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Understanding Type 2 Diabetes

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Understanding Type 2 Diabetes Understanding Type 2 Diabetes Your Guide to Healthy Living February 2017 Understanding Type 2 Diabetes If you have diabetes, prediabetes or high blood glucose (blood sugar)—or if you simply want to learn more about diabetes— this book is for you. Inside, you will find the basics of diabetes care, plus tools to help you manage your diabetes. As you read, keep in mind that diabetes is a complex disease. The knowledge and skills you need for diabetes self-management take time to learn. As you learn, you will be better equipped to adjust your lifestyle for better health. You are not alone. You have the support of a health care team that includes your health care provider and other diabetes experts. 7 Self-Care Behaviors The American Association of Diabetes Educators has a list of seven key behaviors, known as the AADE7TM Self-Care Behaviors, to help patients successfully manage type 2 diabetes and prevent complications. These include: healthy eating, being active, monitoring, taking medication, problem solving, reducing risks and healthy coping. When making healthier lifestyle choices, it helps to set goals in each of these seven key areas. Your health care provider can help you develop a diabetes management plan. Table of Contents What is Diabetes? . 2 Hyperglycemia (high blood glucose) . 25 What Causes Glucose Levels to Become Elevated . 2 Managing Sick Days . 26 Types of Diabetes . ... 3 Reducing Risks . 27 Diagnosis of Diabetes . 3 Complications and Symptoms of Diabetes . 27 Screening for Diabetes . 4 Heart Disease and Stroke . 29 Risk Factors for Type 2 Diabetes . 4 Caring for Your Feet . 30 Healthy Eating . 5 Protecting Your Teeth and Eyes . 31 Make Healthy Choices . 5 Preventing Kidney and Nerve Disease . 31 Choose the Right Portions . 5 Maintaining Your Sexual Health . 32 The Plate Method . 6 Immunizations . 33 Carbohydrate Counting . 7 Diabetes and Pregnancy . 33 Guidelines for Reading Food Labels . 9 Smoking . 33 Being Active . 10 Healthy Coping . 34 Exercise Offers Important Benefits . 10 Stress . 34 Types of Physical Activity . 10 Recognizing Depression . 35 Preparing for Exercise and Physical Activity . 12 Diabetes Burnout . 36 How to Create a More Active Lifestyle . 13 Taking Action . 36 Exercise Precautions . 13 Appendix . 39 Monitoring Your Blood Glucose . 15 Diabetes Health Record . 39 Blood Glucose Goals . 15 Blood Glucose Record . 41 A1C . 17 Carbohydrate Choices . 42 Non-starchy Vegetables . 46 Taking Medicine . 18 Proteins . 47 Oral Medicine . 18 Fats . 49 Injectable Medicine . 20 Disposal of Medical Waste . 52 Insulin . 21 Diabetes Resources . 53 Social Media Sites . 53 Problem Solving . 23 Mobile Apps . 54 Hypoglycemia (low blood glucose) . 23 What is Diabetes? Diabetes is a medical condition that develops when your body cannot regulate the level of glucose (sugar) in the blood. As a result, your blood glucose (blood sugar) levels become higher than normal. When blood glucose climbs too high, this affects the cells and tissues of your body. As a result, you can have uncomfortable symptoms—such as fatigue, blurry vision or extreme thirst. But that’s not all. Over time, unstable blood glucose can lead to serious and harmful complications. What Causes Glucose Levels 4 Glucose and insulin flow throughout the to Become Elevated bloodstream to all the parts of the body. 5 Insulin attaches to cells throughout the body, 1 Glucose is made by the liver. which open “channels” that allow glucose to move from the bloodstream into the cells. 2 Glucose is also made in the gut by the breakdown of carbohydrates from food and drinks. 6 The cells in the body use glucose for energy. 3 In response to glucose, the pancreas makes 7 Without a trigger by insulin, the channels remain and releases insulin. closed, and glucose is unable to enter the cells. 8 This causes glucose levels in the body to become elevated. 8 7 6 1 2 3 4 5 2 Types of Diabetes This is the most common type of diabetes. It can often be managed with healthy eating, exercise and Type 1 diabetes prescription medicine (pills). Some people may also need insulin injections to manage the disease. Type 1 diabetes occurs when the immune system mistakenly attacks the pancreas, damaging it so that it can no longer make insulin. Without any Prediabetes insulin, the glucose level in the body becomes Prediabetes occurs when blood glucose levels elevated. People with type 1 diabetes need to take are higher than normal, but not high enough to be insulin to manage the disease. diagnosed as diabetes. Prediabetes increases the This type of diabetes most commonly strikes risk of developing type 2 diabetes. Research has children, teens and young adults, but it can occur shown that healthy eating and lifestyle changes can at any age. To date, scientists do not know what help delay or prevent the onset of type 2 diabetes in causes type 1 diabetes, and type 1 diabetes cannot people with prediabetes. be prevented. Gestational diabetes Type 2 diabetes Gestational diabetes, also known as GDM, is high Type 2 diabetes occurs when the body becomes blood glucose that first shows up during pregnancy. unable to use the insulin you make. The pancreas GDM occurs when the body becomes resistant is then unable to make enough insulin to overcome to insulin due to the hormones from the placenta. the resistance. Without adequate insulin to It is usually diagnosed after the 24th week of overcome this resistance, the glucose level in the pregnancy. High blood glucose is harmful to both body becomes elevated. the mother and her developing baby. Women who have had gestational diabetes have a higher risk of developing Type 2 diabetes. Diagnosis of Diabetes In-range Prediabetes Diabetes Fasting Blood Glucose (mg/dL) less than 100 100-125 126 or higher Blood Glucose two hours after a less than 140 140-199 200 or higher 75 gram glucose tolerance test (mg/dL) 200 or higher Random Blood Glucose (mg/dL) (in a person having symptoms) A1C (%) less than 5.7 5.7-6.4 6.5 or higher Without clear symptoms of diabetes, test should be repeated to confirm diagnosis. 3 What is Diabetes? Screening for Diabetes additional risk factor (see table below) they should be screened regardless of age. Screening may be The American Diabetes Association recommends repeated every three years. Discuss screening for screening all adults age 45 and older for diabetes. diabetes with your health care provider. If a person is overweight or obese and has one Risk factors for type 2 diabetes • Smoking • Gestational diabetes or had a baby that weighed more than 9 pounds • Unhealthy eating • History of heart disease • Prediabetes • High blood pressure • Older age • High-density lipoprotein (HDL) • Overweight or obese cholesterol less than or equal to 35 • Physical inactivity • Triglyceride level greater than or • Family history of diabetes equal to 250 • Ethnic populations that are at • Polycystic ovarian syndrome higher risk: African American, Latino, Native American, Asian American, Pacific Islander 4 Healthy Eating Eating Right to Manage Diabetes How you eat is very important for managing your health and your diabetes. There is no standard meal plan or eating pattern that works for all people with diabetes. Work with your healthcare providers to learn what to eat, how much to eat and when to eat. This will help you manage your blood glucose levels and your weight. It may also help lower your risk of heart disease and other diabetes complications. Make Healthy Choices • Fat is found in many foods and there are many types of fat. Choose heart-healthy fats in As often as possible, choose nutritious, less- moderation if weigh loss is desired. processed foods. This can help you to achieve The following chart can help to estimate portion sizes. a healthy weight and manage diabetes. These include: Visual Aids to Help You Estimate • High-fiber foods such as whole grains, beans, Portion Size fresh vegetables and fruits. • Low-fat protein such as fish and seafood, soy products, fat free and low fat milk, cheese and yogurt, poultry without skin and lean cuts Visual Aids to Help Your Estimate of meat. • Choose heart-healthy fats such as olive, canola 1 cup = baseball or peanut oil, avocado, nuts, and seeds instead of butter. 3/4 cup = tennis ball • Eat fish twice a week, especially salmon and sardines, which contain omega 3 healthy fats. 1/2 cup = computer mouse Choose the Right Portions 1/4 cup = egg • How much energy (calories) you need depends on your age, gender, activity level and weight 3 oz. = deck of cards goal (desire to lose, gain or maintain weight). Weight loss can lead to improved glucose levels. 2 tablespoons = Ping-Pong ball • Energy (calories) comes from 3 key nutrients: • Carbohydrates turn into glucose, so spread evenly through the day. Two methods to help with portion control are “the • Protein builds and maintains muscle, helps plate method” and “carbohydrate counting”. you feel fuller longer and helps keep your blood glucose within range. 5 Healthy Eating The Plate Method The plate method is a good way to plan well- balanced meals that are limited in carbohydrates. Divide your food groups on a 9- to 10-inch plate as shown in the diagram. A common goal for meals may include two to four servings of carbohydrates. More detailed guides to help you choose the correct amount and type of foods to eat are on pages 7-9 and pages 42-51. General Guidelines: • A portion of whole grains, whole grain products (breads and cereals), lentils, dried beans, or starchy vegetables fits on one quarter of the plate. Breakfast • A portion of lean protein fits on one-quarter of the plate. • A variety of colorful, non-starchy vegetables fits on half the plate.
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