A: The main healthcare providers are your loved one's doctor, nurse, diabetes educator and dietitian. A diabetes educator is a health care worker who teaches people how to manage their diabetes and may be a nurse, dietitian or other kind of healthcare worker. A dietitian is someone who’s specially trained to help plan meals. If your loved one feels sad about having diabetes, or is having problems because of work, school or family, a counselor or mental health worker may help. The doctor or diabetes educator can help you find a counselor if one is needed.

To find a diabetes educator near you, call the American Association of Diabetes Educators toll-free, at (800) 832–6874, or look on-line at www.diabeteseducator.org and click on “Find an Educator.”

To find a dietitian near you, call the American Dietetic Association toll-free at (800) 877–1600, or look on-line at www.eatright.org and click on “Find a Nutrition Professional.”
   
To find programs about diabetes or for additional information, contact:

    American Diabetes Association (ADA)
    Attn: National Call Center
    1701 North Beauregard Street
    Alexandria, VA 22311
    Phone: (800) 342-2383 (DIABETES)
    Email: AskADA@diabetes.org
    Internet: www.diabetes.org

    Juvenile Diabetes Research Foundation International (JDRF)
    120 Wall Street
    New York, NY 10005
    Phone: (800) 533-2873 (CURE)
    Email: info@jdrf.org
    Internet: www.jdrf.org

Adapted for caregivers from the National Diabetes Information Clearinghouse, a service of the National Institute of Diabetes and Digestive and Kidney Diseases.

Article provided by Caring Today magazine and www.caringtoday.com

A: After talking to your loved one's health care provider about the most appropriate activities, encourage your loved one to start moving, starting slow and building up as your loved one is able. Offer support and encouragement. You may want to join in the activities and reap the health benefits as well.

When exercising with diabetes, there are some precautions your loved one should take. Everyone's blood glucose levels respond differently to physical activity, so learn your loved one's response. Test blood glucose levels before and after exercise to help prevent highs or lows. Avoid activity when blood sugar is above 300 (physical activity can make it go even higher) and right before bedtime (may cause hypoglycemia during the night). Low blood sugar levels can occur during, or long after, physical activity. It is especially likely if your loved one skips a meal, or exercises a long time or strenuously. In type 1 diabetes, exercise should be avoided if fasting glucose level is above 250 and ketones are present in urine.

If low blood glucose is interfering with the exercise routine, the American Diabetes Association (ADA) recommends eating a snack before exercise. A medication adjustment may be needed, so talk to the health care team about what is right for your loved one. If during an activity symptoms such as hunger, nervousness, shakiness or sweating occur, test blood glucose levels. If it is 70 or below, take 2 to 5 glucose tablets, 1/2 cup fruit juice or regular soft drink to raise blood glucose. Check glucose levels again after 15 minutes. If it’s still below 70, have another serving. Repeat as needed until blood glucose is at least 70.

Advanced planning can prepare you for the common concerns during exercise. Water and snacks should be kept readily available. A medical identification bracelet, necklace or a medical ID tag should be worn in case of emergency.

A: After many years, diabetes can lead to serious problems with eyes, kidneys, nerves, and gums and teeth. But the most serious problem caused by diabetes is heart disease. When you have diabetes, you are more than twice as likely as people without diabetes to have heart disease or a stroke. Those who have diabetes have the same risk of a heart attack as someone who has already had a heart attack—and they may not even have the typical signs of a heart attack.
Controlling blood pressure and blood fat levels can reduce this risk. A smoker should talk with a doctor about quitting.

What can caregivers do every day to help manage the condition?
You can do four things to help your loved ones lower their high blood glucose.
       
1. Be sure that they follow a meal plan.
People with diabetes should have their own meal plan. A dietitian can help you plan meals that include foods that you and your family like to eat, that are good for everyone—and heart-healthy too. A diabetes meal plan will include breads, cereals, rice and grains; fruits and vegetables; meat and meat substitutes; dairy products; and fats. People with diabetes don’t need to eat special foods; they just need to consider and address how much, and when, they eat.

2. Be sure that they stay physically active.
Physical activity is especially good for people with diabetes because it helps keep weight down, helps insulin work better to lower blood glucose, is good for the heart and lungs and it provides more energy. Walking, swimming, dancing, riding a bicycle, playing baseball and bowling are all good ways to be active. Exercise includes cleaning house or working in the garden.
 
Try to have them be active almost every day for a total of about 30 minutes. Begin slowly, if necessary. Start with 5 to 10 minutes, and then add more time. Or exercise for 10 minutes, three times a day.

Before encouraging an exercise regimen, make sure your loved one has spoken with the doctor, who may need to do a check-up first.   

3. Be sure that they take diabetes medicine.
Three kinds of diabetes medicine can help one reach blood glucose targets: medications in the form of pills/capsules, insulin and other injectable medicines.

    Diabetes medications Some are taken once a day, and others are taken more often. Be sure your loved one knows when to take medication, and let the doctor know if the medication is making the person feel sick. And, remember, diabetes isn’t managed by medications alone. You’ll still want to have the individual follow a meal plan and be active in order to help lower blood glucose.

    Insulin Everyone with type 1 diabetes needs insulin, and many people with type 2 diabetes do, too. Some women with gestational diabetes also need to take insulin.

    Other injectable medicine Some people with diabetes use other injectable medicines to reach their blood glucose targets. Be aware that these medicines are not substitutes for insulin.
 

4. Be sure that they check their blood glucose level
Experts say most people with diabetes should try to keep their blood glucose level as close as possible to the level of someone who doesn’t have diabetes. The closer to normal your blood glucose is, the lower your chances are of developing serious health problems. Your loved one’s healthcare team will help you both determine how to reach that target blood glucose range.

No matter how hard everyone tries to keep the blood glucose in check, it occasionally may be too high or too low. Here’s what to know—and do—in those circumstances:

Hyperglycemia may result if the blood glucose level stays above 180. High blood glucose, or hyperglycemia, can happen if one doesn’t take diabetes medicine, eats too much or doesn’t get enough exercise. Having an infection, being sick or under stress can also make blood glucose too high. Discuss with the doctor what glucose levels should be and what to do when they are out of range. Hyperglycemia can lead to ketoacidosis, a very serious condition. If the person experiences shortness of breath, fruity-smelling breath, nausea/vomiting and/or a very dry mouth, seek immediate attention.

Hypoglycemia happens when blood glucose drops too low. It can come on fast. It may be caused by taking too much diabetes medicine, missing a meal, delaying a meal, exercising more than usual or drinking alcoholic beverages.

Hypoglycemia can make one feel weak, confused, irritable, hungry or tired. It may also cause a person to sweat a lot, get a headache or feel shaky. The person could pass out or have a seizure. If you notice any of these symptoms, check blood glucose. If the level is 70 or below, give one of the following right away:

• 3 glucose tablets
• 1 serving of glucose gel (equal to 15 grams of carbohydrate)
• 1/2 cup (4 ounces) of any fruit juice
• 1 cup (8 ounces) of milk
• 1/2 cup (4 ounces) of a regular (not diet) soft drink
• 5 or 6 pieces of hard candy
• 1 tablespoon of sugar or honey

(Orange juice, soda, apples and candy are considered quick-fix foods.)

A note about Glucagon: Ask your doctor about glucagon, a medicine that quickly raises blood glucose. It is given as an injection with a syringe. If you take insulin, keep a glucagon kit at home and at a few other places where you go often. Family, friends and co-workers should be shown how to give you a glucagon injection if you pass out because of hypoglycemia. If you pass out, someone should immediately call 911 and inject glucagon.
 

A: The symptoms of diabetes are;

• being very thirsty
• urinating often
• feeling very hungry or tired
• losing weight without trying
• having blurry eyesight

A person with diabetes may have had one or more of these symptoms—or no symptoms at all. A blood test to check glucose levels will show pre-diabetes or diabetes.
 

A: Type 1 diabetes, formerly called juvenile diabetes or insulin-dependent diabetes, is usually first diagnosed in children, teenagers or young adults. With this form of diabetes, the beta cells of the pancreas no longer make insulin because the body’s immune system has attacked and destroyed them. Treatment for type 1 diabetes includes taking insulin, making wise food choices, being physically active, when appropriate taking aspirin daily and controlling blood pressure and cholesterol.

Type 2 diabetes, formerly called adult-onset diabetes, is the most common form of diabetes. People can develop type 2 diabetes at any age—even during childhood. This form of diabetes usually begins with insulin resistance, a condition in which fat, muscle and liver cells do not use insulin properly. At first, the pancreas keeps up with the added demand by producing more insulin. In time, however, it loses the ability to secrete enough insulin in response to meals. Being overweight and inactive increases the chances of developing type 2 diabetes. Treatment includes using diabetes medicines, making wise food choices, being physically active, controlling blood pressure and cholesterol, and when appropriate, taking aspirin daily.

Some women develop gestational diabetes during the late stages of pregnancy. Although this form of diabetes usually goes away after the baby is born, these women are more likely to develop type 2 diabetes later in life. Gestational diabetes is caused by the hormones of pregnancy or a shortage of insulin.
 

A: Glucose comes from the food you eat and is also made in your liver and muscles. Your blood carries the glucose to all the cells in your body. Insulin is a chemical (a hormone) made by the pancreas. The pancreas releases insulin into the blood. Insulin helps the glucose from food get into your cells. If your body doesn’t make enough insulin, or if the insulin doesn’t work the way it should, glucose can’t get into your cells. It stays in your blood instead. Your blood glucose level then gets too high, causing pre-diabetes or diabetes.
 

A: Diabetes is a disease that occurs when your blood glucose (often called blood sugar) is too high. Your blood always has some glucose in it because your body needs glucose for energy to keep you going. But too much glucose in the blood isn’t good.