Diabetes is a lifelong disease that can have serious consequences for the heart and blood vessels. Complications from diabetes include coronary artery disease, high blood pressure, high cholesterol and blockages in the blood vessels that may lead to amputation. With proper management of your disease, however, you can greatly reduce the risk of further damage to your heart and blood vessels. The following guidelines will help you in your journey to recovery and wellness.
Diabetes is a disease in which you have too much sugar in your blood. When you have Type 1 diabetes, your body can no longer make insulin, a chemical that lets the sugar get into your cells to give you energy.
Type 2 diabetes often is linked to being overweight and inactive. Your body still makes some insulin. Either your cells resist the insulin, or you may not make enough insulin. You may be able to control your blood sugar with diet and exercise. Some people may need to take pills to control their sugar, and some people may need to use insulin shots.
There is a link between diabetes and heart disease. High blood sugar acts like sandpaper and causes the walls of the arteries to become rough. This allows “bad” cholesterol to build up in the walls of an artery, causing more plaque. Controlling your blood sugar can help slow or prevent this damage.
Diabetes is a chronic disease and currently cannot be cured. However, when it is managed properly, you can prevent damage to the tissues in your body.
Eat Smart. Certain foods will help to keep your blood sugar under control. A visit with a dietitian is very important. A dietitian will teach you how to eat well-balanced meals and snacks. Smart eating is a good way to lose extra weight. This will help your body use insulin better.
Exercise regularly. Exercise helps you lose weight and keep your blood sugar well-controlled. It also helps your cardiovascular system. For the person with diabetes, exercise is as important as diet and medication.
Test your blood sugar regularly. Monitoring your sugar every day is the only way that you know how well you are taking care of your diabetes. You can no longer depend on the way you feel to tell you whether your blood sugar is well-controlled.
Take your medication as prescribed. Talk with your health care provider or pharmacist to learn the best time of day to take your medicine so that you get the greatest benefit from your pills or insulin.
Smart eating is the first step in taking care of your diabetes. You do not need special or diet foods. Food that is good for you also is good for the whole family. The types and amounts of foods you eat every day will make a big difference in your blood sugar.
Your body makes sugar from the carbohydrates you eat. Carbohydrates are starches and complex sugars. They include food made with flour or sugar, rice, and certain vegetables, such as corn, peas and potatoes.
Basic Guidelines to a Healthy Diabetic Diet
- Eat 3 balanced meals each day. Meals should include protein (meat, cheese, fish, poultry, eggs, peanut butter or tofu), and high-fiber foods such as fresh fruit, vegetables, whole grains and beans.
- Have a small evening snack before bedtime. It should contain protein, such as low-fat cheese and crackers, or half a sandwich.
- Eat about the same amount of food each day. Watch your portion sizes. Do not take second helpings.
- Meals should be four to five hours apart. Do not skip meals. If meals are delayed, eat a small snack.
- Eat less fat. Use low-fat cooking methods like baking, roasting, broiling, grilling, poaching, steaming or boiling, instead of frying.
- Sweets such as cake, ice cream or cookies should be eaten less often. When eaten, they should be part of the meal, and not an extra snack.
- Limit alcohol (beer, wine and liquor) to one to two servings per day.
- Try to lose weight if you are overweight. Even small amounts of weight loss can make a big difference in your blood sugar control.
- Use the Nutrition Facts panel on food labels to help you make healthier food choices. Select foods that are low in fat and high in fiber.
Examples of non-nutritive sweeteners that are approved for use by the Food and Drug Administration (FDA) are:
Saccharine (Sweet & Low®)
Aspartame (Equal®, Nutrasweet®)
Acesulfame (Sweet One®)
Sugar alcohols (sorbitol, mannitol, xylitol) occasionally can be used in small amounts. They have about the same amount of calories as table sugar. When used in large amounts, they can cause diarrhea and cramps.
Sugar Free and Diet Foods
If a food is advertised as “sugar free” it has very little or no sugar, but it may still be high in fat and calories, and may still contain carbohydrates – be cautious and read the label. Also be careful with foods labeled “reduced” or “less.” They may have less sugar or calories than the regular products, but may still raise blood sugar levels.
Testing Your Blood Sugar
To keep your blood sugar as close to normal as possible, you must test your blood sugar frequently. Other terms for this are monitoring your blood sugar or blood glucose. Obtain a blood glucose monitor that you can use yourself at home after you are discharged. The nurse will show you and/or your family how to use the monitor so that you can regularly test your blood sugar.
We recommend that you test four times a day your first week home from the hospital. Generally, you should test right before each meal and before you go to bed. Your doctor or nurse will tell you what schedule you should use. Be certain you haven’t had anything to eat for two hours before you test so that your results are accurate. If you have eaten within two hours, your blood sugar may be high.
Your blood glucose goals are:
- Before breakfast (fasting): 70 to 110
- Before meals: less than 120
- Two hours after meals: 70 to 140
- Bedtime: 100 to 140
Call your primary care doctor (family doctor) if your sugar stays above 160 each time you test it for a 24-hour period.
When your sugar stays above these goals, your healing is much slower. If you have surgery, you are at greater risk of getting an infection in one of your incisions. It is very important that your blood sugar remains within these ranges.
There is a second blood test that shows how well your diabetes is controlled. An A1c blood test measures your average blood sugar levels over a two- to three-month period to tell you if your current treatment plan is working as it should. Based on the results of this test, your doctor may make changes in your medication. This test gives results over a longer time than daily blood sugar readings. It also helps predict risk for heart disease and other problems. The level for people with diabetes should be less than 6.5 percent. Your treatment may be changed if the level is higher. You should have this test done every three to six months.
Helpful Hints for Blood Sugar Testing
Be sure you know how to use your meter and that the batteries in your meter are good. Most meters will give you a picture of a battery on the display screen when the batteries are getting weak.
Check your strips to be sure that they haven’t expired. Strips are sensitive to light, heat and moisture. Keep them in their original container until you are ready to use them. If your meter requires calibration, make certain that the number in the meter matches the number on your strip container. Refer to your meter instruction manual for changing this number.
Wash your hands in warm soapy water before your test. Clean, warm hands will make it easier to get a good drop of blood.
Be sure you follow the directions for your meter when you test your sugar. It is important that you do the test exactly the way the maker of your meter tells you to do it.
Write your blood sugar results in your diary. Take the diary with you to your regular doctor appointments so that the doctor or the diabetes educator can review and discuss your results with you. This will help you see how your meals, activity and medicines work together to control your sugar.
Any time your treatment changes, you should test more often. When you take pills to control your blood sugar, you should test two hours after you eat. This will tell you if your sugar is going too high when you eat. Your doctor wants to know this so that he or she can adjust your medicine if your sugar is too high after meals.
When you’re going to be away from home at the time when you are supposed to test, take your meter with you. Don’t leave your meter in your hot car during the summer months or out in the cold during the winter.
Remember, regular blood glucose testing helps you make decisions about your meals and exercise. It is your key to better control.
Type 1 Diabetes
People with Type 1 diabetes must take insulin. You must test your blood sugar regularly so you can make decisions about your insulin dose. Talk this over with your doctor or diabetes educator so that you learn how to adjust your insulin dose depending on your blood sugar results, planned activities or meals.
There are various types of insulin. Your doctor will help you decide which type of insulin will be best for you and your lifestyle. Remember to be flexible, because your insulin type and dose may need to be changed at times. Take your insulin at the same time every day. Try not to change the time you take it by more than one hour. Some insulins are taken before meals. Be sure you know how soon you should eat after taking your insulin. Your doctor may tell you to take your insulin at bedtime. It is especially important that you take this insulin at the same time each night, because it is designed to last 24 hours.
Type 2 Diabetes
When you have Type 2 diabetes, you may be able to control your blood sugar by your diet alone. Many people with Type 2 diabetes, however, need to take medication. Pills for diabetes are not insulin. They are simply pills that work to make your body produce more insulin, or help your cells use insulin.
Take the medicine exactly as it is prescribed. Some pills work best if they are taken before meals, and some should be taken with food. Other medicines for diabetes are taken only if you are going to have a meal. You have to know when to take your pills, how many to take and how often you are supposed to take them.
Side effects may occur when you start taking your diabetes pills but will usually go away within a few weeks. Nausea or increased “gas” are common side effects that should last only a short time. Call your doctor if you have vomiting, skin rash, acne, hives or dizziness.
Oral Medications for Diabetes Type 2
Glipizide (Glucotrol, Glucotrol XL)
Glyburide (Diabeta, Micronase)
Glyburide micronized (Glynase)
These medicines help your body make insulin. Take your medicine 30 minutes before meals. If you are allergic to sulfa, you usually cannot take a sulfonylurea.
Metformin (Glucophage, Glucophage XR, Glumetza)
Metformin may help with weight problems because it helps the body use insulin better. It can cause nausea or diarrhea in some people. Take metformin with meals.
These medicines help your body respond better to insulin. Periodic liver blood tests are needed. Notify your doctor if you develop weight gain or swelling. Take with or without food.
These medicines work in your stomach and bowels to slow down the absorption of sugars and carbohydrates. They can cause abdominal pain, gas and diarrhea. Take with the first bite of food at each meal.
Insulin Secretagogues (Meglitinides)
These medications increase insulin secretion. Take your medicine 1 to 30 minutes before meals to control your blood sugar.
ACTOplus met (Pioglitazone/Metformin)
Sitagliptin Phosphate (Januvia)
These medications increase the release of insulin and decrease the release of glucose from the liver.
This medication slows the rate of movement of food from stomach to intestine and signals the liver to decrease glucose output.
This medication signals the pancreas to make insulin and signals the liver to stop producing glucose. It also slows the rate of movement of food from stomach to intestine.
High Blood Sugar — Hyperglycemia
High blood sugar may occur within hours or may develop over several days. You may have one or all of the following symptoms:
- High blood sugar levels (over 200)
- Extreme thirst
- Using the bathroom a lot
- Pain in stomach with or without nausea and vomiting
Causes of high blood sugar include:
- Too much food or eating the wrong foods
- Not enough diabetes pills or insulin
- Illness or infection
- Not enough exercise (Do not exercise if your sugar is above 240)
What to do to Prevent Hyperglycemia
- Always take your diabetes medicine unless your doctor tells you not to.
- Test your blood sugar every four to six hours.
- If you usually take insulin, test your urine for ketones. Call your doctor if moderate to large ketones are present.
- If your blood sugar is over 150, drink 8 ounces of sugar-free liquid every one to two hours.
- Call your doctor if you are vomiting and unable to eat or drink liquids.
Remember to call your doctor if your blood sugar stays above the goals you’ve been given for 24 hours.
Low Blood Sugar — Hypoglycemia
Low blood sugar usually occurs quickly and may require that someone help you get treatment. Symptoms include:
- Fast and/or pounding heartbeat
Causes of low blood sugar include:
- Too much insulin or too man y diabetes pills
- Not enough food or missing a meal
- Too much exercise or extra physical activity
What to do to Prevent Hypoglycemia
Try to test your blood sugar. If you are too shaky, eat or drink a fast-acting carbohydrate such as:
- 4 ounces juice (orange, apple, cranberry or grape)
- 6 ounces (½ can) of a regular soft drink
- 8 ounces skim milk
- 3 glucose tablets
- 8 SweetTart candies
- 2 tablespoons raisins
Test blood sugar every 15 to 30 minutes until it is above 100. Eat a second fast-acting carbohydrate if needed. If your next regular meal is more than two hours away, eat a snack such as half a sandwich or three peanut butter or cheese crackers.
If you are unconscious, someone should call 911 immediately. You should not be given anything by mouth if you are unconscious.
Be sure to tell your doctor about this episode in case your medication needs to be adjusted.
Avoiding Complications of Diabetes
Diabetes can affect every organ of your body, especially your eyes, your heart, your kidneys, your nerves and your feet. You may be able to avoid these problems by controlling your blood sugar.
For well-controlled blood sugar, you should:
- Test your blood sugar. Keep it in the ranges suggested by your health care professional.
- Have your A1c tested every three to six months to be sure your sugar is in control even when you are not testing (like when you are sleeping).
- Sit down with a dietitian, who can give you a meal plan that you can follow.
- Exercise regularly.
- Take all of your medication as ordered.
- Use no tobacco products or recreational drugs.
- Limit alcohol. The dietitian will help you with types and amounts.
- Check your feet every day to be certain there are no new cuts, corns, reddened areas, increased warmth, swelling, etc.
- See your doctor regularly.
- Keep your blood pressure well controlled (under 120/80).
- Lose weight if you are overweight.
- Keep your cholesterol levels under control: Keep your LDL under 100, your HDL over 40 for men and over 50 for women, and your triglycerides under 150.
- Prevent or manage symptoms of metabolic syndrome.
Taking Good Care of Your Feet and Skin
When you have diabetes, you are more likely to have foot or skin infections. These can be very serious. Therefore, you need to take extra care to protect your feet and skin.
- Inspect your entire body every day for minor cuts or scratches. If you can’t see the bottoms of your feet, have someone look for you or use a hand mirror.
- Wash daily with soap and lukewarm water. Dry yourself completely. Pay special attention to the areas between your toes.
- Use lotion to add moisture to your skin and feet. Avoid leaving lotion between your toes, because the moisture can cause athlete’s foot.
- Trim your toenails after bathing when they are softer. Cut them no shorter than the end of your toe. Be careful to trim them straight across.
- If you have trouble trimming your toenails or cannot see your toenails clearly, a podiatrist (foot doctor) can trim them for you.
- Make sure your shoes fit well. Put your hand in your shoe to be certain you have no tears or holes in the lining of your shoes.
- Socks should fit well and have no holes.
- Clean any cuts/scratches with warm soapy water. Place a thin coat of antibiotic ointment (such as Polysporin® or Neosporin®) on the cut and cover it with a bandage.
Remember to see your doctor if you notice:
- Abnormal color anywhere on your skin or feet.
- Signs of infection such as redness, swelling or increased warmth.
- Itchy, cracked areas between your toes or on your heels.
- Ingrown toenails, corns, calluses or painful areas on your feet.
- Any cuts/scratches or sores that do not heal completely within two weeks.
Standards of Care
Special tests and exams need to be part of your diabetes care. Below are guidelines from the American Diabetes Association.
|Test or Exam||Frequency|
|Routine physical exam||Once a year|
|Blood pressure||At every routine exam|
|Lipid (cholesterol) test||Yearly; if low risk, every two years|
|Complete foot exam||Yearly, including sensory (nerve) test|
|Eye exam||Yearly, or as recommended by your eye doctor|
|Microalbumin (protein) urine test||Yearly|
|Hemoglobin A1c(HbA1c)||Every three months|
Our hospitals have a tremendous education program for people with diabetes. For information, call Diabetes Outpatient Education:
Penrose Health Learning Center
3207 N. Academy Blvd., Suite 100
Colorado Springs, CO 80917
Insurance coverage of your diabetes education should be verified before your first scheduled appointment. Otherwise, you will be responsible for payment when you receive the bill.
Based on your insurance coverage or by personal self-pay arrangement, you will be scheduled to see the diabetes nurse educator and registered dietitian for 30 minutes to one hour each on three separate visits. You also will be encouraged to schedule a visit with an exercise specialist of your choice, or as recommended by your doctor. All appointments will be made at approximately one-month intervals. The number of appointments will be modified according to individual needs. It is preferred that the first two visits be scheduled during your first phone call.
Learning to manage diabetes is the best way to minimize the potential complications of this disease. We want you to take an active part as an informed member of your diabetes team, along with your physicians, nurse educator, dietitian and exercise specialist.
Diabetes Forecast, a monthly magazine published by the American Diabetes Association. To subscribe, call 1-800-DIABETES.
Diabetes Interview, a monthly magazine. To subscribe, call 1-800-488-8468.
American Association of Diabetes Educators (to find a diabetes educator near you): www.aadenet.org
American Diabetes Association: www.diabetes.org
Children with Diabetes: www.childrenwithdiabetes.com
Juvenile Diabetes Research Foundation International: www.jdrf.org
National Diabetes Education Program: www.ndep.nih.gov