1. A
Teaching
Resource
Guide

2. Diabetes: What it is and why it happens
Diabetes is a condition that causes sugar levels in your blood to be high
When you have diabetes:
Your pancreas does not make insulin, or
It does not make enough insulin, or
Your body prevents the insulin you do make from working right
As a result, sugar can’t get into your cells, so it stays in your blood
That’s why your blood sugar gets too high
If you have diabetes, you are not alone. Millions of people today have diabetes. Diabetes cannot yet be cured. But it can be managed.
When it comes to diabetes, knowledge really is power. The more you know about diabetes, the better you’ll be able to manage it.

3. Taking care of your diabetes
Diabetes can cause problems. But diabetes-related problems don’t have to happen
Millions of people live long, full lives with diabetes
You can be one of them
Taking care of yourself and managing your blood sugar is the key
When it comes down to it, high blood sugar is the main cause of many of the problems of diabetes. You can do many things to prevent problems. Managing your blood sugar is key.
The more you work to manage your blood sugar, the better you’ll feel each day. It may also help you avoid diabetes problems down the road.

4. Your diabetes care: it’s a team effort
You are not alone when it comes to managing your diabetes
You may have a team of healthcare professionals working with you
You may also have family members or friends for help and support
But the most important member of the team is you
As the captain of your team, you need to:
Learn as much as you can about diabetes in general
Know as much as possible about your diabetes and your health
Good diabetes care takes a team. Your doctor, nurse, diabetes educator, dietitian, and others are all members of your team.
And then, of course, there’s you. You are the most important member of your team. Your fellow team members are experts on diabetes. But you are the expert on how you feel with diabetes. All of us on your team have the same goal: to help you live well with diabetes.

5. Your diabetes care plan should include:
A meal plan
A physical activity plan
A plan for how often you should check your blood sugar
Your personal blood sugar goals
When to take your diabetes medicines
A schedule for regular checkups
Other health goals
“The key to diabetes management is getting educated about diabetes and realizing that this disease is controllable.”
–Karen R., South Carolina
Your diabetes care plan helps keep your sugar and insulin in balance, the way your body did before diabetes.
We will work with you to make your diabetes care plan. Your plan will help you to set and reach your goals.

6. Diabetes care schedule
Daily:
Check blood sugar as recommended by your diabetes care team
Every 3 months:
Regular office visit
A1C test (if blood sugar is not stable)
Blood pressure check
Weight check
Foot check
Every 6 months:
A1C test (if blood sugar is stable)
Dental exam
Regular checkups with your diabetes care team are an important way for you to avoid diabetes problems.
This slide shows a suggested schedule for care you should do daily, every 3 months, and every 6 months. Let’s discuss a schedule that is right for you.

7. Diabetes care schedule
Every year:
Physical exam
Comprehensive foot exam
Blood fats and cholesterol tests (more often if not at goal)
Kidney tests
Dilated eye exam
Flu shot
“I’ve learned to be proactive in my own care and to educate myself. It is never too late and might just give you more years to enjoy with life.”
–Cheryl K., Maryland
This slide shows a suggested annual care schedule people with diabetes should follow. Let’s discuss the right schedule for you.

8. Checking your blood sugar
Why:
Checking your blood sugar yourself is often the best way to be sure your diabetes is under control. It tells you:
If your insulin or other diabetes medicine is working
How physical activity and the foods you eat affect your blood sugar
Based on your care plan, you may want to test when:
You wake up
Before meals or large snacks
1 or 2 hours after meals or large snacks
Before and 15 minutes after physical activity
You’ll usually feel better and have more energy when your blood sugar stays at or near normal. Managing your blood sugar can also help to reduce your risk of developing problems from diabetes. (Diabetes & You, p 24, para 2)
Here’s a schedule of times you should take your blood sugar throughout the day. Let’s discuss a schedule that works for you. (Diabetes & You, p 25, para 1)

9. Keeping a blood sugar diary
It’s important to write down your blood sugar levels so that you can keep track of what makes them go up or down.
You might want to use a blood sugar diary like the one shown here. You can ask your diabetes care team to give you one. Or, if you’d like to use an online blood sugar diary, you can find one at ChangingDiabetes-us.com.
Show your diary to your diabetes care team at your office visits. Good diary records will help you and your team make the best possible decisions about your diabetes care plan.

10. Target blood sugar levels for people with diabetes
Goals for People With Diabetes
A1C
Less than 7%
Before meals
70 – 130 mg/dL
2 hours after meals
Less than 180 mg/dL
This table lists blood sugar goals that many doctors suggest for people with diabetes.
Let’s think about the blood sugar goals we should set for your diabetes care plan.
For tips on making blood sugar monitoring a part of your life, visit ChangingDiabetes-us.com.
Adapted from the American Diabetes Association. Standards of medical care in diabetes—2009. Diabetes Care. 2009;32(suppl 1):S13-S61.

11. Insulin: a medical breakthrough
People with type 1 diabetes must take insulin to control blood sugar
People with type 2 diabetes who take insulin may find that they have more flexible eating and activity schedules
Insulin helps to lower blood sugar by helping sugar move from the blood into your cells.
Everyone with type 1 diabetes needs to take insulin. Over time, many people with type 2 diabetes may also need insulin. That's because even if you do everything right, your pancreas will make less insulin over time.

12. What are the different types of insulin?
Rapid-acting:
Controls blood sugar surges at mealtime
Long-acting:
Controls blood sugar between meals and during sleep
Premixed:
Combines rapid-acting and intermediate-acting insulin
Controls blood sugar at mealtime and all day and night
There are several different types of insulin. Some work for short periods of time, whereas others are longer acting.
Each type of insulin helps keep diabetes under control. But no one type is right for everyone. Each person’s insulin need is different. And each person’s insulin need may change over time.

13. What is an insulin plan?
Your plan will help you take insulin the way your body would make it if you did not have diabetes
Your plan tells you:
What type of insulin to take
How much insulin to take
When to take insulin
Your plan is based on:
When and how much you eat
Your current blood sugar level
Your level of physical activity
Your lifestyle
Everyone who takes insulin needs a personal insulin plan. You and your diabetes care team will work together to make an insulin plan that’s right for you.
Your plan will help you take insulin the way your body would make it if you did not have diabetes.
Your body’s need for insulin goes up and down all day. Your need for insulin depends on what you are doing and how much sugar is in your blood.

14. Injecting insulin How: Where: Insulin pen
Syringe filled from a bottle of insulin
Insulin pump
Where:
Abdomen
Thighs
Backs of the upper arms
Insulin is taken by injection. That’s because if insulin were taken as a pill, the acid in your stomach would destroy it before it had a chance to work.
Some people worry that insulin injections might be painful. But the needles used today are very small. That makes injecting insulin practically pain free. Prefilled disposable insulin pens can be used to inject insulin.
Insulin may work better if you inject it in the same general areas each day. For instance, you can inject it in the abdomen each morning and in the thigh at bedtime.
“With the insulin pen, it’s as easy as 1, 2, 3… The pen technique has brought me more freedom to take care of my diabetes.”
–Mayra A., New Jersey

15. Storing insulin Follow the instructions on the insulin label
Keep unopened insulin containers in the refrigerator
It’s usually okay to store insulin at room temperature once it’s been opened, but check the label to make sure
Don’t let insulin become too hot or too cold
Keep insulin out of bright light and sunlight
Do not use insulin after the expiration date on the label
Once insulin is opened, it is good for a shorter period of time than the date on the container. Check the package insert to see how long the opened insulin is safe to use.

16. Getting rid of used diabetes supplies
Use needles and syringes only once. Then throw them away in a safe container
Find out if your state has laws about how to dispose of used diabetes supplies
Unless your state says otherwise, get a “sharps” container at your local pharmacy
Ask your diabetes care team how to get rid of the container after it’s full
Follow your diabetes care team’s advice for getting rid of used diabetes supplies.
You can read more about storing and disposing of diabetes supplies at ChangingDiabetes-us.com.

17. 3 steps to starting your activity program
Talk with your doctor before you start
Choose your activity:
Walking
Jogging
Bicycling
Swimming
Dancing
Set a goal:
At least 30 minutes, at least 5 days a week
Exercise and activity are important to your health and blood sugar control. Even a small increase in activity can make a big difference. Your activity plan and your meal plan work together.
Being active can help to lower your blood sugar, reduce your need for insulin or help your body use the insulin better, improve your heart health, and manage your weight.
If that isn’t enough, being active can also strengthen your bones and muscles, give you energy, relieve stress, and improve how you look and feel.

18. Planning healthy meals
For teenagers and adults, a day’s worth of healthy meals includes at least:
2-3 servings of nonstarchy vegetables
2 servings of fruits
6 servings of grains, beans, or starchy vegetables
2 servings of low-fat or fat-free milk
About 6 oz of meat or meat substitutes
Your meal plan is an important part of your diabetes care plan. Your meal plan should be easy to follow and include:
A wide variety of foods so that you get needed nutrients (the healthy things in food)
Many of your favorite foods so that you enjoy what you eat
The goals of your meal plan are to help you:
Keep your blood sugar within your goal range
Manage your weight
Reduce your risk of diabetes problems

19. Carb counting and diabetes
Carbs raise blood sugar more than other nutrients
Carb counting can help you:
Manage your blood sugar
Be flexible in your choice of foods and mealtimes
Eat more foods that you enjoy
The only foods that generally don’t contain carbs are:
Meats and meat substitutes, such as eggs and cheese
Fats and oils
Carbohydrates (or “carbs”) are the main kind of food that raises blood sugar levels. That's why it’s important to be aware of the amount of carbs you eat.
Carb counting is a tool that can help you choose healthy foods. Many people with diabetes use this tool.

20. How many carbs are in your favorite foods?
For foods that come in packages, the best place to find the carb count is on the Nutrition Facts label. The grams of total carbohydrate on the label are the key to carb counting. Don’t worry about counting the sugar and fiber grams. They are included in the total carb number.

21. Using exchange lists for meal planning
Each list has foods that have about the same amount of carbs, calories, protein, and fat
The lists come in these groups:
Starch
Fruits
Milk
Sweets, desserts, and other carbohydrates
Nonstarchy vegetables
Meat and meat substitutes
Fats
Exchange lists can be used to count carbs. They can be used to count calories too.
Each list has foods that have about the same amount of carbs. They have about the same amount of calories, protein, and fat, too. So you can exchange, or switch, one food from a list with another food from that list.
“There will be a cure one day; until that time, diligence in watching your diet and testing your blood sugar will play a huge part in combating the disease.”
–Russell S., Illinois

22. Portion sizes count
It’s important to eat not only the right types of foods, but also the right amounts
Weigh and measure your foods when you first start carb counting and once in a while after that
Use your hand to estimate portion sizes:
Your fist = 1 cup
Your palm = 3 ounces
Your thumb = 2 tablespoons or 1 ounce
Your thumb tip = 1 teaspoon
A handful = 2 ounces (¼ cup) of a snack food
To make sure your portions are right, you need to weigh and measure your foods.
If you’re dining out or are unable to use measuring cups and spoons or a scale, you can use your hand to estimate portion sizes.
Note that these estimates are based on the size of a small hand.

23. Short-term diabetes problems: managing low blood sugar
Recognize the symptoms:
Weakness, tiredness
Hunger
Dizziness or shakiness
Nervousness, sweating
Fast heartbeat
Blurry vision
Eat or drink something high in sugar right away, such as:
4 oz of regular fruit juice or soda pop
3 to 4 glucose (sugar) tablets
3 to 5 hard candies that you can chew quickly
When your blood sugar drops too low, it’s called hypoglycemia. You might get low blood sugar if you:
Skip a meal or eat too little food
Take too much insulin and/or more diabetes pills than prescribed
Are more active than usual
For most people, it’s 70 mg/dL or lower. Check your blood sugar right away if you have any symptoms of low blood sugar.

24. Short-term diabetes problems: managing high blood sugar
If your blood sugar is too high, you may:
Feel very thirsty or hungry
Need to pass urine more than usual
Feel like your mouth and skin are dry
Have blurry vision
Feel sleepy
Manage high blood sugar by:
Checking your blood sugar
Following your meal plan
Doing some exercise (follow your plan)
Taking your medicine as prescribed
High blood sugar (also called hyperglycemia) is when there is too much sugar in your blood. Over time, it can cause serious health problems. High blood sugar can happen if you:
Skip a dose of insulin or diabetes pills
Eat more than usual
Are less active than usual
Are under stress or sick
Take certain medicines, such as cough syrup
Call your diabetes care team if:
Your blood sugar level has been above your goal for 3 days and you don’t know why
You have ketones

25. Diabetes care plan checkup
Make sure you know:
When and how to take your insulin or diabetes medicine
When and how to check your blood sugar and what the numbers mean
Your target blood sugar goals (before meals, after meals, and A1C)
What you can do if your blood sugars are out of goal range
How to follow your meal and exercise plans
When and how to call your diabetes care team
Do you know everything you need to know about your diabetes care? Do you have all the answers you need about your diabetes care? This checklist can help you find out.

26. Long-term diabetes problems
Over time, high blood sugar can cause problems with your:
Heart and blood vessels
Kidneys
Teeth and gums
Feet
Eyes
Nerves
Skin
To help prevent these problems, keep your blood sugar as close to normal as possible. That means following your diabetes care plan.
Most of the long-term problems of diabetes are due to high blood sugar levels. Over time, high blood sugar that is not managed can lead to serious health problems.
The most important thing you can do to prevent these problems is to keep your blood sugar as close to normal as possible. That means following your diabetes care plan.

27. Coping with changes in your diabetes care plan
Don’t blame yourself
Learn as much as you can
Think about joining a diabetes support group
Focus on the positive parts of the change
“Don’t give up. It’s your life we are talking about and your body, and you can be in control…Decide you will do what it takes.”
– Sally W., Washington
Change is part of life when you have diabetes. Usually, the changes are small. But at some point you may need to make a major change in your diabetes care plan. For example, you may need to advance from diabetes pills to an injected medicine or insulin. This slide lists some things to keep in mind.
To find out more about coping with changes in your diabetes care plan, visit ChangingDiabetes-us.com.

28. Time to take charge! You are not alone
Diabetes cannot be cured, but it can be managed
You can live a full and active life with diabetes:
Learn as much as you can
Work with your team
Get support to stay strong!
As we wrap up, here are a few things to keep in mind:
If you have diabetes, you’re not alone. Millions of people today have diabetes.
Diabetes cannot yet be cured. But it can be managed.
You can live a full and active life with diabetes by taking charge of your health.
When it comes to diabetes, knowledge really is power. The more you know about diabetes, the better you’ll be able to manage it.
Good diabetes care takes a team.
We all need support at times. You can get support from family and friends. You can also check with your local hospital to find a diabetes support group.

29. For more information, visit the Changing Life With Diabetes Tip Line at or visit us online at ChangingDiabetes-us.com.
For more information about Novo Nordisk products for diabetes care call
The photographs used in the booklets are for illustration only. The models in the photographs do not necessarily have diabetes or other ailments or use or endorse any products mentioned.
For more information, visit the Changing Life With Diabetes Tip Line at or visit us online at ChangingDiabetes-us.com.
For more information about Novo Nordisk products for diabetes care call
©2009 Novo Nordisk Inc February ChangingDiabetes-us.com