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Diabetes Management: Managing and Reversing It 
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Diabetes Management: Managing and Reversing It
Here are some additional tips beyond the Get Started web page to further help you manage your diabetes. After you get the book and once you are able to manage your diabetes and blood sugar, you can take your program to the next level and get the juicing book, cookbook, or boot camp program so that you can reverse the disease.Menu Planning for Diabetes
Get a diabetes meal plan for breakfast, lunch, dinner, and snacks.
For more details, get the cookbook or boot camp program.
Stress Management
When you have diabetes, stress can significantly affect your ability to control the disease. If you are under stress, you may skip meals or forget to take your medicines, which will affect your blood sugar level. Learning to deal with this stress is especially important if you have diabetes.
Although you can't completely remove stress from your life, there are several ways you can reduce it. And by learning to better cope with stress, you can help keep your diabetes under control. Here are some tips.
Fight Stress With a Positive Attitude
When things seem to be going wrong, it's always easier to see the bad instead of the good.
Find something good in each important area of your life: work, family, friends, and health. Thinking about the good can help you get through the bad times and the stress.
Be Nice to Yourself
What are your talents, abilities, and goals? Are you expecting too much from yourself? Don't expect more of yourself than you have or are able to give.
Accept What You Cannot Change
For those stressful situations or problems that cannot be changed, develop a simple plan of action. Ask yourself the following questions:
* "Will this be important two years from now?"
* "Do I have control over this situation?"
* "Can I change my situation?"
Talk to Someone About Your Stress
Don't keep stress bottled up inside. If you don't want to talk with a family member or close friend, there are counselors and clergy trained to provide support and insight. Ask your doctor for recommendations if you would like to see a psychologist or counselor.
Exercise to Fight Stress
The benefits of exercise in reducing stress are well known, particularly for someone with diabetes. Exercise gives you a feeling of well-being and may relieve symptoms of stress.
Take Time to Relax
Practice muscle relaxation, deep breathing, meditation, or visualization. Ask your health care provider for information and available programs.
For more details, read Chapter 13 of Death to Diabetes or get the Stress PDF.
Sick Day Management for Diabetes
When you have diabetes, sick days often means more than a runny nose and sneezing. An illness such as a cold or the flu, or any condition resulting in nausea, vomiting, or diarrhea, may cause your blood sugar to increase.
An infection also can raise blood sugar levels. Therefore, it is very important to test your blood sugar when you are sick. Here are some guidelines to follow when you are ill:
Note: Ketones are a form of waste often produced in the bodies of people with type 1 diabetes when they are under stress (such as during an illness). Call your doctor if ketones are found in your urine. Depending on the degree of your illness, he or she may suggest that you go to the emergency room.
When Should I Call My Doctor?
If you have diabetes and are sick, call your doctor if:
* Your blood sugar stays higher than 180 mg/dL or lower than 70 mg/dL.
* You are unable to keep liquids or solids down.
* You have a fever (temperature over 101 degrees F or 38.3 degrees C).
* You have diarrhea or are vomiting.
What Foods Should I Eat When I'm Sick?
If you are sick and have diabetes, you should eat or drink 45 to 50 grams of carbohydrates every three to four hours to maintain your nutrition needs, to avoid ketone development and to prevent hypoglycemia.
If you can't eat foods, you could try more easily tolerated foods, i.e. broths, soups, gelatin, light salad, light sandwich, unsweetened applesauce, raw juices.
Exercise: Diabetes Guidelines
Exercise helps control your diabetes by:
* Improving your body's use of insulin.
* Burning excess body fat, helping to decrease and control weight (decreased body fat results in improved insulin sensitivity).
* Improving muscle strength.
* Increasing bone density and strength.
* Lowering blood pressure.
* Helping to protect against heart and blood vessel disease by lowering 'bad' LDL cholesterol and increasing 'good' HDL cholesterol.
* Improving blood circulation and reducing your risk of heart disease.
* Increasing energy level and enhancing work capacity.
* Reducing stress, promoting relaxation, and releasing tension and anxiety.
How Does Exercise Affect Blood Sugar Levels?
Normally, insulin is released from the pancreas when the amount of sugar (glucose) in the blood increases, such as after eating. Insulin stimulates the liver and muscles to take in excess glucose. This results in a lowering of the blood sugar level.
When things seem to be going wrong, it's always easier to see the bad instead of the good.
Find something good in each important area of your life: work, family, friends, and health. Thinking about the good can help you get through the bad times and the stress.
Be Nice to Yourself
What are your talents, abilities, and goals? Are you expecting too much from yourself? Don't expect more of yourself than you have or are able to give.
Accept What You Cannot Change
For those stressful situations or problems that cannot be changed, develop a simple plan of action. Ask yourself the following questions:
* "Will this be important two years from now?"
* "Do I have control over this situation?"
* "Can I change my situation?"
Talk to Someone About Your Stress
Don't keep stress bottled up inside. If you don't want to talk with a family member or close friend, there are counselors and clergy trained to provide support and insight. Ask your doctor for recommendations if you would like to see a psychologist or counselor.
Exercise to Fight Stress
The benefits of exercise in reducing stress are well known, particularly for someone with diabetes. Exercise gives you a feeling of well-being and may relieve symptoms of stress.
Take Time to Relax
Practice muscle relaxation, deep breathing, meditation, or visualization. Ask your health care provider for information and available programs.
For more details, read Chapter 13 of Death to Diabetes or get the Stress PDF.
Sick Day Management for Diabetes
When you have diabetes, sick days often means more than a runny nose and sneezing. An illness such as a cold or the flu, or any condition resulting in nausea, vomiting, or diarrhea, may cause your blood sugar to increase.
An infection also can raise blood sugar levels. Therefore, it is very important to test your blood sugar when you are sick. Here are some guidelines to follow when you are ill:
- Check your blood sugar every four hours.
- Test for ketones if your blood sugars are above 240mg/dl, or as directed by your health care provider.
- Check your temperature regularly.
- Make sure you are drinking liquids if you are unable to keep down solid food. Drink one cup of liquid every hour while you are awake to prevent dehydration. If you are unable to hold down liquids, you may need to go to the emergency room or hospital.
- People with type 2 diabetes who are on oral medicines may need to stop taking their medicines when sick. Check with your doctor if you are unsure of what to do.
- If you need an over-the-counter medicine to control symptoms such as cough and nasal congestion, ask your doctor or pharmacist for a list of sugar-free products that are available.
Note: Ketones are a form of waste often produced in the bodies of people with type 1 diabetes when they are under stress (such as during an illness). Call your doctor if ketones are found in your urine. Depending on the degree of your illness, he or she may suggest that you go to the emergency room.
When Should I Call My Doctor?
If you have diabetes and are sick, call your doctor if:
* Your blood sugar stays higher than 180 mg/dL or lower than 70 mg/dL.
* You are unable to keep liquids or solids down.
* You have a fever (temperature over 101 degrees F or 38.3 degrees C).
* You have diarrhea or are vomiting.
What Foods Should I Eat When I'm Sick?
If you are sick and have diabetes, you should eat or drink 45 to 50 grams of carbohydrates every three to four hours to maintain your nutrition needs, to avoid ketone development and to prevent hypoglycemia.
If you can't eat foods, you could try more easily tolerated foods, i.e. broths, soups, gelatin, light salad, light sandwich, unsweetened applesauce, raw juices.
Exercise: Diabetes Guidelines
Exercise helps control your diabetes by:
* Improving your body's use of insulin.
* Burning excess body fat, helping to decrease and control weight (decreased body fat results in improved insulin sensitivity).
* Improving muscle strength.
* Increasing bone density and strength.
* Lowering blood pressure.
* Helping to protect against heart and blood vessel disease by lowering 'bad' LDL cholesterol and increasing 'good' HDL cholesterol.
* Improving blood circulation and reducing your risk of heart disease.
* Increasing energy level and enhancing work capacity.
* Reducing stress, promoting relaxation, and releasing tension and anxiety.
How Does Exercise Affect Blood Sugar Levels?
Normally, insulin is released from the pancreas when the amount of sugar (glucose) in the blood increases, such as after eating. Insulin stimulates the liver and muscles to take in excess glucose. This results in a lowering of the blood sugar level.
When exercising, the body needs extra energy or fuel (in the form of glucose) for the exercising muscles. For short bursts of exercise, such as a quick sprint to catch the bus, the muscles and the liver can release stores of glucose for fuel. With continued moderate exercising, however, your muscles take up glucose at almost 20 times the normal rate. This lowers blood sugar levels.
But intense exercise can have the opposite effect and actually increase your blood glucose levels. This is especially true for many people with diabetes. The body recognizes intense exercise as a stress and releases stress hormones that tell your body to increase available blood sugar to fuel your muscles. If this happens to you, you may need a little bit of insulin after intense workouts.
For a variety of reasons, after exercise, people with diabetes may have an increase or a decrease in their blood sugar levels.
For more details, read Chapter 10 of Death to Diabetes or get the Exercise PDF.
Tips for Traveling With Diabetes
For people with diabetes, going on vacation or traveling for business requires extra planning. Changes in meal patterns, activity levels, and time zones can affect your blood sugar levels. Here are some tips to make traveling easier.
Before You Leave
* Make an appointment with your health care provider to discuss your travel plans.
* Get twice as many supplies needed to travel and bring extra prescriptions and a letter from your doctor explaining that you have diabetes.
* If you need immunization shots, plan to get them three to four weeks before your vacation. Some of these shots can upset your blood sugar levels.
* Be prepared. Know what facilities are available within the region that you will be traveling.
What Should I Bring With Me?
* Bring your doctor's name and phone number and keep it with you at all times.
* Bring a list of current medicines and keep it with you at all times.
* Always carry and wear medical identification that states that you have diabetes.
* Keep medicines, syringes, and blood sugar testing supplies in your carry-on luggage. Do not check these supplies with your luggage in case it is lost. Also, the cargo hold is not heated or insulated well, so medicine and supplies can be damaged.
* Take enough medicines and medical supplies to last an extra week in case you get stranded or stay longer than you planned.
* Have a traveling companion carry some of your medical supplies, if possible.
* Always carry some type of sugar source in case you develop hypoglycemia.
* Inform the airlines, cruise ships, and tour guides in advance that you have diabetes. Most airlines and cruise ships will provide special meals.
* Test your blood sugar more often than usual.
At the Airport
Steps you can take to make your trip through airport security hassle-free include:
* Make sure you tell security that you are diabetic and that you are carrying medical supplies. Your supplies can be taken through security check points, but they must have a prescription label on them
* All of your supplies should have a proper manufacturer's label.
* Syringes will be allowed through security if you have insulin as well.
* If you are wearing an insulin pump you must notify security. They will visually inspect the meter. You must request that the meter not be removed.
Insulin Injections
If you are traveling on an airplane and you need an insulin injection during your flight, follow your normal procedure -- with one difference: Put only half as much air into your insulin bottle as you normally would. The pressure is different in airplanes than on the ground.
Time zone changes of two or more hours may mean you need to change your injection schedule. Check with your doctor for special instructions.
Keep the temperature of your insulin between 33 degrees F and 80 degrees F. Do not freeze your insulin or keep it in direct sun.
On the Road Foot Care
People with diabetes require special foot care. Follow these tips:
* Pack at least two pairs of shoes so you can change shoes often. Changing shoes helps prevent blisters and sore pressure points.
* Pack comfortable shoes, socks, and a first aid kit to treat minor foot injuries.
* Do not go barefoot. Instead, wear shoes that are specially made for ocean or beach walking. Protect your feet at all times when you are walking by the pool, in the park, on the beach, or swimming in the ocean.
* Do not wear open-toe shoes, including sandals, flip-flops, or others (you increase your risk for injury and infection when your toes are exposed).
* Follow your daily foot-care regimen.
Coping With an Emergency When Out of the Country
If an emergency occurs and you do not know where to go, try to reach the American consulate, the Red Cross, or a local medical school. Learn certain phrases in the local language such as: "I need help" or "I have diabetes, where is the hospital?" or "I need sugar."
Planning a Pregnancy With Diabetes
If you have diabetes and are considering having a baby, there are a number of steps you should take before you get pregnant to ensure a safe and healthy pregnancy and baby. Here are some tips.
* Meet with your health care provider before becoming pregnant. Your doctor can help determine if your diabetes is controlled well enough for you to stop your birth control method.
* Have your urine checked for diabetic kidney complications.
* Check your cholesterol and triglyceride levels.
* Have an eye exam to screen for glaucoma, cataracts, and retinopathy.
* Undergo pre-conception counseling.
Counseling Before Getting Pregnant
A counseling appointment with your doctor before getting pregnant is another important step for women with diabetes. Preconception counseling will help educate you so that you can be physically and emotionally prepared -- and healthy -- for pregnancy. Here's what a preconception appointment usually includes:
For people with diabetes, going on vacation or traveling for business requires extra planning. Changes in meal patterns, activity levels, and time zones can affect your blood sugar levels. Here are some tips to make traveling easier.
Before You Leave
* Make an appointment with your health care provider to discuss your travel plans.
* Get twice as many supplies needed to travel and bring extra prescriptions and a letter from your doctor explaining that you have diabetes.
* If you need immunization shots, plan to get them three to four weeks before your vacation. Some of these shots can upset your blood sugar levels.
* Be prepared. Know what facilities are available within the region that you will be traveling.
What Should I Bring With Me?
* Bring your doctor's name and phone number and keep it with you at all times.
* Bring a list of current medicines and keep it with you at all times.
* Always carry and wear medical identification that states that you have diabetes.
* Keep medicines, syringes, and blood sugar testing supplies in your carry-on luggage. Do not check these supplies with your luggage in case it is lost. Also, the cargo hold is not heated or insulated well, so medicine and supplies can be damaged.
* Take enough medicines and medical supplies to last an extra week in case you get stranded or stay longer than you planned.
* Have a traveling companion carry some of your medical supplies, if possible.
* Always carry some type of sugar source in case you develop hypoglycemia.
* Inform the airlines, cruise ships, and tour guides in advance that you have diabetes. Most airlines and cruise ships will provide special meals.
* Test your blood sugar more often than usual.
At the Airport
Steps you can take to make your trip through airport security hassle-free include:
* Make sure you tell security that you are diabetic and that you are carrying medical supplies. Your supplies can be taken through security check points, but they must have a prescription label on them
* All of your supplies should have a proper manufacturer's label.
* Syringes will be allowed through security if you have insulin as well.
* If you are wearing an insulin pump you must notify security. They will visually inspect the meter. You must request that the meter not be removed.
Insulin Injections
If you are traveling on an airplane and you need an insulin injection during your flight, follow your normal procedure -- with one difference: Put only half as much air into your insulin bottle as you normally would. The pressure is different in airplanes than on the ground.
Time zone changes of two or more hours may mean you need to change your injection schedule. Check with your doctor for special instructions.
Keep the temperature of your insulin between 33 degrees F and 80 degrees F. Do not freeze your insulin or keep it in direct sun.
On the Road Foot Care
People with diabetes require special foot care. Follow these tips:
* Pack at least two pairs of shoes so you can change shoes often. Changing shoes helps prevent blisters and sore pressure points.
* Pack comfortable shoes, socks, and a first aid kit to treat minor foot injuries.
* Do not go barefoot. Instead, wear shoes that are specially made for ocean or beach walking. Protect your feet at all times when you are walking by the pool, in the park, on the beach, or swimming in the ocean.
* Do not wear open-toe shoes, including sandals, flip-flops, or others (you increase your risk for injury and infection when your toes are exposed).
* Follow your daily foot-care regimen.
Coping With an Emergency When Out of the Country
If an emergency occurs and you do not know where to go, try to reach the American consulate, the Red Cross, or a local medical school. Learn certain phrases in the local language such as: "I need help" or "I have diabetes, where is the hospital?" or "I need sugar."
Planning a Pregnancy With Diabetes
If you have diabetes and are considering having a baby, there are a number of steps you should take before you get pregnant to ensure a safe and healthy pregnancy and baby. Here are some tips.
* Meet with your health care provider before becoming pregnant. Your doctor can help determine if your diabetes is controlled well enough for you to stop your birth control method.
* Have your urine checked for diabetic kidney complications.
* Check your cholesterol and triglyceride levels.
* Have an eye exam to screen for glaucoma, cataracts, and retinopathy.
* Undergo pre-conception counseling.
Counseling Before Getting Pregnant
A counseling appointment with your doctor before getting pregnant is another important step for women with diabetes. Preconception counseling will help educate you so that you can be physically and emotionally prepared -- and healthy -- for pregnancy. Here's what a preconception appointment usually includes:
- An evaluation of your weight: Try to reach your ideal body weight before becoming pregnant. This means losing weight if you are overweight to reduce your risk of high blood pressure complications, or gaining weight if you are underweight to reduce the risk of delivering a low birth-weight baby.
- A discussion of your lifestyle: Smoking and drinking alcohol are two habits that must be stopped in order for you to have a healthy pregnancy and baby. Smoking during pregnancy affects you and your baby's health before, during, and after your baby is born. The nicotine (the addictive substance in cigarettes), carbon monoxide, and numerous other poisons you inhale from a cigarette are carried through your bloodstream and go directly to your baby. These substances can lower the amount of oxygen available to you and your growing baby, increase your baby's heart rate, increase the chances of miscarriage and stillbirth, increase the risk that your baby is born prematurely and/or born with low birth weight, and increase your baby's risk of developing respiratory problems. Excessive drinking can lead to Fetal Alcohol Syndrome, a pattern of birth defects that includes mental retardation, as well as cardiovascular, skeletal, and facial abnormalities.
- Discussion of prenatal vitamins: Before becoming pregnant, start taking a daily vitamin that contains folic acid. Folic acid has been shown to decrease the risk of having a baby with a neural tube defect, such as spina bifida -- a serious condition in which the brain and spinal cord do not form normally. The March of Dimes Birth Defects Foundation recommends taking 400 micrograms of folic acid daily before conception and in early pregnancy. Many pharmacies sell over-the-counter prenatal vitamins that do not require a prescription
- Blood sugar screening: If you have diabetes, your doctor will check to see if your blood sugar is in control. Good blood sugar control is important before becoming pregnant because many women do not even know they are pregnant until the baby has been growing for 2-4 weeks. High blood sugar levels early in the pregnancy (before 13 weeks) can cause birth defects. In addition, good blood sugar control is just as important during pregnancy because high blood sugar levels can increase the risk of miscarriage and can increase your risk of developing diabetes complications.
- Make medication adjustments: It is important to have good control of your diabetes your entire pregnancy. If you take insulin to control your diabetes, your doctor can tell you how to adjust your medication. Generally your body will require more insulin during pregnancy, especially during the last 3 months of pregnancy. If you take oral medications to control your diabetes, your doctor may switch your medication to insulin during pregnancy, since certain oral medications could harm the developing baby.
- Diabetes meal planning: During pregnancy, you and your health care provider should work together to adjust your diabetes meal plan. Changing your meal plan will help you avoid problems with low and high blood sugar levels. Your meal plan will also be adjusted to include more calories for your growing baby. If you need help with meal planning, read Chapters 6-7 of Death to Diabetes or get one of the meal planning PDFs.
