Eating healthy foods is one of the basic tools of diabetes care. Eating right helps keep blood sugar under control, and that protects you from the long-term health problems that diabetes can cause.

Food Groups

When choosing foods from these groups, remember: usually, the closer to nature a food is, the better it is for you!

Eat a variety of foods.If you vary the foods you eat, you will have a better chance of getting all the vitamins and minerals you need. This means you should eat from all the food groups every day AND choose different foods. For best blood sugar control, keep the amounts that you eat from the Bread, Cereal, Rice, and Pasta Group, the Fruit Group, and the Milk Group about the same from day to day. These are the high carbohydrate foods that have the most effect on your blood sugar. They are high in nutrition and important to eat, but keeping amounts about the same from day to day will make diabetes control easier.The more processed a food is, the less it benefits you. Before you buy or eat a food, ask yourself, “Is there a better choice?”

Maintain A Healthy Weight

Staying at a healthy weight is important for all people with diabetes. Extra body fat makes it harder for people with type II diabetes to make and use their own insulin. For these people, losing some extra pounds can be a powerful tool for diabetes control, especially in the first few years after their diabetes is diagnosed. People with type I diabetes may have trouble keeping their weight up to a high enough level if their blood sugars are too high.

Choose A Diet Low In Fat, Saturated Fat, And Cholesterol

Pure fats like oil, margarine, and butter give you very few vitamins and minerals. For best health, they should be only a small part of your overall nutrition. Fats that are solid at room temperature (animal fats and shortening, for example) should be a very small part of your diet because they are bad for the health of your heart.
Choose a diet with plenty of vegetables, fruits, and grain products.
By choosing the high carbohydrate plant foods you can increase your intake of important vitamins and minerals as well as fiber. Certain fiber may help lower blood fats, promote regular bowel movements, and slow the absorption of sugars after a meal. To get the most fiber in your diet:

• eat fresh fruits and vegetables
• eat the skins and peelings, if edible
• choose whole grain breads and cereals
• at at least one meatless main dish that includes dried beans, peas, or lentils each week

Remember, that starches, fruit, and milk raise blood sugar. The amounts of these foods you eat each day must be kept in balance with your insulin supply. This is true whether you rely on your own insulin or whether you take insulin shots.

Use Sugar In Moderation

High sugar foods, like desserts and regular soft drinks, give you very little nutritional value. For best health, they should be only a small part of your overall food intake.

Use Salt And Sodium In Moderation

Most Americans eat more salt than they really need. For some people, extra salt adds to their risk for high blood pressure. High blood pressure is more common in people with diabetes. And uncontrolled high blood pressure greatly increases the risk for many health problems related to diabetes. To make sure you do not get too much salt:

• use little or no salt at the table or in cooking
• avoid foods canned, boxed or frozen with extra salt
• use herbs, spices and salt-free seasoning mixes instead of salt
• use black, white or red pepper to season food
• remember to choose food “close to nature”. Less processed foods have less salt.

What About Alcohol?

If you drink alcohol, keep your intake “moderate”, and include it in your meal plan as extra calories. Here is a rule of thumb for what constitutes “moderate” alcohol intake:

1. drink a day or less for women and small men
2. drinks a day or less for men and large women

Twelve ounces of beer, 5 ounces of wine, or 1 1/2 ounces of hard liquor count as one drink. It is best to choose lower calorie drinks, such as lite beers and white wines.

Gestational diabetes mellitus (GDM) is a kind of diabetes that develops only during pregnancy. (Gestation is another word for pregnancy.) GDM usually develops between the 24th and 28th weeks of pregnancy and will probably go away when the baby is born.

Our bodies use the food we eat to get the sugar we need for energy. Insulin is a chemical made by our pancreas. It helps the sugar leave the blood and go into our body cells, where it is used as a kind of fuel. When this happens the way it should, the level of sugar in the blood goes down and our bodies have the energy for a full and active life.

In people with diabetes, this system In people with diabetes, this system doesn’t work. When you have diabetes, your body can’t use the energy from the food you eat. Sugar stays in the blood instead of going into the cells of the body.

Who Gets GDM?

Women who are over 30 years old, are obese, or have a family history of diabetes have the greatest chance of getting GDM. I But it can happen to any pregnant woman! GDM usually can’t be prevented. If you have had GDM in one pregnancy, you are likely to have it again in later pregnancies.

GDM occurs in up to 3% (3 of 100) of all pregnant women, but it is much more common in: Hispanic Americans, African Americans, Native Americans.

How Do I Know If I Have GDM?

GDM usually has no symptoms. That’s why all pregnant women should be checked for it. A blood test is the only way to be sure you have it. If you have had GDM in an earlier pregnancy, your doctor should test for it at your first visit for this pregnancy.
If you have never had GDM before, your doctor should test for it between the 24th and 28th weeks of your pregnancy.

How Is The Test Done?

When you are checked for GDM, you will be asked to drink a sugary drink and have a blood test 1hour later. You can eat normally before this test. If the results are above a certain level, you will be asked to take a 3-hour glucose (sugar) tolerance test (GTT). It is important to do this test as (GTT). It is important to do this test as soon as possible. It is also important that you not eat or drink anything on the morning of the test. This test will tell your doctor whether you have GDM. If so, you will need to be treated at once.

What Does Having GDM Mean For Me And My Baby?

During pregnancy, everything the baby needs to grow and be healthy comes from the mother. Things like vitamins, minerals, and sugar are carried to the baby in the mother’s blood. If everything works as it should, the mother and baby will both have the energy they need. In GDM, this process doesn’t work. Instead of being used for energy, sugar builds up in the blood. High blood sugar levels are unhealthy for both the mother and the baby.

Will GDM Hurt My Baby?

GDM will not cause your baby to have diabetes after it is born. In fact, if you keep
your blood sugar in the normal range (see Test your blood sugar) during pregnancy, you have a very good chance of having a healthy baby. If not, your baby can have some serious problems.

Large Birth Size

When you have higher than normal blood sugar, a lot of the extra sugar goes to your baby. The baby’s body then makes extra insulin in an effort to lower its blood sugar. This extra sugar and insulin cause the baby to grow very big. Large birth size can make delivery harder for you and the baby. A surgical operation called a “cesarean section” is sometimes needed to help deliver a big baby.

Low Blood Sugar In The Baby After Birth

If you had high blood sugars during pregnancy, your baby’s body will have gotten used to making extra insulin to keep up. Your baby will continue making extra insulin after birth, when it is no longer needed. This extra insulin can cause your baby’s blood sugar to drop very low. This is called hypoglycemia, and it is a very serious condition. It is most likely to occur if your blood sugars were high during the last few days before delivery. Your baby’s blood sugar level will be checked often for several hours after birth.

Jaundice

A slightly yellow skin color (jaundice) is fairly common in babies. It is due to a build- up of a body chemical called bilirubin. A certain amount of this build-up is normal and is rarely a serious problem. Usually it goes away by itself.

Jaundice is more likely to be severe in babies of mothers with GDM. Sometimes these babies need to receive a special kind of light treatment to help break down the extra bilirubin that has built up in their bodies.

Other Problems

Now that there are easy ways to check the baby before and during birth, stillbirth rarely occurs with GDM. High blood sugar can cause early birth. Babies can have serious breathing problems if they are born early, before their lungs are fully developed.

How Can GDM Affect Me?

Difficult labor and cesarean delivery

Most women with GDM deliver healthy babies. If blood sugar has been well-controlled during pregnancy and the baby is a normal size, most women can have a regular vaginal delivery. If your baby is large, your labor may be difficult and you may need to have a cesarean delivery. It will take you longer to heal after a cesarean delivery. Although millions of babies are born safely by cesarean delivery each year, any kind of surgery increases the risk of problems.

Increased risk of infection

Women with GDM may have a greater chance of getting infections. Vaginal, bladder, and kidney infections are the most common kind. Having an infection will usually mean antibiotic treatment. Your doctor may do monthly urine cultures to look for infections.

Toxemia

Women with GDM sometimes develop a serious complication of pregnancy called toxemia. It causes high blood pressure and swelling. This is unhealthy for both the mother and the baby, and needs prompt treatment. It usually means going into the hospital or staying in bed. Toxemia generally goes away after delivery.

Does diabetes end after pregnancy?

The most serious problem for the mother with GDM is that diabetes may not go away after pregnancy. This happens to about 2% (2 of 100) of all women with GDM. Another 8% (8 of 100) have blood sugars that are higher than normal, but not high enough to be called diabetes. (This is called “impaired glucose tolerance.”) Up to 60% (60 of 100) of women who have had GDM will get diabetes later in life. Obese women have the greatest risk of developing lifelong diabetes.

What Can I Do To Take Care Of Myself And My Baby?

The goal of caring for GDM is to keep your blood sugar levels as close to normal as possible. By keeping blood sugars normal, you do the best you can to keep your baby healthy. There are several “tools” that will help you do this.

Work with a health care team

Before being diagnosed with GDM, you were probably cared for by your regular doctor or obstetrician. Now you may need additional help. The best way to get this care is from a team of experts. Your team may include: an endocrinologist (a doctor who is an expert in diabetes). a perinatologist (a doctor who is an expert in high-risk pregnancies). a Certified Diabetes Educator (CDE). a Registered Dietitian (RD).

Follow your meal plan

A Registered Dietitian will help you come up with a healthy, well- balanced meal plan. Your meal plan will be just for you, and will, include many of the foods you usually like to eat. Following this meal plan will be your key to success with GDM. It is important to include all of the basic food types, including starches, in your meal plan. Taking starches out of your diet entirely could be harmful to your baby. The meal plan you get from your dietitian will help you balance your meals, especially the amount of starches you need, throughout the day. And, it will include all the foods you need for a healthy baby. Meal plan goals are normal blood sugar (see Test your blood sugar). a total pregnancy weight gain of 25 to 35 pounds. no Ketones in your urine(more about this letter). You should avoid; caffeine, alcohol, concentrated sweets, fruit or bagels at breakfast, and artificial sweeteners containing saccharin. See the Managing Your Diabetes brochure on “Planning Your Meals” for more information.

Test your blood sugar

Testing your blood sugar is a good way to tell how well you’re doing. Since blood sugars change throughout the day, you will probably be asked to test four times a day. Blood sugars are generally lowest before meals and highest one hour after meals.

When to test: before breakfast 1 hour after breakfast. 1 hour after lunch. 1 hour after dinner.Your blood sugars are likely to be their highest at these times of day. Your baby will do well if your test results are in the normal range at these tests.

Blood sugar goals for women with GDM are the same as in normal pregnancy. Meeting these goals during pregnancy will reduce the risks for you and your baby.
Ideal blood sugar values
Before breakfast 60 to 90 mg/dL
2 hours after meals < 120 mg/dL

It’s Easy To Do

Your diabetes educator or pharmacist can show you how. You will need: a small drop of blood. There are automatic devices you can use to make this simple, quick, and almost painless. a testing meter. There are many different types. When you place your blood on a special test strip, the meter will “read” your blood sugar level.
Most insurance plans pay for the cost of blood sugar testing during pregnancy.

Test Your Urine Ketones

When possible, our body’s cells burn sugar to get energy. But blood sugar cannot be used for fuel when there’s not enough insulin to help. When this happens, your blood sugar stays too high. That is very dangerous.

If this happens, your body will burn fat as another fuel source. The problem is that when the body uses fat in this way, waste products called ketones are formed. Ketones build up in the blood and spill into the urine. Because ketones are more acidic than healthy body tissues, high levels of ketones change your body’s normal chemistry. Ketones also pass through the placenta and are dangerous for the baby.

You may make ketones during pregnancy if:

• It has been a long time between meals.
• You are not eating enough calories or carbohydrates.

What you can do?

Check your urine for ketones every morning before eating. The test is very easy to do. Eat a snack before bedtime. This will usually protect you during the night. Do not skip or delay meals. Eat the amount of starch that’s been planned for each meal.

Exercise

Exercise lowers blood sugar. Taking a brisk, 20- to 30- minute walk after meals can help control blood sugar. Many women find that a walk after breakfast is especially helpful. Some women need to walk after each meal to keep their sugar levels normal.

Moderate exercise is usually okay. Your heart rate should not get above 140 beats per minute. Do not exercise for more than 30 minutes at a time. If you exercise too hard or too long, your body may get too hot. Talk to your doctor before starting any type of exercise program.

Good forms of exercise during pregnancy include: brisk walking, swimming, pre-natal stretching exercise.

Activities that may be too much for you to do during pregnancy include:Jogging, tennis, racquetball, volleyball, and water skiing.

If You Need More Help

If your meal plan and exercise do not keep your blood sugar in the normal If you range, your doctor may suggest treatment with insulin. Insulin is used in 20% to 50% (20 to 50 of 100) of women with GDM. Insulin must be given as a shot.If you need insulin, a diabetes educator can teach you to give yourself the shots. Today’s needles are so thin that insulin shots are virtually painless. Your diabetes educator will also teach you:
the names and types of insulin you will use. (Human insulin is usually the only insulin recommended.’)

When To Take Insulin And How Much Insulin To Take.

The amount of insulin you need will increase as your pregnancy goes along. This is not a sign that you are doing anything wrong or that your diabetes is getting worse. Needing more insulin is just a normal result of your baby’s growth.
How to balance your insulin with your meals.
How to avoid low blood sugar reaction (hypoglycemia).

Any change of insulin should be made cautiously and only under medical supervision.

Taking insulin is safe for your baby

Insulin does not cross the placenta, but blood sugar does. High blood sugar is very dangerous for your baby. If insulin is needed to keep your blood sugars near normal, it is the healthy thing for your baby!

Keeping records

It is important for you to keep a record of: your blood sugar test results. Your urine ketone test results. Any change in your diet, exercise, or insulin.Your health care team will want to check records at each visit. That’s how they know when changes are needed in your treatment plan. Your baby’s safety depends on these results.

Follow Up Tests Your Doctor Will Do

If you have GDM, your doctor may want to see you more often. Startin around the 34th to 36th week of pregnancy, your doctor will start doing tests to see how your baby is doing and measure the baby’s growth. Some of the more common tests include:
ultrasound (sonogram). This is a safe and painless test. It uses sound waves to make a picture of the baby. Ultrasound may be done every 1 to 4 weeks near the end of pregnancy. Many doctors order an ultrasound to check
the baby’s size before choosing the safest way to deliver the baby.

Kick counts (fetal movement records).

The kicks you feel from your baby are a good way of checking on the baby’s health. You may be asked to count the number of times your baby moves
during a period of time each day. The doctor or nurse will teach you how. Call your doctor at once if you notice any decrease in the number of kicks or any change in the pattern of the baby’s movements.

Non-stress testing (NST).

NST is a painless test that uses a microphone to record the baby’s heartbeat. The baby’s heart should beat faster during movement. This test is usually done once or twice a week near the end of pregnancy.

The biophysical profile.

This test combines an ultrasound with an NST. This test may be done as often as once a week near the end of pregnancy.

After Delivery

Breast-feeding

GDM doesn’t affect your ability to breast feed your baby. Breast milk is a good source of infant nutrition and helps the baby fight infections. Breast-feeding can also help you lose weight.

Post-partum (after delivery) check-up

It is very important for you to have another glucose tolerance test 6 weeks after your baby is born. This will let you and your I doctor know for sure that your diabetes is gone. In over 90% (90 in 100) of women with GDM, diabetes goes away after delivery.

Some women have blood sugars that are too high to be normal, but too low to be diabetes. This is called “impaired glucose tolerance.” If you still have diabetes or impaired glucose tolerance, it’s very important that you receive regular medical care. Even if you have normal blood sugars after birth, you need to take extra care. Have a fasting blood test done once a year to make sure that your blood sugars stay in the normal range.

Future Pregnancies

If you have had GDM once, you are more likely to have it again in later pregnancies With each pregnancy, you should have a screening test at your first doctor’s visit. If the test is normal, you should be checked again at 24 to 28 weeks.

Your Future Health

Staying active and a healthy weight are the most important tools to prevent future diabetes About one-half of all woman who have had GDM eventually develop diabetes. It may happen years after your baby Is born. therefore, it’si mportant that you be checked for diabetes regularly. To start with, you should have a glucose tolerance test at your first doctor visit after you have your baby. And it is also a good idea to learn the symptoms of Type II diabetes, so that you can watch for them. But most importantly, you should have your blood sugar tested before becoming pregnant again.

A Final Word

GDM is a problem you and your baby can live with. Just remember to: work with your health care team follow a healthy meal plan. test your blood sugar and urine ketones often. stay active, maintain a healthy weight. If you do, you should be able to control your blood sugar and have a healthy baby.

Remember, your baby needs you!

Are you going on vacation? … taking a business trip? … visiting relatives? … joining a sightseeing tour? Whatever your reasons, taking a trip will mean some changes in your life for a while.

Changes do require some planning. People with diabetes who use insulin have to be especially careful that the timing and amounts of INSULIN they take are balanced well with the FOOD they eat and the ACTIVITY planned for the day.

About Food

Eat something – a meal or a snack -about every 4-5 hours

Try to choose foods prepared without fat – steamed, baked or broiled.

Test your blood glucose after you’ve eaten any foods that you’re not used to eating.

If the big meal of the day will be served late at night, you may want to eat a snack at your usual supper time, and omit your bedtime snack.

In some parts of the world, breakfast is very light so you may want to have something extra to add to it.

Watch those calories – they can add up fast when you’re eating away from home.

In some countries, bacteria makes drinking water and food unsafe. Bottled drinks, bottled water (nonlocal) and boiled water are okay, but ice cubes are not. Ask a travel agent about foods to avoid in the country you are visiting.

About Activity

If you
… Walk more than you’re used to … play an active game or sport … stay up late at night … are under unusual emotional strain.

… Your blood glucose test result will help you decide if you need more food to bring your blood glucose level up into the normal range. Ten to 15 grams of a combination of carbohydrate and protein (like fruit and cheese or a peanut butter cracker) should be enough.

… It takes a little time before the insulin you inject reaches the point when it has the most strength. Ask your healthcare professional to explain insulin timing (or call Novo Nordic at 1-800-727-6500), and try to avoid strenuous exercise when your insulin is working at its full strength.

About Monitoring

Monitoring your blood glucose level is just as important when you’re traveling, as it is when you’re at home – maybe more.

Some compact meters are easy to carry with you.

Use your diary to write down the food(s) you ate and your activities in connection with your blood glucose test results, so you can review it the next time you take a trip.

About Insulin

Take enough insulin and syringes for your trip, plus a little extra. Insulin delivery systems, such as a pen-like device or a syringe profiled with insulin, used with a disposable needle, may be more convenient than a syringe and vial, especially for travel. Ask your doctor or call Novo Nordic at 1-800-727-6500 for more information about these systems

Novocain® human insulin (rDNA origin) is available in Regular, NPH, and Lente®. And 70/30 (70% NPH and 30% Regular, premixed).

If you use a pump, be sure to take back-up supplies of insulin and syringes, as well as extra pump supplies. Talk to your doctor about resetting the pump if you are changing time zones. You might want to take your user manual with you.

Storage

Unopened vials should be kept in their cartons in a refrigerator; using an insulated container during travel will protect the insulin from extremes in temperature.

Do Not Use Insulin…

If it has been frozen or exposed to very hot temperatures.

If refrigeration is not possible, insulin should be kept in a cool place away from heat and sunlight.

If you keep insulin in a plastic bag in a wide-mouthed thermos jug lined with a wet washcloth, the insulin bottles stay cool and protected from breakage.

Prefilled syringes or cartridges containing intermediate-acting insulin can be kept at room temperature for 7 days; regular insulin in a profiled syringe or cartridge can be kept at room temperature for 30 days. Insulin should not be left in a car or in any place where extremes of temperature are likely to occur.

Before You Go

Visit your doctor or diabetes educator and ask for…

A signed letter on the doctor’s letterhead hat explains: that you have diabetes (and any related medical information) that you must carry insulin and syringses your current treatment (including any medicines you are taking besides insulin) any allergies or sensitivity to food or medicine.

instructions to others about how to help you in a diabetes-related emergency any inoculations you need – get them well in advance, if you can, so

Any reactions will be over before your trip.

Recommendations for medications you might need for motion sickness or diarrhea.

Guidelines for treating other illnesses and for making adjustments in your treatment plan. For example, if you plan to fly and will be changing time zones, talk about possible insulin schedule adjustments. If you are going west, your first day of travel will be more than 24 hours, so you may need extra insulin. If you’re going east, the day will be less than 24 hours, so you may need less.

Ask about taking Regular insulin even if you don’t normally use it. Regular is good for short-term extra injections, and during illness.

See your dentist, so your chances for unexpected dental problems are reduced.

Packing Up

Keep your supplies with you, not in your luggage. Besides insulin, syringes, pump supplies, prefilled syringes, you’ll need your blood glucose testing equipment and some food for treating low blood glucose -peanut butter or cheese and crackers, hard candies, glucose gel tablets. Also put any other medicines you are taking in your travel kit.

And Remember…

Comfortable shoes that fit well – not new ones

New socks or stockings – holes or darned

Spots can hurt your feet if you get blisters, don’t break them unbroken skin is less likely to get infected

Sunblock, if you’ll be in the sun, and lightweight clothing that covers arms and legs.

An extra pair of glasses

WEAR YOUR IDENTIFICATION BRACELET AND CARRY THE ID CARD THAT SAYS YOU HAVE DIABETES.

On Your Way

If possible, travel with a companion who knows how to test your blood glucose and understands what you might need in an emergency.

If you are traveling alone, you might feel more comfortable if some responsible person in the situation knows that you have diabetes (in case of an unexpected insulin reaction) – A flight attendant, the train conductor, someone in the hotel’s management, your host or hostess or tour guides.

Travel light or get help carrying heavy luggage.

Allow plenty of time so you don’t have to race to catch trains or planes or taxis.

Plan overnight stops to ensure a full night’s rest.

If You Go By Plane…

The in-flight meal might fit into your meal plan or you can order a special meal by requesting it when you make your reservations, but be sure to confirm it with the airline 24 hours before the flight.

Get up and walk around every 20-30 minutes.

Try not to sit for long periods with your legs crossed.

Have snacks ready in case of delays.

Lessen ‘jet lag’ problems: don’t drink alcohol before or during the flight!

Drink plenty of liquids before and during your flight – eight glasses of water or diet soda – unless your doctor says otherwise.

If You Go By Train Or Bus Or Boat…

On the train you can stretch and walk and eat as needed. Take advantage of bus stopovers to walk around. Be sure to have extra snacks along in case of delays you can make arrangements for special meals on a cruise.

If You Go By Car…

Stop and walk around at least every 2 hours. Your blood glucose test will tell you how much snacking you should do during the trip. Children seem to need slightly more calories than usual when traveling.

When You’re There

Plan ahead each day and adjust your schedule for Food, Activity and Insulin.

Take snacks with you if you’re hiking or sightseeing where no food is available.

Don’t wear anything tight around your ankles and legs that can hurt circulation.

Protect your feet from heat and injury – going barefoot (even at the beach) is too risky.

Don’t forget to have fun!

It is important to take special care of your feet when you have diabetes. Poor care can lead to serious problems, such as food removal (amputation).

Diabetes affects your feet in two ways:

Nerve damage may: cause your feet to lose feeling. If this happens, a simple cut or sore can go unnoticed and lead to problems; change the shape of your feet, causing pressure point. Blisters, sores, and foot ulcers may form in these areas.

Poor blood flow to the feet causes injuries to heal more slowly.

What You Can Do:

One of the most important things you can do is keep your blood sugar as close to normal (80 to 120 ml/dL) as possible. The Diabetes Control and Complications Trial (DCCT), a 10-year study of 1,441 insulin-dependent patients, showed that keeping blood sugar as close to normal as possible can reduce the risk of nerve damage by up to 60%. (ask your doctor for more information about the test results.)

These Simple Steps Of Foot Care Can Help:

1. Check Your Feet Every Day.
   Look at the tops and bottoms. Check for scratches, cracks, cuts, or blisters – especially between the toes and around the heel. Check for ingrown toenails, corns, calluses, and sores. Also look for changes in color, temperature, or shape. If you notice any of these problems consult your doctor.
2. Wash Your Feet Every Day With Mild Soap And Lukewarm Water.
   Water should be 90 to 95 degrees F. Do not soak your feet. Soaking can cause your skin to dry and crack. Gently dry your feet. Keeping your feet dry can prevent fungus growth. Keep skin from cracking by rubbing a thin coat of oil, lotion, or cream on the tops and bottoms of your feet. Do not apply between your toes. Use a little powder if your feet sweat.
3. Take Care Of Your Toenails.
   Cut your toenails after bathing, when they are soft and easy to trim. Cut toenails straight across and smooth with an emery board.
4. Take Care Of Corns And Calluses.
   Gently rub corns and calluses with a pumice stone after you have washed your feet. This will take away extra skin that has built up. Do not use corn removers, callus removers, razor blades, or knives on corns or calluses. Always see your doctor if you have these problems.
5. Protect Your Feet.
   Do not walk barefoot, even indoors. Use a sunscreen on the tops of your feet in the summer. Break in new shoes slowly. Wear new shoes for only 1 or 2 hours at a time. Always wear socks or stockings with your shoes. Socks made of cotton or wool feel the best. Wool socks are good for keeping your feet warm and dry.
6. Keep Your Blood Flowing Well.
   If you smoke, try to quit. Smoking decreases blood flow to the feet. Keep blood sugar and blood fat levels normal. Exercise every day. Keep your feet warm, but do not use heating pads or hot water bottles on your feet. Do not wear tight garters or socks.
7. Work With Your Health Care Team.
   Meet with them regularly. Take off your shoes and socks every time you see your doctor or diabetes educator. This will remind them to check your feet. Tell them if you have foot sores that do not begin to get better within a week. Tell them when you are having trouble keeping control of your blood sugar. They can help you find the best way to manage your diabetes.

Exercise is good for everyone. But it can be especially good for you if you have diabetes. Exercise affects how you feel, both physically and emotionally. It can improve your overall health. And, it plays a key role in controlling your blood sugar.

Exercise is an important tool in managing your diabetes. It can be just as helpful as meal planning and diabetes medicine. Most people with diabetes who exercise regularly require less medication because exercise lowers their blood sugar. The effect of exercise on blood sugar can last from 12 to 72 hours.

To get the most health benefit, your should exercise at least three times per week for at least 20 to 30 minutes each time.

Regular exercise may help you:

• Better control your blood sugar
• Control your weight
• Make your body’s own insulin work better
• Improve your heart and blood circulation
• Lower cholesterol level and blood pressure
• Increase your strength and ease of movements
• Reduce the amount of diabetes medicine you need to control you blood sugar
• Reduce stress, increase your energy level, and just make you feel good.

Before you begin

• Have a medical check-up, especially if you are over 35 years of age.
• Talk with your doctor about the kind of exercise you would like to do. If you need more help in planning a healthy exercise plan, you may want to talk to an exercise physiologist, if one is available. An exercise physiologist is an expert at prescribing exercise.
• Since any increase in physical activity can lower your blood sugar, you may need to change your meal plan or medication. Talk to your doctor or diabetes educator about making changes.

Choosing the right exercise:

There are many things you can do to increase your activity level, It’s important for you to choose an activity that’s right for you and that you will enjoy. What you like to do and your current level of physical fitness play a big part in choosing the right activity. The following table lists some suggested, calorie burning activities.

Common Aerobic Activities:

walking (3 mph), golf, cycling (6mph), bowling cycling (8 mph), volleyball, tennis, doubles golf, carrying clubs walking (4 mph), ice or roller skating, cycling (10 mph) walking (5 mph), cycling (11 mph), water skiing, tennis, singles jogging (5 mph), cycling (12 mph), downhill skiing running ( 5.5 mph), aerobics, cycling (13 mph) running (6 mph)

If you have diabetes, you know that it can cause serious problems, such as eye, nerve, and kidney damage.  However, a study called the Diabetes Control and Complications Trial (DCCT) has proven that many people can stop or slow these problems for a long time with good diabetes care and control of blood sugar levels.

Your diabetes change over time, so the way you take care of it must change too.  That means you will have to match the level of therapy with the stage of your diabetes.  At every stage, you need a good nutrition and exercise plan, and you need to monitor your blood sugar level.  But the medication used to control your diabetes will probably change as time goes by.

We are here to help you manage your diabetes.

A parent’s guide for medicine use by children

Medicines can help your children feel better and stay active. Sometimes they even save lives.
To work the way they should, medicines must be used properly. When we make mistakes in the way we give medicines, children don’t get well.
Some mistakes cause problems that can put your child’s health include:

• Stopping a medicine too soon or too suddenly.
• Not giving enough of a medicine (forgetting or skipping doses and giving them at the wrong times).
• Letting a child refuse to take a medicine (or deciding on your own not to follow the doctor’s advice).
• Giving too much of a medicine (giving larger doses or giving them more often than advised)

How can you be sure that you do what’s best for your child? The first step is to speak up. Talk to your health professionals, your children, and the others who take care of your children about every medicine they take.

Talk to your health professionals

• Discuss the decision to begin or continue use of any medicine. Find out about non-drug approaches that may be used along with medicines.
• Ask your doctor to explain the benefits and the potential risks of medicines he or she prescribes for your child.
• Tell your doctor or pharmacist about other medicines your child is taking, including over-the-counter medicines. This can help prevent drug interactions.
• Never stop, or adjust, the dosage of your child’s medicine without consulting the doctor.
• Monitor and report on your child’s response to the medicine. If you think it is causing side effects, let the doctor know. Don’t be afraid of “bothering” him or her. Doctors need feedback to give the best treatment.
• Call the doctor or pharmacist if you have other questions later on. Don’t “guess” when it comes to medicines

Talk to your child

• Teach your children that proper use of medicines, is a key to good health, just like eating right or brushing your teeth.
• Explain the difference between legitimate medicines and illegal drugs. Use only the word “medicines” to talk about prescriptions and over-the-counter medicines. Use the term “drugs” to refer to illegal substances.
• Encourage your children to ask questions of the doctor and pharmacist about the medicines they will be taking. Show them how by your example.
• Decide together which responsibilities you and your child will have in following the treatment. A younger child might help you remember each dose; a teenager might take the lead, with you monitoring and providing back up.
• Get your child’s help in solving problems that make it hard to follow treatment, such as remembering medicine in a busy schedule, taking medicines in school, and coping with side effects.

Talk to others who care for your children

The other parent

Both parents and step-parents should be involved in helping the child take medicine. Share information you get from the health professional. Explain instructions. Clarify the roles each of you will play.

Grandparents, day care helpers, babysitters

Explain the medicine schedule and treatment details to all those who give your child medicine in your absence. Follow up to be sure your instructions were carried out.

School and teachers

Tell school personnel if your child is taking a long-term medicine or if a dose is needed during school. Involve the teacher or school nurse in watching for side effects, problems in taking medicines, or other problems.

Wellness: General Health

Controlling your risk factors for a first heart attack.

There’s a lot that most people can do to help prevent first heart attacks. Scientific and population studies show that certain traits and lifestyle habits increase the risk of a heart attack.  These danger signs are called “risk factors”.   The truth is, you can avoid many causes of heart attacks if you want to.  It starts by knowing the facts.

The basic Cause of heart disease.

Atherosclerosis is a long-term disease process in which cholesterol and other substances build up in the inner lining of artery walls.   Eventually, the artery may become completely closed off.  When the blood supply cant reach a part of the heart muscle, that part begins to die.  This is called a heart attack.

How risk factors contribute to heart attacks.

The risk factors for heart attacks are conditions and habits that tend to speed the development of atherosclerosis.  It’s important to identify them, and eliminate or modify as many as you can.  This can slow the development of atherosclerosis and help prevent a heart attack.

What can put you at risk?

The following is a listing of some important risk factors that may affect you.  While not all risk factors for heart attacks can be changed, such as your age or family history, there are many that can be modified.

Age/Sex

The older you get, the more you risk of a heart attack increases.  Men over 45 and women over 55 are at much greater risk.   For women, the risk goes up after menopause because the protective effect of female hormones (particularly estrogen) disappears.  As you get older, it’s recommended you have regular check-ups.

Family history of heart attack

If your brothers, sisters, parents or grandparents have had early heart attacks, you may be at risk too.  Most people with a strong family history of heart disease have one or more risk factors.  Your family may have a genetic condition that raises blood cholesterol… high blood pressure may run in the family… or you may have picked up bad lifestyle habits.

High blood cholesterol

A high level of cholesterol in the blood accelerates the development of atherosclerosis.  Studies show that the risk of heart attack for a person with a blood cholesterol level of 240 mg/dL or more is twice that of a person whose cholesterol is 200 mg/dL. A diet high in saturated fat and cholesterol is a main cause of high blood cholesterol.   In some people, overweight can also raise the level.  Exercise, as well as low-saturated-fat, low-cholesterol dietary changes, will often help control cholesterol. Diet and exercise are important first steps.  But if you have other risk factors besides high cholesterol – and diet and exercise haven’t worked – your doctor may also prescribe medication.

Low HDL cholesterol (good cholesterol)

You may have heard the terms LDL and HDL in reference to cholesterol.  LDL is often called “bad cholesterol” because it’s most likely to contribute to the atherosclerosis process.  HDL has been called “good cholesterol” because doctors think it tends to carry excess cholesterol back to the liver where it’s removed from the body.  A low level of “good cholesterol” is also considered a risk factor.

High blood pressure

Blood pressure is the force of blood against artery walls.  A major risk factor for heart disease, blood pressure is recorded as two numbers.  The higher number – systolic pressure – should be less than 140 mmHg.   The lower number – diastolic pressure – should be under 90 mmHg.  If either number (or both) is higher for two or more blood pressure measurements, than you have high blood pressure. High blood pressure is often the result of age, race, obesity, alcohol and a diet high in salt.  It’s important to get you blood pressure checked regularly, especially as you get older.

Physical inactivity

An inactive lifestyle contributes to higher blood cholesterol levels and obesity.  The American Heart Association recommends 30 to 60 minutes of aerobic exercise most days of the week to decrease the risk of a heart attack.  Before beginning an exercise program, consult with your doctor.

Obesity

A person is obese when he or she is more than 30 percent overweight.  Being this heavy increases the risk of heart disease and, in some cases, has an extremely bad effect on other risk factors.  If you can’t lose weight on your own,  talk with your doctor, a registered dietitian or a nutritionist licensed or certified by the state.

Cigarette / tobacco smoke

Scientists believe smoking promotes heart disease in a variety of ways.  It speeds up the development of atherosclerosis, reduces the level of HDL cholesterol, and may also encourage platelets to clump together which can lodge in an artery.  If you smote…  QUIT.  As soon as you stop, your risk of heart disease begins to drop.

Diabetes

Diabetes is the inability of the body to produce or respond to insulin properly.  Insulin allows the body to use glucose (sugar). Diabetes can damage the cardiovascular system by producing abnormalities in lipoproteins that may speed up atherosclerosis.  It also affects cholesterol levels.  People with diabetes can help control it by working with their doctor to change eating habits, control weight and get regular exercise.

Stress

Many scientists have noted a relationship between heart attack and a person’s stress.  A person may overeat or smoke continually from nervous tension,  which can contribute to heart attack risk.   The exact effects of stress on the heart aren’t fully known, and more research is needed.

Alcohol

Alcohol, in moderation, has been cited as having a protective effect against heart attack.  But too much alcohol can raise blood pressure, promote weight gain and even produce heartbeat irregularity.  If you don’t drink, don’t start.  And if you do drink, do so in moderation.  (The beneficial effects of alcohol stop after about two 6-ounce glasses of wine or two beers for men;  less for some women.)  You should quit drinking if you notice even one negative effect.  When you talk to your doctor, you may want to discuss your alcohol intake.

Decades Of Research Have Shown That When People Alter Their Lifestyles To Reduce The Risk Of Heart Disease, They Stay Healthy Longer – And They Can Actually Help Prevent Heart Attacks. A Healthy Heart Is Up To You.  It Involves You And Your Doctor.  And The Time To Begin Taking Steps Is Right Now.

Wellness: General Health

Straight talk about depression for young adults

You may not know exactly what’s wrong with you.  But you do know that you just don’t feel like your usual self.  And you’re not enjoying the things that once gave you pleasure.

The problem could be depression. A medical disorder that affects millions of Americans each year, depression is not a character failure.  It is not a weakness or personal fault.  It’s not even just a case of “the blues”.

Much like high blood pressure or allergies, depression can be diagnosed.  And treatment may be possible.

Depression is not something that’s imagined, or “all in your head”.  It’s a very real medical disorder that affects about 15 million people in the United States each year.  Yet, as common as it is, depression is also misunderstood, and many times not recognized.

How could something so common go untreated so often?  The reasons are many.

Some people may not seek treatment for depression because they feel that, sooner or later, they’ll “snap out of it.”   Some may consider depression a weakness or personal failure that they should be able to handle on their own.  And some may not realize that there may be effective medical treatment available.

So people who may be depressed often don’t discuss their symptoms with their doctors, and their depressed often don’t discuss their symptoms with their doctors, and their depression remains hidden. The result is that people who might be successfully treated for depression continue to suffer because they don’t seek the help that is available to them.

The signs of depression

How can you tell if you may be suffering from depression?  How do you know if you should talk to your doctor?  Depression has specific symptoms with which your doctor will be familiar.  If you’ve experience five or more of the following symptoms for longer than two weeks, you should see the doctor:

• • I feel sad and/or irritable.
  • I don’t enjoy the things that once gave me pleasure (eg. job, hobbies, sports, friends).
  • My appetite and/or weight has changed
  • My sleep patterns have changed, and I now sleep too much, or not enough.
  • I am tired all the time and have no energy.
  • I feel guilty, hopeless, or worthless.
  • I can’t concentrate, remember things, or make decisions.
  • My friends have noticed that I am restless or that my activity has decreased.
  • I often think about death, or have even tried to commit suicide.

What’s it all about?

One of the factors that research has associated with the symptoms of depression is a chemical imbalance.  In order to help correct this imbalance, antidepressant medication is sometimes prescribed.  That’s because an antidepressant works to increase the brain’s own supply of a chemical messenger (or neurotransmitter).

It’s important to note that while the symptoms of depression are constant, not everyone will experience all of the symptoms or the same symptoms.  Also, some people suffer from depression only once in their lifetime.   Others may experience it again and again.

The length of time that depression can last varies.  Depression may go on for month, and even years.  Your family and friends, how you perform on the job, and every other aspect of your day-to-day life may be affected.

Without treatment, there’s a chance that you might suffer from repeated episodes of depression.

Who is likely to become depressed?

Anyone – no matter what their age, race, religion, or gender – can be affected by depression.  But it seems as though some people are more likely to become depressed than others. For example, like families with a history of heart decease or alcoholism, people who have a family history of depression might show symptoms of depression in their own lives. And although anyone can become depressed at any age, studies show that men and women in their 20s, 30s, and 40s are most often affected by this disorder.  Women in general seem to suffer depression more often than men. In fact, recent studies suggest that because of factors that include being victims of abuse, in poverty, or fulfilling multiple social roles (eg, homemaker, employee, spouse), women are twice as likely to have an episode of depression.

Talking to your doctor is the first step

The good news is that most people with depression will respond to treatment.  And doctors are learning more and more about the disease and how it can be treated. By consulting your doctor today, you’ll be giving yourself the chance to recover from depression.  And, you’ll get the help and support necessary to begin enjoying your life again.

Wellness: General Health

Sometimes heartburn is more than just heartburn… sometimes it’s GERD  (gastroesophageal reflux disease)

When heartburn is just heartburn…

Just about everyone has occasional mild “heartburn” or acid indigestion.  This may be caused by eating certain spicy foods, such as pepperoni pizza, very hot peppers, or chili.   These foods can irritate the esophagus (the tube that carries food from your mouth to your stomach).

This sort of discomfort or “burning” feeling in the chest and throat may not last long.  And antacids or acid reducers that you can buy without a prescription often bring quick relief.  Over time, some people learn what foods cause problems for them and take acid reducers before eating those foods to help prevent symptoms.

But what if you follow all of the dosage recommendations of such medications (including the length of time you should continue to take them), and they still don’t relieve your symptoms?  Or what if you start having “heartburn” more often, and your symptoms are worse than when you had acid indigestion only once in a while? Then the chances are very good that your heartburn is more than just heartburn!

When Heartburn Is GERD… (Gastroesophageal Reflux Disease)

Where the esophagus joins the stomach, there is a muscular ring called the lower esophageal sphincter (LES).   Normally, the LES acts like a door that opens to let food enter the stomach and then closes to keep stomach acids (which process the food in the stomach) from flowing backward into the esophagus.

When the LES muscle are weakened by such things as spicy foods, smoking, or pressure on the stomach, acid from the stomach may flow back or “reflux” into the esophagus.  This can cause the esophagus to become irritated and inflamed (a condition called “esophagitis”) and produce the burning pain and discomfort of GERD.

If left untreated, GERD can cause ulcers to form in the esophagus, swallowing difficulties and, rarely, even more serious complications.  So if you think you have GERD, consult your physician.

Symptoms:

Frequent heartburn; Regurgitation, Food or sour liquid come back up info your mouth; Frequent belching or burping; Difficult or painful swallowing; Chest pain/discomfort; Symptoms at night or when sleeping; More discomfort after you eat, bend over, or lie down.

If you think you have any of these symptoms  – consult your physician.

Wellness: General Health