Diabetes: What the Diagnosis Means

If you just found out you have diabetes, you probably have a lot of questions and you may feel a little uncertain.

It may help to know you're not alone. In the United States, nearly 16 million people have diabetes. Most of these people lead full, healthy lives. One of the best things you can do for yourself is to learn all you can about diabetes. This handout will tell you some of the basics about diabetes.

What is diabetes?

Your body changes most of the food you eat into glucose (a form of sugar). Insulin, a hormone produced by the pancreas, allows glucose to enter all the cells of your body and be used as energy.

Diabetes is a disease that occurs when a person’s body doesn’t make enough insulin or can’t use insulin properly. When you have diabetes, the sugar builds up in your blood instead of moving into the cells. Some, but not all, of the excess sugar is carried out of your body (through urine), and the energy is wasted.

There are two types of diabetes.

· Type 1 occurs when the body doesn’t produce any insulin.

· People with type 2 diabetes either don’t produce enough insulin or their cells ignore the insulin. Nearly 95% of people with diabetes have type 2.

How can I help myself stay healthy if I have diabetes?

Although diabetes can’t be cured, you can live a long and healthy life. The single most important thing you can do is control your blood sugar level. You can do this by eating right, exercising, maintaining a healthy weight and, if needed, taking oral medicines or insulin.

Eat a healthy diet. The recommended diet for many people who have diabetes is very similar to that suggested for people who don't have diabetes. It's important to eat at least 3 meals per day and never skip a meal.

Exercise. Exercising will help your body use insulin and lower your blood sugar.

Maintain a healthy weight. Losing excess weight will help you in 2 ways. First, it helps insulin work better in your body. It will also lower your blood pressure (which decreases your risk for heart disease).

Take your medicine. If your diabetes can’t be controlled through diet, exercise and weight control, your doctor may recommend medicine or insulin. Oral medicines (taken by mouth) can make your body produce more insulin or help your body use the insulin it makes more efficiently. Some people need to add insulin to their bodies.  Always take medicines exactly as your doctor tells you to.

Is this really a big deal?

Diabetes is a serious disease. Terms such as "a touch of diabetes" or "your sugar is a little high" suggest that diabetes is not a serious disease. That is not correct and these terms should not be used.

Taking good care of diabetes will help you feel better and avoid the health problems that diabetes can cause.

When your diabetes is in good control, you are more likely to feel better and

• be less tired and thirsty and urinate less often.
• heal better and have fewer gum, skin, or bladder infections.
• be less likely to have blurry vision or numb hands or feet.

What are diabetes problems?

Too much glucose (sugar) in the blood for a long time can cause diabetes problems. This high blood glucose (also called blood sugar) can damage many parts of the body, such as the heart, blood vessels, eyes, and kidneys. This damage can lead to:

Be active to prevent diabetes problems.

• Heart disease and stroke.
• Eye disease that can lead to vision problems or even going blind.
• Nerve damage that can cause your hands and feet to feel numb. This can lead to loss of a foot or a leg.
• Kidney problems.
• Gum disease and loss of teeth.

Will I have diabetes problems?

Maybe. You may have one or more diabetes problems or none at all. It is hard to know if or when your diabetes will cause problems. If you get diabetes when you are young, you may not have diabetes problems for many years. If you find out you have diabetes as an adult, you may already have diabetes problems. Either way, keeping your blood glucose, blood pressure, and cholesterol under control can prevent diabetes problems.

Know you Diabetes ABC’s

Manage your A1C (blood glucose or sugar), Blood pressure, and Cholesterol. This will help lower your chances of having a heart attack, a stroke, or other

diabetes problems. These are called the ABCs of diabetes.

A is for the A1C test.

It shows how well your blood glucose has been controlled over the last 3 months.

It should be checked at least twice a year. High blood glucose levels can harm your kidneys, feet, and eyes.

The goal for most people is less than 7.

B is for Blood pressure.

High blood pressure makes your heart work too hard. It can cause heart attack, stroke, and kidney disease.

The goal for most people is 120/75 or less.

C is for Cholesterol.

Bad cholesterol, or LDL, can build up and clog your blood vessels. It can cause a heart attack or a stroke.

The LDL goal for most people is less than 100.

What should my blood glucose numbers be?

Keeping your blood glucose on target will prevent or delay diabetes problems. For most people, target blood glucose levels are:

Fasting (early morning)	Less than 120
Before meals	90 to 130
1 to 2 hours after the start of a meal	Less than 180

You and your health care provider will agree on when you need to check your blood glucose using a blood glucose meter. You will do the checks yourself. Your health care provider can teach you how to use your meter.

Keep track of your blood glucose checks using a record page. Make copies yourself or ask your health care provider for a blood glucose record book. Your blood glucose check results will help you and your health care provider make a plan for keeping your blood glucose under control. Always bring your record book to your health care appointments so you can talk about reaching your glucose goals.

How can I find out what my average blood glucose is?

Ask your health care provider to do an A1C test. This blood test shows the average amount of glucose in your blood during the past 2 to 3 months. Have this test done at least twice a year. If your A1C result is not as good as it should be, your health care provider will do this test more often to see if it is improving as your treatment changes. Your A1C result plus your blood glucose meter results can show whether your blood glucose is under control.

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Aim for a result below 7 percent. If your A1C test result is below 7 percent, then your blood glucose is in a desirable range and your diabetes treatment plan is working. The lower your A1C is, the lower your chance of getting eye, nerve, and kidney damage.

If your test result is more than 8 percent, you need a change in your diabetes plan. Your health care team can help you decide what part of your plan to change. You may need to change your meal plan, your diabetes medicines, or your exercise plan.

What should my blood pressure be?

Normal blood pressure will help prevent damage to your eyes, kidneys, heart, and blood vessels. Blood pressure is written with two numbers separated by a slash. For example: 120/70. The first number should be below 120 and the second number should be below 75. Keep your blood pressure as close to these numbers as you can. If you already have kidney disease, you may want even lower blood pressure to protect your kidneys.

Meal planning, medicines, and exercise can help you reach your blood pressure target.

Have your blood pressure checked at every visit.

What should my cholesterol be?

Normal cholesterol levels will help prevent heart disease and stroke, the biggest health problems for people with diabetes. Keeping cholesterol levels under control can also help with blood flow. Have your cholesterol level checked at least once a year. Meal planning, exercise, and medicines can help you reach your cholesterol targets:

Total Cholesterol	Under 200
LDL (bad) Cholesterol	Under 100
HDL (good) Cholesterol	Above 40 (men) Above 50 (women)
Triglycerides	Under 150

What does smoking have to do with diabetes problems?

Smoking and diabetes are a dangerous combination. Smoking raises your risk for diabetes problems. If you quit smoking, you'll lower your risk for heart attack, stroke, nerve disease, and kidney disease. Your cholesterol and your blood pressure levels may improve. Your blood circulation will also improve.

If you smoke, ask your health care provider for help in quitting.

What else can I do to prevent diabetes problems?

Check your feet each day to keep them healthy.

There are other things that you can do either each day or one or more times a year to prevent diabetes problems. § To keep your feet healthy, check them each day. Also once a year, your health care provider should do a complete foot exam. § Ask your health care team whether you should take an aspirin every day to lower your risk for heart disease. § To keep your eyes healthy, visit an eye doctor once a year for a complete eye examination that includes using drops in your eyes to dilate the pupils. § Once a year, your urine should be tested for protein.

Things to Check for Good Diabetes Care

Taking care of diabetes is a team effort between you and your health care team (doctor, diabetes nurse educator, diabetes dietitian educator, pharmacist, and others). You are the most important member of the team.

Take charge of your diabetes by learning what to do for good diabetes care.

You can prevent or slow down diabetes problems by reaching your blood glucose, blood pressure, and cholesterol goals most of the time.

Things to Do Every Day for Good Diabetes Care

	Follow the healthy eating plan that you and your doctor or dietitian have worked out.
	Be active a total of 30 minutes most days. Ask your doctor what activities are best for you.
	Take your diabetes medicines at the same times each day.
	Check your blood glucose every day. Each time you check your blood glucose, write the number in your record book.
	Check your feet every day for cuts, blisters, sores, swelling, redness, or sore toenails.
	Brush and floss your teeth and gums every day.
	Don't smoke.

Things for Your Health Care Provider to Look at Every Time You Have a Checkup

Your blood glucose records	Show your records to your health care provider. Tell your health care provider if you often have hypoglycemia (low blood glucose) or high blood glucose.
Your weight	Talk with your health care provider about how much you should weigh. Talk about ways to reach your goal that will work for you.
Your blood pressure	The goal for most people with diabetes is less than 120/75. Ask your health care provider about ways to reach your goal.
Your diabetes medicines plan	Talk to your health care provider about any problems you have had with your diabetes medicines.
Your feet	Ask your health care provider to check your feet for sores.
Your plan for exercise	Talk with your health care provider about what you do to stay active.
Your meal plan	Talk about what you eat, how much you eat, and when you eat.
Your feelings	Ask your health care provider about ways to handle stress. If you are feeling sad or unable to cope with problems, ask about how to get help.
Your smoking	If you smoke, talk with your health care provider about how you can quit.

Things for You or Your Health Care Provider to Do at Least Once or Twice a Year

A1C test	Have this blood test at least twice a year. Your result will tell you what your average blood glucose level was for the past 2 to 3 months.
Blood lipid (fats) lab tests	Get a blood test to check your total cholesterol—aim for under 200 LDL—aim for under 100 HDL—men aim for above 40; women aim for above 50 triglycerides—aim for under 150 These test results will help you plan how to prevent heart attack and stroke.
Kidney function tests	Ask for tests to check your urine for protein. The results will tell you how well your kidneys are working.
Dilated eye exam	See your eye doctor once a year for a complete eye exam.
Dental exam	See your dentist twice a year for a cleaning and checkup.
Flu shot	Get a flu shot each year.
Foot exam	Ask your health care provider to check your feet to make sure your foot nerves and your blood circulation are OK.

How Food Affects Your Blood Glucose

Whether you have type 1 or type 2 diabetes, what, when, and how much you eat all affect your blood glucose. Blood glucose is the main sugar found in the blood and the body's main source of energy.

If you have diabetes (or impaired glucose tolerance), your blood glucose can go too high if you eat too much. If your blood glucose goes too high, you can get sick.

Your blood glucose can also go too high or drop too low if you don't take the right amount of diabetes medicine.

If your blood glucose stays high too much of the time, you can get heart, eye, foot, kidney, and other problems. You can also have problems if your blood glucose gets too low (hypoglycemia).

Keeping your blood glucose at a healthy level will prevent or slow down diabetes problems. Ask your doctor or diabetes teacher what a healthy blood glucose level is for you.

Blood Glucose Levels

What should my blood glucose levels be?

For most people, target blood glucose levels are

Before meals	90 to 130
1 to 2 hours after the start of a meal	Less than 180

Talk with your health care provider about your blood glucose target levels and write them in if they differ.

Before meals	______ to ______
1 to 2 hours after the start of a meal	Less than ______

Ask your doctor how often you should check your blood glucose. The results from your blood glucose checks will tell you if your diabetes care plan is working. Also ask your doctor for an A1C test at least twice a year. Your A1C number gives your average blood glucose for the past 3 months.

How can I keep my blood glucose at a healthy level?

• Eat about the same amount of food each day.
• Eat your meals and snacks at about the same times each day.
• Do not skip meals or snacks.
• Take your medicines at the same times each day.
• Exercise at about the same times each day.

Why should I eat about the same amount at the same times each day?

Your blood glucose goes up after you eat. If you eat a big lunch one day and a small lunch the next day, your blood glucose levels will change too much.

Keep your blood glucose at a healthy level by eating about the same amount of carbohydrate foods at about the same times each day. Carbohydrate foods, also called carbs, provide glucose for energy. Starches, fruits, milk, starchy vegetables such as corn, and sweets are all carbohydrate foods.

The Food Pyramid

Eat a variety of food to get the vitamins and minerals you need. Eat more from the groups at the bottom of the pyramid, and less from the groups at the top.

Starches

Starches are bread, grains, cereal, pasta, or starchy vegetables like corn and potatoes. They give your body energy, vitamins, minerals, and fiber. Whole grain starches are healthier because they have more vitamins, minerals, and fiber.

Eat some starches at each meal. People might tell you not to eat starches, but that is not correct. Eating starches is healthy for everyone, including people with diabetes.

Examples of starches include

bread pasta corn

potatoes rice crackers

tortillas beans yams

How much is a serving of starch?

If you have more than one serving at a meal, you can choose several different starches or have two or three servings of one starch.

What are healthy ways to eat starches?

• Buy whole grain breads and cereals.
• Eat fewer fried and high-fat starches such as regular tortilla chips and potato chips, french fries, pastries, or biscuits. Try pretzels, fat-free popcorn, baked tortilla or potato chips, baked potatoes, or low-fat muffins.
• Use low-fat or fat-free yogurt or fat-free sour cream instead of regular sour cream on a baked potato.
• Use mustard instead of mayonnaise on a sandwich.
• Use the low-fat or fat-free substitutes such as low-fat mayonnaise or light margarine on bread, rolls, or toast.
• Eat cereal with fat-free (skim) or low-fat (1%) milk.

Vegetables

Vegetables give you vitamins, minerals, and fiber, with very few calories.

Examples of vegetables include

lettuce broccoli vegetable juice

peppers carrots green beans

salsa chilies greens

How much is a serving of vegetables?

If you have more than one serving at a meal, you can choose a few different types of vegetables or have two or three servings of one vegetable.

What are healthy ways to eat vegetables?

• Eat raw and cooked vegetables with little or no fat, sauces, or dressings.
• Try low-fat or fat-free salad dressing on raw vegetables or salads.
• Steam vegetables using a small amount of water or low-fat broth.
• Mix in some chopped onion or garlic.
• Use a little vinegar or some lemon or lime juice.
• Add a small piece of lean ham or smoked turkey instead of fat to vegetables when cooking.
• Sprinkle with herbs and spices. These flavorings add almost no fat or calories.
• If you do use a small amount of fat, use canola oil, olive oil, or soft margarines (liquid or tub types) instead of fat from meat, butter, or shortening.

Fruit

Fruit gives you energy, vitamins, minerals, and fiber.

Examples of fruit include

apples fruit juice strawberries

bananas raisins oranges

mango guava papaya

How much is a serving of fruit?

If you have more than one serving at a meal, you can choose different types of fruit or have two servings of one fruit.

What are healthy ways to eat fruit?

• Eat fruits raw or cooked, as juice with no sugar added, canned in their own juice, or dried.
• Buy smaller pieces of fruit.
• Eat pieces of fruit rather than drinking fruit juice. Pieces of fruit are more filling.
• Drink fruit juice in small amounts.
• Save high-sugar and high-fat fruit desserts such as peach cobbler or cherry pie for special occasions.

Milk and Yogurt

Milk and yogurt give you energy, protein, fat, calcium, vitamin A, and other vitamins and minerals.

How much is a serving of milk and yogurt?

Note: If you are pregnant or breastfeeding, have four to five servings of milk and yogurt each day.

What are healthy ways to have milk and yogurt?

• Drink fat-free (skim or nonfat) or low-fat (1%) milk.
• Eat low-fat or fat-free fruit yogurt sweetened with a low-calorie sweetener.
• Use low-fat plain yogurt as a substitute for sour cream.

Meat and Meat Substitutes

The meat and meat substitutes group includes meat, poultry, eggs, cheese, fish, and tofu. Eat small amounts of some of these foods each day.

Meat and meat substitutes help your body build tissue and muscles. They also give your body energy and vitamins and minerals.

Examples of meat and meat substitutes include

chicken fish beef

eggs peanut butter tofu

cheese ham pork

How much is a serving of meat or meat substitute?

*Two to three ounces of meat (after cooking) is about the size of a deck of cards.

What are healthy ways to eat meat or meat substitutes?

• Buy cuts of beef, pork, ham, and lamb that have the least fat on them. Trim off extra fat.
• Eat chicken or turkey without the skin.
• Cook meat or meat substitutes in low-fat ways (broil, grill, stir-fry, roast, steam, stew)
• To add more flavor, use vinegars, lemon juice, soy or teriyaki sauce, salsa, ketchup, barbecue sauce, and herbs and spices.
• Cook eggs with a small amount of fat or use cooking spray.
• Limit the amounts of nuts, peanut butter, and fried chicken that you eat. They are high in fat.
• Choose low-fat or fat-free cheese.

Fats and Sweets

Limit the amounts of fats and sweets you eat. They have calories, but not much nutrition. Some contain saturated fats and cholesterol that increase your risk of heart disease. Limiting these foods will help you lose weight and keep your blood glucose and blood fats under control.

There are good fats and bad fats.

§ Good fats are monounsaturated fat and omega-3 fatty acids. They are found in olive oil, canola oil, fish and nuts (especially almonds and walnuts).

§ Bad fats are saturated fat and trans fats. They are found in butter, whole milk dairy products, margarines, marbled meats and many processed foods such as crackers, cookies, pastries, etc.

Examples of sweets include Examples of fats include

• regular soda • salad dressing

• ice cream • oil

• cake • butter

• cookies • margarine

• pie • avocado

• candy • olives

How much is a serving of sweets? How much is a serving of fat?

How can I satisfy my sweet tooth?

It's okay to have sweets once in a while. Try having sugar-free popsicles, diet soda, fat-free ice cream or frozen yogurt, or sugar-free hot cocoa mix.

Other tips:

• Share desserts in restaurants.
• Order small or child-size servings of ice cream or frozen yogurt.
• Divide homemade desserts into small servings and wrap each individually. Freeze extra.
• Don't keep dishes of candy in the house or at work.

Remember, fat-free and low-sugar foods still have calories. Talk with your diabetes teacher about how to fit sweets into your meal plan.

How much should I eat each day?

Have about 1,200 to 1,600 calories a day if you are

• a small woman who exercises
• a small or medium woman who wants to lose weight
• a medium woman who does not exercise much

Choose this many servings from these food groups to have 1,200 to 1,600 calories a day:

6 starches	2 milk and yogurt
3 vegetables	2 meat or meat substitute
2 fruit	up to 3 fats

Have about 1,600 to 2,000 calories a day if you are

• a large woman who wants to lose weight
• a small man at a healthy weight
• a medium man who does not exercise much
• a medium to large man who wants to lose weight<