A Healthier You with Diabetes - Participant Workbook

A Healthier You with Diabetes Participant Workbook

Napa-Solano Health Education

Napa-Solano Health Education

Workbook A Healthier You with Diabetes

PowerPoint Handout Pages: Your instructor will use these to help guide the discussion each week

Resource Handouts (not pictured): Detailed handouts to support each section will also be provided

Notes Pages: Please use these pages to take down any notes that may come up during or after the class. We’ve also included a checklist section as a space to write down any to-do’s or even use as a healthy grocery list

Meal and Blood Glucose Daily Logs: We encourage you to log the following details each day and we will review your data each week as a group:

Why Do I Need Insulin?

Physical activity What and how much you eat Stress Sickness or infection Your diabetes medication

What Affects Your Blood Sugar Levels?

Diagnosis of Diabetes & Prediabetes

Range Hemoglobin A1C (HgbA1C)

Fasting Blood Sugar (FBS) Glucose

Normal 4.4%-5.6% 70-99 mg/dl

Prediabetes 5.7%-6.4% 100-125 mg/dl

Diabetes 6.5% and above 126 mg/dl and above

Or one random blood sugar over 200 mg/dl with symptoms

Specific Goals for A1C Goal for A1C A1C < 7 A1C < 8*

Goal for pre-meal blood sugars

80–130 mg/dL 100–160 mg/dL

Goal for 2 hours after a meal

Less than 180 mg/dL Less than 200 mg/dL

Goal for bedtime blood sugars

100–160 mg/dL 100–200 mg/dL

*People older than 65 or with additional health conditions.

Check your last A1C results online. © 2017 Regional Health Education. The Permanente Medical Group, Inc.

Taking care of your diabetes means taking care of what's important, such as your family.

How to Test Your Blood Sugar

https://mydoctor.kaiserpermanente.org/ncal/mdo/presentation/common/healthToolPage.jsp?path=healthtool_920032.xml

healthy living Testing Your Blood Sugar

Keeping your blood sugar at or near normal levels helps to prevent diabetes complications, such as problems with your eyes, kidneys, or feet.

hecking your blood sugar puts you in charge of your diabetes by giving you

important information that you can track over time.

Checking your blood sugar gives you more flexibility in making decisions about what to eat and how much exercise you need. If you have made changes to your habits, it also tells you what worked or didn’t work and lets you know when it’s time to call your doctor. Your doctor or other health care professional can use this important information to make needed changes in your treatment. If you use insulin, testing can help you learn when to adjust the amount of insulin you need for optimal control of your diabetes.

Talk with your doctor or other health care professional to learn how to make adjustments to your insulin dose. How do I check my blood sugar? 1. Review the booklet that came

with your meter. 2. Gather together all the supplies

you need before you test: meter, test strips, logbook, etc.

3. Wash your hands with warm water and soap before testing.

4. Prick the side (not the pad) of your fingertip with a lancing device or “penlet.”

5. Apply blood to the test strip according to your meter directions.

6. Write down the blood sugar numbers in your logbook.

Your blood sugar goals may be different from the ideal A1c goals shown in the table at left. Ask your doctor or other health care professional what blood sugar goals are best for you. It is very important to know what actions to take when your blood sugar number is either higher or lower than the numbers in the table. You may want to take a diabetes class to learn more. Not everyone needs to test his or her blood sugar the same number of times each day. Ask your doctor or other health care professional what amount of testing is best for you and at what times of the day you will need to test. Here are

HEALTH EDUCATION

C

Goal for A1C A1C < 7 A1C < 8

Goal for pre-meal blood sugars

80–130 mg/dL 100–160 mg/dL

Goal for 2 hours after a meal

Less than 180 mg/dL Less than 200 mg/dL

Goal for bedtime blood sugars

100–160 mg/dL 100–200 mg/dL

Testing tells you how different things affect

your blood sugar level, such as:

what, how much, physical activity & when you eat

your medications stress or illness

healthy living Testing Your Blood Sugar

some general guidelines about how often to test.

You may be asked to test more often when you are: • sick or have an infection • changing your diabetes

medications or increasing the dose of your medications with your doctor or other health care professional

• considering becoming pregnant, or you are pregnant

• not in good control of your diabetes

Safety and comfort Some people feel pain or have a hard time getting enough blood when pricking their fingers. Here are some ideas to help make it easier: • Prick a different spot or different

finger each time to reduce redness and soreness in your fingertips.

• To get more blood flowing to your fingertips, shake your hand up and down or run warm water over your hand before you prick your finger.

• Ask your doctor or other health care professional about other lancet options.

• Don’t share your lancing device with others.

• Don’t reuse lancets.

More tips for testing your own blood sugar • If you have problems with your

LifeScan meter, call the number on the back.

• For accurate results, keep test strips in their airtight bottle and do not use strips after the expiration date shown on the bottle.

Other resources The LifeScan meter booklet and blood sugar logbook are available from your doctor, other health care professional, local Health Education Center, or pharmacy. • Visit kp.org/mydoctor/diabetes for day-to-day tips and tricks on how to manage your diabetes. • Visit your doctor’s home page at kp.org/mydoctor to find reliable health information, view your medical record, check lab results, email your doctor, and much more. • Contact your Kaiser Permanente Health Education Center or Department for health information, programs, and other resources. • If you are hit, hurt, or threatened by a partner or spouse, this can seriously affect your health, including your diabetes. There is help. Call the National Domestic Violence Hotline at 1-800-799-7233 or connect to ndvh.org.

This information is not intended to diagnose health problems or to take the place of medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only. © 2003, The Permanente Medical Group, Inc. All rights reserved. Regional Health Education. 90399 (Revised 6/16) RL 6.8

http://kp.org/mydoctor/diabetes

http://kp.org/mydoctor

http://ndvh.org/

Recommended care Date & Date & Date & My Goal and testing Result Result Result

A1C (%): 3-month average blood sugar; does not require fasting.

Below 7% for most people*

Blood pressure check: High blood pressure increases your risk for heart attack, stroke, kidney, and eye damage.

Below 140/90

Statin medication: Taking the right dose of statin medication can help reduce your risk of heart attack and stroke.

taken ______________ times a day. mg of ,

My Diabetes Care Plan

Name: Medical Record Number: ____________________________________

This chart can help you keep track of the results of your important medical tests. Record the date and result of each test and/or service on the chart below.

Sharing this chart with your health care team during each visit can be helpful. Use the information to talk about your results or ask questions about the tests.

* If you are older than 65, or have additional health conditions, your goal may be an A1C below 8 percent.

Record when your last procedure or test was done:

Diabetes eye exam / retinal screening every 1 to 2 years: Date ______________________ • Patients without retinopathy should get a retinal screening every 1 to 2 years. • Patients with retinopathy should get a retinal screening every year.

Urine microalbumin or kidney function test (every year): Date _______________________

Thyroid function (every year): Date ____________________________________________

Foot exam (every year): Date _________________________________________________

Dental exam (every 6 to 12 months.): Date ________________ Date _________________

My Diabetes Care Plan

Managing Your Diabetes There are many things you can do to feel well and stay healthy. Every once in a while, it may be helpful to take some time to think about what your diabetes management plans and goals are.

To start, you might ask yourself:

How am I doing managing my diabetes? Check the box that applies to you. Great! I’m totally on track. My diabetes is well controlled. Pretty good. Most days I do well managing my diabetes. Not so good. It’s a challenge to manage my diabetes every day. O t h e r : _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

Next, think about how you are doing with the following diabetes management skills. Check the boxes that apply to you.

I am doing well with: Being physically active Eating healthy Checking my blood sugar Reducing my stress Taking my medications as prescribed Having routine blood tests Other: _________________________

I could improve on: Being physically active Eating healthy Checking my blood sugar Reducing my stress Taking my medications as prescribed Having routine blood tests Other: _______________________________

Once you have an idea of the diabetes self-management skills you want to improve, it can help to create a personal goal or action steps to focus on that problem. Ask yourself:

What is the one skill from the list above that I would like to work on to better manage my diabetes? ________________________________________________________________

Finally, list the action steps you will take to reach your goal:

1 . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

2 . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

3. _______________________________________________________________

This information is not intended to diagnose health problems or to take the place of medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult your doctor. Some conditions, including diabetes, can be seriously affected by violence or abuse. If you are hit, hurt, or threatened by a partner or spouse, this can seriously affect your health. There is help. Call the National Domestic Violence Hotline at 1-800-7997233 or connect to ndvh.org. Some photos may include models and not actual patients.

© 2007, The Permanente Medical Group, Inc. All rights reserved. Regional Health Education. 00679-004 (Revised 9/16)

http://ndvh.org/

A small change I want to make this week: ________________________ Goal achieved?

DATE MEALS & BLOOD GLUCOSE

COMMENTS BREAKFAST LUNCH DINNER SNACKS BEDTIME Before After Before After Before After Before After Before After

1 2 3 BREAKFAST LUNCH DINNER SNACKS BEDTIME 4 5 6 7 Before After Before After Before After Before After Before After 8 1 2 3 BREAKFAST LUNCH DINNER SNACKS BEDTIME 4 5 6 7 Before After Before After Before After Before After Before After 8 1 2 3 BREAKFAST LUNCH DINNER SNACKS BEDTIME 4 5 6 7 Before After Before After Before After Before After Before After 8 1 2 3 BREAKFAST LUNCH DINNER SNACKS BEDTIME 4 5 6 7 Before After Before After Before After Before After Before After 8 1 2 3 BREAKFAST LUNCH DINNER SNACKS BEDTIME 4 5 6 7 Before After Before After Before After Before After Before After 8 1 2 3 BREAKFAST LUNCH DINNER SNACKS BEDTIME 4 5 6 7 Before After Before After Before After Before After Before After 8 1 2 3 BREAKFAST LUNCH DINNER SNACKS BEDTIME 4 5 6 7 Before After Before After Before After Before After Before After 8

Name: MRN: Date:

My Notes

My Checklist

Additional Notes

• Grains like breads, rice, pasta, cereal and tortillas

Surprising Sources of Carbohydrates (Carbs)

• Fruits • Starchy

vegetables

• Milk • Cottage cheese

with fruit • Yogurt

• Sweets • Desserts • Fried food • Soda

Eat Well with Diabetes

What? How Much?

Choose a variety of foods from all food

groups.

Eat portions that are right for your weight

and activity level.

When?

Eat a meal or healthy snack at least every 4 to 5

hours.

Healthy Carbs

• Whole-wheat bread or pasta

• Whole grain cereal

• Brown rice • Grains: quinoa,

couscous, barley, popcorn, & oatmeal

• Beans • Lentils

• Whole-wheat tortillas

Let’s Practice the Plate Method!

Simple Sugars

Turn quickly into sugar in the blood stream Raise your blood sugar quickly Examples of simple sugars: table sugar,

honey, candy, soda, and sugary drinks.

How Many Carbs (Simple Sugars) are in a 20 oz. Soda?

20 ounces of soda = 15 teaspoons of sugar = 60 grams of sugar! 1 teaspoon of sugar = 4 grams of sugar

healthy living Eating Well with Diabetes and Carbohydrate Basics

here are three things to keep in mind to help control your blood

sugars: 1. When you eat 2. What you eat 3. How much you eat

Here are some tips to get you started.

1 WHEN to eat Eating at regular times will help control your blood sugars. This also helps to pre-vent low blood sugars (or hypoglycemia). • Eat at least 3 meals each day

including breakfast. This helps you feel satisfied. It also reduces your chances of overeating later.

• Try to eat at the same times each day. • Try to eat a meal or a snack every 4

to 5 hours during your day. If you take insulin at dinner or bedtime, you may need a small bedtime snack.

• To prevent low blood sugars, don’t skip or delay your meals and snacks.

2 WHAT to eat You do not need special foods because you have diabetes. In fact, the foods that are good for you are good for everyone in your family. It is a good idea however, to try to choose more whole grain foods full of fiber. Fiber helps to keep your blood sugars in control. Each day try to eat a variety of healthy foods like: • Grains, whole grain breads and cereals,

pasta and rice, beans and peas, starchy vegetables (like corn, potatoes or yams)

• Fruit • Vegetables • Low-fat, nonfat milk or soy milk, and

nonfat artificially sweetened yogurt • Fish, poultry (without skin), lean,

trimmed meats, tofu, low-fat or nonfat cheeses, peanut butter

Choose heart healthy fats more often. These include olive or canola oils and some kinds of nuts such as almonds or walnuts. Limit sweets or baked goods and other foods with saturated and trans fats.

3 HOW MUCH to eat Your body changes most of the food you eat into blood sugar (or glucose), to supply your body with energy. When you have diabetes, your body has a hard time turning this sugar into energy. More of the sugar stays in your blood. If you eat too much food, especially too many carbohydrates (or carbs), your

blood sugars may get too high. But if you eat smaller amounts and spread your meals throughout the day, you will better control your blood sugar and feel healthier.

What foods contain carbohydrates? • Starches (grains, beans, starchy

vegetables) • Fruit and fruit juice • Milk and yogurt

A single serving from any of these food groups equals 1 carb serving and contains 15 grams of carbohydrates. • Sweets, and desserts, chips, crackers,

and fried foods usually contain a lot of carbs and fats and often do not provide much added nutrition. Plan to eat small servings of these foods as a special treat every once in a while.

For more help with carbs, check the Diabetes Food Pyramid or the Diabetes Exchange Lists, or other diabetes nutri-tion reference books you can find at our Health Education Centers.

Why are carbohydrates important to my diabetes? Your body turns most of the carbohy-drates (carbs) you eat into sugar (glucose). As we said earlier, when you have dia-betes, the cells in your body have prob-lems storing this sugar to use for energy. So watching your carbs is important. • If you eat too many carbs overall, or

too much at once, your blood sugars can rise too high.

T

healthy living Eating Well with Diabetes and Carbohydrate Basics

• If you eat too few carbs, your blood sugar can go too low, and your body may not get the energy it needs. You might feel dizzy or faint.

How many carbohydrates should I eat? The amount of carbohydrates you need depends on your diabetes goals, calorie and nutrition needs and activity level. For most adults with diabetes, it may help to eat between 3 to 4 carb servings (45 to 60 grams carbohydrate) at each meal and 1 carb serving (15 grams carbohydrate) for snacks. Some men and very active adults may require more carbohydrates than this. Work with your dietitian or diabetes educator to find the right amount of carbs you’ll need at each meal or snack to feel your best.

How do I read a food label? Reading food labels is important. It can show you how different foods fit into your meal plan. The label tells you what the size of one serving is and the amount of grams of “Total Carbohydrate” that serving has. You do not need to look at the sugar grams, since these are already counted in the Total Carbohydrate grams. Carefully read the label on food packages with claims such as “No Sugar Added” or “Reduced Sugar,” even foods that claim to be “Sugar Free.” Many of these foods still contain carbohydrates. Remember: 1 carb serving = 15 grams of carbohydrates.

Where can I start? A good place to start is to limit less healthy carbohydrates like candy, sodas or desserts. It helps to: • Choose diet sodas, calorie-free drinks,

or water instead of sugar-sweetened drinks.

• Consider using sugar substitutes or artificial sweeteners in place of regular sugar.

• If you want a sweet, plan ahead to include it with your meal. At the same time, try to add a little extra time for exercise to help keep those high sugars down. Aim for a small dessert (1 carb serving) such as 1/2 cup of ice cream or 3 graham crackers or 2 small cookies.

When you make your plate, aim for:

This information is not intended to diagnose or to take the place of medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor.

Additional resources • To learn more about nutrition and

diabetes, visit: kp.org/healthyliving or call your Health Education Center for diabetes programs, classes and videos available at your local Kaiser Permanente facility.

• Visit your physician’s Home Page at kp.org/mydoctor.

• Visit kp.org/diabetes.

1/4 grains

1/2 vegetables 1/4 protein

http://kp.org/healthyliving

http://kp.org/mydoctor.

http://kp.org/diabetes.

Controlling your diabetes with healthy eating

KAISER PERMANENTE

healthy living

Establish Consistent Eating Patterns • Eat three meals a day, add snacks if meals are

more than 4 -5 hours apart

• Eats meals and snacks at about the same time each day

• Eat about the same amount of carbohydrate at each meal

Eat a Variety of Foods • Eat foods from each of the food groups to ensure

you are getting all the nutrients you need

• Eat the recommended number of servings for each of the food groups

Control Your Carbohydrate Intake • Control total carbohydrate intake, not just sugar

• Carbohydrate includes starches and sugars and both make your sugar go up – at about the same amount and at about the same speed

• 1 serving of starch, fruit or milk provides 15 grams of carbohydrate and is referred to as 1 carbohydrate choice

• A general guide is women need 3-4 choices per meal and men need 4-5 choices per meal

• It’s OK to occasionally eat sweets, but they must be substituted for other carbohydrates, rather than just added to the meal plan

Eat Less Fat • Choose foods that are low in saturated fat, trans

fat, and cholesterol

• Watch the amount of fat you add to foods such as margarine, mayonnaise, salad dressing or gravy

• Use low fat cooking methods such as broiling, baking, steaming or grilling

Eat More Fiber • Increase the intake of fiber – aim for 21 to 38

grams per day

• Fiber is found in whole grain breads and cereals, fruits and vegetables, and dried beans and peas

• Increase fiber intake slowly and drink plenty of fluids

Be More Active • Increase lifestyle activity - use stairs, park further

away

• Aim for 30 – 60 minutes per day of some type of regular activity e.g., walking, swimming, biking, dancing

• Use a step counter to measure your activity and aim for 10,000 – 12,000 steps/day

Maintain a Healthy Body Weight • If overweight, aim for a moderate weight loss of 5 –

10 % of current weight

• Watch portion sizes, be active and keep a daily food/fluid/activity record

Foods with carbohydrates

Starch 6 Servings per day

Fruit 3-5 Servings per day

Milk and yogurt 2-3 Servings per day Other carbohydrates

• 1/4 large bagel

• 1 slice bread

• 1/2 pita or English muffin

• 1/2 hamburger bun

• 1 6-inch tortilla or chapati

• 1/2 cup sweetened cereal

• 3/4 cup unsweetened

cereal

• 1/3 cup cooked pasta, rice or couscous

• 1/2 cup cooked cereal

• 1/2 cup beans

• 1/2 cup peas or corn

• 1 small potato (3 oz.)

• 1/2 cup sweet potato

• 1 cup winter squash

• 4 to 6 crackers

• 3 graham cracker squares

• 3 cups light popcorn

• 1 small apple • 1 cup fat-free or • 1 small banana 1% milk

• 1 cup soy milk • 1 cup berries

• 6-8 oz. plain nonfat • 1/2 cup grapes

yogurt • 1 cup melon • 6-8 oz light yogurt • 1 small orange

• 1/2 grapefruit

• 2 tbsp. raisins

• 1 small pear

• 1/2 cup 100% fruit juice

• 1/2 cup canned fruit (in juice or light syrup)

• 1/2 mango

Combination Foods • 1 cup casserole

• 1 cup chili with beans

• 1 cup spaghetti & meat sauce

• 1 cup macaroni and cheese

• 1 slice thin-crust pizza

• 1 cup noodle soup

• 1 cup bean soup

• 1/3 cup hummus

Sweets

• 1 tbsp table sugar, pancake syrup or honey

• 1 tbsp jelly

• 3 graham cracker squares

• 3 gingersnaps

• 5 vanilla wafers

• 1 granola or cereal bar

• 2x2 square Rice Krispie bar

• 3 cups air popped or light microwave popcorn

• 1 frozen fruit juice bar

• 1/2 cup frozen yogurt or light ice cream

• 1/2 cup sugar-free pudding

Non carbohydrates and other food groups

Vegetable 4-6 Servings per day

Protein 4-6 Servings per day

Fat and oil 3-6 Servings per day

Reduced calorie and low calorie sweetners

1 cup raw vegetables or 1/2 cup cooked vegetables. • broccoli

• cucumber

• carrots

• cauliflower

• celery

• green beans

• peppers

• lettuce

• spinach

• 1/2 cup V-8 or tomato juice

• greens (kale, collard, mustard)

• zucchini

• mushrooms

• 1 oz fish

• 1 oz skinless chicken or turkey

• 1 oz lean beef, pork, lamb, or veal

• 1/2 cup tofu

• 1 egg or 2 egg whites

• 1/4 cup egg substitute

• 1/4 cup low fat cottage cheese

• 1 oz low fat cheese

• 1 tbsp. peanut butter

Heart Healthy Choices • 1 tsp. oil: olive, canola, corn, soybean, sunflower, sesame, safflower

• 1 tbsp. tub margarine or trans fat free margarine

• 2 tbsp. fat free, light, reduced fat, or low-fat salad dressing

• 1 tbsp. fat free, low-fat, reduced-fat or light mayonnaise

• 6 almonds

• 1/8 avocado

• 10 peanuts in shell

Less Healthy Choices • 1 tsp. butter

• 1 slice bacon

• 1 tsp. regular mayonnaise

• 1 tbsp cream cheese or regular salad dressing

• 1 tbsp half & half

• 3 tbsp. low fat sour cream

Sugar alcohols (reduced calorie sweeteners) are often used in sugar-free foods, but they do not contain sugar or alcohol. They provide less carbohydrates and a smaller rise in blood glucose than other carbohydrates. Sugar alcohols are not “free foods” and may cause diarrhea.

Low-calorie sweeteners are “free foods.” They do not count as carbohydrates. Examples include:

• Acesulfame K (Sunett® or Sweet One®)

• Aspartame (Equal®)

• Saccharin (Sweet N Low®)

• Stevia (TruviaTM or PureViaTM)

• Sucralose (Splenda®)

Free foods “Free foods” are any food or beverage with less than 20 calories and 5 grams or less carbohydrate per serving. Some can be eaten in unlimited amounts, others should be limited to 3 servings per day, spread throughout the day.

Kaiser Permanente does not endorse any brand names; any similar products may be used.

Protein Fill 1/4 of your plate with

lean meat or protein. Vegetables Fill 1/2 of your plate with non-starchy vegetables.

Carbohydrate Fill 1/4 of your plate with grains or starchy foods.

C a r b o h y d r a t e c h o i c e s p e r m e a l : W o m e n : 3 - 4 ( 4 5 - 6 0 g r a m s ) M e n : 4 -

5 ( 6 0 - 7 5 g r a m s )

1 2 3 4 5 6 7 8 9

The food plate

Select a 9 inch plate and use this guide to help keep

your portions in control.

1 cup 1/2 cup 1/3 cup 2 Tbs 1 Tbs 1 tsp 3 oz. 1 oz.

Baseball Light bulb Egg Golf ball Walnut Penny Deck of cards Four dice

REGIONAL HEALTH EDUCATION, HEALTH PROMOTION AND WOMEN’S HEALTH 0036-0048 Revised/reprinted 7/10 Kaiser Foundation Health Plan of the Mid-Atantic States, Inc. 2101 East Jefferson Street, Rockville, MD 20852

healthy living How to Read the Food Label

ou can make healthier food choices by reading the

“Nutrition Facts” label on the foods you buy.

Serving size: Look here first! Is your serving the same as the one on the label? • If you eat double the serving

size listed, you need to double the calories and other nutrient values.

• If you have diabetes or are following a specific meal plan, the serving size on the label may not match the serving sizes in your meal plan.

Always double check the serving size. See sample label at right.

Calories This is the number of calories you will consume in one serving of this food. Knowing how many calories your food contains helps you monitor calorie intake over the course of the day. The number of calories needed each day depends on your age, sex, height, weight, and level of physical activity. Estimates range from 1,600 to 2,400 calories for women and 2,000 to 3,000 calories for men. If you are trying to lose weight, you should avoid or limit high-calorie foods.

Check the serving size to find out how much you are actually eating. If you eat 2 servings, this doubles the calories and nutrients, including the Percent Daily Values (DV).

Make your calories count. Look at the calories on the label and compare them with the nutrients it contains. Then decide whether the food is a good choice for you.

Know your fats. Look for foods low in saturated fats, trans fats, and cholesterol to help reduce the risk of heart disease (5% DV or less). There is no DV for trans fat because it is best to limit or avoid it entirely.

Keep sodium in check. Processed foods are often high in sodium. Look for low-sodium foods with less than 140 mg per serving. Track the total amount you eat.

Fiber. Aim for 25 to 38 grams of fiber per day.

Some vitamins and minerals may be listed with DV in one serving.

Percent Daily Values (DV) tell you how much you should be eating based on a 2,000 or 2,500 calorie diet. This section is the same on every food label. It is a refer-ence to remind you how much of these nutrients you should aim for each day.

Number of calories in a gram of fat, carbohydrate, and protein.

Saturated fat and trans fat: Saturated fat and trans fat are included in the amount of total fat. They are also listed separately because they are the 2 types of fat we should try to limit or avoid in our diets.

Y

Calories per gram

Fat 9 • Carbohydrates 4 • Protien 4

Sample label

Total fat This tells you how much fat is in one serving. A low-fat food has 3 grams (g) or less of total fat per serving.

healthy living How to Read the Food Label

A quick check of the “Nutrition Facts” label can help you spot foods that are good for your health.

Diets high in these fats may increase the risk of heart disease. Trans fats increase your risk more than saturated fat. A food is low in saturated fat if it has less than 1 gram per serving. Aim for fewer than 20 grams of saturated fat per day, and as little trans fat as possible.

Cholesterol Cholesterol is found only in foods from animal sources, such as meats, poultry, fish, eggs, and dairy products. Try to keep your cholesterol intake to less than 300 milligrams (mg) per day. A low-cholesterol food has less than 20 mg per serving.

Sodium We know this as “salt.” Too much sodium may raise your blood pressure. Less than 2,300 mg of sodium each day is recommended. A low-sodium food has 140 mg or less in one serving.

Total carbohydrate Carbohydrates are found in bread, pasta, rice, cereal, fruit, potatoes, starchy vegetables, and sweets. If you have diabetes, pay attention to total carbohydrate grams per serving, not just the sugar grams. Dietary fiber: It is important to eat plenty of fiber, and most Americans don’t get enough. Fiber helps reduce the risk of diabetes and heart disease and can help with weight control. Aim for 25 to 38 grams of fiber per day. It is found in whole grains, vegetables, and fruits. Sugars: Sugar is listed separately, and is also included in the total grams of carbohydrate. It includes both naturally occurring and added sugar. It’s best to avoid added sugar when possible.

Protein Protein is found in both plant and animal foods, including beans, nuts, fish, poultry, meat, eggs, and dairy products.

Percent Daily Value This is the percentage of the recommended daily amount of this nutrient in one serving of the food. The Percent Daily Values (DV) are what would be recommended in a 2,000 calorie per day diet. The important part of these percentages is that they help you find foods that are high in good nutrients and low in nutrients you want to avoid. If the value is 20% or more, it’s considered high. If it’s 5% or less, it’s low.

Other resources Visit kp.org/mydoctor to: • View most lab results and

check your preventive health reminders.

• Email your doctor • Use online tools to help keep

you and your family healthy.

This information is not intended to diagnose health problems or to take the place of medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor.

© 2002, The Permanente Medical Group, Inc. All rights reserved. Regional Health Education. 90200 (Revised 4/17) RL 6.8


Healthy snacking for people with diabetes

You may want to add snacks to your meal plan. Healthy snacks may: Add nutritional value. Prevent hunger and overeating. Help prevent low blood sugars. Healthy snacks still need to be limited to prevent weight gain. Keep in mind that hidden fats in snacks will increase your calorie intake. When you want to limit calories, choose a low-calorie, low-carbohydrate snack. When you want to prevent low blood sugar, adding a carbohydrate choice and sometimes a protein food is helpful. When possible, choose a fresh fruit or vegetable, whole-grain starches, and lean or low-fat protein foods.

Snack ideas 0 carbohydrate choice (less than 5 grams of carbohydrate) Sugar-free gelatin. Celery and cucumber sticks. Broccoli and cauliflower florets

with light ranch dip. Green salad with light ranch

dressing. 1 large carrot or 8 baby carrots. 6 cherry tomatoes. Salsa. Nuts (these add protein and fat): • 1/4 cup peanuts or

sunflower seeds. • 20 almonds. • 10 walnut halves.

1 carbohydrate choice (15 grams of carbohydrate) Fruit: • 1 small orange, apple, or pear. • 1/2 banana. • 15 grapes. • 2 Tbl. raisins or cran-raisins. • 1 frozen juice bar (check

the label). Starch/bread: • 1 slice whole-wheat bread. • 5 Triscuit crackers, reduced fat. • 15 multigrain Wheat Thins. • 3 Rye Krisp. • 3 graham cracker squares. • 1 package plain instant

hot cereal.

1 cup soup. 1 granola bar (check the

label). 1/2 cup sugar-free pudding. 1 Dixie cup ice cream.

1 carbohydrate choice and protein* (15 grams of carbohydrate) 1/2 meat sandwich. 1 oz. cheese or meat with 4–

6 Triscuits or whole-grain crackers. 1/2 cup refried beans with

salsa. 1 Tbl. peanut butter on 3

graham-cracker squares. 1/4 cup cottage cheese

with 1/2 cup cut-up fruit. 1 oz. string cheese with 3

cups popcorn. 1 cup chili. 1 hard-cooked egg with

1 slice of toast. 1 cup milk. 6–8 oz. light yogurt.

* These snacks provide the correct balance of protein and carbohydrate for a snack after treating low blood sugar.

from Cultiating Health(R) Managing Diabetes Kit (c)Kaiser Foundation Health Plan of the Northwest

healthy living How Fats Compare

at is a necessary part of a healthy eating plan. It supplies your body

with energy and essential fatty acids (EFA). Fat from your diet also helps you to absorb vitamins such as A, D, E and K. Unfortunately, not all fats are created equal. The key to healthier eating? Choose foods with fats that help protect your heart and reduce your heart disease risk.

Research shows that a very low-fat diet is not necessary to protect the heart. Instead, the goal is to eat a moderate amount of healthy fat combined with more fiber-rich whole grains each day. A moderate amount of fat means no more than 25-35 percent of your total daily calories come from fat.

Eating foods with lots of saturated fats, trans fats and cholesterol can raise the LDL (or bad cholesterol) and triglyceride levels in your blood. Having high levels of LDL and triglycerides puts you at greater risk

for heart disease. Trans fats also increase your risk for heart disease because they lower HDL, or good cholesterol. A high level of HDL cholesterol in your blood helps to protect your heart.

Which fats help to protect my heart? • Monounsaturated and polyun-

saturated fats help to raise your HDL level.

• Omega-3s, an important polyunsaturated fat, are found in fish oils and some plant sources and protect your heart in several ways. Omega-3 fatty acids help to reduce inflammation inside your blood vessels, which slows plaque build-up in the arteries, a process also called atherosclerosis. Selecting up to 12 ounces of fish a week helps your heart while limiting your exposure to toxins like mercury found in some types of fish.

• For pregnant and nursing women or women who plan to get pregnant, we recommend that they eat no more than 6 ounces of fish a week.

• Alpha-linolenic acid (ALA) comes mainly from plant sources and turns into omega-3 fatty acids in the body. ALA may also help to lower the risk of heart disease.

• Plant sterols and stanols (phytosterols) help lower LDL cholesterol. Tub, liquid, or squeeze margarine products, some cheese, and fruit juices are available with these beneficial compounds.

• Omega-3 supplements and other products may not be appropriate or necessary for you depending upon your current health and risk for heart disease. Some people may be at high risk for bleeding with large doses of fish oil supplements. Discuss whether or not they are recommended for you with your health care team before you start to use them.

How do I find foods that will help protect my heart? Read food labels carefully. Compare the nutrition information of similar food products when you shop. Foods with less than 3 grams of fat in a serving are low-fat. They may be heart healthy options. To avoid foods that contain trans fats, choose foods without any ‘partially hydrogenated’ oils or shortening listed on the label. For example, many types of tub or squeeze margarine are better choices than stick margarines, which have trans fat. Review the chart on the next page to see lists of foods with fats that can protect your heart and those foods with fats to avoid.

HEALTH EDUCATION

F

healthy living How Fats Compare

Healthy Fats Harmful Fats Choose in moderation Avoid

High in monounsaturated fats

High in polysaturated fats

High in omega-3 fat* High in saturated fats

High in trans fats

• olive oil • canola oil • peanut oil and

peanut butter • olives • avocados • almonds • pecans • macadamia nuts • cashews • hazelnuts • pistachio nuts • peanuts

• safflower oil • corn oil • walnuts • soybeans • sunflower oil and

seeds • sesame oil and

seeds • oils made from seeds • brazil nuts (about

equal amounts of mono- and polyun-saturated fats)

• salmon • sardines • mackerel (pacific

or jack) • herring • tuna (canned light) • tuna (albacore) • pollack • trout • soybean oil • walnuts • walnut oil • ground flaxseeds • flaxseed oil • canola oil

• pastries, pies, and bakery items • palm oil, palm kernel oil, and coconut oil • heavily marbled meats • meats high in fat, such as sausage, cold cuts, hot dogs, bacon • chicken fat and skin • Butter and dairy products with

Processed foods including: • chips • cookies, pastries • fried foods • fast food • crackers • stick margarine • regular shortening

*The fish listed tend to have lower amounts of mercury.

Are you ready to make some changes? Indicate on the scale below how ready you are to make a change. 10 means that you are very ready, and 0 means that you are not ready at all. Here are some ideas to help you get started: Check the food label when I buy products to find those with little or no trans fat. Add more fish to my diet. Add more fiber to my diet by eating more fruits/vegetables and whole grain foods each day. Consult my provider about which fish oil, ALA supplements, or other products could help me lower my risk for heart disease.

0 1 2 3 4 5 6 7 8 9 10 not ready very ready

If you circled Consider these questions 3 or less What would need to happen for me to become more ready to make changes? 4 to 6 What are some of the advantages of keeping things the same and not making any

changes? What are some of the advantages of eating a healthier diet? 7 to 10 What is the next step to create a realistic plan to eat healthier?

Who can support me as I make changes?

Other resources • Ask your doctor for a referral to a registered dietitian. • Visit kp.org/mercuryinfish • Check FDA’s Seafood Information and Resources website: cfsan.fda.gov/seafood1.html • Call 1-888-SAFEFOOD, CFSAN’s toll-free information line. • For other health education resources please visit kp.org/healthyliving

This information is not intended to diagnose health problems or to take the place of medical advice or care you receive from your physician or other medical professional. If you have persistent health problems, or if you have further questions, please consult your doctor.

© 2004, The Permanente Medical Group, Inc. All rights reserved. Regional Health Education. 915800069 (Revised 9-08) RL 7.5

http://kp.org/mercuryinfish

http://cfsan.fda.gov/seafood1.html


healthy living Alcohol and Diabetes

If you have diabetes and want to have an occasional drink, it’s important to learn about alcohol and diabetes.

Before you decide to drink alcohol, there are some questions and issues to discuss with your doctor when you have diabetes or other health problems.

Why might it be a good idea for me to limit or to stop drinking alcohol? • Your diabetes is not well controlled

and your blood sugars are either too high or too low.

• You have high blood triglycerides (a type of fat in the blood).

• You have other health problems, such as nerve damage, eye disease, or problems with your stomach or pancreas.

• You are pregnant or breastfeeding. • You have had problems with drinking

alcohol in the past.

Will alcohol interfere with any of my medications? When you have diabetes, your health care team will probably prescribe several types of medications to help control your blood pressure, cholesterol, and blood sugars. You may also take several over-the-counter medications or supplements. Be sure to talk with your doctor, pharmacist, or diabetes educator

Beer or Cooler

5% alcohol 7% alcohol

12 oz. 8.5 oz.

about how to stay safe and avoid problems. Drinking alcohol may change the way these medications work.

If you decide to drink alcohol: • Limit how much you drink. Keep

it to 1 drink a day for women; 2 drinks or fewer a day for men.

• Always eat a meal or a snack when you plan to drink alcohol. If you take insulin or diabetes pills, or if you drink on an empty stomach, alcohol can make your blood sugar drop. This is called hypoglycemia (blood sugar less than 70mg/dL). Eating a meal or a small snack when you drink alcohol can reduce your chances of having a low blood sugar reaction. Check your blood sugar often

to learn your body’s response to alcohol.

• Be careful with exercise. Alcohol and exercise both lower blood sugars.

HEALTH EDUCATION

Malt

Liquor

Table Wine

80-Proof Spirits

(gin, vodka, whiskey, etc.)

12% alcohol 40% alcohol 5 oz. 1.5 oz.

One Alcoholic Drink. . . = One 12-ounce bottle of

beer or wine cooler; or = One 5-ounce glass of wine; or

= 1.5 ounces of liquor (like vodka, scotch, or gin) in a shot or a mixed drink (with tonic or juice).

To prevent low blood sugar (hyp-glycemia), don’t drink if you just exercised or plan to exercise.

• Choose your drinks wisely. What you drink makes a difference. Sweet wines or mixed drinks made with regular soda or juices not only have extra calories, they also have carbohydrates that can raise your blood sugars. Use calorie-free and sugar-free-beverages like club soda, tonic, or water as mixers

• Be safe. Alcohol can affect your judgment and behavior. It can also cause blood sugars to get dangerously low. Friends and family members could easily mistake symptoms of severe low blood sugar for indications that you have had too much to drink. To prevent this problem—or

any embarrassment—make sure your family and friends recognize your low blood sugar symptoms, how to treat it, and how to help you in case you can’t help yourself. If you take insulin or diabetes medications, always wear medical identi-fication. Never drink and drive.

Calorie and Carbohydrate Values in Alcoholic Beverages Alcoholic beverages often have different amounts of carbohydrates and can contain a lot of calories. Drinking too much can make you gain weight and make your blood sugars harder to control. A registered dietitian or diabetes educator can show you how to use the chart on this page if you want

Drink Amount Calories Carbohydrate grams

regular beer 12 oz. 150 13

light beer 12 o

100 5

nonalcoholic beer 12 oz. 60 12

dry wine 4 oz. 80–90 0–5

6–7

4

nonalcoholic wine 4 oz. 25–35

champagne or sparkling wine

4 oz. 100

sweet dessert wine 2 oz. 100 7

wine cooler 12 oz. 215 30

gin, rum, vodka, brandy, scotch whiskey

1.5 oz. 100–115 0

liqueurs, cordials 1.5 oz. 160 17

martini 2.5 oz. 156 0

margarita 8 oz. 420 80

piña colada 5 oz. 290 44

bloody mary 5 oz. 115 5

regular beer

healthy living Alcohol and Diabetes

‘

Other resources • Connect to our website at kp.org/mydoctor/diabetes to learn more. • Contact your Kaiser Permanente Health Education Center or Department for health information, programs,

and other resources. • If you are hit, hurt, or threatened by a partner or spouse, this can seriously affect your health. There is help.

Call the National Domestic Violence Hotline at 1-800-799-7233 or connect to ndvh.org.

regular beer

light beer

nonalcoholic beer

nonalcoholic wine

champagne or sparkling wine

dry wine


http://ndvh.org/

This information is not intended to diagnose health problems or to take the place of medical advice or care you receive from your physician or other medical professional. If you have persistent health problems, or if you have further questions, please consult your doctor.

© 2008, The Permanente Medical Group, Inc. All rights reserved. Regional Health Education. 00042-003 (Revised 2/16) RL 7.8





Name: MRN: Date:

My Notes

My Checklist

Additional Notes

Being Active with Diabetes: How to Get Started

s you may already know, being active improves your health in

many ways.

Physical activity can help: • control your blood sugar • lower your blood pressure • help you feel better and reduce stress • lower your risk of heart disease

It helps to start with an activity that you find to be: • simple • something you want to do • easy to start slowly—and easy

to increase a little each week

For most people with diabetes, walking is an ideal activity. Using a step counter or a pedometer can help you keep track of your progress over time. It’s also important to try to be more active throughout your day. For example, you may want to try taking stairs instead of an elevator as part of your daily routine—or try parking a little further away from where you usually park.

Be sure to check with your doctor or diabetes care team to see if the activity you choose is right for you. When you begin any new physical activity program, try to check your blood sugars more often so that you know your body’s response to the new activity.

Depending upon your health and fitness level, other aerobic options include: • jogging • biking • swimming • low-impact or chair aerobics • dancing • using an elliptical or step machine

Physical activity and diabetes Remember that some people living with diabetes need to be more cautious before starting a new physical activity program.

Here are some important things to keep in mind: • Always carry fast-acting sugar

sources such as a tube of glucose gel or 3-4 glucose tablets, identification, and your Medic-Alert bracelet, if you have one.

• Stop exercising right away if you are dizzy, have shortness of breath, feel sick to your stomach, or are in pain.

• Drink extra fluids before, during, and after exercise.

• Wear shoes and socks that fit well.

Low blood sugar precautions If you have type 1 diabetes or if you have type 2 diabetes and take insulin and/or diabetes pills, be sure to: • Check your blood sugar before and

after physical activity. If you use insulin to manage your diabetes, work with your diabetes care team to learn how you might need to

adjust the amount of insulin you use and/or discuss how you might want to change your meal plan to account for the amount and type of activity you plan to do. This is especially important to help you prevent low blood sugars during long periods (over 3 hours) of exercise.

• You may need to eat an extra snack when your insulin or diabetes pills are working the strongest or you are doing moderate to high levels of exercise for over 30 minutes.

• Be aware that moderate to high activity levels can lower your blood sugar right away or up to 24 hours after you have stopped being active.

• If you do not take insulin, plan to be active within an hour after eating your meals or snacks to prevent low blood sugars. If you have type 1 diabetes and your blood sugar is less than 120 before exercising, eat 15-30 grams of carbohydrate before you start exercising.

• If you have type 1 diabetes and your blood sugar is over 250, use a urine test strip to check your urine for ketones before you start exercising. Do not exercise if ketones are moderate or high. Ketones are a certain type of chemical that forms in your blood when your body starts to break down fat to use for energy instead of glucose. This happens when you have high blood sugar levels and not enough insulin in your body. When the level of ketones in your blood gets

A

too high, your kidneys help to remove it from your blood so it appears in your urine.

What can help you stick with your activity plan? It may be hard to add activity into your life, especially if you haven’t been active lately. Once you have chosen a simple, easy activity which appeals to you and which can be increased gradually, try to: • Make your activity as regular as

sleeping and eating. Mark it on your calendar like any other appointment. You may also want to write it down on an activity goal sheet. (See the “Weekly Plan” below.)

• Connect with someone else to keep you motivated and to make it more enjoyable. Invite a friend to be your exercise partner.

• When you reach your goal, give yourself a reward. Treat yourself to movie tickets, a book, a magazine, a song or album.

• If you get bored doing one activity over and over, try a different activity. Or do different types of activities on different days of the week.

• When it is raining or too cold out-side, try doing aerobics or stretching exercises inside where it’s warm instead of not doing any activity. You can try walking in an indoor mall, using an exercise video or fitness

Other resources

• Visit kp.org/mydoctor to try an Online Health Coach video coaching program. Start today to improve your eating habits and get more active.

• Visit our Web site at kp.org/diabetes. Here you’ll find more information about diabetes and other topics.

• Try our personalized online programs at kp.org/healthyliving to get support for your weight loss and activity goals.

• Contact your facility’s Health or

Education Center Department for books, videos, classes, and additional resources.

Being Active with Diabetes: How to Get Started

To help you get started—and keep you going—you may want to use the “Weekly Plan” to set activity goals that you can easily reach.

This information is not intended to diagnose health problems or to take the place of medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor.

© 2005, The Permanente Medical Group, Inc. All rights reserved. Regional Health Education. 915800114 (Revised 9-10) RL 7

Weekly Plan

This week, I will __________________________________________________________________ (what?)

________________________________________________________________________________________ (how much?)

_____________________________________________________________________________________________ (when?)

________________________________________________________________________________________ (how many?)

How confident am I that I can follow my plan? 1 2 3

5 6 7 8 9 10 Not at all confident ___________________________________________________ Very confident

How I plan to reward myself:


http://kp.org/diabetes.






Name: MRN: Date:

My Notes

My Checklist

Additional Notes

Diabetes Medications How They Help You

Diabetes medications help keep you well There are many types of diabetes medications that work in different ways to help control blood sugars. It is important to learn about these medications and how they work so you are prepared to discuss your options with your diabetes care team.

Blood sugar goals To lower the risk of complications, the goal for most people with diabetes is to get to an A1C test result of less than 7 percent or an estimated average glucose (eAG) result of below 150 mg/dL. If you are over age 65, or have certain conditions such as heart disease, your doctor or health care professional may recommend an A1C goal of less than 8 percent. Both the A1C and eAG measure your average blood sugar over the past 2 to 3 months.

Common medications explained

Medication type: biguanides Main site of action: liver How it controls blood sugar: Keeps the liver from releasing too much glucose. Names: metformin (Glucophage) metformin ER (extended release) Medication type: insulin How it controls blood sugar: Helps get blood sugar out of the bloodstream and into cells for energy. Most patients will choose to add insulin to achieve or maintain their blood sugar goals. Names: • Long-acting: NPH insulin • Rapid-acting: regular insulin,

insulin lispro (Humalog)

Medication type: sulfonylureas and glinides

Main site of action: pancreas How it controls blood sugar: Helps pancreas to make more insulin. Names: sulfonylureas:

glipizide (Glucotrol) glyburide (Micronase, DiaBeta) glinide glimepiride (Amaryl)

Medication type: thiazolidinediones Main site of action: muscle cells How it controls blood sugar: Makes muscle cells more sensitive to insulin. Names: pioglitazone (Actos)

Information to remember about diabetes medicines • Take diabetes medicines to help lower high blood sugar levels. They do not take the place

of healthy eating and exercise. • Know when and how to take the medicines. Do not skip a dose. • Wear a medical alert bracelet for emergencies. • Bring an updated list of your medications to visits with your doctor or other health care professional.

To learn more about your diabetes medications, find information at our website at kp.org/medications or consult with a pharmacist.

Tips to help you remember to take your medications Everyone struggles with remembering to do things regularly. There are a number of ways that can help you remember. Check off things you might try:

� Make a simple chart and post it in an obvious place where you will see it every day, like on the mirror in the bathroom.

� Set an alarm clock or watch as a reminder. � Establish a daily routine for taking your

medications, such as at bedtime, mealtime, or the beginning of a daily TV show, such as the evening news.

� Use a pillbox that has sections representing the days of the week.

� Record taking your medications on a wallet card or calendar.

� Can you think of others?

It’s easy to get prescription refills at Kaiser Permanente pharmacies. • Reorder your medications at least 1 to 2 weeks before you run out. • Use EasyFill, our automated phone prescription refill system. Find the number to call in the upper right-

hand corner of your prescription label, or call the pharmacy near you. • Refill prescriptions at our website at kp.org/mydoctor/diabetes. You can also arrange to

have many medications sent to you by mail.

Some conditions, including diabetes, can be seriously affected by violence or abuse. If you are hit, hurt, or threatened by a partner or spouse, there is help. Call the National Domestic Violence Hotline at 1-800-799-7233 or connect to ndvh.org.

This information is not intended to diagnose health problems or to take the place of medical advice or care you receive from your physician or other medical professional. If you have persistent health problems, or if you have further questions, please consult your doctor. If you have questions or need additional information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only.

© 2003, The Permanente Medical Group, Inc. All rights reserved. Regional Health Education. 011061-212 (Revised 6/16) RL 7.8

Questions to ask your diabetes care team about your medications • When do I need to take the medicine—

before a meal, with a meal, or after a meal? • How often should I take the medicine? • Should I take the medicine at the same

time every day? • What should I do if I forget to take

my medicine? • What kind of side effects could I have

and what symptoms should I look for? • How should I manage my medications

when I’m sick and can’t keep my food or drinks down as usual?

http://kp.org/medications


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Name: MRN: Date:

My Notes

My Checklist

Additional Notes

Better Blood Sugar Control

Pattern management is making changes in your diabetes self-care plan based on your blood sugar readings over time.

Keeping a log or record for several days can help identify patterns to your lifestyle.

What are some things we can write down to help us find patterns? – Doses and times of your medication – Times and results of blood sugar tests – Foods you ate and when you ate them – When you exercise – Stressful events – Missing a meal

Finding Patterns

The times you should eat your meals and snacks

The amount of daily exercise Portion sizes for each meal or dessert The types of food you eat When to call your doctor

Pattern Management Helps You Make Decisions

Let’s Review Ed’s Numbers Date Before Breakfast Before Dinner Before Bed

Oct 14 143 130 No test

Oct 15 118 No test ( ate pizza) No test

Oct 16 253 No Test 161


Oct 18 151 No test (ate dessert: pie, ice cream)

263

Oct 19 251 No test 160


Ed aims for a blood sugar target between 80 and 140 before meals.





Name: MRN: Date:

My Checklist

My Notes

Additional Notes

Before Appointment – Come prepared with specific questions – Bring a family member for additional support

During Appointment – Repeat your doctor’s key points – Make notes and ask for clarification

After Appointment – Stop by the health education center for helpful

resources and/or activate your kp.org account – Send non-urgent emails to health care team

with other questions that you might have

Take Advantage of Your Medical Appointments

http://kp.org/

How to Stay Healthy with Diabetes

Find tips and tricks on how to eat well, exercise, and take your diabetes medications to keep you feeling healthy and well:

Day to Day 3 to 6 Months Every 12 Months

Text DIABETES to 45356 or visit kp.org/mydoctor/diabetes


Taking Care of Your Diabetes: Managing Sick Days and Infections

olds, flu, and infections can happen at any time. If you have

diabetes, being sick can cause your blood sugar to get too high. When you are not feeling well, you may not be able to eat or exercise as usual. These changes in your usual routine can affect your blood sugar control.

Infections in any part of your body, including teeth or gums, can cause high blood sugar. Good dental hygie-ne and regular checkups with your dentist are important ways to prevent this type of infection from starting.

How much medication should I take? Keep taking your usual dose of diabetes medications or insulin, unless your doctor or health care professional advises you to make changes while you are sick. If you are on insulin, your doctor or health care professional may suggest you use extra insulin. There is an exception to this recom-mendation if you take metformin (Glucophage). Stop taking this medicine temporarily when you have nausea, vomiting, or diarrhea. Call the Appointment and Advice line for the facility near you to get instructions on when to begin taking metformin again when you are feeling better. If you choose to use over-the-counter medications, look for sugar-free products and others that do not affect your blood sugars. If you have questions about which products to use, contact a pharmacist at your local Kaiser Permanente pharmacy, or through the Pharmacy Center at kp.org.

Write down the following information and have it ready when you call the Appointment and Advice line, your doctor, or your health care professional: 1. How long you have been sick. 2. Your temperature. 3. Your blood sugar levels and urine

ketone test results. 4. Whether you are throwing up or

have diarrhea. 5. The last time you urinated. 6. How much food and liquids you

have had. 7. How much and what type of

diabetes medicine you have taken and the time you took it; other medications you have taken.

8. Any other symptoms, including your mood.

What foods and drinks can I have when I am sick? When you aren’t feeling good, you may not want to eat three meals a day. If you are unable to keep any food in your stomach (due to throwing up) and your blood sugar is under 240 mg/dL, it is OK to have foods that are not “diet,” such as regular gelatin or a sports drink (such as Gatorade). The chart on the back of this page lists easy-to-tolerate foods. All of these items have about 15 grams of carbohydrate. Try to eat or drink one of these foods or beverages every hour when your blood sugar is below 240 mg/dL. If your blood sugar is over 240 mg/dL, try to eat or drink them every 2 hours.

Self-care tips to manage your diabetes on sick days When you are not feeling well, it is easy to forget your daily self-care tasks. However, monitoring your blood sugar and other symptoms is very important on sick days. Here are some simple guidelines: • Test your blood sugar 2 to 4 times

a day. If your blood sugar is over 300 mg/dL, test every 3 to 4 hours.

• Track how much fluid you drink. To prevent dehydration, try to sip at least 8 ounces (1 cup) of fluids every hour while awake.

• Check your temperature twice a day and record it.

• If you take insulin, and if your blood sugar is above 300 mg/dL, test your urine for ketones.* Record whether you have small, moderate, or large amounts. Your blood glucose meter will remind you to test for ketones when a blood sugar level is over 240 mg/dL. Get emergency care right away if your blood sugar is 500 mg/dL or above.* *Ketones are a type of chemical that forms in your blood when your body starts to break down fat to use for energy instead of glucose. This happens when you have high blood sugar levels and not enough insulin in your body. When the level of ketones in your blood gets too high, your kidneys help to remove it from your blood so it appears in your urine.

If you feel symptoms of low blood sugar, check your blood sugar. If it is 50 to 70 mg/dL, eat a fast-acting source of sugar with about 15 grams of carbohydrate, like 3 or 4 glucose tabs or a glucose gel tube. If your blood

C

http://kp.org/

*Be sure to use calorie-free and/or sugar-free products if blood sugars are over 240 mg/dL.

sugar is less than 50, eat or drink 2 carbohydrate sources (30 grams total). Re-check your blood sugar to make sure it is rising closer to normal. Then eat something more to keep your blood sugar level in the normal range.

Call the advice nurse or your doctor or health care professional when: • Your blood sugar is less than

70 mg/dL 2 times in 1 day. • Your blood sugar is over 300 mg/dL

for 2 days or your blood sugars are much higher than they usually are.

• Your temperature is over 100°F for 2 days.

• You have diarrhea for more than 6 hours.

• You have thrown up more than once. • You have small to moderate ketones

in your urine. • You experience deep or troubled

breathing; dry, cracked lips, mouth, or tongue; or have a fruity odor to your breath.

• You have been sick for 2 days, and you are not getting better.

• You are not sure what you need to do to take care of yourself.

Get emergency care right away if you have either of the following: • Blood sugar over 500 mg/dL • Moderate to large amounts

of ketones in your urine.

Be sure to talk to your family, friends, or caregivers about what to do when you have a diabetes emergency. Teach them: • How to recognize and help you

manage your low blood sugar. Your doctor or health care professional may prescribe a glucagon kit for you if you use insulin and are at high risk for extremely low blood sugar.

• The appropriate steps to take if you lose consciousness or remain unconscious.

Prepare a Sick Day Kit You may need certain medications to help manage sick days. Talk with your diabetes care team or pharmacist beforehand to make sure you have the medications that are appropriate for you. Routinely check the expiration date of products and replace them if they have expired. Here are some suggested items to have on hand before you get sick: • List of sick day foods and

beverages (in case someone should shop for you)

• Sugar-free cough medicine and throat lozenges and any other over-the-coun-ter medications

• Thermometer • Aspirin or acetaminophen (such as

Tylenol) • For diarrhea: loperamide (such as

Imodium, for adults) or bismuth

subsalicylate (such as Kaopectate) for children • Nasal decongestants: phenylephrine (such as Neo-synephrine) or oxy-metazoline solution (such as Afrin) • Rectal suppositories for severe nausea (available by prescription) • Ketone testing sticks (such as Ketostix, unopened, foil-wrapped) • An extra bottle of quick-acting insulin as prescribed by your doctor or health care professional • Phone number for the Appointment and Advice line (advice nurse) or health care team at the facility nearest to you • Phone numbers of friends or relatives who are able to help you

Other resources • Visit kp.org/mydoctor. • Try our personalized online pro-

grams at kp.org/healthyliving to get support for your weight loss and activity goals.

• Contact your facility’s Health Education Center or Department for books, videos, classes, and additional resources.

• If you are hit, hurt, or threatened by a partner or spouse, this can seriously affect your health. There is help. Call the National Domestic Violence Hotline at 1-800-799-7233 or connect to ndvh.org.

This information is not intended to diagnose health problems or to take the place of medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products mentioned. Any trade names listed are for easy identification only. Some photos may

What to eat 1/2 cup gelatin (such as Jell-O)*

1/2 cup applesauce

6 oz. yogurt, plain or artificially sweetened 1/2 banana

1 slice toast or bread 3 graham crackers 1/2 cup pudding*

6 saltines 1/2 cup cooked cereal 6 vanilla wafers 1/2 cup custard

1 popsicle 1/4 cup sherbet 1/2 cup ice cream

1/2 cup mashed potato

What to drink 1/2 cup juice

1/2 cup regular* or caffeine-free soda

1 cup sports drink (such as Gatorade)* water herbal tea broth clear soups

http://kp.org/mydoctor.


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healthy living Relaxation Skills

There are many ways you can relax. Deep breathing, muscle relaxation,

and the relaxation response are simple and good for your health.

elaxation has many benefits. It can help you feel calmer,

think more clearly, and relieve stress, headaches, and tight muscles. Whether you want to take a break from a stressful day or manage your stress for the long-term, a regular relaxation practice can really help you get back to a calmer state.

There are many ways to relax. Three common methods are: deep breathing, progressive muscle relaxation, and the relaxation response. When learning these skills, it is important to find a quiet place where you won’t be disturbed. Try to practice for 10

or 20 minutes once or twice a day. It may take two to three weeks to fully develop these skills, but once you have trained your mind and body to relax, you’ll be able to get the same relaxed feelings quickly.

Deep breathing When it is done with purpose, deep breathing can help calm you down. It can help you let go of stress and worries and focus quietly on the present moment. How to do deep breathing Place both hands on the lower part of your stomach and inhale so that your belly pushes gently against your hands. Your stomach muscles should be relaxed. Then, gently push with your hands as you exhale slowly. If it helps, imagine a balloon in your stomach that inflates when you inhale and deflates when you exhale. Practice this several times. When you breathe out, try to imag-ine tension and stress leaving your body; say to yourself, “I am feeling relaxed and calm.”

Here are some important tips for practicing this skill: • Wear loose, comfortable clothing

and find a quiet, relaxing place to practice.

• Start practicing for just one to two minutes. Slowly increase your practice time up to five minutes. Practice several times a day.

• In the beginning, it may help to practice deep breathing while lying down on your bed or on the floor. Lie on your back, bend your knees, and place your feet comfortably apart.

• If you feel lightheaded, dizzy, or anxious, you may be breathing too deeply or too quickly. If this happens, stop practicing for a moment and breathe normally until the symptoms pass. Try inhaling and exhaling through your nose to prevent hyperventilation.

• As you progress, practice deep breathing in a variety of settings (e.g., sitting at your desk, waiting in line, or watching television).

• Be patient and gentle with yourself.

Progressive muscle relaxation The body responds to tense thoughts or situations with muscle tension, which can cause pain or discomfort. Progressive muscle relaxation will help you reduce stress and become more relaxed. It involves tensing and releasing each muscle group to create a deeper sense of relaxation. It can also reduce feelings of anxiety. You can use a recording to help you go through all the muscle groups, or you can follow the instructions below. Progressive muscle relax-ation often helps with stress-related health problems and can help you fall asleep.

Note: If you have fibromyalgia or myofascial pain syndrome, check with your health care professional before practicing progressive muscle relaxation.

HEALTH EDUCATION

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healthy living Relaxation Skills

How to do progressive muscle relaxation Pick a place where you can stretch out comfortably, such as on a pad or carpeted floor. Tense each mus-cle group for 4 to10 seconds (hard, but not to the point of cramping). Then release the muscle and give yourself 10 to 20 seconds to relax. Try to relax each muscle group a little more deeply each time you do this exercise.

How to tense muscle groups • Hands: Make a fist. • Wrists and forearms: Extend

your arms and bend hands back at the wrist.

• Biceps and upper arms: Make a fist, bend arms at elbows, and flex biceps.

• Shoulders: Shrug them. • Forehead: Wrinkle it into a deep

frown. • Around the eyes and bridge of

the nose: Close eyes as tightly as possible. (Remove contact lenses before beginning this exercise.)

• Cheeks and jaws: Grin from ear to ear.

• Around the mouth: Press lips together tightly.

• Back of the neck: Press head back against the pad or supporting surface.

• Front of the neck: Touch your chin to your chest.

• Chest: Take a deep breath, hold it, then exhale.

• Back: Arch your back up and away from support surface.

• Stomach: Suck your stomach into a tight knot. • Hips and buttocks: Press your buttock cheeks together tightly. • Thighs: Clench hard. • Lower legs: Point your toes toward your face, as if trying to bring them up to touch your head. • Lower legs: Point your toes away and curl them downward at the same time.

Relaxation response The relaxation response slows the heart rate and breathing, lowers blood pressure, and helps relieve muscle tension. It can help you slow down, reduce stressful feelings, and refocus your thoughts. Technique (adapted from Herbert Benson, MD): • Sit quietly in a comfortable position with your eyes closed. • Become aware of your breath-ing. Breathe slowly and steadily; breathing from your belly and not from your chest. • Each time you exhale, say the word “one” (or any other word or phrase) silently or aloud. Or, you may choose to fix your gaze on a stationary object. Any mental stimulus will help shift your mind away from distracting thoughts. • Continue this for 10 to 20 minutes. As distracting thoughts enter your mind, don’t dwell on them. Just allow them to drift away.

• Sit quietly for several minutes until you are ready to open your eyes.

• Notice the difference in your breathing and your pulse rate.

Don’t worry about becoming deep-ly relaxed. The key to this exercise is to be passive, to let distracting thoughts slip away like waves on the beach. Practice for 10 to 20 minutes once or twice a day, but wait for at least two hours after a meal. When you have set up a routine, the relaxation response should come with little effort.

Additional resources • Connect to our Web site at kp.org. • Visit your facility’s Health

Education Department for books, videos, classes, and additional resources.

• Want a customized online stress management plan? Check out our HealthMedia® RelaxTM Healthy Lifestyles program at kp.org/healthylifestyles.

• Try out our Health Coach Stress Less Program at kp.org/mindbody.

• If you are hit, hurt or threatened by a partner or spouse, this can seriously affect your health, including your ability to manage stress. There is help. Call the National Domestic Violence Hotline at 1-800-799-7233 or connect to ndvh.org.

This information is not intended to diagnose or to take the place of medical advice or care you receive from your physician or other health care professional. If you have persistent health problems, or if you have additional questions, please consult with your doctor. If you have questions or need more information about your medication, please speak to your pharmacist. Kaiser Permanente does not endorse the medications or products

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