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living with diabet

 

You can manage your diabetes by setting short-term and long-term goals for your meal planning, blood glucose monitoring, and exercise.

Meal planning: Work with a dietitian to develop a meal plan that works with your daily schedule and lifestyle. For example, if you need to lose weight, your short-term goal might be to follow your meal plan and lose one pound a week for 10 weeks. Your long-term goal would be to lose 10 pounds and maintain the weight loss.


Blood Glucose Monitoring:  You and your doctor can decide on:
  • The best blood glucose meter for you
  • How often you need to check your blood sugar
  • Your blood sugar "target range"
Your short-term goal is to decide on a schedule for checking your blood sugar that works for your lifestyle. Your long-term goal is to monitor the effect of food, exercise, and stress on your blood sugar.

Exercise: Your doctor may develop an exercise plan for you or recommend a visit to an exercise specialist. Your short-term goal is to start the program; the long-term goal is to monitor the effects on your blood sugar levels.
Dealing with Setbacks: Everyone has setbacks from time to time. Maybe you forgot to test your blood sugar, missed a scheduled meal, gave into a sweets craving, or skipped a workout at the gym. There are lots of reasons for setbacks.
But don't let setbacks stop you from staying focused on your goals. Try these helpful hints:
  • Set an alarm to remind you to test your blood sugar at the right times.
  • Add an extra walk to your schedule so you can have an occasional treat.
  • Ask a friend to join you for your daily walks or workouts to make exercise more fun.
Blood Glucose Monitoring
Because of the nature of diabetes and its short- and long-term complications, it's important that you have a constant awareness of the level of glucose (sugar) in your blood. In fact, a "Blood Glucose Monitoring" (BGM) program is an essential part of any diabetes management plan.

Monitoring your blood sugar will tell you how your body is responding to certain foods, activities, and medications, and will help you manage your meal and exercise plans. With the data you get from monitoring, you and your doctor can:
  • Identify trends in your glucose levels
  • Identify factors that may cause high or low glucose levels
  • Evaluate the impact of food, activity, and medications on your diabetes
  • Identify where changes in the treatment plan are needed
  • Decide what you need to do when you are sick
  • Confirm whether or not the feelings you have are the result of low or high blood glucose or if it is something unrelated to your diabetes.
Six steps to proper monitoring
  • Know your blood sugar target
  • Learn how to check your glucose
  • Decide when to check your glucose levels
  • Identify glucose patterns
  • Determine what causes blood glucose changes
  • Decide what to do to get your blood glucose levels back on target
Setting Targets
Just how important is it to keep your blood sugar close to your target? According to one study, people with type 1 diabetes can reduce the risk of the complications associated with diabetes - including the ones leading to blindness, kidney failure and amputation - by as much as 76 percent by lowering blood sugar to normal or near-normal levels. Other studies have shown reductions in complications of up to 25-70 percent for type 2 patients.

Blood sugar targets vary from person to person and can even vary in the same person over time. You and your doctor should work together to determine what your target blood sugar range should be. Many doctors use guidelines developed by the American Diabetes Association as a starting point.

Blood glucose meters read either plasma values or whole blood values. Check the user manual that came with your meter to find out whether it reads plasma or whole blood, and then refer to the appropriate row in the chart below.
ADA Recommended Target Blood Sugar Levels
(source: American Diabetes Association)
Normal
Target Range for People with Diabetes
Plasma blood values *
 
 
Average pre-meal glucose (mg/dL)
Less than 100
90-130
Average post-meal glucose (mg/dL)
Less than 110
Less than 180
* Measurement of capillary blood glucose
Note: The above values are for non-pregnant adults and are averaged for the entire population of people with diabetes. Patients with other diseases, as well as the very young, older adults, and people with unusual conditions or circumstances may need different target goals.
The table shows that people with diabetes should keep their blood glucose levels within a target range. Your doctor can determine a target that is appropriate for your individual health condition and lifestyle by considering such specifics as:
  • Your willingness to test your blood sugar levels often.
  • Your willingness to follow an intensive treatment plan.
  • Your risk for severe hypoglycemia and your ability to recognize its symptoms.
  • Your age.
  • Other health conditions you might have, such as cardiovascular disease, kidney disease, or pregnancy.
 
Achieving Your Blood Glucose Target
To keep your blood sugar at or near your target, you and your doctor should develop an individual treatment plan that includes the following elements:
  • Keeping track of your blood glucose levels
  • A meal plan that is right for your lifestyle and your taste buds
  • Regular exercise
  • Continuing education and explanations of your regimen
  • Regular review of your treatment goals

Ask your doctor for guidelines so you'll know when to notify the office about blood sugar results. Your doctor should tell you when to report high blood sugars. For example, he or she may want you to report:
  • Blood sugars that are consistently running higher than 300 mg/dL for more than two or three days
  • Any illness that's accompanied by nausea, vomiting, diarrhea, or fever
When to Test
Ask your doctor or nurse educator how often you should check your blood glucose.
Some people need to check several times a day; others may only need to check a few times a week.
You may want to check at different times of the day to get an idea of how well your diet and exercise program is working for you.
Typical times to check are before breakfast, before lunch, before dinner, and before bedtime. Sometimes it is helpful to check blood glucose one or two hours after a meal to see the effect of food on your glucose levels.
 
There are certain times when you should check your blood glucose more often than usual:
  • During periods of illness or stress
  • When you suspect that your blood glucose is high
  • When there are changes made in your meal plan or exercise activity
  • When taking new medications
  • If you are pregnant
 
 
Your doctor or diabetes educator will help you choose the glucose meter that is best for you, teach you how to use it and how to record the results. Several different meters and supplies are available to help you check your blood glucose levels.
Important features of a blood glucose meter to consider include:
  • Fast results
  • Small blood sample size
  • Size of meter
  • Easy-to-read numbers on display
  • Ability to check blood sugar in other places besides finger
  • Data management (such as tracking date and time of blood sugar results)
  • Cost of supplies and insurance coverage
  • How easy is it to use the meter and strips

Steps to Follow
Checking your blood sugar is a simple process using a lancing device, lancet, test strip and a meter. Your diabetes educator will teach you how to do this with the blood glucose meter you have chosen. The following are general instructions for using a blood glucose meter.
  1. Wash your hands or clean your finger or other site with alcohol. If you are using alcohol, let it dry before you prick your finger.
  2. Prick the site with a lancing device.
  3. Put a little drop of blood on a test strip.
  4. Follow the instructions for inserting the test strip and using the blood glucose meter.
  5. In seconds, the blood glucose meter reads your blood sugar level.
Supplies You Will Use
  • Blood glucose meter — reads blood sugar
  • Test strip — collects blood sample
  • Lancet or small needle — fits into lancing device, pricks finger, and provides small drop of blood for glucose strip.
  • Lancing device — pricks finger when button is pressed. Most devices have dials to select how deep the needle goes into the skin. Start with middle depth. If you get more blood than needed, dial the number down so the lancet does not go as deep. If you get less blood, dial the number up so lancet goes deeper.
  • Alcohol wipes or soap and water — to clean fingers or other testing site.
  • Control solution — checks test strip for accuracy. The amount of sugar in the control solution is already known. When placed on a test strip, value should match control solution value on bottle, package of strips or package insert with your strips.
  • Check strip — comes with some models to make sure your meter is working. It checks the meter only, not the strips.
  • User manual — provides information about your meter. After reading it, place the manual in a safe place so that you can find it when you have a question about your meter.
  • Warranty card or papers — complete, make file copy and send in immediately.

Troubleshooting Tips
Can’t get blood out of your finger?
  • Place hands under warm water and rub together
  • Hang hand down below waist
  • Grasp finger near area to be pricked and squeeze gently for three seconds
  • Place finger on table or firm surface to avoid moving while pricking
  • If lancing device has dial-a-depth, increase setting by 1 level
  • Use new lancet every time you check blood sugar
Hurts too much?
  • If lancing device has dial-a-depth, decrease setting by 1 level
  • Use new lancet every time you check blood sugar
  • Try a thinner lancet or a different lancing device
  • Use sides of fingertips instead of fingertip pad
  • Try alternative test sites such as arm or thigh
  • Ask diabetes educator for suggestions
Error message?
  • Review user manual – error codes and problems are identified in manual
  • Make sure right amount of blood is on strip
  • Make sure blood is on correct part of strip
  • Call toll-free manufacturer’s number (listed on back of meter and in user manual)
  • Ask diabetes educator for suggestions
Alternative Site Testing
Alternative site refers to testing blood glucose on parts of the body other than the fingertip: most commonly the forearm, palm or thigh.
Testing somewhere other than the finger may bring a sigh of relief to many people with diabetes.
 
However, alternative test sites are not all the same:
With all meters, routine testing on an unrubbed forearm, upper arm, thigh or calf gives a test result that is 20 to 30 minutes old.
We will call these sites 'lagging' alternative test sites.
The fingertips and the palm hold the most recent 'memories' of your blood glucose. Fingertip and palm testing tell you what your blood glucose level is right now.
On the other hand, lagging test sites such as the forearm or thigh tell you what your blood glucose was around 20 to 35 minutes ago - not what it is right now. That difference can be crucial if your blood glucose is dropping fast --- a forearm test might tell you that the level is fine, because the forearm is a lagging test site, while a fingertip test correctly alerts you to a low number. Because of this, lagging test sites cannot replace the fingertip or palm completely for any person.
Several monitoring companies give people the choice to test their blood glucose using alternative sites. However, lagging test sites such as the forearm or thigh are only reliable when your blood glucose levels are relatively stable, such as fasting blood glucose.
So when is alternative site testing not recommended? The U.S. Food and Drug Administration gives these guidelines:
1. People who cannot feel the symptoms of low blood sugar (this is called hypoglycemia unawareness) should not use alternative site testing at all.
 
2. Do not use alternative sites when a seriously low blood glucose might go undetected:
  • Any time during or after exercise
  • When there are unknown variables occurring in your day, such as illness
  • Any time you just feel "low"
Talk to your doctor to see if alternative site testing is right for you. With a little bit of education, you can give your fingertips a rest and maybe test more often than you do now. For people with diabetes, more frequent testing is a good thing. Just remember: any time you want to be sure of an accurate, up-to-date blood glucose reading, test on your fingertip or palm.

 

You can manage your diabetes by setting short-term and long-term goals for your meal planning, blood glucose monitoring, and exercise.

Meal planning: Work with a dietitian to develop a meal plan that works with your daily schedule and lifestyle. For example, if you need to lose weight, your short-term goal might be to follow your meal plan and lose one pound a week for 10 weeks. Your long-term goal would be to lose 10 pounds and maintain the weight loss.


Blood Glucose Monitoring:  You and your doctor can decide on:
  • The best blood glucose meter for you
  • How often you need to check your blood sugar
  • Your blood sugar "target range"
Your short-term goal is to decide on a schedule for checking your blood sugar that works for your lifestyle. Your long-term goal is to monitor the effect of food, exercise, and stress on your blood sugar.

Exercise: Your doctor may develop an exercise plan for you or recommend a visit to an exercise specialist. Your short-term goal is to start the program; the long-term goal is to monitor the effects on your blood sugar levels.
Dealing with Setbacks: Everyone has setbacks from time to time. Maybe you forgot to test your blood sugar, missed a scheduled meal, gave into a sweets craving, or skipped a workout at the gym. There are lots of reasons for setbacks.
But don't let setbacks stop you from staying focused on your goals. Try these helpful hints:
  • Set an alarm to remind you to test your blood sugar at the right times.
  • Add an extra walk to your schedule so you can have an occasional treat.
  • Ask a friend to join you for your daily walks or workouts to make exercise more fun.
Blood Glucose Monitoring
Because of the nature of diabetes and its short- and long-term complications, it's important that you have a constant awareness of the level of glucose (sugar) in your blood. In fact, a "Blood Glucose Monitoring" (BGM) program is an essential part of any diabetes management plan.

Monitoring your blood sugar will tell you how your body is responding to certain foods, activities, and medications, and will help you manage your meal and exercise plans. With the data you get from monitoring, you and your doctor can:
  • Identify trends in your glucose levels
  • Identify factors that may cause high or low glucose levels
  • Evaluate the impact of food, activity, and medications on your diabetes
  • Identify where changes in the treatment plan are needed
  • Decide what you need to do when you are sick
  • Confirm whether or not the feelings you have are the result of low or high blood glucose or if it is something unrelated to your diabetes.
Six steps to proper monitoring
  • Know your blood sugar target
  • Learn how to check your glucose
  • Decide when to check your glucose levels
  • Identify glucose patterns
  • Determine what causes blood glucose changes
  • Decide what to do to get your blood glucose levels back on target
Setting Targets
Just how important is it to keep your blood sugar close to your target? According to one study, people with type 1 diabetes can reduce the risk of the complications associated with diabetes - including the ones leading to blindness, kidney failure and amputation - by as much as 76 percent by lowering blood sugar to normal or near-normal levels. Other studies have shown reductions in complications of up to 25-70 percent for type 2 patients.

Blood sugar targets vary from person to person and can even vary in the same person over time. You and your doctor should work together to determine what your target blood sugar range should be. Many doctors use guidelines developed by the American Diabetes Association as a starting point.

Blood glucose meters read either plasma values or whole blood values. Check the user manual that came with your meter to find out whether it reads plasma or whole blood, and then refer to the appropriate row in the chart below.
ADA Recommended Target Blood Sugar Levels
(source: American Diabetes Association)
Normal
Target Range for People with Diabetes
Plasma blood values *
 
 
Average pre-meal glucose (mg/dL)
Less than 100
90-130
Average post-meal glucose (mg/dL)
Less than 110
Less than 180
* Measurement of capillary blood glucose
Note: The above values are for non-pregnant adults and are averaged for the entire population of people with diabetes. Patients with other diseases, as well as the very young, older adults, and people with unusual conditions or circumstances may need different target goals.
The table shows that people with diabetes should keep their blood glucose levels within a target range. Your doctor can determine a target that is appropriate for your individual health condition and lifestyle by considering such specifics as:
  • Your willingness to test your blood sugar levels often.
  • Your willingness to follow an intensive treatment plan.
  • Your risk for severe hypoglycemia and your ability to recognize its symptoms.
  • Your age.
  • Other health conditions you might have, such as cardiovascular disease, kidney disease, or pregnancy.
 
Achieving Your Blood Glucose Target
To keep your blood sugar at or near your target, you and your doctor should develop an individual treatment plan that includes the following elements:
  • Keeping track of your blood glucose levels
  • A meal plan that is right for your lifestyle and your taste buds
  • Regular exercise
  • Continuing education and explanations of your regimen
  • Regular review of your treatment goals

Ask your doctor for guidelines so you'll know when to notify the office about blood sugar results. Your doctor should tell you when to report high blood sugars. For example, he or she may want you to report:
  • Blood sugars that are consistently running higher than 300 mg/dL for more than two or three days
  • Any illness that's accompanied by nausea, vomiting, diarrhea, or fever
When to Test
Ask your doctor or nurse educator how often you should check your blood glucose.
Some people need to check several times a day; others may only need to check a few times a week.
You may want to check at different times of the day to get an idea of how well your diet and exercise program is working for you.
Typical times to check are before breakfast, before lunch, before dinner, and before bedtime. Sometimes it is helpful to check blood glucose one or two hours after a meal to see the effect of food on your glucose levels.
 
There are certain times when you should check your blood glucose more often than usual:
  • During periods of illness or stress
  • When you suspect that your blood glucose is high
  • When there are changes made in your meal plan or exercise activity
  • When taking new medications
  • If you are pregnant
 
 
Your doctor or diabetes educator will help you choose the glucose meter that is best for you, teach you how to use it and how to record the results. Several different meters and supplies are available to help you check your blood glucose levels.
Important features of a blood glucose meter to consider include:
  • Fast results
  • Small blood sample size
  • Size of meter
  • Easy-to-read numbers on display
  • Ability to check blood sugar in other places besides finger
  • Data management (such as tracking date and time of blood sugar results)
  • Cost of supplies and insurance coverage
  • How easy is it to use the meter and strips

Steps to Follow
Checking your blood sugar is a simple process using a lancing device, lancet, test strip and a meter. Your diabetes educator will teach you how to do this with the blood glucose meter you have chosen. The following are general instructions for using a blood glucose meter.
  1. Wash your hands or clean your finger or other site with alcohol. If you are using alcohol, let it dry before you prick your finger.
  2. Prick the site with a lancing device.
  3. Put a little drop of blood on a test strip.
  4. Follow the instructions for inserting the test strip and using the blood glucose meter.
  5. In seconds, the blood glucose meter reads your blood sugar level.
Supplies You Will Use
  • Blood glucose meter — reads blood sugar
  • Test strip — collects blood sample
  • Lancet or small needle — fits into lancing device, pricks finger, and provides small drop of blood for glucose strip.
  • Lancing device — pricks finger when button is pressed. Most devices have dials to select how deep the needle goes into the skin. Start with middle depth. If you get more blood than needed, dial the number down so the lancet does not go as deep. If you get less blood, dial the number up so lancet goes deeper.
  • Alcohol wipes or soap and water — to clean fingers or other testing site.
  • Control solution — checks test strip for accuracy. The amount of sugar in the control solution is already known. When placed on a test strip, value should match control solution value on bottle, package of strips or package insert with your strips.
  • Check strip — comes with some models to make sure your meter is working. It checks the meter only, not the strips.
  • User manual — provides information about your meter. After reading it, place the manual in a safe place so that you can find it when you have a question about your meter.
  • Warranty card or papers — complete, make file copy and send in immediately.

Troubleshooting Tips
Can’t get blood out of your finger?
  • Place hands under warm water and rub together
  • Hang hand down below waist
  • Grasp finger near area to be pricked and squeeze gently for three seconds
  • Place finger on table or firm surface to avoid moving while pricking
  • If lancing device has dial-a-depth, increase setting by 1 level
  • Use new lancet every time you check blood sugar
Hurts too much?
  • If lancing device has dial-a-depth, decrease setting by 1 level
  • Use new lancet every time you check blood sugar
  • Try a thinner lancet or a different lancing device
  • Use sides of fingertips instead of fingertip pad
  • Try alternative test sites such as arm or thigh
  • Ask diabetes educator for suggestions
Error message?
  • Review user manual – error codes and problems are identified in manual
  • Make sure right amount of blood is on strip
  • Make sure blood is on correct part of strip
  • Call toll-free manufacturer’s number (listed on back of meter and in user manual)
  • Ask diabetes educator for suggestions
Alternative Site Testing
Alternative site refers to testing blood glucose on parts of the body other than the fingertip: most commonly the forearm, palm or thigh.
Testing somewhere other than the finger may bring a sigh of relief to many people with diabetes.
 
However, alternative test sites are not all the same:
With all meters, routine testing on an unrubbed forearm, upper arm, thigh or calf gives a test result that is 20 to 30 minutes old.
We will call these sites 'lagging' alternative test sites.
The fingertips and the palm hold the most recent 'memories' of your blood glucose. Fingertip and palm testing tell you what your blood glucose level is right now.
On the other hand, lagging test sites such as the forearm or thigh tell you what your blood glucose was around 20 to 35 minutes ago - not what it is right now. That difference can be crucial if your blood glucose is dropping fast --- a forearm test might tell you that the level is fine, because the forearm is a lagging test site, while a fingertip test correctly alerts you to a low number. Because of this, lagging test sites cannot replace the fingertip or palm completely for any person.
Several monitoring companies give people the choice to test their blood glucose using alternative sites. However, lagging test sites such as the forearm or thigh are only reliable when your blood glucose levels are relatively stable, such as fasting blood glucose.
So when is alternative site testing not recommended? The U.S. Food and Drug Administration gives these guidelines:
1. People who cannot feel the symptoms of low blood sugar (this is called hypoglycemia unawareness) should not use alternative site testing at all.
 
2. Do not use alternative sites when a seriously low blood glucose might go undetected:
  • Any time during or after exercise
  • When there are unknown variables occurring in your day, such as illness
  • Any time you just feel "low"
Talk to your doctor to see if alternative site testing is right for you. With a little bit of education, you can give your fingertips a rest and maybe test more often than you do now. For people with diabetes, more frequent testing is a good thing. Just remember: any time you want to be sure of an accurate, up-to-date blood glucose reading, test on your fingertip or palm.


 

 



 

 

 

 

 



 

 

 

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