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Carbohydrate Counting and Exchanges

The truth about carbohydrates and diabetes The myth: If you have diabetes, you can't eat sweets or sugar. The truth: A food doesn't have to be sweet or sugary to raise your blood sugar. Anything with carbohydrates will affect your blood glucose, whether it's from white potatoes, pasta, bread or (insert local sweets here…jelly babies / lollies / strawberry laces).1 Of course, different foods may affect you differently. Why? Eating protein, fat or fiber along with your carbohydrates may slow the absorption of the carbohydrates into your system. That's why the extra fiber in whole-grain foods can help you avoid a big spike in blood glucose. What's more, eating carbohydrates as part of a larger meal that includes fat and protein will also help.2 What foods don't have carbohydrates? Green and leafy vegetables, meat and fish, tofu, cheeses, eggs, nuts and fats.3 To be sure you're accounting for all of your carbohydrates/exchanges accurately, try an online carb counter or app. Certainly, there are other reasons to limit sugary foods in favor of other types of carbs. You'll feel much more satisfied after eating a small potato, for example, than a tablespoon of jam—and you'll take in added fiber, vitamin C and potassium your body needs. Just remember, whether it's from milk, peas, apricots or a biscuit, a carb doesn't have to be loaded with sugar to count. Approximately 15 grams of carbohydrate/One carbohydrate exchange2,3 1 slice of bread or small chapatti 125 ml of pasta or couscous 75 ml of cooked rice 125 ml of lentils or pulses/dried beans 1 small potato 1 medium onion 1 small banana 20 grapes 250 ml of milk 100g natural yoghurt 3 teaspoons of honey 3 teaspoons of sugar 6 or 7 hard candies  

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Creating a Circle of Support

No one can go it alone. Whether you have diabetes or you’re a caregiver, it’s important to have a few options for emotional support. Knowing who to turn to with specific questions will make life easier. Find other people with diabetes  Few things are more comforting than talking with someone who understands you when you have diabetes, or if you are facing a type 1 or type 2 diagnosis. If you don’t already have a friend or family member with diabetes who can fill this role, seek out a diabetes support group near you. What have you got to lose? If you don’t like one group, look for another until something clicks. Another great way to find others who support people with diabetes friends is to volunteer or join fundraising events of diabetes non-for-profit groups. Join the DOC The DOC is the Diabetes Online Community, a deep well of inspiration and support, all online. There are dozens of options: message boards, private groups, social media, blogs…people with diabetes are online everywhere. You can look for private groups on social media sites like Facebook (possible link - https://www.facebook.com/search/more/?q=diabetes&sid=0.21061603794805706. Some popular message boards live at TuDiabetes  https://www.tudiabetes.org/forum and Children with Diabetes http://forums.childrenwithdiabetes.com/activity.php. (more) Know your healthcare team You’ve worked with your healthcare providers to lay out a plan for controlling your diabetes, so don’t let all that hard work go unused. Make (and keep) regular appointments with your primary physician, and find someone like a nurse or diabetes educator you can contact whenever you have questions about your health. Enlist your child’s school If your child has diabetes, build a team of caretakers for your own peace of mind. Ask the principal to arrange a meeting between you and anyone who needs to understand your child’s diabetes needs—office workers, the school nurse, all teachers, coaches, and even transportation or field trip chaperones. The Kids and Diabetes in Schools (KiDS) https://www.idf.org/education/kids project is a valuable resource for creating a supportive environment at school. Download the information pack https://www.idf.org/education/kids/diabetes-in-school-information-pack, which is divided into sections for teachers, parents of children with diabetes, children with diabetes, and parents in general. It’s available in 8 languages; it’s free, and can be used with any educational session you arrange with your school. Additionally, get a clear understanding from your doctor about how the school day should work properly, and then make sure that the school understands your child’s daily treatment needs. The school nurse is your best friend. They’ll be your biggest asset when it comes to teaching other staff at the school about how to care for your child. Above all, don’t get discouraged. Learning curves are high for the first few weeks, and that’s okay. Educate your family and friends One of the tasks that comes with living with diabetes is educating the people around you who aren’t living with it. You may feel like it’s not working, but keep educating, always speak up, and be clear about what really helps you (and what doesn’t). In time, everyone will be on the same page. And if there’s ever an emergency, they’ll know what to do. 6 Big Things You Can Teach Everyone about Diabetes Yes, you can eat anything you want. Not everyone who has diabetes is overweight. Yes, you can get cranky when your blood sugar level drops There are 2 types of diabetes, and they’re treated differently There is no cure for diabetes, only treatment. How they can help if you have low blood glucose.  

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Preparing for Pregnancy

Preparing for pregnancy—good reasons to start today Let's think into the future. Imagine sitting in a rocking chair playing with ten brand-new, tiny toes. That's the image you can remember every time you check your blood glucose, visit your doctor or say no to a glass of wine. And it's absolutely worth it. Not ready for parenthood yet? Here's what you can do now. There are several things you can do to prepare for pregnancy well before you're ready to conceive. Read about it—just not too much. When you understand the risks, you can take steps to reduce them, but it could be overwhelming if you dwell on them. Stay confident knowing that many women with diabetes have happy, healthy pregnancies. Find a great doctor. Seek out an obstetrician/specialist who has cared for other women with diabetes. You two are going to get pretty close throughout your pregnancy, so make sure it's someone you feel good about. Ask about your targets. Your doctor may want you to aim for a tighter blood sugar range when you're trying to get pregnant and throughout your pregnancy.1 Fine-tune your blood sugar. Keeping your numbers in range is incredibly important for your healthy pregnancy—even before you conceive.1 Why start early? You never know. Once you start trying to conceive, it could happen any time. High blood sugar can affect your baby in those first few weeks, before you even know you're pregnant, so make it a habit to stay in range. You may find that more frequent blood glucose checks help you improve control by guiding insulin doses, helping you identify patterns in your numbers, and helping you quickly respond to high or low blood glucose.    Once you're pregnant, you'll have more advice than you can handle—from your doctor as well as family, friends and strangers on the street. Try to stick to the more reliable information sources and keep smiling. After all, there's a baby on the way.

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How to Talk to Your Doctor

How to Talk to Your Doctor Whether you’ve been living with diabetes for years or you’re newly diagnosed, communicating with your healthcare team is one of the best things you can do. If you’re nervous about opening up to your doctor or pharmacist, there are some good reasons to conquer these fears. Less communication leads to measurable increases in your stress, anxiety, and possible depression. It also leads, inevitably, to less frequent and less successful diabetes management.1 Since communicating with your healthcare providers is proven to be good for your health, here are some guidelines for starting the conversation and keeping it going. Know who’s on your healthcare team. If you don’t already know the people involved in your healthcare, get to know them. Your healthcare team could include: Primary care provider Pharmacist Nurse or certified diabetes educator Dietician Endocrinologist Eye doctor Therapist Podiatrist You may not need to see everyone on this list, but it is a good idea to know who to turn to when you have specific questions. You have a say in your healthcare. The most important member of your healthcare team is you! Other than doing what it takes to manage diabetes day-to-day, this also means that you have a say in your treatment. In fact, your healthcare provider should explain your diagnosis and all of your treatment options to you so that you can make an informed decision with regard to your health. The World Health Organization provides a great overview of informed consent, including which treatments require written consent (like surgery) and what you should expect to happen during the informed consent process.2 How much do you want to know? Sometimes the medical details can be overwhelming or intimidating. If you would rather not know these details right away, feel free to tell your doctor or pharmacist . Just make sure you find a comfortable balance between what you want to know and what you need to know in order to successfully manage your diabetes. If knowing every clinical detail puts your mind at ease and makes you feel more in control, tell your doctor this, too. Know what to discuss and ask about. You will likely have general questions you’d like to ask your healthcare provider when you see them—new symptoms, any changes to your treatment, etc. It’s best to get those out of the way first. Make sure you also ask questions about sensitive topics or any other issue that is important to you. And if you’ve decided to add alternative medicines or treatments to your regimen, be open and honest with your team. These conversations are for a good cause: your health! Do you know about your medical tests? It’s important to take the medical tests your healthcare provider requests, but make sure you ask questions about them too. Some questions to ask: Is there anything you need to do before the test? What will the test measure? How will the test influence any changes to your treatment? Are there risks to taking the test? How will you be informed about the results? Know what to do before and after your appointment. If you know there are issues you need to discuss with your healthcare provider, organize your thoughts ahead of time. Jotting them down and bringing the list of questions to the appointment can keep the meeting on track and make you feel confident that you’re getting the information you need. After your appointment, don’t hesitate to follow up if you have questions about your treatment. For example, if you received test results that you don’t understand, make a phone call. Problems talking to your healthcare provider? Yes, doctors are busy, but they are there to serve you and there is no reason for you to delay or forego getting the information you need about your health. If you can’t seem to get a clear answer from your doctor on an issue, try saying, “I don’t understand [this topic]. Can you take a few minutes to explain it to me?” If your healthcare provider can’t make the time for a conversation, offer to make an appointment for a phone call to discuss your concerns. An “advocate”, a friend, or family member that understands more about diabetes can also help by going to medical appointments with you. Never give up on getting the knowledge you need. Talk about these at every appointment. New symptoms Changes to your treatment Sensitive topics The issues most important to you Taking medical tests and getting the results Anything you don’t understand about your health

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Exercise more

Ways to Increase Activity Exercise is good for everyone, but for people with diabetes, it can make a big difference in keeping your blood sugar level under control. Not only that, but staying active allows your cells to process insulin more efficiently, improving your overall A1C levels. The many benefits to staying active Exercise is one of the cornerstones of managing your diabetes, because the list of benefits for people with diabetes is long. Exercise can:1 Improve insulin sensitivity for people with type 12 Decrease the glucose in your blood for people with type 23 Improve glucose utilization Decrease circulating insulin levels, during activity Decrease glucose production from the liver Lower your cholesterol, blood pressure, and reduce stress Improve cardiovascular health, and quality of sleep Reduce obesity, joint pain, and coronary artery disease Prevent osteoporosis and delays the onset of dementia Decrease fatigue and the number of sick days you take from work Increase energy, quality of life, and self-esteem Talk to your doctor about what type of exercise is right for you, and get moving at least once a day. Stay safe while you exercise People with diabetes have a few extra steps to add to their workout routine. Here are a few safety considerations. You can do the same things as people without diabetes, but you should still talk to your doctor or pharmacist to make sure that you have no limitations. For example, someone with diabetic retinopathy may want to skip a strenuous activity like weightlifting.2 Check your blood sugar levels before, during, and after you exercise. Have some carbs or fast-acting sugar on hand—like a banana, juice—that you can take if you start to feel your blood sugar dropping. And the next time you talk to your doctor, let them know your test results so they can offer advice on your regimen. Drink a lot of water while you exercise. If you get dehydrated, your blood sugar levels could drop. Be ready for an emergency. Wear a medical ID tag that provides information about your medical situation, and make sure you have a way to call someone for help. If you can, it’s always a good idea to have a workout buddy or let someone else know where you are. Pay special attention to your feet. Make sure your shoes fit well and offer good support. Ideally, wear socks that will wick sweat away from your skin. After your workout, check your feet for any signs of blisters, irritation or cuts. If you have any that aren’t healing, have them checked out by a doctor. It’s important to get a good workout, but don’t overdo it. If you’re in a lot of pain, out of breath or can’t talk, dial down the intensity to a level you’re comfortable with. It may sound obvious, but don’t forget to breathe. Holding your breath, which we tend to do if we’re in pain or distress, will only deprive your muscles of the oxygen you need to function at your best. Exercising at home If you don’t live near a gorgeous hiking trail, or if you don’t have access to a gym, don’t worry. You can still increase your physical activity at home, and it’s completely free! As you continue to see improved blood sugar test results, you’ll be encouraged to stick to an exercise routine, lengthen it, and even add to it. Here are some moves you can do in the comfort of your own home: Stretching is a good way to get your body ready for exercise. Simple yoga moves increase flexibility and build strength. Make small and large circles with your arms while they are straight out at your sides. Calf raises are an easy strength-building and toning exercise for everything from the waist down. Run in place for 10 minutes, at your own pace. What staying active does for you Increases: insulin sensitivity, heart health, quality of sleep, weight loss, energy, self-esteem Decreases: glucose production from the liver, circulating insulin, cholesterol, blood pressure, stress, joint pain, fatigue    

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How to Travel with Diabetes

How to Travel with Diabetes Having diabetes adds complexity to planning a well-deserved holiday. Changing your schedule, time zones, increased activity, eating on-the-go or new foods can affect your health. You’ll want to be ready for anything. But don’t stress! We’re here to make it easy, with a review of everything you’ll need for hitting the roads, skies, seas, or rails. Make a doctor’s appointment If your trip is going to last longer than a day or two, make an appointment with your doctor or pharmacist a few weeks before you leave. Let them know your travel plans, and ask if they have any concerns or recommendations.Get any immunizations or extra prescriptions. Ask for a letter explaining that you have diabetes and what your treatment includes. It could come in handy at security checkpoints, pharmacies, or with other healthcare providers you may need while you’re away. Ask for what you need Call your airline, railroad, or cruise ship ahead of time and ask them if they have special meals for people with diabetes or can refrigerate insulin. They probably can meet your needs. Traveling internationally? It’s a good idea to learn (or at least write down) helpful phrases such as “I have diabetes” or “Where is the clinic or hospital?” in the local language. Do some research, and find the address of at least one clinic or hospital where you will be traveling that speaks your language. If you’re flying, know your airport’s guidelines for passengers with diabetes before you even start to pack. Most airports let you bring the things you need -- like your medications, insulin, syringes, insulin pumps and all supplies, lancing devices, blood glucose meters and all supplies, and even food for treating low blood sugar -- but it still has to go through security. Your airport may not require you to bring a prescription, but if you have one it may help clear up any questions at screening. Contact your airport to see if there are any other specific, local restrictions you need to follow.1 Don’t cut corners when packing Bring extra equipment and medication. How long will you be away? Now, add another 2 week’s worth of supplies to the pile, and you’ll be comfortably prepared for anything.  If you’re flying or taking a train, you will need a carry-on. All (and we mean all) of your medicine, syringes, meters, test strips, pump supplies—anything you need—should stay with you. Not only is it convenient, it’s safer since cargo holds are usually not climate-controlled. Lists are important: your doctor’s contact information, all the medications you take, and instructions for what you need in case there is an emergency. You’re probably already used to carrying around snacks, juice, or glucose tablets. Just remember to pack extra. To make life easier at security checkpoints, as much as it’s possible, leave your diabetes testing supplies, equipment, and medicine in its original container with prescription labels clearly visible. You’ll probably be walking a lot more than usual, so pack extra shoes and socks for your tired feet. Changing time zones When traveling west, your travel day gets longer. When traveling east, your travel day gets shorter. If you’re on insulin or oral medications, you will most likely need to adjust your treatment schedule – including snacks and meals – while you’re en route to your destination. Generally, a longer day could mean that you need more food and more medication, and a shorter day could mean that you need less of both.2 For this reason, you might want to check your blood sugar level more often to help you stay close to your target range. Before you travel, work with your healthcare provider to create a plan for treating your diabetes while traveling. While you’re on the go While en route, don’t sit for long periods of time. If you can, stand up and stretch or walk around for a few minutes every hour. Check your glucose levels more often than you normally would. You’re probably walking more and trying new foods but these changes to your routine could affect your blood sugar. Speaking of getting more exercise, pay special attention to your feet. Change your shoes often to avoid blisters, and check for blisters often. And if you have issues with your feet related to diabetes, you might want to wear protective shoes at the beach or pool. If you’re not sure what’s on your plate or in your glass, just ask. It’s important to know how many carbohydrates you’re eating. Don’t forget: always wear a medical ID that lets others know what type of diabetes you have. Most importantly, have a great vacation! Before You Travel with Diabetes See your doctor for any immunizations or prescriptions Call ahead to ask if special meals are available, and request them Pack an extra 2 week’s worth of equipment and medication Create a list of contacts: your doctor, insurance, and at least 1 clinic where you are visiting  

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Pick 1 Thing to Improve

Choosing 1 Thing to Improve There are probably many things that each of us would like to change about our life, but thinking about them all at once can be overwhelming. Instead, choose just 1 thing to improve for now. Changing any one of the things below could have a big impact on your life with diabetes – both your physical health, and your emotional well-being. Make testing matter For people with diabetes, testing more often is the key to staying in control of your health. Frequent testing provides the data you need to make informed decisions about your medication, diet, and exercise regimens. Your test results show you the effects of your diet and activity on your blood glucose. Your test results also inform the conversation you’ll have with your health care provider about setting target range goals for yourself, and they show how well you’re achieving them. It also helps you understand how to adjust your own oral medications or insulin dosage if your doctor has taught you how to do this yourself. Over time, as you stay close to your target range, you’ll feel better each day, and you’ll lower your risk for future diabetes complications.1 Learn to count carbs The amount of carbohydrates (starches and simple sugars) you eat has a significant impact on your blood sugar level. Counting them at every meal lets you match the carbs you eat or drink with the insulin you need to process it. Even if you’re not on insulin, it’s a powerful skill for controlling your blood sugar on an ongoing basis. Some of the benefits of counting carbs include4 It singles out the food with the biggest impact on your health. It allows you to enjoy any food you like with the proper amount of insulin. It puts you in control of your insulin doses. Overall, your health and your quality of life improve when you eat the right amount of carbs for your body. Move more Staying active is one of the cornerstones of managing your diabetes, because the list of benefits for people with diabetes is long. Physical activity can:5 Improve insulin sensitivity and glucose utilization Decrease circulating insulin levels, during activity Decrease glucose production from the liver Lower your cholesterol, blood pressure, and reduce stress Improves cardiovascular health, and quality of sleep Reduces obesity, joint pain, and coronary artery disease Prevents osteoporosis and delays the onset of dementia Increases energy, quality of life, and self-esteem Talk to your doctor about what type of activity is right for you, and get moving at least once a day. Be patient with yourself Not every day is going to be perfect. In fact, you can eat and exercise exactly the same for 2 days in a row, and have very different blood sugar test results over the 2 days. Be patient with yourself, adapt any changes in your routine into your life, and keep moving forward if you hit any bumps in the road while managing your diabetes. It’s also important that you don’t compare your diabetes to other people’s diabetes. Everyone has a unique diagnosis story. People respond differently to exercise. Other issues like gluten sensitivity or a heart condition impact one’s self-management plan. Simply put, it’s illogical to look at someone else’s life with diabetes and compare it to your own. Seek out what works for you and continue to learn. Indian population may not be aware of this condition. It would be resourceful to mention about the same below. What Happens When You… Test more often? You have more knowledge with which to manage your diabetes. Quit smoking? Within a year, your risk of heart disease drops by 50%. Count carbs? You have more flexibility for what you eat Exercise more? You can actually improve your body’s insulin sensitivity and glucose use.

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Managing Sick Days

Feeling fine? It's the perfect day to create a sick day plan. When you're feeling ill, you'd like nothing more than to lie in bed with a good book or movie. Yet that's when you need to focus even more on diabetes self-care. The key to sick days with diabetes is doing all of the thinking ahead of time. That way, when you don't feel like concentrating, you can simply follow the plan.  What to include in your plan Involve your diabetes care healthcare team in developing your sick day plan—ask them when you should call for help, how often you should check your blood glucose and ketones, what medicines to take and what to eat. Gather a sick day kit so the additional items you might need will be ready. Sick day kit checklist Thermometer Pain reliever Sugar-free cough syrup or throat lozenges Decongestant (keep in mind that even sugar-free decongestants may cause a rise in blood glucose ) Urine ketone strips Extra blood glucose test strips and lancets Extra insulin and supplies Glucagon emergency kit Easy-to-eat foods that contain carbs At the first sign of illness Understanding how illness might affect your blood glucose can help you take the right steps to care for yourself. For example:1 If you use insulin, don't stop taking it. Even if you are having trouble eating, you will likely need extra insulin to combat the hormones that often cause high blood glucose during illness. You might do this by raising meal or correction boluses, or using a temporary basal rate on an insulin pump. Follow your healthcare provider's recommendations. Monitor blood glucose levels more frequently, at least every 1 to 2 hours. Check your urine for ketones if blood sugar is high. Stay hydrated. Drink calorie-free, caffeine-free, clear liquids. Make sure you eat according to your regular meal plan. Keep easy-to-eat, fast-acting carbohydrates available. They can be useful in treating a low, as well as substituting for a meal. If you feel nauseated or are vomiting, try a sports drink, juice, regular soda or even frozen fruit bars to get the carbs you need. Talk to your diabetes care provider about any medications you take, or any unexpected blood glucose results you experience while taking them. Some cold medicines, antibiotics and other prescription and over-the-counter drugs are known to affect blood glucose levels.2 When to contact your healthcare team Get in touch with your doctor any time they recommend, as well as when you:1 Have been sick or had a fever for a couple of days without improvement. Have had 2 or more vomiting or diarrhea episodes within 4 hours. Detect moderate to large ketones in your urine. Have blood glucose higher than 270mg/DL after increasing insulin and fluids. Experience symptoms that might signal ketoacidosis or dehydration, such as worsening abdominal pain, trouble breathing or breath that smells fruity or like acetone. The key to successfully navigating an illness is preparation. By creating your sick day plan and kit before you experience the first signs of illness, you'll be ready to attack a virus head-on. Sick day snacks These foods contain 10 to 15 grams of carbohydrate, and may be easier to eat when you don't feel well. 1 double-stick ice pop 1 cup sports drink 1 cup soup 4 ounces apple or orange juice 1/2 cup regular soft drink 6 Saltines 3 graham crackers 1/2 cup applesauce 1/2 cup cooked cereal 1/2 cup ice cream or frozen yogurt 1/4 cup sherbet, sorbet or regular pudding *Substitute local foods as appropriate

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