Take Charge of Diabetes

Take Charge ofYour Diabetes

2nd edition

— 1997 —

U.S. Department of Health and Human ServicesCenters for Disease Control and Prevention

National Center for Chronic Disease Prevention and Health PromotionDivision of Diabetes TranslationHealth Communications Section

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Suggested citation:Centers for Disease Control and Prevention.Take Charge of Your Diabetes. 2nd edition. Atlanta: U.S.Department of Health and Human Services, 1997.

This book is in the public domain. Anyone may reproduce anyor all of the contents. It is also available on the Internet at:http://www.cdc.gov/nccdphp/ddt/ddthome

http://www.cdc.gov/nccdphp/ddt/ddthome

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This book is dedicated toall people living with diabetes,

in honor of your struggles and your strength.

Many of us strive for a sense of balance in ourlives. We want to keep our goals in harmony withour minds and souls. For people with diabetes,“balance” carries a special meaning.

We would like to share a story about the eagle, asymbol of power and balance, and how it faceschallenges to get where it wants to be. The storywas told to us by Dr. Gerald Durley of MorehouseSchool of Medicine in Atlanta, Georgia.

An eagle is a focused bird. When it decides to dosomething, it lets nothing get in its way—not evensevere weather. Seeing a storm brewing, an eagleflies closer, then turns around and flies in the otherdirection. About 200 yards away, the eagle turnsback to face the storm. Flying at 75, 85, 95, then upto 110 miles an hour, the eagle hits the storm withall its strength. Then something wondrous happens:the updraft lifts the eagle above the storm. Keepingits balance, rising above its obstacle, the great birdflies off to its goal.

We all see storms in our lives that seem to get inthe way of our plans. Like the eagle, we must facethe challenges, keep our balance, and soar off towhere—and who—we want to be.

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Contents

Some Words of Thanks . . . . . . . . . . . . . . . . . . . . . vii

1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1

2 Controlling Your Diabetes . . . . . . . . . . . . . . . . 13

3 Keeping Track of Your Blood Glucose . . . . . . . 21

4 Feelings About Having Diabetes . . . . . . . . . . 41

5 Eye Problems . . . . . . . . . . . . . . . . . . . . . . . . . . 43

6 Kidney Problems . . . . . . . . . . . . . . . . . . . . . . . 47

7 Heart and Blood Vessel Problems . . . . . . . . . . 51

8 Nerve Damage . . . . . . . . . . . . . . . . . . . . . . . . . 55

9 Foot Problems . . . . . . . . . . . . . . . . . . . . . . . . . 59

10 Dental Disease . . . . . . . . . . . . . . . . . . . . . . . . . 65

11 Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . 69

12 Pregnancy, Diabetes, and Women’s Health . . 73

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RECORDSRecords for Sick Days . . . . . . . . . . . . . . . . . . . 79Tests and Goals for Each Visit . . . . . . . . . . . . 89Tests and Goals for Each Year . . . . . . . . . . . . 99Glucose Log Sheet . . . . . . . . . . . . . . . . . . . . . 105Your Health Care Team . . . . . . . . . . . . . . . . . 109

APPENDIXESGlossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119Resources . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127

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Some Words of ThanksThis guide was written by the Centers for Disease

Control and Prevention’s Division of DiabetesTranslation, which is part of the National Center forChronic Disease Prevention and Health Promotion.We work with partners who share with us a missionto reduce the burden of diabetes in communities.

William H. Herman, M.D., M.P.H., was thegeneral editor of the first book, Take Charge of YourDiabetes: A Guide for Care, printed in 1991. Weasked people with diabetes who read the first bookto help us make this second book even more helpful.

The American Association of Diabetes Educatorsdid a survey among people with diabetes anddiabetes educators to learn what people liked anddidn’t like about the first book. Special thanks forhelping conduct this survey go to BettyBrackenridge, Linda Haas, Julie Meyer, JeanBetschart, Kris Ernst, and Robert Anderson. Focusgroups made up of persons with diabetes were heldby Health Promotion Council of SE Pennsylvaniaand Casals and Associates of Washington, D.C. Thegroups gave us valuable input to help make thisbook more useful.

Important support for this book’s emphasis onglucose control came from the Diabetes Control andComplications Trial. Conducted by the NationalInstitute of Diabetes and Digestive and KidneyDiseases, this important study provided scientificproof that glucose control can help prevent or delaycomplications of diabetes.

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Dawn Satterfield and Patricia Mitchell of thedivision’s Health Communications Section were thelead writers. Claudia Martinez and Hope Woodwardalso helped with the writing. Rick Hull reviewedand edited the final version of this guide. Most ofthe drawings were provided by the Public HealthPractice Program Office, Centers for Disease Controland Prevention. Chris Rigaux and Ward Nyholm ofCygnus Corporation assisted with design andlayout.

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1 Introduction

Diabetes touchesalmost every part of yourlife. It’s a serious,lifelong condition, butthere’s so much you cando to protect yourhealth. You can takecharge of your health—not only for today, butfor the coming years.

Diabetes can causehealth problems overtime. It can hurt your eyes, your kidneys, and yournerves. It can lead to problems with the bloodcirculation in your body. Even your teeth and gumscan be harmed. And diabetes in pregnancy can causespecial problems. Many of these problems don’t haveto happen. You can do a lot to prevent them, andthere are people in your community who can help.This book can help you find how to get the help youneed to prevent problems.

Today and every day, you need to balance yourfood, physical activity, and medicine. Testing yourown blood glucose (also called blood sugar) helps yousee how this balance is working out. You can thenmake choices that help you feel well day-to-day andprotect your health.

Feeling healthy can allow you to play a big part inthe life of your family and community. You may

Take charge of your health—fortoday and for the coming years.

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even want to join a community group to help othersdeal with their diabetes.

Take Charge of Your Diabetes was written to helpyou take important steps to prevent problemscaused by diabetes. You’ll learn many useful things:

■ What problems diabetes can cause.

■ How to work with a health care team to preventproblems.

■ Why it is important to get your blood glucosecloser to normal.

■ How to find out about resources in yourcommunity to help you prevent problems.

A community group can help make life better for peopleliving with diabetes.

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It’s important to work with a primary careprovider, as well as other members of a team thatcare about your health. To find out about resourcesin your community, telephone one of the groupslisted below:

■ Your state medical association, listed in thebusiness section of your phone book.

■ Your state department of health’s DiabetesControl Program, listed in the blue pages ofyour phone book.

■ Local hospitals, listed in the yellow pages.

■ Diabetes organizations, listed on page 127 ofthis book.

Ask your health care team to look over this bookwith you. Stay in touch with them so you will knowthe latest news about diabetes care.

Work with your health careteam to take charge of yourdiabetes.

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Balance is the key word in living well withdiabetes. Strive for balance in all parts of your life.With the support of your family and friends, yourhealth care team, and your community, you can takecharge of your diabetes.

Strive for balance—it’s the key topreventing problems from diabetes.

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Who and What Is This Book for?

This book was mainly written for people whofound out they had diabetes as an adult. It’s meantto be used along with other information your healthcare providers give you.

If you’ve just learned you have diabetes, you’llneed more details than you’ll find in this book. Askyour health care provider for help. See the list onpage 127 for phone numbers and addresses of placeswhere you can get more information. Find out asmuch as you can about the three most importantthings for controlling your diabetes: food, physicalactivity, and diabetes medicine.

Your health care providers can tell you moreabout the topics in this book.

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How to Use This Book

When you’re reading this book, note these points:

■ Words in dark print are explained in theglossary, which starts on page 119.

■ The forms at the back of this book can help youand your team keep records of your care.

■ On page 127, you’ll find a list of healthorganizations where you can call or write formore information about diabetes.

■ When we say “health care team,” we includeany of the professionals who work with you tohelp manage your diabetes: primary doctor,dietitian or nutritionist, nurse, diabeteseducator, social worker, counselor, foot doctor,eye doctor, dentist, pharmacist, and others.

■ The chapters in this book deal with a number oftopics. You may first want to read the partsthat deal with your own special concerns. Takeyour time reading this book. There’s a lot toread, but you don’t have to read it all at once.

Keeping Records

You can use this book to keep some records aboutyour health. The forms to write down details aboutyour health begin on page 77. You can cut out thesepages to take with you on your diabetes care visits.You may also want to make extra copies to use in

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the future. Go over these records with your healthcare team often. Keeping track of your health is oneof the ways you can work together to control yourdiabetes.

On page 109, write down the names and telephonenumbers of your health care team. There’s enoughroom on these pages to write down questions andother points you want to remember when you go toyour visits every four months. On page 116, youmay want to write down some contacts forcommunity groups that deal with diabetes.

Write down thethings you want todiscuss with yourhealth care team.

What Is Diabetes?

Most of the food we eat is turned into glucose(sugar) for our bodies to use for energy. Thepancreas, an organ near the stomach, makes ahormone called insulin to help glucose get into ourbody cells. When you have diabetes, your bodyeither doesn’t make enough insulin or can’t use its

Your Health Care Providers

Primary Doctor

Name: __________________________________________

Telephone number: ________________________________

Your questions: ___________________________________

__________________________________________________

__________________________________________________

Important points: __________________________________

__________________________________________________

__________________________________________________

__________________________________________________

Dr. B. Harper

222-222-2222

What was my last hemoglobin A1c result?

When is my next eye exam due?

— Aim for glucose 80-120 before breakfast

100-140 at bedtime

— Check my feet every day.

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own insulin very well. This problem causes glucoseto build up in your blood.

Signs and Symptoms of Diabetes

You may recall having some of these signs beforeyou found out you had diabetes:

■ Being very thirsty.■ Urinating a lot—often at night.■ Having blurry vision from time to time.■ Feeling very tired much of the time.■ Losing weight without trying.■ Having very dry skin.■ Having sores that are slow to heal.■ Getting more infections than usual.■ Losing feeling or getting a tingling feeling

in the feet.■ Vomiting.

Types of Diabetes

There are two main types of diabetes:

■ Type 1.

■ Type 2.

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Another type of diabetes appears duringpregnancy in some women. It’s called gestationaldiabetes. See page 75 to learn more about this typeof diabetes.

One out of ten people with diabetes has Type 1diabetes. These people usually find out they havediabetes when they are children or young adults.People with Type 1 diabetes must inject insulinevery day to live. The pancreas of a person withType 1 makes little or no insulin. Scientists arelearning more about what causes the body to attackits own beta cells of the pancreas (an autoimmuneprocess) to stop making insulin in people withcertain sets of genes.

Whether you haveType 1 or Type 2diabetes, workclosely with yourhealth care provider.

Most people with diabetes—nine out of ten—haveType 2 diabetes. The pancreas of people with Type 2diabetes keeps making insulin for some time, butthe body can’t use it very well. Most people withType 2 find out about their diabetes after age 30 or40.

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Certain risk factors make people more likely toget Type 2 diabetes. Some of these are:

■ A family history of diabetes.■ Lack of exercise.■ Weighing too much.■ Being of African American, American Indian,

Hispanic/Latino, or Asian/Pacific Islanderheritage.

On the next page, you’ll find a weight chart. If youweigh more than the weight that matches yourheight on the chart, tell your health care provider.You can help manage your diabetes by controllingyour weight, making healthy food choices, andgetting regular physical activity. Some people withType 2 diabetes may also need to take diabetespills or insulin shots to help control their diabetes.

Whether you have Type 1 or Type 2diabetes, learn what your communityhas to offer you.

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At-Risk Weight ChartWomen Men

(shows 20% over (shows 20% overideal weights) ideal weights)

Height Weight in Height Weight in(without Pounds (without Poundsshoes) (without shoes) (without

clothing) clothing)

Feet Inches Feet Inches

4 9 134 5 1 157

4 10 137 5 2 160

4 11 140 5 3 162

5 0 143 5 4 165

5 1 146 5 5 168

5 2 150 5 6 172

5 3 154 5 7 175

5 4 157 5 8 179

5 5 161 5 9 182

5 6 164 5 10 186

5 7 168 5 11 190

5 8 172 6 0 194

5 9 175 6 1 199

5 10 178 6 2 203

5 11 182 6 3 203

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2 Controlling Your Diabetes

There’s good news for people with diabetes. A newstudy shows that keeping your blood glucose (alsocalled blood sugar) close to normal helps preventor delay some diabetes problems.

Scientists in this study learned that through suchcontrol, at least half of the expected eye disease,kidney disease, and nerve damage was prevented orslowed. People who were in the study had Type 1diabetes, but many doctors believe that people whohave Type 2 diabetes can also benefit by keepingtheir blood glucose closer to normal.

You can get more information about this study bycontacting the National Diabetes InformationClearinghouse at 1-800-GET-LEVEL (1-800-438-5383).

You may find that your community supports yourefforts to control your diabetes.

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Keeping a Balance

As the eagle learns its position and adjusts what itmust do to keep its balance in flight, you must alsostrive for balance that helps you keep your bloodglucose in control. To keep your glucose at a healthylevel, you need to keep a balance between threeimportant things:

■ What you eat and drink.

■ How much physical activity you do.

■ What diabetes medicine you take (if your doctorhas prescribed diabetes pills or insulin).

This book gives you only some of the facts youneed. Your health care team can give you more.

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A Few Things About Food

Here are some tips for making healthy eatingchoices:

■ Eat regular meals. Ask your health care teamto help you choose a meal plan. Your dietitianmay suggest you eat three meals and a snack ortwo every day at about the same times. Don’tskip meals.

■ Eat a variety of foods. Choose a variety of foodsto eat so that your body gets the nutrition itneeds. Use the Food Pyramid (see drawing) tochoose a variety of foods every day. Eat morefrom the foods at the bottom of the pyramid andeat less from those at the top. Ask yourdietitian for help.

Choose more foods from the bottom of the pyramid—such as fruits, grains, and bread.

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■ Eat less fat. Avoid fried foods. Foods that arebaked, broiled, grilled, boiled, or steamed aremore healthy to eat. Eat meats that have littlefat. When you eat dairy products (cheese, milk,yogurt, and others) choose those that have littleor no fat or cream.

Ask your market tocarry more heart-healthy foods.

■ Eat less sugar. You may find that eating lesssugar helps you control your blood glucose level.Here are some things you can do to eat lesssugar:

■■■ Read the labels on jars, cans, and foodpackages—before you buy them. If one of thefirst four ingredients listed is sucrose,dextrose, corn sweeteners, honey, high-fructose corn syrup, molasses, or powderedsugar, try to buy something with less sugar,or else use less of that food item.

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■■■ Drink sugar-free sodas and other liquids thathave no added sugar in them.

■■■ Eat fewer foods that have extra sugar, suchas cookies, cakes, pastries, candy, chocolates,brownies, and sugared breakfast cereals.

See pages 28–32 for more on ways to preventproblems when your blood glucose levels are toohigh or too low.

■ Eat less salt. Eating less salt may help controlyour blood pressure. Here are some ways to eatless salt:

■■■ Use less salt when you prepare foods.

■■■ Cut down on processed foods, such as foodsyou buy in cans and jars, pickled foods, lunchmeats (“cold cuts”), and snack foods, such aschips.

■■■ Taste your food first before adding salt. Youmay not need to add any.

■■■ Use herbs and spices instead of salt to flavoryour food.

■ A word about drinking alcohol: Alcohol cancause health problems, especially for peoplewith diabetes. It adds calories and it doesn’tgive your body any nutrition. Drinking alcoholmay cause dangerous reactions with medicinesyou take. Your blood glucose can go down too

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low if you drink beer, wine, or liquor on anempty stomach. If you want to include a drinkin your food plan once in a while, ask yourhealth care team how to do so safely.

A Few Things About PhysicalActivity

■ It’s important to be active.Physical activity has manybenefits. It can help youcontrol your blood glucoseand your weight. Physicalactivity can help preventheart and circulationproblems. Many peoplesay they feel better whenthey get regular exercise.

■ Start with a little. If youhaven’t been doing anyphysical activity, talk to your health care teambefore you begin. Walking, working in the yard,and dancing are good ways to start. As youbecome stronger, you can add a few extraminutes to your physical activity. If you feelpain, slow down or stop and wait until it goes

Walking is a good way toget regular exercise.

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away. If the pain comes back, talk to yourhealth care team right away.

■ Do some physical activity every day. It’s betterto walk 10 or 20 minutes each day than onehour once a week.

■ Choose an activity you enjoy. Do an activity youreally like. The more fun it is, the more likelyyou will do it each day. It’s also good to exercisewith a family member or friend.

If you’re already active now, but want to becomemore active, talk to your health care team about asafe exercise plan.

A Few Things About DiabetesMedicine

If you take diabetes pills orinsulin injections to controlyour diabetes, ask your healthcare provider to explain howthese work. It’s important toknow how and when to takediabetes medicine. If you takeother medicines that are soldwith or without a prescription,ask your doctor how these canaffect your diabetes control.When you take insulininjections or diabetes pills, yourblood glucose levels can get too Be sure you know how

and when to take yourdiabetes medicine.

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low. See pages 28–32 for how to prevent levels thatare too low or too high.

If you inject insulin, your health care team shouldbe able to tell you

■ How to give yourself injections.■ When you need to change your insulin dose.■ How to safely dispose of needles.

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3 Keeping Track of YourBlood Glucose

It’s important toyour health to controlyour blood glucose(also called bloodsugar). Keeping yourglucose close to normalhelps prevent or delaysome diabetesproblems, such as eyedisease, kidney disease, and nerve damage. Onething that can help you control your glucose level isto keep track of it. You can do this by:

■ Testing your own glucose a number of timeseach day (self-monitoring blood glucose).Many people with diabetes test their glucosetwo to four times a day.

■ Getting a hemoglobin A1c test from yourhealth care provider about every 3 months ifyou take insulin and at least every 6 months ifyou don’t take insulin.

You’ll learn more about these tests on the nextpages. These tests can help you and the rest of yourdiabetes health care team—doctor, diabeteseducator, and others—work together to help youcontrol your blood glucose.

Keep a daily record of your bloodglucose levels.

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Testing Your Blood Glucose Each Day

You can do a test to find out what your bloodglucose is at any moment. Your health care teamcan show you how to do the test yourself. Using afinger prick, you place a drop of blood on a specialcoated strip, which “reads” your blood glucose.Many people use an electronic meter to get thisreading.

Testing your ownblood glucoselevels is a key totaking charge ofyour diabetes.

Blood glucose testing can help you understandhow food, physical activity, and diabetes medicineaffect your glucose level. Testing can help you makeday-to-day choices about how to balance thesethings. It can also tell you when your glucose is toolow or too high so that you can treat these problems.

Ask your health care team to help you set a goalfor your glucose range and show you how to recordyour glucose readings in a logbook or record sheet.If you need a daily logbook, ask your health careprovider for one. Or you can make copies of page

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108 if you take insulin or page 106 if you don’t takeinsulin. A sample log sheet is filled out to show youhow to use each.

Be sure to write downeach glucose reading andthe date and time you tookit. When you review yourrecords, you can see apattern of your recentglucose control. Keepingtrack of your glucose on aday-to-day basis is one ofthe best ways you can takecharge of your diabetes.

Getting a Summary Lab Test(Hemoglobin A1c)

A hemoglobin A1c test uses blood drawn from avein in your arm to sum up your diabetes control forthe past few months. Hemoglobin A1c measureshow much glucose has been sticking to part of thehemoglobin in your red blood cells. Since each redblood cell is replaced by a new one every fourmonths, this test summarizes how high the glucoselevels have been during the life of the cells.

If most of your recent blood glucose readings havebeen near normal (70 to 140 mg/dL, with the higherreading occurring after meals), the hemoglobin A1ctest will be near normal (usually about 6%–7%). Ifyou’ve had many readings above normal, the extra

Think of your daily logsheet as a diary for takingcharge of your diabetes.

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glucose sticking to your red blood cells will makeyour hemoglobin A1c test read higher.

You should get a hemoglobin A1c test at least twotimes a year. People who take insulin need to getthis test about four times a year. Ask your healthcare provider for the results and record them onpage 91. This test will help you and your diabetescare team keep track of your average blood glucosecontrol.

Ask your team to tellyou the normal range ofvalues and help you seta goal for yourself.Write your goal down onpage 91 of this guide. Ifyour hemoglobin A1c ishigh, work with yourteam to adjust yourbalance of food, physicalactivity, and diabetes medicine. When yourhemoglobin A1c test result is near your goal, you’llknow you’ve balanced things well.

Having Problems With Low Blood Glucose

In general, a blood glucose reading lower than 70mg/dL is too low. If you take insulin or diabetespills, you can have low blood glucose (also calledhypoglycemia). Low blood glucose is usuallycaused by eating less or later than usual, being moreactive than usual, or taking too much diabetesmedicine. Drinking beer, wine, or liquor may also

Use your hemoglobin A1c test totrack your glucose control.

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cause low blood glucose ormake it worse.

Low blood glucose happensmore often when you’re tryingto keep your glucose levelnear normal. This is noreason to stop trying tocontrol your diabetes. It justmeans you have to watchmore carefully for low levels.Talk this over with yourhealth care team.

Signs of Low Blood Glucose

Some possible signs of lowblood glucose are feelingnervous, shaky, or sweaty.Sometimes people just feeltired.

The signs may be mild atfirst. But a low glucose levelcan quickly drop much lowerif you don’t treat it. Whenyour glucose level is verylow, you may get confused,pass out, or have seizures.

If you have any signs thatyour glucose may be low, testit right away. If it’s lessthan 60 to 70 mg/dL, you

Treat it every 15 minutes,until your glucose level isnormal.

If you have signs thatyour blood glucose is lowbut you can’t test rightthen…

go ahead and treat it!(See page 26.)

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need to treat it right away. See below for ways totreat low blood glucose.

Treating Low Blood Glucose

If you feel like your blood glucose is getting too lowbut you can’t test it right then, play it safe—goahead and treat it. Eat 10 to 15 grams ofcarbohydrate right away. See the box below forexamples of foods and liquids with this amount ofcarbohydrate.

Check your blood glucose again in 15 minutes.Eat another 10 to 15 grams of carbohydrate every 15minutes until your blood glucose is above 70 mg/dLor your signs have gone away.

Eating an item on the list on this page will keepyour glucose up for only about 30 minutes. So

Foods and Liquids for Low Blood Glucose(each item equals about 10 to

15 grams of carbohydrate)

Food Item Amount

Sugar packets 2 to 3

Fruit juice 1/2 cup (4 ounces)

Soda pop (not diet) 1/2 cup (4 ounces)

Hard candy 3 to 5 pieces

Sugar or honey 3 teaspoons

Glucose tablets 2 to 3

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if your next planned meal or snack is more than 30minutes away, you should go ahead and eatsomething like crackers and a tablespoon of peanutbutter or a slice of cheese.

In your glucose logbook or record sheet, writedown the numbers and the times when low levelshappen. Think about what may becausing them. If you think you knowthe reason, write it beside thenumbers you recorded. You mayneed to call your health careprovider to talk aboutchanging your diet, activity,or diabetes medicine.

Tell family members,close friends, teachers, andpeople at work that youhave diabetes. Tell themhow to know when yourblood glucose is low. Showthem what to do if you can’ttreat yourself. Someone will need to give you fruitjuice, soda pop (not diet), or sugar.

If you can’t swallow, someone will need to give youa shot of glucagon and call for help. Glucagon is aprescription medicine that raises the blood glucoseand is injected like insulin. If you take insulin, youshould have a glucagon kit handy. Teach familymembers, roommates, and friends when and how touse it.

Write in your logbook whyyou had a low bloodglucose level.

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Waiting to treat lowblood glucose is notsafe. You may be indanger of passing out.If you get confused,pass out, or have aseizure, you needemergency help.Don’t try to driveyourself to get help.Be prepared for anemergency.

Preventing Low Blood Glucose

Keep a balance

Try to stay close to your usual schedule of eating,activity, and medicine. If you’re late getting a mealor if you’re more active than usual, you may need anextra snack. See page 37 for more ideas aboutmanaging your diabetes.

Test your blood glucose

Keeping track of your blood glucose is a good wayto know when it tends to run low. Show yourlogbook or record sheet to your health careproviders. Be sure to let them know if you’re havinga number of low glucose readings a week.

In a low blood glucose emergency,you may need to go to thehospital.

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To be safe, always check your glucose before doingany of these things:

■ Driving a vehicle.■ Using heavy equipment.■ Being very physically active.■ Being active for a long time.

Ask your health care team whether you shouldtest your glucose before (or during) any otheractivities. Write these in the space below.

Be prepared

Always carry some typeof carbohydrate with youso you’ll be ready at anytime to treat a lowglucose level. See the boxon page 26 for snacksthat have 10–15 grams ofcarbohydrate.

Always carry along some foodwith carbohydrates in it.

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Always wear something (like an identificationbracelet) that says you have diabetes. Carry a cardin your wallet that says you have diabetes and tellsif you use medicine to treat it.

Wear something that letsothers know you havediabetes, in case of anemergency.

Having Problems With High Blood Glucose

For most people, blood glucose levels that stayhigher than 140 mg/dL (before meals) are too high.Talk with your health care team about the glucoserange that is best for you.

Eating too much food, being less active than usual,or taking too little diabetes medicine are somecommon reasons for high blood glucose (orhyperglycemia). Your blood glucose can also go upwhen you’re sick or under stress.

Over time, high blood glucose can damage bodyorgans. For this reason, many people with diabetestry to keep their blood glucose in control as much asthey can.

Some people with diabetes are in danger ofdiabetic ketoacidosis when their glucose level

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stays high. You can tell if you’re in diabeticketoacidosis by checking your urine for ketones (seepage 35). If you have ketones in your urine, callyour doctor or go to the hospital right away. Themost common reason for diabetic ketoacidosis is nottaking your insulin. If you have Type 1 diabetes,ask your health care team about diabeticketoacidosis.

Your blood glucose is more likely to go up whenyou’re sick—for example, when you have the flu oran infection. You’ll need to take special care ofyourself during these times. The guide that beginson page 33 can help you do this.

Signs of High Blood Glucose

Some common signs of highblood glucose are having adry mouth, being thirsty, andurinating often. Other signsinclude feeling tired, havingblurred vision, and losingweight without trying. If yourglucose is very high, you mayhave stomach pain, feel sickto your stomach, or eventhrow up.

If you have any signs thatyour glucose is high, test yourblood. In your logbook or on Frequent urination can be

a sign of high blood sugar.

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your record sheet, write down your glucose readingand the time you did the test. If your glucose ishigh, think about what could have caused it to goup. If you think you know of something, write thisdown beside your glucose reading.

Preventing High Blood Glucose

Keep a balance

Try to stay withyour food and activityplan as much as youcan. Take yourdiabetes medicineabout the same timeeach day. Work withyour health care teamto set goals for weight,glucose level, andactivity.

Test your blood glucose

Keep track of your glucose and go over yourrecords often. You’ll learn how certain foods oractivities affect your glucose.

Show your records to your health care team. Askhow you can change your food, activity, andmedicine to avoid or treat high blood glucose. Askwhen you should call for help.

Balance is the key to takingcharge of your diabetes.

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Taking Care of Yourself When You’re Sick

Keep Taking Medicine

Be sure to keep taking your diabetes pills orinsulin. Don’t stop taking them even if you can’t eat.Your health care provider may even advise you totake more insulin during sickness.

Keep Eating

Try to eat the same amount of fruits and breads asusual. If you can, eat your regular diet. If you’rehaving trouble doing this, use food exchanges: eatenough soft foods or drink enough liquids to take theplace of the fruits and breads you usually eat. Afood exchange is a measured portion of one type offood that can be eaten instead of another type offood. A food exchange will give you similarnutrients. Use the list on the next page to makefood exchanges for bread or fruit.

You’ll need to take special care of yourself whenyou’re sick. The tips that follow can help you do this.

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What to Eat or Drink When You’re Sick(each item equals one bread or fruit exchange*)

Food Item

Fruit juice

Fruit-flavored drink

Soda pop (regular, not diet)

*Jell-OTM ( regular, notsugar-free)

*PopsicleTM (not sugar-free,regular)

Sherbet

Saltine crackers

Milk

Thin soup (examples:vegetable, chicken noodle)

Thick soup (examples: creamof mushroom, tomato)

Ice cream (vanilla)

Pudding (sugar-free)

Pudding (regular)

Macaroni, noodles, rice,mashed potatoes

*Use of trade names is for identification only and does not imply endorsement by the U.S.Department of Health and Human Services.

Amount1/3 to 1/2 cup1/2 cup1/2 cup

1/2 cup

1/2 twin1/4 cup

6 squares

1 cup

1 cup

1/2 cup1/2 cup1/2 cup1/4 cup

1/2 cup (cooked)

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Drink Liquids

Drink extra liquids. Try to drinkat least 1/2 cup (4 ounces) to 3/4 cup(6 ounces) every half-hour to hour,even if you have to do this in smallsips. These liquids should not havecalories. Water, diet soda pop, ortea without sugar are good choices.

Check for Changes

■ Test your blood glucose at least every 4 hours.If your glucose is 240 mg/dL or higher, test yoururine for ketones. Ketones are chemicals theliver makes when there’s not enough insulin inthe blood. It’s easy to test for ketones. Buyurine ketone strips at the drug store. Urinateon the pad part of the strip. Compare the colorthat the strip becomes to the color example onthe package. If the pad turns a purple color,call your health care provider right away.

■ Weigh yourself every day. Losing weightwithout trying is a sign of high blood glucose.

■ Check your temperature every morning andevening. A fever may be a sign of infection.

■ Every 4 to 6 hours, check how you’re breathingand decide how alert you feel. Having troublebreathing, feeling more sleepy than usual, ornot thinking clearly can be danger signs.

Be sure to drinkextra fluids whenyou’re sick.

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Keep Records

Use the “Records for Sick Days,” starting on page79. Ask a family member or friend to help if youneed it.

Call for Help

Ask your health careprovider when youshould call. Duringyour sick times, youmay need to call everyday for advice.

You should call yourhealth care provider orgo to an emergencyroom if any of thefollowing happens:

■ You feel too sick to eat normally and for morethan 6 hours can’t keep food or liquids down.

■ You have severe diarrhea.■ You lose 5 pounds or more without trying to.■ Your temperature is over 101°F.■ Your blood glucose level is lower than 60 mg/dL

or stays over 300 mg/dL.■ You have moderate or large amounts of ketones

in your urine.■ You’re having trouble breathing.■ You feel sleepy or can’t think clearly.

You may need to call your doctordaily when you’re sick.

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Managing Your Diabetes at Work, School,and in Travel

Staying in charge of your diabetes no matter whatyour day holds—work, school, travel, or specialevents—takes planning ahead. Many days will gosmoothly, but some days will hold surprises, such asextra activity or delays that throw your schedule off.

Plan ahead for these times by always keeping atreatment for low blood glucose with you (see page26 for some choices). If you have any signs that yourglucose may be low (see page 25), go ahead and treatit right away.

Stay in charge of your diabetes—no matter whatyour day holds—by planning ahead.

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Stay as close to your eating, activity, and medicineschedule as you can. Keep track of your glucose soyou can pick up changes early. Always wearidentification that says you have diabetes.

Talk with your health care team about yourplanned schedule and activities. Ask for help inplanning ahead for work, school, travel, and specialevents. When you read the rest of this section, youmay think of more questions to ask.

At Work and School

Talk with your health careteam about the type ofactivity you do at work or atschool. From time to time,you and your health careteam may need to makechanges in your activity,medicine, or eating.

Many people take suppliesfor testing their glucose towork and to school so theycan test at regular breaktimes. Some people choose to show their fellowworkers, their teachers, or their classmates how tohelp if they should ever have a problem. They teachthem how to tell when their glucose is low and howto treat it (see pages 25–28). Some people like tohave written steps on file at their place of work orwith their teacher.

Talk with your health careprovider about balancingyour daily activities andyour glucose levels.

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In Travel

When you plan atrip, think aboutyour day-to-dayschedule and tryto stay as close toit as you can. Forexample, if youusually test yourblood glucose at noon and then eat lunch, plan to dothis on your trip, as well. Trips can hold surprises—in delays and changes. Even the types of food andsupplies you can buy on your trip may not be thesame as those you get at home.

Before you travel, work with your health careprovider to plan your timing for medicine, food, andactivity. Talk about what to do if you find changesin your glucose readings.

Plan ahead for trips:■ Keep snacks with you that could be used to

prevent—or treat—low blood glucose.■ Carry extra food and drink supplies with you,

such as cracker packs and small cans of juicesor bottled water.

■ Carry plenty of glucose testing supplies withyou.

■ Take along all the diabetes medicine you’llneed.

Trips can hold surprises. Plan aheadfor delays and changes.

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When you travel, be sure to:■ Test your glucose often and keep track of it.

■ Wear identification that says you havediabetes.

■ Let others know how they can help you.

If you’re traveling in a different time zone, youmay need to change your timing of food, medicine,and activity. Ask your health care provider to helpyou with this. Talk about the food and drink choicesthat would be healthy for you. If you’ll be in anothercountry, ask your doctor to write a letter explainingthat you have diabetes. It’s also a good idea to getyour doctor to write a prescription for you to getinsulin or supplies if needed.

No matter where you travel, you can take charge of yourdiabetes.

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4 Feelings About Having Diabetes

Living with diabetes isn’t easy. It’s normal to feeltroubled about it. Tell your health care team howyou feel. Point out any problems you have with yourdiabetes care plan. Your diabetes educator or otherhealth care provider may be able to help you thinkof ways to deal with these problems.

Talk about the stresses you feel at home, school,and work. How do you cope with these pressures?If your feelings are getting in the way of taking careof yourself, you need to ask for help.

Ask your family to help you manage your diabetes.

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Support Groups

It helps to talk with other people who haveproblems like your own. You may want to thinkabout joining a diabetes support group. Insupport groups, people who have just found out theyhave diabetes can learn from people who have livedwith it for a long time. People can talk about andshare how they deal with their diabetes. They canalso talk about how they take care of their health,how they prepare food, and how they get physicalactivity. Family members who do not have diabetesmay want to join a support group, too. Ask yourhealth care team about support groups for peoplewith diabetes and their families and friends. If

there is nota supportgroup inyour area,you maywant to calla diabetesorganization(see the liston page127) aboutstarting agroup.

Counseling

One-on-one and family counseling sessions mayalso help. Be sure to see a counselor who knowsabout diabetes and its care. Ask your health careprovider to help you find a counselor.

It can help to talk with other people who haveproblems like your own.

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If you’re having trouble with yourvision, talk with your health careteam or eye doctor.

5 Eye Problems

Diabetic eye disease (also called diabeticretinopathy) is a serious problem that can lead toloss of sight. There’s a lot you can do to take chargeand prevent such problems. A recent study showsthat keeping your blood glucose closer to normalcan prevent or delay the onset of diabetic eyedisease. Keeping your blood pressure under controlis also important. Finding and treating eyeproblems early can help save sight.

Signs of Diabetic Eye Disease

Since diabetic eyedisease may bedeveloping even whenyour sight is good,regular eye exams areimportant for findingproblems early. Somepeople may notice signsof vision changes. Ifyou’re having troublereading, if your visionis blurred, or if you’reseeing rings aroundlights, dark spots, orflashing lights, you mayhave eye problems. Besure to tell your health care team or eye doctorabout any eye problems you may have.

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Protecting Your Sight

Keep Your Blood Glucose Under Control

High blood glucose can damage your eyes astime goes by. Work with your health care team tokeep your glucose levels as close to normal as youcan.

Keep Your Blood Pressure Under Control

High blood pressure can damage your eyes.Have your health care provider check your bloodpressure at least four times a year. If your bloodpressure is higher than 140/90, you may want to buya blood pressure cuff and check your blood pressureat home. Ask your health care provider where youcan buy a cuff.

You may want to check your blood pressureat home.

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Get Regular EyeExams

Even if you’reseeing fine, you needregular, complete eyeexams to protect yoursight. Ask yourhealth care providerto help you find aneye doctor who caresfor people withdiabetes. Before theexam, a doctor or nurse will put drops in your eyesto dilate the pupils.

You should have your eyes dilated and examinedonce a year. Keep track of these exams on page 101.Even if you’ve lost your sight from diabetic eyedisease, you still need to have regular eye care. Ifyou haven’t already had a complete eye exam, youshould have one now if any of these conditions applyto you:

■ You’ve had Type 1 diabetes for 5 or moreyears.

■ You have Type 2 diabetes.

■ You’re going through puberty and you havediabetes.

■ You’re pregnant and you have diabetes.

■ You’re planning to become pregnant and youhave diabetes.

Get a complete eye exam each year.

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If you can’t afford an eyeexam, ask about a paymentplan or a free exam. If you’re65 or older, Medicare may payfor diabetic eye exams (butnot glasses). Ask your eyedoctor to accept the Medicarefee as full payment.

Discuss Your PhysicalActivity Plan

If you have diabetic eyedisease, talk with your healthcare provider about the kindof physical activity that isbest for you.

Treating Diabetic Eye Disease

Treating eye problems early can help save sight.Laser surgery may help people who have advanceddiabetic eye disease. An operation calledvitrectomy may help those who have lost theirsight from bleeding in the back of the eye.

If your sight is poor, an eye doctor who is an expertin low vision may be able to give you glasses or otherdevices that can help you use your limited visionmore fully. You may want to ask your health careprovider about support groups and job training forpeople with low vision.

Think of a way to remindyourself to get an eyeexam each year.

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6 Kidney Problems

Diabetes can cause diabetic kidney disease(also called diabetic nephropathy), which can leadto kidney failure. There’s a lot you can do to takecharge and prevent kidney problems. A recent studyshows that controlling your blood glucose canprevent or delay the onset of kidney disease.Keeping your blood pressure under control is alsoimportant.

The kidneys keep the right amount of water inthe body and help filter out harmful wastes. Thesewastes then pass from the body in the urine.Diabetes can cause kidney disease by damaging theparts of the kidneys that filter out wastes. Whenthe kidneys fail, a person has to have his or herblood filtered through a machine (a treatment calleddialysis) several times a week or has to get a kidneytransplant.

Take care of your kidneysby controlling your bloodglucose and blood pressure.

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Testing Your Kidneys

Your health care provider can learn how well yourkidneys are working by testing for albumin (aprotein) in the urine. Albumin in the urine is anearly sign of diabetic kidney disease. You shouldhave your urinechecked for albuminevery year.

Your health careprovider can also do ayearly blood test tomeasure your kidneyfunction. If the testsshow albumin in theurine or if your kidneyfunction isn’t normal,you’ll need to bechecked more often.

On page 101, write down the dates and the resultsof these tests. Ask your health care provider toexplain what the results mean.

Protecting Your Kidneys

Keep Your Blood Glucose Under Control

High blood glucose can damage your kidneys astime goes by. Work with your health care team tokeep your glucose levels as close to normal as youcan.

Work with your health careprovider to prevent kidneyproblems.

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Keep Your Blood Pressure Under Control

High blood pressure can damage your kidneys.You may want to check your blood pressure athome to be sure it stays lower than 140/90. Haveyour health care provider check your blood pressureat least four times a year. Your doctor may have youtake a blood pressure pill, called an ACE inhibitor,to help protect your kidneys.

Choose Healthy Foods

You may want to talkto your health careteam about cutting backon foods that are highin proteins (such asmeat, milk, and cheese).A diet high in proteinscan cause more damageto your kidneys overtime. Eating less salt isalso a good idea.

Preventing and Treating Infections

Bladder and kidney infections can damage yourkidneys. Call your health care provider right awayif you have any of these signs of bladder infection:

■ Cloudy or bloody urine.■ Pain or burning when you urinate.■ An urgent need to urinate often.

Controlling your blood glucoselevels and your blood pressuremay help to prevent or delaykidney failure.

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Call your health care provider right away if youhave any of these signs of kidney infections:

■ Back pain.■ Chills.■ Fever.■ Ketones in the urine. (See page 35.)

Tell your health care providerif you have any signs ofkidney or bladder infection.

Your health care provider will test your urine. Ifyou have a bladder or kidney infection, you’ll begiven medicine to stop the infection. After you takeall the medicine, have your urine checked again tobe sure the infection is gone.

Know the Effects of Some Medicines and X-RayDyes

If you have kidney disease, ask your health careprovider about the possible effects that somemedicines and X-ray dyes can have on your kidneys.

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7 Heart and Blood VesselProblems

Heart and blood vessel problems are the maincauses of sickness and death among people withdiabetes. These problems can lead to high bloodpressure, heart attacks, and strokes. Heart andblood vessel problems can also cause poor blood flow(circulation) in the legs and feet.

You’re more likely to have heartand blood vessel problems if yousmoke cigarettes, have high bloodpressure, or have too muchcholesterol or other fats in yourblood. Talk with your health careteam about what you can do tolower your risk for heart and bloodvessel problems.

You can do a lot to keep yourheart and blood vessels healthy.

Signs of Heart and Blood Vessel Problems

If you feel dizzy, have sudden loss of sight, sluryour speech, or feel numb or weak in one arm or leg,you may be having serious heart and blood vessel

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problems. Your blood may not be getting to yourbrain as well as it should.

Danger signs of circulation problems to the heartinclude chest pain or pressure, shortness of breath,swollen ankles, or irregular heartbeats. If you haveany of these signs, go to an emergency room or callyour health care provider right away.

Signs of circulation problems to your legs are painor cramping in your buttocks, thighs, or calvesduring physical activity. Even if this pain goes awaywith rest, report it to your health care provider.

Preventing and Controlling Heart andBlood Vessel Problems

Eat Right and Get Physical Activity

Choose a healthy diet,low in salt. Work with adietitian to plan healthymeals. If you’reoverweight, talk abouthow to safely lose weight.Ask about a physicalactivity or exerciseprogram for you. Seepages 15–19 to read moreabout healthy choices forfood and physical activity.

If you’re overweight, talk with your dietitian about how tosafely lose weight.

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Don’t Use Tobacco

Smoking cigarettes causes hundreds of thousandsof deaths each year. When you have diabetes andalso use tobacco, the risk of heart and blood vesselproblems is even greater. One of the best choicesyou can make for your healthis to never start smoking—orif you smoke, to quit.

At least once a year, yourhealth care provider will askyou about tobacco use. If yousmoke, ask your providerabout things you can do tohelp you stop, such as joininga stop-smoking program.

Check Your Blood Pressure

Get your blood pressure checked at each visit.Record these numbers on page 91. If your bloodpressure is higher than 140/90, you may want to buya blood pressure cuff and check your blood pressureat home. Ask your health care provider where youcan buy a cuff.

If your blood pressure is still high after 3 months,you may need medicine to help control it. Manymedicines are available to treat high blood pressure.If you have side effects from the medicine, ask yourhealth care provider to change it.

Not smoking is thehealthiest choice you’llmake for your heart.

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Check Your Cholesterol

Get your cholesterol checked once a year. Recordthe results on page 101. Your total cholesterolshould be lower than 200 mg/dL. Ask your healthcare team to explain whatyour HDL and LDL levelsare.

If your cholesterol ishigher than 200 mg/dL ontwo or more checks, you cando several things to lower it.You can work with yourhealth care team to improveyour blood glucose control,you can lose weight (ifyou’re overweight), and youcan cut down on foods thatare high in fat and cholesterol. Ask your health careteam about foods that are low in fats. Also askabout a physical activity program.

If your cholesterol is still high after 6 months, youmay need a medicine to help control it. Your healthcare provider will advise you about what medicine totake.

Ask if You Need an Electrocardiogram (EKG)

If you’re having heart and blood circulationproblems, an EKG may help you and your healthcare provider know if you need to change yourtreatment.

Choose heart-healthy foodsfor your meal plan.

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8 Nerve Damage

Diabetic nerve damage (also called diabeticneuropathy) is a problem for many people withdiabetes. Over time, high blood glucose levelsdamage the delicate coating of nerves. This damagecan cause a number of problems, such as pain inyour feet. There’s a lot you can do to take chargeand prevent nerve damage. A recent study showsthat controlling your blood glucose can helpprevent or delay these problems. Controlling yourblood glucose may also help reduce the pain fromsome types of nerve damage.

Some Signs of Diabetic Nerve Damage

Some signs of diabeticnerve damage are pain,burning, tingling, or loss offeeling in the feet and hands.It can cause you to sweatabnormally, make it hard foryou to tell when your bloodglucose is low, and make youfeel light-headed when youstand up.

Nerve damage can lead toother problems. Some peopledevelop problems swallowing and keeping fooddown. Nerve damage can also cause bowelproblems, make it hard to urinate, cause dribblingwith urination, and lead to bladder and kidney

Having trouble tellingyour glucose is low maybe signs of nerve damage.

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infections. Many peoplewith nerve damage havetrouble having sex. Forexample, men can havetrouble keeping theirpenis erect, a problemcalled impotence. Ifyou have any of theseproblems, tell yourhealth care provider.There are ways to helpin many cases.

Protecting Your Nerves From Damage

Keep Your Blood Glucose in Control

High blood glucose can damage your nerves astime goes by. Work with your health care team tokeep your glucose levels as close to normal as youcan.

Have a Physical Activity Plan

Physical activity or exercise may help keep somenerves healthy, such as those in your feet. Ask yourhealth care team about an activity that is healthyfor you.

Tell your health care provider ifyou have trouble with sexualfunction.

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Get Tests for Nerve Damage

Nerve damage canhappen slowly. You maynot even be awareyou’re losing feeling inyour feet. Ask youhealth care provider tocheck your feet at eachvisit. At least once ayear, your providershould test how wellyou can sense temperature, pinprick, vibration, andposition in your feet. If you have signs of nervedamage, your provider may want to do more tests.Testing can help your provider know what is wrongand how to treat it. Keep track of your foot examson page 101.

Check Your Feet for Changes

If you’ve lost feeling in your feet, you’ll need totake special care of them. Check your feet each day.Wear shoes that fit well. You’ll read more about footcare in the next chapter.

At least once a year, your healthcare provider should do acomplete check of your feet andnerves.

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9 Foot Problems

Nerve damage, circulationproblems, and infections cancause serious foot problems forpeople with diabetes. There’s alot you can do to preventproblems with your feet.Controlling your bloodglucose and not smoking orusing tobacco can help protectyour feet. You can also takesome simple safeguards each day to care for andprotect your feet. Measures like these haveprevented many amputations.

It’s helpful to understand why foot problemshappen. Nerve damage can cause you to lose feelingin your feet. Sometimes nerve damage can deformor misshape your feet, causing pressure points thatcan turn into blisters, sores, or ulcers. Poorcirculation can make these injuries slow to heal.

Signs of Foot Problems

Your feet may tingle, burn, or hurt. You may notbe able to feel touch, heat, or cold very well. Theshape of your feet can change over time. There mayeven be changes in the color and temperature ofyour feet. Some people lose hair on their toes, feet,and lower legs. The skin on your feet may be dryand cracked. Toenails may turn thick and yellow.Fungus infections can grow between your toes.

Take extra care of yourfeet to prevent injuries.

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Blisters, sores, ulcers, infected corns, and ingrowntoenails need to be seen by your health care provideror foot doctor (podiatrist) right away.

Protecting Your Feet

Get Your Health Care Provider to Check Your Feetat Least Four Times a Year

Ask your health care provider to look at your feetat least four times a year. As a reminder, take offyour shoes and socks when you’re in the exam room.Have your sense of feeling and your pulses checkedat least once a year. If you have nerve damage,deformed or misshaped feet, or a circulationproblem, your feet need special care. Ask yourhealth care provider to show you how to care foryour feet. Also ask if special shoes would help you.

Ask your health care provider to check yourfeet at least four times a year.

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Check Your Feet Each Day

You may have serious foot problems yet feel nopain. Look at your feet every day to see if you havescratches, cracks, cuts, or blisters. Always checkbetween your toes and on the bottoms of your feet.If you can’t bend over to see the bottoms of your feet,use a mirror that won’t break. If you can’t see well,ask a family member or friend to help you. Callyour health care provider at once if you have a soreon your foot. Sores can get worse quickly.

Wash Your Feet Daily

Wash your feet every day.Dry them with care, especiallybetween the toes. Don’t soakyour feet—it can dry out yourskin, and dry skin can lead toinfections. If you have dry skin,rub a thin coat of oil, lotion, orcream on the tops and bottomsof your feet—but not betweenyour toes. Moisture betweenthe toes will let germs growthat could cause an infection.Ask your health care providerfor the name of a good lotion orcream.

Trim Your Toenails Carefully

Trim your toenails after you’ve washed and driedyour feet—the nails will be softer and safer to cut.

Be sure to dry betweenyour toes.

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Trim the nails to follow the natural curve of yourtoes. Don’t cut into the corners. Use an emeryboard to smooth off the edges.

If you can’t see well, or if your nails are thick oryellowed, get them trimmed by a foot doctor oranother health care provider. Ask your health careprovider for the name of a foot doctor. If you seeredness around the nails, see your health careprovider at once.

Treat Corns and Calluses Gently

Don’t cut corns and calluses. Ask your healthcare provider how to gently use a pumice stone torub them. Don’t use razor blades, corn plasters, orliquid corn or callus removers—they can damageyour skin.

Protect Your Feet From Heat and Cold

Hot water or hot surfaces area danger to your feet. Beforebathing, test the water with abath thermometer (90 to 95°F issafe) or with your elbow. Wearshoes and socks when you walkon hot surfaces, such as beachesor the pavement aroundswimming pools. In summer, besure to use a sunscreen on thetops of your feet.

Wear shoes to protectyour feet from hotsurfaces.

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You also need to protect your feet from the cold. Inwinter, wear socks and footwear such as fleece-linedboots to protect your feet. If your feet are cold atnight, wear socks. Don’t use hot water bottles,heating pads, or electric blankets—they can burnyour feet. Don’t use strong antiseptic solutions oradhesive tape on your feet.

Wear Shoes and SocksAlways

Wear shoes and socks atall times. Don’t walkbarefoot—not even indoors.

Wear shoes that fit welland protect your feet.Don’t wear shoes that have plastic uppers and don’twear sandals with thongs between the toes. Askyour health care provider what types of shoes aregood choices for you.

New shoes should be comfortable at the time youbuy them—don’t expect them to stretch out. Slowlybreak in new shoes by wearing them only one or twohours a day.

Always wear socks or stockings with your shoes.Choose socks made of cotton or wool—they help keepyour feet dry.

Before you put on your shoes each time, look andfeel inside them. Check for any loose objects, nailpoints, torn linings, and rough areas—these can

Wear shoes that fit well andprotect your feet.

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cause injuries. If your shoe isn’t smooth inside,wear other shoes.

Be Physically Active

Physical activity can help increase the circulationin your feet. There are many ways you can exerciseyour feet, even during times you’re not able to walk.Ask your health care team about things you can doto exercise your feet and legs.

Walking may bea healthy activityfor you.

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10 Dental Disease

Because of high bloodglucose, people withdiabetes are more likely tohave problems with theirteeth and gums. There’s a lotyou can do to take charge andprevent these problems.Caring for your teeth andgums every day can helpkeep them healthy. Keepingyour blood glucose undercontrol is also important.Regular, complete dental carehelps prevent dental disease.

Signs of Dental Disease

Sore, swollen, and red gums that bleed when youbrush your teeth are a sign of a dental problemcalled gingivitis. Another problem, calledperiodontitis, happens when your gums shrink orpull away from your teeth. Like all infections,dental infections can make your blood glucose go up.

Healthy teeth and gumsdepend on regular careand controlling yourblood glucose.

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Preventing Dental Problems

Keep Your Blood Glucose in Control

High blood glucose can cause problems with yourteeth and gums. Work with your health care teamto keep your glucose levels as close to normal as youcan.

Brush Your Teeth Often

Brush your teeth at least twicea day to prevent gum disease andtooth loss. Be sure to brushbefore you go to sleep. Use a softtoothbrush and toothpaste withfluoride. To help keep bacteriafrom growing on your toothbrush,rinse it after each brushing andstore it upright with the bristlesat the top. Get a new toothbrushat least every 3 months.

Floss Your Teeth Daily

Besides brushing, you need to floss between yourteeth each day to help remove plaque, a film thatforms on teeth and can cause tooth problems.Flossing also helps keep your gums healthy. Yourdentist or dental hygienist will help you choose agood method to remove plaque, such as dental floss,bridge cleaners, or water spray. If you’re not sure ofthe right way to brush or floss, ask your dentist ordental hygienist for help.

Protect your teeth bybrushing twice ormore a day andflossing each day.

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See your dentist at least every6 months.

Get Regular Dental Care

Get your teeth cleanedand checked at yourdentist’s office at leastevery 6 months. If youdon’t have a dentist, findone or ask your healthcare provider for the nameof a dentist in yourcommunity.

See your dentist rightaway if you have anysigns of dental disease, including bad breath, a badtaste in your mouth, bleeding or sore gums, red orswollen gums, sore or loose teeth, or troublechewing.

Give your dentist the name and telephone numberof your diabetes health care provider. Each time youmake a visit, remind your dentist that you havediabetes.

Plan dental visits so they don’t change the timesyou take your insulin and meals. Don’t skip a mealor diabetes medicine before your visit. Right afterbreakfast may be a good time for your visit.

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11 Vaccinations

If you have diabetes, take extra care to keepup-to-date on your vaccinations (also calledimmunizations). Vaccines can prevent illnessesthat can be very serious for people with diabetes.This section talks about some vaccines you need toknow about.

Influenza Vaccine

Influenza (often called the flu) is not just a badcold. It’s a serious illness that can lead topneumonia and even death. The flu spreads wheninfluenza viruses pass from one person to the noseor throat of others. Signs of the flu may includesudden high fever, chills, body aches, sore throat,runny nose, dry cough, and headache.

The flu is a serious illness that can put you inthe hospital. A yearly flu shot can helpprevent this.

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People with diabetes who come down with the flumay become very sick and may even have to go to ahospital. If you get the flu, you’ll need to takespecial care of yourself (see pages 33–36).

You can help keep yourself from getting the flu bygetting a flu shot every year. Everyone withdiabetes—even pregnant women—should get ayearly flu shot. The best time to get one is betweenOctober and mid-November, before the flu seasonbegins. This vaccine is fully covered under MedicarePart B.

Pneumococcal Vaccine

Pneumococcal disease is a major source of illnessand death. It can cause serious infections of thelungs (pneumonia), the blood (bacteremia) and thecovering of the brain (meningitis). Pneumococcalpolysaccharide vaccine (often called PPV) can helpprevent this disease.

PPV can be given at the same time as fluvaccine—or at any time of the year. Most peopleonly have to take PPV once in their life. Ask yourhealth care provider whether you are in the smallgroup of people—such as people on dialysis—whomight need a second vaccination. This vaccine isfully covered under Medicare Part B.

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Tetanus/Diphtheria (Td) Toxoid

Tetanus (or lockjaw) and diphtheria are seriousdiseases. Tetanus is caused by a germ that entersthe body through a cut or wound. Diphtheriaspreads when germs pass from one person to thenose or throat of others.

You can help prevent tetanus and diphtheria witha combined shot called Td toxoid. Most people getTd toxoid as part of their routine childhoodvaccinations, but all adults need a Td booster shotevery 10 years. Other vaccines may be given at thesame time as Td toxoid.

Other Vaccines

You may need vaccines to protect you againstother illnesses. Ask your health care provider if youneed any of these:

■ Measles/Mumps/Rubella vaccine

■ Hepatitis A and B vaccines

■ Varicella (chickenpox) vaccine

■ Polio vaccine

■ Vaccines for travel to other countries

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How to Get More Information

Call the immunization program in your statehealth department to find out where you can getvaccinations in your area. Keep your vaccinationrecords up-to-date so you and your health careprovider will know what vaccines you may need.You can record this information on page 101 of thisbook.

For more information onvaccination, call the NationalImmunization InformationHotline at 1-800-232-2533(English) or 1-800-232-0233(Spanish). These are toll-freecalls.

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You can protect you andyour baby by controllingyour blood glucose beforeand during pregnancy.

12 Pregnancy, Diabetes, andWomen’s Health

Becoming Pregnant When You HaveDiabetes

Women with diabetes canhave healthy babies, but ittakes planning ahead andeffort. Pregnancy can makeboth high and low bloodglucose levels happen moreoften. It can make diabeticeye disease and diabetickidney disease worse.High glucose levels duringpregnancy are dangerous forthe baby, too.

If you don’t want tobecome pregnant, talk withyour health care providerabout birth control.

Protecting Your Baby and Yourself

Keeping your glucose levels near normal beforeand during pregnancy can help protect you and yourbaby. That’s why it’s so important to plan yourpregnancies ahead of time.

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If you want to have a baby, discuss it with yourhealth care provider. Work with your diabetes careteam to get and keep your blood glucose in thenormal or near-normal range before you becomepregnant. Your glucose records and yourhemoglobin A1c test results will show when youhave maintained a safe range for a period of time.

You may need to change your meal plan and yourusual physical activity, and you may need to takemore frequent insulin shots. Testing your glucoseseveral times a day will help you see how well you’rebalancing things. Record the test results in yourlogbook or on a log sheet (see sample pages on 107–108).

Get a complete check of your eyes and kidneysbefore you try to become pregnant. Don’t smoke,drink alcohol, or use drugs—doing these things canharm you and your baby.

Your blood glucose and hemoglobin A1c recordswill help you and your health care team knowwhen your glucose range is safe for pregnancy.

75

Having Diabetes During Pregnancy

Some women have diabetes only when they’repregnant. This condition, which is calledgestational diabetes, can be controlled just likeother kinds of diabetes. Glucose control is the key.Your health care team can help you take charge ofgestational diabetes.

Controlling Diabetes for Women’s Health

Some women with diabetes may have specialsproblems, such as bladder infections. See pages49–50 to find out about the signs of bladder andkidney infections. If you have an infection, it needsto be treated right away. Call your doctor.

If you learn you have diabetes when you’repregnant, work closely with your health careteam.

76

Some women get yeast infections in theirvagina, especially when their blood glucose is high.A sign of a yeast infection may be itching in thevagina. If you notice vaginal itching, tell yourhealth care provider. You may learn aboutmedicines you can buy at the drugstore and abouthow to prevent yeast infections.

Some women withdiabetes may have troublewith sexual function.Discomfort caused byvaginal itching or drynesscan be treated.

Ask your doctor how oftenyou should get a Pap smearand a mammogram (breastX-ray). Regular Pap smearsand mammograms helpdetect cervical and breastcancer early. All women—whether or not they havediabetes—need to keep upwith these tests.

Getting Pap smears andmammograms is importantto every woman’s health.

77

RECORDS

Records for Sick Days . . . . . . . . . . . . . . . . . . . . . . 79

Tests and Goals for Each Visit . . . . . . . . . . . . . . . 89

Tests and Goals for Each Year . . . . . . . . . . . . . . . . 99

Glucose Log Sheet . . . . . . . . . . . . . . . . . . . . . . . . 105

Your Health Care Team . . . . . . . . . . . . . . . . . . . . 109

79

Records for Sick DaysHow often Question Answer

Every day How much do _____poundsyou weigh today?

Every evening How much liquid _____glassesdid you drink today?

Every morning What is your _____ a.m.and every temperature? _____ p.m.evening

Every 4 hours How much Time Doseor before diabetes medicine _____ _____every meal did you take? _____ _____

_____ __________ __________ __________ _____

Every 4 hours What is your Bloodor each time blood glucose Time glucoseyou pass urine level? _____ _____

_____ __________ __________ __________ __________ _____

Every 4 hours What are your Time Ketonesor each time urine ketones? _____ _______you pass urine _____ _______

_____ ____________ ____________ ____________ _______

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Every 4 to How are you Time Condition6 hours breathing? _____ _________

_____ ______________ ______________ ______________ ______________ _________

Reminders for Sick Days

Call your health care provider if any of these happento you:

■ You feel too sick to eat normally and are unable tokeep down food for more than 6 hours.

■ You’re having severe diarrhea.

■ You lose 5 pounds or more.

■ Your temperature is over 101°F.

■ Your blood glucose is lower than 60 mg/dL orremains over 300 mg/dL.

■ You have moderate or large ketones in your urine.

■ You’re having trouble breathing.

■ You feel sleepy or can’t think clearly.

If you feel sleepy or can’t think clearly, have someonecall your health care provider or take you to anemergency room.

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_____ __________ __________ __________ _____


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_____ __________ __________ __________ _____


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Things to Do at Each Visit With YourHealth Care Provider

■ Bring your blood glucose logbook and go over thereadings with your provider.

■ Get a hemoglobin A1c test (about every 6 monthsif you don’t take insulin, about every 3 months ifyou take insulin). Write down the result (see page91) and set a target goal for your next test.

■ Get your weight checked and write it down (seepage 91). You may want to set a goal for yournext visit.

■ Get your blood pressure checked and write itdown. You may want to set a goal for your nextvisit.

■ Get your feet checked at least four times a year.

■ Bring a list of questions or other things you wantto talk about.

■ Bring your reminder sheet about “Things to Do atLeast Once a Year” (see page 99) to help keeptrack of these.

90

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99

Things to Do At Least Once a Year

■ Get a flu shot (October to mid-November).■ Get a pneumonia shot (if you’ve never had one).■ Get a dilated eye exam.■ Get a foot exam (including check of circulation

and nerves).■ Get a kidney test:

■■■ Have your urine tested for albumin.■■■ Have your blood creatinine measured.■■■ Get a 24-hour urine test (if your doctor

advises).■ Get your blood fats checked for:

■■■ Total cholesterol.■■■ High-density lipoprotein (HDL).■■■ Low-density lipoprotein (LDL).■■■ Triglycerides.

■ Get a dental exam (at least twice a year).■ Talk with your health care team about:

■■■ How well you can tell when you have lowblood glucose.

■■■ How you are treating high blood glucose.■■■ Tobacco use (cigarettes, cigars, pipes,

smokeless tobacco).■■■ Your feelings about having diabetes.■■■ Your plans for pregnancy (if a woman).■■■ Other ______________________

100

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106


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109

Your Health Care Providers

Primary Doctor

Name: __________________________________________


Your questions: ___________________________________

__________________________________________________

__________________________________________________

__________________________________________________


__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

110

Eye Doctor (Ophthalmologist, Optometrist)

Name: __________________________________________


Your questions: ___________________________________

__________________________________________________

__________________________________________________

__________________________________________________


__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

111

Foot Doctor (Podiatrist)

Name: __________________________________________


Your questions: ___________________________________

__________________________________________________

__________________________________________________

__________________________________________________


__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

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Dentist

Name: __________________________________________


Your questions: ___________________________________

__________________________________________________

__________________________________________________

__________________________________________________


__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

113

Dietitian

Name: __________________________________________


Your questions: ___________________________________

__________________________________________________

__________________________________________________

__________________________________________________


__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

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Diabetes Educator

Name: __________________________________________


Your questions: ___________________________________

__________________________________________________

__________________________________________________

__________________________________________________


__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

115

Counselor

Name: __________________________________________


Your questions: ___________________________________

__________________________________________________

__________________________________________________

__________________________________________________


__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

116

Other

Name: __________________________________________


Your questions: ___________________________________

__________________________________________________

__________________________________________________

__________________________________________________


__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

__________________________________________________

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APPENDIXES

Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

Diabetes Information Resource List . . . . . . . . . . 127

119

Glossary

Albumin A protein found in blood plasma and urine.The presence of albumin in the urine can be a sign ofkidney disease.

Autoimmune process A process where the body’simmune system attacks and destroys body tissue that itmistakes for foreign matter.

Beta cells Cells that make insulin. Beta cells are foundin areas of the pancreas called the islets of Langerhans.

Bladder A hollow organ that urine drains into from thekidneys. From the bladder, urine leaves the body.

Blood glucose The main sugar that the body makesfrom the food we eat. Glucose is carried through thebloodstream to provide energy to all of the body’s livingcells. The cells cannot use glucose without the help ofinsulin.

Blood pressure The force of the blood against the arterywalls. Two levels of blood pressure are measured: thehighest, or systolic, occurs when the heart pumps bloodinto the blood vessels, and the lowest, or diastolic,occurs when the heart rests.

Blood sugar See Blood glucose.

Calluses Thick, hardened areas of the skin, generally onthe foot, caused by friction or pressure. Calluses canlead to other problems, including serious infection andeven gangrene.

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Carbohydrate One of three main groups of foods in thediet that provide calories and energy. (Proteins and fatsare the others.) Carbohydrates are mainly sugars (simplecarbohydrates) and starches (complex carbohydrates,found in bread, pasta, beans) that the body breaks downinto glucose.

Cholesterol A substance similar to fat that is found inthe blood, muscles, liver, brain, and other body tissues.The body produces and needs some cholesterol.However, too much cholesterol can make fats stick tothe walls of the arteries and cause a disease thatdecreases or stops circulation.

Corns A thickening of the skin of the feet or hands,usually caused by pressure against the skin.

Diabetes The short name for the disease called diabetesmellitus. Diabetes results when the body cannot useblood glucose as energy because of having too littleinsulin or being unable to use insulin. See also Type 1diabetes, Type 2 diabetes, and Gestational diabetes.

Diabetes pills Pills or capsules that are taken by mouthto help lower the blood glucose level. These pills maywork for people who are still making insulin.

Diabetic eye disease A disease of the small bloodvessels of the retina of the eye in people with diabetes.In this disease, the vessels swell and leak liquid into theretina, blurring the vision and sometimes leading toblindness.

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Diabetic ketoacidosis High blood glucose with thepresence of ketones in the urine and bloodstream, oftencaused by taking too little insulin or during illness.

Diabetic kidney disease Damage to the cells or bloodvessels of the kidney.

Diabetic nerve damage Damage to the nerves of aperson with diabetes. Nerve damage may affect the feetand hands, as well as major organs.

EKG exam A test that measures the heart’s action. Alsocalled an electrocardiogram.

Flu An infection caused by the ‘flu’ virus. The fluusually causes fever, cough, headaches, congestion, andsore throat.

Food exchanges A way to help people stay on specialfood plans by letting them replace items from one foodgroup with items from another group.

Gestational diabetes A type of diabetes that can occurin pregnant women who have not been known to havediabetes before. Although gestational diabetes usuallysubsides after pregnancy, many women who’ve hadgestational diabetes develop Type 2 diabetes later in life.

Gingivitis A swelling and soreness of the gums that,without treatment, can cause serious gum problems anddisease.

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Glucagon A hormone that raises the blood glucoselevel. When someone with diabetes has a very lowblood glucose level, a glucagon injection can help raisethe blood glucose quickly.

Glucose A sugar in our blood and a source of energy forour bodies.

Heart attack Damage to the heart muscle caused whenthe blood vessels supplying the muscle are blocked,such as when the blood vessels are clogged with fats (acondition sometimes called hardening of the arteries).

HDL (or high-density lipoprotein) A combined proteinand fatlike substance. Low in cholesterol, it usuallypasses freely through the arteries. Sometimes called“good cholesterol.”

Hemoglobin A1c A test that sums up how muchglucose has been sticking to part of the hemoglobinduring the past 3–4 months. Hemoglobin is a substancein the red blood cells that supplies oxygen to the cells ofthe body.

High blood glucose A condition that occurs in peoplewith diabetes when their blood glucose levels are toohigh. Symptoms include having to urinate often, beingvery thirsty, and losing weight.

High blood pressure A condition where the bloodcirculates through the arteries with too much force.High blood pressure tires the heart, harms the arteries,and increases the risk of heart attack, stroke, and kidneyproblems.

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Hormone A chemical that special cells in the bodyrelease to help other cells work. For example, insulin isa hormone made in the pancreas to help the body useglucose as energy.

Hyperglycemia See High blood glucose.

Hypertension See High blood pressure.

Hypoglycemia See Low blood glucose.

Immunization Sometimes called vaccination; a shot orinjection that protects a person from getting an illness bymaking the person ‘immune’ to it.

Impotence A condition of being unable to keep an erectpenis and ejaculate. Some men who have had diabetesa long time become impotent if their nerves havebecome damaged.

Influenza A contagious viral illness that strikes quicklyand severely. Signs include high fever, chills, bodyaches, runny nose, sore throat, and headache.

Inject To force a liquid into the body with a needle andsyringe.

Insulin A hormone that helps the body use bloodglucose for energy. The beta cells of the pancreas makeinsulin. When people with diabetes can’t make enoughinsulin, they may have to inject it from another source.

Insulin-dependent diabetes See Type 1 diabetes.

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Ketones Chemical substances that the body makeswhen it doesn’t have enough insulin in the blood.When ketones build up in the body for a long time,serious illness or coma can result.

Kidneys Twin organs found in the lower part of theback. The kidneys purify the blood of all waste andharmful material. They also control the level of somehelpful chemical substances in the blood.

Laser surgery Surgery that uses a strong ray of speciallight, called a laser, to treat damaged parts of the body.Laser surgery can help treat some diabetic eye diseases.

Low blood glucose A condition that occurs in peoplewith diabetes when their blood glucose levels are toolow. Symptoms include feeling anxious or confused,feeling numb in the arms and hands, and shaking orfeeling dizzy.

LDL (or low-density lipoprotein) A combined proteinand fatlike substance. Rich in cholesterol, it tends tostick to the walls in the arteries. Sometimes called “badcholesterol.”

Meal plan A guide to help people get the properamount of calories, carbohydrates, proteins, and fats intheir diet. See also Food exchanges.

Nephropathy See Diabetic kidney disease.

Neuropathy See Diabetic nerve damage.

Non–insulin-dependent diabetes See Type 2 diabetes.

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Pancreas An organ in the body that makes insulin sothat the body can use glucose for energy. The pancreasalso makes enzymes that help the body digest food.

Periodontitis A gum disease in which the gums shrinkaway from the teeth. Without treatment, it can lead totooth loss.

Plaque A film of mucus that traps bacteria on thesurface of the teeth. Plaque can be removed with dailybrushing and flossing of teeth.

Retinopathy See Diabetic eye disease.

Risk factors Traits that make it more likely that a personwill get an illness. For example, a risk factor for gettingType 2 diabetes is having a family history of diabetes.

Self-monitoring blood glucose A way for people withdiabetes to find out how much glucose is in their blood.A drop of blood from the fingertip is placed on a specialcoated strip of paper that “reads” (often through anelectronic meter) the amount of glucose in the blood.

Stroke Damage to a part of the brain that happenswhen the blood vessels supplying that part are blocked,such as when the blood vessels are clogged with fats (acondition sometimes called hardening of the arteries).

Support group A group of people who share a similarproblem or concern. The people in the group help oneanother by sharing experiences, knowledge, andinformation.

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Type 1 diabetes A condition in which the pancreasmakes so little insulin that the body can’t use bloodglucose as energy. Type 1 diabetes most often occurs inpeople younger than age 30 and must be controlledwith daily insulin injections.

Type 2 diabetes A condition in which the body eithermakes too little insulin or can’t use the insulin it makesto use blood glucose as energy. Type 2 diabetes mostoften occurs in people older than age 40 and can oftenbe controlled through meal plans and physical activityplans. Some people with Type 2 diabetes have to takediabetes pills or insulin.

Ulcer A break or deep sore in the skin. Germs canenter an ulcer and may be hard to heal.

Vitrectomy An operation to remove the blood thatsometimes collects at the back of the eyes when aperson has eye disease.

Yeast infection A vaginal infection that is usuallycaused by a fungus. Women who have this infectionmay feel itching, burning when urinating, and pain, andsome women have a vaginal discharge. Yeast infectionsoccur more frequently in women with diabetes.

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Resources

The following is a list of organizations that can offerinformation on diabetes over the phone or can sendwritten materials. Ask your health care team to help youfind other resources of information or support.

American Association of Diabetes Educators444 North Michigan Avenue, Suite 1240Chicago, Illinois 60611

800-832-6874800-TEAM-UP4 (for names of diabetes educators)

American Diabetes Association1660 Duke StreetAlexandria, Virginia 22314

800-DIABETES (342-2383)800-232-3472703-549-1500

American Dietetic Association216 West Jackson Boulevard, Suite 800Chicago, Illinois 60606-6995

800-745-0775800-366-1655 (consumer nutrition hotline, Spanishspeaker available)

American Heart AssociationNational Center7272 Greenville AvenueDallas, Texas 75231

214-373-6300

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American Optometric Association1505 Prince St.Alexandria, Virginia 22314

800-262-3947703-739-9200

Indian Health ServiceDiabetes Program5300 Homestead Road, N.E.Albuquerque, New Mexico 87110

505-248-4182

International Diabetic Athletes Association1647-B West Bethany Home RoadPhoenix, Arizona 85015

800-898-IDAA602-433-2113

Juvenile Diabetes Foundation International432 Park Avenue SouthNew York, New York 10016-8013

800-223-1138

Medical Eye Care for the Nation’s DisadvantagedSenior Citizens

The Foundation of the American Academyof Ophthalmology

P.O. Box 429098San Francisco, California 94142-9098

800-222-EYES(3937)

National Eye Institute National Eye Health Education Program 2020 Vision Place Bethesda, Maryland 20892-3655

800-869-2020 (to order materials) 301-496-5248

National Institute of Diabetes and Digestive and Kidney Diseases

National Diabetes Information Clearinghouse 1 Information Way Bethesda, Maryland 20892-3560

800-GET LEVEL (800-438-5383) 301-654-3327

U.S. Public Health ServiceOffice of Minority Health Resource Center P.O. Box 37337Washington, DC 20013-7337

800-444-MHRC (6472)

Others

:

Canadian Diabetes Association National Office800-15 Toronto St, Toronto, Ontario, M5C 2E3, Canada

800-BANTING (800-226-8464) 416-363-3373http://www.diabetes.ca/

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http://www.diabetes.ca/

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Take Charge of Diabetes

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