21.

Patient Teaching

Keep Your Diabetes Under Control

 

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What are diabetes problems?

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Will I have diabetes problems?

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What should my blood sugar numbers be?

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How can I find out what my average blood sugar is?

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What should I do about blood pressure?

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What should I know and do about smoking?

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What else can I do to prevent diabetes problems?

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Things to check for good diabetes care

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How to use the daily diabetes record page

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For more information

What Are Diabetes Problem?

Too much sugar in the blood for a long time causes diabetes problems. This high-blood sugar can damage many parts of the body, such as the heart, blood vessels, and kidneys. Diabetes problems can be scary, but there is a lot you can do to prevent them or slow them down.

Will I Have Diabetes Problem?

Maybe. You may have one or more diabetes problems or none at all. It is hard to know if or when your diabetes will cause problems. If you have diabetes when you are young, you may not have diabetes problems for many years. If you find out you have diabetes as an adult, you may already have diabetes problems. Either way, keeping your blood sugar under control can prevent diabetes problems.

What Should My Blood Pressure Number Be?

For most people, good blood sugar levels are

On waking up (before breakfast)  80 to 120
Before meals 80 to 120
2 hours after meals 180 or less
At bedtime  100 to 140

 Ask your health-care provider what your blood sugar numbers should be.

On waking up (before breakfast)  ______ to ______
Before meals ______ to ______
2 hours after meals ______ or less
At bedtime _______ to ______
 

You and your health-care provider will agree on when to check blood sugar using a blood glucose meter. You will do the tests yourself. Be sure to ask your health-care provider to teach you how to use the meter.

Keep track of your blood sugar using the record page. Print out the record page or ask your health-care provider for a blood sugar record book. Your blood sugar check results will help you and your health-care provider make a plan for keeping your blood sugar under control.

How Can I Find Out What My Average Blood Sugar Is?

Ask your health-care provider to do a hemoglobin A–1–c (HE–moh–glow–bin A–1–c) test. This blood test shows the average amount of sugar in your blood during the past 3 months. Have this test done at least twice a year. Your health-care provider uses this test plus your blood glucose meter test results to tell if your blood sugar is under control.

Aim for a score of less than 7 percent. If your test result is less than 7 percent, then your blood sugar is in a good range and your diabetes treatment plan is working. You are doing all you can to prevent diabetes problems.

A test result of more than 8 percent is too high. At more than 8 percent, you have a greater chance of getting diabetes problems, like kidney damage, and you need a change in your diabetes plan. Your health-care provider can help you decide what part of your plan to change. You may need to change your meal plan, your diabetes medicines, or your exercise plan.

Check Your Hemoglobin Alc I.Q.

Find out how much you know about the hemoglobin A1c test (also called H-b-A-1-c). Mark each statement true (T) or false (F). Then see how you did by checking the correct answers and explanations on the bottom of this page.

  1. A hemoglobin A1c test measures the average amount of sugar in your blood over the last 3 months.              T  F

  2. It’s important to know your hemoglobin A1c number.T  F

  3. All people with diabetes need to have a hemoglobinA1c test.                                                                         T  F

  4. The hemoglobin A1c goal for people with diabetes is less than 7 percent.                                                         T  F

  5. Most people can tell what their blood sugar levels are simply by how they feel.                                           T  F

  6. You can have a "touch of sugar" but don’t have to do anything about it.                                                     T  F

  7. You can do something about high-blood sugar.        T  F

  8. A hemoglobin A1c number over 8 percent is a sign that one or more parts of your treatment plan needs to be changed.                                                                 T  F

  9. A hemoglobin A1c test should be done about once a year.                                                                       T  F

  10. There’s no proof that lowering your hemoglobin A1c number can reduce your chances of getting serious eye, kidney, and nerve disease.                                       T  F

Answers to the Hemoglobin A1c I.Q. Quiz

  1. True. The hemoglobin A1c test shows the average amount of sugar in your blood over the last 3 months. It is a simple lab test done by your health-care provider. The hemoglobin A1c is the best test to find out if your blood sugar is under control. Return to Quiz

  2. True. If you know your hemoglobin A1c number, you will know if your blood sugar is under control. A high number is a sign that you should work with your health-care provider to change your treatment plan. A good test result is a sign that your treatment plan is working and your blood sugar is under control.

  3. True. All people with diabetes should have a hemoglobin A1c test at least twice a year. Regular hemoglobin A1c testing can help you track your blood sugar levels over time to see if they stay close to normal or go up and down. If your blood sugar levels are too high or too low, work with your health-care provider to change your treatment plan and reach your target level of control.

  4. True. The hemoglobin A1c goal for people with diabetes is less than 7 percent. The findings of a major diabetes study, the Diabetes Control and Complications Trial (DCCT), showed that people with diabetes who keep their hemoglobin A1c levels close to 7 percent have a much better chance of delaying or preventing diabetes problems that affect the eyes, kidneys, and nerves than people with hemoglobin A1c levels 8 percent or higher. A change in treatment is almost always needed if your hemoglobin A1c is over 8 percent. But, if you can lower your hemoglobin A1c number by any amount, you will improve your chances of staying healthy.

  5. False. Research shows that few people can tell their blood sugar levels simply by how they feel. Testing your blood sugar is the only way to know for sure whether you are reaching your blood sugar goals.

  6. False. If you have "sugar" you have diabetes. Diabetes is a serious disease that causes the sugar in your blood to build up in your body. This buildup of sugar can cause you to go blind, suffer a heart attack, lose your feet or legs to amputations, stop your kidneys from working, and even kill you. There is no cure for diabetes, but there is a lot you can do to control it. For example, you can see your health-care provider more often. You can change some of the foods you eat. You can stay at a weight that is right for you. And you can get regular physical activity.

  7. True. You can do a lot to bring down high-blood sugar and get it under control. Start by asking your health-care provider for a hemoglobin A1c test. If your hemoglobin A1c test result is too high, talk to your health-care provider about how to lower it. To get your blood sugar under control, follow the meal plan recommended by your health-care provider, stick to a physical activity program, take prescribed diabetes medicines, and consult your health-care provider often.

  8. True. A change in treatment is almost always needed if your hemoglobin A1c is over 8 percent. Common causes of high-blood sugar include eating too much food or eating the wrong foods, lack of physical activity, stress, a need to change medicines, and infection or illness. If your hemoglobin A1c number is too high, work with your health-care provider to change your treatment plan and reach the goal of less than 7 percent.

  9. False. You should get a hemoglobin A1c test at least two times a year if your blood sugar is in the target range and stable. If your treatment changes or if your blood sugar stays too high, you should get a hemoglobin A1c test at least every 3 months until your blood sugar level improves.

  10. False. The DCCT showed that the lower the hemoglobin A1c number, the greater the chances that people with diabetes will slow or prevent the development of serious eye, kidney, and nerve disease. The study also showed that if you can lower your hemoglobin A1c number by any amount, you will improve your chances of staying healthy.

What Should I Do About Blood Pressure?

Normal blood pressure will help prevent damage to your eyes, kidneys, heart, and blood vessels. Blood pressure is written with two numbers separated by a slash. For example: 120/70. The first number should be below 130 and the second number should be below 85. Keep your blood pressure as close to these numbers as you can.

If your blood pressure is too high, your doctor might ask you to take a blood pressure medicine called an ACE inhibitor (in–HIB–it–ur). This type of blood pressure medicine is best for people with diabetes.

What Should I Know and Do About Smoking?
Do not smoke. Smoking slows down the blood flow and can make heart and blood vessel problems worse. Smoking can slow blood flow to your feet and legs and make sores and infections harder to heal.

If you smoke, ask your health-care provider for help in quitting.

What Else Can I Do to Prevent Diabetes Problems?

There are other things that you can do either each day or one or more times a year to prevent diabetes problems. For example, to keep your feet healthy, you should check them each day. To keep your eyes healthy, once a year you should have drops put in your eyes and have them examined.

Things to Check For Good Diabetes Care

Taking care of diabetes is a team effort between you and your health-care provider team (doctor, diabetes nurse educator, diabetes dietitian educator, pharmacist, and others). You are the most important member of the team.

Take charge of your diabetes care by learning what to do for good diabetes care:

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Things to do every day for good diabetes care.

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Things for your health-care provider to look at every time you have a checkup.

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Things for you or your health-care provider to do at least once or twice a year.

Keep a daily record of blood sugar test results. (Print out the daily diabetes record page.) This information will help you see if you are reaching your blood sugar goals. Y ou can prevent or slow down diabetes problems by reaching your blood sugar goals most of the time.

Things to do everyday for good diabetes care

Follow the healthy eating plan that you and your doctor or dietitian have worked out. Eat your meals and snacks at around the same times each day.
Be active a total of 30 minutes most days. Ask your doctor what activities are best for you.
Take your diabetes medicine at the same times each day.
Check your blood sugar every day. Each time you check your blood sugar, write the number in your record book. Call your doctor if your numbers are too high or too low for 2 to 3 days.
Check your feet every day for cuts, blisters, sores, swelling, redness, or sore toenails.
Brush and floss your teeth and gums every day.

 
Don’t smoke.

Things for your health-care provider to look at every time you have a checkup:

Your blood sugar records  • Show your records to your 

                                               health-care provider.

                                            • Tell your health-care provider if you 

                                               have low blood sugar or high-blood 

                                               sugar often.

Your weight                        • Ask your health-care provider how 

                                              much you should weigh.

                                            • Talk about ways to reach your goal 

                                               that will work for you.

Your blood pressure           • A good goal for most people is less 

                                               than 130/85.

                                             • Ask your health-care provider    

                                               about ways to reach your goal.

Your diabetes                      • Talk to your health-care provider 

medicines plan                        about any problems you have had 

                                               with your diabetes medicines.

Your feet                             • Ask your health-care provider to 

                                              check your feet to make sure your 

                                              foot nerves and your blood 

                                              circulation are OK.

Your plan for exercise        • Tell your health-care provider what 

                                                 you do to stay active.

Your meal plan                    • Talk to your health-care provider 

                                               about any problems Ask questions 

                                               about what to eat, how much to eat, 

                                               or when to eat.

Your feelings                       • Ask your health-care provider 

Are you tense .                        about ways to handle stress

or depressed?                       • If you are feeling sad or unable to 

                                               cope with problems, ask about how 

                                               to get help.

Your smoking                     • If you smoke, quitting may be very 

                                              hard to do. But your health-care 

                                              provider may be able to help.

Things for you or your health-care provider to do at least once or twice a year:
Hemoglobin A–1–c lab tes t Have this blood test at least twice a year.

This will tell you what your average blood sugar level was for the past 3 months.
Blood lipid (fats)  

labs tests

Get a blood test to check your

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Cholesterol–aim for less than 200.

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LDL—aim for less than 130.

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HDL—men should aim for more than 35; women should aim for more than 45.

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Triglycerides—aim for less than 200.

These test results will help you plan now to prevent heart attack and stroke.
Kidney lab tests

 Ask for tests to check your urine for protein and your blood for end products of protein breakdown. The results will tell you how well your kidneys are working.

  Dilated eye exam

  See your eye doctor once a year because a doctor can detect eye problems before you notice anything wrong.
Dental exam See your dentist twice a year for a cleaning and checkup.
Flu shot

  Get a flu shot each year because the flu in someone with diabetes can be very serious.

How To Use the Daily Diabetes Record Page

Use copies of the record page to keep track of blood sugar checks, medicines, and notes about things that affect your blood sugar. Print one copy of the record page for each week. This record will help you see if your diabetes plan is working. Review your record with your health-care providers.

Blood Sugar Check

Talk to your health-care provider and decide on the best times to check blood sugar. You may be checking blood sugar before meals, after meals, or at bedtime. Write down when to check.

If needed, draw a line in the boxes under "Breakfast," "Lunch," and "Dinner" to make room for blood sugar check results before and after a meal, like this example:

Medicines

Under the heading marked "Medicine," write the name of your diabetes medicine and the amount taken.

Notes

Write down things that affect your blood sugar level. Some examples are
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Eating more or less than usual.

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Forgetting to take your diabetes medicine.

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Exercising (write down what kind and for how long).

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Being sick or upset about something (being under stress).

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Going to a social event or other special event, or being on vacation.

My health-care provider team members

Print out this chart and record names, addresses, and phone numbers.

  Name and Address Phone Number
Doctor    

Diabetes Dietitian Educator

    

Diabetes Nurse Educator

    
Eye Doctor    

Dentist 

    
Foot Doctor     

Pharmacist 

    

Counselor