Your every day guide t o cont rolling diabet es and it s complicat ions
Managing Your Monitoring ............................1 The Low-Down on Low-Glycemic-Index Diets ......................................3 Walk Away From Diabetes ................................4 The Scoop on Noncaloric Sweeteners ........7 Safeguarding Your Skin ..............................9 What If I Get Sick? ............................10


eeping your blood glucose levels under control is the most important part of treating your diabetes. But as you probably know achieving optimal blood glucose control is often easier said than done. It involves a complex interplay between what you eat, your physical activity, and your diabetes medication. And you need to pay attention to these three aspects of your life day in and day out, even if you’re feeling under the weather. This may sound like a lot of work—and it is—but the following advice will help make gaining control of your blood glucose a less arduous task and, in the process, help you prevent such diabetes complications as heart attacks and strokes as well as kidney disease, vision loss, and skin problems.

Managing Your Monitoring
Choosing a home blood glucose monitor and using it correctly Regular home monitoring of blood glucose is essential for anyone with diabetes: It can help keep blood glucose under control and reduce the risk of long-term complications. In addition, by recording each day’s results (along with the time and prior activities such as meals or exercise), problems can be spotted as they develop, patterns in blood glucose fluctuations identified, and problems fixed early on. Most of the blood glucose meters on the market require a drop of blood from your finger or forearm; less invasive models are being investigated. The following tips will help you choose and maintain an accurate blood glucose meter.

Choosing a Meter There are many types of blood glucose meters, so ask your doctor or diabetes educator to recommend one that meets your needs. Before buying a meter, test it out to make sure you feel comfortable using it. Also find out how easy the meter is to maintain, clean, and calibrate.


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glucose Do not use test strips after the expiration date or if they have changed color or have been open for an extended time period. Doing this will not only help ensure that your meter is working properly but will also allow your doctor to monitor your technique. known as continuous glucose monitors. 2 Visit us at www. involve the insertion of a tiny sensor under the skin of the abdomen and measure glucose levels in the fluid outside of cells. The devices. are available and are a good choice for people with vision problems. The U.Dealing W it h Diabet es Some meters are easier to read than others. While a data management feature is helpful. follow the manufacturer’s instructions for cleaning and maintenance. make sure that you really need it and understand how to use . it is certainly not essential. Carefully follow the manufacturer’s instructions for testing accuracy. Unfortunately. The meter results should vary by no more than 15% from the lab’s measurement. Also check to see if your model is compatible with your doctor’s computer. your local pharmacy may be able to give you a printout of your data so you can review it with your doctor. Most models display the results digitally. old test strips. On the Horizon Efforts are under way to develop less invasive blood glucose meters that continuously measure blood glucose levels. Audio meters. which work with a personal digital assistant (PDA). Blood glucose meters with data management systems give a more detailed picture of your blood glucose control than traditional meters. Also be sure to recalibrate your meter when needed. which read the results aloud. To keep your meter in good working order.S. or improper calibration.johnshopkinshealthalerts. Using Your Meter Correctly Most errors in home monitoring result from dirty meters. Copying or downloading this data onto your doctor’s computer and displaying it graphically can make it easier to understand fluctuations in blood glucose. Working With Your Healthcare Professional Bring your meter to each doctor’s appointment and take a reading within 5 to 10 minutes of having your blood drawn. These systems. If your doctor doesn’t provide this service. So before buying this type of meter. Food and Drug Administration (FDA) has approved several of them. Make sure your test strips are fresh (don’t use them after the expiration date or if they’ve changed color or have been open for a long time). can enhance blood glucose control by electronically recording blood glucose levels as well as information about meals and exercise. It’s a good idea to test your meter’s accuracy at least once a month or whenever you suspect a problem.

only raise blood glucose one third as much as white bread. For example. The latest guidelines from the A merican Diabetes A ssociation say monitoring carbohy drate intake— not the gly cemic index of individuals foods— is y our key dietary strategy for achieving blood glucose . The glycemic index of a particular food is determined by how much it causes blood glucose to rise in the two hours after it is eaten. but it can also lead to poor ones.johnshopkinshealthalerts.Dealing W it h Diabet es in this fluid lags 20 to 30 minutes behind levels in the bloodstream. However. Proponents of these diets claim that foods low on the glycemic index (those that cause small increases in blood glucose levels when eaten) are healthier than foods high on this index (those that cause sharp increases in blood glucose). which have a glycemic index of 38. White bread has a glycemic index of 100. The Low-Down on Low-Glycemic-Index Diets Is a Snicker’s bar a better choice than a banana. Although not proven. proponents of low-glycemic-index diets believe that sharp rises in blood glucose levels are detrimental. Eventually. However. 3 Visit us at www. Conversely. What’s more. cause a greater increase in blood glucose than white bread. Shortcomings of the Index Sometimes the glycemic index can encourage healthy food choices. compared with the rise in blood glucose caused by an equivalent amount of carbohydrate in white bread. and this makes people feel hungry again sooner. kidney beans. fat slows carbohydrate absorption and gives some fatty foods a low value on the index. Foods with a glycemic index above 100. guidelines from the American Diabetes Association recommend monitoring carbohydrate intake—not the glycemic index of individuals foods—as your key dietary strategy for achieving blood glucose control. such a device would require major surgery to implant. like instant rice. researchers hope to develop a blood glucose meter that can provide continuous glucose readings directly from the bloodstream. just because it’s considered healthier on the glycemic index? A number of books and diet doctors advocate low-glycemic-index diets. They argue that the surge of insulin that accompanies ingestion of high-glycemic-index foods causes blood sugar to drop to below-normal levels. the device must be replaced every three to seven days. What the Glycemic Index Means The glycemic index is a system for classifying carbohydrate-containing foods based on how quickly and for how long they raise blood glucose levels.

vegetables. It’s also important to note that no long-term clinical trials have tested whether a low-glycemic-index diet effectively regulates blood glucose levels or controls weight. But the American Diabetes Association’s nutritional guidelines state that people with diabetes do not have to restrict their food choices to those low on the glycemic index. and low-fat dairy products are better carbohydrate sources than candy or white bread. while most meals include fat and protein as well. glycemic index values are not listed on most food labels. Second. Fortunately. walking is none of these things: It’s essentially free. a food’s effect on blood glucose levels depends on whether it is cooked or raw and what the person’s blood glucose level is before eating it. But the main problem with the index is that it is often not practical. The most important thing is for people with diabetes to be able to recognize the size of their carbohydrate portions and to try to keep their carbohydrate intake relatively stable. whole-grain breads. 4 Visit us at www. the index only rates single foods eaten individually. On the other hand. beginning a program of physical activity may seem daunting. some healthy foods. Most importantly. The total amount of carbohydrate eaten each day is more important in determining the body’s response to glucose than the glycemic index of each individual food eaten. It can conjure up images of expensive gym memberships. such as carrots and raisins. For instance. complex exercise equipment. The Bottom Line Because people with diabetes need to control their blood glucose. Some carbohydrates are preferred over others because they have more fiber or more vitamins and other nutrients.johnshopkinshealthalerts. In addition. Walk Away From Diabetes Getting started and staying motivated For people who don’t exercise regularly. but people usually eat several different foods together. First. .Dealing W it h Diabet es People w it h diabet es do not have t o res t rict t heir food choices t o t hos e low on t he gly cemic index. the index considers only the amount of carbohydrates in a food. physically strenuous workouts. simple. legumes. and generally easy on your body. and observational studies have yielded inconsistent results. making them seem healthier than they really are. and boring. the glycemic index might seem like a useful tool for helping to make food choices. are high on the glycemic index.

At the end of your walk. Setting the Right Pace To achieve significant health benefits. the benefits of walking can be immense for those who have diabetes and have been sedentary. Also do a few stretches to reduce the risk of soreness or injury. The control group saw increases in their blood glucose levels and gained weight. and preferably all. Getting Started Unlike many other exercise options. Warm-Up and Cool-Down Before beginning a brisk walk. it’s a good idea to start slowly and gradually build up to at least 30 minutes on most. Walking also helps prevent osteoporosis. and body weight. slow down gradually over five minutes. and body temperature. and is relatively easy on the . HbA1c levels.Dealing W it h Diabet es Despite its simplicity. You can estimate your maximal heart 5 Visit us at www. exercised 30 minutes a day. But the guidelines below can help make walking safer. In another study called the Diabetes Prevention Program. and the risk of coronary heart disease (a common complication of diabetes). people at high risk for diabetes who followed a low-calorie. the warm-up prepares the heart and other muscles for exercise and decreases the risk of soreness or injury. and lost an average of 15 lbs were nearly 60% less likely to develop type 2 diabetes over three years compared with people who did not make these lifestyle changes. generally about 50 to 70% of your maximal heart rate. more comfortable. heart rate. days of the week. body weight. and more effective. This cool-down allows heart rate and breathing to return to normal resting levels and prevents dizziness that may occur if blood pools in your legs. Making It Work for You A walking program has the greatest benefits when combined with dietary changes. reduces stress. Like other aerobic activities. A w alking program has the greatest benefits for someone w ith diabetes w hen combined w ith dietary changes. walking helps reduce blood glucose levels. warm up with five minutes of slow walking or jogging in place. low-fat diet. walking requires no formal training. the need for diabetes medications. By increasing blood flow. In general. Those who walked for 60 minutes three times a week and attended weekly nutrition classes for 11 weeks lowered their fasting blood glucose levels. 75 people with type 2 diabetes were randomly assigned to either exercise and nutritional counseling or to a control group.johnshopkinshealthalerts. In a study published in Diabetes Care. you should walk vigorously enough to reach your “target” heart rate zone.

) Build up to reaching your target heart rate gradually: In general. (If you take your pulse for a full minute. the maximal heart rate for someone age 60 is 160. rolling your foot forward. • Try to avoid busy roads. your heart will slow down and you will get an inaccurate result. Each arm should move with the opposite leg. It’s always a good idea to consult your doctor before starting a walking program. and a flexible. Keeping Blood Glucose Levels in Check People who take insulin or oral medication to control their diabetes need to protect against hypoglycemia while exercising. • If it’s too hot or cold outdoors. Swinging your arms can burn 5 to 10% more calories by exercising your upper body. • Walking on hilly terrain also increases the intensity of the workout. polluted air decreases the amount of oxygen that reaches the heart. Both uphill and downhill walking require extra exertion. and the target heart-rate zone is between 80 and 112. Your doctor may provide an “exercise prescription” that outlines the types and amount of exercise appropriate for you. a reinforced heel.johnshopkinshealthalerts. you should not exert yourself so much that you’re unable to talk. For example. take your pulse for 10 seconds and multiply the result by six. try walking at a local shopping mall. Walking with a partner makes it easier to maintain the routine. To measure heart rate while exercising. and with each stride. Look for shoes with good arch support. • To increase your level of exertion. stop and rest. weakness. • At any sign of chest pain. keep shoulders erect (but not stiff).com .Dealing W it h Diabet es It’s alw ay s a good idea to consult y our doctor before starting a w alking program. Walking Tips • Maintain good form: Stand tall with your head up. it is 6 Visit us at www. Specially designed walking shoes are available. • Make your walking plan fit into your life: Choose a time of day that is most convenient and enjoyable and ask friends or family members to join you. curved sole. adequate cushioning. swing your arms vigorously and/or carry light weights. This prescription may recommend a heart rate that does not exceed 80 to 90% of what you can safely achieve on an exercise stress test and may include precautions on how to avoid foot trauma if you have peripheral neuropathy or peripheral arterial disease. or dizziness. taking deep breaths. Here’s how: • Check your blood glucose level before your walk. plant your heel first. If your glucose is between 100 and 300 mg/dL and you have type 2 diabetes. rate by subtracting your age from 220. • Wear comfortable clothing and shoes.

Don’t fall into the trap of filling up on them rather than on healthful foods.Dealing W it h Diabet es safe to begin . or weakness). have a snack. yogurt. Do not exercise if your blood glucose levels are 300 mg/dL or higher. Noncaloric sweeteners. and gum. before starting. cookies. candy. so test your levels immediately after your walk and again a few hours later. What’s Available? There are six noncaloric sweeteners that are FDA-approved or recognized as safe: acesulfame-K. • Blood glucose levels can drop hours after exercise. these products add sweetness and flavor without the calories. If glucose is lower than 100 mg/dL. frozen desserts. Also be careful to look at the other nutritional aspects of sugar-free foods. which can be loaded with calories and carbohydrates despite the use of noncaloric sweeteners. saccharin. sucralose. Some Caveats Many artificially sweetened foods and beverages do contain other sources of calories and are not nutritious. • Always have a source of fast-acting carbohydrate (such as glucose tablets or hard candies) with you when exercising. neotame. palpitations. aspartame. • If your starting glucose level is below 150 mg/dL. The American Diabetes Association considers FDAapproved noncaloric sweeteners to be safe and refers to them as free foods because they do not raise blood glucose levels. • If you experience any symptoms of hypoglycemia during your walk (faintness. which has 15 calories per teaspoon. such as a piece of fruit or three graham crackers. 7 Visit us at www. The Scoop on Noncaloric Sweeteners Will they help control blood glucose? Are they safe? Do not fall into the trap of filling up on foods made w ith noncaloric sw eeteners. can be valuable for people with diabetes. If it starts to fall. found in such foods as soft drinks.johnshopkinshealthalerts. (Stevia is also noncaloric and used as a sweetener. and tagatose. test your blood glucose levels immediately and have a snack if necessary. but it is considered a food supplement and is not regulated by the FDA). Unlike sucrose (sugar). test your blood glucose level every 30 minutes during your walk. have a carbohydrate snack.

was banned by the U. In addition. candies. frozen desserts. sodas. frozen dairy desserts. FDA-approved. desserts. Food and Drug Administration (FDA) several decades ago because it was associated with an increased cancer risk. Cyclamate. Necta Sweet Tabletop sweeteners. Is 200 times sweeter than sugar. Honey Leaf Tagatose Naturlose Has “generally recognized as safe” status from the FDA. Sweet Twin. Aspartame Equal. Sweet One Used in Baked goods. may soon be used in other products Stevia Sweet Leaf. NutraSweet. The only artificial sweetener made from sugar. diet beverages. chewing gum Neotame — Being developed for use in foods and beverages Saccharin Sweet ’N Low. a rare genetic disorder. Has a very small effect on blood glucose.Dealing W it h Diabet es Sugar Substitutes Sweetener Acesulfame-K Brand/other names Sunett. 8 Visit us at www. baked goods Sucralose Splenda Baked goods.S. Ask your doctor before using. fruit juices. NatraTaste Tabletop sweeteners. 600 times sweeter than sugar. gelatins Often combined with fiber and sold as a supplement. Sold as a dietary supplement. FDA-approved. not subject to regulation by the FDA. Putting Safety Concerns to Rest Over the years. diet sodas. chewing gum.000 times sweeter than sugar).000 to 13. 200 to 700 times sweeter than sugar. beverages Comments FDA-approved. breakfast cereals. Cancer-related warning label removed in 2000 after FDA determined that saccharin was safe. FDA-approved. only in 7-Eleven’s Diet Pepsi Slurpees. Is 200 times sweeter than sugar and is often blended with other artificial sweeteners to more closely resemble the taste of sugar. questions have arisen regarding the safety of noncaloric sweeteners. FDA-approved. The most powerful sugar substitute (7. once a popular sugar substitute. cannot be promoted as a sweetener So far. Should not be used by people with .

sugar cane. most noncaloric sweeteners can be used in recipes. using them may affect a food’s taste and texture. xylitol. Cooking and Baking In addition to sweetening coffee or tea. or visit the manufacturer’s website. honey. so it should be added during the last few minutes of heating or cooking. The FDA regularly monitors safety information on noncaloric sweeteners and may take action to protect the public if credible scientific evidence indicates a safety problem. it must undergo rigorous investigation by the FDA. mannitol. Safeguarding Your Skin 14 skin-care tips for avoiding diabetes-related problems Diabetes can have some surprising effects on the largest organ in your body—the skin. lactitol. When you substitute a noncaloric sweetener for sugar in a recipe. Make sure to read labels carefully to achieve the best results. it was suspected of causing cancer in humans. Aspartame tends to lose sweetness at high temperatures. and can cause diarrhea and other gastrointestinal problems when consumed in large quantities. will raise blood glucose. and sugar beets. however. The sugar alcohols sorbitol. you will need to experiment with small amounts of the sugar substitute (since most of them are much sweeter than sugar) to get the right amount of sweetness. however. Fruit sugar has a smaller effect than sucrose on blood glucose levels. vegetables. they do contain calories.Dealing W it h Diabet es Before a noncaloric sw eetener is deemed safe and made available to consumers as a food . Many sugar substitutes are suitable for use in home cooking and baking because they do not degrade at high temperatures. Before a noncaloric sweetener is deemed safe and made available to consumers as a food ingredient. known as fruit sugar. current evidence indicates that all of the available noncaloric sweeteners are safe for consumption by humans. Other Sugar Substitutes Be careful when reading nutrition labels—sugar isn’t the only sweetener that contains calories. have not borne out this concern. but it still contains calories.johnshopkinshealthalerts. However. In fact. it must undergo rigorous investigation by the FDA . 9 Visit us at www. about 30% of people with diabetes experience a diabetes-related skin problem at some point. In fact. is found naturally in fruits. Fructose. More recent studies in humans. because large amounts of saccharin caused bladder cancer in rats. and maltitol are absorbed by the body more slowly than sucrose.

especially when the humidity is low. Use warm (not hot) water in the bath or shower. Drink plenty of fluids—this helps prevent dry skin. Use moisturizer after you bathe. 11. increasing the risk of infection. and betw een y our toes. as cotton “breathes” better. 14. To prevent diabetesrelated skin problems. 3. 9. and be sure to rinse off the soap completely. groin. or lesions on your skin. especially during dry times of the year. Don’t scratch itchy skin. 4. Place cornstarch in places where moisture can accumulate. 13. 1. 7. dry them carefully (being sure not to make the opening worse). Use a mild soap (preferably one with moisturizer such as Dove). and exercise—activities closely linked to blood glucose control—it may also cause the liver to make and release glucose into the bloodstream. What If I Get Sick? Controlling blood glucose when you have a cold or the flu People with diabetes must be especially careful when suffering from an illness like a cold or the flu. feet. Wear underwear made of cotton rather than synthetic fabric. and thighs). This can make your skin dry. Avoid putting any moisturizer between your toes. See your doctor if the cut is large. This can cause it to open up. Treat cuts quickly. like the armpits. taking the 14 steps listed below will help lower your risk of these and other skin problems. Dry yourself thoroughly after bathing and check for any unusual . Instead. apply antibiotic ointment if your doctor recommends it. Use a humidifier in your home. and cover the cut with sterile gauze. Don’t take bubble baths if you have dry skin.johnshopkinshealthalerts. use cornstarch in places w here moisture accumulates—y our armpits. Control your blood glucose levels. Try not to bathe frequently. This increase in glucose 10 Visit us at www. 6. 12. 5. Consult your doctor about any skin problems that do not get better on their own or that you cannot treat with self-care measures.Dealing W it h Diabet es The most common of these skin problems are infections and shin spots (reddish-brown scaly spots that typically appear on the shins but can also occur on the forearms. use moisturizer. groin. sleeping. Being under the weather not only affects your eating. and between the toes. 8. Fortunately. blemishes. 2. Wash them with water and mild soap. 10.

unless. Inform your doctor when you become sick. as well as to minimize fluctuations in blood glucose levels. of course. If you have type 1 diabetes.or very rapidacting. For example. testing blood glucose levels four times during the day is probably enough. Treat the illness. If you use insulin. Test your blood glucose levels more often than usual. Take your diabetes medication as usual. follow these nine sick-day precautions: 1. and exercis e— act iv it ies clo s ely link ed t o blo o d gluco s e co nt ro l—it can als o caus e t he liv er t o mak e and releas e gluco s e int o t he blo o ds t ream.) If you have type 2 diabetes. provides you with extra energy to combat the stress of an illness. being sick causes blood glucose levels to rise. whether you are eating or not. even throughout the night. s leeping. but it can cause your blood glucose to rise too high. such as antibiotics for an infection. your doctor advises otherwise. even if you do not take these types of insulin regularly. To prevent these serious complications. As we’ve already explained. even if you are not eating. if blood glucose levels exceed 250 mg/dL. (Set an alarm clock or have someone wake you up. have diarrhea or vomiting for more than six hours. 11 Visit us at www. Someone without diabetes can produce extra insulin to help get the additional glucose into cells. make sure he or she is aware that you have diabetes. 3.johnshopkinshealthalerts. If the illness is treated by a new doctor.or very rapid-acting insulin if your doctor tells you to take an extra sick-day dose or if you need to lower your blood glucose levels . keep handy a bottle of rapid. take any necessary medications. 4. or have had a fever for a couple of days and the fever is not improving. Use the rapid. Call your physician if blood glucose levels are consistently above 250 mg/dL and are accompanied by ketones in the urine. 2.Dealing W it h Diabet es Hav ing a co ld o r t he flu no t o nly affect s y o ur eat ing. This is particularly important if you are unable to eat regular foods. but people with diabetes are less able to produce extra insulin or respond to it effectively. Being ill also decreases the sensitivity of your cells to insulin and makes it more difficult for these cells to remove glucose from the bloodstream. test blood glucose and urine ketone levels every four hours. test urine for ketones. The resulting rise in blood glucose increases the risk of diabetic ketoacidosis in people with type 1 diabetes and hyperosmolar nonketotic state in those with type 2 diabetes. 5.

You should consume at least one 8-oz glass of clear fluid each hour while awake. If necessary. dry skin with no sweating. ketoacidosis. If you are unable to eat meals. increased hunger. LLC All rights reserved. and sleepiness or confusion. If your usual diet is not disrupted by the illness. dry or flushed skin. and dry or flushed skin. 7. labored breathing. 12 Visit us at www. alternate sugar-containing fluids with those that are sugar free. The information contained in Healt h Tips is not intended as a substitute for the advice of a physician. and call your doctor if any occur. ask a family member or friend to help care for you. confusion. warm. Copyright ©2006-2008 Medletter Associates. Rest as much as possible. or sleepiness are all symptoms of ketoacidosis. nausea. drink . Eat easy-to-digest foods such as gelatin. Symptoms of hyperosmolar nonketotic state include dry or parched mouth. rapid. cracked lips. 8. The symptoms of dehydration include dry mouth. fruity odor on breath.Dealing W it h Diabet es 6. Try to consume a normal amount of carbohydrates. lack of appetite. or stomach pains. vomiting. 9. shallow breathing. Eating many small portions throughout the day may help. Prevent dehydration by drinking plenty of liquids. Watch for symptoms of dehydration. Nausea. soup.johnshopkinshealthalerts. crackers. or hyperosmolar nonketotic state. Readers who suspect they may have specific medical problems should consult a physician about any suggestions made. vomiting. or other sugar-free beverages. broth. tea. and applesauce. or abdominal pain. lack of coordination.

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