Self Care Behaviors- Healthy Eating

Healthy Meal Planning
Eating healthy foods is one of the most important tools for managing your blood sugar. Good blood sugar control protects your health and decreases complications from diabetes.
MyPlate, the new dietary guidelines for Americans, encourages you to:

  • Make half of your grains whole grains
  • Vary your vegetables by eating a variety of green, white, yellow, red and orange vegetables. *For those with diabetes, try to eat more non-starchy vegetables (such as leafy green vegetables, tomatoes, cucumbers, peppers, and zucchini). Starchy vegetables and legumes such as corn, potatoes, dried beans (such as black, pinto, and navy beans), peas, and lentils contain more carbohydrates and will raise blood sugar more quickly.
  • Focus on fruits by eating a variety of fresh fruit, unsweetened frozen fruit, or canned fruit canned in fruit juice instead of syrup.
  • Get your calcium-rich food such as milk, yogurt, and leafy-green vegetables.
  • Go lean with protein by eating a variety of lean meats, fish and beans.

myplate_white

If you choose to drink alcohol, limit to 2 servings per day for men and one serving for women. (1 serving = 4 oz. wine, 12 oz. beer, or 1 ½ oz. liquor)
Avoid skipping meals. Skipping meals can make you extra hungry and likely to eat more than you should at one meal. Space your meals about 4 to 5 hours apart. If you go longer than 4 to 5 hours without eating, try to eat a snack in between meals.

Keep Portions in Control
Your blood sugar is affected not only by the kind of food you eat, but also by how much food you eat.

Serving sizes differ among food groups. The following will help you estimate serving sizes:

  • 3-4 oz. of meat, poultry, or fish is about the size of one deck of cards or the palm of a small hand.
  • ½ cup of fruit, vegetables, or pasta is about the size of a small fist or a tennis ball.
  • 1 oz. of cheese is about the size of your thumb.
  • The tip of your thumb is about 1 teaspoon.

Check the size of your dinner plate! Using a 9 inch plate is the MyPlate recommendation and can be helpful in controlling portion sizes. If you prefer, using a sectioned plate can help keep starches to ¼ of the plate, increasing the servings of fruits and vegetables one consumes at a meal.

Try to use moderation when eating foods high in sugar such as honey, regular sodas, syrup, jelly, candy, doughnuts, fruit packed in syrup, cake with icing, and pies.

Carbohydrate Choices

How much carbohydrate should you have per meal?
For someone living with diabetes, a typical meal plan may recommend that women consume 45-60 grams or 3-4 servings of carbohydrate at each meal and 15 grams or 1 carb serving for a snack. For men, it may be recommended to consume 60-75 grams or 4-5 servings of carbohydrate at each meal and 15-30 grams or 1-2 carb servings for a snack. A registered dietitian can help you determine how much carbohydrate you should have at each meal and snack.

How do you count carbohydrates?
You can count carbohydrates using carbohydrate counting, the exchange system, and looking at the food label on your product. Remember to look at the total grams of carbohydrate on the food label, and not the grams of sugar, for how many carbohydrates are in a serving of the product.

15 grams of carbohydrate = 1 serving

As an example, each item below equals 15 grams of carbohydrate:

  • 1/2 cup of sugar-coated cereal
  • 1/3 cup of cooked rice
  • 1/2 cup of corn
  • 1/2 cup of cooked beans
  • 1 small piece of fruit
  • 4 ounces, or ½ cup, of juice
  • 1 cup of milk

Sample Breakfast Meal with 45 grams of Carbohydrate:

¾ cup, unsweetened cereal = 1 serving or 15 grams

1 small banana or ½ a large banana = 1 serving or 15 grams

1 cup skim or low fat milk = 1 serving or 15 grams

Understanding Food Labels
The Nutrition Facts label lists the amount of carbohydrate, protein, fat, calories, and other nutrients found in labeled foods that you might purchase.

The first step is to look at the serving size! It is located on the first line of the nutrition facts panel, towards the top. Serving size does not determine how much you are allowed to eat or “should” eat, but if you eat more than the amount listed you will need to increase the calories, carbohydrates, protein, and fat accordingly.

Focus on total grams of carbohydrate. Sugars are included in the total carbohydrate listing. The total carbohydrate grams will tell you how that food is going to impact your blood sugar, and you will use this number in carbohydrate counting.

Calories from Fat tell you how many of the calories in the food are from fat. Try to limit foods to about 3 grams of fat per 100 calories to keep the fat grams lower.

Aim for foods with less than 400 milligrams (mg) of sodium per serving. The general recommendation for Americans is to limit sodium intake to 2300 mg of sodium per day.

Ingredients are listed at the bottom of the food label so you know what your product is made of. Items are listed by weight, the first items being the recipe ingredients in the highest amounts (by weight). As you get towards the end of the ingredient list, there may be only a very little bit of that ingredient included in the product recipe. Even if the nutrition facts panel says zero grams trans fat, if “partially hydrogenated” oils or fats are included in the ingredient list, there are trans fats lurking in that product. Try to avoid products with trans fats.

Sources:
http://www.choosemyplate.gov/about.html
http://www.sparkpeople.com/resource/nutrition_articles.asp?id=1588

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Seven Self Care Behaviors- Being Active

With regular and appropriate exercise, blood sugar levels can be lowered. Exercise has the additional benefit of lowering cholesterol, decreasing weight, increasing muscle, strengthening the heart, and improving circulation. Exercise and weight loss for people living with prediabetes may help delay the onset of type 2 diabetes. Always discuss with your doctor and/or diabetes educator about before changing or starting a new exercise plan.

It is recommended that Americans get at least 150 minutes of physical activity per week, which doesn’t have to be done all at once. Splitting up your total activity goal into 10-minute segments of moderate activity is just as effective. Use the talk test to see if you are getting your heart rate up enough. If you cannot say a sentence without gasping for air, you should decrease your intensity. If you can say a whole paragraph with ease, you should increase your intensity.

Helpful Tips for a Successful Exercise Routine:

  • Choose an enjoyable activity.
  • Begin slowly and gradually build up endurance over time.
  • Prepare for low blood sugars – bring your blood sugar meter and have a quick-acting carbohydrate ready!
  • Wear or carry diabetes identification.
  • Drink plenty of water before, during, and after the activity.
  • Ward comfortable, loose clothing.
  • Wear proper shoes and cotton socks. Change out of wet socks as soon as your exercise routine is completed.
  • Inspect your feet before and after exercise and use proper first-aid if any cuts or blisters are found.
  • If you use insulin, inject insulin in a body part you will not be using during your exercise routine for that day.
  • Avoid exercising during insulin’s peak effect to avoid low blood sugar events.
  • Never exercise if your blood sugar is 250 mg/dl or more or if you have ketones present in your urine.

Physical activity does not mean you have to go to a gym. You can:

  • Join a walking group
  • Bike ride with family or friends
  • Walk the dog
  • Do housework or yard work
  • Try using a stationary bike while watching television
  • Use a workout video
  • Walk for 10 minutes of your lunch break
  • Dance in your living room
  • Try low-impact activity such as water aerobics
  • Stretch it out at yoga
  • Canoe, row, or kayak
  • Participate in a pickup game of basketball, softball, or soccer
  • Enjoy a nature walk

Sources:
http://www.cdc.gov/physicalactivity/everyone/guidelines/adults.html
http://www.choosemyplate.gov/physical-activity/increase-physical-activity.html

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Self-care Behaviors: Monitoring

When your blood sugar is within normal range, you will feel better and you will also reduce the risk of developing long-term complications from diabetes. It is important to check your blood sugar regularly to determine if it is within range. Depending on the type of diabetes and medications someone might be taking, different people are recommended to check their blood sugar at different times of the day. Your physician and certified diabetes educator will recommend a blood sugar monitoring plan for you.

Blood sugar monitoring gives a snapshot of your current blood sugar at that point in time. It also helps you analyze how your body responds to many things including certain foods, medication, exercise, illness, and stress. Your doctor will also give you a target blood sugar range that is best for you.

If your blood sugar is too high:

  • Drink water
  • Exercise (but not if blood sugar is above 250 mg/dl)

If your blood sugar is too low:

  • Eat or drink 15 grams of a fast acting carbohydrate, such as juice, regular soda, or hard candy. Recheck blood sugar 15 minutes later. If blood sugar has not risen to a safe range, repeat and consume another 15 grams of fast acting carbohydrate.
  • Call your healthcare provider if you see a pattern of low or high blood sugars at the same time each day. If your blood sugar is high or low at the same time for 3 days in a row, your physician may want to make changes in your medication regimen.

The hemoglobin A1c test is an excellent tool for determining someone’s average blood sugar levels over the last three months. Monitoring blood sugar on a personal blood glucose meter will tell one’s levels at that point in time, like a photo snapshot. The hemoglobin A1c test will display an average blood sugar, which takes all the snapshots and represents the entire photo album from the last 3 months. The A1c test is used for diabetes diagnosis, as well as diabetes management. It should be checked every 6 months, with some people needing checks every 3 months.
It is also important to monitor other lab values important for diabetes care, such as your blood pressure and cholesterol numbers. Know your ABC’s: A1c, Blood Pressure, and Cholesterol!

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Self-care Behaviors: Medication

For many people with diabetes, taking medication is an important part of their diabetes management. Taking medication in combination with healthy eating and physical activity helps to keep blood glucose levels in target ranges. This can reduce the risk of developing diabetes complications.

Depending on what type of diabetes you have and other risk factors present, your healthcare providers will decide which medications you should be taking. A person with type 1 diabetes always has to take insulin injections or have insulin delivered through an insulin pump. A person with type 2 diabetes may manage their diabetes with meal planning and exercise alone, with oral medications, and/or with insulin. Taking one particular type of medication does not mean a person’s diabetes is “better” or “worse”. Your physician will prescribe the best medications for your present situation. Diabetes is a chronic disease, so it is very common for people to need more or different types of medications over time.

Diabetes medications work in different ways. Some medications help the body’s cells to be more sensitive to the insulin; some medications keep the liver from producing too much glucose; some medications work to signal the pancreas to make and release more insulin; and some medications work on other organs such as the kidneys. It is important for you to talk with your doctor and/or pharmacist about what medications are right for you. Always be sure to ask about and share any concerns you have about medication side effects.

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Self-care behaviors: Problem Solving

It may sound simple, but being good at problem solving is an important diabetes management skill. A person has to be prepared for unexpected events that might disrupt his or her diabetes management or make it more challenging. For example, knowing what to do when a person is sick to manage their blood sugars is an example of problem solving. Planning ahead for meals when on the go or traveling is another example of problem solving. A diabetes self management class and working with a certified diabetes educator or registered dietitian can help people with diabetes strategize for challenges in their diabetes management.

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Self-care behaviors: Healthy Coping

Living health with diabetes means not only taking care of your physical health, but your emotional health as well. Managing stress, avoiding burnout, and recognizing depression are important parts of your emotional health.

Stress Management: Managing stress is important because stress can raise your blood sugar levels. It is important to learn how to identify causes of stress for you and find ways to manage or eliminate that stress if possible.

Avoiding Burnout: Living with a chronic disease can be challenging. It can feel like a burden to have to think about your diabetes everyday and that can leave you feeling burned out. Some of the same skills used to manage stress such as physical activity, spiritual practices like meditation or prayer, engaging in activities you enjoy, and getting support can help you overcome feeling burned out.

Depression: Every person has days when they feel sad, discouraged or unmotivated, but when those feelings last for days and weeks, a person may be having symptoms of depression. Symptoms of depression can include: feelings of hopelessness and helplessness, lack of energy, changes in sleeping or eating patterns, and thoughts of suicide or self-harm. Being depressed can affect how motivated you are to care for your diabetes. Depression is a very treatable condition! If you are experiencing any of the symptoms of depression above, talk to your doctor right away.

Take a diabetes self-management class or join a diabetes support group to learn more about healthy coping!

Atlanta Support Groups List (click to download)

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Self-care behaviors: Reducing Risk

The goal in managing your diabetes is to enable you to enjoy a long, healthy life with as few complications as possible! In order to reduce the risk of diabetes complications, there are a number of preventative care actions for you to take.

  • Stop Smoking – There are free smoking cessation programs out there to assist you. Talk with your doctor if you need assistance.
  • Get regular check-ups, including annual visits with your primary care doctor or endocrinologist. Also seek out preventative services such as a yearly dilated eye exam, yearly foot exam (or as needed), and dental cleanings every 6 months.
  • Conduct daily foot inspections to check for any cuts, bruising, or blisters so you can treat them quickly.
  • Know your numbers! If you go to a doctor’s visit, it is likely that they are collecting numbers that are important for your diabetes management. Ask for a copy of these numbers to be sent to you after your visit, and request that a nurse call to explain the results. Create a file folder to store these records properly in case you need to refer to them in the future.
    • Hemoglobin A1c
    • Blood Pressure
    • Cholesterol
    • Microalbumin (to test for kidney function)
  • Check your blood sugar at home as instructed by your physician. Remember to rotate which finger you use to prevent scar tissue build up in your fingers.
  • Take medications on time as instructed by your physician and pharmacist. If the instructions just say to “take twice daily”, ask questions! Do I take both pills at once or one in the morning and one in the evening? Do I need to take them at specific times or with/without food? Do any other medications or foods interfere with how this medication works?

Remember, 99% of diabetes care is done by YOU! It is up to you to keep a schedule of your annual visits and medical records. If you know where you stand with your diabetes management, then you can make any needed changes. Knowledge is power

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