If you have diabetes you are the most important member of your diabetes care team–which is why taking charge of your health is so important! If you’re supporting a loved one with diabetes you also play a critical role in encouraging proper maintenance and a healthy lifestyle.

However, it is also important to connect with the right health care professionals who will provide key information, guide and oversee care. Depending on the specific needs of you or your loved one, these professionals may include:

• family doctor or diabetes specialist
• diabetes educator: nurse
• diabetes educator: dietitian
• visiting nurse
• pharmacist
• social worker
• psychologist
• foot care specialist
• eye care specialist

These professionals are available to discuss any aspect of diabetes, including:

• A1C targets
• blood pressure
• cholesterol
• eye exams
• foot exams
• depression/anxiety
• kidney health
• nerve damage test
• sexual problems
• healthy eating
• physical activity
• home blood glucose monitoring

If you or a loved one have diabetes, the risk for heart disease, stroke and other complications such as eye and kidney disease, nerve damage and foot problems increases. Keeping blood glucose, blood pressure and cholesterol in a healthy range can reduce the risk of these complications. Discuss the results of these tests with a doctor but refer to the values below for recommended targets:

Recommended Targets

A1C: 7.o or below*
Blood Pressure: Below 130/80 mm Hg
Cholesterol
LDL: 2.0 mmol/L or lower
Total cholesterol to HDL ratio: below 4
*For most patients with diabetes. A1C targets for pregnant women and children 12 years of age and under are different.

What is an A1C?
A1C is a blood test that indicates an average of overall blood glucose levels over the past three to four months. A1C levels are measured in different units and on a different scale than finger prick blood glucose testing. It is important to speak to a doctor about the A1C test.

Check blood glucose levels at least once a day, but testing more often can offer valuable information about how well you or your loved one are managing diabetes.

For example, we recommend that diabetics check their blood glucose:

• At least twice a day.
• Sometime before meals, or two hours after the start of a meal.
• Before and after being active.
• When sick.
• Any time a situation may be affecting blood glucose levels.

Keep detailed records of all blood glucose test results using the book or software that came with the meter and refer to these targets:

Target for most patients with diabetes

Fasting blood glucose: 4.0 to 7.0 mmol/L
Blood glucose two hours after the start of a meal: 5.0 to 10 mmol/L 5.0 to 8.0 mmol/L if A1C targets are not being met

Why should you check blood glucose levels?

• It is the only way to know if you’re in your target range.
• It helps you understand the effect of what you eat, your activities and your medications/insulin.
• It provides important information your health care team needs to adjust and build your treatment plan.
• You will know if you are having a blood glucose ‘high’ or ‘low.’

Blood Glucose Monitoring Checklist

To make sure you’re testing blood glucose levels properly, follow these points but discuss any concerns with a visiting nurse. Ensure that:

• The meter is calibrated.
• Test strips have not expired.
• You’re following the instructions that came with the meter.
• You have properly inserted the test strips into the meter.
• You have washed your hands with soap and water.

Then:

• ‘Milk’ the finger to get blood into the area.
• Prick the sides of the finger, not the finger pads.
• Wipe off the first drop of blood.
• Gently milk the finger again until you get enough blood–be patient.
• Place the drop of blood onto the test strip or allow the strip to absorb the blood
• Record the results.

High and Low Blood Glucose Levels

Signs and symptoms of low blood glucose levels include feeling:

• shaky, light-headed, nauseous
• nervous, irritable, anxious
• confused, unable to concentrate
• hungry
• your heart race
• sweaty, headachy
• weak, drowsy
• a numbness or tingling in your tongue or lips

If you or your loved one are experiencing these signs, check blood glucose levels right away. If you don’t have the meter with you, treat symptoms anyway. Eat or drink a fast-acting carbohydrate that includes:

• 15g of glucose in the form of glucose tablets
• 15 mL (3 teaspoons) or 3 packets of table sugar dissolved in water
• 175 mL (3/4 cup) of juice or regular (not diet) soft drink
• 6 Life Savers®
• 15 mL of honey

Wait 10 to 15 minutes, and then check the blood glucose again. If it is still low:

• Treat again.
• If your next meal is more than one hour away, or you’re going to be active, eat a snack such as a half sandwich or cheese and crackers (something with 15 grams of carbohydrate and a protein source).

Signs and symptoms of high blood glucose levels:

• feeling thirsty
• urinating more often
• feeling tired

If you or your loved one are experiencing these symptoms, food, activity or medication amounts may be unbalanced. High blood glucose may also happen when a person is sick or under stress. Talk to your health care team about:

• Adjusting medication and/or insulin, adjusting meal plans or increasing physical activity.

Diabetes can affect a number of the body’s systems, including circulation, immune system and nerves. Over time, this damage may show up in the feet resulting in pain or a loss of sensation. You or your loved one may be less likely to feel a foot injury such as a blister or cut. Because the body may have a harder time fighting infections, even small foot injuries can quickly become infected, which may lead to serious complications.

Daily Foot Care Checklist:

• Wash feet in warm (not hot) water, using a mild soap making sure you don’t soak them.
• While feet are still wet, use a pumice stone to keep calluses under control.
• Dry feet carefully, especially between the toes.
• Thoroughly check feet, including between the toes, to make sure there are no cuts, cracks, ingrown toenails, blisters, etc. Use a hand mirror to see the bottom of your feet, or regularly check your loved one’s for them.
• Clean cuts or scratches with mild soap and water and cover with a dry dressing for sensitive skin.
• Trim toenails straight across and file any sharp edges. Don’t cut the nails too short.
• Apply an unscented lotion to heels and soles and wipe off any excess lotion that is not absorbed. Don’t put lotion directly between the toes.
• Wear fresh, clean socks and well-fitting shoes every day. Whenever possible, choose white socks – if there’s a cut or sore, the blood or pus will be easy to see.

Inspect feet daily and feel for skin temperature differences between each foot and have them checked by a family health care provider at least once a year. Also, make sure you or your loved one are screened for nerve damage and loss of circulation at least once a year.

If you or a loved one has Type 2 diabetes, regular physical activity can help:

• weight loss or management
• keep bones strong
• improve blood pressure control
• reduce risk of heart disease and cancer
• boost energy levels

A healthy active lifestyle will also improve the body’s sensitivity to insulin and help manage blood glucose levels.

How much is enough?

You or your loved one should aim to complete at least 150 minutes of moderate to vigorously intense aerobic exercise each week (e.g., 30 minutes, five days a week). If this seems like a lot, start with five to ten minutes of comfortable activity each day, gradually building up to your goal. If possible and when ready, try adding resistance exercises like lifting weights three times a week.

The key is to make a plan and start with activities that make sense. Getting active doesn’t have to mean strenuous runs or pumping iron in the gym. Try activities like:

• walking – use the support of a cane or a friend!
• gentle movements while sitting or lying down
• gentle weights at home – soup cans will do the trick!
• specialty fitness classes at a community centre
• wheeling – using a wheelchair is great exercise)
• simple stretches
• Tai Chi
• swimming
• dancing

Keeping yourself or your loved one at a healthy weight is a very important part of managing Type 2 diabetes. This will help keep blood glucose, blood pressure and cholesterol at ideal levels and prevent complications like heart disease and stroke.

Two easy ways to measure a healthy weight are Body Mass Index and Waist Circumference.

Body Mass Index (BMI): This measurement compares your weight to your height. For most adults aged 18-64 a BMI of 25 or higher is overweight. Calculate your BMI using this formula:

BMI= weight (kg) ÷[height (m) x height (m)]

Waist Circumference (WC): In general, a healthy WC for men is less than 40 in. (102 cm), and for women, less than 35 in. (88 cm).

If you or your loved one have Type 2 diabetes, it is very important to speak to a dietitian. Ask your doctor or local Community Care Access Centre for a referral. A dietitian works with you to develop a meal plan for better overall health and will help keep your blood glucose levels in a target range.

A great deal of information about healthy eating and diabetes is available. Be sure to read:

• Eating Well with Canada’s Food Guide, Health Canada
• Just the Basics–Tips for Healthy Eating, Diabetes Prevention and Management, Canadian Diabetes Association

Healthy Eating Tips

• Eat three meals per day at regular times.
• Space meals no more than six hours apart.
• Make healthy snack choices.
• Limit sugars and sweets including regular pop, desserts, candies, jam and honey.
• Limit high-fat foods such as fried foods, chips and pastries.

Eat more high-fibre foods like:

• whole grain
• breads and cereals
• lentils
• dried beans and peas
• brown rice
• vegetables and fruits

Choose starchy foods at every meal. For example:

• whole-grain breads and cereals
• rice
• noodles
• potatoes

Speak with a dietitian to understand what food choices are best for you or your loved one.

Many people with Type 2 diabetes require medications and/or insulin to stay healthy. This is normal and important because taking medications will help you or your loved one prevent and manage possible health complications.

There are a number of diabetes medications, which work in different ways. For example, some medications:

• Help the body produce insulin.
• Help the body use the insulin it produces.
• Prevent the body from creating excess glucose.
• Helps the body take glucose from blood and use it where it’s needed.
• Slow down the rate at which glucose is absorbed, and/or helps with weight loss.

There are also many types of insulin available. This offers more flexibility in terms of the number and timing of injections needed. Differences between insulin’s include:

• how long they work;
• how quickly they start working and;
• when they are most effective.

Your doctor will prescribe the medications and/or insulin that meet your needs.

Using Insulin: The Right Device Makes it Easier

Insulin can be taken with a syringe, a pen, a jet injector or a pump depending on specific preferences. Talk to your doctor or diabetes educator about the right device for you or your loved one. For example:

• Pens are very portable and convenient but if more than one type of insulin is required, two pens and two injections are needed.
• Jet injectors have no needles, but force insulin through the skin with pressure.
• Syringes today have very fine needles to make injections as painless as possible. If more than one type of insulin is needed, you can mix the insulin into one, single injection.
• An insulin pump uses a small catheter inserted into the skin and a pump that is worn outside of the body, delivering insulin according to the schedule that is programmed in.