Prevent diabetes problems

Keep your diabetesunder controlKeep your diabetesunder control

NATIONAL INSTITUTES OF HEALTHNational Diabetes Information Clearinghouse

Prevent diabetes problems:Keep your diabetesunder control

NATIONAL INSTITUTES OF HEALTHNational Diabetes Information Clearinghouse

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ContentsWhat are diabetes problems?.................................. 3Will I have diabetes problems? ............................... 3What should my blood sugar numbers be? ............ 4How can I find out what my average bloodsugar is?..................................................................... 5What should I do about blood pressure? ............... 7What should I know and do about smoking? ........ 8What else can I do to preventdiabetes problems? .................................................. 9Things to check for good diabetes care ................ 10How to use the daily diabetes record page .......... 15Daily diabetes record pages .................................. 17My health provider team members....................... 19For more information ............................................ 20More in the series................................................... 21Acknowledgments .................................................. 22

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What are diabetes problems?Too much sugar in the blood for a long time causesdiabetes problems. This high blood sugar candamage many parts of the body, such as the heart,blood vessels, and kidneys. Diabetes problems canbe scary, but there is a lot you can do to preventthem or slow them down.

Will I have diabetes problems?Maybe. You may have oneor more diabetes problemsor none at all. It is hard toknow if or when your diabeteswill cause problems. If youhave diabetes when you areyoung, you may not havediabetes problems formany years. If you findout you have diabetesas an adult, youmay already havediabetes problems.Either way, keepingyour blood sugarunder control canprevent diabetesproblems.

Be active to prevent diabetesproblems.

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What should my blood sugarnumbers be?For most people, good blood sugar levels are

On waking (before breakfast) 80 to 120Before meals 80 to 1202 hours after meals 180 or lessAt bedtime 100 to 140

Ask your health care provider what your bloodsugar numbers should be and write them here.

On waking (before breakfast) ______ to ______Before meals ______ to ______2 hours after meals ______ or lessAt bedtime ______ to ______

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You and your health care provider will agree onwhen to check blood sugar using a blood glucosemeter. You will do the tests yourself. Be sure toask your health care provider to teach you how touse the meter.

Keep track of your blood sugar using the recordpage in this booklet. Make copies or print out therecord page from the web site. Or ask your healthcare provider for a blood sugar record book. Yourblood sugar check results will help you and yourhealth care provider make a plan for keeping yourblood sugar under control.

How can I find out what my averageblood sugar is?Ask your health care provider to do a hemoglobinA-1-c (HE-moh-glow-bin A-1-c) test. This bloodtest shows the average amount of sugar in yourblood during the past 3 months. Have this test doneat least twice a year. Your health care provider usesthis test plus your blood glucose meter test results totell if your blood sugar is under control.

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Keep your hemoglobin A-1-c below 7 percent.

Hemoglobin A-1-c testing: How to compare

4% 605% 90

6% 1207% 150

8% 1809% 210

10% 24011% 270

Hem

oglo

bin

A-1-

cBlood sugar

Aim for a score of less than 7 percent. If your testresult is less than 7 percent, then your blood sugaris in a good range and your diabetes treatment planis working. You are doing all you can to preventdiabetes problems.

A test result of more than 8 percent is too high.At more than 8 percent, you have a greater chanceof getting diabetes problems, like kidney damage,and you need a change in your diabetes plan. Yourhealth care provider can help you decide what partof your plan to change. You may need to changeyour meal plan, your diabetes medicines, or yourexercise plan.

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What should I do about blood pressure?Normal blood pressure will help prevent damage toyour eyes, kidneys, heart, and blood vessels. Bloodpressure is written with two numbers separated bya slash. For example: 120/70. The first numbershould be below 130 and the second number shouldbe below 85. Keep your blood pressure as close tothese numbers as you can.

If your blood pressure is too high, your doctormight ask you to take a blood pressure medicinecalled an ACE inhibitor (in-HIB-it-ur). Thistype of blood pressure medicine is best for peoplewith diabetes.

Keep your bloodpressure below130/85.

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What should I know and doabout smoking?Do not smoke. Smoking slows down blood flowand can make heart and blood vessel problemsworse. Smoking can slow blood flow to your feetand legs and make sores and infections harderto heal.

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

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What else can I do to preventdiabetes problems?There are other things that you can do either eachday or one or more times a year to prevent diabetesproblems. For example, to keep your feet healthy,you should check them each day. To keep youreyes healthy, once a year you should have dropsput in your eyes and have them examined.

See page 11 for what you can do each day to stayhealthy with diabetes. See pages 12 to 15 for otherthings to check for good diabetes care.

Check your feet each dayto keep them healthy.

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Things to check for good diabetes careTaking care of diabetes is a team effort betweenyou and your health care provider team (doctor,diabetes nurse educator, diabetes dietitianeducator, pharmacist, and others). You are themost important member of the team.

Take charge of your diabetes care by learning whatto do for good diabetes care:

● Things to do every day for good diabetescare (see page 11).

● Things for your health care provider tolook at every time you have a checkup(see pages 12 and 13).

● Things for you or your health careprovider to do at least once or twicea year (see pages 14 and 15).

Keep a daily record of blood sugar test results.(Make copies of the daily diabetes record page inthis booklet.) This information will help you see ifyou are reaching your blood sugar goals. You canprevent or slow down diabetes problems byreaching your blood sugar goals most of the time.

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Things to do every day for good diabetes care:Follow the healthy eating plan thatyou and your doctor or dietitian haveworked out. Eat your meals and snacksat around the same times each day.

Be active a total of 30 minutes mostdays. Ask your doctor what activitiesare best for you.

Take your diabetes medicine at thesame times each day.

Check your blood sugar every day.Each time you check your bloodsugar, write the number on your dailydiabetes record page. Call yourdoctor if your numbers are too highor too low for 2 to 3 days.

Check your feet every day for cuts,blisters, sores, swelling, redness, orsore toenails.

Brush and floss your teeth and gumsevery day.

Don’t smoke.

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Your blood Show your records to yoursugar records health care provider.

Tell your health care providerif you have low blood sugaror high blood sugar often.

Your weight Ask your health care providerhow much you should weigh.Talk about ways to reach yourgoal that will work for you.

Your blood A good goal for most peoplepressure is less than 130/85.

Ask your health care providerabout ways to reach your goal.

Your diabetes Talk to your health caremedicines plan provider about any problems

you have had with yourdiabetes medicines.

Your feet Ask your health care pro-vider to check your feet tomake sure your foot nervesand your blood circulationare OK.

Things for your health care provider to look atevery time you have a checkup:

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Your plan Tell your health care providerfor exercise what you do to stay active.Your meal Ask questions about what toplan eat, how much to eat, or when

to eat.Your feelings Ask your health care provider(Are you about ways to handle stress.tense or If you are feeling sad ordepressed?) unable to cope with problems,

ask about how to get help.Your smoking If you smoke, quitting may be

very hard to do. But yourhealth care provider may beable to help.

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Things for you or your health care providerto do at least once or twice a year:

Hemoglobin Have this blood test at leastA-1-c lab test twice a year (see pages 5

and 6). This will tell you whatyour average blood sugar levelwas for the past 3 months.

Blood lipid Get a blood test to check your(fats) lab tests

● Cholesterol—aim for lessthan 200.

● LDL—aim for less than 130.● HDL—men should aim

for more than 35; womenshould aim for more than 45.

● Triglycerides—aim for lessthan 200.

Kidney lab Ask for tests to check yourtests urine for protein and your

blood for end products ofprotein breakdown. Theresults will tell you how wellyour kidneys are working.

These test results will help you planhow to prevent heart attack and stroke.

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How to use the daily diabetesrecord pageUse copies of the record pages (pages 17 and 18)in this booklet to keep track of blood sugar checks,medicines, and notes about things that affect yourblood sugar. Make one copy of the record pages foreach week. This record will help you see if yourdiabetes plan is working. Review your record withyour health care providers.

Blood sugar checksTalk to your health care provider and decide onthe best times to check blood sugar. You may bechecking blood sugar before meals, after meals,or at bedtime. Write when to check here:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Dilated eye See your eye doctor once aexam year because a doctor can

detect eye problems beforeyou notice anything wrong.

Dental exam See your dentist twice a yearfor a cleaning and check up.

Flu shot Get a flu shot each year becausethe flu in someone with diabetescan be very serious.

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If needed, draw a line in the boxes under“Breakfast,” “Lunch,” and “Dinner” tomake room for blood sugar check resultsbefore and after a meal, like this example:See page 4 for information about good bloodsugar levels.

MedicinesUnder the heading marked “Medicine,” writethe name of your diabetes medicine and theamount taken.

NotesWrite down things that affect your blood sugarlevel. Some examples are

• Eating more or less than usual.

• Forgetting to take your diabetes medicine.

• Exercising (write down what kind and forhow long).

• Being sick or upset about something(being under stress).

• Going to a social event or other specialevent, or being on vacation.

Daily diabetes record page*

*Keep this copy clean. Make photocopies and write on the copies.

Other Breakfast Medicine Lunch MedicineBlood Blood BloodSugar Sugar Sugar

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

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Dinner Medicine Bedtime Medicine Notes:Blood Blood (Special events,Sugar Sugar sick days, exercise)

Week starting

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My health care provider team members:

Name and Address Phone Number

Doctor

DiabetesDietitianEducator

DiabetesNurseEducator

Eye Doctor

Dentist

Foot Doctor

Pharmacist

Counselor

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For more informationDiabetes Teachers (nurses, dietitians, pharmacists,and other health professionals)

To find a diabetes teacher near you, call theAmerican Association of Diabetes Educatorstoll-free at 1–800–TEAMUP4 (1–800–832–6874),or look on the Internet at www.aadenet.org andclick on “Find an Educator.”

Recognized Diabetes Education Programs(teaching programs approved by the AmericanDiabetes Association)

To find a program near you, call toll-free at1–800–DIABETES (1–800–342–2383), orsee www.diabetes.org/education/edustate2.aspon the Internet.

Dietitians

To find a dietitian nearyou, call the AmericanDietetic Association’sNational Centerfor Nutrition andDietetics toll-free at1–800–366–1655, orlook on the Internetat www.eatright.organd click on “Find aDietitian.”

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More in the seriesThe “Prevent Diabetes Problems” series includesseven booklets that can help you learn more abouthow to prevent diabetes problems.

For free single copies of these booklets, call, write,fax, or email the

National Diabetes Information Clearinghouse1 Information WayBethesda, MD 20892–3560

Phone: 1–800–860–8747 or (301) 654–3327Fax: (301) 907–8906Email: ndic@info.niddk.nih.gov

These booklets are also available under “HealthInformation” at www.niddk.nih.gov on the Internet.

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For AmericanAssociation of DiabetesEducatorsLynn Grieger, R.D.,C.D.E.Arlington, VTCelia Levesque, R.N.,C.D.E.Montgomery, ALTeresa McMahon,Pharm.D., C.D.E.Seattle, WABarbara Schreiner, R.N.,M.N., C.D.E.Galveston, TX

For American DiabetesAssociationPhyllis Barrier, M.S.,R.D., C.D.E.Alexandria, VALinda Haas, Ph.C., R.N.,C.D.E.Seattle, WAKathleen Mahoney,M.S.N., R.N., C.D.E.Drexel Hill, PARandi Kington, M.S.,R.N., C.S., C.D.E.Hartford, CT

Diabetes Research andTraining CenterAlbert EinsteinSchool of MedicineNorwalk HospitalNorwalk, CTJill Ely, R.N., C.D.E.Sam Engel, M.D.Pam Howard, A.P.R.N.,C.D.E.

Diabetes Research andTraining CenterIndiana UniversitySchool of MedicineIndianapolis, INMadelyn Wheeler, M.S.,R.D., F.A.D.A., C.D.E.

Diabetes Research andTraining CenterVA/JDF DiabetesResearch CenterVanderbilt School ofMedicineNashville, TNOk Chon Allison,M.S.N., R.N.C.S.,A.N.P., C.D.E.Barbara Backer, B.S.James W. Pichert, Ph.D.Alvin Powers, M.D.Melissa E. SchweikhartMichael B. SmithKathleen Wolffe, R.N.

Grady Health SystemDiabetes ClinicAtlanta, GAErnestine Baker, R.N.,F.N.P., C.D.E.Kris Ernst, R.N., C.D.E.Margaret Fowke,R.D., L.D.Kay Mann, R.N., C.D.E.

Health Care FinancingAdministrationBaltimore, MDJan Drass, R.N., C.D.E.

Indian Health ServiceAlbuquerque, NMRuth Bear, R.D., C.D.E.Dorinda Bradley, R.N.,C.D.E.Terry Fisher, R.N.Lorraine Valdez, R.N.,C.D.E.

Indian Health ServiceRed Lake, MNCharmaine Branchaud,B.S.N., R.N., C.D.E.

Medlantic ResearchCenterWashington, DCResa Levetan, M.D.

Texas Diabetes CouncilTexas Departmentof HealthAustin, TXLuby Garza-Abijaoude,M.S., R.D., L.D.

AcknowledgmentsThe National Diabetes Information Clearinghousethanks the people who helped review or field-testthis booklet.

National DiabetesInformation Clearinghouse

1 Information WayBethesda, MD 20892–3560Phone: 1–800–860–8747 or (301) 654–3327Fax: (301) 907–8906Email: ndic@info.niddk.nih.gov

The National Diabetes Information Clearinghouse (NDIC)is a service of the National Institute of Diabetes andDigestive and Kidney Diseases (NIDDK). NIDDK is part ofthe National Institutes of Health under the U.S. Departmentof Health and Human Services. Established in 1978, theclearinghouse provides information about diabetes to peoplewith diabetes and to their families, health care professionals,and the public. NDIC answers inquiries; developsand distributes publications; and works closely withprofessional and patient organizations and Governmentagencies to coordinate resources about diabetes.

Publications produced by the clearinghouse are carefullyreviewed for scientific accuracy, content, and readability.

This publication is not copyrighted. The clearing-house encourages users of this booklet to duplicateand distribute as many copies as desired.

This booklet is also available under “HealthInformation” at www.niddk.nih.gov on the Internet.

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U.S. DEPARTMENT OF HEALTHAND HUMAN SERVICESNational Institutes of Health

National Institute of Diabetes andDigestive and Kidney Diseases

NIH Publication No. 00–4349May 2000