Your Journey to

Diabetes Wellness
A Diabetes Education Manual

TriHealth.com/diabetes
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Dear Patient,

Thank you for choosing TriHealth for your diabetes care. We strive to provide
excellence in prevention, identification and management of diabetes across the
TriHealth system.

Our team works together to ensure that every patient with diabetes is provided
state-of-the-art care every time. Everyone from our doctors and nurses to our
testing centers and doctor offices works hard to do everything we can to help you
return to and maintain good health.

This book is a tool packed with information you need to help manage your diabetes.
Your nurses and diabetes educators will work with you to get the most out of this
book, and then we encourage you to use it at home as an ongoing reference.

We wish you the best in your journey as we work together to help you live a healthier
life.

Sincerely,

The doctors and staff of the TriHealth Diabetes Team

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Your Diabetes Care Team Members

Jimmy D. Michael Jyothi Elie

Alele, MD Heile, MD Joseph-Hayes, MD Klam, MD
Endocrinology Family Medicine Endocrinology Endocrinology
Anderson Western Hills Kenwood Clifton
513 246 7000 513 389 1400 513 246 7004 513 246 7004

Padma Fumie Jill Michael Timothy

Mangu, MD Nishiyama, MD Webb, MD Williams, MD
Endocrinology Endocrinology Endocrinology Endocrinology
Mason, Western Hills Norwood Anderson
West Chester 513 246 7004 513 977 6700 513 528 5600
513 246 7004

Julie Burns, Lindsey Neese, Elissa Pleshinger,

BSN,RN,CDE MSN, RN, ACNS-BC MSN, RN ACNP-BC
Lead Diabetes Diabetes Diabetes
Educator Bethesda North Good Samaritan
TriHealth Hospital Hospital
513 865 4596 513 865 5568 513 862 5051
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What is prediabetes? Risk factors for prediabetes and type 2 diabetes:

 Over 45 years of age
Prediabetes is a serious health problem that
increases the risk of having type 2 diabetes, heart  Overweight
problems and stroke. Prediabetes means that your  Have a parent or sibling with diabetes
blood sugar is high but not so high that it is
considered to be diabetes. A blood sugar checked  Race: African‑American,
first thing in the morning before you have eaten is Hispanic/Latino, Indian‑American,
called a fasting blood sugar. A normal fasting blood Asian‑American or Pacific Islander
sugar is less than 100.  Polycystic ovary disease, gestational
A fasting blood sugar between 100 and 125 is diabetes or gave birth to a baby
considered prediabetic, or the doctor may say you weighing nine pounds or more
have impaired fasting glucose.
 Physically active fewer than three
A lab value called a hemoglobin A1C is considered times a week
normal if it is less than 5.7%. An A1C between 5.7%
It is important to screen early for prediabetes and
and 6.4% is considered prediabetic. An A1C of 6.5%
type 2 diabetes because early treatment can prevent
or higher is considered to be diabetic.
serious problems that diabetes can cause, such as
The Centers for Disease Control and Prevention blindness, nerve damage or kidney damage. Talk to
(CDC) estimates that one in every three adults has your doctor about testing.
prediabetes. That is 88 million people!
Most people living with prediabetes do not What is diabetes?
know they have it.
Diabetes is a disease in which you have too much
Without lifestyle changes to improve health, 15% to sugar in your blood (hyperglycemia). It is a lifelong
30% of people with prediabetes will end up with type disease that can lead to serious health problems.
2 diabetes within five years. With proper care of your disease, you can greatly
Losing 5% to 7% (10 to 20 pounds) of body weight reduce the risk of these health problems, which
and regular exercise can help prevent or delay type 2 include damage to your heart, blood vessels,
diabetes by up to 58% in people with prediabetes. kidneys, nerves and eyes.
Getting at least 30 minutes of exercise, such as brisk Normally, insulin moves sugars from food into the
walking, five days a week is important for overall cells, which the cells use for energy. The lack of
health. insulin or the lack of normal response to insulin
causes excess sugars to build up in the blood. The
cells are unable to use the sugar for energy. You may
be able to control your blood sugar with diet and
exercise. As diabetes progresses, some people may
need to add pills to control their sugar and some
people may need to use insulin shots.

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Type 1 diabetes is usually diagnosed in kids

and young adults and used to be called juvenile
What is gestational diabetes?
diabetes. Only 5% of people with diabetes have this Pregnant women who did not have diabetes before
form of the disease. In type 1 diabetes, they became pregnant, but who have high blood
the body does not produce insulin. The body breaks sugars during pregnancy, have gestational diabetes.
down the sugars and starches you eat into a simple Gestational diabetes is like type 2 diabetes- the
sugar called glucose, which it uses for energy. Insulin pancreas does not make enough insulin and/or the
is a hormone produced in the pancreas that the cells are less responsive to the insulin that is made
body needs to move glucose from the blood into the (insulin resistance). As a result, high blood sugar
cells develops. High sugar levels can cause problems for
of the body. With the help of insulin shots and other the unborn baby. About 2% to 5% of pregnant women
treatments, even young children can learn to develop gestational diabetes. Testing for gestational
manage their condition and live long, healthy lives. diabetes is done between the 24th and 28th weeks of
Type 2 diabetes is often linked to being pregnancy. Women with gestational diabetes have a
overweight and inactive. The amount of insulin three to seven times higher risk of getting type 2
produced by your pancreas has diabetes within five to 10 years. Your baby also has a
already decreased by 80% at the time you are greater risk of getting type 2 diabetes.
diagnosed. Your body still makes some insulin,
but your cells have become resistance to insulin Risk factors
(insulin resistance). You have a higher risk of gestational diabetes if
you have a family history of diabetes and/or one
or more of the following risk factors:
 You are obese (body mass
index (BMI) greater than 30)
 You had a prior pregnancy
with gestational diabetes
 You are pregnant at an older age
 Previous baby weighed more than 9 lbs.
 History of polycystic ovary syndrome (PCOS)
Current guidelines from the American Diabetes
Association recommend that women with
gestational diabetes have blood sugar testing
done 4 to 12 weeks after the baby is born and
every one to three years thereafter depending on
risk factors.
All women with a history of gestational diabetes
should exercise, eat healthy and work toward a
normal body weight to prevent type 2 diabetes.

Go to www.trihealth.com\diabetes for more

information on gestational diabetes
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Symptoms of high blood sugar

(hyperglycemia)
 Increased thirst
 Increased urination
 Increased urination during the night
 Weight loss (may be rapid)
 Frequent infections
 Tiredness
 Weakness
 Vision changes, such as blurred vision
 Fruity smell to your breath
 Stomach pain

Diagnosis
Diabetes is diagnosed when blood sugar  An oral glucose tolerance test (OGTT):
levels are too high. Your blood sugar level may A test commonly used during pregnancy.
be checked by one or more of the following Your blood glucose is measured at least
blood tests: one to three hours after you have last
 A fasting blood glucose test: You will eaten and then after you drink a glucose
not be allowed to eat for at least eight containing beverage. Because the
hours before a blood sample is taken. hormones that cause insulin resistance are
highest at about 24 to 28 weeks of a
 A random blood glucose test: Your pregnancy, an OGTT is usually done
blood glucose is checked at any time during that time. If you are at risk for
of the day, no matter when you last gestational diabetes, your doctor may test
ate. you for gestational diabetes earlier than 24
 A hemoglobin A1C blood glucose test: weeks of pregnancy.
Provides information about blood
glucose control over the previous three
months.

Hemoglobin A1C 6 7 8 9 10 11 12 13 14 15

Average
Blood Sugar 126 154 183 212 240 269 298 326 355 384

5.7% 6.4% = Prediabetes, Greater than 6.5% = Diabetes

The American Diabetes Association recommends an A1C of less than 7% for most people.

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Checking blood sugar

Checking your blood sugar (blood glucose) Some meters may allow alternate site testing-
is important. Changes in blood sugar are areas other than the finger- such as the fleshy
common and can vary greatly throughout part of the hand, the forearm, the outer thigh, the
the day depending on your diet, activity calf or the stomach. Talk with your doctor or
and medications. pharmacist to see what meters and supplies are
covered by your insurance. If you do not have
 Write your blood sugar results in your diary insurance, store brand meters and supplies are
every day.
usually less costly.
 Take the diary with you to your
regular What are the blood sugar targets for people
 Your care team will review and discuss with diabetes?
your results with you. The targets recommended by the American
Diabetes Association are listed below.
 Your doctor may adjust your medicine if
your blood sugar is too high.  When I wake up and before
meals: 80 to 130 mg/dl
 The diary will also help you see how your
meals, activity and medications work  Two hours after starting a meal:
together to control your blood sugar. less than 180 mg/dl
 Controlling your blood sugar can delay or Check with your doctor and your health care team
prevent diabetes complications, such as to make sure these goals are correct for you.
heart attack, stroke or blindness.
When is the best time to check blood sugar
How do I check my blood sugar? and how often?
You will use a blood glucose meter to check Most people check after fasting (first thing in
your blood sugar several times a day. A meter the morning before they eat) and before other
is a small device that tests a tiny drop of blood meals. Your doctor may ask you to test your
and then displays your blood sugar level at that blood sugar after a meal (postprandial)
moment. A lancet is a device used to prick the when your blood sugar may be higher. Usually
skin to get the drop of blood. The results are a postprandial blood sugar is checked two
used to make decisions about food, physical hours after eating.
activity and medications. Other times you may want to test are:
Experts recommend using the side  When you have symptoms of high or
of the fingertip to get the most accurate result. low blood sugar
There are times that other sites should not be
used because the result may be less accurate.  When you are ill, especially if you
These times include: are throwing up or dehydrated

 If your blood sugar is likely to be low  Before, during and after exercise

 If you have trouble knowing your blood  Before you go to sleep

Your health care team can help you decide how
sugar is low (hypoglycemia unawareness)
often you should test.
 starting a
meal or if you have been physically active
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How do I know if my results are accurate?


doing your check.
 Keep your meter clean.
 Check test strips to make sure they
are not past their expiration date.
 Do not leave testing supplies in a
hot car or direct sunlight or in the
freezer.
 Make sure skin is clean and dry before testing.
 Make sure your blood sample is big enough.
 Check your meter with control
solution as recommended by the
manufacturer.
All meters have a 1-800 phone number on the
back in case you have questions about your
meter. Your doctor will write prescriptions for
your glucose meter and supplies. Insurance
pays part of the cost of meters and supplies.
Store brand meters and supplies may be less
expensive if you do not have insurance.

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Make exercise a permanent part of  Decreased appetite following exercise

your life  Lower heart rate and blood pressure

Exercise helps you lose weight and/or stay at a  A stronger heart muscle and better
healthy weight as well as improve your blood blood flow: the more you use your
sugar. It also helps your heart stay healthy. heart muscle, the stronger it becomes
For the person with diabetes, exercise is as  Better sleep at night
important as diet and medication. You should
 Stronger bones and a lower risk
get at least 30 minutes of physical activity that
of osteoporosis
increases your heart rate five days a week.
It is important to design a lifelong home  Better resistance to illness
exercise routine. Walking is one of the easiest  Improved cholesterol levels
and most convenient options, but there may be
 Lower stress, anxiety, boredom,
others you enjoy.
frustration and depression
Exercise should be continuous and rhythmical. The American Diabetes Association
recommends different types of exercise for
with
managing diabetes.
a regular, consistent program, you can expect
these rewards:
Aerobic
 Increased insulin sensitivity This exercise is done by using your arms and/
 Lower blood sugar levels or legs in a continuous, rhythmic movement
in order to increase your heart rate (pulse).
 More energy and endurance
(stamina) throughout the day Aerobic activities include:

 Improved appearance  Aerobics

A slimmer, trimmer body  Running
Better posture
 Dancing
 Weight loss (5-7% weight loss is
 Skating (ice or roller)
recommended for most people needing
to lose weight)  Biking/stationary biking
Less body fat  Hiking
Increased muscle tone
 Swimming
 Jogging/walking
 Rowing
Moderate intensity means that you are working
hard enough that you can talk, but not sing,
during the activity.
Vigorous intensity means you cannot say more
than a few words without pausing for a breath
during the activity.

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These types of exercise can make all the Exercise in the presence of
muscles in your body stronger. Pick an aerobic
uncontrolled blood sugars
exercise that you enjoy and set realistic goals.
This way, you will be more likely to keep doing High blood sugar
it on a regular basis. For people with type 1 diabetes who have
ketones in the urine and/or blood, exercise
Strength training can cause blood sugar and ketones to go up
Strength training (also called resistance training) further. Ketones are made when body fat is
makes your body more sensitive to insulin and broken down for energy because glucose is not
can lower blood sugar. The American Diabetes getting into the cells. Vigorous activity should
Association recommends doing strength- be avoided when your blood sugar is high and
training exercises at least two to three times there are ketones in your urine. Ketones are
per week in addition to aerobic activity. Some checked by dipping a strip in your urine. You
people have higher blood sugars after doing can exercise when your blood sugar is high as
strength training. It is a good idea to check your long as there are no ketones in your urine.
blood sugar before and after these exercises. (See section on sick-day plans.)
Below are examples of strength-training activities:
 Using weight machines or lifting free
weights at the gym
 Using resistance bands
 Lifting light weights or objects, such
as canned goods or water bottles,
at home
 Exercises that use your own body
weight to work your muscles, such as
pushups, sit ups, squats, lunges, wall‑sits
and planks
 Strength‑training classes Low blood sugar
 Other activities, such as heavy gardening, For people taking insulin and/or medications
that build and keep muscle such as glipizide or glyburide (insulin
secretagogues), exercise can cause low blood
Flexibility and Balance Training sugar if the medication dose or carbohydrate
Flexibility and balance training is recommended intake is not changed.
2-3 times per week in older adults. This
For people on these medicines, extra
includes activities like yoga and tai chi to
carbohydrates should be eaten if pre-exercise
increase flexibility, muscular strength and
sugar levels are 100 mg/dl or less.
balance.
Low blood sugar is less common in diabetic
patients who are not treated with insulin or
Be aware that exercise can lower blood sugar insulin secretagogues, and no preventive
quickly. Blood sugar should be monitored measures for low blood sugar is usually needed
before and after all exercise routines. in these cases.
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Hints for a successful

exercise program
 You should avoid prolonged sitting- get
up and move every 30 minutes.

 Talk with your doctor before starting any

exercise program.
 Set short and long term goals for yourself.
Reward yourself when you meet them.
 Exercise with music or in front of
the television.
 Wait one hour after eating before exercising.
 Pick an exercise you like that fits into
your lifestyle.
 Exercise with a friend for both safety
and motivation.
 Stop exercising and call 911 immediately
if you have any of these symptoms during, or
even several hours after, exercise:
Lightheadedness or dizziness
Rapid heart beat
Chest discomfort
Jaw, arm or upper back discomfort
Nausea
Unusual shortness of breath
Sudden weakness
Severe or unusual fatigue or
sleepiness
Severe discomfort of any kind

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Nutrition and diabetes guidelines

Healthy eating is the first step in taking care of your
diabetes. You do not need special foods or diet
foods. Food that is good for you is also
good for the whole family. The type of food and the
amount of food you eat every day will make a big
difference in your blood sugar levels.
 Eat three meals each day. At each meal,
add high fiber foods such as fruit,
vegetables, whole grains and beans. At
each meal, also have protein such as
chicken, lean beef or pork, cheese, fish,
eggs, nuts, peanut butter or soy products.
 Eat about the same amount of food at
each meal and at the same time each day.
 Use low-fat cooking methods such as
baking, roasting, broiling, grilling, poaching
Cut back on your portion sizes and try to
resist second helpings. or lightly stir-frying instead of deep‑
frying.
 Each meal should be eaten four or five
hours apart. Do not skip meals. If you have  When dining out, choose grilled or baked
to go more than five hours between meals, food. For example, order a baked potato
eat a small snack. instead of French fries. Take half of your
meal home from restaurants to help cut
 Be careful of how much carbohydrate you eat back on portion sizes.
at one time. Carbohydrates include starchy
foods (breads, pasta, rice, beans, peas, corn Carbohydrates
and potatoes), all fruits and juices, milk, snack
foods and sweets. Many of these are good When you have diabetes, you must limit the
foods amount of carbohydrates you eat because this
how much you eat of them at one time. is the part of your meal that affects your blood
sugar. A serving of carbohydrates is 15 grams.
 Beverages can make a big difference in
your blood sugars. Limit fruit juice and How much carbohydrates?
regular soda. Drink water, diet beverages or Finding the right amount of carbohydrates
other low sugar drinks instead. depends on many things, including how active
 Sweets and desserts can be worked into you are and what, if any, medicines you take.
your diabetes meal plan. For an individual Some people are active and can eat more
meal plan, see a registered dietitian. carbohydrates. Others may need to have less
carbohydrates to keep their blood sugar in
 Only drink alcohol (beer, wine and control. Finding your balance is important so
liquor) in moderation- one drink or less you can feel your best, do the things you enjoy
per day for women and two or less per and lower your risk of diabetes complications.
day for men. A standard alcoholic drink
is 12 ounces of beer, 5 ounces of wine or Most meals should contain 45 to 60 grams
1.5 ounces of liquor. Drinking alcohol of carbohydrates. You may need more or less
without food may cause hypoglycemia. carbohydrates at meals depending on how you
manage your diabetes.

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You and your health care team can figure out the Adults should eat 25 to 30 grams of fiber each
right amount for you. Once you know how many day. Fiber contributes to digestive health, helps
keep your bowels regular and helps make you
carbohydrates to eat at a meal, choose your food
feel full after eating.
and the portion size to match.
Good sources of fiber include:
Types of carbohydrates  Beans and legumes: black beans,
Starch kidney beans, pintos, chickpeas
Foods high in starch include: (garbanzos), white beans and lentils

 Green peas, corn, lima beans and potatoes  Fruits and vegetables, especially those
with edible skin such as apples and
 Dried beans, lentils, pinto beans, kidney those with edible seeds such as berries
beans, blackeyed peas and split peas
 Whole grains: whole-wheat pasta,
 Grains such as oats, barley and rice. Grain whole-grain cereal with three grams of
products such as pasta, bread and fiber or more per serving and whole-grain
crackers. breads
The grain group can be broken down even  Nuts: peanuts, walnuts and almonds are
further into whole grains or refined grains. all good sources of fiber and healthy fat
Whole grains contain the entire grain and are (watch portion sizes because they are
more nutritious than refined grains. also high in calorie)
Sugar Excellent source of fiber = 5 grams or more
Sugar is another type of carbohydrates. Sugar is per serving
sometimes called a simple carbohydrate. There are
two main types of sugar:
 Naturally occurring sugars such as those
in milk or fruit
 Added sugars such as those added during
processing such as fruit canned in heavy
syrup or sugar added to make a cake
On the nutrition facts label, the number of sugar
grams includes both added and natural sugars.
Added sugar adds no nutritional value.
Fiber
Fiber comes from plants. There is no fiber in
animal products such as milk, eggs, meat,
poultry and fish. Fiber is the indigestible part of plant
foods. Most dietary fiber passes through the
intestines undigested.
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Carb Counting
Reading food labels is a great way to know how many carbohydrates are in a food. For foods that
do not have a label, you have to estimate how many carbohydrates are in it. Keeping general
serving sizes in mind will help you estimate how many carbohydrates you are eating.

One Carbohydrate Choice or Serving

(15 grams of carbohydrates)
1 slice of high fiber bread (whole wheat) Three (4-inch) graham cracker squares
1 small fresh fruit (size of a tennis ball) ½ cup corn, peas, lima beans
½ small whole wheat bagel ½ cup sweet or mashed potatoes or yams
½ cup cooked unsweetened oatmeal ½ cup dried beans(cooked)
½ cup potatoes or 1/3 cup of pasta ½ cup regular/no added sugar ice-cream
½ whole wheat English muffin 4-6 whole wheat crackers
½ hamburger or hot dog bun 1/3 cup of rice
¾ cup unsweetened dry high fiber cereal 15 medium grapes
1 cup milk or 6 oz. of Lite yogurt 3 cups of low fat popcorn

Two Carbohydrate Choices or Servings

(30 grams of carbohydrates)
2 slices of whole wheat bread 1 hamburger or hot dog bun
8-12 whole wheat crackers
2/3 cup of whole wheat pasta 1 cup corn or peas
6 cups of low fat popcorn One cup sweet potatoes or yams
4 inch baked or sweet potato 1 cup cooked beans
1 whole wheat English muffin

Three Carbohydrate Choices or Servings

(45 grams of carbohydrates)
1 cup milk, ¾ cup unsweetened dry cereal 2 slices of whole wheat bread and 1 small
and 1 small banana fresh fruit
2/3 cup whole wheat pasta and ½ cup of ½ cup potatoes, ½ cup corn and 1 slice of
whole wheat bread
spaghetti sauce
½ cup cooked beans, 1/3 cup rice and 1 small
2 slices whole wheat bread and 1 cup of
corn muffin
vegetable soup

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Read the nutrition facts label

The nutrition facts label is the best tool for Serving size
shopping smart to manage your diabetes. Portion of food that gives the amount of
Be aware of serving sizes as well as total carbohydrates, fat and other nutrients listed
carbohydrate grams. This information will aid on the label.
in carbohydrate counting and keeping blood
sugars on target. Choose foods with lower Servings per container
amounts of saturated fat, trans fat, cholesterol The number of servings in that package of food.
and sodium to make your diet healthier, lower Calories
your cholesterol level and help reduce your The amount of energy you get from one serving
risk of heart disease. of that food. If you are trying to lose weight,
look for foods with less calories per serving.
Calories from fat
The amount of calories that come from fat in
one serving of that food.
Total fat
Total amount of fat grams in the serving size
that is listed on the label. This total includes
saturated, unsaturated and trans fats.
Saturated fat and trans fat
These are
tend to increase the chance of heart disease.
Strive for the least amount of saturated and
trans fats you can get from the foods you eat.
A healthy starting goal for most people is less
than 20 grams of saturated fat per day and less
than 2 grams of trans fat per day. Your doctor
may give you a more specific goal.
Unsaturated fat
ause they
tend to be more heart-healthy. These include
polyunsaturated and monounsaturated fats.
Cholesterol
Limit the amount of cholesterol in your food
to 200 mg per day.
Sodium
Limit the amount of sodium in your food
to 2,300 mg or less per day unless your doctor
gives you other instructions.

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Total carbohydrate Protein

Total amount of carbohydrate grams in the Be sure to eat the amount of protein your
serving size that is listed on the label. This doctor recommends. Use lean protein sources,
total includes dietary fiber, sugars and other such as skinless poultry, fish, low-fat dairy
carbohydrates. Focus on total carbohydrate, products and beans.
not on sugars. References
Dietary fiber 1. US Food and Drug Administration. Letter regarding sugar‑
Look for foods with at least 3 grams of fiber free claim. http://www.cfsan.fda.gov/~dms/lclmguid.html.
per serving. High-fiber, less-processed foods 2. American Heart Association. Choose Whole Grain,
are better for you and can even help you reach High Fiber Foods. http://americanheart.org/presenter.
your blood sugar and healthy weight goals. jhtml?identifier=3040347.
Sugars
This includes both natural sugars (as in fruits)
and added sugars (as in table sugar).
This is only a part of the total carbohydrate;
it is more important to focus on total
carbohydrate than on sugars.

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Low-calorie sweeteners The chart below lists the brand names seen in
stores for low-calorie sweeteners:
When you have diabetes, including sweets in your
For more information, visit the Food and Drug
diet requires careful planning. However, it can be
Administration website at fda.gov.
hard to save sweets for special occasions. Foods
and drinks that use artificial sweeteners are
another option that may help curb your cravings
for something sweet. However, they should be
used in moderation only*. Sweetener Brand Names
Name Found in Stores
Sometimes low-calorie sweeteners are also called
artificial sweeteners, sugar substitutes or non-
nutritive sweeteners. They can be used to sweeten Acesulfame Sunett
food and drinks for fewer calories and carbohydrates potassium Sweet One
when they replace sugar.
The sweetening power of most low-calorie Aspartame Nutrasweet
sweeteners is at least 100 times more intense than
Equal
regular sugar, so only a small amount is needed
when you use these sugar substitutes. Neotame N/A
Also, with the exception of aspartame, all of the
sweeteners listed cannot be broken down by the
Saccharin
Sweet Twin
body. They pass through our systems without being
Sugar Twin
digested so they provide no extra calories.

- Sucralose Splenda

Still, many foods containing low-calorie sweeteners Stevia/ Sweet Leaf

will provide some calories and carbohydrates from rebaudioside Sun Crystals
other ingredients. That means foods that carry claims Steviva
such as - Truvia
re not necessarily carbohydrate-free or PureVia
lower
in carbohydrates than the original version of the
food. A food that contains no more than
0.5 grams of sugar per serving may be labeled as
* Overall, people are encouraged to replace sugar
- sweetened and artificial beverages with water.
Always check the nutrition facts label for total grams
of carbohydrates per serving. Sugar-free products
may also have sugar alcohols in them, which are
used in place of sugar to sweeten foods. Sugar
alcohols are carbohydrates,
but they are digested more gradually than regular
sugar. Foods containing sugar alcohols may cause
diarrhea or stomach cramps, especially if eaten in
large portions.
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Seven ways to size up your servings

Measure food portions so you know exactly how much food you are eating. When a food scale or
measuring cups are not handy, you can still estimate your portion.

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Family-friendly recipes Apple-Cherry Cinnamon Oatmeal

Makes 2 servings
to get you started
Ingredients
1 cup water
Breakfast recipes 1/4 cup apple-cherry juice
(less than 35 grams of carbohydrates per serving)
2/3 cup old-fashioned oats1
tsp. ground cinnamon
Bran Flake Muffins
1 cup 1% low‑fat milk
Makes 10 servings

Ingredients Directions
Nonstick cooking spray 1. Combine water and apple‑cherry juice
1 cup bran flakes cereal in a small saucepan.
3/4 cup 1% milk
1 egg 2. Bring to a boil over high heat; stir in oats
1/4 cup margarine, melted and cinnamon.
1 cup flour
2 1/2 tsp. baking powder 3. Return to a boil, then reduce heat to low
1/2 tsp. salt and cook until thick, about 2 minutes.
1/4 cup sugar
4. Spoon oatmeal into two bowls. Pour 1/2 cup
Directions milk over each serving.
1. Preheat oven to 400 degrees F. Coat 10
muffin cups with nonstick cooking spray. Nutrition information per serving:
190 calories, 9 g protein, 35 g carbohydrate,
2. Combine bran flakes and milk: let sit for 5 3 g fat, 4 g dietary fiber, 60 mg sodium
minutes until cereal is soft.

3. Stir in egg and margarine. Mix in flour,

baking powder, salt and sugar, stirring
until combined.

4. Fill 10 muffin cups.

5. Bake for 30 minutes, until toothpick or

knife inserted into center of muffin comes
out clean.

Nutrition information per serving:

130 calories, 3 g protein, 19 g carbohydrate,
5 g fat, 1 g dietary fiber, 280 mg sodium
A diabetic diet is a healthy diet that anyone can
benefit from.
Lindsey Neese and Elissa Pleshinger,
Diabetes Advisory Team

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Cinnamon Oatmeal Pancakes Lunch and dinner recipes

Makes about 10 servings (less than 40 grams of carbohydrates per serving)

Ingredients Chicken and Vegetable Quesadillas

1 1/4 cups flour
Makes 4 servings
1 tsp. baking powder 1/2
tsp. salt Ingredients
1 tbsp. cinnamon 1/4 cup nonfat sour cream
1 egg 1/4 tsp. chili powder
1 1/2 cups cooked oats 1/2 4 medium whole-wheat tortillas
cup evaporated milk 1/4 cup 1/2 cup cooked chicken, cut in small pieces
water 1/2 cup chopped tomatoes
Nonstick cooking spray 1/2 cup pinto beans, drained and rinsed
1/2 cup frozen or canned corn
Directions 1/2 cup reduced-fat cheddar cheese, shredded
1. Mix flour, baking powder, salt and cinnamon in a 1/4 cup sliced black olives
large bowl. Salsa, chopped lettuce and extra sour cream
(optional)
2. In a separate bowl, combine egg, oats, milk and
water, and stir well. Directions
1. In a small bowl, combine sour cream and
3. Stir the oatmeal mixture into the flour chili powder; set aside.
mixture, and stir until combined.
2. Spread about 1 tablespoon seasoned sour
4. Heat a large skillet coated with nonstick cream on each tortilla. Place desired filling
cooking spray over medium heat. ingredients on half of each tortilla. Top with
about 2 tablespoons of cheese.
5. Pour large spoonfuls of batter into the skillet. Cook
until bubbles appear on the tops of the pancakes, 3. Fold tortilla in half; place in a hot
about 2 to 3 minutes. Flip over and cook an nonstick skillet.
additional 2 minutes, or until golden brown and
cooked through. 4. Cook until tortilla starts to turn golden
brown. Using spatula, carefully flip tortilla;
6. Serve warm by themselves or top with cook until the other side is golden brown
canned or fresh fruit. and cheese is melted. Return to plate and
cut in half to serve.
Nutrition information per serving:
120 calories, 4 g protein, 20 g carbohydrate, 2 g 5. Serve immediately with salsa, chopped
fat, 1 g dietary fiber, 190 mg sodium lettuce and extra sour cream, if desired.

From diabetes.org Nutrition information per serving:

239 calories, 22 g protein, 33 g carbohydrate,
4 g fat, 4 g dietary fiber, 425 mg sodium

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32 21

Lentil Chili, Cincinnati-Style Rainbow Veggie Salad

Makes 6 servings (1 cup per serving) Makes about 10 servings

Ingredients Ingredients
1 tbsp. olive oil 1 can (15 ounce) low sodium black
1 1/2 cups chopped onion, fresh or frozen 2 beans, drained and rinsed
stalks celery, chopped 1 can (15 ounce) low sodium red kidney
1 cloves garlic, minced 1/4 beans, drained and rinsed
tsp. cinnamon 3 carrots, scrubbed and sliced
1/4 tsp. ground cloves 1 tsp. 1 small yellow squash, washed and
ground cumin sliced
4 cups reduced sodium vegetable broth 1 cup 1 small green squash (zucchini),
lentils, washed washed and sliced
1 cup carrots, chopped ½ cup light Italian dressing
1/4 tsp. ground black pepper ½ teaspoon black pepper
1 can (14.5 ounce) diced tomatoes
Directions
Directions 1. Mix all the beans and vegetables in
1. In a large saucepan, heat oil for 1 to 2 minutes. a large bowl.
Add onions and celery; sauté until onions are
tender, about 5 minutes. 2. Pour dressing over the vegetables.

2. Reduce heat; add garlic, cinnamon, cloves and 3. Sprinkle with pepper.
cumin. Cook for 1 minute. 4. Stir gently, coating ingredients.
3. Add broth, lentils, carrots and black pepper; bring 5. Cover and refrigerate at least 8 hours.
to a boil. Reduce heat, cover and simmer for 40
to 50 minutes or until lentils and carrots are soft. Nutrition information per serving:
100 calories, 7 g protein, 6 g carbohydrate,
4. Add tomatoes with juice; cook another 10 5 g fat, 6 g dietary fiber, 190 mg sodium
minutes until soup is hot throughout.

5. Adjust seasonings to taste. From diabetes.org

Nutrition information per serving:

204 calories, 12 g protein, 35 g carbohydrate, 3 g
fat, 8 g dietary fiber, 0 mg cholesterol, 427 mg
sodium

From Nutrition Council

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34

Taking diabetes medications

Medications may be needed to help you reach your Your insulin dose depends on your blood
blood sugar goals. You and your doctor should sugar results, activity level and meals. Your
discuss your blood sugar goals based on your doctor or diabetes educator can help you learn
overall health, lifestyle and personal wishes. All how to adjust your insulin dose.
medications should be taken as ordered by the
doctor. Call your doctor if you think your diabetes Type 2 diabetes
medicine is not working right or if it is having In type 2 diabetes, the pancreas is not able to
adverse effects. make enough insulin and/or the insulin does
You must test your blood sugar regularly. Your not work well to control blood sugar. People
doctor or diabetes educator will help you decide with type 2 diabetes need to check their blood
how often to test your blood sugar. Your doctor sugar. Your doctor or diabetes educator will tell
will adjust your diabetes medications based on you how often to do so.
your blood sugar results. Always take your meter Some people with type 2 diabetes are able
or a record of your blood sugar results with you to control their blood sugar by balancing
what they eat with how active they are, but
You may need to take more than one medicine. many people need to take pills and/or insulin.
These can be pills, insulin or both. You may take Diabetes pills work in different ways. They help
more than one type of insulin. Bring all the your body make more insulin, help your cells
medications you are taking to all use insulin or help your kidneys remove sugar
appointments. from your body.
It is important to have a plan for sick days. Your You should take your medicine exactly as your
insulin dose may need to be changed while you doctor tells you. You should know when to take
are sick. If you take pills to control your blood your pills, how many to take and how often
sugar, continue to take your medications. (see you are supposed to take them.
section on sick-day plans). Pills alone may not be enough to lower your
blood sugar to meet your goal. Some people
Type 1 diabetes with type 2 diabetes need to take insulin to
People with type 1 diabetes must take insulin lower their blood sugar even though they have
because their pancreas does not make any insulin. worked hard at eating and exercising right.
They need to inject insulin to live. There are different
types of insulin. Your doctor will help you decide
which type of insulin will be best for you and your
lifestyle. Remember to be flexible because your
insulin type and dose may need to be changed at If you are struggling to pay for insulin
times.
or know someone who is, the ADA
has resources to help visit
InsulinHelp.org.

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 23
23

Insulin use Intermediate-acting or NPH insulin: This

Insulin is injected under the skin, which is type of insulin takes one to three hours to start
called a subcutaneous injection. Insulin cannot lowering blood sugar and lasts 12 to 16 hours.
be given in pill form because the acid in the It is usually taken before breakfast and in the
stomach destroys insulin. Insulin may be given evening.
continuously by an insulin pump Premixed: This type of human insulin is
(see section on insulin pumps). a combination of regular insulin and NPH
insulin. It is taken twice daily, usually 30
Different types of insulin minutes before breakfast and 30 minutes
There are many types of insulin. Insulin is before dinner.
divided into types based on how it is made.
There is human insulin and analog insulin. Analog insulin
Human insulin is the same as the insulin Fast-acting: This type of analog insulin starts
produced in your pancreas. Analog insulins to work in 15 minutes. It is usually taken right
are slightly different than human insulin, which before a meal is eaten.
allows them to work faster or slower than Novolog, Humalog, Apidra or Fiasp
regular human insulin. Human and analog
Long-acting: This insulin works slowly for
insulins are divided into types based on how
24 hours in your body. It is used to control
fast they begin to lower blood sugar (onset)
your blood sugar between meals and while you
and how long they continue to work in the
sleep. It should be taken at the same time every
body (duration).
day because it works for 24 hours.

Human insulin Levemir, Lantus, Basaglar, Toujeo or Tresiba

Short-acting or regular insulin: This Premixed: This is a combination of fast and
type of insulin takes 30 minutes to start intermediate acting analog insulin. It is taken
working to lower blood sugar and lasts five twice daily, usually 30 minutes before
to eight hours. It is usually taken 30 minutes breakfast and 30 minutes before dinner.
before meals.
24

Currently available insulins

Insulin
Therapy Name Administration Onset, Peak Duration Considerations
Fast Acting
Lispro Usually given Onset 5 – 15 Less than 5 hours Usually taken with
Humalog 2-4 times per day minutes food
(U100 & U200) (Fiasp is 2.5 minutes)
Ademelog
To be given Can be used in insulin
Aspart No more than 15 pumps- Fiasp not
Peaks 30-90 minutes
Novolog, Fiasp minutes before approved for pumps
after injection
(ultra fast) meal
Glulisine
Apidra
Short Acting
Regular Usually given Onset 30-60 5-8 hours When mixing, draw
Humulin R 2 times per day minutes up Regular insulin
Novolin R No more than 30 first
minutes before Peaks 2-3 hour after
meals injection Cloudy appearance
Combination Effect
Mix of NPH & 5-15 minute onset 10-16 hours Numbers in name
Usually given
Humalog or Dual Peaks give percentage of
2 times per day
Novolog insulin (70% NPH,
70/30, 50/50, 75/25 etc.)
Mix of NPH &
Cloudy appearance
Regular
50/50, 70/30
30-60 minute onset 24 hours Give before meals
Usually given
Mix of Degludec & Dual Peaks
1-2 times per day
Aspart
Ryzodeg Mix 70/30
Intermediate Acting
NPH Usually given 2-4 hour onset 10-16 hours Cloudy
Humulin N 1-2 times/day 4-10 hour peak
When mixing, draw
Novolin N
up Regular then NPH
Long acting insulin
Glargine Given 1-2 times/day Onset 2-4 hours 20-24 hours Monitor for low
Lantus, Basaglar, No Peak blood sugar at any
Toujeo (U300) In general, this long time
acting insulin is 6-24 hours
Detemir Onset 3-8 Hours
never held. DO NOT mix with
Levemir No Peak
other insulin
Degludec Onset ~1 hour Up to 42 hours
Tresiba No Peak
(U100 & U200)
Humulin R Unit-500
Concentrated insulin Given 2-3 times per Onset 15 minutes 13-24 hours For patients that
day Peak 6 hours need more than 200
To be given no more units of insulin per
than 30 minutes day
before meal

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 25

How to inject insulin Where you inject insulin can make a difference
Insulin comes in bottles in how quickly the insulin is absorbed from
(vials) or in prefilled under the skin into the blood. For example,
insulin pens. Insulin injecting insulin into your thigh when you have
syringes are used to give been exercising your legs may cause the insulin
to be absorbed more quickly.
insulin from a bottle. The syringe is a tube that
has a needle on one end and a plunger on the
other. The needle is pushed through the
rubber stopper on the insulin bottle after
cleaning the stopper with an alcohol swab.
The plunger is pulled back to the right amount
of insulin to draw the insulin into the tube part
of the syringe.
Insulin pens are prefilled with insulin. They look
like writing pens with a cap. A needle, called
a pen needle, is placed on the end of the pen
before each insulin dose. Be sure to remove
BOTH caps from the pen needle. The amount
of insulin is chosen by turning a dial. Not all
insulin types come in pens. Pens may be more
expensive than insulin in vials. There are other
medicines for diabetes that are also injected
under the skin, which also come in pens.
You and your doctor will decide whether an
insulin pen or bottle and syringe are best for Side effects of insulin
you. Always read the label on the insulin bottle Hypoglycemia (low blood sugar) is a side effect
or insulin pen to be sure you have the right of insulin. Hypoglycemia is a blood sugar less
type of insulin. than 70 mg/dl.
Hypoglycemia can occur when you missed
Where to inject insulin
a meal or ate too few carbohydrates, increased
Insulin can be injected into your: activity, or took too much insulin or too much
1. Abdomen (belly) except for a 2 inch of certain diabetes pills.
circle around your belly button. Signs and symptoms of hypoglycemia
2. Thighs (top and outer parts) are shakiness, sweating, dizziness, unusual
3. Backs of upper arms hunger, confusion or changes in behavior,
feeling weak or tired, headaches, or feeling
You may inject insulin into the same area of nervous or upset. You may have several of
the body each day but not in the exact same these signs and symptoms. If the low blood
spot. Injecting insulin in the same spot every sugar is not treated, you may pass out
time can cause scars or hard lumps to form
(see section on hypoglycemia for how to
under the skin.
treat low blood sugar).
26

Storing insulin and other diabetes tips  Do not use insulin or other diabetes
Injectables injectables after the expiration date on the
 Follow the instructions that come with the label.
insulin or injectable product.  Once insulin and other diabetes
 Keep new, unopened boxes in the refrigerator injectables have been opened, it is good
but not where they might freeze. for a shorter length of time than the
expiration date. See chart below and read
 Do not freeze insulin or other diabetes
label to confirm.
injectables. If accidently frozen, throw the
insulin or other injectable out because it is no  Do not use insulin that has changed colors
longer good. or has flakes or clumps floating in it.

 Most insulin and other diabetes injectables may  Do not use your insulin if it is normally
be stored at room temperature after they have clear but has become cloudy.
been used for the first time. Check the
instructions to be sure. How to dispose of needles, syringes and
lancets
 Keep insulin out of bright light or sunlight.
Needles, syringes with needles and lancets are
 Do not store insulin or other diabetes injectables in called sharps. Loose sharps should not
the car or other places that get hot. be thrown away in the trash. In Ohio and
sharps should be placed in a hard, leak proof
container that is hard to poke a holein and

Insulin Vials Storage

Apidra, Ademelog, Humalog, Humalog 75/25, Humalog
50/50, Humulin R, Humulin N, Humulin 70/30, Lantus, 28 days
Novolog, Novolog 70/30
Regular (concentrated) U500 40 days
Levemir, Novolin R, Novolin N, Novolin 70/30, 42 days

Insulin Pens
Humulin 70/30, Humalog 75/25, Humalog 50/50 10 days
Humulin N, Novolin N, Novolog 70/30 14 days
Apidra, Ademelog, Basaglar, Fiasp, Humalog, Lantus,
28 days
Novolin R, Novolog, Fiasp, Regular U500, Ryzodeg
Levemir, Toujeo 42 days
Tresiba u-100 and u-200 56 days

Other Injectables
Trulicity 14 days
Bydureon, Byetta, Symlin, Victoza, Ozempic 30 days

Note: All UNOPENED products should be stored in refrigerator and are good until expiration date on label.
Guidelines above are for products at room temperature or in refrigerator OR unopened at room temperature.

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 27

has a tight lid. Detergent bottles, bleach bottles, two- Some people cannot take metformin because
liter bottles, plastic juice containers and coffee cans their kidneys or heart do not work well.
with the lid taped to the can work as containers for Metformin may be stopped if you are in heart
sharps. Write the failure because it can cause a serious medical
container in big letters. You can also buy containers problem called lactic acidosis. Lactic acidosis
that are made to hold sharps. Safe sharps containers is when lactic acid builds up in the blood faster
can be placed in the trash. than it can be removed. Lactic acid is produced
when oxygen levels in the body are low.
For more information about disposal of sharps,
contact your local health department. Insulin secretagogues
Work by stimulating insulin release
Oral medications (pills) for type 2 diabetes
Meglitinides: Take these medications one
There are many options for oral diabetes
medications. These pills work in different ways to 30 minutes before meals to control your
to lower blood sugar. blood sugar. Repaglinide (Prandin),
Nateglinide (Starlix)
Biguanides Sulfonylureas: They are taken once or
Work by reducing production of sugar in the twice daily, 30 minutes before meals. If you
liver are allergic to sulfa, you usually cannot take
Metformin (Glucophage, Glucophage XR, a sulfonylurea. Glipizide (Glucotrol, Glucotrol
Glumetza, Fortamet): This medicine given to XL), Glyburide (Diabeta, Micronase), Glyburide
lower blood sugar in type 2 diabetics. micronized (Glynase), Glimepiride (Amaryl)
Metformin may help with weight problems Both meglitinides and sulfonylureas can
because it helps the body use insulin better. cause low blood sugar if not balanced with
It can cause nausea or diarrhea in some people, but carbohydrate intake and exercise. They may
the nausea and diarrhea usually go away soon. also cause weight gain.
Taking metformin with food helps, so take it with
meals. It is usually given two or three times daily.
28

Thiazolidinediones (glitazones) Combinations

Work by helping your body respond better to Sometimes two diabetic medications are
insulin combined in a single pill.
Periodic liver blood tests are needed. They may These combination medicines work like both
cause or worsen heart failure notify your doctor if medicines in the pill and reduce the number of
you gain weight or notice swelling in your legs, pills needed. They can be costly and may not
ankles, feet, arms, hands or belly. They can be taken be covered by insurance. If you are prescribed
with or without food. a combination pill, discuss how it works with
They may increase the risk of bladder cancer and your doctor or pharmacist.
bone fracture. Rosglitazone (Avandia),
Pioglitazone (Actos) Non-insulin medications that
Alpha-glucosidase inhibitors
are given as injections
Work in your stomach and bowels to slow Synthetic amylin
down the absorption of sugars and Work by slowing the rate of movement of food
carbohydrates from the stomach to the intestine and tells the
They can cause abdominal pain, gas and diarrhea. liver to decrease glucose output
Take with the first bite of food at each meal. Take right before a big meal. It is used
Acarbose (Precose), with insulin for the treatment of type 1 and
Miglitol (Glyset) type 2 diabetes. Pramlintide (Symlin)

SGLT-2 inhibitors Incretin mimetics

Work by increasing the amount of sugar leaving the Works by causing your pancreas to release
body in the urine insulin when blood sugar is rising
Take once daily. These medicines may lower your Incretin is a natural hormone made in your
blood pressure. These medicines act as water pills digestive tract. Incretin mimetics act like
(diuretics). If you are on a water pill already, the (mimic) the incretins in your body that lower
dose of your water pill may need to be reduced. blood sugar after eating. They may cause
Have your kidney function tested before starting nausea and vomiting, which usually resolves
this medication. These medicines may cause soon after the medication is started. Tell your
modest weight loss and lower blood pressure. They doctor if you have abdominal pain (pain in your
may also cause urinary tract infections or yeast belly), nausea and vomiting. They can cause
infections. The medications have caused diabetic some modest weight loss. These medicines are
ketoacidosis even though blood sugar is 250mg/dL approved for treatment of type 2 diabetes.
or less. They should be avoided if you have a personal
Canagliflozin (Invokana), Dapagliflozin or family history of pancreatitis or medullary
(Farxiga), Empagliflozin (Jardiance), thyroid cancer notify your doctor if you have
Ertugliflozin (Steglatro) hoarseness or a throat lump.

DPP-4 inhibitors Exenatide (Byetta): twice daily with meal

Work by increasing the release of insulin and
Liraglutide (Victoza): once daily
decreasing the release of sugar from the liver Take
once daily. Tell your doctor if you have Exenatide XR (Bydureon), Dulaglutide
abdominal pain (pain in your belly), nausea and (Trulicity), Semaglutide (Ozempic): once weekly
vomiting. Sitagliptin (Januvia), Saxigliptin (Onglyza),
Linagliptin (Tradjenta), Alogliptin (Nesina) Semaglutide (Rybelsus): once daily ORAL

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 29

Insulin pumps Medication used to correct

Insulin pumps are small electronic devices that
a low blood sugar
deliver insulin in two ways: Glucagon
 In a steady, measured and continuous dose This medicine is available in a kit for a low blood
sugar emergency. Symptoms of a low blood sugar
emergency are unconsciousness (cannot wake the
 direction,
patient), patient is awake but unable to eat, the
around mealtime
patient is having a seizure, or the blood
Doses are delivered through a flexible plastic tube sugar is still less than 70 even after eating or
called a catheter. With the aid of a small needle, drinking food containing sugar. It is important to act
the catheter is inserted through the skin into the quickly when someone with diabetes becomes
fatty tissue and is taped in place. The needle is unconscious or will not wake up.
removed, leaving the catheter in place. Most often, glucagon is injected into the muscle.
Insulin pumps can help some people achieve better This type of glucagon is a powder in a bottle to
control, and many people prefer this continuous which sterile water is added from a prefilled
system of insulin delivery over injections. syringe. The same syringe is then used to give the
Ask your primary care provider if you are interested injection. Do not mix the glucagon with water
in an insulin pump. You may need to be seen by an unless you are going to inject the glucagon.
endocrinologist someone who specializes in
diabetes. Check with your insurance carrier to see
if insulin pumps are covered under your policy.
All insulin pumps have a toll-free number on the
back in case you have questions or problems
with your pump.

Intensive Insulin Pump Support Group

The Family Medical Group
6331 Glenway Avenue
Some glucagon can be given as a puff through
Join others to share ideas and get support focused
the nose. Talk to your healthcare provider about
on living a healthy lifestyle with diabetes. Groups
which type may be best for you and your family.
are free, and all are welcome.
A family member or friend should know where
Contact Betty Hollstegge, CDE, at you keep your glucagon kit and how to
betty_hollstegge@TriHealth.com or 513 389 1400 administer the medication. Read the directions
for more information. that come with the kit with your friend or family
Note: It is a good member. That way you will be prepared if a low
idea to carry extra blood sugar emergency happens.
insulin pump
supplies with you,
especially if you will
be in the hospital.

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3042

Medicines that increase blood sugar

If a diabetic person is unable to be woken up, turn
them on their side. They may vomit when they
 Alcohol (acute use social drinking)
wake up so turning them on their side will stop
them from choking on it. Administer the glucagon.  Antibiotics (Dapsone, Rifampin)
Feed the patient as soon as they wake up.  Antidepressants (Zyprexa, Risperdal,
Try small sips of fruit juice or regular soft drink. If Clozaril, Seroquel, Abilify, Geodon,
tolerated, follow with a snack of a carbohydrate and Lithium)
a fat, such as peanut butter crackers. Call 911 even if
 Beta-2 stimulators (Proventil, Alupent,
the patient wakes up.
Serevent, Foradil, Brethine, Theo-Dur)
Glucagon will not revive someone who is
 Caffeine
unconscious because of high blood sugar.
 Corticosteroids (Prednisone, Decadron,
Check the expiration date on your glucagon kit and
DepoMedrol)
ask your doctor for a new prescription if your kit
has expired.  Dilantin (phenytoin)
 Nicotine (smoking and patches)
 Estrogens (Premarin, hormone
Medications that can affect your replacement therapy)
blood sugar  Heart and blood pressure medications
(amiodarone, beta blockers, calcium
Some medicines that are used for other conditions,
channel blockers, catapress, diuretics)
such as high blood pressure, COPD or depression,
can affect your blood sugar. Some over-the-  Oral contraceptives (birth control pills)
counter medicines can affect your blood sugar.  Niacin or nicotinic acid
Alcohol, caffeine and nicotine all affect your blood
 Protease inhibitors (ritonavir, etc. AIDS
sugar.
drugs)
Following are lists of some of the medicines that
might cause your blood sugar to increase or  Thyroid hormones (Synthroid,
Levothroid)
decrease. Do not stop taking prescription
medicines or change the dose without talking to
your doctor. Always let your doctor know what Medicines that decrease blood sugar
over-the-counter medicines, vitamins and
supplements you take.
 Alcohol (acute excess amounts)
 Antibiotics (Bactrim/Septra)
 Aspirin and other salicylates in larger
doses
 Heart and blood pressure medications
(ACE inhibitors, beta blockers, Norpace,
Quinidine)
 Quinine
 Tylenol (acetaminophen especially in
larger doses)
 31

What to expect when you are  If you use an insulin pump, call your
having a medical procedure endocrinologist or the doctor who adjusts the
pump. He/she will develop a plan for adjusting
If your procedure or surgery is elective or scheduled the insulin doses in your pump in preparation
ahead of time, there are some things you can do to for your procedure.
help manage your diabetes before, during and after  Even if you are told to not take your diabetic
the surgery. medications or insulin, continue to check your
 Take good care of yourself during the time blood sugar as prescribed and monitor for
before surgery. Eat healthy, exercise if symptoms of low or high blood sugar.
permitted, stop smoking and drinking alcohol  If you are going home the same day after the
or reduce the amount you smoke and drink. procedure or surgery, bring your diabetic
Take all medications as prescribed. medications and/or insulin with you to take
 Be sure the surgeon or doctor preforming the afterwards.
surgery or procedure knows what type of  Metformin or Glucophage should not be taken
diabetes you have and knows what medicine for 48 hours after IV contrast is given. IV
and/or insulins you take for diabetes. contrast is used during CT scans, MRIs and
 Be sure to bring an updated list of your angiograms.
medications including your diabetes
medications and insulin to the appointment.
Doses are important. If you use a sliding scale If you will be admitted to the hospital after the
to determine your insulin dose, bring the procedure or surgery:
written scale with you.  Your nurses will check your blood sugar
 Follow the instructions provided by your frequently and your doctors will adjust your
surgeon or the doctor prior to your procedure, insulin based on your blood sugar.
especially when to stop eating and drinking.  If you use an insulin pump, keep it on. If you are
Follow the instructions provided by your surgeon or staying overnight in the hospital bring extra
the doctor about which diabetic medications to take infusion sets, insulin and batteries for the pump.
the night before surgery and the morning of surgery. If your pump needs to be stopped for any
reason, make sure you are given insulin
 Often pills for diabetes are not taken the injections.
morning of a surgery or procedure because
they can cause low blood sugar if you do not  If you are staying in the hospital, your diabetes
eat. Insulin doses may be reduced depending will likely be treated with insulin while in the
on what time of day the procedure is scheduled hospital even if you use pills at home. Using
and how long you are not allowed to eat. insulin allows for better control of your blood
sugar.
 If the surgeon or doctor has not given you
instructions about which diabetic medications to  Many diabetes pills can cause low blood sugars
take, call the doctor who prescribes your if you are not eating like usual.
diabetic medications for guidance. Do not wait  If you use insulin at home, you may need more
until the day before surgery to call the doctor. or less insulin after surgery for a short time due
 People with type 1 diabetics should always take to stress on the body and changes in diet.
their basal insulin or keep their pump on.
32

Treatment of diabetes in Meals

the hospital Please do not eat your meal until after your blood
sugar is checked by the nursing staff.
While you are in the hospital, your doctor
Please do not let your family or friends eat food
will likely order insulin injections to keep your blood
from your meal tray. Also, please let us know if
sugar in a normal range. It is important to have your
you have eaten food that was brought to you by
blood sugar between 110 and 180. If your blood
your family or friends. The nursing staff will need
sugar is too high, you will not heal as well.
To make sure your blood sugar is in control, your insulin dose.
blood sugar will be tested before every meal and
at bedtime. Low blood sugar
Let the nurse know if you feel shaky, dizzy or
Diabetes pills are usually stopped while you are in
sweaty. This can be a sign of low blood sugar.
the hospital due to changes in your appetite and/or
The nurse will check your blood sugar and give
mealtimes due to tests and procedures.
you juice or milk if it is less than 70. If you are
Instead, insulin is often used to manage blood sugar. not allowed to eat, you may be given dextrose
Most patients need long-acting insulin once a day (sugar solution) through your IV.
and short-acting insulin with each meal.
When you go home
Unless your medications needs adjusted,
most patients return home on their usual
diabetes medications. If changes are
needed, the nurse will explain the new
regimen and make sure you have the right
supplies before you leave.

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 33

High blood sugar hyperglycemia

What to do to prevent hyperglycemia
High blood sugar may occur within hours or it may
develop over several days. You may have one or all  Always take your diabetes medicine unless your
of the following symptoms: doctor tells you not to.

 High blood sugar levels (greater than 200)  Test your blood sugar every four to six hours.

 Extreme thirst  If you usually take insulin, test your urine for
ketones. Call your doctor if moderate to large
 Using the bathroom a lot
amounts of ketones are present.
 Very hungry
 If your blood sugar is greater than 240, drink 8
 Fatigue/sleepiness ounces of sugar-free liquid every one to two
hours.
 Blurry vision
 Call your doctor if you are vomiting and unable
 Infections or slow to heal wounds
to eat or drink liquids. Remember to call your
 Pain in stomach with or without doctor if your blood sugar stays above the goals
nausea and vomiting 24 hours.

Causes of high blood sugar

 Too much food or eating the wrong foods
 Not enough diabetes pills or insulin
 Illness or infection
 Not enough exercise (do not exercise if your
sugar is greater than 240)
 Stress

Signs and Symptoms of High Blood Sugar

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Low blood sugar hypoglycemia

What to do to prevent hypoglycemia
Low blood sugar (usually less than
Try to test your blood sugar. If you are too
70 mg/dl) usually occurs quickly
shaky, eat or drink a fast-acting carbohydrate
and may require that someone
such as:
help you get treatment.
Symptoms include:  ounces of juice (orange, apple,
cranberry or grape)
 Shaking
 6 ounces (1/2 can) of a regular soft drink
 Sweating
 8 ounces of skim milk
 Dizzy
 glucose tablets
 Irritability/confusion
 8 SweeTarts® candies
 Hunger
 tablespoons of raisins
 Weak or tired
Test blood sugar every 15 to 30 minutes until
 Headache it is greater than 100. Eat a second fast-acting
 Nervous or upset carbohydrate if needed. If your next regular
meal is more than two hours away, eat a snack
Causes of low blood sugar such as half a sandwich or three peanut butter
or cheese crackers. If you are unconscious,
 Too much insulin or too many diabetes pills
someone should call 911 immediately. You
 Not enough food or missing a meal should not be given anything by mouth if you
are unconscious. Be sure to tell your doctor
 Too much exercise or extra physical activity
about this episode in case your medication
needs to be adjusted.

Signs and Symptoms of Low Blood Sugar

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Sick-day plan
Sick-day tips
Illness or injury can make managing your diabetes more
difficult. When you are sick, your body is in a state of  Always take your long-acting insulin.
stress and produces stress hormones.  Generally, you will need more insulin when
These hormones help your body fight the illness or you are sick. Your doctor will decide how
injury, but they also cause your blood sugar to much insulin you will need to take while
increase. Your blood sugar can increase when you are sick or if you should continue your
sick even if you are unable to eat or drink. diabetes pills.
Untreated high blood sugar can lead to diabetic  If you are taking a type of diabetic pill
ketoacidosis (DKA) or hyperosmolar hyper-glycemic called an insulin secretagogue such as
syndrome (HHS). DKA and HHS are health glyburide, glipizide, glimepiride, repaglinide
emergencies and require treatment in the hospital. or nateglinide and are unable to keep food
These problems can be avoided by having a sick day down, call your doctor to decide if you
plan, which you should develop with your doctor. should take it.
 Check your blood sugar every two to four
hours.
 Urine should be checked for ketones if
your blood sugar is greater than 240 or if
you have been vomiting or having diarrhea.
 Discuss with your doctor any other
instructions that are specific to your
condition.

When should I call the doctor?

 You have been sick for 24 hours or more
 Your temperature is greater than 101.5
degrees
 You have been throwing up or had diarrhea
for more than six hours
What type of illness can make controlling my
blood sugar harder?  There are moderate to large amounts of
Just about any type of illness can make controlling ketones in your urine
your blood sugar more difficult, including:  Your blood sugar is greater than 240 or less
than 70 for two checks in a row
 Colds
 You have symptoms of infection such as
 Stomach bugs that cause vomiting and pain with urination or wounds with
diarrhea drainage
 Infections of the ear, sinuses, throat, teeth  You are dehydrated
or bladder
 You have chest pain or abdominal pain
 Pneumonia
 You have difficulty breathing
 Infected sores including those on the feet
 You have any questions or are unsure what
you should do

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What things do I need to have on hand to be

prepared for a sick day?
 Foods that are easy on the stomach such as
applesauce, crackers and soup
 Liquids that provide calories such as juices,
regular caffeine-free soft drinks, reduced-
sugar sports drinks, regular gelatin and
popsicles
 Liquids that are calorie-free such as water,
diet sodas, sugar-free gelatin and herbal teas
 Thermometer
 Diabetic medications and/or insulin
 Glucose meter, glucose strips and supplies
for checking your blood sugar
 Ketone sticks (especially for type 1
diabetics)
 List of emergency telephone numbers. If
you live alone, it is important that you let a
friend know that you are sick.
 Over-the-counter medicines such as Tylenol
What should I eat and drink while I am sick?
(acetaminophen) for fever and pain, Lomotil
When you are ill, you may not be able to eat as you (loperamide) for diarrhea, and sugar-freecough
normally do because you are sick to your drops and syrups for cough and sore throat.
stomach and  You should discuss the use of over-the-counter
feel like eating. You might not have the energy to go medicines with your doctor before using them
shopping or to prepare food. You will probably be as some medications can increase your blood
less active than you are when you feel good. sugar.
 Drink at least 8 ounces of caffeine-free fluid
every hour. Caffeine increases urination and Should I exercise when I am sick?
can lead to further dehydration when you are You should not exercise when you are sick.
already vomiting or have diarrhea. Exercise during illness can increase your blood
 Eat 50 grams of carbohydrates (3 carbohydrate sugar and ketones.
servings) every three to four hours. Even if your
blood sugar is high, it is important to continue
to take in carbohydrates.
 If you are vomiting, eat foods that are easy on
the stomach such as toast, crackers, broth and
soups. Include fluids that have calories such as
fruit juice, regular caffeine free-soda, gelatin
and popsicles.

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Diabetes action plan

GREEN ZONE: All Clear

If you have any of the following: Then:

 Most fasting blood sugars are less than 130  Your blood sugars are under control

 Average blood sugars two hours after  Continue taking your diabetes
meals are less than 180 medications and doing home blood
sugar testing
 No low blood sugars are less than 70
 Follow healthy eating habits and activity goals
 HbA1C is less than 7%
 See your doctor/diabetes educator every three
to six months unless directed to be seen more
often
YELLOW ZONE: Caution
If you have any of the following: Then:
 Most fasting blood sugars are between 130 and
 Improve your eating habits
180
 Increase your activity level
 Average blood sugars two hours after meals
are between 180 and 240  You may need a medication change

 Low blood sugars one to two times a  If your blood sugars are not better in one
week are less than 70 week, call your doctor, diabetes educator or
home health nurse
 HbA1c is above 7%

RED ZONE: Medical Alert

If you have any of the following: Then:
 Most fasting blood sugars are greater than 180
 You need to be seen by your health care provider.
 Average blood sugars two hours after  Call your doctor.
meals are greater than 240

 Frequent low blood sugar

Note: You may need to be seen by your doctor
 Moderate to large ketones (type 1 only) monthly for follow-up to get your blood sugar
 Use of glucagon kit under control.

 HbA1c is above 8%

Contact information for home care, family doctor or endocrinologist

Name: Name:

Phone: Phone:
 39

Problem-solving Problem: Eating right when I am away from home

is even harder.
Controlling your blood sugar is hard work. Eating a
healthy diet, exercising regularly, taking medication Solution:
and monitoring your blood sugar all take time and  Carry food with you so that you have healthy
effort. Having a routine and being prepared for food choices, even if you are delayed on the
unexpected roadblocks can make controlling your road.
blood sugar easier.
 Download an app on your phone to help you
The key to meeting the challenge of controlling your keep track of carbs when eating at popular
blood sugar is to plan ahead, act and restaurants.
learn from your mistakes. Keep a diary of your blood
sugar values, your diet and your activity. Looking at Problem: What about eating on holidays and
a record of these three things can help you see what special occasions?
is working and what is not working. Forgive yourself
for mistakes. Join a support group to learn from Solution:
others who have faced the same problems.  Decide ahead of time what one holiday treat
you cannot skip, and have a small portion.
Problem: There are so many things I need to control
 Bring a dish to the party that you can enjoy
my blood sugar.
and share.
Solution:  Experiment with holiday recipes to reduce
 Keep your blood sugar meter and supplies, sugar and fat.
insulin and syringes, or insulin pens and  If well-meaning family urges you to eat too
needles in a safe place together. much, politely explain that you are eating for
 Store unopened insulin in the refrigerator. your health.
 Buy or make a pouch or case to keep the
needed supplies together when away from Problem: What about emergencies?
home.
Solution:
 Keep all medications and needles away from
 When the weather forecast is bad, make
children.
a trip to the store so that you have healthy
food at home.
Problem: Eating right is hard, especially when time is
tight.  Have some foods on hand that do not need
to be in the refrigerator in case there is a
Solution: power outage.
 Plan meals and snacks ahead of time.
 Keep some hard candy in your purse or
Consider creating a menu for several days into
the future. pocket, in your glove compartment and next
to your bed so if your blood sugar is low, a
 Write a grocery list with all the needed
source of carbohydrates is handy.
ingredients on it.
 Prepare several meals at a time and freeze to
eat later.
 Pack leftovers for lunches at work to avoid
missing a meal or grabbing whatever is
available. Bring a snack to work in case your
blood sugar gets low.

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42

Problem: Finding time to exercise is hard. Depression can make it hard to follow your diabetes
Solution: care plan. If you are depressed, you may not have
the energy to:
 Pick activities that you enjoy so that you
will make time.  Prepare and eat healthy meals
 Have both outdoor and indoor choices so  Get regular exercise
you
 Take diabetes medicines
from exercising.
 Find an exercise buddy. You can encourage  Check your blood sugar
each other on the days one of you does not Tell your health care team if you:
feel like exercising.
 pleasure in your
 Exercise while watching a favorite show. Take activities
a 10-minute walk on your lunch break.
 Avoid talking about your diabetes with family
 When traveling, use the motel pool or and friends
gym, or take walks.
 night
 Exercise can be broken down into smaller
time periods. Being active is better than  Struggle with finding motivation or making a
sitting still. plan to manage your diabetes
Problem: No matter what I do, my blood sugars  yourself
are too high or too low or both.
 Feel like diabetes is controlling you
Solution:  yourself
 Keeping a diary of your blood sugars,
Diabetes is also linked to stress. Stress can increase
exercise and food will help you and your
your blood sugar and make you more likely to
doctor figure out what may be the cause of
overeat. Conversely, increased blood sugar levels
high or low blood sugars.
can cause stress.
 Ask for expert help. Take your diary to
Consider healthy ways to cope with depression and
appointments with your doctor and with
stress from living with diabetes:
your diabetic educator. They may be able to
spot the reason your blood sugar has been  Physical activity
out of control.  Breathing exercises/relaxation
Coping  Make small, reachable goals and celebrate
when you achieve them
People with diabetes are more likely to have
depression than people without diabetes. This  Replace negative, defeating thoughts with
may be due to: positive, more realistic ones

 The strain of managing diabetes on  Ensure healthy sleep patterns

a daily basis  Get help from your diabetes care team
  Go outside
family and friends
 Help others/volunteer/make social contact
 Feeling out of control if you are having
trouble keeping your blood sugar in your  Consider joining a support group
target range
 41

Diabetes care checklist CDC vaccine recommendations for diabetics

Vaccination recommendations □ Flu vaccine every year

Vaccines are very important for people with type
1 or type 2 diabetes. People with diabetes are
□ Tdap vaccine to protect against tetanus,
diphtheria and whooping cough
more likely to get the flu and other infections
than people without diabetes. Diabetes can make □ Pneumococcal polysaccharide vaccine
the immune system less able to fight infections to protect against pneumonia and other
while the infection makes blood sugar control similar diseases. People over age 65 may
more difficult. need a second dose.
When people with diabetes get sick, they are at risk
for pneumonia, bronchitis, sinus infections and ear □ Hepatitis B vaccine series to protect
infections. The good news is the immune system of against hepatitis B
a diabetic person responds to vaccinations as well
as a nondiabetic
□ Zoster vaccine to protect against
shingles if you are 60 years and older
People with diabetes should take everyday
precautions including avoiding sick contacts. □ HPV vaccine to protect against human
Those with flu-like symptoms should stay home papillomavirus if you are a man or
for 24 hours after the fever is gone (without the woman under age 45
use of fever-reducing drugs).
Covering nose and mouth when sneezing and
□ MMR vaccine to protect against measles,
mumps and rubella if you were born in
coughing with a tissue; not touching eyes, nose
1957 or after and have not gotten this
and mouth; washing hands often; and cleaning
vaccine or do not have immunity to
surfaces such as keyboards and
these diseases.
phones between users are all recommended as
Your doctor may do a blood test to see if
everyday preventive actions.
you have immunity.
Diabetics should have a sick-day plan andsupplies
to implement the plan on hand. (See section on □ Varicella vaccine to protect against
sick-day plans.) chickenpox if you were born in 1980 or
after and have not gotten two doses of
this vaccine or do not have immunity to
this disease. Your doctor may do a blood
test to see if you have immunity.

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Know your numbers

□ Cholesterol check: at least once every year
Diabetes affects many aspects of your health.
Goal HDL (good) cholesterol: men greater
Long term uncontrolled high blood sugar can lead
than 40 mg/dl, women greater than 50
to health problems for people with type 1 and type
mg/dl
2 diabetes. These problems include:
Goal LDL (bad) cholesterol: based on your
− Damage to nerves (neuropathy), which can
risk for heart disease discuss with your
cause numbness or discomfort in hands or
doctor
feet or may affect organs such as your
stomach Goal triglycerides: less than 150 mg/dl

− Damage to blood vessels in the eyes My HDL:

(retinopathy), which may lead to blindness My LDL:
− Damage to blood vessels in the kidneys, My triglycerides:
which may lead to kidney failure
□ Dilated and complete eye exam: every
− Blockages in blood vessels, which can cause year. Call your eye care specialist with any
heart disease or stroke changes in vision.
− Blockages in the blood vessels in the legs, Date of next eye complete exam:
which can lead to slow healing sores on thelegs
and feet and even to amputation □ Complete foot exam: every year. Let your
doctor know if you have problems such as
In addition to controlling your blood sugar, regular
loss of feeling or tingling, changes in shape,
follow-up with your doctor is important in maintaining
or sores on your feet. Take your socks and
overall wellness. Regular monitoring of the items
shoes off during every office visit.
below will help keep you on track.
At home, check your feet every day. Inspect
□ Quit smoking (including e-cigarettes): decide for cuts, blisters, cracks, swelling and dry skin.
on a quit date and reward yourself for small Wear shoes and socks that fit well. Do not go
victories. For free help, call 1 800 QUIT NOW or barefoot or wear sandals.
visit smokefree.gov. Date of next complete foot exam:
My quit date:
□ Dental exam: at least yearly. Let your dentist
□ A1C: at least two to four times per year know if you have bad breath or bad taste;
Goal A1C: 6% to 8% for most people red, sore, swollen, tender or bleeding gums;
receding gums; loose teeth or teeth that
My A1C:
have moved; pain while chewing or sensitive
□ Kidney exam: every year. Have your urine and teeth; longer appearing teeth, change in bite;
blood tested to monitor kidneys change in fit of partial dentures; or history of
mouth or gum abscesses.
Date of next kidney exam:
Brush teeth twice daily with a soft bristled
□ Blood pressure: check at every doctor visit toothbrush and fluoride toothpaste. Floss
Goal blood pressure: 130/80-140/90 mmHg daily.
My blood pressure: Date of next dental exam:
It is recommended that you wear a medical ID
bracelet and/or carry an ID card indicating that
you have diabetes.
 43

Free smartphone apps for Free general nutrition information/

diabetes management healthy living apps
Bant Log blood sugar readings and provide trend CalorieKing Calorie, fat and carb counts
data for up to 90 days (iPhone) for 70,000+ foods with an up-to-date listthat
includes 260 fast-food chains and
Blood Sugar Tracker Log blood sugar levels, set restaurants (iPhone and Android)
target blood sugar ranges, and view history and GoMeals Large list of restaurant foods and
simple graphs to identify numbers that are out of grocery store items; has customized settings
range (iPhone) for counting daily calories, carbs, fats and
other nutrients (iPhone and Android)
Diabetes Companion Complete nutrition
facts for common foods, tons of recipes, MyFitnessPal Allows user to set a daily
videos, Q&A for common diabetes related calorie goal and record daily food intake and
issues and blood sugar tracking tools (iPhone) exercise. Has a very large food database.
Calculates calories burned by exercise (iPhone
Diabetes Log Track sugar readings, and Android)
carbohydrate intake and insulin dosage by date
(iPhone) Lose It! Can be used as a weight-loss tool;
helps with keeping track of food intake and
Glucose Buddy Diabetes Tracer Track blood exercise (iPhone and Android)
sugar medication, A1C, and carb intake, log ShopWell Can help you build a healthy
weight, blood pressure (iPhone and Android) grocery list, create a profile with health,
nutrition and weight goals, as well as scan
Carb Master Free Track carbohydrate intake
item barcodes of more than 60,000 foods
plus calories, fat, sugar, protein and fiber for the
(iPhone and Android)
day (iPhone)
Allows you to create, edit and view
Diabetes Buddy Lite Track factors that influence recipes. Helps organize, search and email your
blood sugar levels such as daily carb intake, favorite recipes and allows you to make a
glucose measures, medication, and food and cookbook and do grocery list and menus
water intake (iPhone) (iPhone and Android)
Baritastic - Work toward goals by setting
My Sugr- Log sugars, carbohydrates, and reminders and timers to take vitamins and
medications. Features statistics and graphs track water intake. Keep a photo time line to
including estimated hemoglobin A1C that updates stay motivated. (iPhone and Google Play)
as sugars are recorded

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Websites and resources Health coach programs

American Diabetes Association
Novo Nordisk Cornerstones4Care®
www.diabetes.org
www.cornerstones4care.com
Local Office:
AstraZeneca Fit2Me
4555 Lake Forest Drive, Suite 396
www.fit2me.com
Cincinnati, OH 45242
513 759 9330 TriHealth Employees
www.TriHealthLifestyles.com
Centers for Disease Control and Prevention
www.cdc.gov/diabetes
Prediabetes
Children With Diabetes
www.childrenwithdiabetes.com Do I Have Prediabetes?
doihaveprediabetes.org
Choose My Plate
www.choosemyplate.gov YMCA Diabetes Prevention Program
ymca.net/diabetes-prevention

www.cincinnatichildrens.org/service/d/diabetes/team
cincinnatiymca.org/health-fitness/healthy-
living
Food and Nutrition Information Center
www.fnic.nal.usda.gov National Diabetes Prevention Program
cdc.gov/diabetes/prevention/index.html
JDRF Type 1 Diabetes
www.jdrf.org
Financial Assistance Programs
Joslin Diabetes Center Eli Lilly
www.joslin.org
1-800-545-6962 http://www.lillycares.com/
National Institute of Diabetes and Digestive
Sanofi Aventis
and Kidney Diseases
1-800-981-2491
www.niddk.nih.gov
http://www.sanofipatientconnection.com/
TriHealth Diabetes
Novo Nordisk
www.TriHealth.com/Diabetes
1-866-310-7549
TriHealth Fitness Pavilion https://www.novocare.com/psp/PAP.html
www.TriHealth.com/hospitals-and-
AstraZeneca and Me
practices/trihealth-fitness-and-health-
pavilion 1-800-292-6363 http://www.azandmeapp.com/
Wal-Mart
TriHealth Seniority Group
Low cost diabetes medications & supplies- Relion Brand
www.TriHealth.com/institutes-and-services/senior-
services/seniority Kroger

TriHealth Weight Management Discount plan with $36 annual fee, many prescriptions for
less than $6
www.TriHealth.com/hospitals-and-
https://www.krogersc.com/static/files/KrogerRx-
practices/trihealth-weight-management Program-Drugs.pdf

If you are struggling to pay for insulin or know someone who is, the ADA has
resources to help visit InsulinHelp.org.

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Outpatient Diabetes Education

Talk with your primary care doctor to enroll in any of the classes below.

One-on-One Diabetes Education Session

These sessions are ideal for:
- Patients living with Type 1 Diabetes, Type 2 Diabetes or Prediabetes
- Patients who would not learn well in a group environment or prefer/need individualized training
or instruction
- Patients who have attended the group classes, and now want more individualized follow-up
May include one or both of the following separate sessions:
Comprehensive Diabetes Self-Management Training/Education (1:1 with RN, CDE)
Medical Nutrition Therapy (1:1 with RD, CDE)
Your insurance company may cover the cost of your visits- this varies so it is highly recommended
you confirm what your plan covers. You can also make self-payment arrangements if needed.
Currently, Medicare allows 10 hours of education the first year after you are diagnosed and then pays
for two hours each year after for an update of current information.
Must be referred by doctor to attend class.

Free Group Diabetes Education Sessions

These classes are ideal for:
- Patients living with prediabetes or Type 2 Diabetes
- Patients who learn well in a group environment
- Patients who do not have insurance coverage for 1:1 education referrals
- Patients who can arrange to attend the 2.5 hour class
- Please bring your glucose meter and testing supplies, if available.
Registration is required, so please call 513 569 6200 or register online at www.trihealth.com/diabetes
If leaving a message, please give location you plan to attend
Please Note: no cost to patients to attend, but registration is required

Bethesda North Hospital Good Samaritan Hospital McCullough-Hyde

10496 Montgomery Road 375 Dixmyth Avenue Memorial Hospital | TriHealth
Suite 206 Cincinnati, OH 45220 110 North Poplar Street
Cincinnati, OH 45242 Fax: 513 569 6617 Oxford, OH 45056
Fax: 513 569 6617 Contact: 513 865 1126 Fax: 513 524 5409
Contact: 513 865 1126 Scheduling: 513 524 5555
Contact: 513 524 5692
or 513 524 5691
46

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Glossary

Blood glucose or blood sugar The amount Glucose A simple sugar needed by the
of a sugar called glucose in the blood. Normal body for energy. Carbohydrates are digested
blood sugar is between 70 and 180 mg/dl. to glucose.

Carbohydrates Food group consisting Glucose meter A machine that shows the
of starchy and sugary foods, both naturally amount of sugar in the blood using a small drop
sweet foods, such as fruit, and foods to of blood.
which sugar has been added. Carbohydrates
are changed to glucose in the digestive Hemoglobin A1C A blood test that shows the
tract. 15 grams of carbohydrates equals one average blood sugar level for the past two to
carbohydrate serving. three months.

Cholesterol A waxy, fat-like substance used Hormone A chemical produced in the body
by the body to build cell walls. If too much is that acts as a signal for another part of the body
present, it can build up and block arteries. to produce a particular response.

Diabetes A group of diseases that results Hyperglycemia A condition in which there is

from too much sugar in the blood. too much glucose in the blood. Usually defined
as a blood sugar level greater than 180 mg/dl.
Diabetic ketoacidosis (DKA) A health Hyperosmolar Hyperglycemic Syndrome (HHS)
emergency in which the body does not have A health emergency most often seen in older
enough insulin and cannot break down sugar. persons in which high blood sugar levels result
Without enough insulin, your body begins to from lack of insulin. HHS is usually brought
break down fat as fuel. This process produces on by something else, such as an illness or
a buildup of acids in the bloodstream called infection. If HHS continues, the loss of too much
ketones. body fluid through frequent urinating, sweating,
diarrhea or vomiting may lead to seizures or
Diabetologist A doctor that specializes in coma.
diabetes care.
Hypoglycemia Blood sugar that is lower than
Endocrinologist A doctor who specializes in the normal range. Usually defined as a blood
diabetes and how hormones work in the body. sugar less than 70 mg/dl.

Fasting blood sugar A blood sugar that is Hypoglycemia unawareness When a diabetic
checked after you have not eaten for at least does not have symptoms of low blood sugar even
eight hours. though his blood sugar is less than 70 mg/dl.

Glucagon A hormone that quickly raises Impaired fasting glucose The condition in
blood glucose levels. which a blood sugar obtained at least eight
hours after the last time you ate is high (100 to
126 mg/dl) but lower than the blood sugar level
used to diagnose diabetes.

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Impaired glucose tolerance The condition Preprandial blood sugar A blood sugar
in which a blood sugar obtained two hours after measured before you eat.
drinking a sweet liquid during an oral glucose
tolerance test is high (140 to 199 mg/dl) but lower Protein Food group consisting of meats,
than the blood sugar level used to diagnose poultry, fish, eggs and nuts.
diabetes.
Random blood sugar A blood sugar that is
Insulin A hormone produced by the pancreas checked regardless of when you last ate.

Triglycerides Building blocks of fats.

Insulin resistance Insulin does not work
effectively in the body to reduce blood sugar,
resulting in high blood sugar. It is one of the
causes of high blood sugar in type 2 diabetes
and gestational diabetes.

Ketones They are produced when the body

burns fat for energy or fuel and when there is
not enough insulin to help your body use sugar
for energy. Without enough insulin, glucose
builds up in the blood. Because the body is
unable to use glucose for energy, it breaks
down fat instead.

Lactic acidosis A condition in which acid

builds up in the blood stream because the
tissues are not getting enough oxygen.

Lancet A device that uses a tiny needle to

prick the skin for a drop of blood.

Oral glucose tolerance test A series of blood

sugar checks taken before and after drinking
a glucose containing liquid. This test is most
often used to diagnose gestational diabetes.

Pancreas An organ located behind the

stomach that produces insulin and other
hormones and digestive enzymes.

Postprandial blood sugar A blood sugar

measured after you eat.

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Bethesda North and Good Samaritan Hospitals
have been awarded the Joint Commission Gold
Seal for Advanced Inpatient Diabetes Care

© 2020 TriHealth, Inc. All rights reserved.