping blood glucose andblood pressure as close tonormal as possible will help to prevent eye disease.

7. Diabetes-related problems with Gums and TeethHigh blood glucose brings abouthigher levels of glucose in yoursaliva. This can lead to infection in your gums and the bones thathold your teeth in place. Infectioncan make your blood glucose riseeven higher. Without treatment,your teeth may become loose and fall out.

Dental Exam (twice a year)Inform your dentist that you have diabetes. A

dentist or dental hygienist should cleanyour teeth and check for decay atleast once a year.

ADA recommendation: To preventdental disease, you should try tokeep your blood glucose as close tonormal as possible. Brush and flossyour teeth at least twice a day.

8. Preventive action related to FluFor people with diabetes, the flu can mean longerillness, complications, and hospitalization, evendeath. Diabetes that is poorly controlled makesyou more vulnerable to severe cases of flu.

Flu Shot (once a year)Serious flu symptoms will make your blood glucoselevel rise — an annual flu shot can help preventcommon flu viruses and avoid this problem.

ADA recommendation: Everybody with diabetes,of any age, should get a flu shot.

YOU are the Most Important Memberof Your Health Care Team

Managing your diabetes presents challenges. While some tasks can seem hard, youwill be surprised how well you cancontrol your condition with the help of your diabetes team. Each year, new research and products are beingdeveloped to help you better manageyour diabetes and prevent its seriouscomplications. By understanding yourdiabetes and working with your team to constantly monitor and improve yourtreatment plan, you will be able to live a long and healthy life.

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Follow-up with Your Diabetes Team Members

To get the very best results from your diabetes care,you should follow up with your diabetes health careteam members regularly and at least once a year.Let them know how you are doing and find outhow your treatment plan may need to be adjusted.They will also update you about any new researchresults, medications or advances in treatment thatmight benefit you. Be sure to cover all of thefollowing topics.

Your Review Checklist:

✔ Meal Plan

✔ Exercise Plan

✔ Self-Monitoring of Blood Glucose (SMBG)

✔ Low/High Blood Glucose

✔ Foot Care

✔ Insulin/Diabetes Medications

✔ Sick Day Management

✔ Stress Management

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10D06012330GRENGUnless otherwise noted, BD, BD Logo and all other trademarksare the property of Becton, Dickinson and Company. ©2010 BD.

BD1 Becton DriveFranklin Lakes, NJ 07417-18831.888.BDCARES (232.2737)www.bd.com/us/diabetes

BD provides this brochure for informational purposes only. It is not intended to be asubstitute for professional medical advice, diagnosis or treatment. Always seek theadvice of your physician or other qualified healthcare provider with any questionsyou may have regarding a medical condition. Never disregard professional medicaladvice or delay in seeking it because of something you have read in this brochure.

Written by:Rita Saltiel-Berzin, RN, MPH, CDE, CHESBD Diabetes CareFranklin Lakes, NJ

We wish to acknowledge the following health professionals forreviewing this publication and providing their valuable insights:

Andrea Zaldivar, RN, MS, ANP, CDENew York, NY

Laura Hieronymus, MSEd, APRN, BC-ADM, CDELexington, KY

Alice Taniguchi, RN, MPH, CDEHonolulu, HI