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DIABETES MELLITUS TYPE 2 IN ADULTS |
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GENERAL INFORMATION |
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What you should know?
• Diabetes is also called diabetes mellitus. With type 2 diabetes, your body does not make enough insulin, or has trouble using insulin or both. It may be called non-insulin dependent or adult onset diabetes. Type 2 diabetes is more common in overweight people who are older than 40 years and are not active. Type 2 diabetes is also being found more often in children who are overweight. There is no cure for diabetes but you can have a long and active life if your diabetes is controlled.
• Insulin is a hormone (a special body chemical) made by your pancreas The pancreas is an organ that lies behind the stomach. Your body changes much of the food you eat into sugar. This sugar goes into the blood and travels to the cells of your body to be used for energy. Insulin acts as a "key" to help sugar enter the cells. Sugar builds up in your blood when your body does not have enough insulin. Sugar also builds up when your body does not respond to insulin the way it should.
• You may be able to control your diabetes with diet and exercise, but you may also have to take medicine. You may need to take oral medicine (pills) to help your body make more insulin or use insulin better, or you may need insulin shots.
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Instructions for care
• Keep a written list of what medicines you take and when and why you take them. Bring the list of your medicines or the pill bottles when you see your caregivers. Learn why you take each medicine. Ask your caregiver for information about your medicines. Do not take any medicines without first talking to caregivers.
• Always take your medicine as directed by caregivers. Call your caregiver if you think your medicines are not helping or if you feel you are having side effects. Do not quit taking it until you discuss it with your caregiver.
• You may be able to control your blood sugar levels with diet, exercise and medicine that can be taken by mouth. These medicines control the amount of sugar in your blood.
• You may need one or more shots of insulin every day to decrease the amount of sugar in your blood. Caregivers will teach you about insulin if you need to take it. You will learn about the different types of insulin, and how fast and how long each type works. Caregivers will also teach you how to give yourself insulin shots. Ask your caregiver for more information about insulin and giving insulin shots.
• Tell your caregivers about all of the vitamins and herbal supplementals you take. Some of these may not work with medicines you are taking.
Keep all appointments: Call your caregiver for a follow-up visit. Write down questions you have about your diabetes and how it is being treated. This way you will remember to ask these questions during your next visit.
Keep your blood sugar in the "target range": Keeping your blood sugar levels within a target range means that your blood sugar is not too high or too low. To do this, you and your caregivers will work together to find the right balance of diabetes medicine, food, and physical activity. Food raises blood sugar levels. Diabetes medicine and physical activity lower blood sugar levels.
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Do I need to change my diet?
Food puts sugar in your body. You can help control your blood sugar by making sure you eat the right kinds and amounts of food. A dietitian or diabetes nurse will help you learn what to eat and how food affects your diabetes. There is no one diet that is right for everyone who has diabetes. Following are some of the important changes your caregivers may suggest:
• Certain foods such as carbohydrate can quickly raise your blood sugar. Your caregiver may want you to limit the amount of carbohydrates you eat. Examples of carbohydrates are bread, grains, cereal, pasta, or starchy vegetables like corn and potatoes. Ask your caregiver about the amount of carbohydrate that is right for you.
• Choose foods that are good sources of fiber. Examples of high fiber foods are fruits, vegetables, legumes (dried beans and peas), and whole grain breads and cereals.
• Choose foods low in fat, saturated fat, and cholesterol. Examples of low fat foods are lean cuts of meat, fish, poultry (chicken and turkey) without skin, and low-fat milk.
• Limit the amount of sugar you eat. Examples of high sugar foods are candy, regular soda, and desserts such as cake or pie.
• Eat your meals and snacks at about the same times, and in the same amounts each day. Never skip a meal.
Drink enough liquids: Drink six to eight (8 ounce) cups of liquid each day. Follow your caregiver's advice if you are on a liquid limit. Good liquids to drink are water, bubbly water, flavored diet drinks, or caffeine-free teas. Limit the amount of caffeine you drink. Caffeine may be found in coffee, tea, soda and some foods.
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Can I drink alcohol?
People who have certain health problems should not drink alcohol. Talk to your caregiver before you drink alcohol. Drinking alcohol without having food in your stomach may cause a drop in your blood sugar. If you are able to drink alcohol, drink it with meals. You should drink only one serving of alcohol per day if you are a woman, or two servings of alcohol per day if you are a man. A serving is the same as five ounces of wine, 12 ounces of beer or one and one-half ounces of hard liquor (like gin or whiskey). |
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Why is exercise important if I have diabetes?
Exercise helps keep your blood sugar level under control by helping your body better use insulin. It also makes your heart stronger, lowers blood pressure, and keeps you healthy. Exercising and controlling your weight can change the amount of diabetes medication (pills or insulin) your body needs. Work with your caregiver to help plan the best exercise program for you.
• Check your blood sugar before and after exercise to learn how your blood sugar responds to exercise. Caregivers may tell you to change the amount of diabetes medicine you take or food you eat.
• If your blood sugar is less than 100 mg/dl, eat or drink a carbohydrate snack before you exercise. This will help to avoid low blood sugar. Examples of carbohydrate snacks are four to six crackers, one-half banana, eight ounces (one cup) of milk, or four ounces (one-half cup) of juice.
• Always have a carbohydrate snack available during and after exercise.
• Drink plenty of liquids before, during, and after exercise.
• Wear good socks and footwear to prevent sores and blisters on your feet.
Maintain a healthy weight: Weighing too much can make your heart work harder and cause health problems. Losing as little as 10 to 15 pounds may make it easier to control your blood sugar. If you are overweight, you may need to eat less and exercise more. Talk to your caregiver about a plan to help you maintain a healthy weight.
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How do I check my blood sugar levels?
• Your caregiver will teach you how to use a glucose monitor. This a small device that tells how much sugar is in your blood. There are many different kinds of monitors. All monitors use a small drop of blood. Usually the blood is from a prick on your finger. Caregivers will help you choose the monitor that is best for you. Ask your caregiver for more information about checking your blood sugar.
• Test your blood for glucose (sugar) as instructed by your caregiver. Write down the number in your record book. This test tells caregivers if your diabetes is in control. Bring the record book with you when you see caregivers.
Ketoacidosis and testing for urine ketones:
• Sometimes when your blood sugar gets very high, your body starts to break down fat for energy. When this happens, your body makes chemicals called ketones that are bad for you. This may happen when you are sick or under a lot of stress. It may also happen if you have eaten too much or have not taken enough of your diabetes medicine (insulin or pills). Ask your caregiver for more information about ketoacidosis.
o Following are some of the symptoms of high ketones:
- More thirsty than usual.
- Passing more urine than usual.
- Confused, or trouble thinking clearly.
- Fatigue (feeling tired).
- Fast deep breathing at rest.
- Fruity-smelling breath.
- Nausea (feeling sick to your stomach) and vomiting (throwing up).
- Stomach pain.
- So sleepy you cannot be woke up.
o Test your urine for ketones when your blood sugar levels are over 300 mg/dl. Your caregiver may want you to test your urine for ketones when your blood sugar levels are over 240 mg/dL. Also test your urine for ketones if you are sick, or have symptoms of high ketones.
- Dip a special test strip into your urine. The strip changes color when there are ketones present.
- Call your doctor right away if there are ketones in your urine.
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What is Hyperosmolar Hyperglycemic Nonketotic Syndrome?
• Diabetes may also cause Hyperosmolar (hi-per-oz-MO-ler) Hyperglycemic (hi-per-gli-SE-mik) Nonketotic (non-ke-TOT-ik) Syndrome (SIN-drom) (HHNS). This is a condition that happens most often in older adults with type 2 diabetes. It is usually caused by illness or an infection (in-FEK-shun). With HHNS, blood sugar levels rise and the body tries to get rid of the extra sugar in your urine. If HHNS continues for a long time, you can become very dehydrated. This is a very serious condition and needs to be treated right away.This is a very serious condition and needs to be treated right away. The following are signs and symptoms of HHNS:
• Having a high blood sugar level greater than 600 mg/dl (milligrams/deciliter).
• Having a very dry mouth.
• Feeling more thirsty than usual.
• Having warm, dry skin with no sweat.
• Having a very high fever (greater than 101°F).
• Feeling very sleepy or confused.
• Having a loss of vision.
• Having hallucinations (seeing or hearing things that are not there).
The best way for you to avoid HHNS is to do the following:
• Check your blood sugar several times a day. Talk to your caregiver about checking your blood sugars. They can tell you what blood sugar levels you should have and when to call if your blood sugars are too high or too low.
• When you are sick, check your blood sugar more often. Drink an eight-ounce glass of liquid (caffeine-free and alcohol-free) every hour. Talk to your caregiver about your sick day plan.
Other information:
• Take special care of your skin, feet, or any sores or cuts you may have on your body. Diabetes can change your body's ability to fight infection because your blood sugar is higher than normal. High blood sugar can damage nerves and blood vessels. Because of this, blood and oxygen cannot get to your body tissues. You may lose feeling in your feet because of nerve damage. Ask your caregiver for more information about diabetic foot care.
• Brush and floss your teeth every day. See your dentist two times a year to have your teeth cleaned and checked.
• Wear a medical alert bracelet that says you have diabetes. You may get one from us.
• There is a lot to learn about diabetes and you should learn all that you can. Ask your caregiver, diabetes nurse, or dietitian about diabetes classes. The more you know about diabetes, the easier it will be for you to control your disease and to live an active life.
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Call your Physician if:
• You have a temperature over 100.4 °F.
• Your blood sugar is more than 300mg/dl or less than 60 mg/dl.
• You have any of the following signs or symptoms of high blood sugar:
o Blurry vision.
o Fatigue (feeling very tired).
o Hungry all of the time but losing weight without trying.
o Losing feeling, have pain or tingling in your hands or feet.
o Sores that take a long time to heal, or very dry skin.
o Urinating often.
o Very thirsty and drinking a lot of liquids.
o Vaginal infections in women.
• You have any of the following signs or symptoms of low blood sugar:
o Becoming confused, or having difficulty paying attention.
o Becoming crabby or grumpy.
o Becoming sweaty.
o Feeling faint (lightheaded).
o Feeling hungry.
o Feeling tired.
o Feeling like your heart is beating very fast.
o Feeling shaky.
o Headache.
• You have burning or stinging when you urinate, or you are urinating often and passing only small amounts of urine. These may be signs that you have a bladder infection.
• You are vomiting (throwing up).
• You have any questions about your medicine, exercise, or diet.
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Seek care immediately if:
• You are having trouble thinking clearly.
• You are feeling worse even though you are following your caregiver's directions.
• You have the following signs of a heart attack:
o Chest pain that spreads to your arms, jaw, or back.
o Nausea (sick to your stomach).
o Trouble breathing.
o Sweating.
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