Take Charge of Your Health….orhs.connecthealthcare.com/pdf_library/Diabetes_booklet.pdfTake Charge of Your Health…. Diabetes Education Program . Table of Contents Module 1- Basics

Take Charge

of

Your

Health….

Diabetes Education Program

Table of Contents

Module 1- Basics of Diabetes

About Type 2 Diabetes Type 2 Diabetes Action Plan A1C: Do You Know What Your “Number” Is? Tracking Your A1C Diabetes and Low Blood Sugar Taking Your Medicine the Right Way Basics of Healthy Eating Carbohydrate Counting Ready, Set, Start Counting Diabetes and Grocery Shopping Exercise and Diabetes

Module 2- Diabetes; Your Plan of Care

Your Diabetes Care Team Type 2 Diabetes from Head to Toe Prevent and Manage Complications, What Else Can I Do? Eye Care for People with Diabetes Take Care of Your Feet Diabetes and Mouth Care Diabetes and the Risk of Heart Disease or Stroke High Blood Pressure-What Is It? My Blood Pressure Numbers- What Do They Mean? My Blood Pressure Goals- What Are They? Lipids- What Are They? My Numbers-Ask About Each One Nerve Damage and Skin Problems Sexual Health for Men with Diabetes Diabetes and Depression

Module 3- Healthy Living with Diabetes

Diabetes and Your Sick-Day Plan Nutrition and Diabetes Eat Healthy….Eat Vegetables, Fruits, and Whole-Grain Foods Spice Up Your Food with Flavor Healthy Eating with Less Salt Are You Overweight? Plan To Be Healthy! Building Heart-Healthy Habits for Exercise and Diet Smoking and Your Health Helping To Care for Someone with Diabetes Diabetes Resources

Module 1 Basics

of Diabetes

©2008The GlaxoSmithKline Group of Companies All rights reserved. Printed in USA. HMI727R0 July 2008

Type 2 diabetes occurs when your body:

• does not make enough insulin Food turns to

Insulin helps sugar get into cells

to give them fuel for energy

• does not respond well to its own insulin

sugar in your blood

You eat food

Without enough insulin:

• Your body does not get the energy it needs

• Sugar builds up in the blood and can lead to serious health problems

Signs of diabetes

If you say yes to one or more of these signs, you may have type 2 diabetes:

• Are you often very thirsty?

• Do you urinate a lot?

• Do you often feel very tired or hungry?

• Do you have blurry vision?

• Have you lost weight without trying?

• Do you have sores that are slow to heal?

• Do you sometimes lose feeling or have tingling in your feet?

If diabetes is not managed, it can cause serious health problems over time. Talk to your doctor if you think you could have type 2 diabetes. Talk to your doctor about what you can do to help manage your type 2 diabetes.

This material has been developed by GlaxoSmithKline

About type 2 diabetes

©2008 The GlaxoSmithKline Group of Companies All rights reserved. Printed in USA. HMI740R0 July 2008

Name

Doctor

Date

Phone

Meeting your diabetes goals can be as easy as 1-2-3! Work with your doctor to fill out this form to help set goals that are right for you.

1 Know your goals

A1C (3 month average):

Daily blood sugar number when I wake up and before meals: to

Daily blood sugar reading after a meal:

Blood pressure:

Weight:

Cholesterol:

Other:

2 Take action to meet your goals

• Test your blood sugar daily

• Take your medicines the way your doctor tells you

• Eat healthy foods and follow your meal plan

• Be more active

• Check your feet daily

• Get all the exams your doctor tells you

• Stop smoking

Write down reasons you want to control your diabetes:

Problems you may have to solve to meet your goals:

3 Talk to your diabetes care team

• Ask your doctor or nurse for help—they want to!

• Ask your family or friends for help

Call your doctor if your blood sugar reading is below or over

In an emergency, call 911

This material has been developed by GlaxoSmithKline.

Type 2 diabetes action plan

Is your blood sugar under control?

Testing your blood sugar lets you know how well you are managing your diabetes. Managing your diabetes well can help you avoid diabetes problems.

Testing your blood sugar at home only tells you how well you are doing at the moment you do the test. At different times, your blood sugar could be higher or lower. To know the whole story, you need an A1C test.

What is an A1C test?

An A1C is a blood test done at your doctor’s office to tell you how well you are managing your blood sugar over time. Your A1C number tells you your average blood sugar for 2-3 months before the test.

Und

7er

%

What is your “number?”

The American Diabetes Association (ADA) says that A1C should be less than 7%. Your doctor may set a different A1C goal for you and it may change over time. Ask your doctor what your A1C goal should be. Your final goal should be less than 7%.

How often should you have an A1C test?

A1C tests should be done every 3 to 6 months. Ask your doctor what your last A1C was and when you should have your next test.

Talk to your doctor about:

• What your A1C goal should be

• How often you should have an A1C test

more on back

Blood sugar can be high one day... A1C is your average blood sugar for 2-3 months

And low the next...

A1C: Do you know what

your “number” is?

The American Diabetes Association (ADA) A1C goal: Less than 7%

• You and your doctor will set an A1C goal. This goal may change over time.

• Work with your doctor to reach a final goal less than 7%.

Get your A1C checked every 3 to 6 months*

Keep track of your A1C numbers on the chart below

• In the chart below, write down the date and your test result

• Write down when you should have your next test

• Fill in the circle on the graph closest to your test results

• Track your progress over time

My A1C goal:

Date:

Next test:

A1C number:

11.5%

11.0%

10.5%

10.0%

9.5%

9.0%

8.5%

8.0%

7.5%

7.0%

6.5%

6.0%

Know Your “Number!”

% % % % % %

* Ask your doctor how often you should get an A1C test


Tracking your A1C

This material was developed by GlaxoSmithKline.

©2011 The GlaxoSmithKline Group of Companies All rights reserved. Printed in USA. HM3257R0 December 2011

• 3 or 4 glucose tablets (buy at a drugstore)

• 1/2 cup (4 ounces) of fruit juice

• 5 or 6 pieces of hard candy

Wait 15 minutes.

What is low blood sugar (hypoglycemia)?

Low blood sugar is when your blood sugar level drops below 70 mg/dL. Low blood sugar can happen when you eat too little food or get too much exercise after taking diabetes medicines.

Some of the signs of low blood sugar include having or feeling:

• Shaky or clumsy • Hungry • Dizzy • Sweaty • Tingly mouth

• Confusion • A headache • A seizure • A sudden change in mood

What to do about low blood sugar:

• Check your blood sugar using a blood sugar meter if you think your blood sugar is too low

If you have low blood sugar often, talk to your healthcare provider about changing your diabetes care plan. Please fill out in case of an emergency:

Healthcare Provider: Phone:

If you need medical help or an ambulance right away,

have someone call 911 or your local emergency number.

2

3 Check your blood sugar again. REPEAT steps 1-3 until your blood sugar is above 70 mg/dL.

• 1/2 cup (4 ounces) of regular (not diet) soft drink

• 8 ounces of milk

• 1 tablespoon of sugar or honey

When in doubt, treat for low blood sugar!

1 Quickly raise your blood sugar by taking some form of sugar. Take ONE of these:

Diabetes & low blood sugar


©2012 The GlaxoSmithKline Group of Companies All rights reserved. Printed in USA. HM3350R0 June 2012

Taking your diabetes medicine as directed by your healthcare provider is one of the most important things you can do to help manage blood sugar.

There are different types of diabetes medicines. Each one works in a different way to help manage blood sugar. Over time, you may need more than one kind of medicine to manage your diabetes. It may take a while before the medicine takes effect. Even when your diabetes is managed, you may need to keep taking your medicine for a long time.

Talk with your provider about your medicines, and make sure you understand:

• Strength of medicine

• When to take it

• What your pill looks like

• How much you should take

• What you take it for

• Any special instructions

Not taking your medicine as directed by your provider means:

• Your medicine may not work the way it should

• Your blood sugar may go up

• You may be at risk for serious health complications, such as heart attack and stroke, eye problems, foot problems, amputations, and kidney problems

Talk with your provider if you have questions about your medicine or how to take it.

Name of medicine How much I take When I take it What I take it for

From this provider

On this date

Medicine name 1 tablet Before breakfast

and dinner

To lower my blood sugar

Dr. Jones

May 31, 2012

Sometimes it is easy to forget to take medicines. Here are some tips:

If you often forget to take your medicine:

• Use a pill box marked with the days of the week. Take it with you when you are away from home

• Wear a watch. Set an alarm. Leave yourself a note on the bathroom mirror

• Keep your medicine in a place where you will see it every day

If you forget to refill your medicine on time:

• Write “refill medicine” on your calendar about a week before your medicine will run out

• Make sure you have enough refills to last you until your next provider visit

• Ask your pharmacy to send you reminders to refill your prescription

• Use reminder notes to remember to take your medicine

Even if you feel fine, you need to take your medicine as directed by your provider. This may help

to prevent or reduce the risk of serious health problems.

Taking your diabetes medicine as directed by your healthcare provider is one of the

most important things you can do to help manage blood sugar. Work with your

provider to find ways to take your diabetes medicine every day as directed.

Taking your medicine as directed

Be aware of carbohydrates

Carbohydrates are found in grains and starches, fruits and vegetables, milk and yogurt.

These foods are important to a healthy diet, but they may raise blood glucose (sugar) quickly. What kind of carbohydrates you eat will affect how high your blood sugar will go.

Balance your plate for healthy meals

Eat more vegetables, smaller portions of lean meat, and starches like a potato.

Space meals and healthy snacks to help control blood glucose levels throughout the day

Timing is important! Work with your doctor, nurse, or diabetes educator to set times for your meals and snacks.

Sample Meal/Snack Times

My breakfast time

My lunch time

My dinner time

My snack time


MEAL 1/4 plate starch 1/4 plate protein 1/2 plate vegetable

= + +

Basics of healthy eating

South Eastern Florida Regional Diabetes Program Diabetes Education Service

1450 Northwest 10th Avenue, Miami FL, 33136 Phone: 305‐243‐3696

Fax:305‐243‐5791 © 2009

D

Carbohydrate Counting

o you know what foods have the greatest impact on your blood sugars? If you an‐ swered CARBOHYDRATE FOODS...you’re right! Carbohydrates are broken down into

glucose, so if you eat too much of them, your blood sugar level may rise. For this reason, people with diabe‐ tes find it helpful to keep track of the “carbs” they eat in order to manage their blood sugars. This is referred to as “Carb Counting.” Food that contain carbohydrate include starch, fruit, milk, and yogurt.

Carb counting is easy, it just takes some practice at first.

Rule 1: If a food has a label, use it. The Nutrition Facts Label (see reverse for sample label) on a food package is the most reliable way to understand what you are eat‐ ing. First look at the Serving Size. The numbers listed on

the label are based on this amount of the food. Then look at The Total Carbohydrate. This is the most important information to you. Included in this

amount are: dietary fiber and sugars.

Rule 2: If a food has more than 5 g of fiber, you may con‐ sider subtracting the fiber from the total amount of car‐ bohydrate. Dietary Fiber is a carbohydrate that is not digested and therefore does not raise blood glucose like sugar does.

Rule 3: Sugar Alcohols are not completely absorbed in the blood. Therefore we normally subtract half the amount of sugar alcohols from the total carbohydrate amount. Due to the reduced effect on blood sugar and because it has less calories than sugar, it is often used as

Rule 4: If a food does not have a label, use measuring tools. Measuring food with cups, spoons, or food scales helps to deter‐ mine the amount of carbohydrate. The fol‐ lowing will provide approx 12—15 g carbo‐ hydrate: 1 oz in weight of bread, cereal, rice*, or

pasta* 1/3 cup rice*, pasta* 3/4 cup dry cereal 4‐6 saltine crackers 1 slice bread 1/2 cup beans*, lentils* 1 small fruit 3/4 cup berries 1 cup low fat milk 6 oz light yogurt * Should be measured after cooking

a sweetener in diet foods.

South Eastern Florida Regional Diabetes Program Diabetes Education Service

1450 Northwest 10th Avenue, Miami FL, 33136 Phone: 305‐243‐3696

Fax:305‐243‐5791 © 2009

less than 20 g of saturated fat, and less than 2400 mg of sodium per day to maintain good heart health.

Vitamins and minerals are healthy compounds that play an important role in many body processes, and so getting adequate amounts is important. Fiber is good in that it makes you feel satisfied for a longer time after a meal and it has less of an effect on blood sugars. Aim for 20‐30 grams of fiber each day.

Remember, the Nutrition Facts label is the best way to understand what you are eating, so use it!

Food Labels are Important

Reading food labels is easy and it provides you with good information. Here’s how to make sense of it…

The first thing to look at is Serv‐

ing Size. The information printed on this label is based on 1 cup of that food. If you were to have double the serving size, then you would have to double the num‐ bers.

Next, be aware of the Calories. Calories matter when con‐ sidering weight manage‐ ment. If you are trying to lose weight be conscious of the calorie content in foods. In the label above, 1 cup of this product will give is 250 calories, and 2 cups will give us 500 calories.

It is also important to look at fat and sodium content when trying to make healthier food choices. It is best to limit foods high in choles‐ terol, saturated fat, and so‐ dium. Try to consume less than 300 mg of cholesterol,

Ready, Set, Start Counting!

Carbohydrate Counting — a Tool to Help Manage Your Blood Glucose When you have diabetes, keeping your blood glucose in a healthy range will help you feel your best today and in the future.

Carbohydrate counting — or “carb counting” — is a flexible meal-planning tool (not a diet) that helps you understand how your

food choices affect your blood glucose level.

Carbohydrate and blood glucose

Any carbohydrate food you eat (e.g., milk, fruit, bread and

pasta) is digested into glucose, which causes your blood

glucose level to increase. That said, it’s still important to eat

carbohydrates throughout the day because they provide

energy and essential nutrients for your body. To better

manage your blood glucose, energy levels and weight, pay

attention to how much carbohydrate you eat.

Maintaining the right balance between carbohydrate and

insulin (whether you make it or take it) regulates your blood

glucose level. Determining when and how much you eat

— and whether or not you have snacks — should be based

on your lifestyle, medications and meal-planning goals. A

Registered Dietitian (RD) may consider the following factors

in helping you determine the healthiest plan for you:

y Consistency: If you use diabetes medications or insulin,

it is important to eat the same amount of food and

carbohydrate at the same time each day. Doing this

can keep your blood glucose from getting too high

or too low.

y Maximums: Setting a meal-time maximum for

carbohydrates along with focusing on a healthy lifestyle,

and/or taking diabetes medications, is another way you

can help keep your blood sugar from getting too high.

y Matching: If your insulin plan includes varying your dose

based on what you are eating, it is important to know

how much carbohydrate you are eating.

Carbohydrate choices and portion sizes

• A “carbohydrate choice” is a portion

of food, like a slice of bread, that has 15

grams of carbohydrate (1 carbohydrate

choice = 15 grams of carbohydrate).

The total carbohydrate from any food

has about the same effect on blood

glucose.

• Small portions of sweets or sugar can

occasionally be used in place of other

carbohydrate-containing food.

• Measure or weigh foods to learn what common portion sizes

look like. If you do not have access to a scale or measuring

cups, refer to these hand-estimated illustrations.

Foods that contain carbohydrate: • Grains (e.g., breads, crackers, rice, hot and cold cereals,

tortillas and noodles)

• Starchy vegetables (e.g., potatoes, peas, corn, winter

squash, lentils and beans)

• Fruit and juices

• Milk and yogurt

• Sweets and desserts

Non-starchy vegetables (e.g., carrots, broccoli and tomatoes)

contain only a small amount of carbohydrates and will not

affect blood glucose when eaten in small portions.

1 Find the 3 Compare the

serving size. serving size listed to

your actual portion.

2 Locate the

total carbohydrate

in one serving.

(Sugars are

included in this

number, so you do

not need to count

them separately.)

4 Count the grams

of carbohydrate

or the number

of carbohydrate

choices. In this

example, 10 crackers

would have about

15 grams of carb and

equal 1 carb choice.

Learn how to read food labels

Here are tips to keep in mind when reading food labels. Remember:

Always compare the serving size listed to your actual portion.

Nutrition Facts

Serving Size 15 crackers (30g)

Servings Per Container about 14

Calories 130

Calories from Fat 30 Total Fat 3g 5%

Saturated Fat 0g

Cholesterol 0mg 0%

Sodium 160mg 7%

Total Carbohydrate 22g 7% Dietary Fiber 2g 8%

Sugars 3g

Protein 3g –

Vitamin A 0%

Vitamin C 0%

Calcium 2%

The number of carbohydrate

choices you need depends on

your body size, activity level and

weight-management goals.

Determine carbohydrate choices online

When a nutrition label is not available, often you

can find the information online.

1. Locate the name of the company that

produced or packaged the food, then

visit its website.

2. Refer to a reliable website that provides

nutrition information, such as:

a. Calorie King (www.calorieking.com)

b. The USDA National Nutrient Database

(http://www.nal.usda.gov/fnic/foodcomp/search)

c. MyFoodAdvisor

(http://tracker.diabetes.org/explore)

3. Visit the home page of your preferred search

engine (like Google or Bing) and enter the key

words “nutrition information for ____ (the

name of the food you are looking for)” in the

search window.

4. Download a nutrition app onto your cell

phone such as:

a. My Food-a-Pedia

(http://apps.usa.gov/myfood-a-pedia)

b. MyFitnessPal

(http://www.myfitnesspal.com/mobile)

5. Check out your favorite chain restaurant’s

nutrition information on their website so you

can stick to your plan when you are eating

away from home.

Food lists

The lists below provide a basic idea of the carb count in common foods. Each portion is one carbohydrate choice (15 grams of

carbohydrate). Foods with fewer than 20 calories and fewer than 5 grams of carbohydrate are considered “free.” These include

sugar-free beverages, sugar substitutes, spices and seasonings.

Breads, Grains and Cereals Milk and Yogurt Fruits Vegetables and Beans Sweets and Snack Foods

1 ounce bread product (1 slice bread, ¼ large bagel, 6” tortilla)

1/3 cup cooked rice or pasta

1 cup soup

¾ ounce unsweetened cold cereal (serving sizes vary, check label)

½ cup cooked cereal

3 cups air-popped popcorn

1 cup milk

1 cup low-fat or skim milk, or low-fat or fat- free plain yogurt

6 ounces flavored yogurt made with low- cal sweetener (these vary, check label)

1 small piece fresh fruit

½ medium fruit (apple, banana)

½ cup canned fruit in own juice

1 cup melon

½ cup fruit juice

2 TBSP dried fruit

1 cup raspberries

1 ¼ cup strawberries

¾ cup blackberries, blueberries

½ cup potato, sweet potato, peas, corn

½ cup cooked beans, legumes (garbanzo, kidney, black beans)

1 cup winter squash

1 ½ cups cooked vegetables (small portions of non-starchy vegetables are free)

¾ ounce snack food (pretzels, 4-6 crackers)

15 potato chips

1 ounce sweet snack (2 small sandwich cookies, 5 vanilla wafers)

1 TBSP sugar or honey

½ cup regular ice cream

http://www.nal.usda.gov/fnic/foodcomp/search)

http://tracker.diabetes.org/explore)

http://apps.usa.gov/myfood-a-pedia)

http://www.myfitnesspal.com/mobile)

How much to eat?

Women Many women need about

3-4 carbohydrate choices

(45-60 gram) at each meal

Men Many men need about

4-5 carbohydrate choices

(60-75 gram) at each meal

My Individual Carbohydrate Goals

Carb choices for common serving sizes

• 1 regular sandwich = 2 carb choices,

or about 30 grams of carbohydrates

• 1 6” sub sandwich = 3 carb choices,

or about 45 grams of carbohydrates

• 1 cup cooked rice or pasta =

3 carb choices, or about 45 grams

of carbohydrates

• 1 medium (average) apple or banana

= 2 carb choices or about 30 grams

of carbohydrates

Better carb choices

All carbs are not alike. Choose better carb

choices, such as whole grains and less-

processed foods.

• Select whole grain bread, whole

grain pasta and brown rice over white

(refined) varieties.

• Experiment with many types of whole

grains, including barley, oatmeal,

quinoa and bulgur.

• Go for whole fruits instead of fruit

juice or sugary foods.

• Opt for beans and other legumes.

• Select a variety of vegetables such

as cauliflower, tomato, carrots and

spinach (most vegetables are great

choices).

Healthy eating is about more than

just counting carbohydrates. It is

important to eat balanced meals

with an emphasis on vegetables

and fruits.

Eat a variety of foods, including:

• at least 5 servings of fruits and

vegetables

• at least 3 servings of whole

grains

• 2–3 servings of low-fat or fat-

free dairy

Foods in the protein (including meat, poultry and fish) and fat groups do not directly

affect blood glucose. However, to keep your heart healthy, some healthy fats (like

those found in nuts, seeds and fish) can be helpful.

© 2011 Diabetes Care and Education Dietetic Practice Group. Permission to reproduce for non-profit educational purposes granted through 2014.

This handout has been authored by Susan Wang, MS, RD, CDE and Belinda O’Connell, MS, RD, CDE. It is meant to help you get started in carb counting. For a referral to an RD, or for more

information on meal planning and advanced carbohydrate counting, contact the Diabetes Care and Education Practice group, at www.dce.org, or the American Dietetic Association at

www.eatright.org, or 1-800-877-1600.

Dinner

1 cup pasta 3 carb choices

½ cupredsauce withmeat 1 carb choice

1 piece bread 1 carb choice

1 large green salad

Dinner

1 piece of chicken

1 cup winter squash 1 carb choices

1 small fruit 1 carb choice

1 -2 cups broccoli 1 large green salad

0-1 carb choice

1 cup skim milk 1 carb choice

Lunch

1 cup brown rice 3 carb choices

1-2 cups chicken and veggie stir fry 0-1 carb choice


Lunch

1 sandwich 2 carb choices


1-2 cups veggies 0-1 carb choice

Breakfast

2 slices whole grain toast 2 carb choices

1 teaspoon light margarine

1 egg omelet with spinach and mushrooms

1 small orange 1 carb choice

Carbohydrate Time

choices or grams

Breakfast

Snack

Lunch

Snack

Dinner

Snack

TOTAL

Breakfast

1 small orange 1 carb choice

1 cup cooked oatmeal

made with water 2 carb choices

1 cup fat-free milk 1 carb choice

2 tablespoons nuts

2 tablespoons raisins 1 carb choice

http://www.dce.org/

http://www.eatright.org/

©2009 The GlaxoSmithKline Group of Companies All rights reserved. Printed in USA. HM2267R0 July 2009

Eating healthy is an important part of managing diabetes.

Follow these simple tips when shopping for groceries:


Take charge of what you eat. Grocery-shop smart to help you and your family make healthy food choices.

Choose wisely:

Buy a variety of fruits and vegetables

• Get frozen, canned, or fresh fruits like melons, berries, or oranges.

• Choose canned or frozen fruit without added sugar or syrup.

• Buy fresh leafy dark-green vegetables like broccoli or spinach.

• Buy orange vegetables like carrots or squash.

• Choose frozen vegetables without added salt, butter, or sauces.

Choose calcium-rich foods

• Buy low-fat or skim milk.

• Try kale or collard greens because they contain calcium.

Buy whole grain products

• Try whole wheat bread, crackers, cereals, brown rice, oatmeal, and barley.

Go lean with protein

• Buy lean meats like chicken without the skin and low-fat ground beef.

• Try different types of protein like fish, nuts, seeds, beans, and peas (like pinto beans, split peas).

Diabetes and grocery shopping

Before you

go to the store:

• Make a grocery list.

• Eat something. If you are hungry, you may buy food you do not need.

Once you are shopping:

Stay in the outer aisles of

the store

• This is where the fresh foods are kept. Processed foods (like canned foods) often have more salt in them and can be found in the inner aisles.

Read and compare

food labels

• Choose foods that have fewer calories and are lower in:

— Saturated fat

— Trans fat

— Cholesterol

— Sodium (salt)

— Sugars


Exercise—It’s Good For Life!

Exercise can help you:

• Lower your blood sugar

• Lower your blood pressure

• Control your cholesterol

• Lose weight (with healthy food choices)

• Lower risk for heart disease and stroke

• Lessen stress

• Make your body stronger

What counts as exercise?

Anything that gets you moving counts as exercise. You can:

• Walk

• Dance

• Work in the house or yard

• Take the stairs

• Go to aerobics classes

• Ride a stationary bicycle

• Swim, skate, or play tennis

Plan for success!

Be safe and have fun:

• Talk with your doctor about what activities are right for you

• Know low blood sugars and what to do about them

– Have a plan of action if your blood sugar falls below 70 mg/dL

• Check your blood sugar before and after activity

– Eat a snack if your number is below 100 mg/dL

– Don’t exercise when it is above 300 mg/dL

• Try to be active about 30 minutes a day at least 5 days a week

– Start slowly and work up to 30 minutes

– Be active in smaller amounts at different times of the day

• Drink water before, during, and after activity

• Warm up and cool down for 5-10 minutes

• Wear shoes that fit well and clean, dry socks

• Check your feet for redness or sores after activity

Always talk with your doctor before you begin an exercise program.

Exercise and Diabetes

Module 2

Diabetes; Your Plan of Care


Take advantage of the health benefits your Diabetes Care Team can give you!

There are a number of things you can do to take care of your diabetes. Talk to your

doctor about watching what you eat, taking your medicines, checking your blood sugar,

and exercising.

Your doctor will help you manage your diabetes. Your doctor may also have you see

other healthcare specialists who may help you stay healthy. Think of these specialists as

your Diabetes Care Team.

Your Team Members

Here are some people who may be members of your Diabetes Care Team:

Primary Care Doctor—This is the doctor you will see for regular checkups.

Often people with diabetes will see a specialist in diabetes care called an

endocrinologist.

Diabetes Nurse Educator—This is usually a Registered Nurse (RN)

with special diabetes training who can help you with your diabetes care

questions.

Registered Dietitian—This person is trained to help you with making a meal

plan and answer any questions about what you eat.

Eye Doctor (Ophthalmologist)—This doctor will check your eyesight and

help treat eye problems.

Dentist (or Periodontist)—This doctor can help you with your mouth care,

especially gum problems.

Foot Doctor (Podiatrist)—This doctor is trained to help you with problems

with your feet or lower legs.

Social Worker/Psychologist/Psychiatrist/Marriage and Family Therapist—

They can help you with emotional stresses that can come with diabetes.

Exercise Physiologist—This specialist has training to help you set up an

exercise program.


Your Diabetes Care Team


Controlling blood sugar is important for people with type 2 diabetes.

Over time, high blood sugar can cause diabetes-related health problems. One way to measure blood sugar is by the A1C test.

My A1C goal is %

High blood sugar and...

Your eyes

You may get glaucoma, cataracts, or have problems with blood vessels in your eyes. These conditions may cause cloudy or blurry vision and even blindness. Have an eye exam every year. Call your doctor if you are having problems with your eyes.

Your gums and teeth

You may get gum disease. See your dentist at least twice a year. Tell your dentist you have diabetes. Brush your teeth at least twice a day. Floss daily.

Your heart and blood vessels

Diabetes can damage your blood vessels. You are more likely to have heart disease or a stroke. Have your blood pressure checked at every doctor visit. Have your cholesterol checked at least once a year.

Your kidneys

Diabetes may damage your kidneys. Make sure your doctor checks for kidney damage at least once a year.

Your feet

You may lose feeling in your feet. A cut or sore can become infected. Check your feet every day for cuts, blisters, sores, swelling, redness, or sore toenails. Call your doctor about any problems with your feet. Ask your doctor to check your feet at every visit.


Type 2 diabetes from head to toe

Diabetes

Prevent and Manage Complications—

What Else Can I Do?

High blood sugar can harm your body in many ways. It is important to keep your blood sugar

levels under control. You can do this with diet, exercise, and medicine. To see how well your

treatment plan is working, your doctor will check your A1C levels at least twice a year.*

You can help prevent and manage complications by taking these steps:

A Heart Attack and Stroke

• Have your blood pressure checked at every doctor visit.

• Have your cholesterol checked yearly.

High blood sugar levels can harm your blood vessels and raise your blood pressure.

This can lead to a heart attack or a stroke.

B Eye Problems

• Have a dilated† eye exam every year.

• Call your doctor right away if you notice any problems with your vision, like spots or blurriness.

High blood sugar can also harm the blood vessels in your eyes. This can lead to blindness.

C Foot Problems and Amputations

• Check your feet every day for cuts, sores, bumps, and/or red spots. Call your doctor if you

notice any changes.

• Take off your shoes and socks at every doctor visit to have your feet checked.

High blood sugar can lead to nerve damage, like a loss of feeling in your feet. When

this happens, a cut or sore can become infected badly before you know it. It may also

take longer for it to heal.

D Kidney Problems

• Your doctor should check your urine for small amounts of protein

(microalbumin) at least once a year.

• Your doctor should also check your serum creatinine levels once a year. This helps your

doctor know how well your kidneys remove waste (glomerular filtration rate, or GFR).

Your kidneys help remove wastes from your blood. Over time, high blood sugar can cause the

kidneys to stop working the right way. When this happens, wastes build up in your body and

good things (like protein) leak out. This can lead to kidney failure.

*The A1C test tells your average blood sugar level over the past 2 to 3 months. †Your eye doctor needs to dilate your eyes with eyedrops. This helps your doctor see the blood vessels in the back of your eyes.

© 2007 The GlaxoSmithKline Group of Companies All rights reserved. Printed in USA. HMI455R0 October 2007

Taking care of your diabetes every day may help you prevent and manage health problems

that diabetes can cause over time.

People with diabetes are more likely to get:

• Gradual vision loss (glaucoma)

• Cloudy eye lenses (cataracts)

• Damaged eye blood vessels (diabetic retinopathy)

Diabetes causes most new cases of blindness in adults every year. Most of the time, there are no early warning signs.

You can help avoid eye problems and blindness:

• Control your blood sugar

• Control high blood pressure

• Stop smoking

• See your eye doctor (ophthalmologist) for an eye exam at least once each year

Call your eye doctor if you:

• Have blurry vision or trouble reading

• Have eye redness that won’t go away

• See spots or floaters

• See double

• See straight lines that don’t look straight

• Have eye pain or pressure

• Can’t see things at the side of your eyes

Normal Vision

Damaged Vision

Eye problems can be treated by an eye doctor. But you also have a lot of control over what happens to your eyes.


©2011 The GlaxoSmithKline Group of Companies All rights reserved. Printed in USA. HM3271R0 December 2011

Eye care for people with diabetes


Foot care is important when you have diabetes. Controlling your blood sugar levels can help you avoid diabetes foot problems.

Here are some helpful tips:

• Check your feet daily. Look for red spots, cuts, swelling, and blisters. Use a mirror or ask for help if you cannot see the bottom of your feet.

– If sores don’t start healing after 1 day, call your doctor.

• Wear comfortable, well-fitting shoes and socks. Make sure there is nothing inside before you put them on.

• Never walk barefoot.

• Wash and carefully dry your feet daily.

• Use lotion to keep the tops and bottoms of your feet soft and smooth. Do not put lotion between the toes.

• Trim your toenails straight across.

• Protect your feet from too much hot and cold.

• Put your feet up when sitting.

• Don’t cross your legs for very long.

• Wiggle your toes and move your ankles up and down for 5 minutes at least 2 or 3 times a day.

Copyright 1999 Tim Peters and Company, Inc. Peapack, NJ 07977. All Rights Reserved.

Get a complete foot exam once a year, or more often if you have problems.

Take Care of Your Feet


Having diabetes means you may have more problems

with your teeth and gums.

Diabetes and dental health

When diabetes is not well-controlled, high sugar levels in your saliva (“spit”) may help germs grow. This may cause tooth decay or gum disease.

Having diabetes can also cause you to have:

• Mouth infections, like thrush • Poor healing in your mouth • Dry mouth

Get good dental care

• Tell your dentist that you have diabetes and any other medical condition.

• Eat before you see your dentist.

– The best time for dental work is when your blood sugar level is in a normal range.

– If you take insulin, a morning visit after breakfast is best.

• Stick to your meal plan after dental work.

– If you cannot chew well, plan how to get the calories you need.

– You may need to use your sick-day meal plan and eat more soft or liquid foods.

• Call your dentist if you have:

– Gums that bleed, are red, puffy, swollen, or sore

– Bad breath or a bad taste in your mouth

Take care of your mouth

• Control your blood sugar.

• Help get rid of the germs in your mouth by:

– Brushing for 2 minutes 2 times every day.

– Flossing every day using a clean piece of floss.

• Ask your dentist to show you how to brush and floss your teeth the right way.

• Have a dental checkup every 6 months, or as often as your dentist tells you.


Control your blood sugar levels and get regular dental checkups to help keep a healthy smile.

Diabetes and mouth care

If you have diabetes, you’re more likely to be at risk for or have:

• Heart disease

• Heart attack

• Stroke

But you can do things to help lower your risk for these conditions!

Good choices can help control blood sugar, blood pressure, and cholesterol

• Eat less fatty foods

• Use less salt

• Eat five servings of fruits and vegetables a day

• Cook the low-fat or no-fat way

• Be physically active

• Get to and stay at a healthy weight

• Quit smoking

To help lower your risk for heart disease and stroke:

• Take medicines regularly, as directed by your healthcare provider

• Ask your provider if taking aspirin, such as low-dose aspirin, is right for you

• Ask your provider about how other changes in the way you live can help lower your risk

Meet your goals!

The American Diabetes Association suggests that people with diabetes have the following goals. Work with your provider to see if these goals are right for you or to set your own goals.

A1C test goal: Below 7% My goal: %

Test at least twice a year, or every 3 months if you are not meeting your goal

Blood pressure goal: Below 130/80 mm Hg My goal: mm Hg

Check at every regular diabetes visit

LDL cholesterol goal: Below 100 mg/dL My goal: mg/dL

Check at least once a year, or more often if your provider tells you to


©2012 The GlaxoSmithKline Group of Companies All rights reserved. Printed in USA. HM3278R0 January 2012

Diabetes and the risk of

heart disease or stroke


© 2009 The GlaxoSmithKline Group of Companies All rights reserved. Printed in USA. HM2151R0 February 2009

Normal blood vessel

High blood

pressure caused

by stiff/narrow blood vessel

Use a goal checklist. Set goals that you are ready to reach.

High Blood Pressure

High Blood Pressure—What Is It?

How could I have high blood pressure? I feel fine.

High blood pressure is called a "silent killer" because it usually does not cause any symptoms. Learn more

about high blood pressure and how to treat it.

What is blood pressure?

Your heart pumps oxygen-rich blood through blood vessels to all parts of your body. Blood pressure is the

force of blood against the walls of your blood vessels. Normal blood vessels are wide open and the blood

moves freely. This leads to normal blood pressure.

What is high blood pressure?

• High blood pressure occurs when your blood vessels become stiffer

and more narrow.

• Your heart has to work harder to push blood through the blood

vessels to all parts of your body.

• If high blood pressure is not treated, it can lead to serious health

problems like heart attack and stroke.

What causes high blood pressure?

There are many risk factors for high blood pressure. Some of these risk

factors can be controlled and others cannot:

Taking care of high blood pressure every day

Talk to your doctor about the changes you can make to lower your blood pressure.

• Get your blood pressure checked at every visit.

• Limit alcohol intake.

• Follow a healthy diet that is low in salt (sodium) and fat.

• Start a regular exercise program.

• If you smoke, ask about ways to quit.

• Try to lose weight and keep it off.

• Take your medicine as directed.

“

“ Risk Factors You Cannot Control Risk Factors You Can Control

• Older age • Being overweight

• Family history of high • Drinking too much alcohol blood pressure

• Eating too much salt • Race (African Americans are at higher risk) • Inactive lifestyle

• Smoking

• Stress


© 2010 The GlaxoSmithKline Group of Companies All rights reserved. Printed in USA. HM2417R0 January 2010

140 90

High Blood Pressure

My Blood Pressure Numbers—

What Do They Mean?

Blood pressure is measured with a cuff that is wrapped around your arm and a pressure

gauge that reads 2 numbers.

The top number (systolic) is the blood pressure

when your heart is pumping.

The bottom number (diastolic) is the blood pressure

when your heart is resting.

What do your numbers mean?

Blood pressure goes up and down

throughout the day. But when your

blood pressure stays above a

certain level, it is called high blood

pressure or “hypertension.”

To manage high blood pressure, you have to stick with your treatment. Your doctor may want you to check

your blood pressure (BP) at home. Write down your numbers each time and share them with your doctor.

Goal*:

Date: Blood Pressure: Date: Blood Pressure: Date: Blood Pressure:

* In most people with high blood pressure, the BP goal is less than 140/90. In people who also have conditions such as diabetes, kidney disease, or certain kinds of heart disease, the BP goal is less than 130/80.

If your blood pressure is: You have:

Less than 120/80 Normal blood pressure

Between 120/80 and 139/89 Pre-hypertension (you are at risk for high blood pressure)

140/90 and above High blood pressure


© 2009 The GlaxoSmithKline Group of Companies All rights reserved. Printed in USA. HM2155R0 February 2009

Get emergency medical help right away if you thinkyou are having a heart attack: 1) Chest pain or discomfort 2) Upper body (ie, shoulder, arm, or jaw) discomfort 3) Shortness of breath 4) Cold sweats, nausea, or light-headedness

High Blood Pressure

My Blood Pressure Goals—

What Are They?

You are the most important person in managing your blood pressure. Talk with your doctor to help you choose one or more goals you are ready to work on now.

Diet

I will eat a heart-healthy diet that is low in salt and fat.

My sodium goal will be mg per day.

I will limit the amount of alcohol I drink.

Exercise

I will exercise for

minutes

days per week, if my doctor tells me it is safe.*

My doctor and I agree that the best activities for me are .

If I notice chest pain, shortness of breath, or chest tightness, I will get emergency help.

Stop Smoking

I will ask my doctor about ways I can quit smoking.

I will think of all the reasons why I should quit and then take the steps to quit.

If I start smoking, I will try to quit again.

Medicine

I will take my blood pressure medicine(s) as directed.

I will call my doctor if I have problems.

I will ask questions when I do not understand.

EMERGENCY:

Check Blood Pressure

I will have my blood pressure checked at every doctor visit.

I will reach my blood pressure goal of .

Doctor Visits

I will keep my doctor appointments even when I feel fine.

I will ask my doctor questions when I do not understand something.

Asking for Help

I will ask for help when I need it.

I will make time for myself.

I will let my doctor know if I feel sad or blue.

*Some medical conditions may make exercise dangerous for some people. Before starting any exercise program, talk to your doctor.



Normal blood vessel

High cholesterol

and other fats

reduce blood flow

Lipids

Lipids—What Are They?

My doctor said my lipids are high. Should I be worried?

Lipids are fats found in your blood. Cholesterol and triglycerides are 2 types of lipids. Here are some

things you should know.

What is cholesterol?

Your body needs some cholesterol, but you can have too much. When you have too much cholesterol, it can

build up on the walls of your blood vessels and lead to heart disease.

• Blood brings needed oxygen to your heart.

• When blood vessels, like arteries, get blocked by lipids, it is hard for

blood to move through the blood vessels.

• If an artery in the heart gets completely blocked, then your heart does

not get the oxygen it needs.

What are triglycerides?

Your body stores fats as triglycerides for later use as energy. When you

have too much fat in the blood, it can lead to serious medical conditions.

Am I at risk for heart disease?

Along with lipid levels, there are many other risk factors for heart disease.

As the chart shows, many of these risk factors can be controlled.

Taking care of lipids every day

Talk to your doctor about the changes you can make to lower your risk of heart disease.

• Follow a healthy diet that is low in fat.

• Start a regular exercise program.

• If you smoke, ask about ways you can quit.

• Try to lose weight and keep it off.

• Take your medicines or supplements as directed.

Use a goal checklist. Set goals that you are ready to reach.

“

“ Risk Factors You Cannot Control Risk Factors You Can Control

Age

– You are a man 45 or older

– You are a woman 55 or older

Family History

– Your father or brother had

heart disease before age 55

– Your mother or sister had

heart disease before age 65

High cholesterol and triglycerides

High blood pressure

Diabetes

Being overweight

Cigarette smoking

Lack of exercise



100-129 Good

160-189 High

150-199 Somewhat high

LDL Cholesterol

Less than 100

What It Means

Very good


190 and above Very high

HDL Cholesterol

60 and above

Less than 40

What It Means

May protect against heart disease

Major risk factor for heart disease

Triglycerides

Less than 150

What It Means

Normal

200-499

500 and above

High

Very high

Lipids

My Numbers—Ask About Each One Keep track of your lipid numbers in the chart below. Compare your numbers to the chart on the left. Ask your doctor what your goal numbers should be.

From the National Heart, Lung, and Blood Institute.

• Total cholesterol is the amount of all cholesterol in your blood. The higher the number, the greater your risk for heart disease. Your doctor may want you to lower this number.

• LDL cholesterol is the "bad cholesterol" that sticks to your blood vessels and blocks blood flow. Your doctor may want you to lower this number.

• HDL cholesterol is the "good cholesterol" that prevents cholesterol from sticking to your blood vessels. Your doctor may want you to raise this number.

• Triglycerides are a type of fat that your body stores for later use as energy. When you have too much fat in your blood, it can lead to serious medical conditions.

LDL Cholesterol

Date Result Goal

Total Cholesterol

HDL Cholesterol

Triglycerides

Total Cholesterol What It Means

Less than 200 Good


240 and above High


With diabetes, you can have nerve damage

Having high blood sugar for a long time can damage your nerves and lead to a number of problems.

Nerve damage in your feet and hands may cause:

• Tingling

• Pain

• Numbness

• Weakness

Nerve damage in other parts of the body may cause:

• Bladder problems

• Problems with sexual function

• Feeling dizzy or faint

• Too much or too little sweating

• Throwing up, diarrhea, or constipation

• Feeling full or sick to your stomach

Skin problems are more common for people with diabetes

Some of the skin problems include:

• Itchy skin

• Styes on eyelids

• Boils or infections at hair roots

• Infections deep under the skin or at nails

• Jock itch, athlete’s foot, ringworm, and vaginal infections

Things you can do to help avoid nerve damage and skin problems

• Control your blood sugar • Do not smoke

• Limit how much alcohol you drink • Take care of your feet

• Keep skin clean and dry • Treat cuts right away

• Don’t take very hot baths and showers • Don’t let your skin get dry

• Keep your home more humid in cold, dry weather

It is good to catch problems early. Tell your doctor if you have any signs of nerve damage and skin problems.

Nerve damage and

skin problems


Diabetes can affect a man’s sex life. Diabetes can lead to erectile dysfunction (ED). ED means it is hard to have or keep an erection.

Men with diabetes:

• Are two times more likely to have ED

• Experience some degree of ED 10 to 15 years earlier than men without diabetes

Just because you have diabetes does not mean you will get ED. But if you do, there are ways to treat ED!

In addition to diabetes, ED can be caused by:

• Poor blood supply or nerve damage to penis

• Prostate or bladder surgery

• Some medicines for treating blood pressure or depression

• Smoking

• Weighing too much

• Lack of activity

• Stress

• Depression

• Too much worrying about ED

• Guilt

• Low self-esteem

You can help yourself!

You may be able to avoid ED if you:

• Stop smoking

• Lose weight

• Be more active

ED is not the end of your sex life

There are many ways to treat ED, such as:

• Counseling and life changes

• Medicines taken by mouth or injection

• Vacuum aids

• Surgery, including implants

Talk with your doctor to find out what treatment is best for you.

• Ask your doctor if ED is a side effect of any of your medicines.

Talk to your doctor before changing your medicine or treatment regimen.

Sexual health for

men with diabetes


As many as 1 out of 3 people with type 2 diabetes may have symptoms of depression

Depression is more than just feeling sad once in a while and then feeling better. You may have depression if you have some of the signs listed below that last most of the day for at least 2 weeks.

Do you have symptoms of depression?

Do you always feel sad, anxious, or down?

Do you have no hope and think things will not get better?

Do you feel guilty, helpless, or like you are not worth anything?

Do you have no interest in hobbies or things you like to do, including sex?

Do you have less energy? Do you feel tired or slowed down?

Do you find it hard to think, remember, or decide?

Do you have a hard time sleeping, wake up early, or sleep too late?

Do you eat differently, or has your weight changed?

Do you think of death or killing yourself?

Do you feel restless or irritable?

Yes No

Do you have 5 or more of these signs every day for at least 2 weeks? Do they make it hard to do regular daily activities? If you think you may have depression, talk to your doctor.

Depression can be treated

Depression can make it harder for you to take care of your diabetes.

The good news is that depression can be treated with medicines and counseling. Your doctor can help you decide what to do if you have depression.

Your doctor may prescribe medicines to help you with your depression. If you take a medicine for depression, make sure you tell all your doctors. Always talk to your doctor before stopping or changing any of your medicines.

Remember, you can get help if you have depression!

Diabetes and depression


Why should I have a sick-day plan?

• Being sick with a cold, flu, or stomach problems can make your blood sugar levels go up very high.

• A sick-day plan helps you know what to do when you are sick.

Make a sick-day plan

Work with your doctor so you will know:

• When to call your diabetes care team, and what to tell them.

• How often to test your blood sugar and urine.

• Which medicines to take.

• What and when to eat and drink.

Call your doctor if you:

• Have been sick or have had a fever for 2 or more days.

• Have been throwing up or having diarrhea for more than 6 hours.

• Have tested your blood sugar and it is higher than your doctor wants it to be for more than 1 day.

• Have any of the following symptoms that may be more serious:

• Chest pain • Trouble breathing • Fruity breath • Dry, cracked lips or tongue


Work with your doctor to make a sick-day plan. Follow your sick-day plan when you do not feel well so that a simple illness does not become serious.

When you are sick, you still need to take your diabetes medicines. Even if you are throwing up, keep taking your medicines. You need to take your diabetes medicines because your body makes extra sugar when you are sick.

Diabetes and your sick-day plan

Module 3

Healthy Living with Diabetes


Eating the right kinds of food is an important part of your diabetes management plan.

Vegetables (such as lettuce, broccoli, vegetable juice, peppers, carrots, green beans, salsa, chilies, greens)

• Eat for vitamins, minerals, and fiber without many calories

• Eat raw or cooked, but go easy on fat, sauces, or dressings

Grains (such as bread, pasta, corn, potatoes, rice, crackers, tortillas, beans, yams)

• Eat some “starchy foods” at every meal

• Choose whole-grain breads and cereals

Fruits (such as apples, juices, strawberries, bananas, raisins, oranges, mango, guava, papaya)

• Choose pieces of fruit more than fruit juice

• Eat raw or cooked fruit, juice with no sugar added, canned in their own juice, or dried

Milk and Yogurt

• Drink fat-free (skim or nonfat) or low-fat (1%) milk

• Try low-fat or fat-free yogurt made with a low-calorie sweetener

Meats and Meat Substitutes (such as chicken, fish, beef, eggs, peanut butter, tofu, cheese, ham, pork)

• Choose meat with only a little fat on it

• Cook eggs with just a little oil or use cooking spray

• Use low-fat or fat-free cheese

Fats, sweets, and alcohol

• Limit solid fats like butter, margarine, shortening, and lard

• Keep servings of sweets small. Save them for a special treat

• Talk with your doctor about how alcohol fits in with your meal plan

Talk with your doctor or dietitian about

• How many servings from each food group you should eat each day

• The best way to prepare foods

Work with your doctor and dietitian to make good food choices that help you manage your diabetes.


Nutrition and Diabetes

Eat healthy... Eat vegetables, fruits,

Hea Hea

and whole-grain foods

Hints rt lth

Vegetables, fruits, and whole-grain foods are heart-healthy because they are low in calories and have lots of

fiber. Add more fiber to your diet by eating:

Servings Sample serving sizes (USFDA MyPyramid, 2000 calories a day)

Whole Grains 6 ounces 1 slice bread; 1 cup ready-to-eat cereal; 1/2 cup cooked brown rice, cooked cereal, or wheat pasta

Vegetables 21/2 cups 2 cups raw leafy vegetables; 1 cup cut-up raw or cooked vegetables; 1 cup vegetable juice

Fruits 2 cups 1 cup fresh, frozen, or canned fruit; 1/2 cup dried fruit; 1 cup 100% fruit juice

Make smart choices for your meals • Choose whole-grain foods made of whole wheat, oats, oatmeal, rye, barley, or corn.

Try brown rice, wild rice, buckwheat, or cracked wheat

• Choose fresh or frozen vegetables and fruits without high-calorie sauces and added salt and sugars

• Choose fruits, vegetables, or popcorn for snacks instead of junk food like chips, cookies, or doughnuts

Try this simple pasta recipe Makes six 3/4-cup servings*

Ingredients:

Olive oil – 2 tablespoons

Small chopped onions – 2

Chopped garlic – 3 cloves

Sliced zucchini – 11/4 cup

Dried oregano – 1 tablespoon

Dried basil – 1 tablespoon

No-salt-added tomato sauce – 1 8-ounce can

No-salt-added tomato paste – 1 6-ounce can

Instructions: • Heat oil in medium skillet

• Sauté onions, garlic, and zucchini for 5 minutes, medium heat

• Add other ingredients, cover, and simmer 45 minutes

• Serve over whole-wheat spaghetti or other pasta

Nutritional information per serving*:

102 calories

5 grams total fat

1 gram saturated fat

0 mg cholesterol

260 mg sodium 5 grams total fiber

3 grams protein

14 grams carbohydrates

623 mg potassium

Chopped medium fresh tomatoes – 2

Water – 1 cup

*Sauce only, not including pasta

Find more heart-healthy recipes in special cookbooks or Web sites like:

✓ American Heart Association at www.americanheart.org

✓ American Diabetes Association at www.diabetes.org

✓ National Heart, Lung, and Blood Institute at www.nhlbi.nih.gov


©2008 The GlaxoSmithKline Group of Companies All rights reserved. Printed in USA. HM2058R0 October 2008

Photograph by Enrico Corno

http://www.americanheart.org/

http://www.diabetes.org/

http://www.nhlbi.nih.gov/

No matter what kind of food you like, adding spices can make it tastier without adding excess salt or too many calories. Here are some examples:

Asian Mexican

light soy sauce ginger garlic cumin peppers tomatoes

Southern Italian

low-sodium hickory onion and olive oil garlic tomatoes chicken broth smoke pepper

Healthy cooking choices

Favorite dishes Old way of cooking Healthy choice

Chicken, fish, and Fried in hard grease • Pan-fry with a small amount of oil and shrimp or in deep fat then bake until done

• Marinate or season and then grill

• Stir-fry with vegetables

Southern-style Boiled with fat meat • Steam the greens, add smoked greens turkey or lean ham hock

• Steam the greens and season with hickory smoke and chicken broth

Refried beans Pinto beans fried with lard • Use pinto beans and a small amount of oil or vegetable shortening • Use canned low-fat refried beans

Other ways to bring out flavor

• Add lime to seafood

• Add mustard to chicken or tuna

• Use herb-infused oils (rosemary, basil)



Spice up your food with flavor

Hints Heart Health

Healthy eating with less salt

How much salt (sodium) should you have each day? • Most people should have less than 2300 mg (about 1 teaspoon)

• People who have heart failure should have no more than 2000 mg

Learn to cook using less salt You can lower the amount of salt you eat if you:

• Compare food labels and choose the one with the least amount of salt (sodium)

• Choose low-salt or no-salt options for sauces and seasonings

• Eat fewer processed meats that are high in salt such as hot dogs and many lunch meats

• Do not cook using salt, bouillon cubes, or meat tenderizers

• Season food with lemon juice, vinegar, and herbs

• Rinse and drain canned foods before use

• Use fresh fruits and vegetables whenever possible

• Taste your food before adding salt

Try this low-salt meat loaf recipe Makes six 11/4"-thick slices

Ingredients:

Extra-lean ground beef – 1 pound 4 ounces of tomato paste – 1/2 cup Chopped onions – 1/2 cup

Green peppers – 1/2 cup Fresh, blanched, chopped tomatoes – 1 cup Low-salt mustard – 1/2 teaspoon (tsp) Ground black pepper – 1/2 tsp Chopped garlic – 2 cloves Chopped scallion – 2 stalks

Ground ginger – 1/2 tsp

Instructions:

• Mix everything together

• Put in 1-pound loaf pan (drip rack is preferred)

• Bake covered for 50 minutes at 350° F

• Uncover and bake for 12 more minutes

Nutritional information per serving:

193 calories 9 grams total fat

3 grams saturated fat

45 mg cholesterol 91 mg sodium

2 grams total fiber

17 grams protein 11 grams carbohydrates 513 mg potassium

Ground nutmeg – 1/8 tsp Grated orange rind – 1 tsp Crushed thyme – 1/2 tsp

Finely grated bread crumbs – 1/2 cup

Find more heart-healthy recipes in special cookbooks or Web sites like:

✓ American Heart Association at www.americanheart.org

✓ American Diabetes Association at www.diabetes.org

✓ National Heart, Lung, and Blood Institute at www.nhlbi.nih.gov



Photography by Gabor Palla



http://www.nhlbi.nih.gov/


Hints Heart Health

Are you overweight? Plan to be healthy!

If you have too much fat — especially around your waist — there is more of a chance you may have

health problems. These problems include heart disease, high blood pressure, high cholesterol, stroke, and

type 2 diabetes.

Am I overweight? To see if you are overweight, your doctor may use what is called a Body Mass Index (BMI). BMI compares

your height and weight. It shows if you are underweight, at a healthy weight, overweight, or obese.

Your doctor may also measure your waist. Knowing both your BMI and your waist size will tell you if your

weight is in a healthy range. It can also help you plan your weight loss goals.

You may be overweight if: Your BMI (kg/m2) is Or your waist size is

For a Woman 25 or more 35 inches or more

For a Man 25 or more 40 inches or more

What can I do? Eating healthy foods and being more active can help you lose weight and keep it off. Losing just 10-20 pounds

can help lower your health risks!

Eat healthy foods — Work with your doctor or dietitian to come up with a healthy eating plan.

Your plan should include:

• Foods you like to eat

• Different kinds of food

• The calories and nutrients you need to be healthy

Be more active — Work with your doctor to make a plan to get regular physical activity. If your doctor

agrees, almost every day you should get at least 30 minutes of moderate-intensity exercise, like taking a brisk

walk. This 30 minutes of exercise does not need to be done all at one time. Being a little active is better than

not being active at all.

If you think you may be overweight, talk to your doctor about a plan

to be healthier.



Hints Heart Health

Building heart- healthy habits for exercise and diet

Make changes one step at a time When you have heart disease, or are at risk for it, it can mean making some changes. Where do you start? You can

start by taking a single step. With practice each day, you may find that your heart-healthy change has become a heart-

healthy habit. Read the tips below. Check off 1 or more to try.

Tips for healthy eating Try to eat foods that are low in salt. Eat fresh fruits and vegetables as part of your meals and snacks.

If you usually . . . Try this instead . . .

Eat a cookie for dessert Eat an apple

Deep-fry your chicken Grill or broil your chicken

Use salt to season your food Season your food with herbs, spices, or lemon

Drink regular soda Drink water or seltzer

Drink whole milk Drink low-fat or fat-free milk

Eat everything on your plate in a restaurant Cut your portion in half. Take the rest home

Talk to your doctor about making heart-healthy changes.


Tips for being more active Aim for 30 minutes of being active each day. Start with 10 minutes and work up to 30 minutes. Before

starting any exercise activity, talk with your doctor about physical activity that is safe and right for you.

If you often . . .

Read a magazine during your lunch break

Search for the parking space closest to the mall

Take the elevator

Sit at the kitchen table and talk with a friend

Try this instead . . .

Take a walk

Choose a parking space far away

from the entrance

Take the stairs

Take a walk with your friend


[ ]

[ ]

[MCO Logo]

When you have diabetes, it is very important to take care of yourself. You may be healthier if you stop smoking.

Quit smoking... and stick with it!

Stopping smoking is not easy. Here are some things that can help:

• Know when and why you smoke

• Find another way to relax

• Get exercise

• Keep your hands busy, with beads or a pen

• Reward yourself when you stick to it

• Ask family and friends to help

• Set a date to quit

And talk with your doctor about treatments that can help you stop smoking… for good!

When you smoke:

• You may get cancer

• Your chance of a stroke or heart attack goes up

• Your chance of dying from heart disease or stroke goes up

• Your blood pressure may go up

• Your nerves and kidneys may be damaged

• Foot ulcers may get worse and lead to leg and foot infections

• Your sex life may be affected

When you stop smoking:

• Your health will improve

• You may add years to your life

If you can stop for 15 years, your chance of heart disease is like someone who never smoked at all!


Smoking and your health


Diabetes can be hard for people who have it. Here are some ways you can help make it easier for a family member or friend with diabetes.

Learn about diabetes

• Ask the doctor or nurse how you can learn more

• Go to a diabetes class

• Search on the Internet (see below for places to start)

• Read pamphlets containing diabetes information

Ask what you can do

Find out what your loved one needs and ways you can help. You might offer to:

• Go along to the doctor

• Go walking or dancing with them

• Cook a good, healthy meal

• Watch out for other problems with diabetes, such as not seeing clearly, foot or skin problems, or depression

• Talk about how you may feel so it can help both of you

If your family member gets very sick, you might be able to take time off from work to help. Ask your employer if you are covered by the Family and Medical Leave Act.

Get help

You don’t have to do this alone. See if there is a diabetes support group where you live. Talk to the doctor if your loved one has problems or gets depressed. You can also get help from these groups:

The resources listed above are administered by independent third parties not affiliated with or endorsed by GlaxoSmithKline.

GlaxoSmithKline is not responsible for the contents of these resources. All contents of these resources and all trademarks relating to them are the property of the respective third-party owners.

American Association of Diabetes Educators

1-800-338-3633, www.diabeteseducator.org—help finding an educator near you

American Diabetes Association

1-800-DIABETES, www.diabetes.org—find out about diabetes care

American Dietetic Association

1-800-877-1600, www.eatright.org—find tips on healthy eating

Helping to care for

someone with diabetes

http://www.diabeteseducator.org/


http://www.eatright.org/


Use these resources for more information about diabetes, including treatment, blood sugar monitoring, and the importance of healthy living.

*These organizations offer information on support groups and/or local resources. † 1on1health is a Web site sponsored by GlaxoSmithKline.

Unless noted, the resources listed above are administered by independent third parties not affiliated with or endorsed by GlaxoSmithKline. GlaxoSmithKline is not responsible for the contents of these resources. All contents of these resources and all trademarks relating to them are the property of the respective third-party owners.

National Organizations

American Diabetes Association (ADA)*

www.diabetes.org | 1-800-DIABETES (1-800-342-2383)

National Institute of Diabetes and Digestive and Kidney Diseases www.niddk.nih.gov

National Diabetes Education Program of the National Institutes of Health

www.ndep.nih.gov | 301-496-3583

Centers for Disease Control and Prevention (CDC) www.cdc.gov/diabetes | 1-877-232-3422

American Heart Association*

www.americanheart.org | 1-800-AHA-USA1 (1-800-242-8721)

Other Internet Resources

www.1on1health.com†

www.webmd.com

Books about Diabetes

Diabetes: A Guide to Living Well, 4th edition, by Gary Arsham, MD, PhD, and Ernest Lowe

Uncomplicated Guide to Diabetes Complications, 2nd edition, by Marvin Levin, MD, and Michael Pfeifer, MD

Books by the ADA American Diabetes Association Complete Guide to Diabetes, 4th edition

101 Tips for Coping with Diabetes

101 Nutrition Tips for People with Diabetes, 2nd edition

101 Tips for Improving Blood Sugar, 2nd edition

101 Tips on Foot Care for People With Diabetes, 2nd edition

Diabetes Resources


http://www.niddk.nih.gov/

http://www.ndep.nih.gov/

http://www.cdc.gov/diabetes


http://www.1on1health.com/

http://www.webmd.com/

Documents

Take Charge of Your Health….orhs.connecthealthcare.com/pdf_library/Diabetes_booklet.pdfTake Charge of Your Health…. Diabetes Education Program . Table of Contents Module 1- Basics