4 Steps to Control Your Diabetes For Life
NDEP is a partnership of the National Institutes of Health, the Centers for Disease Control and Prevention, and more than 200 public and private organizations.
4 Steps to Control Your Diabetes. For Life.
4 Steps to Control Your Diabetes. For Life.
Also available in these languages:
Cambodian, Chinese, Gujarati, Haitian Creole, Hindi, Hmong, Indonesian, Japanese, Korean, Laotian, Samoan, Spanish, Tagalog, Thai, Tongan, Vietnamese
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(NDEP-52EN)
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Tips to Help You Stay Healthy
(NDEP-8)
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In addition to a downloadable file (PDF) of the four-page tip sheet, online only, two-page PDF versions in two-color and black &white formats are available for ease of printing.
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These four steps help people with diabetes understand, monitor, and manage their diabetes to help them stay healthy. This publication is excellent for people newly diagnosed with diabetes or who just want to learn more about controlling the disease.
Publication date: 11/01/2009
Contents
- Introduction
- Step 1: Learn about diabetes.
- Step 2: Know your diabetes ABCs.
- Step 3: Manage your diabetes.
- Step 4: Get routine care.
- My Diabetes Care Record
- Where to get help
This booklet presents four key steps to help you manage your diabetes and live a long and active life.
Diabetes is a serious disease. It affects almost every part of your body. That is why a health care team may help you take care of your diabetes:
- doctor
- dentist
- diabetes educator
- dietitian
- eye doctor
- foot doctor
- mental health counselor
- nurse
- nurse practitioner
- pharmacist
- social worker
- friends and family
You are the most important member of the team.
The 
marks in this booklet show actions you can take to manage your diabetes.
- Help your health care team make a diabetes care plan that will work for you.
- Learn to make wise choices for your diabetes care each day.
Step 1: Learn about diabetes.
Diabetes means that your blood glucose (blood sugar) is too high. There are two main types of diabetes.
Type 1 diabetes – the body does not make insulin. Insulin helps the body use glucose from food for energy. People with type 1 need to take insulin every day.
Type 2 diabetes – the body does not make or use insulin well. People with type 2 often need to take pills or insulin. Type 2 is the most common form of diabetes.
Gestational (jes-TAY-shon-al) diabetes – occurs in some women when they become pregnant. It raises her future risk of developing diabetes, mostly type 2. It may raise her child’s risk of being overweight and developing type 2 diabetes.
Diabetes is serious.
You may have heard people say they have “a touch of diabetes” or that their “sugar is a little high.” These words suggest that diabetes is not a serious disease. That is not correct. Diabetes is serious, but you can learn to manage it!
It’s not easy, but it’s worth it!
All people with diabetes need to make healthy food choices, stay at a healthy weight, and move more every day.
Taking good care of yourself and your diabetes can help you feel better. It may help you avoid health problems caused by diabetes such as:
- heart attack and stroke
- eye problems that can lead to trouble seeing or going blind
- nerve damage that can cause your hands and feet to hurt, tingle, or feel numb. Some people may even lose a foot or a leg.
- kidney problems that can cause your kidneys to stop working
- gum disease and loss of teeth
When your blood glucose is close to normal you are likely to:
- have more energy.
- be less tired and thirsty and urinate less often.
- heal better and have fewer skin, or bladder infections.
- have fewer problems with your eyesight, feet, and gums.
- Ask your health care team what type of diabetes you have.
- Learn why diabetes is serious.
- Learn how caring for your diabetes helps you feel better today and in the future.
Step 2: Know your diabetes ABCs.
Talk to your health care team about how to manage your A1C, Blood pressure, and Cholesterol. This can help lower your chances of having a heart attack, stroke, or other diabetes problems. Here’s what the ABCs of diabetes stand for:
A for the A1C test (A-one-C).
It shows what your blood glucose has been over the last three months. The A1C goal for many people is below 7. High blood glucose can harm your heart and blood vessels, kidneys, feet, and eyes.
B for Blood pressure.
The goal for most people with diabetes is below 130/80.
High blood pressure makes your heart work too hard. It can cause heart attack, stroke, and kidney disease.
C for Cholesterol (ko-LES-ter-ol).
The LDL goal for people with diabetes is below 100.
The HDL goal for men with diabetes is above 40.
The HDL goal for women with diabetes is about 50.
LDL or “bad” cholesterol can build up and clog your blood vessels. It can cause a heart attack or a stroke. HDL or “good” cholesterol helps remove cholesterol from your blood vessels.
- Ask your health care team:
- what your A1C, blood pressure, and cholesterol numbers are
- what your A1C*, blood pressure, and cholesterol numbers should be
- what you can do to reach your targets
- Write down all your numbers on the record card at the back of this booklet.
*An A1C of less than 7 is the goal for many people but not for everyone. Talk to your health care team about what A1C target is right for you.
Step 3: Manage your diabetes.
Many people avoid the long-term problems of diabetes by taking good care of themselves. Work with your health care team to reach your ABC target. Use this self-care plan.
- Follow your diabetes meal plan.If you do not have one, ask your health care team to help you develop a meal plan.
- Eat healthy foods such as fruits and vegetables, fish, lean meats, chicken or turkey without the skin, dry peas or beans, whole grains, and low-fat or skim milk and cheese.
- Keep fish and lean meat and poultry portions to about 3 ounces (or the size of a deck of cards). Bake, broil, or grill it.
- Eat foods that have less fat and salt.
- Eat foods with more fiber such as whole grain cereals, breads, crackers, rice, or pasta.
- Get 30 to 60 minutes of physical activity on most days of the week. Brisk walking is a great way to move more.
- Stay at a healthy weight by using your meal plan and moving more.
- Ask for help if you feel down. A mental health counselor, support group, member of the clergy, friend, or family member who will listen to your concerns may help you feel better.
- Learn to cope with stress. Stress can raise your blood glucose. While it is hard to remove stress from your life, you can learn to handle it. NDEP’s Diabetes HealthSense provides online access to resources that support people with diabetes in making changes to live well. For more information visit www.YourDiabetesInfo.org/HealthSense.
- Stop smoking. Ask for help to quit. Call 1-800-QUITNOW (1-800-784-8669)
- Take medicines even when you feel good. Ask your doctor if you need aspirin to prevent a heart attack or stroke. Tell your doctor if you cannot afford your medicines or if you have any side effects.
- Check your feet every day for cuts, blisters, red spots, and swelling. Call your health care team right away about any sores that do not go away.
- Brush your teeth and floss every day to avoid problems with your mouth, teeth, or gums
- Check your blood glucose. You may want to test it one or more times a day. Use the card at the back of this booklet to keep a record of your blood glucose numbers. Be sure to show it to your health care team.
- Check your blood pressure if your doctor advises.
- Report any changes in your eyesight to your health care team.
- Talk with your health care team about your blood glucose targets. Ask how and when to test your blood glucose and how to use the results to manage your diabetes.
- Use this plan as a guide to your self-care.
- Discuss how your self-care plan is working for you each time you visit your health care team.
Step 4: Get routine care.
See your health care team at least twice a year to find and treat any problems early.
At each visit be sure you have a:
- blood pressure check
- foot check
- weight check
- review of your self-care plan shown in Step 3
Two times each year have an:
- A1C test – it may be checked more often if it is over 7
Once each year be sure you have a:
- cholesterol test
- triglyceride (try-GLISS-er-ide) test – a type of blood fat
- complete foot exam
- dental exam to check teeth and gums – tell your dentist you have diabetes
- dilated eye exam to check for eye problems
- flu shot
- urine and a blood test to check for kidney problems
At least once get a:
- pneumonia (nu-mo-nya) shot
- Ask your health care team about these and other tests you may need. Ask what yours results mean.
- Write down the date and time of your next visit.
- Use the card at the back of this booklet to keep a record of your diabetes care.
- If you have Medicare, ask your health care team if Medicare will cover some of the costs for
- learning about healthy eating and diabetes self-care
- special shoes, if you need them
- medical supplies
- diabetes medicines
My Diabetes Care Record
Record your targets and the date, time, and results of your tests. Take this card with you on your health care visits. Show it to your health care team to remind them of tests you need.
Self Checks of Blood Glucose
Record your targets and the date, time, and results of your checks. Take this card with you on your health care visits. Show it to your health care team.
Self Checks of Blood Glucose card
Where to get help:
Many of these groups offer items in English and Spanish.
National Diabetes Education Program
1-888-693-NDEP (1-888-693-6337)
www.YourDiabetesInfo.org
Diabetes HealthSense
An online library of resource for living well.
www.YourDiabetesInfo.org/HealthSense
National Kidney Disease Education Program
1-866-4-KIDNEY (1-866-454-3639)
www.nkdep.nih.gov
National Institute of Diabetes and Digestive and Kidney Diseases
National Diabetes Information Clearinghouse
1-800-860-8747
www.niddk.nih.gov
American Association of Diabetes Educators
1-800-TEAM-UP4 (1-800-832-6874)
www.diabeteseducator.org
American Diabetes Association
1-800-DIABETES (1-800-342-2383)
www.diabetes.org
American Dietetic Association
1-800-366-1655
www.eatright.org
American Heart Association
1-800-AHA-USA1 (1-800-242-8721)
www.americanheart.org
Centers for Disease Control and Prevention
1-800-CDC-INFO (1-800-232-4636)
www.cdc.gov/diabetes
Centers for Medicare & Medicaid Services
1-800-MEDICARE (1-800-633-4227)
www.medicare.gov/navigation/manage-your-health/preventive-services/diabetes-screening.aspx
Source:
What I Need to Know About Diabetes Medicines
What I need to know about Diabetes Medicines
On this page:
- What do diabetes medicines do?
- What targets are recommended for blood glucose levels?
- What happens to blood glucose levels in people with diabetes?
- Medicines for My Diabetes
- Types of Diabetes Medicines
- What do I need to know about side effects of medicines?
- For More Information
- Acknowledgments
Inserts:
- Insert A: My Diabetes Medicines
- Insert B: Questions to Ask about Your Diabetes Medicines
- Insert C: Types of Insulin
- Insert D: Glyset and Precose (Alpha-Glucosidase Inhibitors)
- Insert E: Glucophage, Glucophage XR, and Riomet (Biguanides)
- Insert F: Starlix (D-Phenylalanine Derivative)
- Insert G: Januvia (DPP-4 Inhibitor)
- Insert H: Prandin (Meglitinide)
- Insert I: Amaryl, DiaBeta, Diabinese, Glucotrol, Glucotrol XL, Glynase PresTab, Micronase, tolazamide, and tolbutamide (Sulfonylureas)
- Insert J: Actos and Avandia (Thiazolidinediones)
- Insert K: Actoplus Met, Avandamet, Avandaryl, Duetact, Glucovance, Janumet, and Metaglip (Combination Diabetes Pills)
- Insert L: Symlin (Amylin Mimetic)
- Insert M: Byetta (Incretin Mimetic)
- Insert N: About Low Blood Glucose
What do diabetes medicines do?
Over time, high levels of blood glucose, also called blood sugar, can cause health problems. These problems include heart disease, heart attacks, strokes, kidney disease, nerve damage, digestive problems, eye disease, and tooth and gum problems. You can help prevent health problems by keeping your blood glucose levels on target.
Everyone with diabetes needs to choose foods wisely and be physically active. If you can’t reach your target blood glucose levels with wise food choices and physical activity, you may need diabetes medicines. The kind of medicine you take depends on your type of diabetes, your schedule, and your other health conditions.
You may need diabetes medicines to reach your blood glucose targets.
Diabetes medicines help keep your blood glucose in your target range. The target range is suggested by diabetes experts and your doctor or diabetes educator. See below for more information about target levels for good health.
What targets are recommended for blood glucose levels?
The National Diabetes Education Program uses blood glucose targets set by the American Diabetes Association (ADA) for most people with diabetes. To learn your daily blood glucose numbers, you’ll check your blood glucose levels on your own using a blood glucose meter.
Target blood glucose levels for most people with diabetes
My targets:
Before meals:
70 to 130 mg/dL*
1 to 2 hours after the start of a meal:
Less than 180 mg/dL
* Milligrams per deciliter.
Also, you should ask your doctor for a blood test called the A1C at least twice a year. The A1C will give you your average blood glucose for the past 3 months.
Target A1C result for people with diabetes
My targets:
Less than 7 percent
Your personal A1C goal might be higher or lower than 7 percent. Keeping your A1C as close to normal as possible—below 6 percent without having frequent low blood glucose—can help prevent long-term diabetes problems. Doctors might recommend other goals for very young children, older people, people with other health problems, or those who often have low blood glucose.
Talk with your doctor or diabetes educator about whether the target blood glucose levels and A1C result listed in the charts above are best for you. Write your own target levels in the charts. Both ways of checking your blood glucose levels are important.
If your blood glucose levels are not on target, you might need a change in how you take care of your diabetes. The results of your A1C test and your daily blood glucose checks can help you and your doctor make decisions about:
- what you eat
- when you eat
- how much you eat
- what kind of exercise you do
- how much exercise you do
- the type of diabetes medicines you take
- the amount of diabetes medicines you take
What happens to blood glucose levels in people with diabetes?
Blood glucose levels go up and down throughout the day and night in people with diabetes. High blood glucose levels over time can result in heart disease and other health problems. Low blood glucose levels can make you feel shaky or pass out. But you can learn how to make sure your blood glucose levels stay on target—not too high and not too low.
What makes blood glucose levels go too high?
Your blood glucose levels can go too high if:
- you eat more than usual
- you’re not physically active
- you’re not taking enough diabetes medicine
- you’re sick or under stress
- you exercise when your blood glucose level is already high
Some diabetes medicines can also lower your blood glucose too much. Ask your doctor whether your diabetes medicines can cause low blood glucose. SeeInsert N for information about low blood glucose.
The results of your blood glucose checks can help you make decisions about your diabetes medicines, food choices, and physical activity.
Medicines for My Diabetes
Ask your doctor what type of diabetes you have and write down your answer.
I have:
- type 1 diabetes
- type 2 diabetes
- gestational diabetes
- another type of diabetes: ____________________
Medicines for Type 1 Diabetes
Type 1 diabetes, once called juvenile diabetes or insulin-dependent diabetes, is usually first found in children, teenagers, or young adults. If you have type 1 diabetes, you must take insulin because your body no longer makes it. You also might need to take other types of diabetes medicines that work with insulin.
Medicines for Type 2 Diabetes
Type 2 diabetes, once called adult-onset diabetes or noninsulin-dependent diabetes, is the most common form of diabetes. It can start when the body doesn’t use insulin as it should, a condition called insulin resistance. If the body can’t keep up with the need for insulin, you may need diabetes medicines. Many choices are available. Your doctor might prescribe two or more medicines. The ADA recommends that most people start with metformin, a kind of diabetes pill.
Medicines for Gestational Diabetes
Gestational diabetes is diabetes that occurs for the first time during pregnancy. The hormones of pregnancy or a shortage of insulin can cause gestational diabetes. Most women with gestational diabetes control it with meal planning and physical activity. But some women need insulin to reach their target blood glucose levels.
Medicines for Other Types of Diabetes
If you have one of the rare forms of diabetes, such as diabetes caused by other medicines or monogenic diabetes, talk with your doctor about what kind of diabetes medicine would be best for you.
Types of Diabetes Medicines
Diabetes medicines come in several forms.
Insulin
If your body no longer makes enough insulin, you’ll need to take it. Insulin is used for all types of diabetes. Your doctor can help you decide which way of taking insulin is best for you.
- Taking injections. You’ll give yourself shots using a needle and syringe. The syringe is a hollow tube with a plunger. You will put your dose of insulin into the tube. Some people use an insulin pen, which looks like a pen but has a needle for its point.
- Using an insulin pump. An insulin pump is a small machine about the size of a cell phone, worn outside of your body on a belt or in a pocket or pouch. 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. Insulin is pumped from the machine through the tube into your body.
- Using an insulin jet injector. The jet injector, which looks like a large pen, sends a fine spray of insulin through the skin with high-pressure air instead of a needle.
If your body no longer makes enough insulin, you’ll need to take it.
What does insulin do?
Insulin helps keep blood glucose levels on target by moving glucose from the blood into your body’s cells. Your cells then use glucose for energy. In people who don’t have diabetes, the body makes the right amount of insulin on its own. But when you have diabetes, you and your doctor must decide how much insulin you need throughout the day and night.
What are the possible side effects of insulin?
Possible side effects include:
- low blood glucose (for more information, see Insert N)
- weight gain
How and when should I take my insulin?
Your plan for taking insulin will depend on your daily routine and your type of insulin. Some people with diabetes who use insulin need to take it two, three, or four times a day to reach their blood glucose targets. Others can take a single shot. Your doctor or diabetes educator will help you learn how and when to give yourself insulin.
Types of Insulin
Each type of insulin works at a different speed. For example, rapid-acting insulin starts to work right after you take it. Long-acting insulin works for many hours. Most people need two or more types of insulin to reach their blood glucose targets.
Look at the list of types of insulin on Insert C. Check off the names of the kinds of insulin you take. Then print and write the names of your insulins under My Insulins in the chart on Insert A.
Diabetes Pills
Along with meal planning and physical activity, diabetes pills help people with type 2 diabetes or gestational diabetes keep their blood glucose levels on target. Several kinds of pills are available. Each works in a different way. Many people take two or three kinds of pills. Some people take combination pills. Combination pills contain two kinds of diabetes medicine in one tablet. Some people take pills and insulin.
Diabetes pills help people with type 2 diabetes or gestational diabetes keep their blood glucose levels on target.
Your doctor may ask you to try one kind of pill. If it doesn’t help you reach your blood glucose targets, your doctor may ask you to:
- take more of the same pill
- add another kind of pill
- change to another type of pill
- start taking insulin
- start taking another injected medicine
If your doctor suggests that you take insulin or another injected medicine, it doesn’t mean your diabetes is getting worse. Instead, it means you need insulin or another type of medicine to reach your blood glucose targets. Everyone is different. What works best for you depends on your usual daily routine, eating habits, and activities, and your other health conditions.
For information about the different kinds of pills and what they do, see the inserts. You’ll see the brand name and the generic name—the scientific name—for each medicine. Find your diabetes pills and check off the names. Then print and write the names of your diabetes pills under My Pills and Injected Medicines in the chart on Insert A.
Injections Other Than Insulin
In addition to insulin, two other types of injected medicines are now available. Both work with insulin—either the body’s own or injected—to help keep your blood glucose from going too high after you eat. Neither is a substitute for insulin.
See the cards in the pocket of this booklet for more information about these injected medicines. Check off the kinds you take. Then write the names of your injected medicines under My Pills and Injected Medicines in the chart on Insert A.
Talk with your doctor if you have questions about your diabetes medicines. Do not stop taking your diabetes medicines without checking with your doctor first. See Insert B for a list of questions to ask your doctor about your medicines.
What do I need to know about side effects of medicines?
A side effect is an unwanted problem caused by a medicine. For example, some diabetes medicines can cause nausea or an upset stomach when you first start taking them. Before you start a new medicine, ask your doctor about possible side effects and how you can avoid them. If the side effects of your medicine bother you, tell your doctor.
For More Information
To find diabetes educators—nurses, dietitians, and other health professionals—near you, call the American Association of Diabetes Educators toll-free at 1–800–TEAMUP4 (1–800–832–6874). Or go to www.diabeteseducator.org and see the “Find a Diabetes Educator” section.
For additional information about diabetes, contact
American Diabetes Association
National Service Center
1701 North Beauregard Street
Alexandria, VA 22311–1742
Phone: 1–800–DIABETES (1–800–342–2383)
Fax: 703–549–6995
Email: AskADA@diabetes.org
Internet: www.diabetes.org
Juvenile Diabetes Research Foundation International
26 Broadway, 14th Floor
New York, NY 10004
Phone: 1–800–533–CURE (1–800–533–2873)
Fax: 212–785–9595
Email: info@jdrf.org
Internet: www.jdrf.org
National Diabetes Education Program
1 Diabetes Way
Bethesda, MD 20814–9692
Phone: 1–888–693–NDEP (1–888–693–6337)
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: ndep@mail.nih.gov
Internet: www.ndep.nih.gov
This publication may contain information about medications. When prepared, this publication included the most current information available. For updates or for questions about any medications, contact the U.S. Food and Drug Administration toll-free at 1–888–INFO–FDA (1–888–463–6332) or visit www.fda.gov. Consult your doctor for more information.
Acknowledgments
Publications produced by the Clearinghouse are carefully reviewed by both NIDDK scientists and outside experts. This booklet was reviewed by Stuart T. Haines, Pharm.D., University of Maryland School of Pharmacy, Baltimore.
The U.S. Government does not endorse or favor any specific commercial product or company. Trade, proprietary, or company names appearing in this document are used only because they are considered necessary in the context of the information provided. If a product is not mentioned, the omission does not mean or imply that the product is unsatisfactory.
Source
National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892–3560
Phone: 1–800–860–8747
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: ndic@info.niddk.nih.gov
Internet: www.diabetes.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 of 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.
This publication is not copyrighted. The Clearinghouse encourages users of this publication to duplicate and distribute as many copies as desired.
NIH Publication No. 11–4222
October 2010
Foot Health Critical for People With Diabetes
Foot Health Critical for People With Diabetes
April is Foot Health Month. Remember: Don’t take foot health for granted—especially if you have diabetes. Prevent foot problems by controlling diabetes and practicing good foot health.
Diabetes and Foot Health
Almost 26 million people in the United States have diabetes and many more are at high risk for developing diabetes. Problems with the legs and feet caused by diabetes are common and can be severe. These problems cause suffering and reduce one’s quality of life. In recognition of Foot Health Month, April 2011, the Centers for Disease Control and Prevention’s Division of Diabetes Translation (CDC/DDT) wants to make sure that you are aware that people with diabetes can develop many different foot problems and to remind you that foot health should not be taken for granted.
In 2006 alone, about 65,700 people with diabetes had a leg or foot amputated. This is more than 60% of the amputations of legs and feet not resulting from an injury, such as from a car crash. Many of these amputations could be prevented by taking good care of your feet and your health:
- Learning to manage your diabetes
- Making healthy food choices
- Staying at a healthy weight
- Being physically active every day
- Taking your medicines even when you feel good
- Having your doctor give you a comprehensive foot exam every time you visit (but at least four times a year)
- Checking your feet for sores and other injuries every day
- Wearing shoes that fit right and do not rub or pinch your feet, or cause blisters. Never walking barefoot or while wearing just socks.
Links to Foot Health Resources
The National Diabetes Education Program
(NDEP), jointly led by CDC/DDT and the National Institutes of Health, provides several web pages and publications with helpful information on foot care and diabetes care. Click on the web links below and see the Foot Health Facts section of this feature for important information on diabetes prevention and control, foot health, and what you can do to maximize your likelihood for good health in the future.
Take Care of Your Feet for a Lifetime is a booklet from NDEP with information on foot care and how to avoid foot problems.
Cuide sus pies durante toda su vida es un folleto ilustrado de NDEP que le ayuda a cuidar sus pies y ofrece consejos para evitar problemas graves de los pies.
4 Steps to Control Your Diabetes. For Life. [PDF - 2.87MB] These four steps help people with diabetes understand, monitor, and manage their diabetes to help them stay healthy. This publication, available in English, Spanish, and other languages, is excellent for people newly diagnosed with diabetes or for those who want to learn more about controlling the disease. It has information on the importance of getting routine care to avoid diabetes complications.
Feet Can Last a Lifetime: A Health Care Provider’s Guide to Preventing Diabetes Foot Problems is a foot care guide from NDEP targeted to health care professionals.
What should I do on a regular basis to take care of my feet?is a CDC diabetes web page with a list of simple ways to care for and avoid potential problems with your feet.
Chapter 9. Foot Problemsin DDT’s Take Charge of Your Diabetespublication compiles tips for diabetes control and care along with information on diabetes and its health complications.
Foot Health Facts
- These are some of the ways that diabetes can harm your feet:
- Diabetes slows blood flow to certain areas of the body, especially limbs such as the legs, which impairs your body’s ability to heal injuries.
- Diabetes nerve damage may cause you to no longer feel pain in your feet, and you may not realize you have a wound or injury that needs care.
- Diabetic nerve damage appears to be more common in people who have had problems controlling their blood glucose (sugar) levels, in those with high cholesterol or high blood pressure, in overweight people, and in people older than 40 years.
- These are some signs of problems with your feet or legs. If you experience any of these symptoms, you need to contact your health care provider or a podiatrist (foot doctor) right away.
- You may feel pain in your legs or cramping in your buttocks, thighs, or calves during physical activity.
- Your feet may tingle, burn, or hurt.
- You may lose the sense of touch or not be able to feel heat or cold very well.
- The shape of your feet may change over time.
- The color and temperature of your feet may change.
- You may lose hair on your toes, feet, and lower legs.
- The skin on your feet may become dry and cracked.
- Your toenails may turn thick and yellow.
- Fungus infections may appear between your toes.
- You may experience blisters, sores, ulcers, infected corns, and ingrown toenails.
Contact Us:
- Centers for Disease Control and Prevention
1600 Clifton Rd
Atlanta, GA 30333 - 800-CDC-INFO
(800-232-4636)
TTY: (888) 232-6348
24 Hours/Every Day - cdcinfo@cdc.gov
Content source: National Center for Chronic Disease Prevention and Health Promotion, Division of Centers for Disease Control and Prevention 1600 Clifton Rd. Atlanta, GA 30333, USA
800-CDC-INFO (800-232-4636) TTY: (888) 232-6348, 24 Hours/Every Day – cdcinfo@cdc.gov
Insulin Pump Therapy
Dr. Steven Edelman discusses how insulin pump therapy works, who can benefit from using an insulin pump, and common concerns people have before starting.
Source: UCtelevision on YouTube
Diabetes and Depression
Diabetes at Work: What’s Depression Got to Do with It?
The purpose of “Diabetes at Work: What’s Depression Got to Do with It?” is to provide employers with information about the association between diabetes and depression, the economic cost of untreated depression, and the role that employers can take to help employees who are experiencing both illnesses.
The following case study describes the experience of an employee who has both diabetes and depression.
Case Study:
Cindy S. is a 52-year old employee at Networth Industries, Inc. More than 5 years ago, Cindy was diagnosed with diabetes. For the last 2 months, Cindy has found that she is less interested in tasks that she used to enjoy at work such as analyzing data, reporting the findings to management, and presenting the results to national stakeholders. Most days, it is difficult for Cindy to get out of bed and to make it to work on time. Once there Cindy finds herself distracted and unable to complete tasks that used to take her only an hour to finish. Cindy has noticed that she feels sad most of the time and has had trouble sleeping and remembering to take her diabetes medication. Cindy has thought about telling her supervisor that she feels depressed, but she worries about whether she will lose her job because she now has both diabetes and depression.
This case study highlights several of the concerns and challenges that employees with diabetes and depression may experience at the workplace. This Web page will review key topics highlighted in the case study and the role of the employer when their employee experiences both diabetes and depression. The topics that will be covered include the following:
- An introduction and statistics related to depression and diabetes
- The symptoms of depression
- Gender differences and depression
- The seriousness of depression in diabetes
- Concerns for employers when their employee has diabetes and depression
- The impact that depression can have on job functioning
- How depression may manifest in the workplace
- The Americans with Disabilities Act
- How an employer can help an employee who has depression
- Treatment options
- Resources for diabetes and depression
Depression and Diabetes: Is There a Link?
Evidence suggests that an association between depression and diabetes exists, but it is not clear which comes first or why they are often linked. What is clear is that both depression and diabetes can be effectively managed and treated.
Anyone can develop depression, but people with diabetes may be at greater risk. Depression might result from the daily burden of having diabetes.1 Recent research has reported that depression is twice as common in people who have diabetes than it is in people who do not have this disease. In addition, the chances of becoming depressed increases as diabetes complications worsen.
Additional information from research on depression and diabetes suggests that depression alone may also increase the likelihood of a person developing type 2 diabetes. In fact, research shows that depressed adults have a 37% increased risk of developing type 2 diabetes.
Clinical depression is one of the most costly illnesses in the world. It is also a leading cause of disability in the United States and worldwide. Approximately 70% of people who have depression are employed; depression results in 400 million lost work days a year. It is estimated that the annual salary-equivalent cost of major depression due to work loss in the U.S. labor force is $44 billion per year.13
Although depression can occur at any age, it tends to affect people in their prime working years, 25-44 years of age, and, if untreated, can last a lifetime.
Employers should know that there are several treatment options available to assist employees who are experiencing depression in the workplace. Research has shown that 80% of those who seek treatment show improvement. Depression does not have to be a debilitating disease.
What are the Symptoms of Depression?
Depression is a medical condition that should be diagnosed and treated by a trained healthcare professional, such as a primary care provider, psychiatrist, psychologist, or a social worker. Occupational health nurses, wellness coordinators, employers, supervisors and co-workers can be the first to recognize signs of depression in a fellow employee.
Depression is more than occasionally feeling sad, stressed, or irritable. People with depression tend to have some ofthe following symptoms most of the day for at least two weeks:
- Frequent feelings of sadness that last most of the day
- Decreased interest in most things that were once enjoyed
- Loss of self-esteem or feelings of guilt and worthlessness
- Sleep problems, such as sleeping too much or having trouble sleeping
- Difficulty concentrating or making decisions
- Unintentional changes in weight (weight loss or gain)
- Irritability or restlessness
- Decreased energy
- Possible thoughts of death or suicide
Who Gets Depression?
While anyone can develop depression—there are some differences based on gender.
- Women are twice as likely to become depressed as men. About 10-25% of all women will be depressed during their lives.
- Men have a lower risk for depression than women, but when they are depressed they are more likely to go undiagnosed and less likely to seek help. Men may experience the typical symptoms of depression, but they may also feel more angry and irritable. They may also be more likely to try and relieve their condition with alcohol or drug abuse. Depression increases the risk for suicide and men who have suicidal thoughts are more likely to die of suicide than women with suicidal thoughts. However, suicidal thoughts in all individuals should be taken very seriously and the person who has those thoughts should be evaluated by a mental health professional.
Why is Depression in Diabetes Serious?
Depression in diabetes is very concerning for several reasons:
- Individuals who are depressed may have more difficulty following the medical treatment that their health care team establishes challenging. For example, depressed persons might not take their medication as prescribed or monitor their glucose levels as health care professionals recommend.
- Depression can result in poor physical and mental functioning, so a person is less likely to maintain regular physical activity.
- Individuals who are depressed might adopt unhealthy behaviors, such as a sedentary lifestyle and/or a poor diet.
- Social isolation is also common for people who are depressed, which decreases opportunities for social support that is often needed for self-management of diabetes.
- Untreated depression in diabetes can result in
- Hyperglycemia (high blood glucose)
- Poor metabolic control
- Decreased quality of life
- Increased health care usage and costs
- Increased risk of mortality
- Untreated depression places people with diabetes at risk for complications that could be avoided. These complications include—
- Heart disease
- Blindness
- Amputations
- Erectile Dysfunction
- Stroke
- Kidney disease
DID YOU KNOW THAT…
Treating depression may help a person’s mood and glucose control.
Why Should Employers Be Concerned?
Depression in people who also have diabetes is associated with increased health care costs. Total health care expenditures for individuals with depression was 4.5 times higher than for individuals without depression.
Like diabetes, depression is serious, common and costly, but also potentially preventable and definitely treatable. Yet many people who have both diabetes and depression do not seek treatment for their depressive symptoms. Although depression affects more than 19 million Americans every year, fewer than half seek treatment.
Depression is often unrecognized and undertreated in health care settings. Researchers have found that only 30% of patients with depression and diabetes receive adequate treatment for depression and fewer than 20% complete more than four visits for psychotherapy.
There are many reasons why employees may be reluctant to seek out help for depression:
- Cost. Some people may avoid seeking medical attention for chronic conditions, such as depression and diabetes, because of the additional cost and burden that it may place on the individual or family budget. There could also be concern about the cost associated with lost time from work.
- Stigma. Many people feel there is a stigma associated with depression. Employees might also be concerned with how employers and colleagues will respond if the employee discloses that he or she is depressed.
- Shame. Some employees may be embarrassed or self-conscious about needing to ask for help, or may view depression as a “weakness” or as being their fault.
- Being uninformed.
- Some employees may not be aware of available treatment options. Some who have begun treatment might not have been aware that medications take time to yield the desired levels for benefit. Such persons sometimes discontinue medications before the medications had time to work.
- Some employees may be unaware of health benefits that their employer provides and what their insurance may cover.
- In addition, some individuals may be unaware that they are depressed or they may believe that they can take care of themselves on their own.
- Cultural differences. Research regarding ethnic minorities’ attitudes toward seeking professional mental health care has yielded inconsistent results. For example, in one study, mistrust and opinions about mental illness was found to negatively impact help-seeking behavior among African Americans. Other studies have found more positive attitudes towards mental health treatment and medication options for African Americans and Hispanics.
How Does Depression Impact Job Functioning?
Depression can interfere with job functioning in several ways. For example, depression can affect a person’s ability to perform tasks, to think clearly, or to communicate with others.
People who suffer from depression sometimes have difficulty—
- Sustaining concentration
- Maintaining stamina
- Handling pressures, deadlines, and multiple tasks
- Interacting with others
- Responding to negative feedback
- Responding to change
How Might Untreated Depression Manifest Itself in the Workplace?
Untreated depression can manifest itself in the following ways at the work site:
- Consistent late arrivals or frequent absences
- Irritability
- Substance use or abuse
- Low morale
- Increased lack of cooperation or an inability to work with others
- Decreased productivity
- Problems concentrating
- Safety problems as a result of problems with attention
- Poor work or missed deadlines
- Decreased interest in one’s work
- Frequent complaints of body aches or fatigue
Employers, supervisors, and co-workers can be the first to recognize significant changes in an employee’s work habits, behaviors, performance, and attendance. However, employers must also be aware that individuals with psychiatric or physical disabilities have rights, which are covered under the Americans with Disabilities Act.
What Legal Rights do Employees have When They have a Physical or Psychiatric Disability?
The Americans with Disabilities Act:
- prohibits employment discrimination against individuals with disabilities in the private sector, and in state and local governments, and it
- prohibits discrimination in all employment practices, including:
- job application procedures,
- hiring,
- firing,
- advancement,
- compensation,
- training, and
- other terms, conditions, and privileges of employment.
The Americans with Disabilities Act covers qualified individuals with physical and psychiatric disabilities, such as mental disorders. Diabetes or depression would be considered a disability under the Americans with Disabilities Act if the disease substantially limits one or more of a person’s major life activities, such as eating or caring for oneself. Diabetes would also be considered a disability when it causes side effects or complications that substantially limit a major life activity.
The Americans with Disabilities Act prohibits employers from asking employees and job applicants whether they have a psychiatric or physical disability. Disclosure about one’s mental or physical condition is a personal decision and an employee should not be coerced into informing an employer or colleagues about their health. However, if the employer has concrete reasons to believe that a physical or psychiatric condition may be affecting an employee’s ability to perform their job, the employer may ask questions or have the employee obtain a medical examination.
If an employee discloses that he or she has a physical or psychiatric disability, the employer may only ask whether there is a need for a reasonable accommodation and type of accommodation needed.
For more information about disability and diabetes in the workplace please visit: www.eeoc.gov./facts/diabetes.html.
What Accommodations Must an Employer Make for an Employee with a Disability?
Individuals with disabilities can perform all types of jobs in a variety of settings. However, employers may exclude such persons from certain positions because of stereotypes and fears about what types of work such individuals can perform. Employees with diabetes and/or depression may require a change in their workplace setting to allow them to better manage their condition.
Under the Americans with Disabilities Act, employers must make reasonable accommodations to individuals with a known disability.37 Examples of reasonable accommodations might include:
- Time-off for scheduled medical appointments
- Regular work schedules
- Meal breaks
- A place to test blood sugar levels
- Clear delineation of performance expectations
- Schedules which allow for flex-time
- Extending additional leave to allow an employee to keep his or her job after a hospitalization.
Think back to the case study of Cindy S, repeated here.
Case Study:
Cindy S. is a 52-year old employee at Networth Industries, Inc. More than 5 years ago, Cindy was diagnosed with diabetes. For the last 2 months, Cindy has found that she is less interested in tasks that she used to enjoy at work such as analyzing data, reporting the findings to management, and presenting the results to national stakeholders. Most days, it is difficult for Cindy to get out of bed and to make it to work on time. Once there Cindy finds herself distracted and unable to complete tasks that used to take her only an hour to finish. Cindy has noticed that she feels sad most of the time and has had trouble sleeping and remembering to take her diabetes medication. Cindy has thought about telling her supervisor that she feels depressed, but she worries about whether she will lose her job because she now has both diabetes and depression.
Points to consider:
What legal protection does Cindy S. have under the Americans with Disabilities Act?
- In order for Cindy to have any legal protection under the Americans with Disabilities Act, the diabetes or the depression must substantially limit Cindy’s major life activities. More information is needed to determine whether her condition(s) limit her major life activities, such as thinking, eating, or caring for herself.
What accommodations must the employer make to assist Cindy S. in returning to the work site?
- If it has been determined that diabetes or depression substantially limits Cindy’s major life activities, then her employer must make reasonable accommodations. These adjustments could include:
- Time-off for scheduled medical appointments
- A place to test blood sugar levels
- Schedules which allow for flex-time
How can the employer assist Cindy S. if she discloses that she has depression?
- The employer should handle this situation with confidentiality.
- Employers should not attempt to treat a person with diabetes, but instead provide the employee with the assistance needed to receive the appropriate care.
- If an employee assistance program exists, the employer should assist the employee with seeking such services.
How Can an Employer Help an Employee who is Depressed?
If an employee is struggling with depression, the employer can be a valuable resource.
In reaching out to an employee who has disclosed that he or she is suffering from depression, employers should remember to handle this situation with confidentiality.
Employers should avoid trying to diagnose or treat a person with depression. Instead, the primary objective of the employer should be to assist the employee with receiving the appropriate, professional help needed, such as through an employee assistance program, which may be available at the work site.
In providing assistance to an employee with depression, employers should—
- Be empathetic and understanding
- Avoid critical or shaming statements
- Emphasize that depression is treatable
- Provide information to employees about symptoms of depression and treatment options.
Employers can also raise awareness about depression by—
- Educating management and employees about depression and effective treatment options
- Informing employees of the availability of an employee assistance program
- Provide an easily accessible behavioral health system
- Including depression recognition screenings and stress management at health fairs
- Developing a return-to-work plan for employees who have been absent from work due to depression
To learn more about depression resources that are available, please visit the “Resources” section of this Web page.
Can Depression be Treated?
There is good news! Depression, with or without diabetes, can be treated. It is important to diagnose depression early and accurately to reduce the risk of developing diabetes and/or diabetes complications. Treating depression has also been found to improve diabetes control. In addition, appropriate treatment and monitoring of depression can increase workplace productivity, lower absenteeism, and decrease disability costs.
There are currently a variety of highly effective interventions available for treating depression. The majority of depressive disorders can be treated with either psychotherapy (talk therapy), antidepressants, or both treatments together. A combination of psychotherapy and medication has been identified as being most effective. Psychotherapy allows people the opportunity to learn skills to reduce their depression or to address underlying issues associated with the depression.
In treating diabetes and depression, it is important for the health care team (e.g., the family doctor, endocrinologist, diabetes health care team, psychiatrist, social worker, or clinical psychologist) to all work closely together. Occupational health nurses or other work site medical professionals also play an important role in this health care team. Work site medical professionals may have suggestions for employers on how to deal with depression in the workplace. In addition, such health professionals may also be able to provide employees with referrals for mental health professionals who practice in specific communities near the work site or that are convenient for the employee.
Where Can Employers Find More Information about Diabetes at Work?
The National Diabetes Education Program (NDEP), which is jointly sponsored by the National Institutes of Health and the Centers for Disease Control and Prevention, provides information for employers on its Web site: http://www.diabetesatwork.org/.
DiabetesAtWork.org can help businesses and managed care companies to assess the impact of diabetes in the workplace, and provide intuitive information to help employees manage their diabetes and take steps toward reducing risks for related complications, such as heart disease.
DiabetesAtWork.org can help you:
- Develop a diabetes prevention or management program.
- Estimate the number of employees in your company with diabetes.
- Estimate the total cost of diabetes in your company.
- Choose or design a health plan for people with diabetes.
- Obtain support from leadership for a diabetes program.
NDEP also maintains a Web site, http://www.yourdiabetesinfo.org/ which has educational materials on diabetes prevention and control for business professionals. On the YourDiabetesInfo.org Web site, employers can find out more information about diabetes, such as:
- How business leaders can become more involved in workplace and community activities to help control diabetes related complications to reduce the human and economic impact of this serious disease.
- How to plan a workshop for employers and business coalitions to address diabetes in the workplace.
Resources for Diabetes Prevention and Control
The following resources provide information, products, and tools about diabetes prevention and control:
American Association of Diabetes Educators
http://www.diabeteseducator.org/*
American Diabetes Association
http://www.diabetes.org/*
Centers for Disease Control and Prevention
www.cdc.gov/diabetes
Diabetes Action Research and Education Foundation
http://www.diabetesaction.org/*
Diabetes Education and Sports Association
http://www.diabetes-exercise.org/*
Diabetes Prevention Program
www.bsc.gwu.edu/dpp/manuals.htmlvdoc*
National Diabetes Information Clearinghouse
diabetes.niddk.nih.gov
diabetes.niddk.nih.gov/spanish/index.asp (Spanish Web page)
The National Diabetes Education Program
http://www.yourdiabetesinfo.org/*
www.cdc.gov/diabetes/ndep
http://www.diabetesatwork.org/*
http://www.betterdiabetescare.nih.gov/
Resources for Depression
Several resources are available for employers and employees who are dealing with depression issues at the workplace. These resources include:
Agency for Health Care Policy and Research
Depression is a treatable illness No 5
www.AHRQ.gov/consumer
American Academy of Family Physicians
Patient Education Information
familydoctor.org/handouts/587.html*
American Psychiatric Association
http://www.psych.org/*
http://www.healthyminds.org/*
American Psychological Association
http://www.apa.org/*
A Pathway for Life Long Mental Health: A Mental Health Resource Guide
http://www.freedomfromfear.org/*
Depression and Bipolar Support Alliance
http://www.dbsalliance.org/*
Depression Booklet:
http://www.1on1health.com/
Depression Health Center
my.webmd.com/medical_information/condition_centers/depression/default.htm
Depression in the Workplace Magazine
www.managedcaremag.com/workplace
Depression Screening Test: An Online Self-test for Depression
psychcentral.com/depquiz.htm
Depression—You Don’t Have to Feel that Way. American Family Physician. Published by the American Academy of Family Physicians. March 1, 2000. www.aafp.org/afp/20000301/1523ph.html*
Mental Health Matters: Self Help Center: Video and Audio Tapes.
www.mental-health-matters.com/selfhelp/m_media.php
National Alliance on Mental Illness
http://www.nami.org/*
National Business Group on Health. An Employer’s Guide to Behavioral Health Services: A Roadmap and Recommendations for Evaluating, Designing, and Implementing Behavioral Health Services. www.businessgrouphealth.org/pdfs/fullreport_behavioralhealthservices.pdf*
National Institute of Mental Health
http://www.nimh.nih.gov/
- For NIMH’s publications on depression, please call Toll-free 1-800-421-4211
- For NIMH’s publication on diabetes and depression, visit: www.nimh.nih.gov/publicat/index.cfm
National Mental Health Association
http://www.nmha.org/*
SONRISA: A curriculum toolbox for Promotores/Community Health Workers to address mental/emotional health issues associated with diabetes. Southwest Center for Community Health Promotion, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona. Available at: www.caldiabetes.org/content_display.cfm?contentID=705&categoryID=75*
The Partnership for Workplace Mental Health
- A Mentally Healthy Workforce—It’s Good for Business http://www.workplacementalhealth.org/*
Article Source:
The U.S. Department of Health and Human Services’ National Diabetes Education Program is jointly sponsored the National Institute of Diabetes and Digestive and kidney Diseases of the Institutes of National Health and the Division of Diabetes Translation of the Centers for Disease Control and Prevention with the support of more than 200 partner organizations.
Foot Care For Diabetics
With the estimated
By Shaun Parker
Shaun Parker is a leading podiatrist and chiropodist in London, with many years of experience in foot care. Find out more about chiropody at: http://www.gotosee.co.uk/therapies/Podiatry-(Chiropody).htm.
Not only do diabetics have to keep an eye on their diet, monitor their blood sugar levels and administer insulin shots, they must also ensure their feet are free from infection. With an estimated 120 million diabetics worldwide, podiatry has its work cut out treating the foot problems associated with diabetes. Foot ulcers, infections and even amputation are among the risks diabetics face from poor foot care. However, by following some simple guidelines, and regular visits to a podiatrist, diabetics can keep their feet clean, healthy and reduce the risk of disability.
People with diabetes have impaired nerve and circulatory function. Nerve damage can lead to a loss of sensation in the extremities, often the feet. An insensitivity to pain means the diabetic may not feel a blister, cut or sore on their foot. Poor circulation means that blood flow to the foot is reduced, impacting on the resistance to infection or the healing of an existing infection. An aggressive infection can potentially lead to the loss of a toe, foot or leg. Every year in the UK, nearly 5,000 diabetics need an amputation arising from a foot infection.
Half of all foot ulcers and amputations on people with diabetes could be prevented through improved foot care. Diabetics should develop a daily routine of inspection and cleaning along with periodic examination by a podiatrist. Diabetics should inspect their feet every morning and night checking for blisters, cuts and inflammation or toenail problems. It may be necessary to use a mirror to see the sole of the foot or ask someone else to take a look. Feet should be washed in warm water using a mild soap and dried carefully but thoroughly(paying particular attention to between the toes). Once dry, the feet should be moisturised. Podiatrists sell a specialist foot moisturiser that can prevent dry skin from cracking, however this shouldn’t be used between the toes as this can cause a fungal infection.
Toenails should be cut straight and across but not too short as this can lead to an ingrowing nail. Also file down any edges to prevent snagging. Socks should be clean, dry, changed daily and not be too tight around the ankle as this can restrict circulation (remember, diabetics can have poor circulation to the extremities). Before putting on shoes, diabetics should check inside and shake them out; a small stone can easily cause a cut or irritation to the foot. When at home, avoid walking around the house in bare feet; wear slippers with a hard rubber sole. Diabetics are advised to avoid walking in bare feet on any occasion as the risk of a scratch or cut is possible on any surface. Heat should never be applied to the feet with hot water bottles or heat pads. If feet get cold in bed at night, wear a clean pair of socks instead.
Even following all these guidelines, diabetics are as prone to corns and calluses as non-diabetics. However, diabetics should not use corn plasters or chemical agents to treat the problem. Regular podiatry visits will clear up any skin problems and if creams or solutions are needed the podiatrist will recommend safe products. A podiatrist can also give advice on correctional devices like orthotics that can be placed in the sole of the shoe to ease pressure on the foot and prevent blisters forming.
Awareness, common sense, cleanliness and treatment from a trained podiatry practitioner can prevent diabetics from developing foot problems that can potentially lead to disastrous consequences.
Source: Shaun Parker
How to Use Insulin Pens: video 6:16 min.
Source: postcare.com on YouTube
Uploaded by postcarecom on Nov 8, 2007
http://www.PreOp.com
This program will demonstrate the use of insulin pens.
The goal is to inject the insulin into the subcutaneous tissue between the top layer of the skin, the dermis and the underlying muscle layer.
Insulin pens are devices that can provide an easy way to carry and give insulin when away from home. Also, for people who are not comfortable working with syringes and bottles to draw up and measure individual doses, the pens provide a convenient and accurate alternative.
There are two types of insulin pens: * those that are completely disposable after providing a single dose of insulin * and those that use disposable cartridges to provide multiple doses. * If you use more than one type of insulin, you must use a separate pen for each type. The basic method of use is similar for both pens and there are four main steps to be learned.
An insulin pen has three components. * A base which contains the mechanism for measuring the correct dose. * A holder for the cartridge of insulin * and a cap, which is removed and replaced by the needle prior to the injection.
Follow the manufacturer’s instructions to remove the cap, separate the base from the cartridge holder by unscrewing it.
Rewind the base dose regulating mechanism back to zero and put down the base.
Pick up the cartridge holder. Shake out the used cartridge.
Check that the new cartridge contains the correct insulin and insert it, metal end first, into the holder.
Screw the cartridge holder back onto the base. * Keep a record of all your injections and also record when you begin a new cartridge. * Subtract the total insulin used in previous injections from the total of 150 units in each cartridge to be sure you have enough insulin left for the next dose.
Clean the end of the cartridge holder and the projecting cartridge with an alcohol swab.
Remove the seal from the end of the new needle unit. Don’t touch the exposed needle or allow it to touch any other object.
Screw the needle unit onto the end of the cartridge holder.
Pull the outer shield off the needle. Do not throw it away. You will need it later to remove the needle unit from the pen.
Pull the inner shield off the needle and discard it. Hold the pen upright and tap the cartridge holder to enable air bubbles to escape through the needle.
Dial the dose knob so that #1 is in the dose scale window and prime the pen according to the manufacturer’s instructions.
Hold the needle upright. Press in the injection button at the end of the unit and check that insulin comes out of the tip of the needle. If no insulin is seen, continue to dial up one unit at a time and press the injection button until insulin is seen. A new cartridge may take 4-6 units before insulin flows.
Dial in your dose of insulin in addition to the units needed to produce the insulin flow. For example, if it took 4 units to start the insulin flow and your insulin dose is 20, the total in the dose scale window will be 24. * Choose and clean the injection site as usual.
Pinch the skin and insert the needle through the skin at a 90Ë? angle. Press the injection button at the end of the needle and wait 5 seconds for the injection to be completed before removing the needle from the skin. * The needle must be removed from the pen immediately after the injection is finished.
Place the outer needle shield that you had saved on the counter top with the opening facing up.
Without holding onto the shield, insert the pen needle carefully into the shield and push down firmly. Grip the shield and unscrew the needle from the pen.
Dispose of the shielded needle into the puncture proof container that you have reserved for your needles. Store all pens that are in use at room temperature.
Diabetes and Sexual Problems: Topics A to Z
Posted June 7, 2009
PDF Version * (446 KB) Also see: Nerve Disease and Bladder Control Urinary Tract Infections in Adults
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Home : Diabetes A-Z List of Topics and Titles : Sexual and Urologic Problems of Diabetes
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Source: Natinal Diabetes Information Clearinghouse, (NDIC)
Free Diabetes Supplies
Posted June 5, 2009
By Roger Thompson
The average person with diabetes spends more than $13,000 in medical care annually while the typical person without diabetes only spends approximately $3,000 per year on health care. While this cost sounds high, the toll of uncontrolled blood glucose levels and associated complications is a lot higher.
Think of all the prescriptions, lab work, and doctor’s visits as a form of preventive maintenance. Free diabetes supplies are provided to those who cannot afford to purchase them. There are also some insurance companies that provide these services. In fact, the majority of diabetes service companies are affiliated with health insurance companies, which is why you can get free diabetes supplies.
So, how do you get free diabetes supplies? Most companies that focus on providing health services and supplies for diabetics give out free supplies and will even ship them at no extra cost. However, you need to be covered by health insurance. Once you are covered, you will have to find a medical supply company that has either free or low cost diabetes supplies. Most of these places will deliver your supplies directly to your home for free.
Testing is important for diabetics because carefully monitoring blood glucose can give valuable information, helping to obtain great control which can seriously delay the progression of long term diabetic complications. Blood glucose is easy to monitor at home, using thumb prick blood tests. Many people who test this way daily do not actually understand how serious and important it is for them to do so.
Frequent monitoring can answer a lot of questions about diet and exercise, and what is happening over a long term period. Not only can monitoring blood glucose allow the diabetic control of his or her day to day – It can also indicate changes over time and help predict long term complications.
Health experts say that the ultimate goal of diabetics should be to get their blood glucose levels as close to normal as possible. However, if you have any medical conditions that affect your ability to control your glucose level, then these levels may be a bit higher. Therefore, it is important that you always have reliable blood glucose monitors, meters and other equipment so that you can check your present blood sugar levels.
Of course, this can be very costly because you have to pay for blood glucose monitors and test strips. It is actually these test strips that can leave a big hole in your pocket, which is why free diabetes supplies are very much appreciated by many diabetics. You should know that free diabetes supplies are safe to use as long as they have not expired because if they are expired they can be dangerous because they may not detect your glucose levels accurately.
Even if you decide to purchase large quantities of your supplies they will still cost you a lot of money, which is why it is advantageous to try to get them for free if you can.
Source: Roger Thompson
When Your Child is Diagnosed With Diabetes
Home About Diabetes and Pre-diabetes Resources for Health, Education, and Business Professionals Awareness Campaigns Partnerships About NDEP What’s New? Publications Catalog Contact Us Site Map Search NIDDK When Your Child Is Diagnosed with DIABETES:
PARENTS’ QUESTIONS for the Health Care Team
Parents of children with diabetes often have concerns about the disease, its impact on their family, and how to keep their children safe and healthy. Use these questions to talk with your child‘s health care team and learn about your child‘s diabetes care needs at diagnosis and later on as well. To find out more about possible answers, use the links under each set of questions.
What are the different types of diabetes?
Which type of diabetes does our child have?
Will it ever go away?
www.ndep.nih.gov/diabetes/WhatIs/WhatIs.htm
www.ndep.nih.gov/diabetes/youth/youth_FS.htm
www.jdrf.org
What does this mean for other members of our family?
Does it mean our other children will get diabetes too?
What about other family members?
www.ndep.nih.gov/diabetes/youth/youth_FS.htm#Identifying
www.ndep.nih.gov/diabetes/prev/prevention.htm
www.ndep.nih.gov/diabetes/youth/youth.htm
(See Tips for Kids: Lower Your Risk for type 2 Diabetes)
What are my child’s treatment goals?
How can we help our child meet these goals?
How often will our child need to visit you each year?
www.ndep.nih.gov/diabetes/youth/youth_FS.htm#Treatment
(See Treatment Goals and Family Support)
www.ndep.nih.gov/diabetes/pubs/4_Steps.pdf*
www.ndep.nih.gov/diabetes/youth/youth.htm
(See Tip Sheets for Kids with Type 2 Diabetes)
What other health care team members can help care for our child’s diabetes?
How do we contact them?
www.ndep.nih.gov/diabetes/youth/youth_FS.htm (See Visiting the Health Care Team)
How can we work together as a family to help our child?
How can we help our child check blood glucose, take insulin, eat healthy foods, be more active, and learn about diabetes?
Who can help us work together as a family?
www.ndep.nih.gov/diabetes/youth/youth_FS.htm (See Helping Children Manage Diabetes)
What emotional issues might our child and family face?
Will diabetes affect the way our child behaves?
When do we start letting our child manage his/her own diabetes care?
Who can help us cope with these issues?
www.ndep.nih.gov/diabetes/youth/youth.htm (See Tips for Teens with type 2 Diabetes: Dealing with the Ups and Downs of Diabetes)
www.ndep.nih.gov/diabetes/youth/youth_FS.htm#Transition (See Transition to Independence )
www.ndep.nih.gov/resources/SchoolNurseNews.htm (See Understanding Emotional & Psychological Considerations of Children with Diabetes: Tips for School Nurses)
www.diabetes.org/for-parents-and-kids/living-with-diabetes/age-related-issues.jsp
www.diabetes.org/for-parents-and-kids/living-with-diabetes/reactions.jsp
Should we tell friends and family about our child’s diabetes?
www.diabetes.org/for-parents-and-kids/living-with-diabetes/friends-family.jsp
Who can help us if we don’t have medical insurance?
www.insurekidsnow.gov/questions.asp
www.usgovinfo.about.com/od/medicarehealthinsurance/a/schip.htm
What resources are there to help our child in school?
www.ndep.nih.gov/diabetes/pubs/Youth_NDEPSchoolGuide.pdf*
www.ndep.nih.gov/diabetes/youth/youth_fs.htm#diabetes (See Diabetes at School)
www.diabetesinchildren.com
What research is going on?
Three large nation-wide studies are under way.
The TODAY study wants to find the best ways to care for type 2 diabetes in children and teens and has begun in 13 medical sites. To find out if you can join go to www.TODAYstudy.org.
Type 1 Diabetes TrialNet is a group of studies looking at ways to prevent or to treat type 1 diabetes early. To find out if you can join go to www.diabetestrialnet.org/public.html or call1- 800- HALT- DM1(1-800-425-8361).
The SEARCH for Diabetes in Youth study will help us learn about how type 1 and type 2 diabetes differ, what medical problems arise, the health care children receive, and how diabetes shapes their daily lives. www.searchfordiabetes.org
A lot of other research is going on. To find studies in your area, talk to your health care team and visit the JDRF and ADA (links below).
Additional Resources for Parents and Children
National Diabetes Education Program
www.ndep.nih.gov or call 1-800-438-5383
Juvenile Diabetes Research Foundation International (JDRF)
www.jdrf.org or call 1-800-223-1138
Children with Diabetes
www.childrenwithdiabetes.com
American Diabetes Association ( ADA )
www.diabetes.org or call 1-800-DIABETES (1-800-342-2383)
*PDF files require the free Adobe Acrobat Reader application for viewing.
The U.S. Department of Health and Human Services’ National Diabetes Education Program is jointly sponsored by the National Institutes of Health and the Centers for Disease Control and Prevention
August 2006 Reviewed by Janet Silverstein, M.D. Professor, Department of Pediatrics, University of Florida
NDEP Home | About Diabetes | Resources for Health, Education, and Business Professionals
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Source: NDEP, (National Diabetes Education Program)
Diabetes and Social Security Disability Insurance
For those of you that may eventually find that your diabetic condition has stopped you from working you may be eligible for Social Security Disability payments. This is important! It is not widely publicized. You can find loads of information about SSDI (Social Security Disability Insurance) at www.socialsecurity.gov.
FoodSpook
Diabetes SSI Disability, Do You Have the Right Team?
Posted May 4, 2009
By Matt Berry
Diabetes, with its myriad complications and side effects, has come to be known as the fifth-deadliest disease in the country. While many are able to notice symptoms and receive a diagnosis with plenty of time to get it in check, there will always be others who don’t realize they have diabetes until they begin to suffer from some of its more serious side effects.
With all the different forms of pain and suffering diabetes can cause, as well as how difficult it can make daily life, it’s important that every diabetic find a team to support them. In some cases, the team is comprised solely of medical professionals. In other instances, it might be made up of medical professionals, various specialists, and retailers that focus on diabetic needs.
For those that have found themselves facing too many effects of the illness to continue working in a day-to-day full-time capacity, part of this team might include an attorney who specializes in social security disability benefits. Whoever the team is comprised of though, it’s important that they all work together and are aware of each other, as that will help them make decisions to benefit the patient.
Building a Team: While the diabetic patient has quite a bit of responsibility, the team they’re surrounded with can also be a huge help in keeping their health and life on track. The patient, therefore, needs to be extremely careful when selecting doctors, specialists and a SSI Diabetes Social Security Lawyer (Attorney) as members of their team. Developing a rapport and trust with each of these team-members will ultimately serve to make managing their diabetes even easier.
Importance of Your Doctor: A primary care doctor is integral to any diabetic support team, as this is often where referrals to specialists will come from. For some, their primary care doctor will be an endocrinologist who what specialized training and certifications in diabetic care. If an endocrinologist isn’t available, a primary care doctor could be a family practice doctor or internist who has had experience with diabetes. When considering new doctors, especially one who will be a cornerstone of the diabetic’s support team, asking them some of the following questions might be helpful.
- What kind of diabetes training have you had? What percentage of your patients are diabetics? -
Who do I turn to for back-up care when you’re not available? Will you accept my insurance? Are there any other fees I’ll be responsible for? If the answers to those questions seem satisfactory, and the patient feels that the doctor listened to and responded well to their concerns, it may be a perfect match.
Importance of Your Social Security Lawyer: A Social Security Disability Lawyer specializing in diabetes cases is often another cornerstone of the diabetic support team. When it isn’t possible for patients to work a full-time job and support themselves, a Social Security lawyer or attorney can help file an application to receive social security disability benefits. The process for receiving diabetes SSI disability can be long and complicated, which is why it’s imperative that the benefits attorney selected has sufficient experience.
Similar questions to those that were asked of the doctor also apply when interviewing attorneys.
- What percentage of your patients are diabetics? (Your lawyer should have extensive experience with diabetes cases as well as other medical conditions that are often associated with the disease.)
- How will you work with my medical support team to gather the information you’ll need? (The answer should be that your attorney has a sufficient legal team that can assist you and will track your claim as it moves through the Social Security system.)
- What kind of fees will I be responsible for? (The answer should be “none” unless you are awarded Social Security disability benefits). As the diabetes social security benefits case hinges on whether or not diabetes has made it impossible for the patient to work, communication between the doctor, patient and SSI disability attorney must be open and clear. With trusted and experienced doctors and a diabetes SSI disability attorney, the patient will be well-situated to care for their diabetes in all aspects of their life.
Matt Berry is a Social Security attorney . As a Social Security lawyer (attorney) he works with various disabled with Social Security Disability impairments.
Source: Matt Berry
Buying Diabetes Medical Supplies on The Internet
Home Advice
By Trevor Price
Did you know you can save a lot of money by buying your diabetes medical supplies on the Internet? Are you also aware that many of these retailers are not based in the U.S. and therefore not subject to FDA laws or standards? If you’re considering the purchase of your diabetes supplies and equipment online, keep reading to find out what you can do to protect yourself.
U.S. Supplier If you’re buying diabetes medical supplies off a web-based company, look for one that’s either based in the United States or your own country. Even if the prices are better, a supplier stationed in a foreign land isn’t held to the same quality standards as one here.
Remember, this is your health. On top of potentially being unsafe, importing foreign drugs or medical equipment may be against the law and could get you into serious trouble with U.S. customs. So, don’t risk your health or your record by buying medical supplies from outside the country.
Prescription Required When Needed Not all types of insulin require a prescription, but if yours requires one either nationally or in your state, then always purchase from a seller that obligates you to submit proof of prescription.
Buying a prescription-only product without a prescription is illegal. Check the Shipping Policy Before you buy from an online retailer, find out how the goods are shipped. Are they properly protected against breakage and possible contamination? How fast do they ship and by what methods? If they send your product by ground then how do they ensure the package won’t be pierced or possibly damaged? And don’t forget to include the shipping costs into your total costs calculation. If the shipping is outrageous, then your online deal may not be such a steal after all.
Scan Customer Reviews Before you buy a product online, you should read the customer reviews of both the online retailer and the product itself. For example, if you’re in the market for a new test strip system, be sure to peruse the customer reviews of other users. They should be right on the retailer’s website. You should also read retailer reviewers. It’s here that customers talk about a retailer’s customer service, their shipping fees, return policy and the overall buying experience.
To find reviews for online retailers, try sites like Nextag or Froogle. Be Wary of Purchasing on eBay Unless a seller has a stellar reputation with strong customer feedback from buyers who have purchased diabetes medical supplies specifically, then stay away. eBay is full of expired products, recalled brands and rejected stock items that aren’t suitable for the regular market. Unless you’re buying from a seller that has excellent feedback from customers who have purchased diabetes medical supplies in the past, then you should stay away.
Your purchase of any equipment for the care of diabetes is nothing to take lightly. Though we all want to save money on health care costs, none of us should take undue risks related to the quality of those items.
For great information on the treatment of various diseases and conditions – please visit diseasetreatmenttips.com – a popular site about tackling ailments – such as Rheumatoid Arthritis pain relief – natural sleeping aids – and many more!
Source: Trevor Price
Camp-DT 2007 Diabetes-Teens.Net
Source: Diabteens, Reprinted from YouTube
Diabetes Topics, A to Z
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The NDIC is a service of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.
National Diabetes Information Clearinghouse
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Phone: 1–800–860–8747
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: ndic@info.niddk.nih.gov
Source: National Institute of Health, (NIH)
Sex and Diabetes
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Quote from the Book, ‘Sugar Busters!’
In 1995 a book was released and became a #1 Best Seller on the New York Times list. That book was called ‘Sugar Busters!’ I read this book and it fundamentally changed my understanding of how sugar in our diets effects our health. This book was quite controversial when first published. It challenged to medical community to face up to its lack of willingness to admit that the over consumption sugar, especially in processed foods was ruining our citizens health. The authors (4) also took on the the powerful food industry. Back 1n 1995, these authors were considered “mavericks.” Just look at what is happening in 2008. In spite of all the medical advances during the past 13 years, diabetes, heart disease and strokes are at a all time high. Something is wrong with our food system.
I quote from ‘Sugar Busters!’, “Let’s get the point. Sugar is toxic. Sugar? Some sugar? Most sugar? All sugar? Toxic? Well we will say that refined sugar in any significant quantity is toxic to many human bodies, and it certainly helps make many bodies fat. Moreover, significant quantities of sugar are derived in our digestive systems from carbohydrates and starches. Certain of these foods cause a definite strain on the health of the body, probably the mind, and certainly the waistline. Fructose, sugar in fruit, will not normally hurt you, but eaten at the wrong time or in the wrong combinations can create digestive and metabolic problems. Therefore, what we are recommending is a low-sugar diet. Surprisingly, that cannot be achieved by simply putting away your sugar cannister.”
“How can sugar, something that tastes so god and has been fed so readily to most of us since childhood by our most trusted person on earth, our mother, possibly be so bad for us? Aside from a few bad side effects, such as dissolving our teeth, sugar largely acts as a stimulus in causing our pancreas gland to secrete one of the body’s most powerful hormones, insulin.” …”Most significantly, insulin signals our livers to make the other big”C” word, cholesterol”. …”When our borderline diabetics get to where they cannot control their diabetes with pills, diet, and excercise, and we will have to give them insulin injections, we know the first major side effect be that their cholesterol will become quite elevated, and as the insulin shots continue, Type II diabetics will start getting more obese”.
This book is a very compelling study of how to avoid obesity and diabetes. It is not conventional. The concepts it presents is not rocket science. It is real solid information that other doctors seemed to have been ignoring at the time the book was written. It provides recipes for breakfast, lunch and dinner. I give you a lesson on the food industry in this country. It provides you with a viable road map on how to live a healthy life. I hope you get a chance to read it.
Please feel free to leave a comment!
Source: ‘Sugar Busters’ 1995, by H. Leighton Steward, Morrison C. Bethea, M.D., Sam S. Andrews, M.D., and Luis A. Balart, M.D.
Injecting Insulin-Video 4.53 min.
Source: Postcarecom, Reprinted from YouTube
Diabetes A to Z
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- AAA Foundation for Traffic Safety
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Also available in: Spanish - AgrAbility Project (Dept. of Agriculture)
- Agricultural Research Service
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- Al-Anon/Alateen (Al-Anon, Alateen)
- Alcoholics Anonymous
Also available in: Spanish - Alexander Graham Bell Association for the Deaf and Hard of Hearing
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Also available in: Spanish - American Rhinologic Society
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Also available in: Spanish - Angelman Syndrome Foundation
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Also available in: Spanish - Anxiety Disorders Association of America
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Also available in: Spanish - Arthroscopy Association of North America
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Your Feet, Skin and Diabetes
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Prevent Diabetes Problems Series
Take Care of Your Feet for a Lifetime (PDF, 272 KB)
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NIH’s comprehensive, consumer-friendly database of clinical trials
Home : Diabetes A-Z List of Topics and Titles : Prevent Diabetes Problems Series : Prevent Diabetes Problems: Keep Your Feet and Skin Healthy
 
Prevent diabetes problems: Keep your feet and skin healthyOn this page:
What are diabetes problems?Too much glucose in the blood for a long time can cause diabetes problems. This high blood glucose, also called blood sugar, can damage many parts of the body, such as the heart, blood vessels, eyes, and kidneys. Heart and blood vessel disease can lead to heart attacks and strokes. You can do a lot to prevent or slow down diabetes problems. This information is about feet and skin problems caused by diabetes. You will learn the things you can do each day and during each year to stay healthy and prevent diabetes problems.   High blood glucose can cause feet and skin problems. [Top] What should I do each day to stay healthy with diabetes?
[Top] How can diabetes hurt my feet?High blood glucose from diabetes causes two problems that can hurt your feet:
These two problems can work together to cause a foot problem.
For example, you get a blister from shoes that do not fit. You do not feel the pain from the blister because you have nerve damage in your foot. Next, the blister gets infected. If blood glucose is high, the extra glucose feeds the germs. Germs grow and the infection gets worse. Poor blood flow to your legs and feet can slow down healing. Once in a while a bad infection never heals. The infection might cause gangrene. If a person has gangrene, the skin and tissue around the sore die. The area becomes black and smelly. To keep gangrene from spreading, a doctor may have to do surgery to cut off a toe, foot, or part of a leg. Cutting off a body part is called an amputation. [Top] What can I do to take care of my feet?
[Top] How can my doctor help me take care of my feet?
[Top] What are common diabetes foot problems?Anyone can have corns, blisters, and other foot problems. If you have diabetes and your blood glucose stays high, these foot problems can lead to infections.
Tell your doctor about any foot problem as soon as you see it. [Top] How can special shoes help my feet?Special shoes can be made to fit softly around your sore feet or feet that have changed shape. These special shoes help protect your feet. Medicare and other health insurance programs may pay for special shoes. Talk with your doctor about how and where to get them. [Top] How can diabetes hurt my skin?Diabetes can hurt your skin in two ways:
[Top] What can I do to take care of my skin?
[Top] Pronunciation Guideamputation (AM-pyoo-TAY-shuhn) gangrene (GANG-green) neuropathy (noo-ROP-uh-thee) peripheral (puh-RIF-ur-uhl) podiatrist (poh-DY-uh-trist) vascular (VASS-kyoo-lur) [Top] For More Information
Diabetes Teachers (nurses, dietitians, pharmacists, and other health professionals)
Dietitians
Government
To get more information about taking care of diabetes, contact National Diabetes Information Clearinghouse National Diabetes Education Program American Diabetes Association Juvenile Diabetes Research Foundation International This publication may contain information about medications used to treat a health condition. When this publication was prepared, the NIDDK included the most current information available. Occasionally, new information about medication is released. For updates or for questions about any medications, please contact the U.S. Food and Drug Administration at 1–888–INFO–FDA (463–6332), a toll-free call, or visit their website at www.fda.gov. Consult your doctor for more information. [Top] More in the SeriesThe “Prevent Diabetes Problems” series has seven booklets that can help you learn more about how to prevent diabetes problems.
For free single copies of these booklets, write, call, fax, or email the
These booklets are also available at www.diabetes.niddk.nih.gov on the Internet. [Top] AcknowledgmentsThe National Diabetes Information Clearinghouse thanks the people who helped review or field-test this publication. For the American Association of Diabetes Educators For the American Diabetes Association For the Centers for Medicare & Medicaid Services For the Diabetes Research and Training Centers Indiana University School of Medicine VA/JDF Diabetes Research Center For the Grady Health System Diabetes Clinic For the Indian Health Service Red Lake, MN For the Medlantic Research Center For the Texas Diabetes Council [Top] National Diabetes Information Clearinghouse
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 of 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. NIH Publication No. 08–4282 [Top] |
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Diabetes Home | Diabetes A to Z | Introduction | Treatments | Complications | Statistics | Clinical Trials | NDEP | Awareness and Prevention | Additional Resources | Order Publications | About Us | Información en Español
Contact Us | Health Information
The NDIC is a service of the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health.
National Diabetes Information Clearinghouse
1 Information Way
Bethesda, MD 20892–3560
Phone: 1–800–860–8747
TTY: 1–866–569–1162
Fax: 703–738–4929
Email: ndic@info.niddk.nih.gov
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Source: National Institute of Health (NIH)
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