Living with Diabetes

There are many ways to cope with stressful situations in your life, such as being diagnosed with Diabetes. Here are a few of the things to do in order to cope in a healthy way:

Tip #1: Accept the diagnosis

Accepting the diagnosis is an emotional adjustment which involves acknowledging important feelings of denial, anger, guilt, or fear about your future health. Acknowledging these emotions by talking to others can be a helpful step in taking control of your diabetes.

Tip #2: Build a solid network of support

It is essential to build a network of support by first telling your friends and family about the diagnosis. Then turn to your physician, diabetes education, and treatment team to help you adjust to lifestyle changes, such as medication management, eating a balanced diet, and getting regular exercise.

Tip #3: Stay motivated to continue taking care of yourself

Diabetes can be an especially emotional and overwhelming diagnosis because it is a chronic condition. Motivation to keep taking care of yourself can come through diabetes support groups, reaching out to friends and family, and being educated about your diabetes.

When you understand your own diabetes, you can better manage lifestyle changes and learn to cope with the emotional adjustment to diabetes.

Checking Blood Sugar

Checking your blood sugar (blood glucose) is important. Changes in blood sugar are common and can vary greatly throughout the day depending on what you eat, your activity, and medications you take.

• Write your blood sugar results in your diary.
• Take the diary with you to your regular doctor appointments.
• The doctor or the diabetes educator will review and discuss your results with you.
• Your doctor may adjust your medicine if your blood sugar is too high or too low.
• The diary will also help you see how your meals, activity and medicines work together to control your blood sugar.
• Controlling your blood sugar can delay or prevent diabetes complications such as heart attack, stroke, or blindness.

How do I check my blood sugar?

You will use a blood glucose meter to check your blood sugar several times a day. A meter is a small device that tests a tiny drop of blood and then displays your blood sugar level at that moment. A lancet is a device used to prick the skin to get the drop of blood. The results are used to make decisions about food, physical activity, and medications.

Areas other than the finger maybe used such as the fleshy part of the hand, the forearm, the outer thigh, the calf or the stomach. Experts recommend using the side of the fingertip to get the most accurate result. There are times that other sites should not be used because the result may be less accurate. These times include:

• If your blood sugar is likely to be low
• If you have trouble knowing your blood sugar is low (Hypoglycemia Unawareness)
• If less than 2 hours after starting a meal
• You have been physically active

Talk with your doctor or pharmacist to see what meters and supplies are covered by your insurance. If you do not have insurance, store brand meters and supplies are usually less costly.

What are the blood sugar targets for people with diabetes?

For most people, the American Diabetes Association recommends

• When I wake up and before meals: 80 to 130 mg/dL 
• 2 hours after starting a meal: below 180 mg/dL 

When is the best time to check blood sugar and how often?

Most people check their blood sugar after fasting (first thing in the morning before they eat) and before other meals. Your doctor may ask you to test your blood sugar after a meal (post-prandial) when your blood sugar may be higher. Usually a post-prandial blood sugar is checked 2 hours after eating.

Other times you may want to test are:

• When you have symptoms of high or low blood sugar.
• When you are ill, especially if you are throwing up or dehydrated.
• Before, during and after exercise.
• Before you go to sleep.

If you are using the results to decide on how much insulin to take, you will need to check your blood sugar several times during the day. Some people only need to check once or twice a day. If you are making medication changes, changing your activity or meal plan, if you are pregnant or if you are ill, you may need to check more often. Your health care team can help you to decide how often you should test.

How do I know my results are accurate?

Follow your meter’s instructions when doing your check.

• Keep your meter clean.
• Check test strips to make sure they are not past their expiration date.
• Do not leave testing supplies in a hot car or direct sunlight, or in the freezer.
• Make sure skin is clean and dry before testing.
• Make sure your blood sample is big enough.
• Check your meter with control solution as recommended by manufacturer.

All meters have a 1-800 phone number on the back in case you have questions about your meter. Your doctor will write prescriptions for your glucose meter and supplies. Insurance pays part of the cost of meters and supplies. Store brand meters and supplies may be less expensive if you do not have insurance.

Check with your doctor and your healthcare team to make sure these goals are correct for you.

Exercise helps you lose weight and/or stay at a healthy weight as well as improve your blood sugar. It also helps your heart stay healthy. For the person with diabetes, exercise is as important as diet and medication. You should get at least 30 minutes of physical activity that increases your heart rate 5 days a week.

It is important to design a lifelong home exercise routine. Walking is one of the easiest and most convenient options, but there may be others you enjoy. Exercise should be continuous and rhythmical. It should be done at a comfortable pace. “No pain, no gain” does not apply.

If you stick with a regular, consistent program, you can expect these rewards:

• Increased insulin sensitivity
• Lower blood sugar levels
• More energy and endurance (stamina) throughout the day
• Improved appearance
• A slimmer, trimmer body
• Better posture
• Weight loss
• Less body fat
• Increased muscle tone
• Decreased appetite following exercise
• Lower heart rate and blood pressure
• Stronger heart muscle and better blood flow: the more you use your heart muscle, the stronger it becomes
• Better sleep at night
• Stronger bones and a lower risk of osteoporosis
• Better resistance to illness
• Improved cholesterol
• Lower stress, anxiety, boredom, frustration and depression

Recommended Exercise for Diabetes Management

The American Diabetes Association recommends two different types of exercise for managing diabetes: aerobic and strength training.

Aerobic Exercise

This exercise is done by using your arms and/or legs in a continuous, rhythmic movement in order to increase your heart rate (pulse).

Aerobic activities include:

• Aerobics
• Running
• Dancing
• Skating (ice or roller)
• Biking/Stationary bike
• Hiking
• Swimming
• Jogging/Walking
• Rowing

Note: Moderate intensity means that you are working hard enough that you can talk, but not sing, during the activity. Vigorous intensity means you cannot say more than a few words without pausing for a breath during the activity.

These types of exercise can make all the muscles in your body stronger. Pick an aerobic exercise that you enjoy and set realistic goals. This way you will be more likely to keep doing it on a regular basis.

Strength Training

Strength training (also called resistance training) makes your body more sensitive to insulin and can lower blood sugar.

The American Diabetes Association recommends doing strength training exercises at least 2 times per week in addition to aerobic activity. Some people have higher blood sugars after doing strength training. It is a good idea to check your blood sugar before and after these exercises.

Below are examples of strength training activities:

• Weight machines or free weights at the gym
• Using resistance bands
• Lifting light weights or objects like canned goods or water bottles at home
• Exercises that use your own body weight to work your muscles (examples are pushups, sit ups, squats, lunges, wall-sits and planks)
• Strength training classes
• Other activities like heavy gardening that build and keep muscle.

Flexibility and Balance Training

Flexibility and balance training is recommended 2-3 times per week for older adults. This includes activities like yoga and tai chi to increase flexibility, muscular strength and balance.

Exercise in the Presence of Uncontrolled Blood Sugars

High Blood Sugar

For people with type 1 diabetes who have ketones in the urine and/or blood, exercise can cause blood sugar and ketones to go up further. Ketones are made when body fat is broken down for energy because glucose is not getting into the cells. Vigorous activity should be avoided when your blood sugar is high and there are ketones in your urine. Ketones are checked for using a strip that is dipped in your urine. You can exercise when your blood sugar is high as long as there are no ketones in your urine. 

Low Blood Sugar:

In people taking insulin and/or medications such as glipizide or glyburide (insulin secretagogues), exercise can cause low blood sugar if medication dose or carbohydrate intake is not changed.

For people on these medicines, extra carbohydrate should be eaten if pre-exercise sugar levels are 100 mg/dL or less.

Low blood sugar is less common in diabetic patients who are not treated with insulin or insulin secretagogues, and no preventive measures for low blood sugar is usually needed in these cases.

Hints for a Successful Exercise Program

• Talk with your doctor before starting any exercise program.
• Set short- and long-term goals for yourself. Reward yourself when you meet them.
• Exercise with music or in front of the television.
• Wait one hour after eating before exercising.
• Pick an exercise you like that fits into your lifestyle.
• Exercise with a friend for both safety and motivation.

Stop exercising and call 911 immediately if you have any of these symptoms during, or even several hours after, exercise:

• Lightheadedness or dizziness
• Rapid heart beat
• Chest discomfort
• Jaw, arm, or upper back discomfort
• Nausea
• Unusual shortness of breath
• Sudden weakness
• Severe or unusual fatigue or sleepiness
• Severe discomfort of any kind

**Be aware that exercise can lower blood sugar quickly. Blood sugar should be monitored before and after all exercise routines.

The more you know about your diabetes and how to control your blood sugar levels, the better off you will be. Below are tips for managing your diabetes at your workplace. Organization and planning are important keys.

Never skip breakfast

• Prepare breakfast, either at home or on-the-go, the night before

Educate your co-workers and supervisors on diabetes

• If you experience low blood sugar levels, explain the signs (e.g., shakiness, confusion, sweating) and treatment (e.g., small box of raisins, ½ cup regular soda, ½ cup orange juice, 6 Lifesavers®

Bring your lunch or know the healthy choices at area restaurants or the cafeteria

Bring snacks

• Nuts
• Juice boxes
• Individual fruit cups
• Individual sugar-free gelatin cups
• Sweetener
• Sugar-free chewing gum

Wear a diabetes ID bracelet or necklace

Keep moving

• Leave a pair of walking shoes at work to use at lunchtime
• For sitting jobs, get up every hour and walk for 5 minutes

Manage stress

• Deep breathing
• Meditation
• Short walk

Your diabetes goes with you when you travel so why not continue your good control while you are gone to make the trip safe and less stressful. Maintaining your blood glucose control will help you feel well so you can enjoy the trip.

Packing:

Make sure you pack enough medication and testing supplies for the entire trip. If you are on insulin and will be traveling by air, it is helpful to have a letter from your doctor stating your diagnosis and the medications that you are currently taking. Medications should be in the original prescription bottle with the label intact.

Carry-on:

Pack a small carry-on bag that contains all your diabetes supplies and all medications. Take extra medications and monitoring supplies in case you are delayed or canceled. Insulin should be kept in a cool dry place. Do not put it in the trunk of the car or in your checked luggage. You should include snacks and low blood sugar treatment. You may want to include batteries for your meter or replace them before you go.

Meals:

Maintain your usual eating plan as close as possible. Look for new things to try but don’t overeat. You can research the local cuisine of your destination to determine the carbohydrate content of new foods. Drink plenty of non-sweetened beverages to prevent dehydration.

Be Prepared:

Low blood sugar (hypoglycemia) is more likely to occur when traveling because of changes to the routine. Be prepared with snacks, your meter, and have your low blood sugar treatment available at all times.

Remain Active:

Physical activity helps your body use insulin effectively so don’t reduce your normal activity while traveling. Many hotels have fitness rooms or pools. Look for walking and hiking paths to explore your destination.

Timing:

Time zones can throw you off when trying to carefully plan meals and medication timing. Try to adjust your medications and meals to the new time zone as soon as possible.

Travel is possible with diabetes and can be enjoyable and smooth if you are prepared for the snags that occur in any trip. Don’t let your diabetes be one of the snags!

If you are going into the hospital, you can expect changes in your glucose readings and changes to your diabetic medications while you are in the hospital.

What Can I Expect?

Stress and certain medications will alter your glucose. Changes you may experience in diet while in the hospital will also alter your glucose.

You can expect to receive insulin injections while hospitalized since this is the expert’s recommendation to manage your diabetes while ill or having surgery.

As long as you had good diabetes control at home, you will most likely resume the same routine when you are discharged.