Live With Diabetes

Part 1: Diabetes Will Change Your Life (Maybe for the Better)

Finding out you have diabetes and beginning treatment will definitely affect your day-to-day life. Some of the many lifestyle changes you will likely have to make include:

Setting aside time each day for exercise
Changing the way you shop for and prepare food
Changing your eating behavior at home and elsewhere
Remembering to take any diabetes medications as prescribed
Remembering to monitor and record your blood glucose levels

A diagnosis of diabetes is certain to change your day-to-day life, but in large measure, it’s up to you whether that change is good or bad.
The sections that follow have tips to help keep you on track with diet and exercise when you are away from home. Think of them as examples and let them inspire you to come up with solutions for your own personal challenges.

When Meal Timing Is out of Your Control

How do you time your meals when attending social functions where food is a central feature? It’s not as difficult as you might think. For one thing, you can usually get a pretty clear idea ahead of time as to when food will be served. If it’s not spelled out in the invitation, call someone and ask.

If the time of food service coincides with one of your scheduled meals, you may be able to count it as a meal. If it falls at an odd time (midmorning or midafternoon), you may need to eat sparingly at the event (treat it as a snack) and have your regular meal at home before or after the event.

Eating Smart Away From Home

Sticking to your diabetes meal plan can be a challenge at home, especially if you live with others who don’t have diabetes and can eat what they want, when they want. But eating smart when you’re away from home—at a party, in restaurants, or when you travel—presents a whole new set of challenges.

Here are some tips to help you toe the line in different situations.

At a party:

Offer to bring a healthy party-appropriate dish that is consistent with your own diabetes meal plan
Eat healthy before you leave home so you don’t feel like you’re starving when you get there
Drink water or a diet beverage while you’re there; if you are allowed alcohol, alternate with glasses of water or diet soda
Before eating, survey all the foods available so you’ll know all your options
Make the smartest choices you can from what’s available; raw vegetables are standard party fare and a good choice for you, but watch out for the dip (often a hidden source of calories and carbohydrates)
Look for lean meats and try to resist cakes, cookies, and pastries
When you eat, sit down to eat, away from the buffet table, and eat with utensils so you feel like you’re really having a meal
Eat slowly—it takes 15 to 20 minutes for your brain to catch up with your mouth and stomach and tell you you’re full
When you finish the food on your plate, get up and move around; socialize and enjoy the company of other people at the party
Never leave home without your diabetes ID on your wrist or neck—the signs of low blood sugar are easily mistaken for drunkenness

At a restaurant:

Don’t be lured by the bread basket
Look for baked, broiled, grilled, or roasted poultry or seafood, and trim away any visible fat from other meats
Consider a non-meat alternative, like veggie lasagna, a grilled veggie sandwich, or a veggie burger
Avoid fatty condiments like mayonnaise, tartar sauce, and sour cream, or ask for low-fat alternatives
Ask that gravy and creamy or cheesy sauces be omitted or served on the side so you control how much goes on your food
Many fast-food restaurants now have brochures of nutritional facts for their menus; if you don’t see one, ask
Make healthy substitutions—for example, ask for a side salad instead of French fries
Ask your waiter about the ingredients in unfamiliar dishes
Eat slowly and remember—you don’t have to eat everything on your plate; ask for a take-home container early and put one-half of your meal in it immediately to remove temptation
If the restaurant is buffet style, use a small plate, and load up on vegetables and other healthy choices

Visit the American Diabetes Association’s Web site for more tips on dining out and eating healthier foods.

When traveling:
When it comes to maintaining your meal plan on the road, air travel may present the greatest challenge. Long delays are common in air travel today, and many flights no longer serve meals. You will need to take special care to keep your meal plan balanced.

Never get on a plane without taking some food with you. Consider a well-wrapped, air-tight package of crackers and cheese or peanut butter. Throw in some fruit, a bottle of juice, and hard candies or glucose tablets in case of hypoglycemia (low blood sugar). Also be sure to drink plenty of fluids.

Estimating Portion Sizes

To effectively control your intake of calories and carbohydrates, you need to know how to read a food label. But you’ll probably need to retrain yourself on standard portion or serving size. Food label values are calculated on the basis of standard serving size.

Below are some handy visual cues for estimating portion sizes. You should also review the nutrition section of the American Diabetes Association’s Web site.

Derived from the National Heart Lung and Blood Institute.

Getting Your Exercise When Traveling Or On Vacation

If you’re concerned about maintaining your daily level of physical activity when you travel, there are several things you can do.

Make Sure You Get Enough Exercise
If you will be staying in a hotel or motel, there’s a pretty good chance it will have a small gym, work-out facility, and perhaps even a swimming pool. Call ahead or go online to confirm what facilities are available. Some hotels and motels have agreements with local spas and fitness clubs that offer temporary memberships.

Use your problem-solving skills to think of ways to maintain your normal therapeutic level of physical activity when you’re out of town on business or vacation:

If your hotel is in a city, you may be able to fulfill your daily walking requirement simply by strolling around downtown
Walk to nearby parks or museums
If you are visiting friends or family, walk around their neighborhood or take some laps inside a local shopping mall
Exercise in your hotel or motel room

Make Sure You Don’t Get Too Much Exercise
Whether you’re traveling for business or pleasure, it’s a good idea to wear a pedometer. On vacations, especially, you may find that you are walking more in the course of a day and expending more energy than you normally do at home.

You don’t want to accidentally trigger an episode of low blood sugar (hypoglycemia) by exercising more than you do at home and failing to compensate with an increased intake of carbohydrates.

Talk to a Member of Your Care Team Before You Leave
Depending on your general state of health and degree of diabetes control, there may be other travel-related issues for you to consider:

Will you be crossing time zones? If so, will that affect your medication schedule?
Do you manage your diabetes with injectable drugs? Are there any special considerations regarding airport security and what you can have in your carry-on luggage?
Do you have enough of your medications to tide you over in case of a long delay?
What happens if you lose your medications? Do you have a prescription that can be refilled in another state or town? Will you be traveling outside the country?

Consult your care team. Tell them where you’re going, what you’ll be doing, and how long you’ll be gone. Ask for their help in planning a diabetes-safe journey.

Part 2: Be prepared for low blood sugar

Knowing what to do when you have an episode of low blood sugar is one thing. (Follow the Rule of 15 [link to info on rule of 15]). But having access to what you need to manage an episode of low blood sugar is not automatic.

What do you do if you develop hypoglycemia at work, especially if it’s late at night? Plan ahead for this situation by making sure you have adequate carbohydrates on hand. Keep a packaged snack with a long shelf-life in your desk or locker. You should also know where the closest vending machines can be found.

If you have the flu or a stomach bug that causes you to vomit, it may be difficult to keep your blood sugar in line. Carbohydrate-rich fluids (eg, juices and regular sodas) may be your best bet in such cases. If you’re having trouble keeping solid food down, it might also be a good idea to check your blood sugar more often than usual.

Coping With Low Blood Sugar Quickly

When your blood sugar gets too low, your body releases a hormone (chemical messenger) called epinephrine (also known as adrenaline) into your blood. The immediate effects of epinephrine are the familiar symptoms of hypoglycemia:

Shakiness
Dizziness
Nervousness
Sweatiness or clamminess, including night sweats
Irritability
Unexplained anger, sadness, crankiness, combativeness
Hunger
Headache
Impatience
Anxiety
Light-headedness
Rapid heartbeat
Fainting

If you feel any of these symptoms or have other reason to believe your blood sugar is low, you should check it. Generally, a blood glucose level below 70 mg/dL is considered too low. Your doctor may set a higher safe level for you, but whatever your safe level, if your blood sugar is too low, you should treat it immediately using the Rule of 15.

Rule of 15: “Eat 15, Wait 15”

Eat or drink about 15 grams of glucose or other fat-free carbohydrate (fats slow the absorption of carbohydrate and add unwanted calories)
Check your blood glucose in 15 minutes, and if it has not risen above your safe level, eat or drink another 15 grams of fat-free carbohydrate (see suggestions below)
Recheck your blood glucose in another 15 minutes. If it has not risen above your safe level, eat or drink another 15 grams of fat-free carbohydrate. Check your blood sugar level again in another 15 minutes, and if it still has not risen above the target safe level, contact your doctor or call 911
If your blood sugar rises above the safe level but it is the middle of the night or the next meal is more than one hour away, have a snack—for example, cheese and crackers.

Each of the examples below contains about 15 grams of carbohydrate:

2 to 5 glucose tablets, varies by brand
(This is the best treatment.)
One-half of a can of regular soda
One-half of a cup (4 oz) of orange juice
5 to 7 LifeSavers® candies or
3 Jolly Ranchers® candies
2 large lumps of table sugar
1 tablespoon of honey or corn syrup
1 tube of Cake Mate® decorator gel
1 cup of skim milk

Finding the Long-Term Motivation for SMBG

Self-monitoring of your blood glucose (SMBG) is essential for people with diabetes, but it can be a bit of a challenge. You have to obtain a small sample of your blood, put the sample on a test strip, and put the strip in a meter. And testing supplies are not cheap. Some people with diabetes grow weary of SMBG after a while and question its value.

Here are four typical barriers to continued SMBG and some solutions to help keep you on track:

Testing is too painful
- Ask a care team member—a nurse or your diabetes educator—to review the proper technique for getting a blood sample.
- Fingertips have a lot of nerve endings. Ask about testing on the sides of your finger or at a site other than your fingertip (forearm, palm, or thigh). Samples from these sites may not give as accurate of a blood sugar reading as samples from fingertips, but they are acceptable substitutes if they help you to keep testing.
Testing can be inconvenient
- Try using a smaller meter that is more conveniently carried in purse or pocket when you’re away from home, or keep a spare in another location (for example, in your desk at work).
- Ask a care team member to help you establish a routine around SMBG so it becomes more natural.
Testing is too costly
- Talk to your healthcare provider about ways to get the most valuable information out of the money you spend.
- Some insurance companies cover tests and supplies. Ask your doctor or diabetes educator for a recommendation.
- Medicare covers the cost of certain number of testing strips and lancets every three months for people with type 2 diabetes.
- Medicaid usually covers diabetes supplies, but not in all states.
- Ask your doctor or diabetes educator about the possibility of enrolling in a research study (clinical trial) in diabetes. Many clinical trials offer free testing supplies to participants.
I don’t need to test; I can tell when my blood sugar is off
- Yes, there are symptoms of low and high blood sugar that you can learn to recognize, but they are not reliable. For proof of that, you might ask your doctor to hook you up temporarily to a continuous glucose meter.
- It’s not just about the fact of hypoglycemia or hyperglycemia; it’s a matter of degree. The value of a meter is that it can give you and your doctor a specific measurement. Even if you didn’t need your meter to know you were hypoglycemic, you still need it to know by how much your blood sugar is off.
- Testing gives you information about the effect of meals and medication on blood sugar.