How do I stay healthy?

Transcription

1 How do I stay healthy? Diet and exercise info At Novo Nordisk, we are changing diabetes. In our approach to developing treatments, in our commitment to operate profitably and ethically and in our search for a cure.

2 With you all the way is a patient support programme created by Novo Nordisk, providing practical information on diabetes and its management for children and young adults with diabetes. This material has been reviewed by a panel of experts: Lead Diabetes Specialist Nurse Nicola Lewis, UK Paediatric Endocrinologists Prof Thomas Danne, Germany and Dr Nandu Thalange, UK This information is not designed to replace the advice of a healthcare professional. Please consult your doctor or nurse if you have any questions or concerns about managing your diabetes. 1

3 Staying healthy Diet and exercise are important, whether you have diabetes or not. The key to managing diabetes is getting the right balance between your food intake, insulin dose and physical activity. 1 When you learn how your body reacts to different types of food and exercise, it will get easier to manage your diabetes. This leaflet provides information on diet and exercise. If you have any questions or concerns speak to your doctor, nurse or dietitian for advice. 2

4 Physical activity is an important part of diabetes management. Activity helps to lower your blood glucose levels and has other health benefits. Benefits of regular exercise: 2 Staying active Makes you feel better Helps you stay at a healthy weight Improves physical fitness Improves cardiovascular health How often should I exercise? You should try and be active for 30 to 60 minutes each day. 2 Even if you are not sporty, there are lots of other enjoyable ways to stay active, such as walking or dancing, or getting a part-time job. You could try taking the stairs instead of using a lift or escalator, or getting off the bus a stop earlier so you have a longer walk than usual. 3

5 Testing your blood Before exercise you should always test your blood before exercise. If your blood glucose is too low, you may need an extra carbohydrate snack before exercise. If your blood glucose is very high, particularly if you have elevated ketones, you should avoid exercise, otherwise you may develop diabetic ketoacidosis. 2,3 After exercise sometimes blood glucose levels decrease after activity, so it is a good idea to test afterwards too. 4 During exercise you may need to test during activity, especially if you are exercising for a long time. You may need a snack during exercise if your blood glucose levels are low. 2 4

6 Preparing for exercise Nearly all activities lasting 30 minutes or more (such as a sports lesson at school or a football match) will require an adjustment of your food intake and/or insulin dose. 4 Your doctor or nurse will advise what to eat and teach you how to adjust your dose for the activity you are going to be doing. If you have an insulin pump, you may choose to disconnect this for a short time (maximum of 2 hours). 4 Depending on how active you are going to be, you can do some or all of the following: Have a carbohydrate-containing snack just before exercise Reduce your insulin dose for the meal before exercise Include long-acting carbohydrate in the meal after exercise (to reduce your risk of hypoglycaemia afterwards) Reduce your long-acting insulin the evening after exercise, particularly after strenuous endurance type exercise Make sure you have a fast-acting carbohydrate snack with you when you exercise to treat hypoglycaemia should it occur. 5

7 Ayse Naz Baykal, Turkey Ayse has type 1 diabetes Examples of fast-acting carbohydrate snacks: 3, 4 Sports drinks Fruit juice Glucose tablets or sweets If you feel like you have low blood glucose (hypoglycaemia) while you are exercising, you will need to stop to have a fast-acting carbohydrate snack or drink before you resume. 4 Examples of long-acting carbohydrates: 3,4 Fruit, such as a banana Cereal or fruit bar Biscuits Bread Milk If you are planning longer activities you may need an additional long-acting carbohydrate snack. 6

8 Healthy eating A balanced diet It is important to try and maintain a healthy balanced diet, along with regular exercise and taking insulin. 1 You should have three balanced main meals with snacks in between, depending on your insulin regimen. 1 Different types of food No single food group provides you with all the energy and nutrients you need. You should aim to have a healthy balance of different food groups. 5 Carbohydrates 7 Foods that contain carbohydrates provide your body with energy. When carbohydrates are digested they are broken down into sugars, increasing your blood glucose levels if they are not used up as energy. Some carbohydrates act slowly, some quickly. 6

9 Different types of carbohydrates There are three main types of carbohydrates: 5 Sugar (simple carbohydrates) Starch (complex carbohydrates) Fibre (complex carbohydrates) Simple carbohydrates Simple carbohydrates are short-acting carbohydrates that will increase your blood glucose levels quickly. 6 These are used when you have a hypoglycaemic episode. These are sometimes called high glycaemic index (GI) carbohydrates. Complex carbohydrates Complex carbohydrates are long-acting carbohydrates which take longer to digest (you may hear people call these low GI carbohydrates). They increase your blood glucose levels slowly over time. Ideally, the majority of carbohydrates should come from complex carbohydrates. These types of carbohydrates can help to prevent hypoglycaemia. 6 What foods contain carbohydrates? Sugar (simple carbohydrates) Starch (complex carbohydrates) Fibre (complex carbohydrates) Common foods that contain carbohydrates: Fruits and juices Potatoes Fruits and vegetables Cakes Bread Whole grain bread Cookies Pasta Whole grain/oat cereals Some cereals Rice Lentils and beans Peas Nuts Corn Lentils and beans 8

10 Carbohydrate counting There are two main ways to count carbohydrates: Changing insulin dose to match carbohydrate intake ( carb counting ) With this method, you can eat different amounts of carbohydrate and will need to change the insulin dose to match. 7 This may make it easier when you are eating out or eating at someone else s house. Your doctor, nurse or dietitian will advise you how to work out how much carbohydrate you need to match your insulin dose. You will have your own insulin-tocarbohydrate ratio to help you calculate how much insulin you need. 7 This will depend on your age and weight and will change as you get older and may also vary at different times of the day. Some people, especially during puberty, will need a higher carb ratio (more insulin) at certain times of the day particularly at breakfast time. If you are not very good at working out your insulin dose in your head, talk to your doctor or nurse about tools, such as apps for your mobile phone, that can help. Planning carbohydrate intake to match insulin dose With this method, you need to try and eat the same amount of carbohydrate at each meal to match your insulin dose. 7 Your doctor, nurse or dietitian will advise how much carbohydrate you need each day and what insulin dose you should take. 9

11 How do I know how much carbohydrate is in food? Lots of foods show how much carbohydrate they contain on the label. Food labels often show how much carbohydrate is in each serving and per 100g (this may be different in some countries). Reading food labels: Nutrition Facts Serving Size 8 Crackers (28g) Amount per serving Calories 120 Fat Calories 30 % Daily Value Total Fat 3.5g 5% Saturated Fat 1g 5% Trans Fat 0g Polyunsaturated Fat 1.5g Monounsaturated Fat 0.5g Cholesterol 0mg 0% Sodium 140mg 6% Total Carbohydrate 22g 7% Dietary Fiber less than 1g 3% Sugars 7g Protein 2g Vitamin A 0% Vitamin C 0% Calcium 10% Iron 4% Check the serving size: 8 Crackers Is that how much you are going to eat? This number (28g) is the weight of the crackers, not the amount of carbohydrate in the serving. Count total carbohydrate. You do not need to count sugars separately because they are already counted as part of the total carbohydrate. Some foods also have a traffic light system on their labels which shows foods with low, moderate or high sugar. Serves 2 half pizza provides cals % sugar 9.0g 10% fat 18.3g 26% sat fat 9.2g 46% salt 2.0g 33% of your guideline daily amount Your doctor, nurse or dietitian will advise you how to work out how much carbohydrate different foods contain. 10

12 Timing of meals Your doctor or nurse will help you to plan when is best to eat and when to take your insulin. Depending on your insulin regimen, they may recommend that you try and eat each meal at around the same time every day. However, if you are out and about, at after school activities or at a friend s house, it isn t always possible to plan your mealtimes. If you are going to eat much later than usual, you should test your blood and have a snack if your blood glucose levels are low. If you eat much earlier than usual, you may need to increase your insulin dose or take an extra dose. If you are unsure how to do this, speak to your doctor or nurse. Eating out It is not always easy to eat healthily, time meals and count carbohydrates when you go out for dinner. It s OK to treat yourself occasionally, as long as you adjust your insulin dose to balance your blood glucose levels. If you would like to check the carbohydrate content of foods, many restaurants will provide nutritional information if you ask them. Some restaurants also show this information on their website so you can look before you go. Sometimes it can be hard to time your insulin dose if you are unsure of when your meal will arrive. On these occasions, it is better to wait until your meal arrives before injecting your insulin. 11

13 Weight and insulin It is normal for a teenager s weight to increase over time due to growth. However, you may notice that you put on weight once you start taking insulin. 8 This may be some of the weight you may have lost before you were diagnosed. It is important that you continue your insulin regimen and eat healthy meals as advised by your doctor or nurse. Skipping insulin or meals or going on crash diets is not good for you. Poor glucose control can lead to long-term complications. 9 Prolonged high blood glucose levels have been shown to increase the risk of problems with your feet, eyes, kidneys, nervous system or heart. 10 If you are concerned about weight gain: It is important that you speak to your doctor or nurse if you are concerned about your weight. They may be able to suggest ways to help maintain a healthy weight, including altering your insulin regimen, dietary intake or activity level. Sometimes using an insulin pump will help you to manage your weight better, as usually you won t need as much insulin when you are using a pump. The best approach to maintain a healthy weight is to keep up a healthy lifestyle, with a balanced diet and regular exercise. 12

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15 SUDE IĞDIR, Turkey Sude has type 1 diabetes References 1. Smart C et al. ISPAD Clinical Practice Consensus Guidelines 2009 Compendium: Nutritional management in children and adolescents with diabetes. Pediatr Diabetes 2009; 10(Suppl. 12): Silverstein J et al. Care of children and adolescents with type 1 diabetes. Diabetes Care 2005; 28(1): Sydney Children s Hospital. Physical activity and diabetes. Available at: au/health/factsheets/joint/?physical_ activity_and_diabetes.htm Accessed October Robertson K et al. ISPAD Clinical Practice Consensus Guidelines 2009 Compendium: Exercise in children and adolescents with diabetes. Pediatr Diabetes 2009; 10(Suppl. 12): American Diabetes Association. Food and Fitness: Planning meals. Available at: planningmeals/ Accessed October NIH Medline Plus Library. Diabetes diet type 1. Available at: medlineplus/ency/article/ htm Accessed October International Diabetes Foundation. A parent/caregiver guide: Carbohydrate counting for children with diabetes. Available at: files/attachments/hi62553-carbohydrate- Counting-for-Children.pdf Accessed October American Diabetes Association News. Deborah Young-Hyman, PhD: Evaluating the risk of eating disorders in teenagers with type 1 diabetes. Available at: research-discoveries/in-the-news/evaluatingthe-risk-of-eating.html Accessed October 2012 Accessed October Rewers MP et al. ISPAD Clinical Practice Consensus Guidelines 2009 Compendium: Assessment and monitoring of glycemic control in children and adolescents with diabetes. Pediatr Diabetes 2009; 10(Suppl. 12): NIH Medline Plus Library. Type 1 diabetes. Available at: medlineplus/ency/article/ htm Accessed October Novo Nordisk website. Available at: Accessed October

16 About Novo Nordisk This information was developed by Novo Nordisk, a global healthcare company specialising in the care of people with diabetes. Novo Nordisk was started up almost 90 years ago by a Danish couple with a passion for changing diabetes. August Krogh was a professor at the University of Copenhagen and Nobel Prize winner and his wife Marie, a doctor and researcher into metabolic diseases, suffered from type 2 diabetes. They learned of insulin being developed in Canada and were determined to ensure access to insulin for everyone with diabetes, hence in 1923 Novo Nordisk was born. Since then Novo Nordisk has grown to become a world leader in the provision of diabetes products and support for patients of all ages. 11 We fully understand the challenges that children with diabetes face and are working together with parents, schools and healthcare professionals to improve the care of children with diabetes, as they grow up and develop. For more information about Novo Nordisk, please visit: This information is not designed to replace the advice of a healthcare professional. Please consult your doctor or nurse if you have any questions or concerns about managing your diabetes. APROM ID#4601; approval date: December Changing Diabetes and the Apis bull logo are registered trademarks of Novo Nordisk A/S. Novo Nordisk A/S Novo Alle 2880 Bagsværd Denmark