Manage Stress

Stress can make blood pressure go up for a while, and it has been thought to contribute to high blood pressure. But the long-term effects of stress are as yet unclear. Stress management techniques do not seem to prevent high blood pressure. However, such techniques may have other benefits, such as making you feel better or helping you to control over-eating.

Glucose Control - Special Times

Stress

It seems like there's no getting around stress. From time to time, everyone experiences it. For people with diabetes, however, stress can be a problem. Stress hormones speed up your body, make your heart beat faster and your blood pressure rise a bit. Sometimes, stored glucose is released from your liver and muscles causing your blood sugar to rise quickly.

Also, diabetes is a disease that can add stress to your life. There are fears, worries and the constant care involved in living with a chronic disease. Managing stress is part of controlling diabetes.

Glucose Control - Exercise

Sometimes, it may seem easier to pop a pill or even take a shot than to put on your walking shoes and hit the trail. But the truth is that exercise, in combination with a healthy diet, is one of the best things you can do to take care of yourself if you have diabetes.
Why exercise?
Exercise burns calories, which will help you lose weight or maintain a healthy weight.
Regular exercise can help your body respond to insulin and is known to be effective in managing blood glucose. Exercise can lower blood glucose and possibly reduce the amount of medication you need to treat diabetes, or even eliminate the need for medication.
Exercise can improve your circulation, especially in your arms and legs, where people with diabetes can have problems.
Exercise can help reduce your cholesterol and high blood pressure. High cholesterol and high blood pressure can lead to a heart attack or stroke.
Exercise helps reduce stress, which can raise your glucose level.
It can lower your risk for heart disease, reduce your cholesterol levels and your blood pressure.
In some people, exercise combined with a meal plan, can control Type 2 Diabetes without the need for medications.

How to start exercising
If you're out of shape or have recently been diagnosed as having diabetes, see your doctor before you begin an exercise program. Your doctor can tell you about the kinds of exercise that are good for you depending on how well your diabetes is controlled and any complications or other conditions you may have. Here are some tips for starting:
If you're planning to walk or jog, be sure your shoes fit well and are designed for the activity you have in mind. Be alert for blisters. Wear new shoes for a bit each day until they're comfortable and not as likely to cause blisters. Remember, always wear socks.
Start slowly with a low-impact exercise such as walking, swimming, or biking.
Build up the time you spend exercising gradually. If you have to, start with five minutes and add a bit of time each day.
Always wear an ID tag indicating that you have diabetes to insure proper treatment in case there's a problem when you're exercising or you have an injury.
Avoid lifting very heavy weights as a precaution against sudden high blood pressure.
If you have foot problems, consider swimming or biking, which is easier on the feet than jogging.
Stretch for five minutes before and after your workout regardless of how intense you plan to exercise.
How often should you exercise?
Try to exercise at the same time every day for the same duration. This will help control your blood sugar. Exercise at least three times a week for about 30 to 45 minutes.
What about food and insulin?
If you plan to exercise more than an hour after eating, it's a good idea to have a snack. Generally, it's good to have a high-carbohydrate snack such as six ounces of fruit juice or half of a plain bbagel.If you're doing heavy exercise such as aerobics, running or handball, you may need to eat a bit more such as a half of a meat sandwich and a cup of milk.
If you haven't eaten for over an hour or if your blood sugar is less than 100 to 120, eat or drink something like an apple or a glass of milk before you exercise. Carry a snack with you in case of low blood sugar.
If you use insulin, exercise after eating, not before. Test your blood sugar before, during and after exercising. Don't exercise when your blood sugar is more than 240.
If you're not an insulin user, test your blood sugar before and after exercising if you take pills for diabetes.
When is exercise a problem?If your blood sugar level is over 300 mg/dl, if you are sick, short of breath, have ketones in your urine or are experiencing any tingling, pain or numbness in your legs, don't exercise. Also if your medication is peaking, it's better not to exercise.
Insulin reaction and exercise
Treat it when you feel it. Don't wait. Be sure you have some raisins or candy on hand to raise your blood glucose level.

Medications for Diabetes - Types of Insulin

Types of Insulin

Very Fast acting - The fastest acting insulins are called lispro (Humalog)and insulin aspart (Novolog). They should be injected under the skin within 15 minutes before you eat. You have to remember to eat within 15 minutes after you take a shot. These insulins start working in five to 15 minutes and lower your blood sugar most in 45 to 90 minutes. It finishes working in three to four hours. With regular insulin you have to wait 30 to 45 minutes before eating. Many people like using lispro because it's easier to coordinate eating with this type of insulin.

Fast acting - The fast acting insulin is called regular insulin. It lowers blood sugar most in 2 to 5 hours and finishes its work in 5 to 8 hours.

Intermediate acting - NPH (N) or Lente (L) insulin starts working in one to three hours, lowers your blood sugar most in six to 12 hours and finishes working in 20 to 24 hours.

Insulin Mixtures

There may be advantages of using insulin mixtures and these should be discussed with your doctor.

Which Insulin is Right for Me?
People don't respond to individual typ

es of insulin the same way. So, working with your doctor, you have to find the right insulin or combination that works for you. Your insulin choice should dovetail with your eating and exercise patterns, so it's important for you to plan your insulin intake with your doctor or diabetes educator.

Most people who use insulin inject it with a needle and syringe, but there are several other devices that are available. These include:

• Insulin pens - These are handy if you want the convenience of carrying insulin with you in a discreet way. An insulin pen looks like a cartridge pen. Some pens use replaceable cartridges of insulin and other models are disposable. The tip of the pen has a fine, short needle. Users turn a dial to select the desired dose of insulin and press a plunger on the end to deliver the insulin.

  Related information Insulin pens selection

• Insulin jet injectors - These send a fine spray of insulin through the skin by a high-pressure air mechanism instead of needles. These are great for people who fear needles, but they're expensive and you have to boil and sterilize the units fre quently.

  Related information Insulin jet injectors selection

• External insulin pumps - These connect to narrow, flexible plastic tubing that ends with a needle inserted just under the skin near the abdomen. The insulin pump is about the size of a deck of cards, weighs about 3 ounces, and can be worn on a belt or in a pocket. Users set the pump to give a steady trickle or 'basal' amount of insulin continuously throughout the day. Most pumps have the option for setting several rates. Pumps release bolus doses of insulin (this means several doses at a time) at meals and at times when blood sugar is too h igh based on the user's programming. If you use an insulin pump, it's really important to monitor your blood sugar frequently so you can determine the right dose and also to be sure that the insulin is being delivered. These pumps can be expensive to buy and maintain.

  Related information Insulin pumps selection

Where should you inject?
You can inject insulin into several places on your body. Insulin injected near the stomach works fastest. Insulin injected into the thigh works slowest and a shot in the arm works at medium speed.
Ask your doctor or diabetes educator how and where to inject insulin properly.

How to store it

• If you use a whole bottle of insulin within 30 days, keep that bottle of insulin at room temperature. On the label write the date that is 30 days away. That date is when you should throw out the bottle with any insulin left in it.
  
• If you don't use a whole bottle within thirty days then you should store it in the refrigerator all of the time.
  
• If insulin gets too hot or too cold, it doesn't work right. So, don't keep insulin in the freezer or in the glove compartment of your car during warm weather.
  
• Keep at least one extra bottle of insulin around your house. Store extra insulin in the refrigerator.

Medications for Diabetes - Insulin

If you have Type 1 diabetes, your body doesn't make insulin which helps sugar from food be turned into energy. If you have Type 2 diabetes, your pancreas does not make enough insulin and your body can't use it properly. Sometimes, eating a healthy diet and getting enough exercise will control Type 2 Diabetes. Sometimes, your doctor will give you medication. However, diabetes medications that lower blood sugar never, never take the place of healthy eating and exercise. Some people, after a few years of taking oral medication, will need to begin taking insulin.

Insulin

How it works
Insulin lowers blood sugar by moving sugar from the blood into the cells of your body. Once inside the cells, sugar provides energy. If you take insulin, you'll need to eat on time and match your insulin injections to your meals. Your insulin should peak at the same time blood sugar levels from meals are also peaking.
Work with your health care team to establish a meal plan and to work out how to take your insulin in relation to your meals. It's important to plan for those 'what if' situations that come up and to know what to do. A few basic tips include:

• Remember, you need some insulin in your body all of the time.
• You need some insulin before you eat a meal. Match the dose to the estimated amount of carbohydrates in the meal. Your diabetes educator can show you how.
• You may need additional insulin to lower your blood sugar if it is high sometimes.
• By testing your blood sugar at least four times a day, you'll have the knowledge you need to moderate your insulin, activity and eating so that your blood sugar is under good control.

A rough guideline to remember is that one unit of insulin lowers blood sugar by 50 mg/dL and covers about 10 to 15 grams of carbohydrate. How often?
Most people with diabetes need at least two insulin shots a day for good blood sugar control. Some people take three or four shots a day to have a more flexible plan.

When to take?
You should take insulin 30 minutes before a meal if you take regular insulin alone or with a longer-acting insulin. If you take lispro (Humalog), or insulin aspart (Novolog), two insulins that works really fast, you should take your shot just before you eat.

Glucose Control - Diabetic Diet

If You've been diagnosed with diabetes, your doctor has probably mentioned that you should pay careful attention to nutrition and diet as part of your treatment program. Nutrition experts say that there is no one diet for diabetes, but people with diabetes should follow the nutrition guidelines in the Food Pyramid, while paying special attention to carbohydrate intake. People with diabetes should also eat about the same amount of food at the same time each day to keep blood sugar levels stable.

Getting Started With Nutrition Treatment
If you've never attempted to eat a healthy, well-balanced diet before your diabetes diagnosis, it can be difficult to know where to get started. Try these tips from the American Dietetic Association:

• Eat more starches such as bread, cereal, and starchy vegetables. Aim for six servings a day or more. For example, have cold cereal with nonfat milk or a bagel with a teaspoon of jelly for breakfast. Another starch-adding strategy is to add cooked black beans, corn or garbanzo beans to salads or casseroles.
• Eat five fruits and vegetables every day. Have a piece of fruit or two as a snack, or add vegetables to chili, stir-fried dishes or stews. You can also pack raw vegetables for lunch or snacks.
• Eat sugars and sweets in moderation. Include your favorite sweets in your diet once or twice a week at most. Split a dessert to satisfy your sweet tooth while reducing the sugar, fat and calories.

Soluble fibers are found mainly in fruits, vegetables and some seeds, and are especially good for people with diabetes because they help to slow down or reduce the absorption of glucose from the intestines. Legumes, such as cooked kidney beans, are among the highest soluble fiber foods. Other fiber-containing foods, such as carrots, also have a positive effect on blood sugar levels. Insoluble fibers, found in bran, whole grains and nuts, act as intestinal scrubbers by cleaning out the lower gastrointestinal tract.

After a diabetes diagnosis, consider seeing a dietitian and developing a meal plan to get started. Taking into account your lifestyle, your medication, your weight and any medical conditions you may have in addition to diabetes as well as your favorite foods, the dietitian will help you create a diet that will prevent complications of diabetes and still give you the pleasure you've always had in eating. To find a diabetes teacher (nurse, dietitian, pharmacist and other health care professional), call the American Association of Diabetes Educators at 1-800-342-2382. If you want to find a dietitian near you, call the American Dietetic Association's National Center for Nutrition and Dietetics at 1-800-366-1655 or visit their Web site at www.eatright.org/find.html.

A Healthier Weight and Lifestyle
Reaching and maintaining a healthy weight is important for everyone with diabetes. Weight control is extremely important in treating type 2 diabetes because extra body fat makes it difficult for people with type 2 diabetes to make and use their own insulin. If you are overweight, losing just 10 to 20 pounds may improve your blood sugar control so much that you can stop taking or reduce your medication.

If you smoke and have been diagnosed with diabetes, your doctor will recommend that you quit because smoking makes problems caused by diabetes worse. People with diabetes can experience blood flow problems in the legs and feet, which can sometimes lead to amputation. Smoking can decrease blood flow even more. Smoking can also worsen sexual impotence in men, cause high levels of LDL cholesterol (the bad type of cholesterol), and can raise the risk of heart attack and stroke. If you have diabetes and you smoke, you need to quit.

Although alcohol in small amounts can be fit into your meal plan if your blood sugar is under good control, drinking alcohol on an empty stomach can cause low blood sugar. Alcohol can contribute to complications of diabetes, so ask your doctor how much alcohol can be included in your meal plan and then stick to it.

Moderating Sugar, Fat and Carbohydrates
If you've been diagnosed with diabetes, you may have a lot of lifestyle changes to make. Does that mean you have to give up sugar, fat and carbohydrates forever?

The body breaks down different types of foods at different rates. Carbohydrates (be it potato or table sugar) typically take from five minutes to three hours to digest, whereas protein takes three to six hours and fat can take eight or more hours. That's why different foods have different effects on blood sugar, such as why ice cream (higher in fat) raises blood sugar levels more slowly than potatoes. But people with diabetes don’t always have to forgo desserts and sweets. They just have to be sure not to eat moderate amounts more than once or twice a week.

To control carbohydrates, try a technique called carbohydrate counting. Carbohydrate counting means counting the total number of grams of carbohydrate you should eat at a meal or planned snack time based on your medication and exercise habits. Then you can choose how to meet those carbohydrate needs. You'll probably use a carbohydrate counting book, which you can get at a supermarket or bookstore. If you want to learn how to count carbohydrates accurately, make an appointment with a dietitian or a diabetes educator.

Because people with diabetes are at higher risk for heart problems, it's often recommended that they limit fat below 30 percent of total daily calories by eating less overall fat and less saturated fat. They also need to watch cholesterol, choose smaller portions of lean meats, poultry and fish, and low or non-fat dairy products. Because high-protein diets such as the Atkins diets are high in fat, they are not usually recommended for people with diabetes.

Remember that it will take a while to learn how to adjust to the changes in your diet and lifestyle after a diabetes diagnosis. With practice and help, you can have a satisfying diet and keep your blood sugar under control, too.

Glucose Control - Dangers

Blood glucose emergencies

Keeping your blood glucose as close to normal as possible can be a delicate balancing act. If you don't have a healthy diet, you eat too much and don't follow your meal and exercise plan, you can wind up with high blood sugar and risk complications. At the other end of the spectrum, your blood sugar can go too low and cause problems, even a life-threatening coma.

Glucose Control - Blood Sugar Level Testing

About blood sugar testing
To control your diabetes, you absolutely have to know your blood sugar numbers. Testing your blood sugar is the only way to know whether your blood sugar is too high, too low or just right. There are two common tests to measure your blood sugar--the hemoglobin A1c test and daily finger-stick tests. You need to do both of these in order to really get a true picture of your blood sugar control. There are also some relatively new tests that you need to know about.

Hemoglobin A1c test
(Pronounced he-mo-glo-bin A-one-C) measures your blood sugar control over the last three months. It's the best way to know if your blood sugar is under control.


What is the A1c Testing goal?
A hemoglobin A1c goal for people with diabetes is less than 7 percent but not everyone can meet that goal. Each person should try to get as close as possible. A change in your treatment plan is almost always needed if your test result is over 8 percent. Ask for a hemoglobin A1c test at least twice a year. If your treatment changes or your blood sugar stays too high, you should get a hemoglobin A1c test every three months until your blood sugar level improves.
Common causes of high blood sugar include eating too much food, eating the wrong foods, lack of physical activity, stress, a need to change medication and infections or illness.

How to Control Blood-Sugar Levels Naturally

Sugar is the primary culprit in the development of hypoglycemia and diabetes. While sugar does provide a temporary boost of energy, eating it too frequently puts tremendous stress on the organs and glands that regulate blood-sugar levels. If you don't have hypoglycemia or diabetes or if you rarely indulge in sugar, your pancreas can handle occasional sugary treats. But if you frequently eat sugar, your pancreas can become hypersensitive to sugar and overreact, flooding your body with insulin, which causes blood-sugar levels to plummet. This triggers your adrenal glands into action, and they notify your liver to release the glucose that it has stored as emergency fuel, which once again floods your bloodstream with sugar. If this happens too many times, your pancreas can finally give up and stop producing insulin or your cells may become resistant to insulin, and hypoglycemia can slip into diabetes.

Most American women eat about 80 pounds of sugar per year, as well as large amounts of refined carbohydrates such as white flour, which is easily converted into glucose in the body. Even if you don't add sugar to foods, you can still take in tremendous amounts if your diet contains a lot of prepared foods. Obviously, desserts and sweets are loaded with sugar, but other foods such as salad dressings, pasta sauces, and dry cereals also typically contain large amounts of sugar. Sugar is hidden in foods in many forms and is often used in more than one form in processed foods. To help restore healthy blood-sugar levels, avoid all forms of sugar, including sucrose, glucose, maltose, corn syrup, honey, maple syrup, barley malt, and molasses. Learn to enjoy the unprocessed sweetness of fresh fruits (in moderation) and sweet vegetables such as yams, carrots, and winter squash. Although giving up concentrated sweeteners may be difficult initially, you will find that your cravings for sugar will diminish within a few weeks.

Other foods that interfere with healthy blood-sugar levels include refined carbohydrates such as breads and pastas made from white flour and white rice, all of which are rapidly broken down into simple sugars in the body. Stimulants such as caffeine offer a temporary burst of energy, but stress the adrenal glands and further impair their ability to normalize blood-sugar levels. Alcohol also interferes with blood-sugar stability because it hinders the body's ability to use glucose and stimulates the release of insulin, which causes blood sugar take a nosedive.

To help maintain steady blood-sugar levels, eat a diet high in fiber, especially soluble fiber, which slows down the digestion and absorption of carbohydrates and prevents rapid increases in blood sugar levels. Soluble fiber keeps the pancreas from secreting too much insulin by enhancing cell sensitivity to insulin and improves the use of glucose by the liver, which prevents blood-sugar levels from remaining too high. Strive for at least 35 grams and preferably 50 grams of fiber each day. Legumes, whole grains, nuts, seeds, vegetables, and fruits are good sources of fiber, and especially good sources of soluble fiber include legumes, oat bran, most vegetables, apples, and pears. Eat carbohydrates in as close to their natural state as possible, because the fiber content helps to slow the absorption of natural sugars that carbohydrates contain-for example, eat an apple instead of drinking apple juice. Psyllium-seed husks, guar gum, and pectin are excellent sources of supplemental soluble fiber. To help balance blood-sugar levels, take one to three teaspoons of a fiber supplement stirred into a glass of water twice daily before meals.

Protein is essential for the proper functioning of the adrenal glands, pancreas, and liver and prevents cravings for high-carbohydrate foods. Because protein does not stimulate the release of insulin as do carbohydrates, it helps to stabilize blood-sugar levels. For maximum blood-sugar stability, eat three to four ounces of protein at lunch and at dinner. Moderate amounts of healthful fats are also essential for helping to maintain healthy blood-sugar levels and for providing a feeling of satiety, which helps to reduce cravings for carbohydrates. Raw nuts and seeds, avocados, olive oil, and flaxseed oil are all good sources of health-enhancing fats.

Eating frequent small meals is a helpful strategy for stabilizing blood-sugar levels. Avoid skipping meals, or going for more than two to three hours without eating. Get into the habit of eating meals at regular times, because your body functions best on a regular schedule. Plan for three meals a day, plus midmorning, midafternoon, and evening snacks. Include a small amount of protein or fat in your snack to help keep blood sugar stable-for example, have an apple with a few almonds, crackers with tofu spread, or carrot sticks with a few walnuts.

Supplements that are especially helpful for balancing blood sugar include chromium, a trace mineral that is essential for the proper functioning of insulin. Take 200 to 600 micrograms of chromium picolinate daily. To help strengthen the adrenal glands, take 2,000 milligrams of vitamin C daily in divided doses and a high potency multivitamin and mineral that provides 50 to 100 milligrams of the B-complex vitamins.

Glucose Control-Benefits

Glucose Control - Benefits

The federal government conducted a landmark study from 1983 to 1993 that profoundly changed the management of diabetes. The study involved 1,441 volunteers with Type 1 diabetes at 29 medical centers in the United States and Canada. The United Kingdom Prospective Diabetes Study in 1998 produced similar results for people with Type 2 diabetes.

The results from both studies proved that the level of blood sugar control predicts the onset and severity of diabetes-related complications for both types of diabetes. This means that if you have diabetes, if you can keep your blood sugar levels as close as possible to normal, you can live a normal life span with few or even no complications at all.

If you can control your blood sugar level, in the short run, you will:

• Feel better.
• Stay healthy.
• Have more energy.
• Prevent the signs and symptoms of high blood sugar such as feeling very thirsty and tired, urinating often, losing a lot of weight, having blurred vision, and having cuts and bruises that are slow to heal.

In the long run, you will:

• Lower your chances of having eye disease, kidney disease, nerve damage and heart disease.
• Enjoy a better quality of life.

How to reach tight control?

Test your blood sugar levels several times each day. It is valuable to test blood sugar levels as often as you feel it is giving you meaningful information.

• Adjust medication doses according to food intake and exercise.
• Follow a diet and exercise plan. For people with Type 2 diabetes, regular exercise and maintaining a healthy weight may forestall the use of medication.
• Stay in close contact with a health care provider skilled in helping patients manage diabetes.

Who shouldn't strive for tight control?

Tight control isn't recommended for everyone because of age or other health factors, and can increase the risk of low blood sugar episodes. Your doctor can help you decide if tight control is for you, but it isn't recommended for the following people:

• Children under 13
• People with heart disease or advanced complications
• People with a history of frequent, severe hypoglycemia (low blood sugar episodes)
• Older adults

Know your blood sugar numbers

Everyone has some sugar in his or her blood. The normal amount of sugar in the blood ranges from about 70 to about 120 in people who don't have diabetes. Blood sugar goes up after eating, but returns to normal range within one to two hours.

A good blood sugar range for most people with diabetes is from about 70 to 120. This is before a meal -- like before breakfast -- or four to five hours after your last meal. Your blood sugar should be less than 200 about two hours after your last meal. However, these goals vary depending on the person. For an elderly person, it might be better to have higher blood sugar and not worry so much about complications than risk having low blood sugar. You'll need to work out your personal goal with your health care team.

Remember, the fact that you feel fine doesn't mean you can skip testing your blood sugar. You can feel fine and still have high blood sugar.