You Have Diabetes,But It Doesn’t Have YouHave more energy. Feel less tired and thirsty. Prevent infections and sores. And protect your heart, nerves, kidneys, and other organs.

These health perks are all within your reach—you’ll get them by managing your diabetes.

You can’t make your diabetes disappear. But you don’t have to be defined by your disease. Start with small steps and

view taking care of your health as part of your job.

Take charge by:❯❯ Learning about your dis-

ease. Knowledge is power. Ask your doctor to recom-mend a class or a diabetes educator. Visit online resourc-es like www.diabetes.org or www.YourDiabetesInfo.org.

❯❯ Charting your course. Good health is like any other goal. Get there by plotting

steps along the way. Your diabetes care team will help you set targets and create a plan of action.

❯❯ Sticking with it. Day-to-day activities of diabetes care are in your hands. Follow your meal plan, take your medi-cines, and get moving for at least 30 to 60 minutes a day. Consult a friend, support group, or counselor when you need a boost.

OutlookChoosIng a healthIer lIfe | fall 2011

Diabetes OutlookChoosIng a healthIer lIfe | fall 2011

Diabetes

2 Diabetes Outlook

Why Do I Need to Track Glucose Levels Often?

In people with diabetes, food, activity, and stress can cause glucose levels to change through-out the day. Watching your blood glucose level closely can help you avoid hypoglycemia (low blood glucose) and hyperglycemia (high blood glucose). Here’s how you can make it easy to remember to check your blood glucose:❯❯ Establish a routine. Many

people do daily glucose checks before and after meals, and at bedtime. Talk with your doctor to see if you should track your glucose levels, and if so, how often. ❯❯ Record each glucose reading

in a log. Bring your log to every doctor appointment. Your doctor can use the readings to adjust your treatment.❯❯ Know how to use your blood

glucose meter. If you’re not sure how, ask your doctor for help.

Good QuEstionGood QuEstion

For people with diabetes, it’s important to have the following tests and checkups:❯❯ Hemoglobin A1c test two to four times a year❯❯ Blood pressure checked at every office visit❯❯ Foot inspection at every office visit and complete sensory foot

exam once a year❯❯ Dilated retinal (eye) examination once a year❯❯ Fasting lipid profile test at least once a year (includes

cholesterol and triglycerides)❯❯ Urinary protein/microalbumin test once a year❯❯ Serum creatinine measured once a year❯❯ Dental checkup as recommended

Good Health Guidelines

Understanding Your Blood PressureHaving your blood pressure checked regularly can help you keep it at a healthy level. A healthy blood pressure measure-ment for people with diabetes is lower than 130/80 mm Hg. The top number (130 in this example) is the systolic pres-sure, and the bottom number (80 in this example) is the diastolic pressure. Systolic pressure is the pressure of the blood against the blood vessels each time the heart beats. Diastolic pressure is the pressure of the blood against the blood vessels when the heart is resting and refilling between beats. Your doctor will tell you what your blood pressure goal should be.

To help you remember when to have your blood pressure checked, write down the date of your next doctor office visit:

Although these are suggested guidelines for care, please check with your benefits plan for coverage.

A closER looK

The information presented in this publication is not intended to be a substitute for medical care or advice provided by a physician. Always consult your physician for appropriate examinations, treatment and care recommendations. If you have any questions about this information, you should call your physician. Specific treatments and therapies may not be covered by your health plan. For questions about your benefits, please consult your health plan. Any reference in this material to other organizations or companies, including their Internet sites, is not an endorsement or warranty of the services, information or products provided by those organizations or companies. All models are used for illustrative purposes only. © 2011 Healthways, Inc.

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Fall 2011

FAll 2011 | Diabetes Outlook 3

Breast-Feeding’s Extra BenefitsIn fact, according to the U.S. Department of Health and Hu-man Services, breast-feeding:❯❯ Reduces your child’s risk of

developing diabetes later❯❯ Keeps your blood glucose

lower❯❯ Controls your weight, since

you’ll burn more calories

Before your baby is born, talk with your diabetes care team about breast-feeding. Your team can help you prepare and get started on the right foot.

Controlling Your GlucoseWhen you’re breast-feeding, your blood glucose might be more unpredictable. It’s more likely to dip too low than rise too high. Your health care team

might suggest that you check your glucose more frequently during this time.

Ask your doctor or dietitian about adapting your meal plan for breast-feeding. You’ll need to eat more calories overall. And you’ll probably need to add at least 50 grams more carbohydrates each day.

Before or during nursing, eat a snack and drink plenty of clear fluids. Keep a source of sugar and other carbs, such as glucose tablets or fruit juice, nearby while nursing. That way, you won’t have to stop nursing if you feel shaky, get a headache, or have other symptoms of low blood sugar.

Other Health FactorsIf you take insulin, you might not need as much while you

breast-feed. If you have type 2 diabetes and take medicines, your doctor may suggest you switch to insulin. Some diabetes drugs, including metformin, are safe to take while nursing. But doctors aren’t sure about some of the others, including incretin-based medicines, like exenatide (Byetta), liraglutide (Victoza), sitagliptin (Januvia), and saxagliptin (Onglyza).

One warning: With diabetes, you may be at higher risk of developing an infection called thrush. This is a yeast—fungus—infection that could grow on your breasts, thriving on your milk. Call your doctor if you have symptoms such as sore, deep pink or red nipples that last more than a few days; itchy, shiny, or cracked skin; or shooting pains in your breasts.

Breast-feeding is a natural process. But it doesn’t always come easily. Download Your Guide to Breastfeeding at www.womenshealth.gov/pub/bf.cfm

for expert tips, illustrations, and help overcoming common challenges.

Healthy HighlightBreast-Feeding Is Best for Women with Diabetes

Breast milk is the perfect baby food, and nursing gives you time to bond with your little one. Diabetes should not stand in the way of this special experience. In one study, three-fourths of women with diabetes were breast-feeding their babies when they left the hospital.

4 Diabetes Outlook

Should You Be ConcernedAbout Parkinson’s Disease?A recent study has found that diabetes might be linked to an increased risk for Parkinson’s disease. This is a nerve disorder that affects movement and coordination, and causes other problems not related to body movement.

One study published in Diabetes Care has found that people with diabetes seem to be 40 percent more likely to develop Parkinson’s disease. But more research is needed.

The scientists think the two diseases may have a common cause, like inflammation. Or the insulin problems caused by dia-betes may contribute to changes in the nervous system, eventually leading to nerve-related condi-tions like Parkinson’s disease.

Researchers still need to understand if there truly is a connection. But you can educate yourself about Parkinson’s to keep yourself healthy.

Q: What is Parkinson’s?A: When you decide to lift an arm or bend a leg, your nerve cells carry the message between your brain and muscles. One tool they use to communicate is a chemical called dopamine.

In people with Parkinson’s, nerve cells that make dopamine are damaged or destroyed. This makes it harder for nerves to fire off messages. Symptoms of Parkinson’s disease include:❯❯ Tremors, or shaking, in the

hands, arms, legs, or jaw❯❯ Difficulty walking, swallow-

ing, or speaking❯❯ Trouble balancing

❯❯ Trouble with fine motor tasks, like closing buttons

❯❯ Sleep problems❯❯ Bladder problems❯❯ Sexual problems❯❯ Fatigue and loss of energy❯❯ Depression❯❯ Memory problems

Symptoms may begin on one side of the body. But they can spread and worsen over time.

Q: Who’s at risk?A: Parkinson’s can run in fami-lies. But heredity accounts for only about 5 percent of Parkin-son’s cases. Other factors that increase your risk include:❯❯ Age. Most people who get the

condition are 60 or older.❯❯ Exposure to certain chemi-

cals in the environment. These include some pesti-cides and weed-killers.

DID YOU KNOW?

heredity accounts for only about 5 percent of Parkinson's cases.

Q&A

5%

FAll 2011 | Diabetes Outlook 5

❯❯ Getting sick from viruses, in-cluding those that infect the brain and cause a condition known as encephalopathy.

A new theory claims not hav-ing enough vitamin D contrib-utes to Parkinson’s. A study in Archives of Neurology, found about 70 percent of people in the early stages of the disease had low vitamin D levels. An-other study found people with higher vitamin D levels reduced the risk for Parkinson’s by about one-third.

Q: What can I do to reduce my risk?A: You might not be able to prevent it. But you can schedule an appointment if you or some-one you love has symptoms.

There’s no blood test or medi-cal scan that can detect Parkin-son’s. To diagnose Parkinson’s disease, your doctor may:❯❯ Ask about your family history

and medical history❯❯ Check to see if you have

stiffness in your muscles❯❯ Have you extend your arms

to detect a tremor

Parkinson’s can’t be cured. But treatment can relieve symp-toms. One medicine, levodopa, helps the body create more dopamine. If you get better on levodopa, your doctor will be certain you have Parkinson’s and not a similar disorder.

How much do you know about vitamin d,

which is linked to both diabetes and Parkinson’s disease? Take our quiz on the right to test your knowledge.

spEciAl REpoRt

Quiz: How Deeply Do You Know Vitamin D?

If vitamin D were on trial for preventing or treating diabetes, the jury would still be out. But the evidence is getting stronger.

A study in the American Journal of Clinical Nutrition found people with type 2 diabetes who drank a yogurt beverage forti-fied with vitamin D had better blood glucose control than those who got a plain version. How much do you know about the case for vitamin D? Take this true/false quiz to find out.

Questions1. Vitamin D may play a role in both

type 1 and type 2 diabetes. ❍❯t ❍❯F2. Dairy foods are the only source of vitamin D. ❍❯t ❍❯F3. All Americans get plenty of this nutrient. ❍❯t ❍❯F

Answers1. true. A mother’s vitamin D levels seem linked to her baby’s

risk of developing type 1 diabetes. And people with low vitamin D seem prone to getting pre-diabetes or type 2 diabetes later in life. Getting enough vitamin D may help the insulin-producing cells in our pancreas work properly.

2. False. Your body makes vitamin D when exposed to sunlight. But, limit sun exposure to reduce your risk for skin cancer. Besides milk and yogurt—which also contain bone-building calcium—fatty fish like salmon, egg yolks, and fortified cereals, breads, and juices are sources of vitamin D.

3. False. While doctors say many healthy Americans are getting enough vitamin D, others, especially older adults, aren’t getting enough. If you have diabetes or pre-diabetes, ask your doctor if you should get a vitamin D test. If your levels are low, he or she might recommend supplements.

6 Diabetes Outlook

You’ve been told since childhood that washing your hands keeps germs away. This healthy habit may also help you manage your diabetes.

Clean hands get you the most accurate readings from your glucose meter, accord-ing to two new studies. Here’s the lowdown on scrubbing up.

A Fruity DilemmaYou’re probably used to hitting the sink to wash up before meals. But it might be just as important to wash your hands after you dine, especially if fruit is on the menu.

Peeling oranges, grapes, or kiwis can result in too-high blood glu-cose readings, researchers report in Diabetes Care. And eating fruit held in your hand likely has the same effect. The produce leaves a residue of glucose on your hands. Washing it away with soap and tap water helps make sure it doesn’t interfere with your test results.

Take TwoIn a second study published in the same journal, researchers found that unwashed hands changed glucose meter readings by up to 10 percent.

What if you aren’t able to wash your hands before checking your glucose level? After pricking your finger with the lancet, wipe away the first drop of blood. Then, use the second one for a more accurate reading. However, this method won’t work if your hands are visibly dirty or if you’ve handled fruit.

Why Results MatterYour good health depends in part on how well you monitor your blood glucose. Your health care team can teach you how to use your results to decide when and how much to eat, exercise, and take insulin or other medicines.

In general, your blood glucose should be 70 to 130 mg/dl before meals and less than 180 mg/dl after meals. If dirty hands cause falsely elevated readings, you may take too much insulin. This can cause shakiness, weakness, headache, and other symptoms of low blood glucose.

Antioxidant. These substances are found naturally in foods, especially fruits and vegetables. Antioxidants may help prevent the damage to cells thought to cause some diseases. Vitamins C and E are two common examples of antioxidants. Some antioxidants may help to control blood glucose.

dopamine. This is a natural chemical in the brain that helps control how your body moves. People with Parkinson’s disease do not have enough dopamine. This is why they experience symptoms like tremors and stiffness.

Encephalopathy. This refers to brain disease or damage. Possible causes include bacte-ria, viruses, poor nutrition, and lack of oxygen to the brain. Symptoms can include memory loss and behavior changes. It can also lead to difficulty concentrating and seizures.

thrush. This is a yeast (fungal) infection. It can affect the mouth and tongue, but thrush may affect other parts of the body. White sores grow on the mouth and tongue, and red, shiny, itchy, and cracked patches on the skin. It is not considered abnormal in infants unless it doesn’t clear up within two weeks. There are effective treatments, if necessary. Talk with your doctor.

tERms to KnowHow Clean HandsHelp Manage Diabetes

FAll 2011 | Diabetes Outlook 7

Diabetes doesn’t mean the end of good dining. It’s possible to eat healthy, delicious meals that you and your family will love. Try this sample menu of tasty dishes that fit into your dietary needs.

BreakfastDon’t skip this important meal. Your morning meal can help you wake up, think fast, and keep your blood glucose steady.Meal idea: Split open a whole wheat bran muffin. Top it with a variety of berries and a dollop of low-fat yogurt.Good health benefits: Small but mighty berries are packed with antioxidants, vitamins, and fiber.

LunchHealthy vegetarian diets can help control diabetes, notes the American Diabetes Association. You don’t have to go vegetarian forever—but try some meatless meals.Meal idea: Slice onions, zucchini, spinach, and tomatoes. Cook in a dab of olive oil and balsamic vinegar. Sandwich the vegetables between two slices of whole wheat or rye bread.Good health benefits: Tomatoes contain vitamins C and E and iron. And leafy green spinach is low calorie but nutrient rich.

DinnerWeekday suppers don’t have to be complicated. Low-sodium fro-zen, canned, and jarred foods can make healthy cooking a snap.Meal idea: Cut open a bag of mixed frozen veggies. Stir-fry them in a pan with cooked chicken or seafood. Serve over brown rice or whole-grain noodles.Good health benefits: Whole grains contain the germ and bran of the grain, where many nutrients like fiber are stored.

Delicious Meals that Pack Health Benefits

MyFoodAdvisor offers online meal planning

just for people with diabetes. Go to http: / / tracker.

diabetes.org and click "Your Food Advisor," then log in to get started. Set diet goals, track progress, save recipes, and print shopping lists!

ingredients3 cups water¼ lb. smoked turkey breast, skinless1 tbsp. fresh hot pepper,

chopped¼ tsp. cayenne pepper¼ tsp. cloves, ground2 cloves garlic, crushed½ tsp. thyme1 stalk scallion, chopped1 tsp. ginger, ground¼ cup onion, chopped2 lbs. greens (mustard, turnip,

collard, kale, or a mixture)

directions1. Place all ingredients except

greens into large saucepan and bring to a boil.

2. Prepare greens by washing thoroughly and removing stems.

3. Slice leaves into bite-sized pieces.

4. Add greens to stock. Cook for 20 to 30 minutes until tender.

Each 1-cup serving provides:80 calories, 2 g total fat, less than 1 g saturated fat, 16 mg cholesterol, 378 mg sodium, 4 g total fiber, 9 g protein, 9 g carbohydrates, 472 mg potassium

Source: National Institutes of Health

Smothered GreensServes 5

“ the healthIer I ge t, the be t ter I feel.” | fall 2011

3 | Healthy Highlight 5 | Do You Know Vitamin D? 7 | Recipe: Smothered Greens

insidE tHis issuE

An Orange or Orange Juice?Should you eat an orange or drink a cup of orange juice? Both choices contain a day’s dose of vitamin C. No matter what your age, the orange has these added benefits:

An average-sized orange has

about half as many calories as a

cup of orange juice. And drinking

too much juice can cause cavities.

the orange offers more than 6 times as much healthy fiber.

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