Understanding Diabetes We’re here for you If you have diabetes, you are not alone. Over 29 million1 people in the United States have diabetes. The good news is that, by carefully following the advice of your healthcare professional and with regular testing, healthy food choices, and physical activity, you can help to control and manage your diabetes. The trained diabetes-care pharmacists at Walmart® want to be your partners in diabetes management. We look forward to working with you to help you meet your blood sugar control goals. 1 Centers for Disease Control and Prevention. National Diabetes Statistics Report: Estimates of Diabetes and Its Burden in the United States, 2014. GA: U.S. Department of Health and Human Services; 2014. Table of contents Diabetes Fitness What is diabetes? 04 Get active 28 Why test? 06 Healthy tips 36 Health Care Tips for better balanced meals 14 Food facts 20 Label-wise 26 + Healthcare coverage Resources 41 42 What is diabetes? Diabetes is diagnosed when your blood sugar is too high. Did you know that your blood sugar levels change throughout the day? They are affected by food, activity, diabetes medications, and other factors like stress. To reduce the risk of serious complications, the goal of all diabetes treatment is to keep your blood sugar levels in a healthy range — not too high and not too low. 04 | Diabetes What is diabetes? What is diabetes? Diabetes | 05 Why test? Testing with a meter at key times is an easy way to see: • If your food choices are working to keep your blood sugar levels in range—or not • How well diabetes medications are working to keep your blood sugar levels under control MY BLOOD SUGAR RECORD Blood sugar level test results Before meals 1–2 hours after start of meals Guidelines 80–130 mg/dL* Less than 180 mg/dL* My current readings ________ mg/dL • How illness and emotions, like stress, affect your blood sugar levels Plus, knowing if your blood sugar level is high or low, and why, means you can take action to get it back in range. And knowing that your blood sugar is in range lets you get back to enjoying life. Always follow your healthcare provider’s recommendations for testing and for blood sugar levels that are appropriate for you. 06 | Diabetes Why test? A1C Level Guidelines Less than 7%* My current readings ________% ________ mg/dL If your A1C is 7% or higher, ask your healthcare professional what you can do to lower it. *American Diabetes Association. Glycemic targets. Sec. 6. In Standards of Medical Care in Diabetes 2015. Diabetes Care 2015;38(Suppl. 1):S33-S40. Are your meals and snacks working to keep your blood sugar levels in range? Why test? Diabetes | 07 MEALTIME WORK SHEET 2 Try testing around a meal • Test before and 1–2 hours after the beginning of a meal Today’s date: Test before and after a meal: Breakfast Lunch Dinner What I ate/how much: TIP Use these work sheets to help you plan your meals and snacks that work to keep your blood sugar in range. Time: Time: Before-meal blood sugar level: mg/dL Blood sugar level 1–2 hours after start of meal: mg/dL Difference between results? Comments: MEALTIME WORK SHEET 1 MEALTIME WORK SHEET 3 Today’s date: Today’s date: Test before and after a meal: Breakfast Lunch Dinner What I ate/how much: Test before and after a meal: Time: Time: Before-meal blood sugar level: Blood sugar level 1–2 hours after start of meal: Before-meal blood sugar level: 08 | Diabetes Why test? Lunch Dinner What I ate/how much: Time: Difference between results? Comments: Breakfast mg/dL mg/dL Time: mg/dL Blood sugar level 1–2 hours after start of meal: mg/dL Difference between results? Comments: Why test? Diabetes | 09 Keep a logbook A logbook can help you see how food, medication(s), and exercise affect your blood sugar levels. Then you can make healthy decisions each day to better manage your diabetes. Week of: Day Here’s how to work with a logbook: 1 Fill in the date. M 9/8 1 Breakfast Fasting After 70 2 123 Comments: Circle the result each time you’re above or below your target. Add comments on diet, exercise, stress, illness, etc. Lunch Carbs/ Insulin Before After 6 3 4N/3N 1201 01 60 Dinner Bedtime Carbs/ Carbs/ Insulin Before After Insulin 4 8 ? 1802 0210 ? ? 5 T 2 When testing blood sugar levels before and after meals, write down the before-meal result in the Before column and the after-meal result in the After column. “Fasting” refers to your blood sugar reading before breakfast (when you wake up). 3 Jot down how many carbs you’ve eaten and any amount of insulin you’ve taken. Comments: W Comments: What are your blood sugar goals? 4 When your blood sugar level result is high or low, circle it so you can see it at a glance. 5 Use the Comments section to remark on anything important—like if you feel different, diet, exercise, illness, or stress. TIP Test your blood sugar levels as recommended by your doctor or healthcare professional. 10 | Diabetes Why test? Why test? Diabetes | 11 12 | Diabetes Why test? Why test? Diabetes | 13 Download a logbook at no charge at http://www.onetouch.com/diabetes-logbook. Circle the result each time you’re above or below your target blood sugar level. Add comments on diet, exercise, stress, illness, etc. Circle the result each time you’re above or below your target blood sugar level. Add comments on diet, exercise, stress, illness, etc. Tips for better balanced meals • Eat at least one dark green vegetable, like collards or spinach, and one orange vegetable, such as peppers or carrots, each day TIP If you find yourself feeling hungry with your meal plan for diabetes, try starting meals with a low-carb salad or a broth-based soup with plenty of non-starchy vegetables. You’ll find a complete assortment of healthy vegetables at your local Walmart®. • Have vegetables and fruit more often than juice • Consume fat-free milk or lowfat dairy every day • Have meat alternatives, such as beans, lentils, and tofu, often • Eat at least two servings of fish every week • Include a small amount of unsaturated fat every day (like nuts, avocados, and olive oil) • Satisfy your thirst with water instead of full-calorie soft drinks • Make at least half your grain products whole grain every day (brown rice, oatmeal, 100% or sprouted whole-wheat bread) 14 | Health Tips for better balanced meals Tips for better balanced meals Health | 15 Build a better meal Visualize portion sizes Divide your plate into sections, like the plate below. Be sure your vegetable and starch and protein portions match with the example proportions below. Add a serving of lowfat dairy and fruit for dessert and enjoy! This will help you achieve a well-balanced meal. Sometimes there are no food labels or scales to measure the carbohydrate in your meal, like when you’re eating out. So here’s an easy way to estimate portions of different kinds of food to help you keep track of your carbs. Non-Starchy Vegetables (at least two kinds) Starch (potato, rice, corn, peas) Palm of hand = 3-ounce serving of cooked meat, fish, or poultry Protein (fish, lean meat, chicken, beans, eggs) Fist* = 1 cup of pasta or fruit 16 | Health Tips for better balanced meals Thumb = 1 ounce of cheese *Given that men’s and women’s hand sizes vary, amounts can vary. Tennis ball = 1 serving of milk, yogurt, or fresh greens Tips for better balanced meals Health | 17 Use in moderation: salt, fat, & sugar and cheese. A small amount of saturated fat each day is ok, but zero trans fat is best. The less salt, the better Eating too much sodium may increase your risk of developing high blood pressure, heart disease, and stroke. Start by removing the salt shaker from the table. Then add salt sparingly, if at all, when cooking. The skinny on sugar Though it might be delicious, sugar may contribute a lot of calories and carbohydrate if consumed in excess. That’s why no-calorie sweeteners are smart choices for replacing sugar in baking, cooking, or sweetening. Not all no-calorie sweeteners are heat-stable, so be sure to check with the manufacturer. The following foods are generally high in sodium: • Canned vegetables and meats • Processed snack foods • Crackers, chips, cookies, pretzels Best of all, there are now more choices than ever before: • Saccharin (no-calorie, artificial sweetener) • Aspartame (no-calorie, artificial sweetener) • Frozen entrees and snack foods Good vs. bad fat Bad fats can contribute to heart disease. Good fats are healthy for you and can actually protect your heart when consumed in appropriate amounts. You’ll find good fats (monounsaturated and polyunsaturated fats) in nuts and seeds, olive and canola oils, and avocados. Bad fats (saturated fats and trans fats) are found in animal products, such as butter, bacon, sausage, meat, 18 | Health Tips for better balanced meals • Sucralose (no-calorie, artificial sweetener) • Acesulfame potassium (also called Acesulfame K) (no-calorie, artificial sweetener) • Stevia/Rebaudioside A (no-calorie, natural sweetener) • Monk Fruit Extract/Luo Han Guo (no-calorie, natural sweetener) Source: “Calorie-Free Sweeteners Offer Benefits,” Diabetes Forecast Magazine. Accessed October 2012, through diabetes.org, website of the American Diabetes Association, www.diabetesforecast.org. www.diabetesjournals.org (http://care.diabetesjournals.org/content/37/Supplement_1/S120.full.pdf+html). Tips for better balanced meals Health | 19 • When you eat carbs, your body breaks them down into glucose. Glucose is absorbed into the bloodstream • Insulin helps the blood sugar enter your cells, where it can be stored or used for energy • Eating about the same amount of carbs at meals and snacks can help keep your blood sugar levels in your target range • If you check your blood sugar level before meals and then again 2 hours afterward, you’ll begin to get a picture of how your body responds to the amount of carbs you are eating and if changes are needed 20 | Health Food facts Peach Broccoli Toast Potato Skim milk Apple Sandwich bread Cereal Diet soda Plain tuna Oatmeal cookie Raisins Cheddar cheese Pork chop Soda cracker Peanut butter Butter Salmon Answer: Of all the things that affect your blood sugar levels, food has one of the biggest effects. Especially foods with carbohydrate (carbs, for short). Your body uses carbs for energy, but they raise your blood sugar level higher and faster than other kinds of nutrients. What’s more, diabetes is different for everyone, including the way various foods affect blood sugar levels. So the goal is to plan meals with the right amounts of carbs for your body. FIND THE CARBS QUIZ Check the foods that contain carbohydrates. Peach, toast, skim milk, sandwich bread, oatmeal cookie, soda cracker, broccoli, potato, apple, cereal, raisins, peanut butter. Food facts Food facts Health | 21 Most people use this method to keep track of carbs 15 grams CARBS 1 = CARB CHOICE Counting carbs Counting carbs is one way to create meals and snacks that will help you stay in your blood sugar level range. Food labels list the number of carbs in grams (g) per serving. Generally, adults need 45 to 60 grams of carbs in each meal for energy, but it depends on how your body handles carbs. Consult a registered dietitian or other healthcare professional for the amount that’s right for you. Meal and snack planning guide Meal 45 – grams 60 grams CARBS 3–4 CARB CHOICES Snack 15 –grams 30 grams CARBS 22 | Health Food facts = = 1–2 CARB CHOICES Food facts Health | 23 Common carb counts Don’t forget! The following chart gives you an idea of what 15 grams of carbs (1 carb choice) looks like for many of your favorite foods. So you’ll have an idea of how many carbs you’re consuming, even if there’s no package handy. The following are a couple of reminders to help you manage your diet and achieve optimal glycemic (blood sugar) control. Remember: variety, moderation, and balance are key to healthy eating. 15 GRAMS OF CARBS — 34 DIFFERENT WAYS Starches/Grains/Sweets • 1 slice bread or small roll • ¼ of a 4-oz. bagel • ½ English muffin • ¾ cup dry, unsweetened cereal • ½ cup unsweetened hot cereal • ¹∕³ cup cooked pasta or rice • ½ cup peas or corn • ¼ large potato • ½ cup beans/lentils • 1 pancake (4-inch diameter) • 1 frozen waffle (4-inch diameter) • 6 saltine crackers • 3 cups popcorn • ¾ ounce pretzels • 1 tablespoon sugar Dairy • 1 cup milk • 6 oz. artificially sweetened yogurt • 1 cup plain, lowfat yogurt • ½ cup ice cream 24 | Health Food facts Fruits • 1 small apple • 1 small banana • 4 apricots • ¾ cup blueberries • ¹∕³ small cantaloupe • ½ large grapefruit • ¾ cup mandarin oranges • ½ papaya • 1 medium peach • ½ large pear • ¾ cup pineapple • 2 tablespoons raisins • 1¼ cup strawberries • 1¼ cup watermelon • ½ cup apple or orange juice Eat lean proteins, as well as a variety of fruits and vegetables, nonfat and lowfat dairy products, and whole grains • When you eat carbs, your body breaks them down into glucose. Glucose is absorbed into the bloodstream • Insulin helps the blood sugar enter your cells, where it can be stored or used for energy • Eating about the same number of carbs at your meals and snacks can help to keep your blood sugar levels in your target range • Space your meals out consistently, and do not skip meals — these are both important principles in diabetes management • If you check your blood sugar level before meals and then again 2 hours afterward, you’ll begin to get a picture of how your body responds to the number of carbs you are eating and if changes are needed Food facts Health | 25 Label-wise Nutrition labels on packaged foods can be a great help when you’re counting the carbs in your meals or snacks. Nutrition Facts Serving Size 1 slice Servings per container 22 Amount per serving Calories 80 Calories from Fat 10 % Daily Value Zero in on the Serving Size and the Total Carbohydrate lines to see the total grams of carbs for one serving. The label shows you where to look. Want to see more? Check out the packages, cans, and bottles in your kitchen cupboard. Total Fat 1g 2% Saturated Fat 0g Cholesterol 0% 0mg 0% Sodium 210mg Total Carbohydrate 9% 15g Dietary Fiber less than 1g 5% 4% Sugars 2g TIP Is the serving size the same as your portion? If not, adjust the carb content as necessary. 26 | Health Label-wise Protein 2g 4% Ingredients on packages are listed in order, starting from the highest content to lowest. Label-wise Health | 27 Get active The proven positive effects of physical activity can’t be overstated. On top of all the health benefits you might know of, like building up your heart health, getting more activity is a great way for people with diabetes to help improve blood sugar control. For people with type 2 diabetes, activity can help to boost your body’s ability to use the insulin it makes, which helps lower your blood sugar levels. 28 | Fitness Get active Get active Fitness | 29 Getting started Working up to 150 minutes of moderate-intensity aerobic activity (like brisk walking) every week is suggested. Be sure to talk to your healthcare professional before you begin any physical activity or exercise program, especially since exercise can have an effect on blood sugar levels. Find an activity you enjoy, so you can stick with it. For example, walking at a brisk clip is popular because it’s easy on your joints and you don’t need any fancy equipment. 30 | Fitness Get active Not keen on walking? Try riding a bike or check your local recreational center for aquatic programs. Even household chores like raking leaves, vacuuming, or washing the car count as activity. Keep track of your active time, and you’ll be surprised how easy it can be to fit 20 minutes (or more) into your day. Get active Fitness | 31 Exercising safely with diabetes It is not uncommon for people with diabetes to experience hypoglycemia, or low blood sugar levels, during or after exercise. If this happens, treat it immediately. Use the same process as you would at any other time of the day: • Consume at least 15–20 grams of fast-acting carbohydrate (sports drinks, regular soda, or glucose tabs are all effective) • Wait 15–20 minutes and check your blood sugar level again • If it is still low and your symptoms don’t go away, repeat the treatment • After you feel better, be sure to eat your regular meals and snacks as planned to keep your blood sugar level up If low blood sugar levels regularly interfere with your exercise routine, talk to your healthcare provider about adjusting your diabetes management plan. Your provider might suggest eating a small snack before you exercise, or they might make an adjustment to your medication(s). For people engaging in long-duration exercise, a combination of these two regimen changes is often necessary to prevent hypoglycemia (low blood sugar levels) during and after exercise. TIP ACTIVITY WORK SHEET Try testing your blood sugar levels before and after a brisk 30-minute walk. After Before Result: Time: Before walking, I felt: mg/dL My test result was: Result: Time: After walking, I felt: mg/dL My test result was: Good High Better High Okay In range Good In range Sluggish Low Okay Low Edgy Other Comments: Sluggish Comments: Edgy Other 32 | Fitness Get active Get active Fitness | 33 After Before Result: Time: Before walking, I felt: mg/dL Result: Time: After walking, I felt: My test result was: mg/dL My test result was: Good High Better High Okay In range Good In range Sluggish Low Okay Low Edgy Sluggish Comments: Comments: Edgy Other Other After Before Result: Time: Before walking, I felt: mg/dL My test result was: Result: Time: After walking, I felt: mg/dL My test result was: Good High Better High Okay In range Good In range Sluggish Low Okay Low Edgy Other Comments: Sluggish Comments: Edgy Other 34 | Fitness Get active Get active Fitness | 35 Healthy tips Maintaining a healthy lifestyle day to day is important and can help to reduce your risk of developing complications from diabetes. HERE ARE SOME AREAS TO WATCH: Here are some areas to watch: A1C This blood test measures blood sugar control over the past 90 days. A1C should be tested two to four times a year, depending on how well your blood sugar levels are managed and/or whether you have had a recent change in your diabetes medications or management plan. The goal for A1C levels is less than 7.0 percent. Smoking Cessation If you smoke, quit! It is never too late to quit smoking. Cigarette smoking is a strong risk factor for developing heart and lung disease. Ask your healthcare provider to help you quit smoking. 36 | Fitness Healthy tips Oral Care When you’re living with diabetes, you are more susceptible to gum inflammation and you’re at a higher risk for developing the advanced stage of gum disease— periodontitis. Maintaining a consistent oral care routine is crucial to your oral health. The basic steps of daily brushing, flossing, and rinsing are the same for you as for everyone who wants a cleaner, healthier mouth, but vigilance is key. Foot Care Diabetes increases your risk for foot problems. You should inspect your feet every day for signs of redness, warmth, swelling, or calluses. These are early warning signs of conditions that can lead to serious foot problems. Tell your healthcare provider if you have any of these symptoms. In addition, people with diabetes should have their feet inspected by their healthcare provider during each visit. You should also have a complete sensory foot exam done by your healthcare provider every year. Eye Exam People who have diabetes should have a dilated retinal (eye) examination every year. Early detection and treatment of changes in your eyes can often prevent blindness. Remember, this is a special eye exam and is different than having your vision checked for glasses. Healthy tips Fitness | 37 Skin Care Managing diabetes is about eating right, exercising, and following your doctor’s recommendations. But there are other considerations. For instance, many people with diabetes don’t realize the importance of skin care. Here are a few tips to keep in mind: • HYDRATE – Keeping skin hydrated with a moisturizing body lotion or cream helps relieve the itch associated with dry skin while preventing irritation and cracking. Dry skin thoroughly and moisturize with lotion or cream after a shower or bath. Be sure the lotion or cream is fully absorbed before getting dressed. Do not use creams or lotions on open wounds. • CLEAN AND DRY – Ensuring that skin is always clean and dry helps prevent fungal growth and harmful bacteria from developing into infections. • CHECK AND TREAT – Checking skin daily for cracks and treating problems straight away helps prevent infections. The American Diabetes Association® recommends avoiding harsh antiseptics and talking to a doctor before using an antibiotic cream or ointment. • AVOID very hot baths and showers. Hot water can remove natural oils from skin, making it dry and itchy. Try showering or bathing with warm water and limit your time in the water to 10 minutes or less. If your skin is dry, don’t use bubble baths. Moisturizing soaps may help. • ALWAYS DRINK PLENTY OF WATER – It’s wise to cut down on alcohol and caffeine, since these substances can dehydrate the body, robbing the skin of fluids. • REMEMBER TO WEAR SUNSCREEN – Sun exposure can damage your skin’s ability to protect itself, so choose a broad-spectrum sunscreen with an SPF of 15 or higher. Also, apply a lip balm with an SPF of 15 to help moisturize and prevent chapped lips. 26 38 | Fitness Healthy tips Depression It’s not uncommon for people with diabetes to develop depression. Trying to focus on doing the right thing all the time can be draining, and it can be disheartening when things don’t go right. It’s important to be alert for the signs and symptoms of depression. Just as diabetes can be diagnosed, monitored, and treated, so can depression. • Feelings of sadness almost every day, throughout the day • Not performing as well at school or work • • Changes in appetite or weight • • • Loss of interest in work, hobbies, people, or sex • • Feeling agitated or sluggish • • Crying easily or wanting to cry, but not being able to • Having thoughts of suicide (these should always be taken seriously; reach out to those around you right away) Problems sleeping Withdrawing yourself from family or friends Feeling hopeless, guilty, or having low self-esteem Difficulty concentrating, remembering things, or making decisions Feeling out of touch with reality Healthy tips Fitness | 39 Eye Exam People who have diabetes should have a dilated retinal (eye) examination every year. Early detection and treatment of changes in your eyes can often prevent blindness. Remember, this is a special eye exam and is different than having your vision checked for glasses. Flu Vaccine The flu can be a serious illness for people with diabetes. It is important that you get a flu vaccine every year. You should plan to get your flu vaccine as soon as it is available, usually in September. Pneumonia Vaccine A pneumococcal vaccine is recommended for everyone with diabetes beginning at two years of age. A second dose is recommended when you are 65 years of age or older, as long as it has been at least five years since your last pneumococcal vaccine. Talk with your healthcare provider about getting a pneumococcal vaccine. Hepatitis Vaccine The hepatitis B vaccine is recommended for adults with diabetes who are 19–64 years of age. Talk with your healthcare provider to see if the hepatitis B vaccine is right for you. 26 | Fitness 40 Care Healthcare Healthycoverage tips Healthcare coverage Your Walmart Pharmacy® accepts most kinds of insurance including Medicare, Medicaid, and commercial insurance. For more information about insurance coverage, ask your Walmart® pharmacist, check with your insurance provider, or visit one of these websites: Medicare www.medicare.gov Medicaid www.medicaid.gov Insurance Information Institute www.iii.org Commercial Insurance www.healthcare.gov Healthcare coverage Care | 41 Resources CDC Centers for Disease Control. American Diabetes Association® Their mission is to prevent and cure diabetes and to improve the lives of all people affected by diabetes. http://www.diabetes.org Diabetes Forecast® http://www.cdc.gov/ Diabetes Research Institute The Institute’s mission is to develop and rapidly apply the most promising research to treat and cure those now living with diabetes. http://www.diabetesresearch.org/ The premier healthy living magazine for people with diabetes. http://www.diabetesforecast.org Recipes for Health Living Free online recipes, meal plans, and tips for healthy cooking. http://www.diabetes.org/recipes Living With Type 2 Diabetes Insight and support for people new to diabetes. http://www.diabetes.org/freeprogram Tour de Cure® The ADA’s signature fundraising cycling event, with routes designed for all levels. http://www.tour.diabetes.org Step Out: Walk to Stop Diabetes® The ADA’s signature fundraising walk with events in 125 cities nationwide. Joslin Diabetes Center An organization dedicated to ensuring that people with diabetes live long, healthy lives and offers real progress in preventing and curing diabetes. http://www.joslin.org/ Mayo Clinic® Worldwide leader in medical care, research, and education for people from all walks of life. http://www.mayoclinic.com/ SPLENDA® Diabetes-Friendly Recipes The SPLENDA brand wants to help you select recipes that are both delicious and easy to fit into a balanced meal plan for diabetes. http://recipes.splenda.com/recipes/diabetes_friendly Walmart® Diabetes Wellness Center Information and supplies for people with diabetes. http://health.walmart.com/diabetes-wellness-center http://www.stepout.diabetes.org The third-party trademarks used herein are registered trademarks of their respective owners. 42 | Care Resources Provided for informational purposes only. No endorsement or sponsorship is implied. Resources Care | 43 Phone numbers of your healthcare professional team. Clinic Phone / Email Physician / Nurse Practitioner / Physician Assistant Phone / Email Your partners in diabetes care. Endocrinologist At Walmart®, our goal is to help you better manage your Phone / Email Diabetes Educator diabetes. We hope you have found the information in this Phone / Email Registered Dietitian booklet useful. Please don’t hesitate to visit our pharmacy and talk with us about any concerns you may have about your health. Phone / Email Ophthalmologist (eyes) Phone / Email Podiatrist (feet) Phone / Email Other Phone / Email Third-party trademarks used herein are trademarks of their respective owners. ©Johnson & Johnson Services, Inc. 2015 ©Johnson & Johnson Services, Inc. 2015
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