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    Prevent diabetes problems

    Number

    1in a

    Series

    of 7

    Keep your diabetesunder controlKeep your diabetesunder control

    U.S. Department

    of Health and

    Human Services

    NATIONAL INSTITUTES OF HEALTH National Diabetes Information Clearinghouse

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    Contents

    What are diabetes problems?................................. 1

    Will I have diabetes problems?.............................. 1

    What should my blood glucose numbers be? ....... 2

    How can I nd out what my average bloodglucose is? ................................................................ 3

    What should my blood pressure be? ..................... 5What should my cholesterol be?............................ 6

    What does smoking have to do with diabetes problems?................................................................. 7

    What else can I do to prevent diabetes

    problems?................................................................. 8

    Things to Check or Good Diabetes Care ............ 9

    How to Use the Daily Diabetes Record Page..... 14

    Pronunciation Guide............................................. 19

    For More Inormation .......................................... 20More in the Series ................................................. 22

    Acknowledgments ................................................. 23

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    What are diabetes problems?

    Too much glucose* in the blood or a long time cancause diabetes problems. This high blood glucose,also called blood sugar, can damage many parts othe body, such as the heart, blood vessels, eyes, andkidneys. Heart and blood vessel disease can leadto heart attacks and strokes. You can do a lot toprevent or slow down diabetes problems.

    Will I have diabetes problems?

    Maybe. You may have one or more diabetesproblems or none at all. I you get diabetes

    when you are young, you may not have diabetesproblems or many years. I you nd out you havediabetes as an adult, you may already have diabetesproblems. Either way, keeping yourblood glucose, blood pressure, andcholesterol under control can

    prevent diabetes problems.

    *See page 19 or tipson how to say the

    words in bold type.Be active to preventdiabetes problems.

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    What should my blood glucose numbers be?

    Keeping your blood glucose on target can preventor delay diabetes problems. The chart belowshows target blood glucose levels or most people

    with diabetes.

    Target Blood Glucose Levelsfor People with Diabetes

    Beore meals 70 to 130

    1 to 2 hours ater the start o a meal less than 180

    Talk with your health care provider about whatyour blood glucose numbers should be and writethem here:

    My Target Blood Glucose Levels

    Beore meals ______ to ______

    1 to 2 hours ater the start o a meal less than _______

    Talk with your health care provider about whenyou need to check your blood glucose using a bloodglucose meter. You will do the checks yoursel.Your health care provider can teach you how to use

    your meter.

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    Keep track o your blood glucose checks usingthe record page in this booklet on pages 16 and

    17. Make copies yoursel or ask your health careprovider or a blood glucose record book. Yourblood glucose check results will help you and yourhealth care provider make a plan or keeping yourblood glucose under control. Always bring yourrecord book to your doctor visits so you can talk

    about reaching your glucose goals.

    How can I fnd out what my averageblood glucose is?

    Ask your health care provider or theA1C test.This blood test shows the average amount oglucose in your blood during the past 2 to 3months. Have this test done at least twice a year.I your A1C result is not on target, your healthcare provider may do this test more oten to see i

    your result is improving as your treatment changes.Your A1C result plus your blood glucose meterresults can show whether your blood glucose isunder control.

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    The A1C target or most people with diabetes isbelow 7 percent. Ask your health care provider i

    this target is right or you. Then write your A1Ctarget here:

    My A1C target is ____________ percent.

    I your A1C test result is on target, then your bloodglucose is in a desirable range and your diabetestreatment plan is working. The lower your A1C is,the lower your chance o having health problems.

    I your result is too high, you may need a changein your diabetes plan. Your health care team can

    help you decide what part o your plan to change.You may need to change your meal plan, yourdiabetes medicines, or your physical activity plan.

    What Your A1C Result Means

    My A1C Result My Average Blood Glucose

    6% . . . . . . . . . . . . . . . . . 135

    7% . . . . . . . . . . . . . . . . . 170

    8% . . . . . . . . . . . . . . . . . 205

    9% . . . . . . . . . . . . . . . . . 240

    10% . . . . . . . . . . . . . . . . . 275

    11% . . . . . . . . . . . . . . . . . 310

    12% . . . . . . . . . . . . . . . . . 345

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    What should my blood pressure be?

    Normal blood pressure will help prevent damage to

    your eyes, kidneys, heart, and blood vessels. Bloodpressure is written with two numbers separated bya slash. For example, 120/70 is said as 120 over70. The rst number should be below 130 andthe second number should be below 80. Keep yourblood pressure as close to these numbers as you

    can. I you already have kidney disease, ask yourdoctor what numbers are best or you.

    Meal planning, medicines, and physical activity canhelp you reach your blood pressure target.

    Have your bloodpressure checkedat every visit.

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    What should my cholesterol be?

    Normal cholesterol and blood at levels will help

    prevent heart disease and stroke, the biggesthealth problems or people with diabetes. Keepingcholesterol levels under control can also help withblood fow. Have your blood at levels checked atleast once a year. Meal planning, physical activity,and medicines can help you reach your blood at

    targets:

    Target Blood Fat Levelsfor People with Diabetes

    Total cholesterol below 200

    LDL cholesterol below 100

    HDL cholesterol above 40 (men)above 50 (women)

    Triglycerides below 150

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    What does smoking have to do withdiabetes problems?

    Smoking and diabetes are a dangerous combination.Smoking raises your risk or diabetes problems. I

    you quit smoking, youll lower your risk or heartattack, stroke, nerve disease, and kidney disease.Your cholesterol and your blood pressure levelsmay improve. Your blood circulation will alsoimprove.

    I you smoke, ask your health care provider orhelp in quitting.

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    Check your eet each day

    to keep them healthy.

    What else can I do to prevent diabetes problems?

    You can do many things to prevent diabetesproblems. For example, to keep your eet healthy,check them each day. Ask your health care team

    whether you should take a low-dose aspirin everyday to lower your risk or heart disease. To keep

    your eyes healthy, visit an eye care proessionalonce a year or a complete eye examination thatincludes using drops in your eyes to dilate thepupils.

    Make sure your doctorchecks your urine or

    protein every year. At leastonce a year, your bloodcreatinine level should bechecked. Also once a year,

    your health care providershould do a completeoot exam. See page 10or what you can do eachday to stay healthy withdiabetes. See pages 11to 13 or other things or

    your health care providerto check or good diabetescare.

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    Things to Check or Good Diabetes Care

    Taking care o diabetes is a team eort betweenyou and your health care teamdoctor, diabetesnurse educator, diabetes dietitian educator,pharmacist, and others. You are the mostimportant member o the team.

    Take charge o your diabetes by learning what todo or good diabetes care:

    things to do every day or good diabetes care(see page 10)

    things or your health care provider to look

    at every time you have a checkup (see pages11 and 12)

    things or you or your health care providerto do at least once or twice a year (see pages12 and 13)

    Keep a daily record o blood glucose check results.Make copies o the Daily Diabetes Record onpages 16 and 17 in this booklet. This inormation

    will help you see whether you are reaching yourblood glucose goals.

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

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    Things to Do Every Day or Good Diabetes Care

    Follow the healthy eating plan that

    you and your doctor or dietitian haveworked out.

    Be active a total o 30 minutes mostdays. Ask your doctor what activitiesare best or you.

    Take your medicines as directed.

    Check your blood glucose every day.Each time you check your bloodglucose, write the number in yourrecord book.

    Check your eet every day or cuts,blisters, sores, swelling, redness, orsore toenails.

    Brush and foss your teeth every day.

    Control your blood pressure andcholesterol.

    Dont smoke.

    0

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    Things or Your Health Care Provider to Lookat Every Time You Have a Checkup

    Your blood

    glucose records

    Show your records to yourhealth care provider.

    Tell your health care provideri you oten have low bloodglucose or high blood glucose.

    Your weight Talk with your health careprovider about how much youshould weigh.

    Talk about ways to reach yourgoal that will work or you.

    Your blood

    pressure

    The goal or most people withdiabetes is less than 130/80.

    Ask your health care providerabout ways to reach your goal.

    Your

    medicines

    Talk with your health careprovider about any problems

    you have had with yourmedicines.

    Your feet Ask your health care providerto check your eet or problems.

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    Your physical

    activity plan

    Talk with your health careprovider about what you do

    to stay active.

    Your meal

    plan

    Talk about what you eat,how much you eat, and

    when you eat.

    Your feelings Ask your health care provider

    about ways to handle stress.I you are eeling sad orunable to cope with problems,ask about how to get help.

    Your smoking I you smoke, talk with yourhealth care provider abouthow you can quit.

    Things or You or Your Health Care Providerto Do at Least Once or Twice a Year

    A1C test Have this blood test at leasttwice a year (see pages 3 and4). Your result will tell you

    what your average bloodglucose level was or the past2 to 3 months.

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    Blood lipid

    (fats) lab tests

    Get a blood test to check your

    total cholesterolaim or

    below 200 LDLaim or below 100

    HDLmen: aim or above 40;women: aim or above 50

    triglyceridesaim orbelow 150

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

    Kidneyfunction tests

    Once a year, get a urine test tocheck or protein. At leastonce a year, get a blood test

    to check or creatinine. Theresults will tell you how wellyour kidneys are working.

    Dilated eyeexam

    See an eye care proessionalonce a year or a completeeye exam.

    Dental exam See your dentist twice a yearor a cleaning and checkup.

    Foot exam Ask your health care providerto check your eet to makesure your oot nerves and yourblood circulation are OK.

    Flu shot Get a fu shot each year.Pneumonia

    vaccineGet one; i youre over 64 and

    your shot was more than 5years ago, get one more.

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    ___________________________________________

    ___________________________________________

    ___________________________________________

    ___________________________________________

    ___________________________________________

    ___________________________________________

    ___________________________________________

    How to Use the Daily Diabetes Record PageUse copies o the record page on pages 16 and 17to keep track o blood glucose checks, medicines,and notes about things that aect your bloodglucose. Make one copy o the record page oreach week. This record will help you see whether

    your diabetes plan is working. Review your recordwith your health care provider.

    Blood Glucose Checks

    Talk with your health care provider and decide onthe best times to check blood glucose. You may bechecking blood glucose beore meals, ater meals,

    or at bedtime. Write when to check here:

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    I needed, draw a line in the boxesunder Breakast, Lunch, and

    Dinner to make room or bloodglucose check results beore and atera meal, like this example:

    See page 2 or inormation about target bloodglucose levels.

    Medicines

    Under the heading marked Medicine, write thenames o your diabetes medicines and the amountstaken.

    Notes

    Write down things that aect your blood glucoselevel. Some examples are

    eating more or less than usual

    orgetting to take your diabetes medicine

    exercisingwrite down what kind and or

    how long

    being sick or upset about somethingbeingunder stress

    going to a social event or other special event, orbeing on vacation

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    Daily Diabetes Record* Week Starting ___________

    Other

    blood

    glucose

    Breakfast

    blood

    glucose

    Medicine

    Lunch

    blood

    glucose

    Medicine

    Dinner

    blood

    glucose

    Medicine

    Bedtime

    blood

    glucose

    Medicine

    Notes:

    (Special events, sick days, exercise)

    Monday

    Tuesday

    Wednesday

    Thursday

    Friday

    Saturday

    Sunday

    *Keepthiscopyclean.Makephotocopiesandwriteonthecopies.

    16 17

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    My Health Care Team Members

    Name and Address Phone NumberDoctor

    Diabetesdietitian

    educator

    Diabetesnurseeducator

    Eye careproessional

    Dentist

    Foot doctor

    Pharmacist

    Counselor

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    Pronunciation GuideA1C (AY-WUHN-SEE)

    cholesterol (koh-LESS-tur-ol)

    circulation (SUR-kyoo-LAY-shuhn)

    creatinine (kree-AT-ih-neen)

    glucose (GLOO-kohss)

    triglycerides (try-GLISS-ur-eyedz)

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    For More Inormation

    Diabetes Teachers (nurses, dietitians, pharmacists,and other health proessionals)

    To nd a diabetes teacher near you, call theAmerican Association o Diabetes Educatorstoll-ree at 1800TEAMUP4 (8326874),or look on the Internet at

    www.diabeteseducator.organd click on Find aDiabetes Educator.

    Dietitians

    To nd a dietitian near you,

    call the American DieteticAssociation toll-ree at18008771600, or look on the Internet atwww.eatright.organd click on Find a NutritionProessional.

    0

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    To get more inormation about taking care odiabetes, contact

    National Diabetes Information Clearinghouse1 Inormation WayBethesda, MD 208923560Phone: 18008608747Fax: 7037384929Email: [email protected]

    Internet: www.diabetes.niddk.nih.gov

    National Diabetes Education Program

    1 Diabetes WayBethesda, MD 208923560Phone: 18004385383

    Fax: 7037384929Internet: www.ndep.nih.gov

    American Diabetes Association

    1701 North Beauregard StreetAlexandria, VA 22311Phone: 1800DIABETES (3422383)Internet: www.diabetes.org

    Juvenile Diabetes Research Foundation

    International

    120 Wall StreetNew York, NY 100054001

    Phone: 1800533CURE (2873)Internet: www.jdr.org

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    Acknowledgments

    The National Diabetes Information Clearinghouse

    thanks the people who helped review or field-test

    this publication:

    For theAmerican

    Association of Diabetes

    Educators

    Lynn Grieger, R.D.,

    C.D.E.Arlington, VTCelia Levesque, R.N.,

    C.D.E.Montgomery, ALTeresa McMahon,

    Pharm.D., C.D.E.Seattle, WABarbara Schreiner, R.N.,

    M.N., C.D.E.

    Galveston, TX

    For theAmerican

    Diabetes Association

    Phyllis Barrier, M.S.,

    R.D., C.D.E.Alexandria, VALinda Haas, Ph.C., R.N.,

    C.D.E.Seattle, WA

    Kathleen Mahoney,M.S.N., R.N., C.D.E.Drexel Hill, PARandi Kington, M.S.,

    R.N., C.S., C.D.E.Hartford, CT

    For the Centers for

    Medicare & Medicaid

    Services

    Baltimore, MDJan Drass, R.N., C.D.E.

    For the Diabetes Research

    and Training Centers

    Albert Einstein Schoolof Medicine

    Norwalk HospitalNorwalk, CTJill Ely, R.N., C.D.E.Sam Engel, M.D.Pam Howard, A.P.R.N.,

    C.D.E.

    Indiana UniversitySchool of Medicine

    Indianapolis, INMadelyn Wheeler, M.S.,

    R.D., F.A.D.A., C.D.E.

    VA/JDF DiabetesResearch Center

    Vanderbilt School ofMedicine

    Nashville, TNOk Chon Allison,

    M.S.N., R.N.C.S.,A.N.P., C.D.E.

    Barbara Backer, B.S.James W. Pichert, Ph.D.Alvin Powers, M.D.Melissa E. SchweikhartMichael B. SmithKathleen Wolffe, R.N.

    For the Grady Health

    System Diabetes Clinic

    Atlanta, GAErnestine Baker, R.N.,

    F.N.P., C.D.E.Kris Ernst, R.N., C.D.E.Margaret Fowke, R.D.,

    L.D.Kay Mann, R.N., C.D.E.

    For the Indian Health

    Service

    Albuquerque, NMRuth Bear, R.D., C.D.E.Dorinda Bradley, R.N.,

    C.D.E.Terry Fisher, R.N.Lorraine Valdez, R.N.,

    C.D.E.

    Red Lake, MN

    Charmaine Branchaud,B.S.N., R.N., C.D.E.

    For the Medlantic

    Research CenterWashington, DCResa Levetan, M.D.

    For the Texas Diabetes

    Council

    Texas Department ofHealth

    Austin, TXLuby Garza-Abijaoude,

    M.S., R.D., L.D.

    23

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    National DiabetesInormation Clearinghouse

    1 Inormation WayBethesda, MD 208923560Phone: 18008608747Fax: 7037384929Email: [email protected]: www.diabetes.niddk.nih.gov

    The National Diabetes Inormation Clearinghouse (NDIC)is a service o the National Institute o Diabetes and Digestiveand Kidney Diseases (NIDDK). The NIDDK is part othe National Institutes o Health o the U.S. Departmento Health and Human Services. Established in 1978, theClearinghouse provides inormation about diabetes to people

    with diabetes and to their amilies, health care proessionals,and the public. The NDIC answers inquiries, develops anddistributes publications, and works closely with proessionaland patient organizations and Government agencies tocoordinate resources about diabetes.

    Publications produced by the Clearinghouse are careullyreviewed by both NIDDK scientists and outside experts.

    This publication is not copyrighted. The Clearinghouse encourages users othis booklet to duplicate and distribute as many copies as desired.

    This booklet is also available atwww.diabetes.niddk.nih.gov.

    This publication may contain information about medications used to treat a healthcondition. When this publication was prepared, the NIDDK included the mostcurrent information available. Occasionally, new information about medication isreleased. For updates or for questions about any medications, please contact theU.S. Food and Drug Administration at 1888INFOFDA (4636332), a toll-freecall, or visit their website atwww.fda.gov. Consult your doctor for more information.

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    U.S. DEPArTmENT OF HEALTH

    AND HUmAN SErvICESNational Institutes of Health