LIVING WELL WITH DIABETES Patient Booklet

SVMC DIABETES CENTER GEMS: To help you live well with diabetes Today we know a lot about living well with diabetes, and this is great news. By understanding diabetes and making good choices, you can live life to the fullest. This booklet features easy to understand information about the causes of diabetes as well as nutrition, exercise, medications and other things to help you stay healthy. It also tells you about the resources and care available to you at The Diabetes Center at Salinas Valley Medical Clinic. Our staff has specialized training in caring for people with diabetes. Our goal is to educate and support you and your family. We will help you learn self-management skills to improve your health and quality of life and reduce your risk of diabetes related problems. Information on classes designed to get you off to a good start and keep you motivated is also provided with this booklet and at svmh.com/events. If you would like more information about diabetes management in general or about the resources available to you at The Diabetes Center at Salinas Valley Medical Clinic, please talk to your nurse here at Salinas Valley Memorial Hospital or to your doctor once you are home. More information can be found at www.svmh.com/diabetes and www.diabetes.org.

TABLE OF CONTENTS Diabetes Basics: Type 1 & Type 2.............. 4 Eating to Stay Healthy.............................. 5 Keeping Track of your Blood Sugar with a Glucose Meter............................. 10 Medications........................................... 11 Using Insulin.......................................... 12 My Medication & Log Book..................... 13 Dealing with a Low Blood Sugar Level..... 14 Dealing with a High Blood Sugar Level.... 15 What Do You Do When You Are Sick........ 16 Diabetes Education Classes.................... 17

= Glucose Monitoring G

(checking your sugar)

E

= Eating Healthy and Well

= Medications M (pills and insulin)

S

= Staying safe (highs, lows, sick days) LIVING WELL WITH DIABETES

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THE BASICS OF DIABETES

EATING TO STAY HEALTHY

To get energy, your body breaks food down into a fuel called “glucose” (blood sugar). To use this fuel, your body needs the hormone insulin, which is made in the pancreas. Insulin is the “key” that unlocks the door and lets glucose into your cells. When you have diabetes, either your “keys” do not work well or you’ve lost your “keys” altogether. Without treatment, diabetes can cause serious short-term and long-term health problems.

Eating healthy and nutritious food is very important for people with diabetes. Here are some tips to help you plan your diet.

❑ I have this type of Diabetes

It is important to understand that Type 1 diabetes can happen at any age, but is slightly more common in children and young adults. The good news is that insulin can be replaced and along with education, diet and exercise, people with Type 1 diabetes can live a healthy life. ❑ I have this type of Diabetes

With Type 2 diabetes—the most common type of diabetes—your cells do not respond in the right way to insulin; your “keys” have a hard time opening the doors to your cells. This problem is called “insulin resistance.” As a result of this resistance, your cells do not get enough energy. Blood sugar (glucose) levels build up outside the cells. People with this type of diabetes may be able to manage their diabetes with a healthy diet and exercise only, but may need pills and possibly even insulin to keep blood sugar levels as close to normal as possible.

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• Proteins

Healthy Carbohydrates

When you have Type 1 diabetes, your body no longer makes insulin; you’ve lost your “keys.” Without insulin, blood sugar (glucose) builds up outside your cells, and as a result your cells do not get the energy they need to work right. People with this type of diabetes are insulin dependent; they require insulin to live.

TYPE 2 DIABETES

• Carbohydrates (carbs) • Healthy fats

The Main Types of Diabetes TYPE I DIABETES

A good meal plan includes:

Whole Grains

Fruits and Vegetables

High Water Content

Brown Rice Millet Whole Grain Pasta Oats Quinoa Wheat Germ Spelt Flour Rye Flour Oat Flour Almond Flour Buckwheat

Fingerling and Red Potatoes Sweet Potatoes Bananas Carrots Radishes Oranges Apples Melons Berries Mangos Kiwi Pears Peaches Nectarines

Okra Cucumbers Green Beans Asparagus Cabbage Eggplant Zucchini Tomatoes Lettuce Celery Broccoli Cauliflower Spinach Onions Watercress Brussels Sprouts Mushrooms Kale

Beans and Legumes Type 2 diabetes happens most often in adults, but unfortunately, more and more children are being diagnosed with Type 2 diabetes every day. A healthy diet, exercise and education is very important in Type 2 diabetes, and some people may also require medication to keep blood sugar (glucose) levels as close to normal as possible. While there’s no cure, you can manage your diabetes and have a healthy life.

S A L I N A S VA L L E Y M E D I C A L C L I N I C

Black, Kidney, White, Lima and Pinto Beans Garbanzo Beans/Chick Peas Split Peas Lentils

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Knowing your resources:

Healthy Proteins Plant Proteins

Animal Proteins

All beans (whole, not refried) Lentils Low-fat tofu Quinoa Buckwheat Seitan Tempeh Soybeans Edamame Hemp seeds Non-dairy milk (soy, almond) Sprouted grains bread products

White meat chicken or turkey (no skin) White fish (steamed, not fried) Egg whites Nonfat dairy (yogurt, milk, cheese)

Checking food labels:

• Changing your diet is not easy. It takes time and is a gradual process. The most important thing to be aware of is the type of food and how much of it you are putting in your body. • Your doctor, a diabetes educator or a dietitian can provide you with many resources to help you change your diet as well as learn about new foods and ways of cooking to help you keep your diabetes under control. Measuring your food: • A balanced diet means not only eating the right foods, but eating them in the right amounts. To make sure you’re not getting too much sugar from the food you eat, it’s important to control the portion size.

• It’s easy to go to the grocery store and grab items off the shelf without looking at the nutrition label. Take time to read the labels as you shop so you can be sure the foods you buy are not too high in sugar, salt, cholesterol and unhealthy saturated fat Sticking to your plan: • Making and following a meal plan is a good way to manage your diet without having to stress before each meal. Your doctor, a diabetes educator, a dietitian or other healthcare professional can help you set up meal plans that include the right foods, in the right amounts, at the right times.

The plate below shows suggested portions of vegetables and fruits, protein and carbohydrates.

Healthy Fats* Monounsaturated Fats

Polyunsaturated Fats

Fats that raise the good cholesterol (HDL) and help lower the bad cholesterol (LDL)

Fats that lower the bad cholesterol (LDL)

Olive oil Canola oil Sunflower oil Peanut oil Sesame oil Avocados Olives Nuts (almonds, peanuts, macadamia nuts, hazelnuts, pecans, cashews) Natural peanut butter

Soybean oil Corn oil Safflower oil Walnuts Sunflower, sesame, and pumpkin seeds Flaxseed Fatty fish (salmon, tuna, mackerel, herring, trout, sardines)

*While these fats are “healthy,” all fats increase insulin resistance and are concentrated in calories. Treat these foods as “condiments,” not entrees. A little bit goes a long way.

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S A L I N A S VA L L E Y M E D I C A L C L I N I C

HEALTHY OILS Opt for small amounts of healthy oils like canola and olive for cooking and on salads. Limit butter. Avoid trans fats.

OILS

VEGETABLES Eat plenty of vegetables and take advantage of the many choices available. FRUITS Choose from a range of colors and enjoy a variety of fruits. Avoid fruit juices.

LIVING WELL WITH DIABETES

WATER

WHOLE GRAINS VEGETABLES FRUITS

HEALTHY PROTEIN

BEVERAGES Drink water, tea or coffee. If you add sugar, use only a little. Limit milk and other dairy to 1 or 2 servings/day. Avoid sugary beverages like soda and fruit drinks. WHOLE GRAINS Include a variety of whole grains like whole-wheat bread, whole-grain pasta and brown rice. Limit refined grains used in white rice and white bread.

HEALTHY PROTEIN Healthy options include whole beans, lentils, nuts and skinless fish and poultry; rarely eat red meat and cheese. Avoid bacon, cold cuts and other processed meats.

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Simple Substitutions

SAMPLE MEAL PLAN: Pick no more than one from each selection.

SMALL CHANGES THAT MAKE A BIG IMPACT Breakfast

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Change This...

To This!

Eggs

Egg whites or tofu

Cold cereal

Old-fashioned oats/steel-cut oats and bran cereals with more than 5 grams of fiber per serving

White bread, wheat bread

Pumpernickel, rye, sourdough, multigrain or 100% whole wheat bread

Butter or margarine

Canola, olive or vegetable oil

Cheese

Low-fat or fat-free cheese

Whole milk or 2%

Fat free or 1% milk, or sugar free soy, rice or almond milk

Flour tortillas

Corn or low fat whole wheat tortillas

Canned fruit and vegetables

Fresh or frozen fruit and vegetables (avoid watermelon, pineapple and baking potatoes)

Snacks: cookies, chips, cake and ice cream

Fresh fruit, baked tortilla chips with salsa

Fast foods like burgers and fries

Bean & brown rice burrito (no cheese/sour cream) with salsa Salad bar (no pastas) with fat free dressing

Soda, sugary drinks

Water

Processed meats like hot dogs, spam, bologna and salami

Lean meats: white meat turkey, chicken, fish (no skin)

Refried beans and rice

Whole beans and steamed rice

S A L I N A S VA L L E Y M E D I C A L C L I N I C

• Hot cereals: oatmeal with cinnamon, raisins, and/or applesauce • All-bran or muesli with nonfat milk, soy or rice milk and/or berries, peach or banana • Apples, strawberries, bananas, oranges or other fruit • Pumpernickel or rye toast topped with jam (no butter or margarine) • Oven-roasted sweet potato with sautéed mushrooms, peppers and onions • Egg white or tofu scramble Lunch • Garden salad with lemon juice, fat-free or olive oil based dressing or low sodium soy/teriyaki sauce • Legume-based salads: Three-bean, chickpea, lentil or black bean and corn salad • Grain-based salads: noodle, couscous, quinoa, bulgur or rice salad • Soups: carrot-ginger, mixed vegetable, black bean, vegetarian chili, spinach lentil, minestrone, split pea, etc. • Hummus spread into a whole wheat pita with grated carrots, sprouts and cucumbers • Black bean and sweet potato burrito with corn and tomatoes Dinner • Pasta marinara: can be made with many commercial sauces (any brand less than 2 grams of fat per serving) • Beans and rice: black beans with salsa, vegetarian baked beans or fat-free refried beans • Soft tacos: soft corn tortilla filled with beans, lettuce, tomato and salsa • Fajitas: lightly sautéed sliced bell peppers, onion and eggplant with fajita seasonings; may also add white meat fish or chicken. • Chili: homemade or vegetarian boxed or canned versions • Veggie lasagna: low-fat tofu replaces the ricotta cheese, layered with grilled veggies, whole wheat pasta and low-fat pasta marinara • Vegetable stir-fry: vegetables seasoned with low sodium soy sauce or other low-fat stir-fry sauce and served over whole wheat pasta, beans or brown rice Snacks • Fresh fruit • Carrot, celery or other vegetables with low-fat hummus • Baked tortilla chips with salsa or low-fat bean dip • Air-popped popcorn

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KEEPING TRACK OF YOUR BLOOD SUGAR WITH A GLUCOSE METER

MEDICATIONS

Using a small drop of your blood, a glucose meter shows you the amount of blood sugar (glucose) in your blood at the time it’s tested.

While people with Type 1 diabetes take insulin rather than pills, people with Type 2 might take pills. If your healthcare provider prescribes pills, keep this important information in mind:

TAKING PILLS FOR YOUR DIABETES

Read the instructions for setting up and using your meter and follow these simple steps:

The basics:

1. Wash your hands with warm water and soap

• Diabetes pills help lower blood sugar

2. Insert a new needle or lancet in the device

• There are many different types of pills • Different pills work in different ways

3. Put the test strip into the slot on the meter

• Some people take more than one diabetes pill

4. Stick your finger with the lancing device. The center of the fingertip’s pad tends to be sensitive so try the side of the top part of your finger, next to your fingernail.

• Keep stress low

IMPORTANT REMINDERS: • Take diabetes pills at the same time each day • Never take more or fewer pills than prescribed without checking with your doctor • Some pills can be taken when you’re ill and others must be stopped. It is important to call your doctor to make sure you are taking the correct medication when you’re sick

• When to take your diabetes pills • If you should continue taking your diabetes pills when ill

Check your blood sugar every day: 1 time

2 times

3 times

4 times

Dinner

Bedtime

• What you should do if a pill is missed

Before / After: Breakfast

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• Stay physically active each day

Sometimes, questions come up and it’s always a good idea to talk to your doctor if you’re unsure about anything. Make sure you know:

6. Put the used lancet/needle in a sharps container or other sealed container. Do not reuse.

If you have questions, you can always call the number on the meter or ask your doctor or pharmacist.

• Eat the right servings of healthy foods

• Call your doctor if you are too ill to take your diabetes medication

5. Touch the tip of the test strip to the drop of blood. Within seconds, your blood sugar reading will appear on the screen.

Most devices store the readings. It’s not a bad idea to also record them in a logbook, noting the time and reading number.

TIPS FOR MAKING PILLS WORK BEST FOR YOU

Lunch

S A L I N A S VA L L E Y M E D I C A L C L I N I C

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USING INSULIN

MY MEDICATION & LOG BOOK

People with Type 1 diabetes and some people with Type 2 diabetes need insulin to keep blood sugar levels as normal as possible. Insulin works best when injected into fatty parts of your body, right under the skin. Check out the picture (diagram 1) for suggestions.

I am taking the following diabetes pills:

Always ask your healthcare provider if you are unsure about anything or have any questions about taking your insulin. Keep in mind that before leaving the doctor’s office, you should be able to:

1. Either the back or side of upper arms 2. Abdomen at least 2 inches from the belly button

• Prepare and inject insulin. Have someone show you how to draw up the right amount of insulin and how to give a shot. Practice before you leave the office. • Store insulin correctly. Insulin that is being used can be kept at room temperature. Unused insulin should be kept in the door inside the refrigerator, where it has little chance of freezing. • Know the names of your insulins (many people can use more than one type of insulin). Write down the names of the insulins and know the exact times you should be taking the insulin.

I am taking the following insulin:

3. Outer thigh area Log book Name of Insulin: BEFORE BEFORE BEFORE BEDTIME BREAKFAST LUNCH DINNER Blood sugar

Diagram 1



• Keep a record using a table like this one on page 13 (Log book).



Insulin/Meds

Blood sugar

• Know how to properly get rid of your syringes, insulin pens and lancets so they cannot hurt anyone in or outside your home.



• Ask your health care provider if you need a prescription for glucagon—an emergency kit sometime given to people who take insulin.

Insulin/Meds

Blood sugar Insulin/Meds Blood sugar

Insulin/Meds

Blood sugar

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Insulin/Meds

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DEALING WITH LOW BLOOD SUGAR (HYPOGLYCEMIA) When blood sugar is too low, it can be dangerous. It can happen fast and should be considered a medical emergency. Symptoms may include: • Feeling shaky or dizzy • Blurred vision • Feeling anxious or nervous • Fatigue or weakness • Headache • Hunger • Sweats or clamminess • Rapid heartbeat

If you have any symptoms, you should: • Immediately check your blood sugar • If below 70, you need sugar right away. Some ideas include: - 3 to 4 glucose tablets - ½ cup juice or soda - 1 cup nonfat milk - Eat 3 packets or 1 tablespoon of regular sugar • Check your blood sugar 15 minutes after you take sugar. If still below 70, repeat the process. • If it stays below 70 after treating a second time, you need to call your doctor.

DEALING WITH HIGH BLOOD SUGAR (HYPERGLYCEMIA) Blood sugar can get too high when you’re not getting enough insulin or your body isn’t using it effectively. High blood sugar can be dangerous and lead to many health problems. Typical causes: • Not taking enough insulin or missing insulin injections • Not taking your pills • Eating the wrong food, too much food, or not taking your insulin for your food • Not being active or being less active than normal • Dealing with stress related to illness, family, work, etc.

IMPORTANT: If you take insulin, you should also have a GLUCAGON EMERGENCY KIT. Ask your healthcare provider to write you a prescription for this kit and to explain how it should be used in an emergency when your blood sugar is so low you cannot eat or swallow.

Common symptoms when blood sugar level is low:

Hungry 14

• Blurred vision • Dry skin • Frequent need to use the bathroom to pee • Very tired • Very thirsty • Very hungry Steps to take: • Monitor your blood sugar more often; call your healthcare provider if your blood sugar continues to be over 250 • Continue to take prescribed pills/insulin • Drink plenty of water • Exercise, if possible; but not if your blood sugar is over 250. In some cases, exercise can make your blood sugar go even higher, not lower

Common symptoms when blood sugar level is high:

Very tired

Very hungry

Headache

Feeling shaky or dizzy

Warning signs:

Sweats or clamminess

Frequent need to use the bathroom to pee

Very thirsty 15

WHAT TO DO WHEN YOU ARE SICK

FROM EYES TO EXERCISE AND FOOD TO FOOT CARE

When you’re ill, your blood sugar can go up and down and it’s not always easy to control. When you have diabetes, colds, fevers or vomiting can be more serious. It is important to be aware when you are feeling under the weather and: • Stick to your normal meal plan as best you can • Stay hydrated—drink water or other non-caffeinated liquid every hour • Write down - Everything you eat or drink - Check your blood sugar every 4 hours, and write down the number and the time of the test

“The patient with diabetes who knows the most lives the longest.”

• If you have Type 1 diabetes, you should also check your ketones every 4 hours if your blood sugar is over 250. Ask your provider to write you a prescription for a ketone meter and strips or for urine ketone strips. Call your healthcare provider if your ketone test is positive

— Dr. Elliott Joslin

What kind of diabetes do I have? How do I check my blood sugars? What’s the best food to eat? Help, I’m low! What should I do? What can I do so I take fewer pills, not more? How do I prevent diabetes problems? How do I manage it all? If you’ve got diabetes questions, then we’ve got your answers! Diabetes is so much more than taking a pill or eating less sugar! This series of diabetes classes covers a wide range of topics to help you understand your diabetes and provides you with the skills you need to live healthy and well with diabetes.

• Always remember to contact a health professional if you: - Can’t eat or drink - Are vomiting or have diarrhea - Feel too sick to take diabetes pills - Are not able to control your blood sugar - If your ketone test is positive

DIABETES EDUCATION CLASSES:

Call _________________ at _________________ if you are not feeling well or have any of the symptoms listed above.

Salinas Valley Memorial Healthcare System, 450 E. Romie Lane, Downing Resource Center Located under the parking structure. Free valet parking. SPACE IS LIMITED. Pre-registration required. CALL TO SCHEDULE: 831-757-2058 Attendees can bring one person at no additional charge. Classes are billed to insurance if you have diabetes. Co-pays and deductibles apply. No cost for SVMHS employees. Cost without insurance is $50.00 per class.

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LIVING WELL WITH DIABETES

CLASS ONE: HOW TO THINK LIKE A PANCREAS CLASS TWO: THE POWER OF YOUR PLATE CLASS THREE: MANAGING AND MASTERING DIABETES CLASS FOUR: THINGS TO KNOW FROM HEAD TO TOE

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RESOURCES Diabetes & Endocrine Center at Salinas Valley Medical Clinic www.svmh.com/svmc • 831-757-2058 Provides education, management and treatment of diabetes in both English and Spanish.

LINKS/WEBSITES American Diabetes Association (ADA) www.diabetes.org • 800-342-2383 Offers educational information and resources in both English and Spanish. Juvenile Diabetes Research Foundation (JDRF) www.jdrf.org • 415-977-0360 Contact JDRF for resources on local groups. Diabetes Camps www.diabetescamps.org Diabetes Youth Families (DYF) www.DYF.org National Diabetes Information Clearinghouse www.diabetes.niddk.nih.gov Diabetes Monitor www.diabetesmonitor.com

MedicAlert Foundation www.medicalert.org • 800-432-5378 Alliance on Aging http://allianceonaging.org/resources • 831-758-4011 Resource list is available on-line (in both English and Spanish) of local organizations which serve older adults in Monterey County. The Blind and Visually Impaired Center of Monterey County www.blindandlowvision.org • 831-649-3505 Medication Monitoring www.mediguard.org (website and mobile app) www.healthcareready.org/rx-on-the-run

CLASSES Diabetes: From Eyes to Exercise and Food to Foot Care Call 831-757-2058 to register. Series of four, 2-hour classes covered by Medicare and most insurances. Kidney Smart https://kidneysmart.org • 855-343-4951 Visit website and click on “Find Classes Near You” to register. Classes are offered at Salinas Valley Memorial Hospital.

National Diabetes Education Program www.ndep.nih.gov

MOBILE APPS

Tu Diabetes www.tudiabetes.org

SVMHS Glucagon Lose It! My Fitness Pal Fooducate Calorie King

Carb DM https://carbdm.org

(Not all available on both iOS and Android.) 21 Day Vegan Kickstart My Net Diary My Medications MedCoach My Med Schedule Figwee

YMCA Diabetes Prevention Program http://www.centralcoastymca.org/programs/health- wellness-programs • 831-757-4633, extension 17 18

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LIVING WELL WITH DIABETES SVMHS Mktg/10-2015

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