Diabetes

Diabetes
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Diabetes means your blood glucose (often called blood sugar) is too high. Your blood always has some glucose in it because your body needs glucose for energy to keep you going. But too much glucose in the blood isn't good for your health
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How do you get high blood glucose?
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Glucose comes from the food you eat and is also made in your liver and muscles. Your blood carries the glucose to all the cells in your body. Insulin is a chemical (a hormone) made by the pancreas. The pancreas releases insulin into the blood. Insulin helps the glucose from food get into your cells. If your body doesn’t make enough insulin, or if the insulin doesn’t work the way it should, glucose can’t get into your cells. It stays in your blood instead. Your blood glucose level then gets too high, causing pre-diabetes or diabetes.
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What is pre-diabetes?
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Pre-diabetes is a condition in which blood glucose levels are higher than normal but not high enough for a diagnosis of diabetes. People with pre-diabetes are at increased risk for developing type 2 diabetes and for heart disease and stroke. The good news is, if you have pre-diabetes, you can reduce your risk of getting diabetes. With modest weight loss and moderate physical activity, you can delay or prevent type 2 diabetes and even return to normal glucose levels
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The signs of diabetes are:

1. being very thirsty
2. urinating often
3. feeling very hungry or tired
4. losing weight without trying
5. having sores that heal slowly
6. having dry, itchy skin
7. losing the feeling in your feet or having tingling in your feet
8. having blurry eyesight

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You may have had one or more of these signs before you found out you had diabetes. Or you may have had no signs at all. A blood test to check your glucose levels will show if you have pre-diabetes or diabetes
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What kind of diabetes do you have?
People can get diabetes at any age. There are three main kinds:

1. Type 1 diabetes, formerly called juvenile diabetes or insulin-dependent diabetes, is usually first diagnosed in children, teenagers, or young adults. With this form of diabetes, the beta cells of the pancreas no longer make insulin because the body’s immune system has attacked and destroyed them. Treatment for type 1 diabetes includes taking insulin, making wise food choices, being physically active, taking aspirin daily (for some), and controlling blood pressure and cholesterol
2. Type 2 diabetes, formerly called adult-onset diabetes or noninsulin-dependent diabetes, is the most common form of diabetes. People can develop type 2 diabetes at any age—even during childhood. This form of diabetes usually begins with insulin resistance, a condition in which fat, muscle, and liver cells do not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, it loses the ability to secrete enough insulin in response to meals. Being overweight and inactive increases the chances of developing type 2 diabetes. Treatment includes using diabetes medicines, making wise food choices, being physically active, taking aspirin daily, and controlling blood pressure and cholesterol.Some women develop gestational diabetes during the late stages of pregnancy. Although this form of diabetes usually goes away after the baby is born, a woman who has had it is more likely to develop type 2 diabetes later in life
3. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin....

This guide is for people who have either type 1 diabetes or type 2 diabetes.
Why do you need to take care of your diabetes?After many years, diabetes can lead to serious problems with your eyes, kidneys, nerves, and gums and teeth. But the most serious problem caused by diabetes is heart disease. When you have diabetes, you are more than twice as likely as people without diabetes to have heart disease or a stroke.
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If you have diabetes, your risk of a heart attack is the same as someone who has already had a heart attack. Both women and men with diabetes are at risk. You may not even have the typical signs of a heart attack.
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You can reduce your risk of developing heart disease by controlling your blood pressure and blood fat levels. If you smoke, talk with your doctor about quitting. Remember that every step toward your goals helps!
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Later in this guide, we'll tell you how you can try to prevent or delay long-term problems. The best way to take care of your health is to work with your health care team to keep your blood glucose, blood pressure, and cholesterol in your target range.What's a desirable blood glucose level?...Everyone's blood has some glucose in it. In people who don't have diabetes, the normal range is about 70 to 120. Blood glucose goes up after eating but 1 or 2 hours later returns to the normal range....Ask your health care team when you should check your blood glucose with a meter. Talk about whether the blood glucose targets listed below are best for you. Then write in your own targets. Blood glucose targets for most people with diabetes:
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Levels...... My target levels My Actual Levels
Before meals=... 90 to 130............____ to ____............
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Levels 1 or 2 hrs.
after a meal=.....less than 180......less than ____..........
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It may be hard to reach your target range all of the time. But the closer you get to your goal, the more you will reduce your risk of diabetes-related problems and the better you will feel. Every step helps.
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Do four things every day to lower high blood glucose:
.... 1. Follow your meal plan
.... 2. Be physically active
.... 3. Take your diabetes medicine
.... 4. Check your blood glucose
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Experts say most people with diabetes should try to keep their blood glucose level as close as possible to the level of someone who doesn't have diabetes. The closer to normal your blood glucose is, the lower your chances are of developing serious health problems.Check with your doctor about the right range for you
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Your health care team will help you learn how to reach your target blood glucose range.
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Your main health care providers are your
... 1. doctor;
... 2. nurse;
... 3. diabetes educator; and
... 4. dietitian.
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When you see your health care provider, ask lots of questions. Before you leave, be sure you understand everything you need to know about taking care of your diabetes.
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A diabetes educator is a health care worker who teaches people how to manage their diabetes. Your educator may be a nurse, a dietitian, or other kind of health care worker
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A dietitian is someone who's specially trained to help people plan their meals.
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Follow Your Meal PlanPeople with diabetes should have their own meal plan. Ask your doctor to give you the name of a dietitian who can work with you to develop a meal plan. Your dietitian can help you plan meals that include foods that you and your family like to eat and that are good for you too. Ask your dietitian to include foods that are heart-healthy to reduce your risk of heart disease.
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Your diabetes meal plan will include breads, cereals, rice, and grains; fruits and vegetables; meat and meat substitutes; dairy products; and fats. People with diabetes don’t need to eat special foods. The foods on your meal plan are good for everyone in your family! Making wise food choices will help you:

• reach and stay at a weight that's good for your body;
• keep your blood glucose, blood pressure, and cholesterol under control; and
• prevent heart and blood vessel disease

Diabetes can start at any age.
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ACTION STEPS
If you use insulin
Follow your meal plan.
Don't skip meals, especially if you've already taken your insulin, because your blood glucose may go too low.
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ACTION STEPS
If you DON'T use insulin

1. Follow your meal plan.
2. Don't skip meals, especially if you take diabetes medicine, because your blood glucose may go too low.
3. It may be better to eat several small meals during the day instead of one or two big meals. ...

Be Physically Active
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Physical activity is good for your diabetes. Walking, swimming, dancing, riding a bicycle, playing baseball, and bowling are all good ways to be active. You can even get exercise when you clean house or work in your garden. Physical activity is especially good for people with diabetes because:
... 1. physical activity helps keep weight down
... 2. physical activity helps insulin work better to lower blood glucose
... 3. physical activity is good for your heart and lungs
... 4. physical activity gives you more energy
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Before you begin exercising, talk with your doctor. Your doctor may check your heart and your feet to be sure you have no special problems. If you have high blood pressure or eye problems, some exercises like weightlifting may not be safe. Your health care team can help you find safe exercises
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Try to be active almost every day for a total of about 30 minutes. If you haven't been very active lately, begin slowly. Start with 5 to 10 minutes, and then add more time. Or exercise for 10 minutes, three times a day.
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If your blood glucose is less than 100 to 120, have a snack before you exercise.
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Being active helps you feel better. When you exercise, carry glucose tablets or a carbohydrate snack with you in case you get hypoglycemia. Wear or carry an identification tag or card saying that you have diabetes.
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ACTION STEPS
If you use insulin

1. See your doctor before starting a physical activity program.
2. Check your blood glucose before, during, and after exercising.
3. Don't exercise when your blood glucose is over 240 or if you have ketones in your urine.
4. Don’t exercise right before you go to sleep because it could cause hypoglycemia during the night.

ACTION STEPS
If you don't use insulin
See your doctor before starting a physical activity program.
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Take Your Diabetes Medicine Every Day
Insulin and diabetes pills are the two kinds of medicines used to lower blood glucose.
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If You Use Insulin
You need insulin if your body has stopped making insulin or if it doesn't make enough. Everyone with type 1 diabetes needs insulin, and many people with type 2 diabetes do too. Some women with gestational diabetes also need to take insulin.
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You may need insulin to control your blood glucose. There are five ways to take insulin:
Taking shots, also called injections. You’ll use a needle attached to a syringe—a hollow tube with a plunger—that you fill with a dose of insulin. Some people use an insulin pen, a pen-like device with a needle and a cartridge of insulin.

1. Using an insulin pump. A pump is a small device, worn on a belt or in a pocket, that holds insulin. The pump connects to a small plastic tube and a very small needle. The needle is inserted under the skin and stays in for several days.
2. Using an insulin jet injector. This device sends a fine spray of insulin through the skin with high-pressure air instead of a needle.
3. Using an insulin infuser. A small tube is inserted just beneath the skin and remains in place for several days. Insulin is injected into the end of the tube instead of through the skin.
4. Using inhaled insulin. You’ll use a special device to breathe in powdered insulin through the mouth.
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If You Take Diabetes Pills

If your body makes insulin, but the insulin doesn't lower your blood glucose, you may need diabetes pills. Some pills are taken once a day, and others are taken more often. Ask your health care team when you should take your pills.

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Be sure to tell your doctor if your pills make you feel sick or if you have any other problems. Remember, diabetes pills don’t lower blood glucose by themselves. You'll still want to follow a meal plan and be active to help lower your blood glucose.

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Sometimes, people who take diabetes pills may need insulin for a while. If you get sick or have surgery, the diabetes pills may no longer work to lower your blood glucose.

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You may be able to stop taking diabetes pills if you lose weight. (Always check with your doctor before you stop taking your diabetes pills.) Losing 10 or 15 pounds can sometimes help you reach your target blood glucose level.

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If You Don't Use Insulin or Take Diabetes Pills

Many people with type 2 diabetes don't need insulin or diabetes pills. They can take care of their diabetes by using a meal plan and exercising regularly.

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Many people with type 2 diabetes take pills to help keep blood glucose in their target range.

Check Your Blood Glucose as Recommended

You'll want to know how well you're taking care of your diabetes. The best way to find out is to check your blood to see how much glucose is in it. If your blood has too much or too little glucose, you may need a change in your meal plan, exercise plan, or medicine.

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Ask your doctor how often you should check your blood glucose. Some people check their blood glucose once a day. Others do it three or four times a day. You may check before and after eating, before bed, and sometimes in the middle of the night.

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Your doctor or diabetes educator will show you how to check your blood using a blood glucose meter. Your health insurance or Medicare may pay for the supplies and equipment you need. Checking your blood glucose will help you see if your diabetes treatment plan is working.

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Take Other Tests for your Diabetes:

Urine Tests

Tests for Your Diabetes

You may need to check your urine if you're sick or if your blood glucose is over 240. A urine test will tell you if you have ketones in your urine. Your body makes ketones when there isn't enough insulin in your blood. Ketones can make you very sick. Call your doctor right away if you find moderate or large amounts of ketones, along with high blood glucose levels, when you do a urine test. You may have a serious condition called ketoacidosis. If it isn't treated, it can cause death. Signs of ketoacidosis are vomiting, weakness, fast breathing, and a sweet smell on the breath. Ketoacidosis is more likely to develop in people with type 1 diabetes. You can buy strips for testing ketones at a drug store. Your doctor or diabetes educator will show you how to use them.

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The A1C Test

Another test for blood glucose, the A1C, also called the hemoglobin A1C test, shows what your overall blood glucose was for the past 3 months. It shows how much glucose is sticking to your red blood cells. The doctor does this test to see what your blood glucose is most of the time. Have this test done at least twice a year. Ask your doctor what your A1C test showed. A result of under 7 usually means that your diabetes treatment is working well and your blood glucose is under control. If your A1C is 8 or above, your blood glucose may be too high. You’ll then have a greater risk of having diabetes problems, like kidney damage. You may need a change in your meal plan, physical activity plan, or diabetes medicine.A1C Results Target for most people under 7.

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Time to change my diabetes care plan is when my A1C Results are 8 or above. Talk with your doctor about what your target should be. Even if your A1C is higher than your target, remember that every step toward your goal helps reduce your risk of diabetes problems.

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Keep Daily Records

Write down the results of your blood glucose checks every day. You may also want to write down what you ate, how you felt, and whether you exercised.

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By keeping daily records of your blood glucose checks, you can tell how well you're taking care of your diabetes. Show your blood glucose records to your health care team. They can use your records to see whether you need changes in your diabetes medicines or your meal plan. If you don't know what your results mean, ask your health care team.

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Things to write down every day in your record book are:

1. results of your blood glucose checks
2. your diabetes medicines: times and amounts taken
3. if your blood glucose was very low
4. if you ate more or less food than you usually do
5. if you were sick
6. if you found ketones in your urine
7. what kind of physical activity you did and for how long

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ACTION STEPS

If you use insulin

Keep a daily record of:

1. your blood glucose numbers
2. the times of the day you took your insulin
3. the amount and type of insulin you took
4. whether you had ketones in your urine.

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ACTION STEPS

If you DON'T use insulin

Keep a daily record of

1. your blood glucose numbers
2. the times of the day you took your diabetes pills
3. the foods you ate including: amounts, time of day, snacks
4. your physical activity.

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printer-friendly version of sample record page

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printer-friendly version of blank record page

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When Your Blood Glucose Is Too High or Too Low

Sometimes, no matter how hard you try to keep your blood glucose in your target range, it's too high or too low. Blood glucose that's too high or too low can make you very sick. Here's how to handle these emergencies.

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What You Need to Know About Hyperglycemia

If your blood glucose stays over 180, it may be too high. High blood glucose means you don’t have enough insulin in your body. High blood glucose, or “hyperglycemia,” can happen if you miss taking your diabetes medicine, eat too much, or don’t get enough exercise. Sometimes, the medicines you take for other problems cause high blood glucose. Be sure to tell your doctor about other medicines you take.

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Having an infection, being sick, or under stress can also make your blood glucose too high. That's why it's very important to check your blood glucose and keep taking your insulin or diabetes pills when you're sick.

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If you're very thirsty and tired, have blurry vision, and have to go to the bathroom often, your blood glucose may be too high. Very high blood glucose may also make you feel sick to your stomach.If your blood glucose is high much of the time, or if you have symptoms of high blood glucose, call your doctor. You may need a change in your insulin or diabetes pills, or a change in your meal plan.

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What You Need to Know About Hypoglycemia

Hypoglycemia happens if your blood glucose drops too low. It can come on fast. It's caused by taking too much diabetes medicine, missing a meal, delaying a meal, exercising more than usual, or drinking alcoholic beverages. Sometimes, medicines you take for other health problems can cause blood glucose to drop.

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Hypoglycemia can make you feel weak, confused, irritable, hungry, or tired. You may sweat a lot or get a headache. You may feel shaky. If your blood glucose drops lower, you could pass out or have a seizure.

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If you have any of these symptoms, check your blood glucose. If the level is 70 or below, have one of the following right away:

1. 2 or 3 glucose tablets
2. 1/2 cup (4 ounces) of any fruit juice
3. a piece of fruit or a small box of raisins
4. 1 cup (8 ounces) of milk
5. 1/2 cup (4 ounces) of a regular (not diet) soft drink
6. 5 or 6 pieces of hard candy
7. 1 or 2 teaspoons of sugar or honey
   

When your blood glucose is too low, do these steps:

1. Have one of these "quick fix" foods listed above.
2. After 15 minutes, check your blood glucose again to make sure your level is 70 or above.
3. Repeat these steps as needed.
4. Once your blood glucose is stable, if it will be at least an hour before your next meal, have a snack.

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How to protect yourself if you blood glucose has dropped too low:

1. If you take insulin or a diabetes pill that can cause hypoglycemia, always carry food for emergencies.
2. It's a good idea also to wear a medical identification bracelet or necklace.
3. If you take insulin, keep a glucagon kit at home and at a few other places where you go often. Glucagon is given as an injection with a syringe and quickly raises blood glucose.
4. Show your family, friends, and co-workers how to give you a glucagon injection if you pass out because of hypoglycemia.

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You can prevent hypoglycemia by:

1. eating regular meals,
2. taking your diabetes medicine,
3. and checking your blood glucose often. Checking will tell you whether your glucose level is going down. You can then take steps, like drinking fruit juice, to raise your blood glucose.

When you have hypoglycemia, have a snack to bring your blood glucose back to normal.
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ACTION STEPS

If you use insulin

1. Tell your doctor if you have hypoglycemia often, especially at the same time of the day or night several times in a row.
2. Tell your doctor if you've passed out from hypoglycemia.
3. Ask your doctor about glucagon. Glucagon is a medicine that raises blood glucose.
4. If you pass out from hypoglycemia, someone should call 911 and give you a glucagon shot.
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ACTION STEPS

If you DON'T use insulin

1. Tell your doctor if you have hypoglycemia often, especially at the same time of the day or night several times in a row.
2. Be sure to tell your doctor about other medicines you are taking.
3. Some diabetes pills can cause hypoglycemia. Ask your doctor whether your pills can cause hypoglycemia.
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Why Taking Care of Your Diabetes Is Important
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Taking care of your diabetes every day will help keep your blood glucose in your target range and help prevent other health problems that diabetes can cause over the years. This part of the guide describes those problems. You are told these things, not to scare you, but to help you understand what you can do to keep them from happening.

1. Do what you can every day to keep your blood glucose in the range that's best for you.
2. Follow your meal plan every day.
3. Be physically active every day.
4. Take your diabetes medicine every day.
5. Check your blood glucose as recommended.

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Diabetes and Your Heart and Blood Vessels
The biggest problem for people with diabetes is heart and blood vessel disease. Heart and blood vessel disease can lead to heart attacks and strokes. It also causes poor blood flow (circulation) in the legs and feet.
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To check for heart and blood vessel disease, your health care team will do some tests.

1. At least once a year, have a blood test to see how much cholesterol is in your blood.
2. Your health care provider should take your blood pressure at every visit.
3. Your provider may also check the circulation in your legs, feet, and neck.

The best way to prevent heart and blood vessel disease is to take good care of yourself and your diabetes.

1. Eat foods that are low in fat and salt.
2. Keep your blood glucose on track.
3. Know your A1C. The target for most people is under 7.
4. If you smoke, quit.
5. Be physically active.
6. Lose weight if you need to.
7. Ask your health care team whether you should take an aspirin every day.
8. Keep your blood pressure on track. The target for most people is under 130/80. If needed, take medicine to control your blood pressure.
9. Keep your cholesterol level on track. The target for LDL cholesterol for most people is under 100. If needed, take medicine to control your blood fat levels.
   

What's a desirable blood pressure level?
Blood pressure levels tell how hard your blood is pushing against the walls of your blood vessels. Your pressure is given as two numbers: The first is the pressure as your heart beats and the second is the pressure as your heart relaxes. If your blood pressure is higher than your target, talk with your health care team about changing your meal plan, exercising, or taking medicine.
Blood Pressure ResultsTarget for most people with diabetes

under 130/80 ......My last result..............................____________

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...................................... My target............................. ____________

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What are desirable blood fat levels?

Cholesterol, a fat found in the body, appears in different forms. If your LDL cholesterol ("bad" cholesterol) is 100 or above, you are at increased risk of heart disease and may need treatment. A high level of total cholesterol also means a greater risk of heart disease. But HDL cholesterol ("good" cholesterol) protects you from heart disease, so the higher it is, the better. It's best to keep triglyceride (another type of fat) levels under 150. All of these target numbers are important for preventing heart disease.
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Target Blood Fat Levels for People With Diabetes

Total cholesterol under 200.My last result_____My target ..... _____

LDL cholesterol under 100..My last result_____My target ..... _____

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HDL cholesterolabove 40 (men)My last result _____

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My target ...... _____above 50 (women)

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My last result _____

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My target ...... _____

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Triglycerides under 150

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My last result _____

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My target ...... _____

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Diabetes and Your Eyes

1. Have your eyes checked once a year. You could have eye problems that you haven't noticed yet. It is important to catch eye problems early when they can be treated. Treating eye problems early can help prevent blindness.
2. High blood glucose can make the blood vessels in the eyes bleed. This bleeding can lead to blindness. You can help prevent eye damage by keeping your blood glucose as close to normal as possible. If your eyes are already damaged, an eye doctor may be able to save your sight with laser treatments or surgery.
3. The best way to prevent eye disease is to have a yearly eye exam. In this exam, the eye doctor puts drops in your eyes to dilate your pupils. When the pupils are dilated, or big, the doctor can see into the back of the eye. This is called a dilated eye exam and it doesn’t hurt. If you've never had this kind of eye exam before, you should have one now, even if you haven't had any trouble with your eyes. Be sure to tell your eye doctor that you have diabetes.

Here are some tips for taking care of your eyes:

1. For adults and adolescents (10 years old and older) with type 1 diabetes: Have your eyes examined within 3 to 5 years of being diagnosed with diabetes. Then have an exam every year.
2. For people with type 2 diabetes: Have an eye exam every year.
3. For women planning to have a baby: Have an eye exam before becoming pregnant.
4. If you smoke, quit.
5. Keep your blood glucose and blood pressure as close to normal as possible.
6. Tell your eye doctor right away if you have any problems like blurry vision or seeing dark spots, flashing lights, or rings around lights.
7. See your eye doctor for an eye exam with dilated pupils every year.
8. Early treatment of eye problems can help save your sight.
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Diabetes and Your Kidneys

Your kidneys help clean waste products from your blood. They also work to keep the right balance of salt and fluid in your body.

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Too much glucose in your blood is very hard on your kidneys. After a number of years, high blood glucose can cause the kidneys to stop working. This condition is called kidney failure. If your kidneys stop working, you'll need dialysis (using a machine or special fluids to clean your blood) or a kidney transplant.

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Make sure you have the following tests at least once a year to make sure your kidneys are working well:

1. a urine test for protein, called the microalbumin test
2. a blood test for creatinine
3. Some types of blood pressure medicines can help prevent kidney damage. Ask your doctor whether these medicines could help you.

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You can also help prevent kidney problems by doing the following:

1. Take your medicine if you have high blood pressure.
2. Ask your doctor or your dietitian whether you should eat less protein (meat, poultry, cheese, milk, fish, and eggs).
3. See your doctor right away if you get a bladder or kidney infection. Signs of bladder or kidney infections are cloudy or bloody urine, pain or burning when you urinate, and having to urinate often or in a hurry. Back pain, chills, and fever are also signs of kidney infection.
   Keep your blood glucose and blood pressure as close to normal as possible.
4. If you smoke, quit.
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Diabetes and Your Nerves

Over time, high blood glucose can harm the nerves in your body. Nerve damage can cause you to lose the feeling in your feet or to have painful, burning feet. It can also cause pain in your legs, arms, or hands or cause problems with eating, going to the bathroom, or having sex.

1. Nerve damage can happen slowly. You may not even realize you have nerve problems. Your doctor should check your nerves at least once a year. Part of this exam should include tests to check your sense of feeling and the pulses in your feet.
   Tell the doctor about any problems with your feet, legs, hands, or arms. This might be Peripheral Neuropathy. Also, tell the doctor if you have trouble digesting food, going to the bathroom, or having sex, or if you feel dizzy sometimes.
2. Nerve damage to the feet can lead to amputations. You may not feel pain from injuries or sore spots on your feet. If you have poor circulation because of blood vessel problems in your legs, the sores on your feet can't heal and might become infected. If the infection isn't treated, it could lead to amputation.
3. Ask your doctor whether you already have nerve damage in your feet. If you do, it is especially important to take good care of your feet. To help prevent complications from nerve damage, check your feet every day.
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Here are some ways to take care of your nerves:

1. Keep your blood glucose and blood pressure as close to normal as possible.
2. Limit the amount of alcohol you drink.
3. Check your feet every day.
4. If you smoke, quit.
   

Foot Care Tips:
You can do a lot to prevent problems with your feet. Keeping your blood glucose in your target range and taking care of your feet can help protect them.

1. Check your bare feet every day. Look for cuts, sores, bumps, or red spots. Use a mirror or ask a family member for help if you have trouble seeing the bottoms of your feet.
2. Wash your feet in warm—not hot—water every day, but don't soak them. Use mild soap.
3. Dry your feet with a soft towel, and dry carefully between your toes.
4. After washing your feet, cover them with lotion before putting your shoes and socks on.
5. Don't put lotion or cream between your toes.
6. File your toenails straight across with an emery board. Don't leave sharp edges that could cut the next toe.
7. Don't try to cut calluses or corns off with a razor blade or knife, and don't use wart removers on your feet. If you have warts or painful corns or calluses, see a podiatrist, a doctor who treats foot problems.
8. Wear thick, soft socks.
9. Don't wear mended stockings or stockings with holes or seams that might rub against your feet.
10. Check your shoes before you put them on to be sure they have no sharp edges or objects in them.
11. Wear shoes that fit well and let your toes move. Break new shoes in slowly. Don't wear flip-flops, shoes with pointed toes, or plastic shoes. Never go barefoot.
12. Wear socks if your feet get cold at night. Don't use heating pads or hot water bottles on your feet.
13. Have your doctor check your feet at every visit. Take your shoes and socks off when you go into the examining room. This will remind the doctor to check your feet.
14. See a podiatrist for help if you can't take care of your feet yourself.
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Peripheral Neuropathy

If you are found to have Peripheral Neuropathy, there are medications to help you with the pain from this disease. One such medication is Lycra.

About Lycra:

LYRICA is not for everyone. Some of the most common side effects of LYRICA are:

1. dizziness and sleepiness,
2. dry mouth,
3. swelling of hands and feet,
4. blurry vision,
5. weight gain, and
6. trouble concentrating.

You may have a higher chance of swelling or gaining weight if you are also taking certain diabetes medicines. And, if you drink alcohol or take medicines that make you sleepy, you may feel more sleepy when you start LYRICA.

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You should not drive a car or work with machines until you know how LYRICA affects you. Tell your doctor about any changes in your eyesight, muscle pain along with a fever or tired feeling, or skin sores due to diabetes. Also tell your doctor if you are planning to father a child. Tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you have had a drug or alcohol problem, you may be more likely to misuse LYRICA. You should talk with your doctor before you stop taking LYRICA, or any other prescription medication.
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PATIENT INFORMATION (LEER- i- kah) Read the Patient Information that comes with LYRICA before you start taking it and each time you get a refill. There may be new information.

This information does not take the place of talking with your doctor about your condition or treatment. If you have any questions about LYRICA, ask your doctor or pharmacist.
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What is the most important information I should know about LYRICA?
1. LYRICA may cause dizziness and sleepiness.

• Do not drive a car, work with machines, or do other dangerous activities until you know how LYRICA affects how alert you are. Ask your doctor when it is okay to do these activities.

2. LYRICA may cause problems with your eyesight, including blurry vision.

• Call your doctor if you have any changes in your eyesight.
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What is LYRICA?
LYRICA is a prescription medicine used in adults, 18 years andolder, to treat:

1. pain from damaged nerves (neuropathic pain) that happens with diabetes,
2. pain from damaged nerves (neuropathic pain) that follows healing of shingles (a painful rash that comes after a herpes zoster infection)
3. partial seizures when taken together with other seizure medicines
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Pain From Damaged Nerves (neuropathic pain)

• Diabetes and shingles can damage your nerves.
• Pain from damaged nerves may feel:

.........1. sharp,

.........2. burning,

..........3. tingling,

..........4. shooting, or

..........5. numb.

• If you have peripheral neuropathy due to diabetes, the pain can be in your:

..........1. arms,

..........2. hands,

..........3. fingers,

..........4. legs,

..........5. feet, or

..........6. toes.

• If you have shingles, the pain is in the area of your rash.
• You may experience this kind of pain even with a very light touch.

...

LYRICA can help relieve the pain. Some people taking LYRICA had less pain by the end of the first week of LYRICA therapy. LYRICA may not work for everyone. LYRICA has not been studied for nerve pain in children under 18 years of age.

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Partial Seizures

Partial seizures start in one part of the brain. A seizure can make you fearful, confused, or just feel “funny”. You may smell strange smells. A seizure may cause your arm or leg to jerk or shake. It canspread to other parts of your brain, make you pass out, and causeyour whole body to start jerking.

...
LYRICA can lower the number of seizures for people who are already taking seizure medicine.

...

LYRICA has not been studied for partial seizures in children under 18 years of age.
...

Who Should Not Take LYRICA?Do not take LYRICA if you are allergic to any of its ingredients. The active ingredient is pregabalin. See the end of this information for a complete list of ingredients in LYRICA.
What should I tell my doctor before taking LYRICA?

Tell your doctor about all your medical conditions, including if you:

1. • have any kidney problems or get kidney dialysis
2. • have heart problems including heart failure
3. • have a bleeding problem or a low blood platelet count
4. • are pregnant or plan to become pregnant. It is not known if LYRICA may harm your unborn baby. You and your doctor will have to decide if LYRICA is right for you while you are pregnant.
5. • are breastfeeding. It is not known if LYRICA passes into breast milk and if it can harm your baby. You and your doctor should decide whether you should take LYRICA or breastfeed, but not both.
6. • Tell your doctor about all the medicines you take includingprescription or non- prescription medicines, vitamins or herbalsupplements. LYRICA and other medicines may affect each other.

Especially tell your doctor if you take:

1. • rosiglitazone (Avandia®) or pioglitazone (Actos®) for diabetes. You may have a higher chance of weight gain or swelling if these medicines are taken with LYRICA. See "What are the possible side effects of LYRICA."
2. • any narcotic pain medicine (such as oxycodone), tranquilizersor medicines for anxiety (such as lorazepam). You may have a higher chance for dizziness and sleepiness if these medicines are taken with LYRICA. See "What is the most important information I should know about LYRICA?"
3. • any medicines that make you sleepy
   

Know all the medicines you take. Keep a list of them with you toshow your doctor and pharmacist each time you get a new medicine.

Tell your doctor if you plan to father a child. Animal studies showed that pregabalin, the active ingredient in LYRICA, made male animals less fertile. Also, in animal studies, birth defects occurred in the offspring of male animals who were treated with pregabalin. It is not known if these effects would happen in people.
...

How should I take LYRICA?

• Take LYRICA exactly as prescribed. Your doctor may adjust your dose during treatment. Do not change your dose without talking to your doctor.
• Do not stop taking LYRICA suddenly without talking to your doctor. If you stop taking LYRICA suddenly, you may have headaches, nausea, diarrhea or trouble sleeping. Talk with your doctor about how to slowly stop LYRICA.
• LYRICA is usually taken 2 or 3 times a day, depending on your medical condition. Your doctor will tell you how much LYRICA to take and when to take it. Take LYRICA at the same times each day.
• LYRICA may be taken with or without food.
• If you miss a dose by a few hours, take it as soon as you remember. If it is close to your next dose, just take LYRICA at your next regular time. Do not take two doses at the same time.
• If you take too much LYRICA, call your doctor or poison control center or go to the nearest emergency room right away.

What Should I Avoid While Taking LYRICA?

• Do not drive a car, work with machines, or do other dangerous activities until you know how LYRICA affects how alert you are. See "What is the most important information I should know about LYRICA?"
• Do not drink alcohol while taking LYRICA. LYRICA and alcohol can affect each other and increase side effects such as sleepiness and dizziness. This can be dangerous.
• Do not take other medicines without talking to your doctor. Other medicines include prescription and non-prescription medicines, vitamins, and herbal supplements. LYRICA and other medicines may affect each other and increase the side effects of sleepiness and dizziness. Be especially careful about medicines that make you sleepy (such as sleeping pills, anxiety medicines, tranquilizers and some antihistamines, pain relievers and seizure medicines).

...

What are the possible side effects of LYRICA? LYRICA may cause side effects including:

• dizziness and sleepiness. See "What is the most important information I should know about LYRICA?"
• eyesight problems. See "What is the most important information I should know about LYRICA?"
• weight gain and swelling of the hands and feet (edema). Weight gain may affect the management of diabetes. Weight gain and swelling can also be a serious problem for people with heart problems.
• unexplained muscle problems, such as muscle pain, soreness, or weakness. If you develop these symptoms, especially if you also feel sick and have a fever, tell your doctor right away.
• The most common side effects of LYRICA are:

..........• dizziness

..........• blurry vision

..........• weight gain

..........• sleepiness

..........• trouble concentrating

..........• swelling of hands and feet

..........• dry mouth
...

LYRICA caused skin sores in animals. Although skin sores were not seen in studies in people, if you have diabetes, you should pay extra attention to your skin while taking LYRICA and tell your doctor of any sores or skin problems.
...

LYRICA may cause some people to feel “high.” Tell your doctor, if you have abused prescription medicines, street drugs, or alcohol in the past.
...

Tell your doctor about any side effect that bothers you or that doesnot go away. These are not all the side effects of LYRICA. For more information, ask your doctor or pharmacist.
...

How should I store LYRICA?

• Store LYRICA at room temperature, 59 to 86º F (15 to 30º C)in its original package.
• Safely throw away LYRICA that is out of date or no longer needed.
• Keep LYRICA and all medicines out of the reach of children.

...
General information about LYRICA

Medicines are sometimes prescribed for conditions other than those listed in patient information leaflets. Do not use LYRICA for a condition for which it was not prescribed. Do not give LYRICA to other people, even if they have the same symptoms you have. It may harm them.

...
This information summarizes the most important information about LYRICA. If you would like more information, talk with your doctor. You can ask your doctor or pharmacist for information about LYRICA that is written for health professionals.

You can also visit the LYRICA website at:

http://www.lyrica.com/

or call 1- 866- 4LYRICA.

...
What are the ingredients In LYRICA?

• Active ingredient: pregabalin
• Inactive ingredients:

..........1. lactose monohydrate,

..........2. cornstarch,

..........3. talc;

• Capsule shell:

..........1. gelatin and

..........2. titanium dioxide;

• Orange capsule shell:

..........1. red iron oxide;

• White capsule shell:

..........1. sodium lauryl sulfate,

..........2. colloidal silicon dioxide. Colloidal silicon dioxide is a manufacturing aid that may or may not be present in the capsule shells.

• Imprinting ink:

..........1. shellac,

..........2. black iron oxide,

..........3. propylene glycol,

..........4. potassium hydroxide.

...
PARKE -DAVISDiv of PFIZER Inc

New York, NY 10017

LAB-0299-2.0

July 2005© 2005 Pfizer Inc

Avandia is a registered trademark of GlaxoSmithKline. Actos is a registered trademark of Takeda Chemicals Industries,Ltd. and used under license by Takeda Pharmaceuticals of America,Inc. and Eli Lilly and Co.

...

Diabetes and Your Gums and Teeth

Diabetes can lead to infections in your gums and the bones that hold your teeth in place. Like all infections, gum infections can cause blood glucose to rise. Without treatment, teeth may become loose and fall out.

..
Help prevent damage to your gums and teeth by doing the following:

1. See your dentist twice a year. Tell your dentist that you have diabetes.
2. Brush and floss your teeth at least twice a day.
3. If you smoke, quit.
4. Keep your blood glucose as close to normal as possible.

Keeping your blood glucose in your target range, brushing and flossing your teeth every day, and having regular dental checkups are the best ways to prevent gum and teeth problems when you have diabetes.

Taking Care of Your Diabetes at SpecialTimes

Diabetes is part of your life. It's very important to take care of it when you're sick, when you're at school or work, when you travel, or when you're pregnant or thinking about having a baby. Here are some tips to help you take care of your diabetes at these times.
I. When You're Sick
Take good care of yourself when you have a cold, the flu, an infection, or other illnesses. Being sick can raise your blood glucose. When you're sick, do the following:

1. Check your blood glucose every 4 hours. Write down the results.Keep taking your insulin and your diabetes pills. Even if you can't keep food down, you still need your diabetes medicine. Ask your doctor or diabetes educator whether to change the amount of insulin or pills you take.
2. Drink at least a cup (8 ounces) of water or other calorie-free, caffeine-free liquid every hour while you're awake.
3. If you can't eat your usual food, try drinking juice or eating crackers, popsicles, or soup.
4. If you can't eat at all, drink clear liquids such as ginger ale. Eat or drink something with sugar in it if you have trouble keeping food down.
   ..

II. Test your urine for ketones if

1. your blood glucose is over 240
2. you can't keep food or liquids down
   

III. Call your health care provider right away if

1. your blood glucose has been over 240 for longer than a day
2. you have moderate to large amounts of ketones in your urine
3. you feel sleepier than usual
4. you have trouble breathing
5. you can't think clearly
6. you throw up more than once
7. you've had diarrhea for more than 6 hours
   ..

ACTION STEPS

If you use insulin

1. Take your insulin, even if you've been throwing up.
2. Ask your doctor about how to adjust your insulin dose, based on your blood glucose test results.

..
ACTION STEPS

If you DON'T use insulin

1. Take your diabetes pills, even if you've been throwing up.
2. When You're at School or WorkTake care of your diabetes when you're at school or at work:
   ..a. Follow your meal plan.
   ..b. Take your medicine and check your blood glucose as usual.
   ..c. Tell your teachers, friends, or close co-workers about the signs of hypoglycemia. You may need their help if your blood glucose drops too low.
   ..d. Keep snacks nearby and carry some with you at all times to treat hypoglycemia.
   ..e. Tell your company nurse or school nurse that you have diabetes.
   ..

When You're Away From HomeTaking care of your diabetes, even on vacation, is very important.

Here are some tips:

1. Follow your meal plan as much as possible when you eat out. Always carry a snack with you in case you have to wait to be served.
2. Limit your drinking of beer, wine, or other alcoholic beverages. Ask your diabetes educator how much alcohol you can safely drink. Eat something when you drink.
3. If you're taking a long trip by car, check your blood glucose before driving. Stop and check your blood glucose every 2 hours. Always carry snacks like fruit, crackers, juice, or soda in the car in case your blood glucose drops too low.
4. Ask ahead of time for a diabetes meal if you're traveling by plane. Most airlines serve special meals for people with health needs. Carry food (like crackers or fruit) with you in case meals are late.
5. Carry your medicines (insulin and diabetes pills) and your blood testing supplies with you. Never put them in your checked luggage.
6. Ask your health care team how to adjust your medicines, especially your insulin, if you're traveling across time zones.
7. Take comfortable, well-fitting shoes on vacation. You'll probably be walking more than usual, so you should take extra care of your feet.
8. If you're going to be away for a long time, ask your doctor for a written prescription for your diabetes medicine and the name of a doctor in the place you're going to visit.
9. Don't count on buying extra supplies when you're traveling, especially if you're going to another country. Different countries use different kinds of insulin and pills.
10. When traveling by plane, find out if and when a meal will be served. Then decide when to take your insulin shot or diabetes pills. You may need to bring your own food for the trip.
    

ACTION STEPS

If you use insulin

1. When you travel, take a special insulated bags to carry your insulin and to keep it from freezing or getting too hot.
2. Bring extra supplies for taking insulin and testing your blood glucose in case of loss or breakage.
3. Ask your doctor for a letter saying that you have diabetes and need to carry supplies for taking insulin and testing blood glucose.
   ..

When You're Planning a Pregnancy

Planning ahead is very important if you want to have a baby. High blood glucose can be harmful to both a mother and her unborn baby. Even before you become pregnant, your blood glucose should be close to the normal range. Keeping blood glucose near normal before and during pregnancy helps protect both mother and baby.

..
Your insulin needs may change when you're pregnant. Your doctor may want you to take more insulin and check your blood glucose more often. If you take diabetes pills, you'll take insulin instead when you're pregnant.

..
If you plan to have a baby, do the following:

1. Work with your health care team to get your blood glucose as close to the normal range as possible.
2. See a doctor who has experience in taking care of pregnant women with diabetes.
   Have your eyes and kidneys checked. Pregnancy can make eye and kidney problems worse.
3. Don't smoke, drink alcohol, or use harmful drugs.
4. Follow the meal plan you get from your dietitian or diabetes educator to make sure you and your unborn baby have a healthy diet.
5. If you're already pregnant, see your doctor right away. It's not too late to bring your blood glucose close to normal so that you'll stay healthy during the rest of your pregnancy.
   ..

Where to Get More Help With Your Diabetes

People Who Can Help You:

1. Your doctor. He or she may be your doctor at the clinic where you go for health care, your family doctor, or someone who has special training in caring for people with diabetes. A doctor with that kind of special training is called an endocrinologist or diabetologist. You'll talk with your doctor about what kind of medicine you need and how much you should take. You'll also agree on a target blood glucose range and blood pressure and cholesterol targets. Your doctor will do tests to be sure that your blood glucose, blood pressure, and cholesterol are staying on track and that you're staying healthy. Ask your doctor if you should take aspirin every day to help prevent heart disease.
2. Your diabetes educator. A diabetes educator may be a nurse, a dietitian, or another kind of health care worker. Diabetes educators teach you about meal planning, diabetes medicines, physical activity, how to check your blood glucose, and how to fit diabetes care into your everyday life. Don't be shy about asking your doctor or diabetes educator about the information in this guide. Ask questions if you don't understand something. After all, it's your health!Your family and friends. Taking care of your diabetes is a daily job. You may need help or support from your family or friends. You may want to bring a family member or close friend with you when you visit your doctor or diabetes educator. Taking good care of your diabetes can be a family affair!
3. A counselor or mental health worker. You might feel sad about having diabetes or get tired of taking care of yourself. Or you might be having problems because of work, school, or family. If diabetes makes you feel sad or angry, or if you have other problems that make you feel bad, you can talk to a counselor or mental health worker. Your doctor or diabetes educator can help you find a counselor if you need one.

Organizations That Can Help You :

1. to find a diabetes educator near you, call the American Association of Diabetes Educators toll-free at 1–800–832–6874, or look on the Internet at http://www.diabeteseducator.org/ and click on “Find an Educator.”
2. to find a dietitian near you, call the American Dietetic Association toll-free at 1–800–366–1655, or look on the Internet at http://www.eatright.org/ and click on "Find a Dietitian."
   

To find programs about diabetes or for additional information, contact:

1. American Diabetes Association
   1701 North Beauregard Street
   Alexandria, VA 22311
   Phone: 1–800–342–2383
   Internet: http://www.diabetes.org/
2. Juvenile Diabetes Research Foundation International
   120 Wall Street19th Floor
   New York, NY 10005
   Phone: 1–800–533–2873
   Internet: http://www.jdrf.org/
   ..

Both these organizations have magazines and other information for people with diabetes.They also have local groups in many places where you can meet other people who have diabetes.

..

To get more information about taking care of diabetes, contact:

1. National Diabetes Information Clearinghouse
   1 Information Way
   Bethesda, MD 20892–3560
   Phone: 1–800–860–8747
   Fax: 703–738–4929
   Email: ndic@info.niddk.nih.gov
   Internet: http://www.diabetes.niddk.nih.gov/
2. National Diabetes Education Program
   1 Diabetes Way
   Bethesda, MD 20892–3600
   Phone: 1–800–438–5383
   Fax: 703–738–4929
   Internet: http://www.ndep.nih.gov/
3. National Diabetes Information Clearinghouse
   1 Information Way
   Bethesda, MD 20892–3560
   Email: ndic@info.niddk.nih.gov
   ..

The National Diabetes Information Clearinghouse (NDIC) is a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). The NIDDK is part of the National Institutes of Health under the U.S. Department of Health and Human Services. Established in 1978, the Clearinghouse provides information about diabetes to people with diabetes and to their families, health care professionals, and the public. The NDIC answers inquiries, develops and distributes publications, and works closely with professional and patient organizations and Government agencies to coordinate resources about diabetes.
..

Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts.
..

This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired.
..

Scientific Studies Have Proven:

1. Gymnema Sylvestre is perhaps the most powerful herbal agent for improving blood sugar control. Human studies have demonstrated that Gymnema Sylvestre has therapeutic value for both type 1 and type 2 diabetics. In a study involving type 1 diabetics, average insulin requirements dropped by almost 30%. In another study of type 2 diabetics, A1c levels were reduced from 12 – 8.5%.
2. Studies have shown that Cinnamon Extract increases glucose metabolism. All three of the research groups that took Cinnamon Extract had significant reductions in blood sugar, ranging from 18 to 29%. The results of this study were published in the December 2003 issue of Diabetes Care.
3. There have been more than 20 clinical studies on Chromium supplementation in diabetes. The results of these studies have shown that Chromium lowers fasting blood sugar, improves glucose tolerance and lowers insulin levels. At least 90% of Americans have a serious Chromium shortage

...
Talk with your doctor about the use of these three supplements in order to help control your diabetes. If your doctor agrees, check with your pharmacist to find a supplement that contains all three!

To view information on another disease, click on Pancreatitis SOD Library.!

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