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.

National Diabetes Education Program (US Government). May 1, 2011. 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.

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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.

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.

My Diabetes Care Record card

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