Type 2 Diabetes
              Things You Should Know
If you have type 2 diabetes, the information in this   CONTENTS
What is type 2 diabetes?
good news                 Type 2 diabetes happens when your body either doesn’t produce enoug...
How do I manage my diabetes?                                                                   Get the
  Taking responsibi...
Healthy eating
Tips for                    Healthy eating will help you to:
healthy eating:             • Feel better
Eat ...
Eating to avoid complications
  Fibre, vitamins – getting your fibre, vitamins and minerals is important to a
  healthy di...
Choosing artificial sweeteners
                         Artificial sweeteners or sugar substitutes do not provide calories...
You can prevent problems with your feet by:
 • Keeping your blood glucose levels in your target range                     ...
What is
                    What should I know
blood glucose?      about blood glucose?
Blood glucose
(sugar) is the      ...
Everyone’s target range is different. It depends on a person’s age, medical
   condition and other risk factors. Ask your ...
Low blood glucose
What is low             What causes a low blood glucose level (hypoglycemia)?
blood glucose?            ...
High blood glucose
What causes high blood glucose (hyperglycemia)?                                                    What...
Don’t forget
Know who
to turn to                                      Be prepared
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Type 2 Booklet (web version)


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Type 2 Booklet (web version)

  1. 1. Type 2 Diabetes Things You Should Know If you have type 2 diabetes, the information in this CONTENTS booklet will help you to better understand diabetes What is type 2 diabetes? and to live a long and healthy life. How do I manage my diabetes? You will find information about: • Healthy eating • Keeping active • How to live well with your diabetes • Looking after • How to avoid or delay complications your feet • Taking your • Your diabetes medication medication • Blood glucose testing What should • Important lifestyle changes I know about blood glucose? • Low blood glucose This booklet does not replace visits with your • High blood glucose • Managing your doctor and the rest of your healthcare team. blood glucose when Your healthcare team will work with you to develop a you’re sick treatment plan that meets your needs. Don’t forget
  2. 2. What is type 2 diabetes? The good news Type 2 diabetes happens when your body either doesn’t produce enough insulin, or use the insulin it does make properly – insulin is a hormone You can live a long produced by the pancreas. and healthy life by keeping your blood Many of the foods we eat, like bread, potatoes, rice, pasta, milk and fruits are glucose (the amount converted into sugar and give us the energy we need to maintain life. Insulin of sugar in your gets the sugar into the cells, but if you have type 2 diabetes, your body can’t blood) levels in do that without help. your target range. You can do this by: How did I get diabetes? As far as we know there is no single cause of type 2 diabetes, but some factors • Eating healthy put people at a greater risk, including: meals • Exercising • Being aged 45 years and over • Taking diabetes • Being overweight medication, if • Having a family member who has diabetes prescribed • Having had gestational diabetes (diabetes during pregnancy) Type 2 diabetes Should my family be tested for diabetes? is a progressive People should ask their doctor to be tested for diabetes if they: condition, and over time it may be • Are aged 45 or older harder to keep • Are overweight your blood glucose • Have a family history of diabetes levels in a target • Have given birth to a baby over 9lbs range.Your health- • Are of Aboriginal,Asian,African, or Latin-American descent care team can suggest alternatives. Complications of diabetes Diabetes is a life-long condition. High blood glucose levels over a long period of time can cause blindness, heart disease, kidney problems, amputations, nerve damage and erectile dysfunction. Good diabetes care and management can delay the onset of these complications. When you have your regular check-up, ask the doctor to check for complications. Make sure that you are referred to the appropriate specialist, if required. © Canadian Diabetes Association, 2002
  3. 3. How do I manage my diabetes? Get the Taking responsibility for managing your diabetes and looking after yourself will support you help you to delay or even prevent the onset of diabetes-related complications. need To manage your diabetes well, it is very important that you: It is not unusual to • Don’t smoke feel scared, shocked, • Live a healthy lifestyle overwhelmed and • Keep your blood glucose levels (the amount of sugar in your blood) even angry when in your target range you first hear that • Keep your weight in a healthy range you have diabetes. • Keep your blood pressure close to target level A positive and Living a healthy lifestyle includes: realistic attitude towards your • Managing your stress effectively diabetes can help • Following a balanced meal plan you to maintain • Being physically active good blood glucose • Taking care of your feet levels. • Regular visits to your – dentist Blood glucose levels – eye specialist (at least every two years) in your target – doctor for diabetes management range can help delay or even Your diabetes healthcare team can help prevent diabetes Ask your doctor about diabetes education.Your healthcare team can answer all complications. your questions and tell you more about diabetes. For example: • The nurse can explain diabetes and show you how to manage your diabetes Talk to others who • The dietitian can help you with a meal plan have diabetes – ask your local Canadian Your team may also include a: Diabetes Association branch about joining • Pharmacist a Support Group • Social worker or visiting an • Psychologist Information Session. • Foot care specialist • Endocrinologist • Opthamologist © Canadian Diabetes Association, 2002
  4. 4. Healthy eating Tips for Healthy eating will help you to: healthy eating: • Feel better Eat three regular • Stay healthy longer meals a day no more • Achieve the best possible control of your blood glucose, blood fats, than six hours apart. and blood pressure • Reduce the risk of complications Here’s Why: Visit your dietitian Eating at regular times helps your Dietitians are a very important part of your healthcare team.Your dietitian body control blood understands that your meal plan needs to be flexible and will help you to develop glucose levels. a personalized meal plan.The dietitian will: • Determine how much and how often you should eat, and plan for delayed meals Limit sugars and • Fit your lifestyle changes into your meal plan sweets like sugar, • Adapt your meal plan to fit in foods from your culture regular pop, desserts, • Adjust your meal plan so that you can still eat your favourite foods candy, jam and honey. Having diabetes doesn’t mean that food has to be a source of fear and guilt – you can still enjoy the foods that you and your family usually eat! Here’s Why: The more sugar Choose foods that provide energy you eat the higher Many of the foods we eat turn into sugar and give us the energy we need to your blood glucose live.Your body uses the sugar for energy. Ask your dietitian to help you plan will be. your meals to suit your lifestyle. Limit the amount of Here are examples of foods that provide energy from sugar: high fat food you eat • Starchy foods (e.g. bread, rice, pasta, potato) like fried foods, chips • All fruits and pastries. • Some vegetables (e.g. carrots, peas, squash) • Milk and milk products (e.g. milk, yogurt) Here’s Why: High fat foods may Foods that are high in sugar like cakes, pies, syrups, jam and candy are high in cause weight gain. calories and low in nutrients – discuss these with your dietitian. A healthy weight helps control A sign of high blood glucose is thirst. If you are thirsty, drink water – drink blood glucose 8-10 8-ounce glasses of water a day. Regular soft drinks and juice have sugars levels. that raise your blood glucose level – drink limited quantities. Note: the sugar in juice is very concentrated and will raise your blood glucose more quickly than eating fruit so choose whole fruit more often. © Canadian Diabetes Association, 2002
  5. 5. Eating to avoid complications Fibre, vitamins – getting your fibre, vitamins and minerals is important to a healthy diet. Make sure your meals have variety and include vegetables and Tips for fruit, proteins and alternatives and whole grain breads and cereals. healthy eating: Fat – Eating less fat is important for people with diabetes because they are at Eat more high a greater risk for developing high levels of fats in their heart and blood vessels. fibre foods. Many people already have high levels of fat before they are diagnosed with diabetes. Eating less fat is one way to help your heart stay as healthy as possible. Here’s Why: High fibre foods Salt – High blood pressure is also a potential complication of diabetes. Limiting may help you feel how much salt you eat can help control your blood pressure. full and may lower blood glucose and Drinking alcohol cholesterol levels. Drinking moderate amounts of alcohol may be acceptable for people with diabetes. Discuss drinking alcohol with your health care team. Drink water if you are thirsty. A moderate amount is one to two drinks a day. Drinking alcohol is not recommended if you: Here’s Why: • Have high triglycerides (blood fats) Drinking regular • Have high blood pressure pop and fruit juice • Have liver problems will raise your • Are pregnant or breastfeeding blood glucose. If you choose to drink alcohol, remember Add physical activity to your life. • To drink with your meal or snack and not on an empty stomach • To sip your drink slowly or dilute it with diet gingerale, club soda or water Here’s Why: • Liqueurs, sweet wine and dessert wines have a lot of sugar Regular physical Caution: When you drink alcohol it is a good idea to wear your MedicAlert® activity will improve identification. Alcohol can cause hypoglycemia (low blood glucose). Talk to your blood glucose your doctor about the effect of alcohol on your medication.Your dietitian can control. tell you on how much alcohol you can safely include in your meal plan. © Canadian Diabetes Association, 2002
  6. 6. Choosing artificial sweeteners Artificial sweeteners or sugar substitutes do not provide calories and do not Small everyday affect or raise blood glucose levels. changes can make a All sweeteners available in Canada go through rigorous testing. Once they have difference. been approved they are suitable for use by all Canadians, including those with diabetes. Artificial sweeteners approved for use in Canada include Sweet n’ Low®, • Consider walking Equal®, Sugar Twin®, Splenda® and Nutrasweet®. instead of driving • Get off the bus a Caution: If you are pregnant, or planning a pregnancy, discuss the use of stop early artificial sweeteners with your dietitian. • Take the stairs • Play with Keeping active your kids or Being active is one of the best things you can do to improve your overall health. grandchildren For a person with diabetes it can: • Take up gardening • Lower your blood glucose • Lower your blood pressure Before • Help you lose or maintain weight you start a • Help you feel better new activity • Reduce the amount of medication you need remember to: • Relieve tension or stress • Improve your heart and lung function • Discuss it with • Improve your muscle tone your doctor • Take some Being active should be fun – do the things that fit into your lifestyle and that glucose tablets or you enjoy, like walking, swimming, or riding your bike.Your healthcare team candy containing can help you decide what activities will work best for you. sugar with you in case your Looking after your feet blood glucose When you have diabetes it is important to take good care of your feet. High drops to low. blood glucose levels may eventually lead to poor blood flow and loss of feeling • Make sure you in your feet which can lead to foot problems. are wearing comfortable and well-fitting shoes © Canadian Diabetes Association, 2002
  7. 7. You can prevent problems with your feet by: • Keeping your blood glucose levels in your target range Talk to your • Washing daily with warm (not hot!) water and pat dry pharmacist • Checking your feet every day for sores, injuries, red and warm areas on the skin, change in colour, strange odour and other problems. Don’t forget to look In order to work at the bottom of your feet for sores or blisters. well, medicines • Making sure you wear shoes with good support and socks that fit well and that have to be taken do not hurt your feet properly.You can • Not walking barefoot help determine the • Asking your diabetes educator how to cut your toenails properly success of your • Using lotion on the soles to keep the skin soft and prevent dry, cracked skin therapy by taking • Avoiding crossing your legs, squatting or kneeling for long periods of time charge of your • Avoiding using heating pads, hot water bottles or campfires to warm your feet medication compli- ance. Compliance Talk to your healthcare team if you: means taking the • Soak your feet correct amount of • Use corn removal products the right medication • Have concerns about your feet at the appropriate • Notice that cuts and sores are not healing well time and following the instructions Taking your medication precisely.Talk with your pharmacist Healthy eating and regular physical activity are sometimes not enough to keep to make sure you your blood glucose at your target level.When this happens, your doctor may understand the prescribe medication that will help you manage your blood glucose levels. directions for each Every person is different and may require different types of medication to get new prescription good control. you get. Ask your doctor, pharmacist or diabetes educator how and when to take your medication. Any changes to your eating habits and medication should be adjusted to suit your lifestyle. For some people, pills do not work, so they take insulin injections instead.This means that the body is no longer making enough insulin. Remember that insulin is a hormone produced by your body, and your body may not have enough. If you need to take insulin, you will find that it makes you feel better and gives you the energy you need. Don’t be afraid of insulin injections – thousands of Canadians take one or more a day, and most say that it is much easier than they expected. For more information about insulin, ask your healthcare team, read the Canadian Diabetes Association’s brochure, Insulin,Things You Should Know or visit our website at www.diabetes.ca. © Canadian Diabetes Association, 2002
  8. 8. What is What should I know blood glucose? about blood glucose? Blood glucose (sugar) is the Why should I check my blood glucose levels? amount of glucose Checking your blood glucose levels will: in your blood at • Give you a quick measurement of your blood glucose level at ‘that’ time. a given time. • Tell you if you have a high or low blood glucose level at ‘that’ time. • Show you how your lifestyle and medication are affecting your blood glucose levels. • Help you and your diabetes healthcare team to make changes to your lifestyle and medication that will improve your blood glucose levels. How do I test my blood glucose levels? A blood glucose meter is used to test your blood glucose at home. Meters can be purchased at most pharmacies.Talk with your diabetes educator or pharmacist about which model is right for you.When you decide, make sure you receive the proper training before you go home. Ask your diabetes educator about: • The size of the drop of blood needed • The type of blood glucose strips to use • How to clean the meter • How to check if the meter is accurate • How to code your meter Note: Your province or territory may subsidize the cost of blood glucose monitoring supplies. Contact your local Canadian Diabetes Association branch to find out if this applies to you. How do I keep my blood glucose levels in my target range? If you have diabetes, you should try to keep your blood glucose as close to target range as possible.This will help to delay or prevent complications. Maintaining healthy eating habits, an active lifestyle and taking medication if necessary, will help you stay in your target range. © Canadian Diabetes Association, 2002
  9. 9. Everyone’s target range is different. It depends on a person’s age, medical condition and other risk factors. Ask your doctor what your levels should be and write them down on the chart below. Hemoglobin A1c The Canadian Diabetes Association’s Clinical Practice Guidelines for the Management of Diabetes in Canada provides people with diabetes goals for levels of glucose control. Another way to monitor your blood glucose management is by a blood test that Levels of Glucose Control for People With Diabetes* your doctor can (adults and adolescents) request called Hemoglobin A1c. Optimal Suboptimal Inadequate “My Target The results of this Range” test are an average target goal action may be required action required ask your doctor of your overall blood glucose levels Glucose 4–7 7.1– 10 Over before meals mmol/L** mmol/L 10 mmol/L over the past 60 – 90 days. Glucose 1-2 hrs 5.0 – 11 11.1– 14 Over 14 after eating mmol/L mmol/L mmol/L HbA1c Less than 0.07– 0.084 Over (depending on lab) 0.07 0.084 *varies for children **millimoles of glucose per litre of blood This information is only a guide.Talk to your doctor about YOUR blood glucose target ranges. © Canadian Diabetes Association, 2002
  10. 10. Low blood glucose What is low What causes a low blood glucose level (hypoglycemia)? blood glucose? Low blood glucose may be caused by: When the amount • More physical activity than usual of blood glucose • Not eating on time (sugar in your • Eating less than you should have blood) has dropped • Taking too much medication below your target • The effects of drinking alcohol range (less than 4 mmol/L) it is called Low blood glucose can happen quickly, so it is important to take care of it low blood glucose right away. or hypoglycemia. If your blood glucose drops very low you may: • Become confused and disoriented What are the • Lose consciousness signs of a low • Have a seizure blood glucose You will need assistance from another person. Make sure you always wear your level? MedicAlert® identification, and talk to your doctor or diabetes educator about prevention and emergency treatment for severe low blood glucose. You may feel: • Shaky, light-headed How do I treat a low blood glucose? • Nervous, irritable Check your blood glucose immediately. If you don’t have your meter with you, • Confused treat the symptoms anyway. It is better to be safe. • Hungry • Your heart rate Eat or drink a fast-acting carbohydrate (15 grams): is faster • 5 glucose tablets • Sweaty, headachy • 3/4 cup (175 mL) of juice OR regular pop • Weak • 8 Lifesavers® OR 5 hard candies • A numbness or • 3 teaspoons (15 mL) of honey tingling in your tongue or lips Wait 10 to 15 minutes, then check your blood glucose again. If it is still low: • Treat again • If your next meal is more than one hour away, or you are going to be active, eat a snack, such as a half-sandwich or cheese and crackers (something with 15 grams of carbohydrate and a protein source.) © Canadian Diabetes Association, 2002
  11. 11. High blood glucose What causes high blood glucose (hyperglycemia)? What is high High blood glucose can result when food, activity and medications are not blood glucose? balanced. High blood glucose may happen when you are sick or under stress. When the amount What do I do if I have high blood glucose? of blood glucose (sugar in your Call or see your doctor, you may need to: blood) is higher • Adjust your medication and/or insulin than your target • Adjust your meal plan range it is called • Increase your physical activity high blood glucose or hyperglycemia. Managing your blood glucose when you’re sick What do I do when I'm sick? What are the When you are sick you should test your blood glucose levels every two to four signs of high hours. It is very important that you continue to take your diabetes medication. blood glucose? High blood glucose levels often happen during flu season. Many cold remedies When your blood and cough syrups contain sugar – try to pick sugar free products.The pharmacist glucose rises above can help you make a good choice. 11 mmol/L, you may: When you are sick it is VERY IMPORTANT that you: • Be thirsty • Urinate more • Drink plenty of extra sugar-free fluids or water. often • Replace solid food with fluids that have glucose if you can't eat as usual. • Be tired You should try to consume 10 grams of carbohydrate every hour. • Call your doctor or go to an emergency room if you vomit more than twice in 12 hours. • Continue to take your insulin, if you take insulin.You might need to take more than usual depending on your blood glucose levels. © Canadian Diabetes Association, 2002
  12. 12. Don’t forget Know who to turn to Be prepared If you experience severe low blood glucose, you will need help.Talk to your The Canadian doctor or diabetes educator about prevention and emergency treatment, and Diabetes Association tell your family, friends and co-workers how they can help. works to prevent diabetes and improve Always wear your MedicAlert® identification. the quality of life for those affected, Report your diabetes to the motor vehicle licensing office through research, In most provinces and territories a licensed driver who has diabetes must report education, service their condition immediately to the motor vehicle licensing office. and advocacy. Be aware of the changes to your insurance Canadians can turn People with diabetes, may find it more difficult to obtain or renew insurance of to the Canadian all types: vehicle, mortgage, life and travel. Diabetes Association for answers and The Canadian Diabetes Association offers its members the opportunity to help in accessing purchase both travel insurance, which covers all diabetes-related emergency diabetes resources expenses, and credit life insurance. across the country. Be aware of your workplace rights Operating through There is no evidence that people who have diabetes are a greater safety risk at more than 150 work than people who do not have diabetes.You should not need more time locations, the away from work due to illness than other employees. If you think that you are Canadian Diabetes not being treated fairly in your workplace, contact your local Canadian Diabetes Association’s strong Association branch. network of assistance includes volunteers, Talk to us about: employees, health- • Becoming a member, volunteering or making a donation care professionals • Access to travel and Credit Life Insurance for people with diabetes and partners. • Joining a local support group • Obtaining the most up-to-date information on diabetes Canadian Diabetes Association National Office: 15 Toronto Street, Suite 800,Toronto, ON M5C 2E3 Phone: (416) 363-3373 Fax: (416) 363-7465 1-800-BANTING (226-8464) www.diabetes.ca Email address: info@diabetes.ca Presence of the Aventis logo does not constitute an endorsement of the products or services of Aventis. Aventis Pharma is proud to support diabetes research, education, service and advocacy in Canada through the Canadian Diabetes Association. 112006 02-117 04/02 Q-100M