A Teaching Resource Guide Part 1 of 2

Diabetes: What it is and why it happens Diabetes is a condition that causes sugar levels in your blood to be high When you have diabetes: Your pancreas does not make insulin, or It does not make enough insulin, or Your body prevents the insulin you do make from working right As a result, sugar can’t get into your cells, so it stays in your blood That’s why your blood sugar gets too high If you have diabetes, you are not alone. Millions of people today have diabetes. Diabetes cannot yet be cured. But it can be managed. When it comes to diabetes, knowledge really is power. The more you know about diabetes, the better you’ll be able to manage it.

Taking care of your diabetes Diabetes can cause problems. But diabetes-related problems don’t have to happen Millions of people live long, full lives with diabetes You can be one of them Taking care of yourself and managing your blood sugar is the key When it comes down to it, high blood sugar is the main cause of many of the problems of diabetes. You can do many things to prevent problems. Managing your blood sugar is key. The more you work to manage your blood sugar, the better you’ll feel each day. It may also help you avoid diabetes problems down the road.

Your diabetes care: it’s a team effort You are not alone when it comes to managing your diabetes You may have a team of healthcare professionals working with you You may also have family members or friends for help and support But the most important member of the team is you As the captain of your team, you need to: Learn as much as you can about diabetes in general Know as much as possible about your diabetes and your health Good diabetes care takes a team. Your doctor, nurse, diabetes educator, dietitian, and others are all members of your team. And then, of course, there’s you. You are the most important member of your team. Your fellow team members are experts on diabetes. But you are the expert on how you feel with diabetes. All of us on your team have the same goal: to help you live well with diabetes.

Your diabetes care plan should include: A meal plan A physical activity plan A plan for how often you should check your blood sugar Your personal blood sugar goals When to take your diabetes medicines A schedule for regular checkups Other health goals “The key to diabetes management is getting educated about diabetes and realizing that this disease is controllable.” –Karen R., South Carolina Your diabetes care plan helps keep your sugar and insulin in balance, the way your body did before diabetes. We will work with you to make your diabetes care plan. Your plan will help you to set and reach your goals.

Diabetes care schedule Daily: Check blood sugar as recommended by your diabetes care team Every 3 months: Regular office visit A1C test (if blood sugar is not stable) Blood pressure check Weight check Foot check Every 6 months: A1C test (if blood sugar is stable) Dental exam Regular checkups with your diabetes care team are an important way for you to avoid diabetes problems. This slide shows a suggested schedule for care you should do daily, every 3 months, and every 6 months. Let’s discuss a schedule that is right for you.

Diabetes care schedule Every year: Physical exam Comprehensive foot exam Blood fats and cholesterol tests (more often if not at goal) Kidney tests Dilated eye exam Flu shot “I’ve learned to be proactive in my own care and to educate myself. It is never too late and might just give you more years to enjoy with life.” –Cheryl K., Maryland This slide shows a suggested annual care schedule people with diabetes should follow. Let’s discuss the right schedule for you.

Checking your blood sugar Why: Checking your blood sugar yourself is often the best way to be sure your diabetes is under control. It tells you: If your insulin or other diabetes medicine is working How physical activity and the foods you eat affect your blood sugar Based on your care plan, you may want to test when: You wake up Before meals or large snacks 1 or 2 hours after meals or large snacks Before and 15 minutes after physical activity You’ll usually feel better and have more energy when your blood sugar stays at or near normal. Managing your blood sugar can also help to reduce your risk of developing problems from diabetes. (Diabetes & You, p 24, para 2) Here’s a schedule of times you should take your blood sugar throughout the day. Let’s discuss a schedule that works for you. (Diabetes & You, p 25, para 1)

Keeping a blood sugar diary It’s important to write down your blood sugar levels so that you can keep track of what makes them go up or down. You might want to use a blood sugar diary like the one shown here. You can ask your diabetes care team to give you one. Or, if you’d like to use an online blood sugar diary, you can find one at ChangingDiabetes-us.com. Show your diary to your diabetes care team at your office visits. Good diary records will help you and your team make the best possible decisions about your diabetes care plan.

Target blood sugar levels for people with diabetes Goals for People With Diabetes A1C Less than 7% Before meals 70 – 130 mg/dL 2 hours after meals Less than 180 mg/dL This table lists blood sugar goals that many doctors suggest for people with diabetes. Let’s think about the blood sugar goals we should set for your diabetes care plan. For tips on making blood sugar monitoring a part of your life, visit ChangingDiabetes-us.com. Adapted from the American Diabetes Association. Standards of medical care in diabetes—2009. Diabetes Care. 2009;32(suppl 1):S13-S61.

Insulin: a medical breakthrough People with type 1 diabetes must take insulin to control blood sugar People with type 2 diabetes who take insulin may find that they have more flexible eating and activity schedules Insulin helps to lower blood sugar by helping sugar move from the blood into your cells. Everyone with type 1 diabetes needs to take insulin. Over time, many people with type 2 diabetes may also need insulin. That's because even if you do everything right, your pancreas will make less insulin over time.

What are the different types of insulin? Rapid-acting: Controls blood sugar surges at mealtime Long-acting: Controls blood sugar between meals and during sleep Premixed: Combines rapid-acting and intermediate-acting insulin Controls blood sugar at mealtime and all day and night There are several different types of insulin. Some work for short periods of time, whereas others are longer acting. Each type of insulin helps keep diabetes under control. But no one type is right for everyone. Each person’s insulin need is different. And each person’s insulin need may change over time.

What is an insulin plan? Your plan will help you take insulin the way your body would make it if you did not have diabetes Your plan tells you: What type of insulin to take How much insulin to take When to take insulin Your plan is based on: When and how much you eat Your current blood sugar level Your level of physical activity Your lifestyle Everyone who takes insulin needs a personal insulin plan. You and your diabetes care team will work together to make an insulin plan that’s right for you. Your plan will help you take insulin the way your body would make it if you did not have diabetes. Your body’s need for insulin goes up and down all day. Your need for insulin depends on what you are doing and how much sugar is in your blood.

Injecting insulin How: Where: Insulin pen Syringe filled from a bottle of insulin Insulin pump Where: Abdomen Thighs Backs of the upper arms Insulin is taken by injection. That’s because if insulin were taken as a pill, the acid in your stomach would destroy it before it had a chance to work. Some people worry that insulin injections might be painful. But the needles used today are very small. That makes injecting insulin practically pain free. Prefilled disposable insulin pens can be used to inject insulin. Insulin may work better if you inject it in the same general areas each day. For instance, you can inject it in the abdomen each morning and in the thigh at bedtime. “With the insulin pen, it’s as easy as 1, 2, 3… The pen technique has brought me more freedom to take care of my diabetes.” –Mayra A., New Jersey

Storing insulin Follow the instructions on the insulin label Keep unopened insulin containers in the refrigerator It’s usually okay to store insulin at room temperature once it’s been opened, but check the label to make sure Don’t let insulin become too hot or too cold Keep insulin out of bright light and sunlight Do not use insulin after the expiration date on the label Once insulin is opened, it is good for a shorter period of time than the date on the container. Check the package insert to see how long the opened insulin is safe to use.