diabetes- are you a victim bookbing.org

8/9/2019 Diabetes- Are You A Victim BookBing.Org

1/146

Take Chargeof Your

DIABETES

U.S. DEPARTMENT OF HEALTH

AND HUMAN SERVICES

Centers for Disease Control and Prevention

National Center for Chronic Disease

Prevention and Health Promotion Diabetes

TM


2/146

This book belongs to

_____________________________________________

If found, please call or write me at

_____________________________________________

_____________________________________________

_____________________________________________

_____________________________________________


3/146


4/146

The Centers or Disease Control and Preventions (CDCs)

Diabetes Program supports diabetes control programs in all

states, the District o Columbia, and eight U.S. territories orisland jurisdictions. You may contact your local program or

more inormation on diabetes.

To get contact inormation,

call toll ree 1-800-CDC-INFO (232-4636),

E-mail [email protected]. Inormation available in English,

and Spanish 24 Hours/Day, 7 Days/Week.

This book is in the public domain. Anyone may reproduce anyor all o the contents. It is also available on the Internet at

www.cdc.gov/diabetes, or you can call toll ree

1-877-CDC-INFO (232-4636) or more inormation or a copy

o this book and others. This book is also available

in Spanish.

Links or reerences to nonederal organizations mentioned in

this book or in the resource list are provided solely as a

service to our users. These links and reerences do not

constitute an endorsement o these organizations or theirprograms by CDC or the ederal government, and none

should be inerred. CDC is not responsible or the content o

the individual organization Web pages ound at these links.


5/146

Many o us strive or a sense o balance in our

lives. We want to keep our goals in harmony with

our minds and souls. People with diabetes oten

have stories to share about their struggles orbalance and harmony in their lives. We can honor

people by listening to and learning rom their stories

to fnd meaning and hope or our own lives.

An old, well-loved story, told around the world,

is about the turtle and a sure-ooted animal, like

a rabbit. In this story, the turtle tricks the other

animal to win a racesimply by not giving up andby staying on its path. And it has to stick its neck

out! It takes determination like that to ace diabetes,

day ater day, reminding yoursel that you can

do it i you stick to it!

There are about 250 kinds o turtles, and almost

all have the same pattern on their top shell13

plates that ft together in harmony and balanceto orm a strong shell. The turtle and its shell can

remind us o the harmony and balance we seek in all

parts o our livesincluding living with diabetes.


6/146


7/146

Some Words o Thanks . . . . . . . . . . . . . . . . . . . . . . vii

1 Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Controlling Your Diabetes . . . . . . . . . . . . . . . . 13

3 Keeping Track o Your Blood Glucose . . . . . . . 21

4 Feelings About Having Diabetes . . . . . . . . . . . 41

5 Eye Problems . . . . . . . . . . . . . . . . . . . . . . . . . . 43

6 Kidney Problems. . . . . . . . . . . . . . . . . . . . . . . . 47

7 Heart and Blood Vessel Problems . . . . . . . . . . 51

8 Nerve Damage. . . . . . . . . . . . . . . . . . . . . . . . . . 55

9 Foot Problems . . . . . . . . . . . . . . . . . . . . . . . . . . 59

10 Dental Disease . . . . . . . . . . . . . . . . . . . . . . . . . 65

11 Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

12 Pregnancy and Womens Health . . . . . . . . . . . 73

RECORDS

Records or Sick Days . . . . . . . . . . . . . . . . . . . . 79

Tests and Goals or Each Visit . . . . . . . . . . . . . 89

Tests and Goals or Each Year . . . . . . . . . . . . . 99Glucose Log Sheets . . . . . . . . . . . . . . . . . . . . . 105

Your Health Care Team . . . . . . . . . . . . . . . . . 109

GLOSSARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117

RESOURCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127


8/146


9/146

This guide was written by sta in the Centers or

Disease Control and Preventions (CDCs) Division

o Diabetes Translation. The division is part o the

National Center or Chronic Disease Prevention

and Health Promotion, Department o Health and

Human Services. We work with partners who share

our mission to reduce the burden o diabetes in

communities.

William H. Herman, MD, MPH, was the general

editor o the frst book, Take Charge o Your

Diabetes: A Guide or Care, printed in 1991. We

asked people with diabetes who read the frst book

to help us make the second book even more useul.

For this ourth edition o the book, we have updated

the scientifc acts, resources, and art.

The American Association o Diabetes Educators

did a survey among people with diabetes and

diabetes educators to learn what people liked and

didnt like about the frst book. Focus groups made

up o people with diabetes were held by the Health

Promotion Council o SE Pennsylvania and Casals

and Associates o Washington, DC. The groups gave

us valuable input to help us make later books more

useul.


10/146

Important support or this books emphasis on

glucose control came rom the Diabetes Control

and Complications Trial. Conducted by the

National Institute o Diabetes and Digestive andKidney Diseases, National Institutes o Health,

this important study provided scientifc proo

that glucose control can help prevent or delay

complications o diabetes.

Dawn Satterfeld, PhD, RN, CDE and Patricia

Mitchell o the CDC diabetes divisions Health

Communications Section were the lead writerso this book. Ann Constance, Claudia Martinez,

Hope Woodward, Margaret Fowke, Nancy Haynie-

Mooney, Melinda Salmon, Mike Engelgau, and the

Chattahoochee Nature Center also helped with the

writing. Rick Hull, Diana Toomer, Melissa Stankus,

and Kristina Ernst reviewed and edited the fnal

version o this guide. Most o the drawings were

provided by the Public Health Practice ProgramOfce, CDC, some o which were modifed or the

book Take Charge o Your Diabetes: A Shortened

Overview or Pacifc Basin Island Populations

through the National Diabetes Education Program.

Cygnus Corporation assisted with design and layout

o the second edition. Further publication support

or the third edition was provided by Palladian

Partners, Inc., under Contract 200-98-0415 or theNational Center or Chronic Disease Prevention and

Health Promotion, CDC, Department o Health and

Human Services.


11/146

Diabetes touches almostevery part o your lie.

Its a serious, lielong

condition, but theres a

lot you can do to protect

your health. You can

take charge o your

healthnot only

or today, but or thecoming years.

Diabetes can cause

health problems over time. It can hurt your eyes,

your kidneys, and your nerves. It can lead to

problems with the blood ow in your body. Even

your teeth and gums can be harmed. Diabetes

in pregnancy can cause special problems. Manyo these problems dont have to happen. You can

do a lot to prevent them, and there are people in

your community who can help. This book can help

you fnd how to get the help you need to prevent

problems.

Today and every day, strive to balance your ood,

physical activity, and medicine. Test your own bloodglucose (also called blood sugar) to see how this

balance is working out. Then make choices that help

you eel well every day to protect your health.


12/146

Feeling healthy can allow you to play a big part in

the lie o your amily and community. You may even

want to join a community group in which people

share their stories and help others deal with theirdiabetes.


13/146

Take Charge of Your Diabetes was written to

help you take important steps to prevent problems

caused by diabetes. Youll learn many useul things:

What problems diabetes can cause.

How to work with a health care team to prevent

problems.

Why it is important to get your blood glucose

and blood pressure closer to normal.

How to fnd out about resources in yourcommunity to help you prevent problems.

Its important to work with a primary health care

provider, as well as other members o a team who


14/146

care about your health. To fnd out about resources

in your community, contact one o the groups listed

below:

Diabetes organizations, listed on pages

127129 o this book.

Local diabetes programs or hospitals.

Your state health departments diabetes

prevention and control program, which you can

fnd by calling 800-CDC-INFO.

Ask your health care team to look over this book

with you. Stay in touch with them so you will know

the latest news about diabetes care.

Balance is the key word in living well with diabetes.

Strive or balance in all parts o your lie. With the

support o your amily and riends, your health care

team, and your community, you can take charge o

your diabetes.


15/146

This book was mainly written or people who

ound out they had diabetes as an adult. You shoulduse it along with other inormation your health care

providers give you.

I youve just learned you have diabetes, youll

need more details than youll fnd in this book.

Ask your health care provider or help. See the

list beginning on page 127 or phone numbers,

addresses, and web sites o organizations whereyou can get more inormation. Find out as much as

you can about the three most important things or

controlling your diabetes: ood, physical activity, and

diabetes medicine.


16/146

When youre reading this book, note these points:

Words in bold print are explained in theglossary, which starts on page 117.

The orms at the back o this book can help you

and your health care team keep records o your

care.

On pages 127129, youll fnd a list o health

organizations that you can call, write, or

E-mail or more inormation about diabetes.

When we say health care team, we include all

the people who work with you to help manage

your diabetes: primary doctor, dietitian, nurse,

diabetes educator, counselor, oot doctor, eye

doctor, dentist, pharmacist, community health

worker, and others.

The chapters in this book deal with many

topics. You may frst want to read the parts that

deal with your own special concerns. Take your

time reading this book. Theres a lot to read, but

you dont have to read it all at once.


17/146

You can use this book to keep some records about

your health. The orms to write down details aboutyour health begin on page 79. You can cut out these

pages to take with you on your diabetes care visits.

You may also want to make extra copies to use in the

uture. Go over these records oten with your health

care team. Keeping track o your health is one o the

ways you can work together to control your diabetes.

On page 109, write down the names and telephonenumbers o your health care team. Theres enough

room on these pages to write questions and other

points you want to remember when you go to your

visits every 4 to 6 months. On page 116, you may

want to write down some contacts or community

groups that deal with diabetes.

Dr. B. Harper222-222-2222

What was my last A1C result?

When is my next eye exam due?

Aim for glucose 90-130 before eating. Less 180 1-2 hours after beginning to eat. Check my feet every day.


18/146

Most o the ood we eat is turned into glucose

(sugar) or our bodies to use or energy. Thepancreas, an organ near the stomach, makes ahormone called insulin to help glucose get intoour body cells. When you have diabetes, your bodyeither doesnt make enough insulin or cant use its

own insulin very well. This problem causes glucose

to build up in your blood.

Diabetes means that a persons blood sugar is toohigh. Your blood always has some sugar in it be-

cause the body needs sugar or energy to keep you

going. But too much sugar in the blood can cause

serious damage to the eyes, kidneys, nerves, and

heart.

You may recall having some o these signs beore

you ound out you had diabetes:

Being very thirsty.

Urinating a lototen at night.

Having blurry vision rom time to time.

Feeling very tired much o the time.

Losing weight without trying.

Having very dry skin.

Having sores that are slow to heal.


19/146

Getting more inections than usual.

Losing eeling or getting a tingling eeling in

the eet.

Vomiting.

There are two main types o diabetes:

Type 1.

Type 2.

Another type o diabetes appears during

pregnancy in some women. Its called gestationaldiabetes. See page 75 to learn more about this typeo diabetes.

One out o 10 people with diabetes has type 1

diabetes. These people usually fnd out they have

diabetes when they are children or young adults.

People with type 1 diabetes must inject insulinevery day to live. The pancreas o a person with

type 1 makes little or no insulin. Scientists are

learning more about what causes the body to attack

its own beta cells o the pancreas (an autoimmuneprocess) and stop making insulin in people withcertain sets o genes.


20/146

Most people with diabetes9 out o 10havetype 2 diabetes. The pancreas o people with type 2

diabetes keeps making insulin or some time, but

the body cant use it very well. Most people with

type 2 fnd out about their diabetes ater age 30

or 40.

Certain risk actors make people more likely to

develop type 2 diabetes. Some o these are

A amily history o diabetes.

Lack o exercise.

Weighing too much.

Being o Arican American, American Indian,

Alaska Native, Hispanic/Latino, or Asian/PacifcIslander heritage.

Gestational diabetes history.


21/146

You can help manage your diabetes by controlling

your weight, making healthy ood choices, and

getting regular physical activity. Ask or help rom

your health care team. Some people with type 2diabetes may also need to take diabetes pills orinsulin shots to help control their diabetes.

Some people with diabetes are concerned about

their amily members getting diabetes. A national

study shows that people may be able to prevent or

delay the onset o type 2 diabetes. To fnd out more,

talk to your health care provider, visit the CDCDiabetes Web site at www.cdc.gov/diabetes, or call

1-877-CDC-INFO.


22/146


23/146

Theres good news or people with diabetes.Studies show that keeping your blood glucose (alsocalled blood sugar) close to normal helps preventor delay some diabetes problems.

Through careul control, many problems such as

eye disease, kidney disease, heart disease, nerve

damage, and serious oot problems can be prevented

or slowed. People who have type 1 diabetes as wellas people who have type 2 diabetes can beneft bykeeping their blood glucose levels closer to normal.

You can learn more about diabetes and ways to

help you control your blood sugar by calling the

National Diabetes Education Program (NDEP) at

1-800-438-5383.


24/146

As the turtle makes steady progress, so too must

those with diabetes continue to maintain healthy

liestyles and stick to daily routines that involve

regular exercise, good nutrition, glucose monitoring,

and regular visits to health care providers.

To keep your glucose at a healthy level, you need

to keep a balance between three important things:

What you eat and drink.

How much physical activity you do.

What diabetes medicine you take (i your doctor

has prescribed diabetes pills or insulin).

This book gives you only some o the acts you

need. Your health care team can give you more.

Here are some tips or making healthy eating

choices:

Eat regular meals. Ask your health care team

to help you choose a meal plan. Your dietitianmay suggest you eat three meals and a snack or

two every day at about the same times. Eating

every 4 to 5 hours can help control blood sugar.


25/146

Eat a variety of foods. Choose a variety o oods

to eat so that your body gets the nutrition it

Eat less fat. Avoid ried oods. Foods that are

baked, broiled, grilled, boiled, or steamed are

more healthy to eat. Eat meats that have little

at. When you eat dairy products (cheese, milk,

yogurt, and others), choose those that have

little or no at or cream.

Eat less sugar. You may fnd that eating less

sugar helps you control your blood glucose level.Here are some things you can do to eat less

sugar:

Eat more high-fber oods, like vegetables,

dried beans, ruit, and whole grain breads

and cereals.


26/146

Drink water and other drinks that have no

added sugar.

Eat ewer oods that have extra sugar, such

as cookies, cakes, pastries, candy, brownies,

and sugared breakast cereals.

Talk with your health care team about ways

to sweeten ood and drinks without using

sugar.

See pages 2832 or more on ways to prevent

problems when your blood glucose levels are too

high or too low.

Eat less salt. Eating less salt may help control

your blood pressure. Here are some ways to eat

less salt:

Use less salt when you prepare oods.

Cut down on processed oods, such as oods


27/146

you buy in cans and jars, pickled oods, lunch

meats (cold cuts), and snack oods, such as

chips.

Taste your ood frst beore adding salt. You

may not need to add any.

Use herbs and spices instead o salt to avor

your ood.

A word about drinking alcohol:Alcohol can

cause health problems, especially or peoplewith diabetes. It adds calories and doesnt give

your body any nutrition. Drinking alcohol may

cause dangerous reactions with medicines you

take. Your blood glucose can go down too low

i you drink beer, wine, or liquor on an empty

stomach. I you want to include a drink in your

ood plan once in a while, ask your health care

team how to do so saely.

Its important to be active. Physical activity

has many benefts. It can help you control your

blood glucose and your weight. Physical activity


28/146

can help prevent heart and blood ow problems.

Many people say they eel better when they get

regular exercise.

Start with a little. I you havent been doing

any physical activity, talk to your health care

team beore you begin. Walking, working in the

yard, and dancing are good ways to start. As

you become stronger, you can add a ew extra

minutes to your physical activity. I you eel

pain, slow down or stop and wait until it goes

away. I the pain comes back, talk with your

health care team right away.

Do some physical activity

every day. Its better to walk

10 or 20 minutes each day

than one hour once a week.

Choose an activity you enjoy.

Do an activity you really like.The more un it is, the more

likely you will do it each day.

Its also good to exercise with

a amily member or riend.


29/146

I youre already active now, but want to become

more active, talk to your health care team about a

sae exercise plan.

I you take diabetes pills or insulin injections to

control your diabetes, ask your health care provider

to explain how these work. Its important to know

how and when to take diabetes medicine. I you

take other medicines that are sold with or without

a prescription, ask your doctor how these can

aect your diabetes control. When you take insulin

injections or diabetes pills, your blood glucose levels

can get too low. See pages 2832 or how to prevent

levels that are too low or too high.

I you inject insulin, your health care team should

be able to tell you:

How to give yoursel injections.

When you need to change your insulin dose.


30/146


31/146

Its important to

your health to control

your blood glucose(also called bloodsugar). Keeping yourglucose level close to

normal helps prevent

or delay some diabetesproblems, such as

eye disease, kidney

disease, and nerve damage. One thing that can help

you control your glucose level is to keep track o it.

You can do this by:

Checking your own glucose a number o times

each day (sel-monitoring blood glucose).Many people with diabetes check their glucose

2 to 4 times a day.

Getting anA1C test rom your health careprovider about every 3 months.

Youll learn more about these tests on the next

pages. These tests can help you and the rest oyour diabetes health care teamdoctor, diabetes

educator, and otherswork together to help you

control your blood glucose.


32/146

You can do a test to fnd out what your blood

glucose is at any moment. Your health care team canshow you how to do the test yoursel. Using a fnger

prick, you place a drop o blood on a special coated

strip, which reads your blood glucose. Many people

use an electronic meter to get this reading.

Blood glucose testing can help you understand

how ood, physical activity, and diabetes medicine

aect your glucose levels. Testing can help you

make day-to-day choices about how to balance these

things. It can also tell you when your glucose is too

low or too high so that you can treat these problems.

Ask your health care team to help you set a goalor your glucose range and show you how to record

your glucose readings in a logbook or record sheet.

I you need a daily logbook, ask your health care

provider or one. Or you can make copies o page


33/146

108 i you take insulin or page 106 i you dont take

insulin. A sample log sheet is flled out to show you

how to use each.

Be sure to write down

each glucose reading and

the date and time you

took it. When you review

your records, you can see

a pattern o your recent

glucose control. Keeping

track o your glucose on aday-to-day basis is one o

the best ways you can take

charge o your diabetes.

By perorming an A1C test, health providescan sum up your diabetes control or the past ew

months. An A1C test measures how much glucose

has been sticking to your red blood cells. Since

each red blood cell is replaced by a new one every

3 to 4 months, this test tells you how high the

glucose levels have been during the lie o the cells.

I most o your recent blood glucose readings havebeen near normal (70 to 140 milligrams per deciliter

or mg/dL, with the higher reading mainly ater

meals), the A1C test will be near normal (usually

about 6%7%). I youve had many readings above

normal, the extra glucose sticking to your red blood

cells will make your A1C test read higher.


34/146

You should get an A1C test every 3 months i your

test results are not yet at goal. You should get an

AIC test at least 2 times a year i your AIC results

are at goal. Ask your health care provider or theresults and record them on page 91.

Ask your team to tell you the normal range o

values and help you set a goal or yoursel. Write

your goal down on page 91 o this guide.

I your A1C test results

are high, work with

your team to adjustyour balance o ood,

physical activity, and

diabetes medicine.

When your A1C test

result is near your

goal, youll know youve

balanced things well.

In general, a blood glucose reading lower than 70

mg/dL is too low. I you take insulin or diabetespills, you can have low blood glucose (also calledhypoglycemia). Low blood glucose is usually

caused by eating less or later than usual, beingmore active than usual, or taking too much diabetes

medicine. Drinking beer, wine, or liquor may also

cause low blood glucose or make it worse.


35/146

Low blood glucose happens

more oten when youre

trying to keep your glucose

level near normal. This isno reason to stop trying to

control your diabetes. It just

means you have to watch

more careully or low levels.

Talk this over with your

health care team.

Some possible signs o low

blood glucose are eeling

nervous, shaky, or sweaty.

Sometimes people just eel

tired.

The signs may be mild atfrst. But a low glucose level

can quickly drop much lower

i you dont treat it. When

your glucose level is very

low, you may get conused,

pass out, or have seizures.

I you have any signs thatyour glucose may be low, test

it right away. If its less than

60 to 70 mg/dL, you need

to treat it right away. See

below or ways to treat low

blood glucose.


36/146

I you eel like your blood glucose is getting

too low but you cant test it right then, play itsaego ahead and treat it. Eat 10 to 15 grams o

carbohydrate right away. See the box below orexamples o oods and liquids with this amount o

carbohydrate.

Check your blood glucose again in 15 minutes.

Eat another 10 to 15 grams of carbohydrate every

15 minutes until your blood glucose is above 70 mg/dL.

Eating or drinking an item rom the list on this

page will keep your glucose up or only about

30 minutes. So i your next planned meal or snack


37/146

is more than 30 minutes away, you should go ahead

and eat a small snack, something like crackers and

a tablespoon o peanut butter.

In your glucose logbook or record sheet, write

down the numbers and the times when low levels

happen. Think about what may be causing them. I

you think you know the reason, write it

beside the numbers you recorded. You

may need to call your health care

provider to talk about changing

your diet, activity, or diabetes

medicine.

Tell amily members,

close riends, teachers, and

people at work that you

have diabetes. Tell them

how to know when your

blood glucose is low. Show

them what to do i you cant

treat yoursel. Someone will

need to give you ruit juice,

soda pop (not diet), or sugar.

I you cant swallow, someone will need to give you

a shot oglucagon and call or help. Glucagon is aprescription medicine that raises the blood glucose

and is injected like insulin. I you take insulin, youshould have a glucagon kit handy. Teach amily

members, roommates, and riends when and how to

use it.


38/146

Waiting to treat low

blood glucose is not

sae. You may be in

danger o passing out.I you get conused,

pass out, or have a

seizure, you need

emergency help. Dont

try to drive yoursel to

get help. Be prepared

or an emergency.

Try to stay close to your usual schedule o eating,

activity, and medicine. I youre late getting a meal

or i youre more active than usual, you may need

an extra snack. See page 37 or more ideas aboutmanaging your diabetes.

Keeping track o your blood glucose is a good way

to know when it tends to run low. Show your logbook

or record sheet to your health care providers. Be

sure to let them know i youre having a number olow blood glucose readings a week.


39/146

To be sae, always check your blood glucose beore

doing any o these things:

Driving a vehicle. Using heavy equipment.

Being very physically active.

Being active or a long time.

Ask your health care team whether you should

check your glucose beore (or during) any other

activities. Write these in the space below.

Always carry some

type o carbohydrate

sugar ood or drink with

you so youll be ready at

any time to treat a low

glucose level. See the list

on page 26 or snacks

that have 15 grams o

carbohydrate.


40/146

Always wear something (like an identifcation

bracelet) that says you have diabetes. Carry a card

in your wallet that says you have diabetes and tells

i you use medicine to treat it.

For most people, blood glucose levels that stay

higher than 140 mg/dL (beore meals) are too high.Talk with your health care team about the glucose

range that is best or you.

Eating too much ood, being less active than

usual, or taking too little diabetes medicine are

some common reasons or high blood glucose (orhyperglycemia). Your blood glucose can also go up

when youre sick or under stress.

Over time, high blood glucose can damage body

organs. For this reason, many people with diabetes

try to keep their blood glucose in balance as much as

they can.


41/146

Some people withtype 2 diabetes may not eel thesigns o high blood glucose until their blood glucose

is higher than 300. People with blood glucose higher

than 300 are more likely to have dehydration.Dehydration can become a serious problem i nottreated right away.

Your blood glucose is more likely to go up when

youre sickor example, when you have the u

or an inection. Youll need to take special care o

yoursel during these times. The guide that begins

on page 33 can help you do this.

Some common signs o high blood glucose are

having a dry mouth, being thirsty, and urinating

oten. Other signs

include eeling tired,

having blurred vision,

and losing weight

without trying. I your

glucose is very high, you

may have stomach pain,

eel sick to your stomach,

or even throw up. This

is an emergency and you

need to go to the hospital

right away.

I you have any signs that your blood glucose is

high, check your blood. In your logbook or on your

record sheet, write down your glucose reading and


42/146

the time you did the test. I your glucose is high,

think about what could have caused it to go up. I

you think you know o something, write this down

beside your glucose reading.

Try to stay with

your ood and activityplan as much as you

can. Drink water.

Take your diabetes

medicine about the

same time each day.

Work with your

health care team to

set goals or weight,blood glucose level,

and activity.

Keep track o your blood glucose and go over

your records oten. Youll learn how certain oods or

activities aect your glucose.

Show your records to your health care team.

Ask how you can change your ood, activity, and

medicine to avoid or treat high blood glucose.

Ask when you should call or help.


43/146

Be sure to keep taking your diabetes pills or

insulin. Dont stop taking them even i you cant eat.

Your health care provider may even advise you to

take more insulin during sickness.

Try to eat the same amount o ruits and breads

as usual. I you can, eat your regular diet. I youre

having trouble doing this, use carbohydrate

choices or servings: eat enough sot oods or drinkenough liquids to take the place o the ruits and

breads you usually eat.


44/146


45/146

Drink extra liquids. Try to drink

at least1

/2 cup (4 ounces) to3

/4 cup(6 ounces) every hal-hour to hour,

even i you have to do this in small

sips. These liquids should not have

calories. Water, diet soda pop, or tea

without sugar are good choices.

Weigh yoursel every day. Losing weight

without trying is a sign o high blood glucose.

Check your temperature every morning and

evening. A ever may be a sign o inection.

Every 4 to 6 hours, check how youre breathing

and decide how alert you eel. Having trouble

breathing, eeling more sleepy than usual, ornot thinking clearly can be danger signs.

Use the Records or Sick Days, starting on page

79. Ask a amily member or riend to help i you

need it.


46/146

Ask your health

care provider whenyou should call.

During your sick

times, you may need

to call every day or

advice.

You should call your

health care provideror

go to an emergency

room i any o the

ollowing happens:

You eel too sick to eat normally and or more

than 6 hours cant keep ood or liquids down.

You have severe diarrhea (loose bowel movement).

You lose 5 pounds or more without trying to.

Your temperature is over 101F.

Your blood glucose level is lower than 60 mg/dL

or stays over 300 mg/dL.

Youre having trouble breathing.

You eel sleepy or cant think clearly.


47/146

Staying in charge o your diabetes no matter whatyour day holdswork, school, travel, or special

eventstakes planning ahead. Many days will go

smoothly, but some days will hold surprises, such as

extra activity or delays that throw your schedule o.

Plan ahead or these times by always keeping a

treatment orlow blood glucosewith you (see page

26 or some choices). I you have any signs that your

glucose may be low (see page 25), go ahead and treat

it right away.

Stay as close to your eating, activity, and medicine

schedule as you can. Keep track o your blood

glucose so you can pick up changes early. Always


48/146

wear or carry identifcation that says you have

diabetes.

Talk with your health care team about yourplanned schedule and activities. Ask or help in

planning ahead or work, school, travel, and special

events. When you read the rest o this section, you

may think o more questions to ask.

Talk with your healthcare team about the type o

activity you do at work or at

school. From time to time,

you and your health care

team may need to make

changes in your activity,

medicine, or eating.

Many people take supplies

or checking their glucose

to school or work so they

can check i at regular

break times. Some people

choose to show their ellow

workers, their teachers, or their classmates how to

help i they should ever have a problem. They teachthem how to tell when their glucose is low and how

to treat it (see pages 2528). Some people like to

have written steps on fle at their place o work or

with their teacher.


49/146

When you plana trip, think about

your day-to-day

schedule and try

to stay as close to

it as you can. For

example, i you

usually check your blood glucose at noon and then

eat lunch, plan to do this on your trip, as well. Tripscan hold surprisesin delays and changes. Even the

types o ood and supplies you can buy on your trip

may not be the same as those you get at home.

Beore you travel, work with your health care

provider to plan your timing or medicine, ood, and

activity. Talk about what to do i you fnd changes in

your glucose readings.

Plan ahead or trips:

Keep snacks with you that could be used to

preventor treatlow blood glucose.

Carry extra ood and drink supplies with you,

such as cracker packs and small cans o juices

or bottled water. Carry blood glucose testing supplies with you.

Take along all the diabetes medicine youll

need. Keep medicines in the original pharmacy

container with the printed label that clearly

identifes the medicine.


50/146

When you travel, be sure to

Test your blood glucose often and keep track of it.

Wear identifcation that says you have diabetes.

Let others know how they can help you.

Check new airline travel tips by contacting the

I youre traveling in a dierent time zone, youmay need to change your timing o ood, medicine,

and activity. Ask your health care provider to help

you with this. Talk about the ood and drink choices

that would be healthy or you. I youll be in another

country, ask your doctor to write a letter explaining

that you have diabetes. Its also a good idea to get

your doctor to write a prescription or you to get

insulin or supplies i needed.

Federal Aviation Administration (FAA) athttp://www.aa.gov or 800-322-7873.


51/146

Living with diabetes isnt easy. Its normal to eel

troubled about it. Tell your health care team how

you eel. Point out any problems you have with your

diabetes care plan. Your diabetes educator or other

health care provider may be able to help you think

o ways to deal with these problems.

Talk about the stresses you eel at home, school,and work. How do you cope with these pressures? I

your eelings are getting in the way o taking care o

yoursel, you need to ask or help.


52/146

It helps to talk with other people who have

problems like your own. You may want to think

about joining a diabetes support group. In supportgroups, people who have just ound out they have

diabetes can learn rom people who have lived with

it or a long time. People can talk about and share

how they deal with their diabetes. They can also talk

about how they take care o their health, how they

prepare ood, and how they get physical activity.

Family members who do not have diabetes may want

to join a support group, too. Ask your health care

team about support groups or people with diabetes

and their amilies and riends.

I there is

not a support

group in

your area,

you may

want to call

a diabetes

organization

(see the list

on pages

127129)

about start-

ing a group.

One-on-one and amily counseling sessions may

also help. Be sure to see a counselor who knows

about diabetes and its care. Ask your health care

provider to help you fnd a counselor.


53/146

Diabetic eye disease (also called diabetic

retinopathy) is a serious problem that can leadto loss o sight. Theres a lot you can do to take

charge and prevent such problems. Research shows

that keeping your blood glucose level closer tonormal can prevent or delay the onset o diabetic eye

disease. Keeping your blood pressure under control

is also important. Finding and treating eye problems

early can help save sight.

Since diabetic

eye disease may

be developing

even when your

sight is good,

regular dilatedeye exams are

important or

fnding problems

early. Some

people may

notice signs o

vision changes.

I youre havingtrouble reading, i

your vision is blurred, or i youre seeing rings

around lights, dark spots, or ashing lights, you may

have eye problems. Be sure to tell your health care

team or eye doctor about any eye problems you may

have.


54/146

High blood glucose can damage your eyes astime goes by. Work with your health care team to

keep your blood glucose levels in the target range.

High blood pressure can damage your eyes.

Have your health care provider check your bloodpressure at least 4 times a year. I your bloodpressure is higher than 130/80, ask your health

care provider how to keep your blood pressure at a

healthy level. You may need medicine to keep your

blood pressure at a healthy level.


55/146

Even i youreseeing fne, you need

regular, complete

dilated eye examsto protect your sight.

Ask your health care

provider to help you

fnd an eye doctor

who cares or peoplewith diabetes. Beore

the exam, a doctor or nurse will put drops in your

eyes to dilate the pupils.

You should have your eyes dilated and examinedat least once a year. Keep track o these exams by

using the record sheets starting on page 101. Even i

youve lost your sight romdiabetic eye disease, youstill need to have regular eye care. I you haventalready had a complete eye exam, you should have

one now i any o these conditions apply to you:

Youve had type 1 diabetes or 5 or moreyears.

You have type 2 diabetes.

Youre going through puberty and you have

diabetes.

Youre pregnant and you have diabetes.

Youre planning to become pregnant and you

have diabetes.


56/146

I you cant aord an eye

exam, ask about a payment

plan or a ree exam. I youre

65 or older, Medicare may payor diabetic eye exams (but

not glasses). Ask your eye

doctor to accept the Medicare

ee as ull payment.

I you have diabetic eye

disease, talk with your health

care provider about the kind

o physical activity that is

best or you.

Treating eye problems early can help save

sight. Laser surgery may help people who haveadvanced diabetic eye disease. An operation called

a vitrectomy may help those who have lost theirsight rom bleeding in the back o the eye.

I your sight is poor, an eye doctor who is an expertin low vision may be able to give you glasses or other

devices that can help you use your limited vision

more ully. You may want to ask your health care

provider about support groups and job training or

people with poor vision.


57/146

Diabetes can cause diabetic kidney disease

(also called diabetic nephropathy), which canlead to kidney ailure. Theres a lot you can do to

take charge and prevent kidney problems. A recent

study shows that controlling your blood glucosecan prevent or delay the onset o kidney disease.

Keeping your blood pressure under control is also

important.

The kidneys keep the right amount o water inthe body and help flter out harmul wastes. These

wastes, called urea, then pass rom the body inthe urine. Diabetes can cause kidney disease by

damaging the parts o the kidneys that flter out

wastes. When the kidneys ail, a person has to

have his or her blood fltered through a machine (a

treatment called dialysis) several times a week or

has to get a kidney transplant.


58/146

Your health care provider can learn how well your

kidneys are working by testing or microalbumin

(a protein) in the urine. Microalbumin in the urineis an early sign o diabetic kidney disease. You

should have your

urine checked or

microalbumin

every year.

Your health care

provider can also doa yearly blood test to

measure your kidney

unction. I the tests

show microalbumin

in the urine or i your

kidney unction isnt

normal, youll need to

be checked more oten.

Starting on page 101, write down the dates and

the results o these tests. Ask your health care

provider to explain what the results mean.

High blood glucose can damage your kidneysas time goes by. Work with your health care team to

keep your glucose levels as close to normal as you

can.


59/146

High blood pressure (or hypertension) can

damage your kidneys.You may want to check

your blood pressureat home to be sure it

stays lower than 130/80.

Have your health care

provider check your

blood pressure at least

4 times a year. Yourdoctor may have you

take a blood pressure

pill, called anACE

inhibitor, to help

protect your kidneys.

Maintain a healthy weight.

Be acive every day.

Eat ewer oods high in salt and sodium.

Eat more ruits and vegetables, whole grainbreads and cereals, and lowat dairy products.

2. Take your medicine the way your doctor tells you.

3. Have your blood pressure checked oten.


60/146

Call your health care provider right away i you

have any o these signs o kidney inections:

Back pain.

Chills.

Fever.

Ketones in the urine.

Your health care provider will test your urine.

I you have a bladder or kidney inection, youll be

given medicine to stop the inection. Ater you take

all the medicine, have your urine checked again to

be sure the inection is gone.

I you have kidney disease, ask your health

care provider about the possible eects that some

medicines and X-ray dyes can have on your kidneys.


61/146

Heart and blood vessel problems are the main

causes o sickness and death among people with

diabetes. These problems can lead to high bloodpressure, heart attacks, and strokes. Heart andblood vessel problems can also cause poor circulation

(blood ow) in the legs and eet.

Youre more likely to have heartand blood vessel problems i

you smoke cigarettes, have high

blood pressure, or have too much

cholesterol or other ats in yourblood. Talk with your health care

team about what you can do to

lower your risk or heart and blood

vessel problems. Ask about takinga daily aspirin to help prevent

heart and blood vessel problems.

I you eel dizzy, have sudden loss o sight, slur

your speech, or eel numb or weak in one arm or leg,

you may be having serious heart and blood vessel


62/146

problems. Your blood may not be getting to your

brain as well as it should.

Danger signs o circulation problems to the heartinclude chest pain or pressure, shortness o breath,

swollen ankles, or irregular heartbeats. I you have

any o these signs, go to an emergency room or call

your health care provider right away.

Signs o circulation problems to your legs are

pain or cramping in your buttocks, thighs, or calves

during physical activity. Even i this pain goes awaywith rest, report it to your health care provider.

Choose a healthydiet, low in salt. Work

with a dietitian to plan

healthy meals. I youre

overweight, talk about

how to saely lose weight.

Ask about a physical

activity or exercise

program or you. See pages1418 to read more about

healthy choices or ood

and physical activity.


63/146

Smoking cigarettes causes hundreds o thousands

o deaths each year. When you have diabetes andalso use tobacco, the risk o heart and blood vessel

problems is even greater. One o the best choices you

can make or your health is to

never start smokingor i you

smoke, to quit.

At least once a year, your

health care provider will askyou about tobacco use. I you

smoke, talk to your provider

about ways to help you stop.

Get your blood pressure

checked at each visit. Record these numbers onthe record sheets starting on page 91. I your blood

pressure is higher than 130/80, ask what steps to

take to reach your goal.

I your blood pressure is still high ater 3 months,

you may need medicine to help control it. Many

medicines are available to treat high blood pressure.

I you have side eects rom the medicine, ask yourhealth care provider to change it. Talk to your

health care team about whether you need medicine

to take charge o your blood pressure.


64/146

Get your cholesterol

checked once a year. Record

the results on page 101.

Your total cholesterol should

be lower than 200 mg/dL

(milligrams per deciliter).

Ask your health care team

to explain what your HDLand LDL levels are.

I your cholesterol ishigher than 200 mg/dL on two or more checks, you

can do several things to lower it. You can work

with your health care team to improve your bloodglucose control, you can lose weight (i youreoverweight), and you can cut down on oods that

are high in at and cholesterol. Ask your health care

team about oods that are low in ats. Also ask about

a physical activity program.

Ask your health care provider what steps to take

to reach your LDL cholesterol goal. You may need a

medicine to help control it. Ask i you need aspirin

to prevent heart attack or stroke.

I youre having heart and blood circulation

problems, an EKG may help you and your healthcare provider know i you need to change your

treatment.


65/146

Diabetic nerve damage (also called diabetic

neuropathy) is a problem or many people withdiabetes. Over time, high blood glucose levelsdamage the delicate coating o nerves. This damage

can cause many problems, such as pain in your eet.

Theres a lot you can do to take charge and prevent

nerve damage. A recent study shows that controlling

your blood glucose can help prevent or delaythese problems. Controlling your blood glucose may

also help reduce the pain rom some types o nervedamage.

Some signs o diabetic

nerve damage are pain,

burning, tingling, or loss o

eeling in the eet and hands.It can cause you to sweat

abnormally, make it hard or

you to tell when your blood

glucose is low, and make you

eel light-headed when you

stand up.

Nerve damage can leadto other problems. Some

people develop problems

swallowing and keeping

ood down. Nerve damage can also cause bowel

problems, make it hard to urinate, cause dribbling


66/146

with urination, and lead

to bladder and kidney

inections. Many people

with nerve damage havetrouble having sex. For

example, men can have

trouble keeping their

penis erect, a problem

called impotence(erectile dysunction).

I you have any o these

problems, tell yourhealth care provider.

There are ways to help

in many cases.

High blood glucose can damage your nerves as

time goes by. Work with your health care team to

keep your glucose levels as close to normal as you

can.

Physical activity or exercise may help keep some

nerves healthy, such as those in your eet. Ask your

health care team about an activity that is healthy

or you.


67/146

Nerve damage

can happen slowly.You may not even be

aware youre losing

eeling in your eet.

Ask your health care

provider to check your

eet at each visit. At

least once a year, your

provider should testhow well you can sense

temperature, pinprick, vibration, and position in

your eet. I you have signs o nerve damage, your

provider may want to do more tests. Testing can

help your provider know what is wrong and how to

treat it. Keep track o your oot exams on the record

sheets starting on page 101.

For more inormation on oot care, call the

National Diabetes Inormation Clearinghouse at

1-800-860-8747.

I youve lost eeling in your eet, youll need to

take special care o them. Check your eet each day.Wear shoes that ft well. Youll read more about oot

care in the next chapter.


68/146


69/146

Nerve damage, circulation

problems, and inections cancause serious oot problems

or people with diabetes.

Theres a lot you can do to

prevent problems with your

eet. Controlling your bloodglucose and not smokingor using tobacco can help

protect your eet. You canalso take some simple saeguards each day to care

or and protect your eet. Over hal o diabetes-

related amputations can be prevented with regular

exams and patient education.

Its helpul to understand why oot problems

happen. Nerve damage can cause you to lose eeling

in your eet. Sometimes nerve damage can deorm ormisshape your eet, causing pressure points that can

turn into blisters, sores, or ulcers. Poor circulationcan make these injuries slow to heal.

Your eet may tingle, burn, or hurt. You may not be

able to eel touch, heat, or cold very well. The shapeo your eet can change over time. There may even

be changes in the color and temperature o your

eet. Some people lose hair on their toes, eet, and

lower legs. The skin on your eet may be dry and

cracked. Toenails may turn thick and yellow. Fungus


70/146

inections can grow between your toes. Blisters,

sores, ulcers, inected corns, and ingrown toenailsneed to be seen by your health care provider or oot

doctor (podiatrist) right away.

Ask your health care provider to look at your eet

at least 4 times a year. As a reminder, take o yourshoes and socks when youre in the exam room.

Have your sense o eeling and your pulses checked

at least once a year. I you have nerve damage,

deormed or misshaped eet, or a circulation

problem, your eet need special care. Ask your health

care provider to show you how to care or your eet.

Also ask i special shoes would help you.


71/146

You may have serious oot problems yet eel no

pain. Look at your eet every day to see i you havescratches, cracks, cuts, or blisters. Always check

between your toes and on the bottoms o your eet. I

you cant bend over to see the bottoms o your eet,

use a mirror that wont break. I you cant see well,

ask a amily member or riend to help you. Call your

health care provider at once i you have a sore on

your oot. Sores can get worse quickly.

Wash your eet every day.

Dry them with care, especially

between the toes. Dont soak

your eetit can dry out your

skin, and dry skin can lead to

inections. Rub lotion or creamon the tops and bottoms o your

eetbut not between your

toes. Moisture between the toes

will let germs grow that could

cause an inection. Ask your

health care provider or the

name o a good lotion or cream.

Trim your toenails ater youve washed and dried

your eetthe nails will be soter and saer to cut.

Trim the nails to ollow the natural curve o your


72/146

toes. Dont cut into the corners. Use an emery board

to smooth the edges.

I you cant see well, or i your nails are thickor yellowed, get them trimmed by a oot doctor

or another health care provider. Ask your health

care provider or the name o a oot doctor. I you

see redness around the nails, see your health care

provider at once.

Dont cut corns and calluses. Ask your healthcare provider how to gently use a pumice stone torub them. Dont use razor blades, corn plasters, or

liquid corn or callus removersthey can damage

your skin.

Hot water or hot suraces are

a danger to your eet. Beore

bathing, test the water with a

bath thermometer (90 to 95F

is sae) or with your elbow.

Wear shoes and socks when you

walk on hot suraces, such as

beaches or the pavement aroundswimming pools. In summer,

be sure to use sunscreen on the

tops o your eet.


73/146

You also need to protect your eet rom the cold.

In winter, wear socks and ootwear such as eece-

lined boots to protect your eet. I your eet are cold

at night, wear socks. Dont use hot water bottles,heating pads, or electric blanketsthey can burn

your eet. Dont use strong antiseptic solutions or

adhesive tape on your eet.

Wear shoes and socksat all times. Dont walk

bareootnot even indoors.

Wear shoes that ft well

and protect your eet. Dont

wear shoes that have plastic uppers, and dont wear

sandals with thongs between the toes. Ask your

health care provider what types o shoes are goodchoices or you.

New shoes should be comortable at the time you

buy themdont expect them to stretch out. Slowly

break in new shoes by wearing them only 1 or 2

hours a day.

Always wear socks or stockings with your shoes.Choose socks made o cotton or woolthey help keep

your eet dry.

Beore you put on your shoes each time, look and

eel inside them. Check or any loose objects, nail

points, torn linings, and rough areasthese can


74/146

cause injuries. I your shoes arent smooth inside,

wear other shoes.

Physical activity can help increase the circulation

in your eet. There are many ways you can exercise

your eet, even during times youre not able to walk.

Ask your health care team about things you can do

to exercise your eet and legs.

For more inormation on oot care, call theNational Diabetes Inormation Clearinghouse at

1-800-860-8747.


75/146

Because ohigh bloodglucose, people with diabetesare more likely to have

problems with their teeth and

gums. Theres a lot you can

do to take charge and prevent

these problems. Caring or

your teeth and gums every

day can help keep themhealthy. Keeping your blood

glucose under control is also

important. Regular, complete

dental care helps prevent

dental disease.

Sore, swollen, and red gums that bleed when

you brush your teeth are a sign o a dental

problem called gingivitis. Another problem, calledperiodontitis, happens when your gums shrink orpull away rom your teeth. Like all inections, dental

inections can make your blood glucose go up.


76/146

High blood glucose can cause problems with your

teeth and gums. Work with your health care team

to keep your glucose levels as close to normal as you

can.

Brush your teeth at least twicea day to prevent gum disease

and tooth loss. Be sure to brush

beore you go to sleep. Use a sot

toothbrush and toothpaste with

uoride. To help keep bacteria rom

growing on your toothbrush, rinse

it ater each brushing and store it

upright with the bristlesat the top. Get a new toothbrush

at least every 3 months.

Besides brushing, you need to oss between

your teeth each day to help remove plaque, a flm

that orms on teeth and can cause tooth problems.Flossing also helps keep your gums healthy. Your

dentist or dental hygienist will help you choose a

good method to remove plaque, such as dental oss,

bridge cleaners, or water spray. I youre not sure o

the right way to brush or oss, ask your dentist or

dental hygienist or help.


77/146

Get your teeth cleaned

and checked at yourdentists ofce at least

once every 6 months. I

you dont have a dentist,

fnd one or ask your

health care provider or

the name o a dentist in

your community.

See your dentist right

away i you have trouble

chewing or any signs o dental disease, including

bad breath, a bad taste in your mouth, bleeding

or sore gums, red or swollen gums, or sore or loose

teeth.

Give your dentist the name and telephone numbero your diabetes health care provider. Each time you

visit, remind your dentist that you have diabetes.

Plan dental visits so they dont change the times

you take your insulin and meals. Dont skip a mealor diabetes medicine beore your visit. Right ater

breakast may be a good time or your visit.


78/146


79/146

I you have diabetes, take extra care to keep

up-to-date on your vaccinations (also calledimmunizations). Vaccines can prevent illnessesthat can be very serious or people with diabetes.

This section talks about some vaccines you need to

know about.

Infuenza (oten called the fu) is not just a badcold. Its a serious illness that can lead to pneumonia

and even death. The u spreads when inuenza

viruses pass rom one person to the nose or throat

o others. Signs o the u may include sudden high

ever, chills, body aches, sore throat, runny nose, dry

cough, and headache.


80/146

People with diabetes who come down with the u

may become very sick and may even have to go to a

hospital. I you get the u, youll need to take special

care o yoursel (see pages 3336).

You can help keep yoursel rom getting the u

by getting a u shot every year. Everyone with

diabeteseven pregnant womenshould get a

yearly u shot. The best time to get one is between

October and mid-November, beore the u season

begins. This vaccine is ully covered under Medicare

Part B.

Pneumococcal disease is a major source o illness

and death. It can cause serious inections o the

lungs (pneumonia), the blood (bacteremia), and the

covering o the brain (meningitis). Pneumococcal

polysaccharide vaccine (oten called PPV) can helpprevent this disease.

PPV can be given at the same time as the u

vaccineor at any time o the year. Most people only

have to take PPV once in their lie. Ask your health

care provider whether you might need a second

vaccination. This vaccine is ully covered under

Medicare Part B.


81/146

Tetanus (or lockjaw) and diphtheria are serious

diseases. Tetanus is caused by a germ that entersthe body through a cut or wound. Diphtheria

spreads when germs pass rom one person to the

nose or throat o others.

You can help prevent tetanus and diphtheria

with a combined shot called Td toxoid. Most people

get Td toxoid as part o their routine childhood

vaccinations, but all adults need a Td booster shotevery 10 years. Other vaccines may be given at the

same time as Td toxoid.

You may need vaccines to protect you against

other illnesses. Ask your health care provider i you

need any o these:

Measles/Mumps/Rubella vaccine.

Hepatitis A and B vaccines.

Varicella (chicken pox) vaccine.

Polio vaccine.

Vaccines or travel to other countries.


82/146

Call the immunization program in your state

health department to fnd out where you can getvaccinations in your area. Keep your vaccination

records up-to-date so you and your health care

provider will know what vaccines you may need.

You can record this inormation on the record sheets

starting on page 101 o this book.

For more inormation on

vaccination, call the CDCNational Immunization

Hotline at 1-800-CDC-INFO

(English and Spanish). This is

a toll-ree call.


83/146

Women with diabetes can

have healthy babies, but it

takes planning ahead and

eort. Pregnancy can make

both high and low bloodglucose levels happen moreoten. It can make diabeticeye disease and diabetickidney disease worse.High glucose levels during

pregnancy are dangerous or

the baby, too.

I you dont want to

become pregnant, talk with

your health care provider

about birth control.

Keeping your glucose levels near normal beore

and during pregnancy can help protect you and

your baby. Thats why its so important to plan your

pregnancies ahead o time.


84/146

I you want to have a baby, discuss it with your

health care provider. Work with your diabetes care

team to get and keep your blood glucose in the

normal or near-normal range beore you become

pregnant. Your glucose records and yourA1C test

results will show when you have maintained a saerange or a period o time.

You may need to change your meal plan and yourusual physical activity, and you may need to take

more requent insulin shots. Testing your glucoseseveral times a day will help you see how well youre

balancing things. Record the test results in your

logbook or on a log sheet (see sample pages on107108).

Get a complete check o your eyes and kidneysbeore you try to become pregnant. Dont smoke,

drink alcohol, or use drugsdoing these things can

harm you and your baby.


85/146

All women who could become pregnant should

take olic acid (400 micrograms) every day. An easy

way to be sure youre getting enough olic acid is to

take a vitamin with olic acid in it.Think about breast eeding your baby. Breast

eeding has many benefts or you and your baby.

Some women have diabetes only when theyre

pregnant. This condition, which is calledgestational diabetes, can be controlled just likeother kinds o diabetes. Glucose control is the key.

Your health care team can help you take charge o

gestational diabetes. You are more likely to develop

type 2 diabetes. Check again or diabetes at least 6

weeks ater your baby is born and at regular times

or the rest o your lie.


86/146

Some women with diabetes may have special

problems, such as bladder inections. See pages4950 to fnd out about the signs o bladder and

kidney inections. I you have an inection, it needs

to be treated right away. Call your doctor.

Some women get yeast inections in theirvagina, especially when their blood glucose is high.

A sign o a yeast inection may be itching in the

vagina. I you notice vaginal itching, tell your healthcare provider, who can tell you about medicines you

can buy at the drugstore and about how to prevent

yeast inections.

Some women with diabetes may have trouble

with sexual unction. Discomort caused by vaginal

itching or dryness can be treated.

Ask your doctor how

oten you should get

a Pap smear and a

mammogram (breast

X-ray). Regular

Pap smears and

mammograms help

detect cervical andbreast cancer early.

All womenwhether

or not they have

diabetesneed to

have these tests

regularly.


87/146

Records for Sick Days 79

Checks and Goals for Each Visit 89

Checks and Goals for Each Year 99

Glucose Record Sheets 105

Your Health Care Team 109


88/146


89/146

!


90/146

n

n

n

n

n

n

n

n

!


91/146

!


92/146

n

n

n

n

n

n

n

n

!


93/146

!


94/146

n

n

n

n

n

n

n

n

!


95/146

!


96/146

n

n

n

n

n

n

n

n

!


97/146

!


98/146

n

n

n

n

n

n

n

n

!


99/146

n

n

n

n

n

n

n


100/146

!

2/1/2000

145

6/

11/2000

118

9/28/2000

180

1/5/2001

105

4/3/2001

110

9.0

8.0

8.9

8.0

8.2

7.5

notdon

8.4

7.5

165

160

170

165

172

165

175

165

180

170

140/90

140/86

138/84

136/82

124/80

3

3

3

3

3

120

80


101/146

!


102/146

!


103/146

!


104/146

!


105/146

!


106/146

!


107/146

!


108/146

!


109/146

n

n

n

n

n

n

n

n


110/146

!

10/2/1999

10/2/1999

40 1.0

190

10/20

/2000

10/20

/2000

5

0

1.2

11/1/2001

11/1/2001

55 1.1

175

30

35

40

150

140

135

338

3

00

250

5cigrsdy

2cigrs

0

8/11/1999

10/1/200010/20/2001

10/2/199910/20

/200011/1/2001


111/146

!


112/146

!


113/146

!


114/146

!


115/146

My26,2

001


116/146


117/146

SaMple

My26,2

001


118/146


119/146


120/146


121/146


122/146


123/146


124/146


125/146


126/146


127/146


128/146


129/146


130/146


131/146


132/146


133/146


134/146


135/146


136/146


137/146


138/146


139/146


140/146


141/146


142/146


143/146


144/146


145/146


146/146

diabetes- are you a victim bookbing.org

Documents