D I A B E T E S
P L AY B O O K
CONTENTS
INTRODUCTION
DIABETES 101
FOOD
MEDICATION
WELLNESS
DAILY LIFE
VISITS
RESOURCES
D I A B E T E S
P L AY B O O K
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INTRODUCTION
D I A B E T E S
P L AY B O O K
WHAT’S A PLAYBOOK?
Penn State Hershey Diabetes and Obesity Institute is focused on Reinventing
Diabetes Care™ and listening to our patients. So when patients asked us for an
easy way to organize everything they needed to take care of diabetes, we went
right to work. By taking advice from patients, family members, medical staff,
and other experts, we put their thoughts into one book for you. What you hold
in your hands is a book filled with the best tips and information from many
people who live with diabetes and from people who treat diabetes everyday.
When deciding what to call the book, we used the Penn State football theme
and the idea of a playbook. A football team uses a book full of plays to get ready
for game day. It’s a way to prepare for nearly anything. As you work through
this book, you’ll pick out members of your team and make plans so you are
ready for whatever diabetes throws your way.
Featured on the cover: (left to right)
Caren S. and son, Matthew D., Jeannine L. as the Lion, Karen F., Elisa S.
01
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INTRODUCTION
HOW DO I USE THIS PLAYBOOK?
You don’t need to read it cover-to-cover today. You can sort through the parts
that are important to you now and save the rest for later. You can also refer back
to it in the future. The words in bold print are explained in the glossary.
Much of the information you find in the playbook has helped other people with
diabetes stay organized and in control. Bring the playbook to your appointments
to be prepared. Find topics you want to talk about with your medical team.
Make notes about your progress, including your lab work. Add your medical
teams’ business cards to the insert so you can easily locate their contact
information. Share it with your family and friends so they can understand more
about diabetes, too.
While this playbook is a great start, you’ll learn more about diabetes as you visit
our offices, support groups, and events. You will find other tips that help you
live with your diabetes. Feel free to add them to this binder. We will also add
new sections along the way. It is meant to grow and be helpful to you.
If you need more help or have any questions, please give us a call.
717-531-7539
PennStateHershey.org/diabetes
02
Robert Gabbay, M.D., Ph.D.,
endocrinologist, co-director
Penn State Hershey Diabetes and Obesity Institute
D I A B E T E S
P L AY B O O K
I HAVE DIABETES
Simple words to read. Have you said them out loud? You probably have a lot of
questions. The good news is that you have come to the right place. We will help
you answer a lot of those questions. Then you will be well on your way to
learning what it means to say, “I have diabetes.”
At times people
y
may not feel an
oms
physical sympt
of diabetes.
How did I get diabetes?
The cause of diabetes is a mystery. Sometimes, your body can attack itself
causing diabetes. If that is the case, you had no part in causing it. Sometimes
the risk for diabetes is passed down from parents to children or may be
triggered by a “flu” you came in contact with in your life. For some people,
the way we live our lives–ever more car travel, desk jobs, food, stress, and less
physical activity–play a role as well. Research dollars are spent every year
trying to find the cause and the cure for diabetes. We all hope to find those
answers soon. In the meantime, you can learn to live a healthy and happy life
with diabetes.
What are the symptoms of diabetes?
Sometimes people do not feel any physical symptoms from diabetes. If that is
the case, you might have stumbled upon it during blood work at your doctor’s
office. Or, maybe you have noticed:
• Being thirsty/hungry.
• Being tired/cranky.
• Having blurred eyesight.
• Weight loss.
• The need to urinate more than usual.
• Infections that don’t seem to go away.
Is there a cure?
Not yet. But research to treat and to cure diabetes is all around us. The good
news is people can and do live healthy and happy lives with diabetes. So while
research continues, you can learn many ways to control your diabetes now and
maybe prevent health problems in the future.
01
DIABETES 101
DIABETES 101
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DIABETES 101
WHAT IS DIABETES?
When you eat food, your body breaks it down into sugar. This sugar is called
glucose. The sugar travels through your blood stream and throughout your
body. In order to be used as energy, it needs to enter into your cells, the engines
of your body.
The pancreas, an organ located in the abdomen, makes insulin. The insulin
works like a key to unlock the doors of your cells. Once the doors open, the sugar
enters into the cells to be used as energy.
In people with diabetes, the insulin is not doing its job. The sugar remains in
the blood stream. Being diagnosed with diabetes means your medical team
found too much sugar in your blood. You aren’t getting the energy you need to
feel your best.
Is there more than one type of diabetes?
Yes. There are three main types of diabetes.
Type 1 diabetes occurs when your body attacks your insulin producing cells.
Without these cells, you can not make insulin. Without insulin, your body is
not able to use the sugar in your blood. People with type 1 diabetes need to
inject insulin so they can stay healthy. About 5-10% of Americans with diabetes
have type 1.
Type 2 diabetes occurs when your body has trouble using the insulin it makes
or when your body cannot make enough insulin. People with type 2 diabetes
often control their diabetes with diet, exercise, pills, or insulin. About 90% of
Americans with diabetes have type 2.
Gestational diabetes is when it is caused by changes in hormones during pregnancy.
Diabetes can also be caused by steroid use or other diseases. These are much
less common though.
Pre-Diabetes is when a person's blood glucose level is higher than normal but
not high enough to be called diabetes.
GLUCOSE
What’s all the talk about glucose?
Having diabetes means that your body has trouble controlling the amount of
sugar in your blood. This sugar is called glucose. Learning how to help your body
control its glucose can help prevent the long-term health problems from diabetes.
When we talk about the glucose in your blood, we call it your “blood glucose.”
02
If you are told
you have diabetes
it means your
medical team found
too much sugar in
your blood.
D I A B E T E S
P L AY B O O K
What if my blood sugar is not in control?
Your blood is thin, like water. Picture throwing twenty cups of sugar into the water.
That is what happens when the glucose gets stuck in your blood stream. The
blood becomes thicker and grittier, like syrup. This thicker blood may cause
damage to arteries, veins, nerves, eyes, kidneys, and more. Plus, too much or too
little glucose can make you feel sick. To feel your best and prevent long-term
health problems, it is important to keep your blood glucose in a good range.
“The hardest
part about having
diabetes
What makes it go up?
• Food
• Stress
is trying to balance the
roles of mother, wife,
and person with
diabetes. It’s hard to
keep all the balls in the
air and maintain decent
blood sugars.”
• Infection
Lisa T.
What makes it go down?
Enola, PA
Years with diabetes: 38
• Activity/exercise
• Too much diabetes medication
• Alcohol
• Difficulty with digestion
• Skipping a meal
• Weight loss
• Not enough diabetes medications
• Side effects from other medications
• Changes in hormones (monthly period or pregnancy)
How do I check my blood glucose?
You can check your blood glucose with a glucose meter. These are small
devices that go with you no matter how active you are.
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DIABETES 101
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DIABETES 101
What should my blood glucose be when I check it?
70-130 mg/dl
before you eat
140-180 mg/dl
2 hours after you eat
**These are general guidelines. Your diabetes team may adjust your goals for you.
How do I choose a meter?
There are many meters that you can use. Before you buy one,
talk to your medical team. They can help you choose the meter that
is right for you. Some things to ask when getting a meter include:
• Can I check a place other than my fingers?
• How much blood is needed to make it work?
• How long will it take to show me my blood glucose?
• How big is the meter?
• Can I download the meter to my computer?
• Can the test strips be stored in the meter?
• How much will the test strips cost me?
• Will my insurance pay for the test strips?
• Can I get a bigger screen to help me see what my glucose number is?
Jennifer B.,
type 1 diabetes for 3 years
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D I A B E T E S
P L AY B O O K
Is my meter working?
er
Have your met
y
checked ever
six months
for accuracy.
Each time you get a new meter, and every six months after that, you should
check it to make sure it is working correctly. The best way to do that is to take
your meter with you when you get blood work. You can check your blood sugar
using your meter and the lab can check your blood sugar at the same time using
a sample of blood from your arm. As long as the meter and the lab results are
within 15 percent of each other, the meter is said to be accurate. Here are some
other things you can do to make sure your meter is working well:
• Check the expiration date on your test strips.
• Use control solution to check the test strips.
• Set the date and time on your meter.
• Clean your test site before checking your blood sugar (not with alcohol swabs).
• Make sure your meter is set for the correct test strip code if needed.
How often should I use my meter?
This will depend on what type of medications you
take to control your diabetes. Talk with your team
about what is right for you. Check your blood sugar
at least once a day if you are on oral pills, and four
times a day if you are on insulin. You and your
health care team will use these results to adjust
your game plan. Checking more often can
lead to better control. The best time to
check is before meals, at bedtime, or
anytime you are not feeling well.
Bernie B.,
type 1 diabetes for 25 years
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DIABETES 101
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DIABETES 101
What is a glucose log?
It usually helps to write your blood glucose down to see if you can find
patterns. This is called a glucose log. There are several ways you can make a
glucose log. Whichever way you choose, it is important to bring your glucose
log to every appointment with a diabetes medical team member.
• Logbook–a small book that comes with your meter.
• Glucose log sheet–single paper that can be faxed or mailed.
• Downloaded logbook–a way of downloading your glucose from your meter to
your computer.
Example glucose log
You can find a full glucose log sheet under the tab Resources in this playbook.
The log is made available for you to make copies of. Here is an example of what
it looks like:
Morning
DATE
TIME
GLUCOSE
Lunchtime
TIME
GLUCOSE
Evening Meal
TIME
GLUCOSE
Bedtime
TIME
Comments
GLUCOSE
SAMPLE
06
Chris Fan, M.D.
endocrinologist
Penn State Hershey Diabetes and Obesity Institute
D I A B E T E S
P L AY B O O K
WHAT IS AN A1C (PRONOUNCED A-ONE-C)?
When you test your blood sugar with your meter, it only shows you your blood
sugar at that exact time. Because your blood sugar varies from minute to
minute, it doesn’t give you an overall picture of your control. For example,
while you may test your blood sugar throughout the day, you won’t know it
during the hours that you are asleep. An A1C, (also known as glycohemoglobin)
is a simple blood test ordered by your health care team to provide an average
blood sugar for three months. An A1C of 6%-7% is great control.
Why is an A1C of 6%-7% my goal?
While there is no level below which the risks disappear, keeping an A1C
between 6-7% can reduce your chance of various risks:
• heart attacks
• strokes
• eye disease
• kidney disease
• infections
• nerve damage
Is there a way to roughly compare my blood sugar to my A1C?
The following chart gives you an idea of where your A1C will be based on your
home blood sugar checks.
It is important
to remember
your AIC goal.
My goal is _____%
A1C %
Blood sugar average
What it means…
6
126
Great control
7
154
Target for good diabetes control
8
183
A change is needed
9
212
A change is needed
10
240
A change is needed
11
269
A change is needed
12
298
A change is needed
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DIABETES 101
If I can get an A1C, why should I check with my glucose meter?
“I tell my
While your A1C is important for knowing your long-term control, it does not
tell you what things affect your sugars or what time of day your sugars are not
in target range. For example, an A1C of 7% is great if your blood sugars run
between 80-180 mg/dl. However, your sugars can run between 40-500 mg/dl
and still average 7% on your A1C. In that case, you would need to change your
diabetes care plan. So it is important for you to check your blood sugars with
your meter.
I have diabetes so they
know to watch for
symptoms of a low
blood sugar.”
Jeannine L.
Schuylkill Haven, PA
Years with diabetes: 39
LOWS AND HIGHS
Sometimes your blood sugar will be too high or too low. Knowing how to
recognize it and making a plan in advance is a great way to remain in control.
Low blood sugar (also called hypoglycemia)
When your blood sugar goes too low, less than 70 mg/dl on your glucose meter,
it is called hypoglycemia. Your body does not have the sugar it needs to work,
just like a car running out of gas.
Why would my sugar go too low?
• Skipping and/or delaying a meal or snack.
• Not eating at the right time if you take diabetes medication.
• Exercising longer or harder than usual.
• Taking too much diabetes medication.
• Drinking alcohol.
How will I feel if this happens?
No two people feel exactly the same. No two low blood sugars may feel the
same. You may feel various symptoms if you have a low blood sugar:
• Hungry/sweaty
• Clumsy/shaky
• Cranky
• Dizzy /confused
• Headaches
• Tingling feelings around your mouth
While it is rare, you can have a seizure or pass out.
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coworkers
D I A B E T E S
P L AY B O O K
What can I do if I feel my blood sugar dropping?
1. Check a blood sugar, if you can.
2. If less than 70 mg/dl follow the Rule of 15
Eat or drink something with 15 grams of carbohydrates and
recheck your blood sugar in 15 minutes
What are food and drink choices with 15 grams of carbohydrates?
• Eight ounces (one cup) of skim milk.
• Four ounces (one-half cup) of fruit juice (not diet).
• Four ounces of regular (not diet) soda.
• Four teaspoons of table sugar.
• One tablespoon of honey or syrup.
• Two tablespoons of raisins.
• Five small pieces of hard candy (not diet).
What if I don’t have food within reach?
You should always have 15 grams of carbohydrates nearby. If food is not possible,
consider glucose tablets or glucose gels. You can buy these at stores. They do
not require a prescription. You can store them anywhere–your coat pocket, your
bedside table, your workstation, or the glove compartment in your car.
What else do I need to be safe?
t to carry
It is importan
fication.
medical identi
ur life.
It can save yo
Medical identification is anything you can carry with you telling others that
you have diabetes. If you were to pass out, this can tell others you have diabetes
and may save your life. You can buy them at most drug stores, find them online
by searching for “medical identification,” or even make one at home. At the very
least, keep your information behind your driver’s license.
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DIABETES 101
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DIABETES 101
What if I can’t treat myself?
It is possible that a low blood sugar can come on too quickly for you to react.
In that case, you may be too confused or possibly even passed out. You’ll need to
rely on someone else to help you. Teach your loved ones and co-workers about
low blood sugars. Have a game plan in place in case they need to help you.
If you can talk and swallow, have someone help you follow the Rule of 15:
Eat or drink something with 15 grams of carbohydrates and
recheck your blood sugar in 15 minutes
15 grams of carbohydrates = 5 small pieces of hard candy or eight ounces of
fat free milk
If you cannot talk/swallow or if you are passed out, your team members
should know several pointers:
• They should not put food, candies, liquids, or solid objects in your mouth.
You are in more risk of choking on them than from the dangers of the
low blood sugar itself.
• How to use a glucagon injection kit.
This is something that your health care team can teach you and other
members of your team to use. In case of an emergency, it helps your
body make sugar.
• Call 911.
Plan for low blood sugar
• Know warning signs of low blood sugar.
• Know the Rule of 15.
• Have foods that contain 15 grams of carbohydrates.
• Have glucose tablets or glucose gels.
• Call 911 in a medical emergency.
10
Teach loved ones
and co-workers the
Rule of 15.
D I A B E T E S
P L AY B O O K
High blood sugar (also called hyperglycemia)
Too much sugar in your blood makes your blood become thick and gritty.
This thick blood can damage the arteries in your body and make your heart
pump harder than normal. Over time it can lead to heart attacks, strokes,
blindness, infections, amputations, kidney damage, or nerve damage.
What causes my blood sugar to go too high?
• Not enough medication/insulin.
• More food than planned.
• Less exercise than planned.
• Stress.
• Illness.
• Changes in hormones (monthly period/pregnancy).
How will I feel if this happens?
• Thirsty.
• Tired.
• Blurry eyesight.
• The need to urinate more often than usual.
Heather S.,
type 1 diabetes for 25 years
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DIABETES 101
What do I do if my blood sugar is too high?
• If your blood sugar is over 300 mg/dl, drink at least one cup of water every
hour. If it is over 300 mg/dl for more than 24 hours call your doctor.
• Check the sick day game plan you made with your diabetes team to see if
you should use extra insulin.
• Talk to your medical team about changing your pills or insulin dose.
WHAT IS KETOACIDOSIS?
When your body does not have enough insulin, it cannot use the sugar in your
blood for energy. Your body then finds other sources and begins to break down
fat. This sounds like a good thing, but it is not burning fat for energy the same
way as exercising. It is using fat as emergency fuel. When this happens, a waste
called ketones is released. Your body will try to get rid of ketones in your urine,
but if they build up too quickly, you can develop ketoacidosis, or too many
ketones in your blood stream.
This usually only occurs in people with type 1 diabetes, but can occur in people
who have had type 2 diabetes for an extended time. Having an infection can
make you more at risk for ketoacidosis. It is a medical emergency and can be
life threatening. Talk to your medical team about ways to find and treat it.
12
“When I have
high blood
sugar
I try to find out why so
I can adjust my
behavior in the future
to keep good blood
sugar control.”
Darrell E.
Jonestown, PA
Years with diabetes: 6
D I A B E T E S
P L AY B O O K
DOES FOOD REALLY AFFECT
MY BLOOD SUGAR?
Food contains the calories you need for energy. It has carbohydrates (carbs),
proteins, fats, vitamins, and minerals that are important for life. Your body
breaks down the carbohydrates fairly easily to make sugar for energy. With
diabetes, the more carbohydrates you eat, the higher your blood sugar can rise.
Protein and fat do not cause as much of a change in your blood sugar.
What are examples of foods that contain carbohydrates?
• Breads/crackers/pasta
• Cereals/rice/beans
• Fruit/fruit juices
• Milk/yogurt/ice cream
• Corn/peas/potatoes
• Pizza/beer/soda
• Cakes/cookies/pies
• Candy/doughnuts
• Honey/sugar
How should a meal look on my plate?
To get an idea of how many carbohydrates you should eat, divide your plate.
CARBS
MEAT
VEGETABLES
• One-quarter of the plate filled with carbohydrate foods (noodles, rice, corn,
fruit, etc.).
• One-quarter of the plate filled with meat or meat substitute (chicken, fish,
beef, pork, etc.).
• One-half the plate filled with vegetables (salad, broccoli, spinach, etc.).
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DIABETES 101
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FOOD
Where can I get help with my food choices?
Food is a daily part of your life, and your choices may change as time passes.
You need an expert on the sidelines to help you make the best choices. Work
closely with a dietitian specialized in diabetes care. Here are a few things a
dietitian may help you with:
• Learning how the foods you eat affect your blood sugars.
• Reading food labels.
• Making food choices/Help choose a food plan that works for you.
• Finding recipes and cookbooks.
• Making plans for eating out.
Stick with it and keep trying
Learning good food choices may involve learning new behaviors or trying new
foods. It doesn’t happen overnight. Little changes each day can put you on the
path to better control of your diabetes. Take it one bite at a time.
CARBOHYDRATE COUNTING
How can I find out how many carbohydrates are in a food?
The Food and Drug Administration (FDA) has developed a Nutrition Facts label
on most packaged foods in the grocery store. Reading these labels can help you
make wise food choices. There are also books available that list carbohydrate
content in many unpackaged foods such as fruits and vegetables.
What should I look for on the Nutrition Facts label?
• Serving size–how much of the product is in one serving.
• Servings per container–how many servings are in
each container.
• Calories–amount of calories in each serving.
• Total carbohydrates–amount of carbohydrates
in each serving.
• Total fat–the amount of fat in each serving.
• Dietary fiber–amount of total fiber in each serving
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D I A B E T E S
P L AY B O O K
Why should I check total carbohydrates instead of just sugar?
The total carbohydrates, also referred to as “carbs,” are a total of all starch,
sugars, fiber, and sugar alcohols. Any of these may affect your blood sugar.
How many carbohydrates should I eat?
You can use the following table to estimate your carbohydrate needs for one day.
A dietitian can help you with how many calories a day is best.
Daily calorie intake
Daily carbohydrate needs
1500
188 grams
1800
225 grams
2000
250 grams
2500
312 grams
To get started, here is an example of how you might spread out your
carbohydrates throughout the day if your calorie intake goal is 1800 calories.
Meal 1
45-50 grams
Snack 1
10-15 grams
Meal 2
55 grams
Snack 2
10-15 grams
Meal 3
70 grams
Snack 3
10-15 grams
Total
200-220 grams for the day
Most meals should have between 45-70 grams of total carbohydrates. Snacks
should have between 10-15 grams of total carbohydrates. Take a look at the foods
you eat. How many carbs are you eating per meal or snack? How can you adjust
that food choice to meet these goals?
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FOOD
Are all carbohydrates the same?
Most of your carbohydrates should be from whole grains, fruits, and vegetables.
They provide the most nutritional benefit. You can still have sweets in small
amounts, but watch serving size. Substitute a sweet treat for other carbohydrates
on a gram-for-gram basis. For example:
15 grams of carbohydrates = one slice of bread OR two small cookies
Are there any short cuts?
Yes. Many people find it is easier to make lists of their favorite foods and how
many calories/carbohydrates they contain. That way, you can choose from your
list quickly and know how many carbs you have eaten. We’ve included an
example of a food list at the end of this section and in the resource section.
Try a hand guide
Don’t feel like carrying a scale around with you? The following pictures show
you how to use your hand as a guide for portion sizes.
• 1 fist = 1 cup of vegetables, fruit, or pasta
• 1 thumb tip = 1 teaspoon of oil or butter
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FOOD
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FOOD
• 1 small palm = 3 ounces of fish, poultry, or meat
• 1 small handful (not overflowing) = 2 tablespoons (1/2 ounce)
• 2 cupped palms = 11⁄2 ounces of snack foods such as whole grain crackers
• 1 index finger = 1 ounce of cheese
05
FOOD
Do “sugar free,” “no sugar added,” and “low sugar” mean I can eat all
I want?
Unfortunately, no. If something is labeled “sugar free,” it has only a half-gram
(0.5) of sugar or less per serving. Keep in mind, sugar free foods are not always
low carbohydrate, low calorie, or low fat foods. Read the Nutrition Facts label to
find the total carbohydrates before eating them.
Do I need the rest of the Nutrition Facts label?
Even though carbohydrates have the most effect on blood sugars, you should
think about the rest of your health. Added calories can lead to added weight
gain. High fat diets can lead to high cholesterol and clogged arteries. High
sodium diets can lead to high blood pressure. For the best overall health, you
should become familiar with the FDA recommendations and learn to use the
whole Nutrition Facts label.
Are there vitamins and herbs to help my diabetes?
Several vitamins and herbs have been said to have sugar-lowering effects, but
there is not enough data to be sure. Following the FDA recommendations and
choosing from a variety of foods can help ensure the best nutrients for your health.
Additional resources
American Dietetic Association (ADA)
120 South Riverside Plaza, Suite 2000
Chicago, IL 60606
Phone: 1-800-877-1600
eatright.org
American Association of Diabetic Educators (AADE)
100 W. Monroe
Suite 400
Chicago, IL 60603
Phone: 1-800-338-3633
diabeteseducator.org
06
Theresa Gustafson, M.S., R.D., L.D.N., C.D.E.,
dietitian
Penn State Hershey Diabetes and Obesity Institute
D I A B E T E S
FOOD
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Food Choice
Calories
Total Grams of Carbohydrates
1 apple (5 oz)
90
22
1 bagel (2.5 oz)
195
38
1 baked potato (7 oz)
220
51
1 banana (4 oz)
105
27
1 cup broccoli
44
8
1/4 cup cashews
187
9
1 cup green beans
40
9
1 cup ice cream
265
32
7
1
1 cup of corn flakes
110
24
1 cup pasta
185
37
1 cup buttered popcorn
55
6
.25 cup raisins
130
30
1 cup regular gelatin
160
40
1 cup 1% milk
120
12
1 doughnut
198
23
1 orange (4 oz)
60
15
1 oz American cheese
105
0
1 oz candy bar
140
19
1 plum (2 oz)
36
9
1 slice of wheat bread
69
13
1 whole egg
75
1
1/8 of apple pie (4 oz)
290
46
15 grapes (3 oz)
60
15
12 oz beer
146
13
12 oz colas
152
39
12 oz diet soft drink
4
0
2 graham crackers
60
11
3 oz roasted chicken
168
0
3 oz salmon
130
0
3 oz shrimp
132
1
8 oz low fat yogurt
140
16
1 cup lettuce
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FOOD
MY FOOD LIST
FOOD
MY FOOD LISTS
BEVERAGES
Food Choice
Calories
Total Grams of Carbohydrates
Beer (12 oz)
146
13
Beer, light (12 oz)
99
5
Colas (12 oz)
152
39
4
0
160
42
Water
0
0
Wine (4 oz)
82
2
Calories
Total Grams of Carbohydrates
108
0
American (1 oz)
105
0
Cheddar (1 oz)
114
0
Cottage 2% (1 cup)
203
8
Cream (1 oz)
99
1
Light (1 Tbsp)
29
1
Heavy (1 Tbsp)
51
0
Sour (1 Tbsp)
26
1
Vanilla (1 cup)
265
32
1% (1 cup)
102
12
Nonfat (1 cup)
86
12
Whole (1cup)
150
11
Plain, low fat (8 oz)
155
18
Fruit (8 oz)
217
41
Diet soft drink (12 oz)
Root beer (12 oz)
DAIRY
Food Choice
Butter (1 Tbsp)
Cheese
Cream
Ice cream
Milk
Yogurt
08
D I A B E T E S
FOOD
P L AY B O O K
P
Food Choice
Calories
Total Grams of Carbohydrates
170
25
Angel food (1 oz)
73
16
Carrot ( ⁄12)
484
52
Cheesecake ( ⁄12)
457
32
Gingerbread ( ⁄9)
263
36
Pound ( ⁄16)
229
25
Yellow (1⁄8)
243
36
Bar (1 oz)
140
19
Caramels (1 oz)
108
22
Fudge (1 oz)
108
23
Hard (1 oz)
112
28
Chocolate (1 oz)
145
17
Cookies (1)
78
10
Cupcake (1)
173
28
Custard (1 cup)
324
47
Regular (1 cup)
160
40
Sugar-free (1 cup)
16
2
Honey (1 Tbsp)
64
17
Jam (1 Tbsp)
48
13
Jellies (1 Tbsp)
51
14
Marshmallows (1 oz)
90
23
Molasses (1 Tbsp)
55
14
Pie ( ⁄8 of pie)
411
58
Popsicle (2 oz)
42
11
Pudding ( ⁄2 cup)
151
28
Sherbet (1 cup)
254
55
Syrup, maple (1 Tbsp)
52
13
Brownie (1)
Cake
1
1
1
1
Candy
Gelatin
1
1
09
FOOD
DESSERTS & SWEETS
FOOD
FRUITS
Food Choice
Calories
Total Grams of Carbohydrates
Apple (1 medium)
81
21
Apricots (3 meds)
51
12
Avocado (1 med)
306
12
Banana (1 med)
105
27
Blueberries (1 cup)
80
21
Cantaloupe (1 cup)
56
13
Grapefruit ( ⁄2 med)
40
10
Grapes (10)
35
9
Orange (1 med)
60
15
Peach (1 med)
37
10
Pear (1 med)
98
25
Pineapple (1 cup)
76
19
Raisins (1 cup)
435
112
Strawberries (1 cup)
45
11
Watermelon (1 cup)
50
12
Calories
Total Grams of Carbohydrates
Bagel (1)
195
38
Bread (1 slice)
80
15
Cereal-bran (1 cup)
100
20
Crackers, graham (2)
60
11
Doughnut (1)
198
23
Muffin-corn (1 sm)
174
29
Pancakes (4”)
74
14
Pasta (1 cup)
197
40
Pita (2 oz)
130
30
Popcorn (1 cup)
55
6
Pretzel (1 oz)
108
22
Rice-brown (1 cup)
216
45
Roll, hamburger (1)
123
22
Waffles (5”)
218
25
1
GRAINS
Food Choice
10
D I A B E T E S
FOOD
P L AY B O O K
P
Food Choice
Calories
Total Grams of Carbohydrates
Bacon (3 slices)
110
0
Beef (3 oz)
240
0
Fried (3 oz)
220
8
Roasted (3 oz)
168
0
Whole (1)
75
1
White only (1)
17
0
Ham, cured (3 oz)
151
0
Lamb (3 oz)
270
0
Pork chop (3 oz)
216
0
Turkey, breast (3 oz)
160
0
Veal cutlet (3 oz)
242
0
Calories
Total Grams of Carbohydrates
Bass (3 oz)
124
0
Bluefish (3 oz)
135
0
Clams, raw (3 oz)
63
0
Crabmeat (3 oz)
80
0
Fish sticks (4)
308
27
Flounder (3 oz)
100
0
Haddock (3 oz)
140
0
Lobster (3 oz)
83
1
Oysters, raw (3 oz)
70
4
Salmon (3 oz)
118
0
Scallops (3 oz)
113
3
Shrimp (3 oz)
132
1
Trout (3 oz)
144
0
In oil (3 oz)
158
0
In water
99
0
Chicken
Eggs
SEAFOOD
Food Choice
Tuna, canned
11
FOOD
MEATS & POULTRY
FOOD
VEGETABLES
Food Choice
Calories
Total Grams of Carbohydrates
Artichoke (1)
150
34
Asparagus (1 cup)
44
8
Green (1 cup)
40
9
Lima (1 cup)
216
39
Beets (1 cup)
74
17
Broccoli (1 cup)
44
8
Brussel sprouts (1 cup)
60
14
Cabbage (1 cup)
34
7
Cooked (1 cup)
70
16
Raw (1 med)
31
7
Cauliflower (1 cup)
28
5
Celery (1 cup)
28
6
On the cob (1 ear)
83
19
Canned (1 cup)
132
30
Cucumber ( ⁄2 cup)
7
1
Eggplant (1 cup)
26
6
Lettuce (1 cup)
7
1
Mushrooms (1 cup)
42
8
Onions ( ⁄2 cup)
46
11
Peas (1 cup)
118
21
Peppers (1 cup)
28
6
Baked (1)
220
51
French fried (20)
200
31
Mashed (1 cup)
162
37
Spinach (1 cup)
42
7
Sweet potatoes (1)
117
28
Tomatoes-canned (1 cup)
32
7
Beans
Carrots
Corn
1
1
Potatoes
12
D I A B E T E S
FOOD
P L AY B O O K
P
Food Choice
Calories
Total Grams of Carbohydrates
Barbecue sauce (1 Tbsp)
12
2
Catsup (1 Tbsp)
16
4
Cocoa Mix with Milk (1 cup)
213
30
Coconut (1 cup)
283
12
Blue cheese (1 Tbsp)
77
1
Italian, low cal (1 Tbsp)
15
2
100
0
4
0
Almonds (1⁄4 cup)
218
7
Cashews ( ⁄4 cup)
187
9
Peanuts (1⁄4 cup)
209
8
Pecans ( ⁄4 cup)
192
4
Walnuts ( ⁄4 cup)
164
4
Olives (4)
18
0
Peanut Butter (1 Tbsp)
95
3
Pickles (1)
1
0
Tomato sauce (1 cup)
74
18
Calories
Total Grams of Carbohydrates
Beef potpie (7 oz)
330
38
Macaroni & cheese (1 cup)
430
40
Pizza (1 slice)
153
18
Spaghetti & meat sauce (1 cup)
332
40
Taco (1)
210
21
Dressings
Mayonnaise (1 Tbsp)
Mustard (1 tsp)
Nuts
1
1
1
COMBINATION FOODS
Food Choice
13
FOOD
MISCELLANEOUS
FOOD
MY FAVORITE FOODS
BREAKFAST
Food Choice
Calories
Total Grams of Carbohydrates
Calories
Total Grams of Carbohydrates
LUNCH
Food Choice
Make copies to use later.
14
D I A B E T E S
FOOD
P L AY B O O K
Food Choice
FOOD
DINNER
Calories
Total Grams of Carbohydrates
Calories
Total Grams of Carbohydrates
SNACKS
Food Choice
Make copies to use later.
P
15
ALCOHOL
Can I drink alcohol?
There are a few things to keep in mind if you are of legal age and deciding to
drink alcohol. Many drinks with alcohol also have carbohydrates, so they can
affect your blood sugars.
Plus, your liver breaks down alcohol. Your liver also helps make sugar if you
don’t have enough. If you have a low blood sugar after you drink alcohol, the
liver might be too busy getting rid of the alcohol to help bring your blood sugar
back up.
Finally, sometimes having a low blood sugar can seem a lot like being drunk.
You may act confused or have slurred speech. You might have trouble answering
questions or pass out. Your team may decide to let you “sleep off the alcohol”
instead of helping you treat the low blood sugar. This can quickly become lifethreatening.
What are some guidelines if I choose to drink alcohol?
• If your diabetes is well-controlled, you may include one to two servings of
alcohol per day. One serving is equal to five ounces of wine, a 12-ounce light
beer, or one and one-half ounces of 80-proof distilled spirits.
• Drink alcohol close to or with a meal. It may cause low blood sugars on an
empty stomach.
• Use sugar free drink mixers, such as quinine water or club soda.
• Use unsweetened fruit juices or vegetable juice mixers.
• Drink low-sugar alcohols like light beer or dry wine. Avoid liqueurs,
sweet wines, wine coolers, or lagers.
• Discuss the use of alcohol with your health care team first.
Alcohol can be dangerous for some health conditions or
when mixed with medications.
• Avoid alcohol if you are on a weight loss diet. It makes you
hungry and takes the place of calories that provide nutrients
in your diet.
• Make sure you are wearing a medical identification item
in case of emergency.
16
Michelle Kavin, P.A.-C.,
physician assistant
M E D I C AT I O N
D I A B E T E S
P L AY B O O K
P
ARE PILLS FOR ME?
What are the types of diabetes pills?
There are five groups of pills that can help your body control blood sugar. We
divide them by the place in your body where they work. You might be on pills
from one or more of the groups at a time. Combination pills contain medicines
from more than one group.
1. Pancreas–This group helps your pancreas make more insulin. They only
work if your pancreas is making insulin on its own. The two types of pills in
this group are the sulfonylureas and the meglitinides. Examples of pills you
might take are glyburide, glipizide, glymepiride, nateglinide, or repaglinide.
Side effects could include low blood sugar or rash.
2. Liver–This group tells your liver not to make any extra sugar when your body
already has plenty. This group is known as biguanides. An example is metformin.
Side effects could be diarrhea, upset stomach, or nausea. However, sometimes
these side effects get better with time and there are extended release versions
of metformin now that also lessen the chance of side effects.
3. Cells–This group helps your muscles and body tissue use insulin better.
They are also called thiazoladinediones or TZDs. Examples include pioglitazone
and rosiglitazone. Side effects could include swelling in the legs or weight gain.
Rosiglitazone may sometimes increase your chances for a heart attack.
4. Intestine–This group slows down how fast your body digests all of the sugar
in the food you eat. They are also known as the alpha-glucosidase inhibitors.
Examples are acarbose and miglitol. Side effects could include stomach
cramps, gas, or bloating.
5. Incretin–Incretins are hormones made by the stomach and intestines during
a meal. They help control blood sugar levels. The medicine group called
DPP-4 inhibitors increase incretins in your body. This helps keep your
blood sugar under control. So far, the only drug in this group is
sitagliptin. Unlike some other diabetes pills, sitagliptin does
not usually cause weight gain or low blood sugar.
01
MEDICATION
People with type 2 diabetes have a choice of using pills. They help your body make
more insulin or help it to use insulin better. However, there are no vitamins, herbs,
or pills that can take the place of insulin. Therefore, if you have type 1 diabetes
or have had type 2 diabetes for a long time and your body doesn’t make insulin,
the only treatment is insulin itself.
M E D I C AT I O N
IS THERE A DIFFERENCE BETWEEN GENERIC
AND BRAND NAME MEDICINES?
No. Generic medicines are cheaper than branded ones but they are made of the
same thing. Both work the same. Some of your medicines may not have a
generic version yet. Check with your pharmacist or health care provider to find
out your choices. Below is a table of generic medicines with their brand names
listed:
Generic name
Brand name
Glimepiride
Amaryl®
Chlorpropamide
Diabinese®
Glyburide
Diaßeta®, Glynase®, PresTab®, Micronase®
Glipizide
Glucotrol® XL, Glucotrol®
Repaglinide
Prandin®
Nateglinide
Starlix®
Metformin
Fortamet®, Glucophage® XR, Glucophage®,
Glumetza™, Riomet™
Acarbose
Precose®
Miglitol
Glyset®
Rosiglitazone
Avandia®
Pioglitazone
Actos®
Sitagliptin
Januvia™
Metformin + Glyburide
Glucovance®
Metformin + Glipizide
Metaglip™
Metformin + Rosiglitazone
Avandamet®
Metformin + Pioglitazone
Actoplus Met™
Metformin + Sitagliptin
Janumet™
Pioglitazone + Glimepiride
Duetact™
Rosiglitazone + Glimepiride
Avandaryl™
02
M E D I C AT I O N
D I A B E T E S
P L AY B O O K
P
How can I keep track of all my pills?
Keep a list of your pills handy with name, strength, how often you take them,
and when you need your next refill prescription from the diabetes team.
We have put an example chart in the back of this binder for easy use.
Name:
Strength:
How to take it:
Ex. Metformin
1000mg
One pill at 8 a.m.
MEDICATION
SAMPLE
WHAT ELSE DO I NEED TO KNOW ABOUT
MEDICATIONS?
Will steroids affect my blood sugar?
Yes. It can be a steroid injection for joint pain or prednisone by mouth, but
steroids will usually make your blood sugar go high.
Can I take cough syrup or other over-the-counter medications?
Yes. But be careful. Most cough syrups and cold medications
have a lot of sugar in them. Ask the pharmacist or your
medical team before buying any medicines that do not
need a prescription.
How can I find out what my insurance
company will pay for?
Call the customer help phone number on the
back of your insurance card. Ask them for a copy
of your “drug formulary.” This is a list of all the
medication and diabetic supplies your insurance
company will pay for. Place a copy of it in this
binder. Having a copy of it will help you and
your medical team make better choices.
Update it every year.
Madalyn P.,
type 1 diabetes for 7 years
03
M E D I C AT I O N
INSULIN
People with type 1 diabetes and about one third of people with type 2 diabetes
need insulin. If you have type 2 diabetes and need insulin, it does not mean that
you have done anything wrong. It does not mean that you have “failed.” Most
people with type 2 diabetes will need to take insulin to control their blood sugars
at some point. It is because your pancreas becomes tired and unable to handle
your needs. Even if you are not on insulin, it is good for you to learn some basics.
How do I store and handle insulin?
• Keep unopened insulin in the refrigerator.
• Most opened insulin can be kept either in the refrigerator or at room
temperature.
• Most insulin should not be used for more than thirty days. Throw out any
extra insulin at the end of the month.
• Never expose your insulin to extreme temperatures.
• Never shake your insulin. If you have the cloudy type of insulin and need to
mix it before using it, roll it between your hands. Clear insulins do not need
to be mixed.
• Always look at the expiration date printed on the box. Do not use insulin past
the expiration date.
• Make sure you buy the right insulin. Some insulin names look and sound the same.
How much insulin do I need?
Insulin is measured in units. You should always know how many units of insulin
you need. Don't be upset if the amount you need changes often. That is very
common. Keep track of your insulin in your medication list just like your pills.
Never compare yourself to others with diabetes for dosage or medication use.
These are some of the things that will affect your dose:
• Body weight and body build (how much fat and muscle you have).
• Level of physical activity and general health.
• Daily food.
• Other medications.
• Emotions (such as stress).
• General health.
04
M E D I C AT I O N
D I A B E T E S
P L AY B O O K
P
How do I choose a site to inject insulin?
• Most common are the stomach, thighs, or back of the upper arm.
• Don’t inject too close to moles or scars.
• If you inject in the arm, use the outer back area. Otherwise you run the risk
of injecting into muscle.
• If you inject in the thigh, aim for the top and outside area. Stay away from
inner thighs. Rubbing between the legs may make injection sites sore.
Can I use the same spot every time?
No. You should try not to put the insulin in the same spot over and over. Use
many spots (even if they are all on your belly). Putting shots in the same spot
over and over can cause fat to build up under your skin. This can make skin
look lumpy and cause insulin to work too slowly. Think of each injection spot
to be the size of a quarter.
Some people make a plan for how to change spots. One plan would be belly for
breakfast, legs for lunch, etc. If you feel lumps at the injection spot, do not use
that site for a few weeks. The lumps should go away. Call your diabetes team if
the lumps do not go away.
(l) Matthew D.,
type 1 diabetes for 6 years
(r) Amanda S.,
type 1 diabetes for 13 years
05
MEDICATION
• If you inject in the stomach, you should avoid around your belly button. The
skin there is tougher and makes insulin less likely to work at the rate you want.
M E D I C AT I O N
What if I took too much insulin?
Check your blood sugars every two hours until your insulin wears off. You may
need to eat extra carbohydrates. Watch for low blood sugars and call the diabetes
team if needed.
What if I took too little insulin?
If you know right away that you didn’t take the right amount, add another shot
with the rest of the dose. If you do not know about it until hours after you were
supposed to receive it, do not take the insulin. Wait until your next dose. You
may have high blood sugars until your next injection.
What if there is leaking from my skin after I inject insulin?
Sometimes insulin leaks out from the injection site. Blood sugars may be higher
than usual if this happens because you did not get a full dose. If it happens a
lot, try these tips:
• Inject the insulin more slowly.
• Count to five after injecting the insulin and before pulling the needle out.
• Check the angle of the needle (you may need to straighten to a ninety
degree angle).
• Check the injection site for lumps.
• Choose another site.
• Use a longer needle.
06
Mary E. Collins, R.N., C.D.E.,
nurse educator
Penn State Hershey Diabetes and Obesity Institute
M E D I C AT I O N
D I A B E T E S
P L AY B O O K
P
Are syringes my only option for using insulin?
• Pens
Insulin pens look like regular pens except there is a needle at the tip. They are
filled with insulin instead of ink. Many people on the go find them easier than
syringes. Some are designed for people who have trouble seeing the small lines
on a syringe.
• Pumps
Insulin pumps are small devices, the size of a pager, that can be programmed
to give you insulin. They provide constant insulin through a small tube that
you insert under your skin every three days. They are not for beginners.
Before thinking about a pump, you need to work with a dietitian to count
carbohydrates, to check your blood sugars four times a day, and to know how
to make changes in your insulin.
A few years ago, inhaled insulin was for sale in the United States. It has since been withdrawn from the
market. You can check the American Diabetes Association website for latest research on ways to take
insulin. Go to their website at www.diabetes.org.
07
MEDICATION
No. Syringes are the most common because they are cheap and for sale at most
drug stores by prescription. Two other options are:
M E D I C AT I O N
Non-Insulin Injections
These medicines are injected into the body but they are not insulin. There are
two medicines in this group: exenatide (Byetta®) and pramlintide (Symlin®).
Exenetide is based on a hormone, named GLP-1, that is made in the intestines
when you eat. It helps your body make more insulin and slows down your
stomach. This makes some people feel more ‘full’ after a meal. Because people
feel full, they often eat less and may lose weight.
Pramlintide is based on a hormone, named amylin, that is made by the
pancreas when you eat a meal. It is usually used by people that are already on
insulin to keep their sugars more steady. It can also sometimes help people lose
a little bit of weight.
Both exenatide and pramlintide help regulate metabolism and decrease blood
sugars. Side effects could include nausea but this usually subsides with gradual
adjustment of the dose. Exenatide may increase your risk for pancreatitis.
How do I dispose of needles, lancets, and syringes?
It will depend on where you live. Some towns ask that you place your sharps in
a puncture-proof container, like a coffee can or a heavy laundry detergent bottle.
Then you can throw them in the regular trash. Other towns require you to get a
sharps container and return them to a sharps disposal site. Check with your
medical team or recycling center for local laws.
08
Sue Jones, M.S., C.R.N.P., C.D.E.,
nurse practitioner, diabetes educator
Penn State Hershey Diabetes and Obesity Institute
WELLNESS
D I A B E T E S
P L AY B O O K
P
People with diabetes can live long and healthy lives, but it comes with the
responsibility of controlling your blood sugars. When blood sugars are too high
for long periods of time, they can lead to many health problems. Here are a few
things you can do to stay healthy.
Keeping your heart, arteries, and veins healthy
Thick and sticky blood from high blood sugars is harder for your heart to pump
and can damage your arteries and veins. This increased work and damage can
lead to heart attacks or strokes. You can help prevent these health problems by:
• Staying within your blood sugar target range.
• Working with the dietitian to achieve a heart healthy diet.
• Being more active.
• If you smoke, getting help to quit today.
• Maintaining good blood pressure control (see below).
• Maintaining good cholesterol control (see below).
• Discussing with your health care team if aspirin therapy can help decrease
your risk of developing heart disease.
Keeping your blood pressure in control
When the heart beats, it pumps blood to the arteries and creates pressure in
them. A good blood pressure is less than 130/80. This blood pressure can be
greater when your blood is thick from high sugar or your arteries are clogged
with cholesterol. Having high blood pressure can lead to stroke, heart attack,
heart failure, or kidney failure. You can help prevent these health problems:
• Maintain a healthy weight.
• Exercise regularly.
• Limit your alcohol drinks to no more than 1-2 a day.
• Decreasing the amount of sodium or salt in your diet.
• Decrease the stress in your life.
• Discuss the use of blood pressure pills with your medical team.
• Stop smoking
01
WELLNESS
ng
Quitting smoki
e
ov
pr
will greatly im
your health.
WELLNESS
Keeping your cholesterol in control
Cholesterol is a soft, sticky substance found in your body. There are different
types of cholesterol. One type, called LDL, clogs your arteries. Most people with
diabetes should keep their LDL cholesterol below 100. If you have had a heart
attack or other heart problems, your medical team might have you keep your
LDL below 70. Things you can do to help reach the goal:
• Get a cholesterol screening–know your number.
• Work with the dietitian to choose foods low in saturated fat and cholesterol.
• Maintain a healthy weight.
• Exercise regularly.
• Discuss use of pills called “statins” or other medicines with you medical team.
The “good kind” of cholesterol is called HDL cholesterol. Exercise helps to raise
this good cholesterol.
Keeping your eyes healthy
Changes in blood sugars can make your eyesight blurry for short periods of
time. If your blood sugars stay high for long periods of time, the thick and
sticky blood can damage the tiny arteries and veins in your eye. If they become
weak and start to leak fluid or blood, it is called diabetic retinopathy. It can
lead to permanent eye damage and is the number one cause of blindness
in the United States. You can help prevent these health problems by:
• Staying within your blood sugar target range.
• Having a dilated eye exam every year.
• Maintaining good blood pressure control.
• Having your eyes checked by an eye doctor
(ophthalmologist or optometrist) whenever you
notice trouble with your eyesight.
02
Svetlana Douglas, M.D.,
endocrinologist
Penn State Hershey Diabetes and Obesity Institute
WELLNESS
D I A B E T E S
P L AY B O O K
P
Keeping your kidneys healthy
Your kidneys work to filter out all the waste from your blood. High blood
sugars can stick to the walls of the arteries and veins in your kidney causing
them to be blocked or leaky. Some of the important proteins and nutrients that
should stay in the blood are then lost into the urine. When too much protein is
lost in the urine it is called diabetic nephropathy. It can lead to permanent
kidney damage. You can help prevent this health problem:
• Stay within your blood sugar target range.
(It can cut your risks in half!)
• Have your doctor do a kidney test every year.
(Called a microalbumin test)
• Maintain good blood pressure control.
• Maintain good cholesterol control.
• Talk to your medical team about pills called ACE inhibitors or ARB’s.
Keeping your nerves healthy
Your nerves work a lot like the electrical wiring in your home. They send signals
from your brain to all parts of your body. When your blood sugars run too high
for long periods of time, the sugar may stick to the nerves and cause lots of
problems. This is called diabetic neuropathy. Damaged nerves might feel like
tingling or burning, especially in your hands and feet. If they get too bad, you
may not be able to feel your hands and feet at all. Nerve problems can also
make your stomach work more slowly causing nausea, constipation, or bloating.
This may be called gastroparesis. It can interfere with your heart causing you
to feel light-headed or dizzy. You can help prevent these health problems:
• Stay within your blood sugar target range.
• Learn proper foot care
• Talk to your health care team if you think you have the above problems.
03
WELLNESS
It is important
to maintain a
healthy weight.
WELLNESS
Keeping your feet healthy
High blood sugars can cause damage to the arteries, veins, and nerves in your
feet. Infections may start quicker and cuts may heal slower. You may not notice
the pressure from tight shoes which can lead to blisters when walking. You also
might not notice injuries such as cuts and scrapes. You can help keep your feet
healthy:
• Wash your feet daily with warm water, never hot water.
• Pat your feet dry
• Apply a moisturizer, except between your toes, to prevent dry and cracked skin.
• Check your feet every day. Look for cracks, red areas, corns/calluses,
or minor cuts.
• Never use over-the-counter corn/callus remedies.
• Never soak your feet.
• If you get pedicures, make sure you are comfortable with how clean the nail
salon is, and that your technician knows you have diabetes and knows how
to care for diabetic feet.
• Keep toenails trimmed. If you have trouble, see a foot doctor (podiatrist) for help.
• Wear the right size shoes.
• Wear cotton or wool socks without elastic.
• Check your shoes before putting them on. Look for foreign objects inside like
stones or check for damaged soles.
• Have your feet examined every year by your health care team.
• Watch for Charcot foot. This is a rare condition in which the
bones of the foot can move. This can happen after an injury
or even something small like stepping off a curb. The foot
may look swollen, red or be warmer than the other foot.
Quick treatment is important.
04
Nazia Raja-Khan, M.D.,
physician
Penn State Hershey Diabetes and Obesity Institute
WELLNESS
D I A B E T E S
P L AY B O O K
P
Keeping your mouth healthy
Everyone gets plaque on his or her teeth. Plaque is a sticky film that comes from
chewing food. It is filled with germs. High blood sugars can help these germs
grow. Brushing your teeth twice a day and visiting the dentist every six months
can help keep your mouth healthy. Don’t forget to floss. It is also a good idea to let
your dentist know that you have diabetes. Some things to watch for:
• Red, sore, or swollen gums.
• Bleeding gums when you brush your teeth.
• Bad breath.
• Tooth loss.
People who have diabetes are at risk for getting the flu or other colds more
often. Make sure you get your flu vaccine every year. You should also get a
pneumonia vaccine at least once after being diagnosed with diabetes. Check
with your medical team for when a booster might be needed.
Mary Lathrop, M.D.,
endocrinologist
Penn State Hershey Diabetes and Obesity Institute
05
WELLNESS
Getting your vaccines
WELLNESS
For women
“You can have a
Your menstrual cycle, or monthly period, can affect your blood sugars. If you
find your sugars act strangely when you have your period, talk to your medical
team.
You can have a healthy pregnancy when you have diabetes. It is important to
keep your blood sugars between 60-120 mg/dl during pregnancy. That will help
make sure you and your baby stay healthy. Some pills and insulins are not safe
during pregnancy. If you are thinking about becoming pregnant or recently
found out you are pregnant, talk to your medical team.
For men
Damage to nerves, arteries, and veins can also lead to problems with erections
(erectile dysfunction). Talk to your medical team if you are having problems.
06
Caren S.,
type 1 diabetes for 22 years
healthy
pregnancy when you
have diabetes by
keeping your blood
sugar in a safe range.”
Robert Gabbay, M.D., Ph.D.
co-director
Penn State Hershey Diabetes
and Obesity Institute
D A I LY L I F E
D I A B E T E S
P L AY B O O K
P
SICK DAYS
When you are not feeling well, because of a stomach virus, flu, or other illness,
we call it a sick day. Extra stress and changes in the way you eat can make your
sugars act strangely. Usually, sugar levels will rise as your body releases
hormones to fight infections. These hormones make it hard for your body to use
insulin. The best time to think about your sick day game plan is when you feel
well. Planning ahead will help you manage your diabetes and get better faster.
What are things that might affect my diabetes?
• Colds and flu
• Vomiting and diarrhea
• Dental work or infections
• Severe pain or emotional stress
How often should I check my blood sugar when I am sick?
Every two to four hours until you are feeling better.
What if I am not hungry?
Try to choose foods from your meal plan that have at least 15 grams of
carbohydrates each hour. Here are some examples:
DAILY LIFE
Make a sick
day game plan.
• Regular ice cream (one-half cup)
• Fruit juice bar (three ounces)
• Gelatin (one-half cup)
• Cooked cereal (one-half cup)
• Toast (one slice)
• Soup (one cup)
• Rice (one-third cup)
• Applesauce (one-half cup)
What if I cannot eat?
Extra fluids can prevent
dehydration (8 to 12
cups per day or 8 to
12 ounces per hour).
01
D A I LY L I F E
If your blood sugar runs high, try sugar free liquids:
• Water
• Tea
• Sugar free ginger ale
• Broth (chicken, beef, or vegetable)
If your blood sugar runs low, try liquids with about 15 grams of carbohydrates:
• Non-diet beverages (one-half cup)
• Gelatin (one-half cup)
• Popsicles
• Juice (one-half cup)
• Milk (one cup)
Do not skip medication.
You may be eating less, but you still need your medications to balance out the
hormones that are helping you fight the illness. Rest. Do not exercise.
02
Alan B.,
type 2 diabetes for 4 years
D A I LY L I F E
D I A B E T E S
P L AY B O O K
P
Be aware of over-the-counter medications, supplements and lozengers
Cough syrups can raise your sugars. On the other hand, aspirin at high doses
can lower your blood sugars. Check with the pharmacist before taking any extra
medications.
When should I contact my medical team?
• If you feel sick for more than one or two days and are not getting better.
• If you feel very sick or have a high fever more than one day.
• If you cannot eat or drink.
• If you have vomiting or diarrhea for more than six hours.
• If your blood glucoses go below 70 mg/dl.
• If your blood glucoses go above 250 mg/dl.
• If you have signs of dehydration (dry mouth, cracked lips, sunken eyes,
weight loss).
• If you are developing signs of ketoacidosis (stomach pain, nausea, vomiting,
changes in breath, chest pain, or trouble staying awake).
diagnosed
at age 12, I was angry
and didn’t want to talk
about diabetes. I
neglected my care for
years, and hoped I
could forget about my
insulin shots and diet.
I felt alone. What
helped me most was
writing down my
thoughts and trying
to better understand
them. Then, I read
them to someone
whom I respected.”
Heather S.
Harrisburg, PA
Years with diabetes: 25
MY EMOTIONS
What does diabetes mean to me?
Diabetes involves a life-long commitment on your part. No one else can do this
for you. Each day you will need to make many healthy, informed choices. With
practice, your diabetes care will become as every day as putting on your shoes.
What about my emotions?
Having diabetes can be hard work. Some days your blood sugar will be right
where you want it. Other days, things can be all out of line. There are many
feelings you may have about it. Ask yourself, “What are my feelings about
diabetes?” Write them down.
What can I do about my feelings?
Share your thoughts and feelings about having diabetes with someone on your
team. That person can be a close friend, family member, or someone in the
community. Maybe it is another person who has diabetes and can relate to what
you are going through.
03
DAILY LIFE
“When I was
D A I LY L I F E
What about when I stumble?
Occasionally, you will “drop the ball” in your game plan. You may go off your
meal plan, skip your medication, or ignore checking your blood sugar. When
you make a mistake, you may feel angry, guilty, or disappointed in yourself.
In order to get beyond these emotions, you must “get back up” and take
responsibility for making the correct choices. Only you can change your
behavior in ways that will put you firmly in control of your diabetes.
How do I get motivated?
• Put your mistake behind you.
• Remember that one mistake does not represent the total “win-loss” record of
your diabetes care.
• Move forward.
• Team up with your diabetes educator.
Who should I talk to about diabetes?
The choice is yours. Diabetes is a part of who you are, but it is not the only thing
you are! It is good to tell some people, like your co-workers or friends, about your
diabetes. That way you can teach them about low blood sugars so they will know
what is happening if you start to act “strange.” But the choice is always yours.
What can other people do?
Some people may want to help, but may not understand what you need. They
may say, “You shouldn’t be eating that doughnut,” or “You need to exercise.”
Keep in mind that they are trying to show you they care. By talking about what
you need from them, people can show their concern and support you.
1. Ask yourself what you need them to stop doing.
• Do you want them to stop telling you what to eat?
• Do you want them to stop talking about your diabetes in front of
other people?
• Do you want them to stop talking about your weight?
2. Tell them how these comments make you feel.
04
“As a person with
diabetes
for more than fifty
years, I could not have
imagined when I was
diagnosed in 1955 at
age 8 that I would
benefit from home
blood glucose
monitoring and an
insulin pump (for
eleven years now).”
Jane H.
Camp Hill, PA
Years with diabetes: 55
D A I LY L I F E
D I A B E T E S
P L AY B O O K
P
3. Tell them what they can do to help.
• Ask them to eat healthy with you so that you are not tempted.
• Invite them to come to your appointments.
• Challenge them to exercise with you.
• Show them how they can help when you have a low blood sugar.
• You may want to remind them that everyone should try to follow a
healthy diet and exercise, not just people with diabetes.
Where can I get more support?
It can be a great relief to know that you are not the only one who hates to get
low blood sugars or who is having trouble. Penn State Hershey Medical Center’s
Diabetes Team offers support groups every month that meet during the day
and evening. Call 717-531-8395 to learn more or visit our website at
pennstatehershey.org/web/guest/community/classessupportgroups/diabetes.
See the Resources section for more contact information.
Most importantly…
Do what you can to help yourself–medically, physically, and emotionally. You are
a person with diabetes, but that does not take away your value or worth. It is
important to understand and take care of yourself as best you can. You are not
alone. There are many people on your team cheering for you on the sidelines.
TRAVELING
What should I think about ahead of time?
• Pack twice as many supplies as you will need.
• Call the airlines/cruise lines in advance. Let them know you may need a
special meal plan and ask about bringing diabetes supplies aboard.
• Pack extra snacks in case of low blood sugars.
• Find out if your health insurance will cover the cost of emergency health care
out of your state or out of the country.
05
DAILY LIFE
If you are not from the Hershey area, support groups are available through the
American Diabetes Association. Call 1-800-DIABETES (1-800-342-2383) or
visit the Web site at diabetes.org/home.jsp.
D A I LY L I F E
“As a person with
• Carry/wear medical identification with you at all times.
• Keep diabetic supplies with you at all times. Checked bags may not make it
to the destination or be exposed to dangerous temperatures.
• Carry phone numbers for your medical team, insurance company, glucose
meter and insulin pump companies.
What about the trash?
Leaving needles and testing supplies in trash cans at motels, restaurants, or
airports can be both dangerous and illegal. Carry an appropriate waste container.
My diabetes travel checklist
• Medications
• Syringes, pens, pump supplies, needles
• Alcohol swabs
• Extra prescriptions
• Snacks in case of low sugar
• Medical identification
• Blood glucose meter with supplies
• Insurance information
• Batteries
MY RIGHTS AT WORK
Do I have any rights at work?
There are laws that can protect you while you are at work. Your employer does
not have the right to use your diabetes as an excuse for hiring, firing, discipline,
pay, promotion, job training, benefits, or any other part of your job. They are
not legally allowed to “get back” at you for defending your rights. You are
protected under what is called the anti-discrimination laws. To be protected
under these laws, you must tell your employer you have diabetes. You also need
to tell them what you need to stay safe while on the job.
06
diabetes
you may need to be
assertive and ask for
what you need. In Paris
at The Ritz, there were
no vegetables on the
buffet to be found.
When I requested an
option, a plate of
steamed vegetables
appeared before me
and my blood sugar
remained where it
belonged.”
Honi K.
Harrisburg, PA
Years with diabetes: 7
D A I LY L I F E
D I A B E T E S
P L AY B O O K
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What are some examples of things that I can ask for?
Here are a few examples of things that you might need because of your diabetes:
• Breaks to check blood sugar levels, eat a snack, or go to the bathroom.
• Special permission to eat on the job.
• The ability to keep diabetes supplies and food nearby.
• A special schedule or a standard work shift instead of a swing shift.
What can I do if I am having trouble at work?
A good first step is to get information about anti-discrimination laws as they
apply to you. Contact the American Diabetes Association at 1-800-DIABETES
(342-2383) or visit their Web site at diabetes.org for a packet on employment
discrimination.
WHAT IF I CAN’T AFFORD MY SUPPLIES?
There are many people who have difficulty paying for diabetic supplies.
Sometimes it is a short-term problem because of a job change or loss of insurance.
Sometimes it is a life-long problem because of finances. Unfortunately, diabetes
does not take a break. Here are a few things you can do if money is keeping you
from taking care of your diabetes.
DAILY LIFE
To be protected
under these laws,
you must tell your
employer you
have diabetes.
Talk to your medical team
Sometimes they can change your pills, insulin,
or even glucose meter to make it less costly.
Ask for generic names whenever possible.
Deb Shepherd, M.S.N., C.R.N.P., C.S.
nurse practitioner
Penn State Hershey Diabetes and Obesity Institute
07
D A I LY L I F E
Use the American Diabetes Resource Guide
This is a list of all diabetic pills, insulin, and supplies for sale in the United States
with pricing included. It can show you the wide range of prices. For example,
test strips for your glucose meter can range in price from $.33 to $.88 each.
That can be a difference of $800 a year! You can find the resource guide on the
Internet at diabetes.org/for-media/2008/diabetes-forecast-2009-resourceguide.html.
Contact Partnership for Prescription Assistance
The Partnership for Prescription Assistance may be able to help you get your
medicines if your insurance doesn’t cover medicine. You might be able to get
your medicines free or nearly free. You can call 1-888-477-2669 for more
information. You can also find out more on the Internet at pparx.org.
Ask about pharmaceutical patient assistance programs
Many of the companies that make diabetes pills, insulin, and supplies offer free
supplies for a short period of time to those who qualify. These are not state or
federal programs. The companies voluntarily offer these programs and they
design their own rules.
08
VISITS
D I A B E T E S
P L AY B O O K
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WHO’S ON MY MEDICAL TEAM?
A Doctor
Your family doctor will help you take control of your diabetes. They may ask
you to see a doctor with special training in diabetes (also called an
endocrinologist). You should see a doctor every three to six months.
Nurse Practitioners and Physician Assistants
Nurse practitioners and physician assistants help doctors care for patients. They
can teach you about your diabetes, write prescriptions, or order your blood
work. You may see them in-between visits with your doctor.
Nurse Educators
A nurse educator is a registered nurse (RN) with special training in caring for
people with diabetes. They can help teach you about diabetes, how to check
sugars, and how to handle sick days. You should see a nurse educator at least
once a year.
Registered Dietitians
A registered dietitian (RD) is someone trained in nutrition. They can teach you
how the foods you eat affect your blood sugar, how to read food labels, how to
make a sick day meal plan, how to plan for eating out, and how to find good
cookbooks. You should see a registered dietitian at least once a year.
Pharmacist
A pharmacist is usually at a drug store and will be behind the counter to give
you your medications and supplies. You may need their help with things like
keeping track of your pills or deciding which medications to take.
Others
There are many other people who you may want to help you with your care.
These include people to check your eyes (ophthalmologist/optometrist), your
heart (cardiologist), your feet (podiatrist), and your kidneys (nephrologists).
You may also want a counselor or psychiatrist for extra support. If you need
to see a doctor who is a specialist in a medical field not associated with your
diabetes, such as a dermatologist or plastic surgeon, it is very important that
you tell this doctor that you have diabetes.
01
VISITS
t
You are the mos
r
important membe
on your team!
VISITS
How do I keep track of everyone?
Ask for a business card from everyone you see regularly. Keep them in the
business card holder we have provided. You could also make a list of everyone
on your diabetes team that you may need to contact. The following is an
example to get you started:
DIABETES TEAM CONTACT LIST
Team Member
Name
Phone Number
Primary Care Doctor
Endocrinologist
Pharmacist
Friend/Family Member
Co-worker
Emergency Contact
Physician Assistant or
Nurse Practitioner
Diabetes Nurse Educator
Dietitian
Glucose Meter Company
Insurance Company
What should I bring to my visit with the Diabetes Team?
02
D I A B E T E S
RESOURCES
P L AY B O O K
P
USEFUL CONTACT INFORMATION
Penn State Hershey Diabetes and Obesity Institute
1-877-652-2447 (Toll-Free)
PennStateHershey.org/diabetes
• Adult Diabetes Program
717-531-3592
• Pediatric Diabetes Program
717-531-4751
• Adult Diabetes Education
717-531-5684
• Adult Insulin Pump Information
717-531-4220
• Adult Nutrition Scheduling
717-531-1441
• Ophthalmology (for eyes)
717-531-5690
• Podiatry (for feet)
717-531-5638
• Heart and Vascular Institute
717-531-4554
Toll-Free: 877-467-7484
• Nephrology (for kidneys)
717-531-8156
• Neurology Program (for nerves)
717-531-4191
Toll-Free: 800-292-3332
• Surgical Weight Loss
877-609-6848
RESOURCES
Penn State Milton S. Hershey Medical Center
(l) Karen F.,
type 2 diabetes for 8 years
(r) Catherine B.,
type 2 diabetes for 11 years
01
RESOURCES
USEFUL CONTACT INFORMATION
American Association of Diabetes Educators
800-338-3633
diabeteseducator.org
American Diabetes Association (ADA)
800-232-3472
diabetes.org
American Dietetic Association
800-877-1600
eatright.org
Centre Medical Surgical Associates
Diabetes Treatment Program
814-234-8880
Mt. Nittany Medical Center
Diabetes Office
814-231-7095
Susquehanna Health Endocrinology Department
Diabetes Office
570-320-7848
02
RESOURCES
D I A B E T E S
P L AY B O O K
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MY MEDICATIONS
Name:
Strength:
How to take it:
Example: Metformin
1000 mg
One pill at 8:00 a.m.
MY ALLERGIES
Example: Penicillin
Make copies to use later.
What Happens?
I get a rash
RESOURCES
Name:
03
RESOURCES
MY APPOINTMENTS
Appointment with:
Date:
Time:
Place:
Example: Dr. Gabbay
August 5
9:00 a.m.
UPC 300
Make copies to use later.
04
D I A B E T E S
RESOURCES
P L AY B O O K
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LABWORK: MY A1C’S
A1C
298
12
283
11.5
269
11
255
10.5
240
10
226
9.5
212
9
197
8.5
183
8
169
7.5
154
7
126
6
Place date here:
Date
Ex:
6/25/09
LDL
Make copies to use later.
Weight
Blood Pressure
Dilated Eye Exam
RESOURCES
Blood
Sugar
Average
05
06
TIME
DATE
Make copies to use later.
GLUCOSE
Morning
GLUCOSE
My Diabetes Team Member:
My Phone Number :
Name:
TIME
DATE
Morning
INSULIN
INSULIN
TIME
TIME
INSULIN
GLUCOSE
INSULIN
Lunchtime
GLUCOSE
Lunchtime
TIME
TIME
INSULIN
GLUCOSE
INSULIN
Evening Meal
GLUCOSE
Evening Meal
Fax:
Mail to:
TIME
TIME
GLUCOSE
Bedtime
GLUCOSE
Bedtime
INSULIN
INSULIN
Comments
Comments
RESOURCES
GLUCOSE LOG
RESOURCES
D I A B E T E S
P L AY B O O K
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GLOSSARY
A1C or glycohemoglobin—a blood test that can show how your blood sugar has been
controlled over the past two to three months.
ACE Inhibitors—Angiotensin Converting Enzyme Inhibitor. A medication to help lower blood
pressure and help protect the kidney from nephropathy.
ARB’s—Angiotensin Receptor Blocker. A medication that also helps to lower blood pressure and
help protect the kidney from nephropathy. It works slightly differently than ACE inhibitors.
Blood sugar—(also called glucose) the amount of sugar in your blood.
Carbohydrate—main source of energy for the body. Foods that contain carbohydrates are
starches, fruits, milk, desserts, sugar, sweetened beverages, and vegetables. Starchy vegetables
such as potatoes, corn, and peas have more carbohydrates than other vegetables.
Cardiologist—a doctor who specializes in the heart and blood vessels, among other things.
These doctors work with blood pressure and cholesterol.
Cells—the smallest structural unit of an organism that is capable of independent functioning.
Charcot foot—(pronounced shär ko– ) is a rare condition in which the bones of the foot can
move. This can happen after an injury or even something small like stepping off a curb.
The foot may look swollen, red, or be warmer than the other foot. Early treatment is important.
Diabetic ketoacidosis (DKA)—a serious health problem caused by a lack of insulin. Your cells
do not take in enough sugar, and instead your body breaks down your body fat to use for
energy. This breakdown makes a waste called a ketone. Ketones build up in the blood and
appear in the urine. This can lead to coma or death if not treated.
Dietitian or registered dietitian—a person trained in nutrition or food counseling.
Endocrinologist—a doctor who specializes in diabetes, among other things.
Fasting blood sugar—amount of sugar in your blood after you have not eaten or had anything
to drink with calories for at least eight hours.
Gastroparesis—a condition that affects the ability of the stomach to empty its contents, but
there is no blockage.
Gestational diabetes—high blood sugars because of hormone changes during pregnancy.
Glucagon—hormone made by the pancreas to help the body respond to low blood sugars.
Glucagon causes the liver to release stored sugar into the blood.
Glucagon injection kit—an injection available through prescription that contains glucagon
used for the treatment of severe low blood sugar.
Glucose—a type of sugar that, with the help of insulin, is used for energy by the cells of the body.
Glucose gels—cake icing-like product available without a prescription used for the treatment of
mild to moderate low blood sugars.
Glucose log—records of your blood sugar results and the time and dose of your medications.
Also included is anything that may have affected your blood sugar, such as a change in your
level of physical activity, food, stress, or illness.
RESOURCES
Glucose meter—a small device that allows a person to check blood sugars.
07
RESOURCES
GLOSSARY
Glucose tablets—oral product available without a prescription used for treatment of mild to
low blood sugars.
Hormone—a chemical substance made in the body that has a specific effect on how certain cells
or certain organs work.
Hyperglycemia—high blood sugar.
Hypoglycemia—low blood sugar.
Insulin—hormone made by the pancreas in response to high blood sugars. It makes it possible
for the cells of the body to take in sugar from the blood to be used for energy or stored for later use.
Ketones—waste product that is released into the bloodstream when the cells use fat for energy
because they cannot take in sugar. When high levels of ketones appear in the urine, it may be a
sign of a serious complication called diabetic ketoacidosis. See DKA.
Lancet—a tiny needle used in a lancing device to prick your finger.
Lancing device—a tool that makes it easier to collect blood for blood glucose monitoring.
Liver—a large organ that stores extra glucose and releases it back into the bloodstream when
blood sugars are low, among other things.
Long-term complications—health problems from having high blood sugars for a number of
years. Examples may include heart disease, eye damage, kidney disease or nerve damage.
Medical identification—any item that alerts others that you have a medical condition.
They come in various forms including bracelets, necklaces, wallet cards, etc.
Meter correlation—a test done at a laboratory that checks to make sure a glucose meter is accurate.
Nephrologist—a doctor who specializes in taking care of kidneys, among other things.
Nephropathy—when high blood sugars damage the kidneys causing them to leak protein. It
can lead to kidney failure.
Neurologist—a doctor who specializes in taking care of nervous system conditions, like neuropathy.
Neuropathy—when high blood sugars damage the nerves. It causes pain, loss of feeling, and
muscle weakness usually in the hands, legs, and feet. It can also affect the heart, bladder,
digestive system, and sexual organs.
Nurse Educator—a nurse educator is a registered nurse (RN) with special training in caring for
people with diabetes.
Nurse Practitioner—a person trained to care for patients. They can teach you about your
diabetes, write prescriptions, or order your blood work.
Ophthalmologist—a doctor who has attended medical school and specializes in eye care.
Ophthalmologists can prescribe corrective lenses, prescribe drugs or perform surgery.
Optometrist—a person who has attended optometry school and specializes in examining the
eyes. An optometrist prescribes corrective lenses but cannot perform surgery.
Pancreas—the organ that produces the hormone insulin, among other things.
Pancreatitis—pancreatitis is inflammation or infection of the pancreas. The pancreas, a gland
located behind the stomach, releases the hormones insulin and glucagon and substances that
help with digestion.
08
RESOURCES
D I A B E T E S
P L AY B O O K
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GLOSSARY
Pharmacist—are health professionals who dispense the medication to the patient and counsel
them on the proper use and adverse effects of that medication.
Physician Assistant—A person trained to care for patients. They can teach you about your
diabetes, write prescriptions, or order your blood work.
Podiatrist—a doctor who specializes in foot care.
Psychiatrist—a doctor whose primary goal is the treatment of mental difficulties.
Retinopathy—when high blood sugars damage the arteries and veins in your eyes. It can lead
to a change in your vision or blindness.
Rule of 15—used to treat low blood sugars. Take 15 grams of a carbohydrate and repeat blood
sugar in 15 minutes.
Target blood sugar range—the blood sugar goals to prevent long-term health problems.
Type 1 diabetes—high blood sugars because the body’s immune system attacked the pancreas
until it could no longer make insulin.
Type 2 diabetes—high blood sugars because the body’s unable to make enough insulin or use
insulin properly.
RESOURCES
Units—standard measurement used for insulin.
09
RESOURCES
INDEX
A1C................................................................................................................Diabetes 101-07
..........Comparing A1C to blood sugar ..........................................................Diabetes 101-07
..........Goal range ..........................................................................................Diabetes 101-07
“ACE inhibitors”, keeping your kidneys healthy ..............................................Wellness-03
Alcohol ......................................................................................................................Food-16
American Association of Diabetic Educators ..........................................................Food-06
............................................................................................................................Resources-01
American Diabetes Association ........................................................................Daily Life-05
............................................................................................................................Resources-01
American Diabetes Resource Guide ..................................................................Daily Life-08
American Dietetic Association ................................................................................Food-06
............................................................................................................................Resources-01
ARB’s, keeping your kidneys healthy ................................................................Wellness-03
Aspirin..................................................................................................................Wellness-01
Blood pressure control ........................................................................................Wellness-01
Brand Name (medications)..............................................................................Medication-02
Carbohydrates......................................................................................................Food-01-04
“carbs”, see carbohydrates
Cardiologist, (heart doctor)......................................................................................Visits-01
Cells ..............................................................................................................Diabetes 101-02
Charcot Foot ........................................................................................................Wellness-04
Cholesterol control ..............................................................................................Wellness-02
Contact list................................................................................................................Visits-02
Cough and colds ................................................................................................Daily Life-01
Cough Syrup ....................................................................................................Medication-03
Dental care ..........................................................................................................Wellness-05
Dental work ........................................................................................................Daily Life-01
Diabetes
..........Cause ..................................................................................................Diabetes 101-01
..........Cure ....................................................................................................Diabetes 101-01
..........Gestational ..........................................................................................Diabetes 101-02
..........Insulin ....................................................................................................Medication-04
..........Pills ........................................................................................................Medication-04
..........Pre-Diabetes ........................................................................................Diabetes 101-02
..........Steroid induced ..................................................................................Diabetes 101-02
..........Symptoms ..........................................................................................Diabetes 101-01
..........Type 1..................................................................................................Diabetes 101-02
..........Type 2..................................................................................................Diabetes 101-02
Diabetes education ............................................................................................Resources-01
Diabetes program ..............................................................................................Resources-01
Diabetes team contact list ........................................................................................Visits-02
Diabetes team visit checklist....................................................................................Visits-02
Diabetic complications
..........Charcot Foot ..............................................................................................Wellness-04
..........Erections, (erectile dysfunction) ................................................................Wellness-06
..........Eyes, (retinopathy) ....................................................................................Wellness-02
..........Heart disease ..............................................................................................Wellness-01
..........High blood pressure ..................................................................................Wellness-01
..........High cholesterol ........................................................................................Wellness-02
..........Kidneys, (nephropathy)..............................................................................Wellness-03
..........Nerves, (neuropathy) ................................................................................Wellness-03
10
D I A B E T E S
P L AY B O O K
Diarrhea ..............................................................................................................Daily Life-01
Dietitian ....................................................................................................................Food-08
........................................................................................................................Visits-01
Dilated eye exam ................................................................................................Wellness-02
Disposing of needles, lancets and syringes ....................................................Medication-08
Doctor........................................................................................................................Visits-01
..........Cardiologist, (heart) ........................................................................................Visits-01
..........Endocrinologist, (diabetes) ..............................................................................Visits-01
..........Nephrologist, (kidney) ....................................................................................Visits-01
..........Ophthalmologist, (eyes) ............................................................................Wellness-02
........................................................................................................................Visits-01
..........Podiatrist, (feet)..........................................................................................Wellness-04
........................................................................................................................Visits-01
..........Psychiatrist, (depression, denial, frustration) ..................................................Visits-01
Drinks, sugar free ..............................................................................................Daily Life-02
Drinks with 15 grams of carbohydrates ..........................................................Daily Life-02
Drug Formulary ..............................................................................................Medication-03
Emotions ............................................................................................................Daily Life-03
Endocrinologist, (diabetes doctor) ..........................................................................Visits-01
Erectile dysfunction ............................................................................................Wellness-06
Erections ..............................................................................................................Wellness-06
Eyes, (retinopathy) ..............................................................................................Wellness-02
Flu, the................................................................................................................Daily Life-01
Flu vaccine ..........................................................................................................Wellness-05
Food
..........Drinks with 15 grams of carbohydrates ....................................................Daily Life-02
..........Foods high in carbohydrates............................................................................Food-01
..........Foods with 15 grams of carbohydrates................................................Diabetes 101-09
..........................................................................................................................Daily Life-01
..........Hand guide for portion control........................................................................Food-04
..........How many carbohydrates should I eat ............................................................Food-03
..........How should a meal look on my plate ..............................................................Food-01
..........My food list ....................................................................................................Food-07
..........Nutrition Facts label ........................................................................................Food-02
..........Sugar-free drinks ......................................................................................Daily Life-02
..........Total carbohydrate versus sugar ......................................................................Food-03
..........Vitamins and herbs ..........................................................................................Food-06
..........Where do I get help with food choices ............................................................Food-02
........................................................................................................................Food-06
Foot Care ............................................................................................................Wellness-04
Gastroparesis ......................................................................................................Wellness-03
Generic name (medications) ..........................................................................Medication-02
Glucose..........................................................................................................Diabetes 101-02
..........Glucose log..........................................................................................Diabetes 101-06
..........Glucose meter ....................................................................................Diabetes 101-03
..........Goal range ..........................................................................................Diabetes 101-04
..........How do I check it................................................................................Diabetes 101-03
..........What makes it go down ......................................................................Diabetes 101-03
..........What makes it go up ..........................................................................Diabetes 101-03
Glucose gels ..................................................................................................Diabetes 101-09
11
P
RESOURCES
RESOURCES
RESOURCES
INDEX CONTINUED
Glucose meter ..............................................................................................Diabetes 101-03
..........Choosing a meter ................................................................................Diabetes 101-04
..........How often should I use it ....................................................................Diabetes 101-05
..........Making sure it works ..........................................................................Diabetes 101-05
..........Test strips ............................................................................................Diabetes 101-04
..........What if I can’t afford supplies ..................................................................Daily Life-07
Glucose tablets..............................................................................................Diabetes 101-09
Glycohemoglobin ..........................................................................................Diabetes 101-07
High blood glucose ......................................................................................Diabetes 101-11
..........Causes ................................................................................................Diabetes 101-11
..........Ketoacidosis ........................................................................................Diabetes 101-12
..........Symptoms ..........................................................................................Diabetes 101-11
..........Treatment ............................................................................................Diabetes 101-12
Hyperglycemia, see high blood glucose
Hypoglycemia, see low blood glucose
Incretin ............................................................................................................Medication-01
Infections ............................................................................................................Daily Life-01
Insulin ..........................................................................................................Diabetes 101-02
..........................................................................................................................Medication-04
..........Disposing of needles, lancets and syringes ............................................Medication-08
..........How much do I need ............................................................................Medication-04
..........Inhaled ..................................................................................................Medication-07
..........Pens........................................................................................................Medication-07
..........Pumps ....................................................................................................Medication-07
............................................................................................................................Resources-01
..........Sites to inject ..........................................................................................Medication-05
..........Storing and handling..............................................................................Medication-04
..........What if I can’t afford it..............................................................................Daily Life-07
..........What if I took too little ..........................................................................Medication-06
..........What if I took too much ........................................................................Medication-06
..........What if there is leaking after I inject ......................................................Medication-06
Insurance companies
..........Drug formularies ....................................................................................Medication-03
..........Patient assistant programs ........................................................................Daily Life-08
Ketoacidosis ..................................................................................................Diabetes 101-12
Laws, see work rights
LDL, (low-density lipoprotein or cholesterol) ..................................................Wellness-02
Logbook ........................................................................................................Diabetes 101-06
Low blood glucose ........................................................................................Diabetes 101-08
..........Causes ................................................................................................Diabetes 101-08
..........Symptoms ..........................................................................................Diabetes 101-08
..........Treatment ............................................................................................Diabetes 101-09
..........Glucose gels ........................................................................................Diabetes 101-09
..........Glucose tablets ....................................................................................Diabetes 101-09
Medical identification ..................................................................................Diabetes 101-09
12
D I A B E T E S
P L AY B O O K
Medications
..........“ACE inhibitors and ARB’s”, keeping you kidneys healthy.......................... Wellness-03
..........Aspirin ......................................................................................................Wellness-01
..........Cough syrup ..........................................................................................Medication-03
..........Drug formulary ......................................................................................Medication-03
..........Insulin ....................................................................................................Medication-04
..........Non-Insulin 1njections ..........................................................................Medication-07
..........Over-the-counter medications ................................................................Medication-03
..........Pills ........................................................................................................Medication-01
..........“statins”, keeping your cholesterol in control ............................................Wellness-02
..........steroids ..................................................................................................Medication-03
Menstrual cycle....................................................................................................Wellness-06
Micro albumin test, (kidney test) ......................................................................Wellness-03
My diabetes team contact list ..................................................................................Visits-02
My diabetes travel checklist ..............................................................................Daily Life-06
My food list ..............................................................................................................Food-07
My medical team ......................................................................................................Visits-01
..........Cardiologist, (heart) ........................................................................................Visits-01
..........Doctor ............................................................................................................Visits-01
..........Endocrinologist, (diabetes) ..............................................................................Visits-01
..........Nephrologist, (kidney) ....................................................................................Visits-01
..........Nurse educator................................................................................................Visits-01
..........Nurse practitioner ..........................................................................................Visits-01
..........Ophthalmologist, (eyes) ............................................................................Wellness-02
........................................................................................................................Visits-01
..........Optometrist, (eyes)..........................................................................................Visits-01
..........Pharmacist, (drugs) ........................................................................................Visits-01
..........Physician assistant ..........................................................................................Visits-01
..........Podiatrist, (feet)..........................................................................................Wellness-04
........................................................................................................................Visits-01
..........Psychiatrist, (depression, denial, frustration )..................................................Visits-01
..........Registered dietitian, (food) ..............................................................................Visits-01
My visit checklist ......................................................................................................Visits-02
Nephrologist, (kidney doctor)..................................................................................Visits-01
Nephropathy, (kidney disease) ..........................................................................Wellness-03
Neuropathy, (nerve damage) ..............................................................................Wellness-03
Nicotine use ........................................................................................................Wellness-01
Non-Insulin Injections ....................................................................................Medication-07
Nurse educator..........................................................................................................Visits-01
Nurse practitioner ....................................................................................................Visits-01
Nutrition Facts label ................................................................................................Food-02
..........Calories............................................................................................................Food-02
..........Servings per package ......................................................................................Food-02
..........Serving size......................................................................................................Food-02
..........Total carbohydrates..........................................................................................Food-02
..........Total Fat ..........................................................................................................Food-02
Nutrition counseling..........................................................................................Resources-01
Ophthalmologists, (eye doctor) ..........................................................................Wellness-02
........................................................................................................................Visits-01
Ophthalmology, (the department) ....................................................................Resources-01
13
P
RESOURCES
RESOURCES
RESOURCES
INDEX CONTINUED
Optometrist, (eye examiner) ..............................................................................Wellness-02
........................................................................................................................Visits-01
Over-the-counter medications ........................................................................Medication-03
Packing diabetic supplies ..................................................................................Daily Life-05
Pancreas ........................................................................................................Diabetes 101-02
Patient assistance programs ..............................................................................Daily Life-08
Pediatric specialties, (children) ........................................................................Resources-01
Penn State Diabetes Center ..............................................................................Daily Life-05
Period, monthly ..................................................................................................Wellness-06
Pharmaceutical patient assistance programs ....................................................Daily Life-08
Pharmacist ................................................................................................................Visits-01
Physician assistant....................................................................................................Visits-01
Pills
..........Drug formulary ......................................................................................Medication-03
..........Keeping track of ....................................................................................Medication-03
..........Types of ..................................................................................................Medication-01
..........What if I can’t afford them........................................................................Daily Life-07
..........What will my insurance pay for ............................................................Medication-03
Pneumonia vaccine ..............................................................................................Wellness-05
Podiatrist, (foot doctor) ......................................................................................Wellness-04
........................................................................................................................Visits-01
Podiatry, (department) ......................................................................................Resources-01
Pregnancy ............................................................................................................Wellness-06
Psychiatrist, (doctor to help with depression, denial, frustration) ......................Visits-01
Registered dietitian, (food) ......................................................................................Visits-01
Retinopathy, (eye disease) ..................................................................................Wellness-02
..........Dilated eye exam........................................................................................Wellness-02
Sick days ............................................................................................................Daily Life-01
..........Diarrhea....................................................................................................Daily Life-01
..........How often should I check my sugar ........................................................Daily Life-01
..........Ketoacidosis ........................................................................................Diabetes 101-12
..........Over-the-counter medications ..................................................................Daily Life-03
..........What if I am not hungry ..........................................................................Daily Life-01
..........What if I cannot eat ..................................................................................Daily Life-01
..........When should I contact my medical team..................................................Daily Life-03
..........Why I should not skip medication ..........................................................Daily Life-02
..........Vomiting ..................................................................................................Daily Life-01
Smoking ..............................................................................................................Wellness-01
“Statins”, keeping cholesterol under control ....................................................Wellness-02
Steroids ............................................................................................................Medication-03
Supplies
..........What if I can’t afford them........................................................................Daily Life-07
..........American Diabetes Resource Guide ..........................................................Daily Life-08
..........Pharmaceutical patient assistance programs..............................................Daily Life-08
Support groups ..................................................................................................Daily Life-05
Test strips......................................................................................................Diabetes 101-04
..........What if I can’t afford them........................................................................Daily Life-07
Tooth care ............................................................................................................Wellness-05
Traveling ............................................................................................................Daily Life-05
14
RESOURCES
D I A B E T E S
P L AY B O O K
P
RESOURCES
Useful contact information................................................................................Resources-01
..........American Association of Diabetic Educators ....................................................Food-06
..........................................................................................................................Resources-01
..........American Diabetes Association ................................................................Daily Life-05
..........................................................................................................................Resources-01
..........American Dietetic Association..........................................................................Food-06
..........................................................................................................................Resources-01
..........Diabetes education ..................................................................................Resources-01
..........Diabetes program ....................................................................................Resources-01
..........Insulin pump information ........................................................................Resources-01
..........Nutrition scheduling, adult ......................................................................Resources-01
..........Ophthalmology, (eye department) ............................................................Resources-01
..........Pediatric specialties ..................................................................................Resources-01
..........Podiatry, (foot department) ......................................................................Resources-01
..........Support groups ........................................................................................Daily Life-05
Vaccines................................................................................................................Wellness-05
..........Flu ............................................................................................................Wellness-05
..........Pneumonia ................................................................................................Wellness-05
Visit checklist............................................................................................................Visits-02
Vomiting..............................................................................................................Daily Life-01
Work rights ........................................................................................................Daily Life-06
15
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PennStateHershey.org/diabetes
2nd Edition | Revised 4/10 | U.Ed MED 09-0185-MED