Diabetes Mellitus Type II

What is Diabetes Mellitus?

When you eat, your food is broken down into a sugar called glucose. This gives your body the energy it needs to work but to use glucose, your body needs insulin.

Diabetes is a problem with your body that causes blood glucose (sugar) levels to rise higher than normal. This is also called hyperglycemia. Type 2 diabetes is the most common form of diabetes. Your body does not use insulin properly. This is called insulin resistance.

What is Insulin Resistance?

Insulin is a hormone produced by the pancreas that helps the body take sugar (glucose) from the food we eat so it can be used for energy. Individuals with diabetes may not produce enough insulin to meet their needs, so some sugar (glucose) is not used and sugar remains in the bloodstream, causing high blood glucose levels.

Managing Your Diabetes

There is no cure for diabetes but it can be managed by balancing food, exercise, and medicine to keep blood glucose in a healthy range.

What, How Much, and When to eat

· Eat a variety of foods, including vegetables, whole grains, fruits, non-fat dairy foods, healthy fats, and lean meats.

· Try not to eat too much food.

· Try not to eat too much of one type of food. Variety is the spice of life.

· Space your meals evenly throughout the day.

· Don’t skip meals.

Plate Method

The plate method is a simple and effective tool for managing diabetes. It allows you to create your own plate while still allowing you to choose the foods that you want.

Try these six steps to get started:

1. Using your dinner plate, put a line down the middle of the plate. Then on one side, cut it again so you will have three sections on your plate.

2. Fill the largest section with non-starchy vegetables such as:

· spinach, carrots, lettuce, greens, cabbage, bok choy

· green beans, broccoli, cauliflower, tomatoes,

· vegetable juice, salsa, onion, cucumber, beets, okra,

· mushrooms, peppers, turnips

3. Now in one of the small sections, put grains and starchy foods such as:

· whole grain breads, such as whole wheat or rye

· whole grain, high-fiber cereal

· cooked cereal such as oatmeal, grits, hominy or cream of wheat

· rice, pasta, dal, tortillas

· cooked beans and peas, such as pinto beans or black-eyed peas

· potatoes, green peas, corn, lima beans, sweet potatoes, winter squash

· low-fat crackers, snack chips, pretzels and light popcorn

4. And then in the other small section, put your protein such as:

· chicken or turkey without the skin

· fish such as tuna, salmon, cod or catfish

· other seafood such as shrimp, clams, oysters, crab or mussels

· lean cuts of beef and pork such as sirloin or pork loin

· tofu, eggs, low-fat cheese

5. Add a serving of fruit, a serving of dairy, or both as your meal plan allows.

6. To complete your meal, add a low calorie drink like water, unsweetened tea, or coffee.

Fast food options:

Restaurant

Healthier Picks

Nutrition Facts:

Wendy’s

Go for a healthful yet filling salad. This half-size order of Apple Pecan Chicken Salad is served with pomegranate dressing and pecans. To drink, choose unsweetened iced tea.

340 cal., 18 g total fat (4.5 g sat. fat), 60 mg chol., 700 mg sodium, 29 g carb. (4 g fiber, 22 g sugars), 19 g pro

McDonald’s

For 15 grams of fast protein, choose the Filet-O-Fish sandwich, apple slices and unsweetened iced tea.

400 cal., 18 g total fat (3.5 g sat. fat), 40 mg chol., 644 mg sodium, 42 g carb. (2 g fiber, 8 g sugars), 15 g pro.

Burger King

Whopper Jr. sandwich with or without cheese -- but hold the mayonnaise. Resist the fries and balance out the meal with apple slices and diet soda.

330 cal., 13 g total fat (6 g sat. fat), 45 mg chol., 640 mg sodium, 39 g carb. (2 g fiber, 13 g sugars), 16 g pro.

Panera Bread

Opt for a balanced meal from the You Pick Two menu. The low-cholesterol, high-fiber combination of a half Smoked Turkey Breast sandwich on Honey Wheat Loaf bread with a cup of Low-Fat Vegetarian Garden Vegetable with Pesto soup. To drink, have Acai Berry Iced Green Tea.

310 cal., 7 g total fat (2 g sat. fat), 20 mg chol., 1,300 mg sodium, 47 g carb. (11 g fiber, 9 g sugars), 18 g pro

Subway

6-inch Veggie Delite sub on Monterey Cheddar bread with lettuce, tomato, green sweet pepper, cucumber, and provolone cheese. To drink, choose a diet soda.

310 cal., 10 g total fat (4.5 g sat. fat), 20 mg chol., 485 mg sodium, 42 g carb. (3 g fiber, 6 g sugars), 14 g pro.

Popeyes

Six-piece chicken tenders and regular green beans is a good, high-protein choice when you're on the go. Order applesauce on the side and a diet soda to drink.

320 cal, 15.5 g total fat (6 g sat. fat), 45 mg chol., 780 mg sodium, 32 g carb. (5 g fiber, 9 g sugars), 13 g pro.

KFC

Choose grilled or baked chicken over fried, such as this protein-loaded grilled chicken breast and wing at KFC. Order sweet kernel corn and a diet soda.

400 cal., 12 g total fat (3.5 g sat. fat), 185 mg chol., 980 mg sodium, 22 g carb. (2 g fiber, 3 g sugars), 53 g pro

Chick-Fil-A

Char-grilled chicken sandwich, small fruit cup, and unsweetened iced tea.

340 cal., 4 g total fat (1 g sat. fat), 60 mg chol., 790 mg sodium, 49 g carb. (4 g fiber, 20 g sugars), 28 g pro

Chipotle

Three crispy tacos with chicken, lettuce, and fresh tomato salsa, complete with a diet soda.

390 cal., 12.5 g total fat (3.5 g sat. fat), 115 mg chol., 870 mg sodium, 32 g carb. (3 g fiber, 4 g sugars), 33 g pro.

Taco Bell

Fresco Grilled Steak Soft Tacos with Mild Border Sauce and a diet soda.

300 cal., 8 g total fat (3 g sat. fat), 30 mg chol., 1,035 mg sodium, 38 g carb. (4 g fiber, 4 g sugars), 18 g pro.

Starbucks

Spinach and Feta Breakfast Wrap is a relatively lean lunch option when you're in a pinch. Opt for black coffee instead of a sugary specialty drink.

290 cal., 10 g total fat (3.5 g sat. fat), 20 mg chol., 830 mg sodium, 33 g carb. (6 g fiber, 4 g sugars), 19 g pro.

Panda Express

Broccoli Beef (no rice), Veggie Spring Rolls, a fortune cookie, and a diet soda.

312 cal., 11 g total fat (3 g sat. fat), 10 mg chol., 1,208 mg sodium, 42 g carb. (7 g fiber, 8 g sugars), 14 g pro.

Best Choices at Sandwich Shops

To keep carbs within healthful amounts, pick half-size sandwiches or breadless options loaded with vegetables.

Healthful Chicken Choices at Fast-Food Restaurants

Limit saturated fat by ordering skinless grilled chicken or a small serving of breaded chicken, such as nuggets or a half-breast piece. Round out your meal with a side dish that provides a serving of fruit or vegetables.

Nutritious Fast-Food Mexican Meals

Skip large burritos and fried foods to steer clear of excess calories and fat. Top servings with fresh salsa, vegetables, and beans to get some fiber.

Checking Your Blood Glucose

To check your sugar levels, you use a small machine called a blood glucose meter. These meters work by testing a small drop of your blood to measure how much glucose (sugar) is in your blood stream.

Checking your blood glucose is one way you know how food and medicine is affecting your blood glucose.

It is important to regularly check your glucose level as it is a way to make sure that it is not going TOO HIGH or TOO LOW.

How Often to Check

This is something that you need to talk with your doctor about how often and when to check it. In addition, you need to talk with your doctor about your target blood glucose numbers should be.

Normally, blood glucose levels are checked before a meal or two hours after a meal.

You should keep a manual log book (log pages included at the back of the folder). This book will stare at you in the face and it will give you patterns and clues as what changes that you need to make in your therapy. This is a self-monitoring tool to help you in deciding how much insulin you need every time that you are due for an injection. This will help you to predict and avoid low or high blood glucose.

Insulin has 3 characteristics:

· Onset is the length of time before insulin reaches the bloodstream and begins lowering blood glucose.

· Peak time is the time during which insulin is at maximum strength in terms of lowering blood glucose.

· Duration is how long insulin continues to lower blood glucose.

The medication that your doctor has prescribed for you is NovoLog.

Novolog is a fast acting mealtime insulin. The onset is within 10-15 minutes. Therefore, you should eat a meal within 5 to 10 minutes after taking it. The peak time for this drug is 60-90 minutes after taking it and the duration is approximately 4-5 hours.

Rotating Your Injection Site

Knowing exactly where on your body you should give your injection(s) each day is very important. The picture to the right shows recommended sites for your insulin injections in the dark blue grid areas. Each square is a place you can give yourself an injection. Be sure not to inject insulin into a muscle or vein. You may need help from a family member to give injections in some of the sites.

For your insulin to work best, don't use the exact same site each time you inject. There are different sites where you can inject throughout the day. Refer to the image above. This is called site rotation and involves following a regular pattern as you move from site to site. If you take more than one injection each day, inject the insulin in the same general area, and rotate to a different site for the next injection. Different people use different patterns, but the intent should always be to use all of the areas and the sites. When you do this, no one site will be used too often. Overusing a site can cause tissue changes that affect the amount of insulin absorbed or the rate at which it is absorbed.

Insulin enters the blood more quickly from some areas than others, so your blood sugar (glucose) may be higher or lower depending on what area is used. At times, you may want to use a certain area because of how quickly or slowly insulin is taken up from that site. For example, if you plan to eat very soon after an injection, you could use a site on your stomach.

Most insulin enters the blood:

· Fastest from the abdomen (stomach)

· A little slower from the arms

· Even more slowly from the legs

· Most slowly from the buttocks

Manifestations

Causes

Treatment

Preventative Measures

· Elevated Blood glucose

· Increase in urination

· Increase in appetite followed by lack of appetite

· Weakness, fatigue

· Blurred vision

· Headache

· Nausea and vomiting

· Abdominal cramps

· Illness, infection

· Corticosteroids

· Too much food

· Too little or no diabetes medication

· Inactivity

· Emotional, physical stress

· Poor absorption of insulin

· Get medical care

· Continue diabetes medication as ordered

· Check blood glucose frequently and check urine for ketones. Record results

· Drink fluids at least on an hourly basis

· Take prescribed dose of medication at proper time

· Accurately administer insulin

· Maintain diet

· Maintain good personal hygiene

· Adhere to sick day rules when ill

· Check blood for glucose as ordered

· Contact heath care provider regarding ketonuria

· Wear diabetic identification

Manifestations

Causes

Treatment

Preventative Measures

· Blood glucose <70 mg/dl

· Cold, clammy skin

· Numbness of fingers, toes, mouth

· Rapid heartbeat

· Emotional changes

· Headache

· Nervousness, tremors

· Faintness, dizziness

· Unsteady walk, slurred speech

· Hunger

· Changes in vision

· Seizures, coma

· Alcohol intake without food

· Too little food—delayed, omitted, inadequate intake

· Too much diabetic medication

· Too much exercise without compensation

· Diabetes medication or food taken at wrong time

· Loss of weight without change in medication

· Ingest 15-20 grams of simple carbs.

· Ingest another 15-20 grams of simple carbs. in 15 minutes if no relief is obtained

· Contact health care provider if no relief obtained

· Discuss medication dosage with health care provider

· Take prescribed dose of medication at proper time

· Accurately administer insulin

· Ingest all recommended foods at proper times

· Recognize and know symptoms and treat them immediately

· Carry simple carbohydrate

· Educate family about symptoms and treatment

· Check blood glucose as ordered

· Wear medical alert (diabetic) identification.