Managing Diabetes

Follow a healthy diet

Control your weight

Exercise regularly

Do not smoke

Have regular checkups with your physician

A1C

What does A1C tell you? The A1C% represents the level of glucose control you have had over the last 2-3 months. If your daily blood sugars have been high over the last several months, then your A1C% will also be high.

Daily Blood Sugars  =  AIC %

When should I have an A1C test?

You should always have an A1C test when you are first diagnosed with diabetes and then every 6 months thereafter. Some people need an A1C test done more often than others. You should have an A1C test done every 3 months, if ¨ you are on insulin, ¨ you have blood sugars that are out of control, or ¨ your A1C is > 8%. If you are pregnant and have diabetes, you need an A1C test every month.

An A1C test can be done at any time - before or after you have eaten. Be sure to ask your health care provider if it is time for you to have an A1C test done!

What is the difference in A1C and daily blood sugar testing? Self-monitoring blood glucose (SMBG) testing is what you do every day at home with your blood sugar machine. These values are what you write in your logbook and take to your doctor. The A1C test is a test usually done in your physician's office or lab but it can also be done at home with a kit you can buy at your local pharmacy. Both tests are very important in managing your diabetes!

The difference in these two tests is the time period the test results are based on. When you do SMBG testing, it tells you what your blood sugar is right now. These results will be different every time you test depending on the time of day, when and what you have eaten, what medication(s) you have taken, and how much exercise you have done. The A1C test shows what your blood sugar levels have been over the past 2 or 3 months. The A1C results are reported as a percent (%).

The A1C test gives you the BIG picture of your overall glucose control.

How do my A1C results compare to my blood sugar results? Experts suggest that your A1C goal should be less than 7%. Any A1C greater than 8% means that your diabetes is starting to get out of control and you need to adjust your diabetes management plan to get better results. It is important to contact your doctor when you are exhibiting poor glucose (sugar) control. Set your A1C goal with your healthcare provider. My AIC goal is __________%. With optimal control, your A1C can move towards normal.

How should I use the results of the A1C test? The A1C test results can help you manage your diabetes in many ways. Use these results to: Look back and review your glucose control over the past 2-3 months. See if your diabetes treatment plan is working for you - are your medication(s), diet and exercise in the right proportions? Review the last several months to see if a change in your treatment plan has helped to improve your blood sugar control.

How does lowering my A1C help me? A lower A1C value means a lower risk of developing complications such as heart disease (cardiovascular), nerve disease (neuropathy), kidney disease (nephropathy), and eye disease (retinopathy). Research studies have shown that the risks of developing these diseases are much lower when blood sugars are in control and A1C is less than 7%.

How much do I need to reduce my A1C for it to be beneficial? Any reduction is beneficial. A larger reduction is more beneficial than a small one. Even if you have to take small steps to get there, set a goal for yourself to reduce your A1C. Lowering your A1C just 1% can reduce your risk of developing eye, kidney, and nerve disease by 40%.

How can I lower my A1C? Check your blood sugar more often. Test several times a day and at different times from one day to the next. That way you will get a better overall picture of your blood sugar levels. Keep a log and show it to your doctor. AND With your healthcare team, identify high blood sugar patterns and adjust your management plan to help control those high levels. AND Increase your exercise. Ask your doctor before starting or changing your exercise routine. Walking as little as 30 minutes a day can help. AND Attend diabetes self-management education classes and learn more about how you can take control and manage your diabetes! AND Control depression. If you are feeling depressed, seek medical assistance. You are not in this alone.

Diabetes And Your Heart People with diabetes have a 2 to 4 times greater risk of developing heart disease. What is Cardiovascular Heart Disease? The heart and blood vessels pump blood throughout your body to deliver nutrients and essential materials to your cells and to remove waste products. Keeping blood glucose, blood pressure, and blood fat (cholesterol) levels as close to normal as possible can help keep your blood vessels healthy and protect your heart. When any of these levels are increased over time, damage may occur to your blood vessels and/or your heart. People with diabetes need to be aware of how to maintain a healthy heart.

The Link Between Diabetes and Heart Disease Having diabetes is stressful for the heart. Recent research confirms that patients with diabetes do not recognize the high risk of cardiovascular disease and its link with diabetes. Cardiovascular disease (heart attack and stroke) is the leading cause of death in the U.S., and diabetes is a major risk factor for developing heart and blood vessels diseases. However, having diabetes does not mean you will develop cardiovascular disease. There are things patients can do to reduce their risk of heart-related problems. Research shows that even small decreases in blood sugar, blood pressure, and cholesterol levels can help people with diabetes to live longer and healthier lives. Each of these conditions contributes to blood vessel damage. The blood vessels get blocked and are less flexible. This cuts off circulation to the heart and increases its workload. This condition is called cardiovascular disease or CVD.

Take Control Know the ABC's of diabetes care and live a long and healthy life. A is for A1C. The A1C test stands for hemoglobin A1C or A1C. This test measures your average blood glucose over the last 2-3 months. High blood sugar levels lead to a high A1C. B is for blood pressure. High blood pressure makes your heart work too hard. C is for cholesterol. Bad cholesterol, or LDL, builds up and clogs your arteries. If you do not know your ABC numbers, be sure to get them from your health care provider.

A Controlling Blood Sugar When a person has diabetes, the body does not make enough insulin and in some cases the insulin that is being made cannot be used right away. Without insulin, the sugar from the foods you eat remains in your bloodstream and does not go into your cells. This makes the blood sugar high. High A1C levels are the result of high blood sugar or "hyperglycemia." Checking your blood sugar at home is a good way to know the amount of sugar circulating in your blood stream at various times during the day. To learn ways to keep your blood sugar in good control and reduce your risk for complications, enroll in a diabetes self-management class. You can begin now to take steps to reduce your blood sugar level: Lose weight slowly if you are overweight. Control carbohydrate portions and choose foods lower in fat. Take your medicines as prescribed. Increase physical activity. Keep track of your blood sugar levels by monitoring at home.

DESIRED BLOOD SUGAR & A1C LEVELS   Goal Pre-meal 80-120 1-2 hours post-meal Under 180 Bedtime 100-140 A1C Under 7% Discuss specific ranges with your doctor.

B The Role of Blood Pressure Your blood pressure is the force that pushes blood from your heart through the arteries and veins in your body. Blood pressure is always listed as two numbers. The first or top number is your systolic pressure. This number is the pressure when your heart is pumping and your blood pressure is in full force. The bottom or second number is your diastolic pressure. This is the pressure when your heart is relaxing between beats and your blood pressure drops. If you have diabetes, your blood pressure should be below 130/80. High blood pressure, also called hypertension, is often called the "silent killer" because it frequently has no symptoms. That's why it is very important to get regular medical check-ups and have your blood pressure checked often even if you feel well. High blood pressure damages the coronary arteries, making the heart work harder than it should. It also increases the risk of stroke. You can decrease your risk for high blood pressure by eating a low-salt, low-fat diet, exercising regularly, and keeping your weight under control. Also limit alcohol intake, don't smoke, and reduce your stress.

DESIRED BLOOD PRESSURE FOR PEOPLE WITH DIABETES Systolic     130 or less Diastolic      80 or less

C Controlling Cholesterol Know your blood fat levels - the "good" fats and the "bad" ones. Cholesterol is a fat-like substance that is produced and stored in your liver. Cholesterol is also found in your diet but only in animal products. While some cholesterol in the blood is essential, too much of it can be harmful. When it travels through the bloodstream, cholesterol is wrapped in protein and called lipoprotein. Over time, excess cholesterol can build up on the walls of your arteries. This buildup, known as "plaque," can narrow your arteries and reduce blood flow to your heart, causing serious cardiovascular risk. "Bad Cholesterol" LDL (low-density lipoprotein) Easily sticks to the walls of the arteries to form blockages or plaque. "Good Cholesterol" HDL (high-density lipoprotein) Helps to remove excess cholesterol from the bloodstream by taking it back to the liver where it can be processed or removed from the body Healthy eating and physical activity are the first-line therapies to combat high cholesterol. Sometimes medication may be necessary. Be sure your doctor monitors your cholesterol levels and be sure you know your numbers.

DESIRED CHOLESTEROL LEVELS Goals: Men Women HDL Over 45 Over 55 LDL Under 100 Under 100 TOTAL Under 200 Under 200

Reference: National Institutes of Health and the Centers for Disease Control and Prevention. The National Diabetes Education Program. NDEP-52, November 2001.

MEAL PLANNING Eating healthy foods is one of the most important tools for managing your blood sugar. Good blood sugar control protects your health and decreases complications from diabetes. A healthy meal plan consists of multiple serving of vegetables, whole grains, low-fat dairy products, fish, lean meats, and poultry, and some fresh or unsweetened fruit. The food guide pyramid is a tool that can help you make healthy food choices. The pyramid divides foods into six groups. Choose foods from each group to include a variety of foods each day. Most of the foods you eat each day should come from the bottom of the pyramid, the grains, vegetables, and fruits. Fewer servings should come from the milk, meats and protein groups. Very limited choices should come from the fats, sweets, and alcohol group at the tip of the pyramid. If you choose to drink alcohol, limit to 2 servings per day for men and 1 serving for women (1 serving = 4 oz. wine, 12 oz. beer, or 1 ½ oz. liquor). The minimum number of servings from each food group provides about 1600 calories per day. Use the pyramid as a guide to balance your meal plan throughout the day. (Pyramid hyperlink to www.nal.usda.gov:8001/py/pmap.htm ). Avoid skipping meals. Skipping meals can make you extra hungry and likely to eat more than you should at one meal. Space your meals about 4 or 5 hours apart.

Keep Portions in Control Your blood sugar is affected not only by the kind of food you eat, but also by how much food you eat. Serving sizes differ among food groups. The following will help you estimate serving sizes: 3 oz. of meat, poultry, or fish is about the size of one deck of cards or the palm of a small hand. ½ cup of fruit, vegetables, or pasta is about the size of a small fist or a tennis ball. · 1 oz. of cheese is about the size of your thumb. Cooking food can change its size. Serving sizes recommended are based on foods after cooking. Use a salad plate rather that a large dinner plate. Use a sectioned plate to keep servings of vegetables and starches at ½ cup servings. Compare portion sizes to those in an individual size frozen dinner.

Make Healthy Carbohydrate Choices How much carbohydrate should you have? A typical meal plan may allow 45-60 grams or 3-4 servings of carbohydrate at each meal and 15-30 grams or 1-2 servings for a snack. A registered dietitian can help you determine how much carbohydrate you should have at each meal and snack.

How do you count carbohydrate? 15 grams of carbohydrate = 1 serving Each item equals 15 grams of carbohydrate: 1/2c. Pasta 1 slice Whole Wheat Bread 1/2c. Oatmeal 1 small Piece of Fruit

Sample Breakfast Meal: ¾ cup cereal = 1 serving or 15 grams 1 small banana = 1 serving or 15 grams 1 cup skim milk = 1 serving or 15 grams

Limit foods high in sugar such as honey, regular sodas, syrup, jelly, candy, doughnuts, fruit packed in syrup, cake with icing and pies. If you occasionally have something sweet, substitute a small serving for 1 or 2 carbohydrate choices. Refer to the food label to help you count carbohydrate grams.

Understanding Food Labels The Nutrition Facts label lists the amount of carbohydrate, protein, fat, and calories in foods. Remember the nutrition facts listed are based on serving size, which is the first line on the nutrition facts panel. Focus on total carbohydrate. Sugars are included in the total carbohydrate grams. The total carbohydrate grams are more important than the sugar grams on the label. Calories from fat tell you how many of the calories in the food are from fat. Choose foods with no more than 3 grams of fat per 100 calories to keep the fat grams lower. Choose foods with no more than 400 mg of sodium per serving. Ingredients are listed at the bottom of the food label. The first items listed are the ingredients found in the highest amounts (by weight).