Copyright 2007 by Vanderbilt University. All rights reserved. Please contact authors for permission to use.

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1 Copyright 2007 by Vanderbilt University. All rights reserved. Please contact authors for permission to use.

2 PART 1 INTRO TO DIABETES Diabetes is a disease that causes you to have extra sugar in your blood (high sugar). High sugar in the blood can cause you problems with: Poor vision or blindness Kidney disease Heart attacks or strokes Numbness, tingling or pain in your nerve endings Foot sores and foot pain Less blood flow Infections But, control of your blood sugar can help to stop these problems! The Major Problems From Diabetes Eye problems Strokes Heart problems Kidney problems Less blood flow in lower legs Problems with Nerve endings Foot problems 1 PART 1

3 Taking care of your diabetes If you have diabetes, you need to: Check your blood sugar every day. and know what your blood sugar should be. Be aware of how much starch and sugar (carbohydrates) you eat at every meal. Be active every day! Take your diabetes medicines every day. Clean and look at your feet every day. Go to your doctor s office for regular check ups. 2 PART 1

4 PART 2 TESTING YOUR BLOOD SUGAR Test Your Blood Sugar Every Day Why should I test my blood sugar? To know if your blood sugar is too high or too low So your doctor or nurse will know how your diabetes is doing to help control your diabetes What does my blood sugar test result mean? If Blood Sugar Is: Over 300 This is very high. Call your doctor or nurse at if it stays this high for 2-3 days This is too high. Call your doctor or nurse if it stays high for over a week This is a little high before meals This is perfect before meals. Below 70 This is too low. Eat 3-4 glucose tablets or Call your doctor or nurse at if you have more than lows in a week. If you are worried that your blood sugar is too high or too low, call your doctor or nurse at 1 PART 2

5 Blood Sugar Testing: How Do I Get Ready To Test? 1. Wash your hands with warm water or a wipe. Dry your hands. 2. Put these things on a table: Blood sugar meter, test strips, lancet device, lancets, logbook. 3. Put the lancet in the lancet device. 4. Put strip in meter to turn it on. 2 PART 2

6 Blood Sugar Testing: How Do I Test? 1. Match number on meter to number on your bottle of strips if your meter needs this done. 2. Prick your finger or hand and squeeze out a drop of blood. 3. Put blood on strip the right way. 4. Wait for blood sugar number to show up on meter. 5. Write blood sugar test result on log sheet. 6. Bring your blood sugar readings and blood sugar meter to all doctor visits. 7. If tou are having trouble with your blood sugar meter call 3 PART 2

7 LOW BLOOD SUGAR Causes: Too little food or skipping a meal; too much insulin or diabetes pills; more active than usual. Onset may be sudden, you may pass out if untreated Check your blood sugar right away. If you can t test, treat anyway. Treat if blood sugar less than 70 with: 3-4 glucose tablets or 1/2 cup juice or 1/2 can regular soda Check blood sugar in 15 minutes if symptoms don t stop. If blood sugar is still too low, treat again. * Adopted from Novo Nordisk 4 PART 2

8 PART 3 HOW TO FOLLOW MY EXERCISE PLAN Why should I exercise? Exercise is good for diabetes Exercise helps lower blood sugar Exercise can help you lose weight Exercise can help you feel better DATE OF PLAN What kind of exercise will I do? q Walk q Ride a bike q Dance q Swim q Other When will I exercise? q Monday q Tuesday q Wednesday q Thursday q Friday q Saturday q Sunday Minutes a day days a week. Write down the minutes you exercised in your log book. Sometimes exercise can lower blood sugar too much. To prevent low blood sugar I should: q No need to change anything q Eat an extra snack before I exercise q Take less insulin q Test blood sugar 1 PART 3

9 PART 5 INTRO TO EATING WITH DIABETES When you have diabetes being careful about what you eat can help you control your blood sugar. Foods are in three main groups: Carbohydrates (Carbs) Higher Carbohydrates (Carbs) Lower (Carbs) Proteins Fats and Oils How does food affect my blood sugar? Some food makes your blood sugar go up. Diabetes pills, insulin or exercise bring your blood sugar down. If you don t have enough insulin in your body, your blood sugar may be up after you eat. Changing what you eat can help bring your blood sugar down. Do not skip meals to lower your blood sugar 1 PART 5

10 Carbohydrates Does all food make the blood sugar high? No, it is mainly higher carbohydrate foods that make blood sugar go up. Carbohydrate foods are also called Carbs. Foods with higher carbs are: Starches and grains such as bread, pasta or noodles, rice and cereal. Fruits and fruit juice. Soft drinks, sweet drinks, most energy drinks and sports drinks. Milk and yogurt. Sweets including ice cream, cakes, cookies, candy, desserts. Starchy vegetables such as potatoes, peas, most beans, and corn. Should I stop eating carb foods? No, you need to eat carbs at every meal! Do not skip carbs to lower blood sugar. You need to keep track of how many higher carb foods you eat to help control your diabetes. You and your dietitian will figure out the right amount and kind of carbs for you. 2 PART 5

11 Higher Carb Food List Breakfast Foods Hot or cold cereal Milk Fruit Fruit juice Bread, Biscuit, Bagel, Muffin Waffles Pancakes Tortilla Rice Syrup Jelly Yogurt Hot Cocoa Poptarts Breakfast bars Instant Breakfast Lunch and Dinner Potatoes Rice Pasta (noodles, spaghetti, macaroni, etc Beans (pinto, white, black, etc) Corn Peas Bread, roll, tortilla Pretzels Chips Milk Fruit Juice Crackers Sweets Ice cream Pie Pudding Cake Cookies Candy Soda Sweet tea 3 PART 5

12 Lower Carb Foods You can eat all you want of these foods! These lower carb foods are healthy andf low in calories These foods don t raise your blood sugar very much Alfalfa sprouts Artichoke / Artichoke Hearts Asparagus Green beans or yellow Bean sprouts Beets, boiled Broccoli Brussels sprouts Cabbage, any kind Cauliflower Celery Cucumber Eggplant Greens, any kind (turnip, spinach) Lettuce, any kind (salad greens) Leeks Mushrooms, button, raw or cooked Okra, boiled Onion Peppers, any kind Radish Rhubarb Sauerkraut Snowpeas Spinach Sprouts, any kind Squash, yellow or spaghetti squash Sugar snap peas Water Chestnuts Tomatoes Turnip Zucchini Water Diet Drinks, sugar free Kool-Aid 4

13 Lower Carb Foods Protein foods include meats, poultry, fish, and eggs. Common Meats or Proteins Lean Beef, Lamb, Veal and Pork Sandwich or Deli Meats Chicken, Turkey, Cornish Hen Fish, Tuna Fish, Shell Fish Eggs and Egg substitutes Low Fat or fat-free Cheese Low-fat Cottage Cheese Peanut butter Tofu Venison (Deer) and Game For meats, eat about the size of the palm of your hand at each meal. If you are extra hungry, you can eat two servings of very lean meat. Protein foods do not raise your blood sugar, but they do have calories and fat. If you eat too much you could gain weight or make your cholesterol go up. 5 PART 5

14 Use the following tips to help you choose your protein foods. To cut down the fat: Buy only the leanest meat. Good choices are meats that end in "loin" or have "round" in the name. For example, sirloin, tenderloin, eye of round, ground round, round steak. Buy low-fat, 2%, or non-fat cheese; example Kraft s 2% cheese. Eat only 4 egg yolks a week. Egg whites are fine everyday. When cooking: Try to bake, broil or grill your foods. Try not to fry in oil. Use a non-stick skillet sprayed with a cooking spray like Pam and try not to add any oil or other fat. Cut off any fat on the meat before cooking. Remove the skin on chicken or turkey before cooking. 6 PART 5

15 Fats And Oils Fat and oils have more calories than any other foods. Eating to much fat can make you gain weight. These fats are OK to eat: Monounsaturated Fats (lower bad cholesterol) Almonds Cashews Pecans Peanuts Pistachios Macadamia nuts Hickory nuts Filbert/hazelnuts Pine nuts Avocado Canola oil Olives &Olive Oil Tahini paste Peanut oil Peanut butter Sesame seeds Eat less of these: Polyunsaturated Fats (Lower bad and good cholesterol) Pumpkin seeds Sunflower seeds Corn oil Soy oil Safflower oil Margarine Mayonnaise Walnuts Eat very little of these: Saturated Fats (Raise bad cholesterol) Bacon & Sausage Butter Coconut Chitterlings Cream Half and Half Cheese Fatback Shortening Lard Sour cream Salt pork Be careful of hidden fats: Hidden Fat Foods (Raise bad cholesterol) Fast Food Biscuits Chips Fried foods Corn Bread Donuts Muffins Popcorn Crackers Granola Whole Milk Hot Dogs Potted Meat Hamburgers Lunch Meats Sandwich Pizza Cream soups Casseroles Desserts Sauces Dip Gravy 7 PART 5

16 Snack Ideas If you like to have snacks between meals, you can choose one of the following options: KIND AMOUNT Sugar free Jello 1 cup Sugar free popsicle 1 popsicle Sugar free hot chocolate 1 cup Sunflower seeds or pumkin seds 2 tablespoons Walnuts, pecans or pistachio nuts 2 tablespoons Cashews and macadamia nuts 1 tablespoons Peanuts 2 tablespoons Pine nuts 2 tablespoons Low-fat popcorn 2 cups Low fat cheese slices 2 slices Sliced turkey or chicken 2 slices Low-fat or fat-free cottage cheese 1 cup String cheese 1 stick Laughing cow cheese wedge 2 wedges Mozzarella cheese stick 1 stick Baby Bell Cheese, round, red wrap 2 balls Black Olives, canned 18 olives Tomato juice 2 cups V-8 juice 2 cups Low-carb yogurt 6 or 8 ounce container Jerky (try to find low sugar varieties) 1 large piece Hard boiled egg 1 egg 8 PART 5

17 Snack Ideas If you like to have snacks between meals, you can choose one of the following options: Dairy BabyBel cheese, round w/red wrapper Laughing Cow, wedge cheese Cheese slides, 2 % Low-fat or fat-free cream cheese on celery Low-fat or fat-free cottage cheese String Cheese (Mozzarella cheese stick) Low-carb yogurt 1 pieces 2 wedges 2 slices 3 tablespoons of cheese 1/2 cup 1 stick 4, 6, or 8 ounce container Nuts & Seed Walnuts, pistachios, pecans, peanuts, pine nuts Cashews Macadamia nuts Sunflower seed kernels Peanut butter on celery Salty & Crunchy Green or black olives Dill pickles Jerky Low-fat popcorn Edamame (soybeans 2 Tablespoons 1/2 Tablespoons 1/2 Tablespoons 2 Tablespoons 1 Tablespoon of peanut butter 18 olives 1 large 1 large piece 2 cups 1/4 cup shelled Cold Snacks & drinks Jello (sugar-free) Fudgesicle (sugar-free, less than 40 calories) 1 Popsicle (sugar-free, less than 20 calories 2 Egg, hard boiled 1 Turkey or chicken, thin deli slices 2 Unlimited 9 PART 5

18 Snack Ideas If you like to have snacks between meals, you can choose one of the following options: Combo foods 1 tablespoon of Peanut butter on celery 3 tablespoons of low-fat cream cheese on celery Slice of low-fat lunchmeat rolled-up with low-fat cheese, veggies, Raw veggies with 2 Tablespoons low-fat dip Low-fat or fat free ricotta cheese with 1/4 (red) cup fresh fruit or 1 Tbs. nuts Celery with tuna made with low-fat mayonaise Dill pickles and 2% milk cheddar cheese 1/4 ( red) cup berries with 1/3 cup low-fat or fat free cottage cheese Sugar free Jello, alone or with low-fat cottage cheese and a sprinkling of nuts 2% milk cheese with a few apple slices (3-4 thin) 4 oz plain or sugar-free yogurt with a 1/4 (red) cup berries Lettuce Roll ups roll low-fat luncheon meat or tuna made with low-fat mayonaise One rice cake thinly spread with fat-free sour cream, sprinkled with crumbled blue cheese 10 PART 5

19 PART 6 USING YOUR PLATE TO CONTROL YOUR CARBS One way to help track how much you eat is to control how many carbs you put on your plate at each meal. For Breakfast: Here s how much you can eat: 1.You can have any from this list: A hot or cold bowl of cereal 1 cup of milk Small bowl of fruit or small glass of juice 1 piece of toast or small biscuit 1 frozen Eggo waffle or 1/2 of a large waffle 1 tablespoon of jelly or 2 tablespoons of sugar-free jelly 1 tablespoon of syrup or 2 tablespoons of sugar free syrup 2. And from this list: An egg A slice of ham A strip of turkey bacon A piece of turkey sausage 3. And from this list: A teaspoon of regular margerine or regular butter A teaspoon of regular cream cheese A tablespoon of light margerine or light butter or light cream cheese 1 PART 6

20 For Lunch: Here s how to put your plate together: 9-10 Inch plate Protein Foods Palm Size Servings Lower Carb Foods All you can eat Higher Carb Foods Servings You may have up to servings of higher carb foods at lunch or dinner. (see the higher carb food list.) Eat a serving of meat, chicken or fish about as big as the palm of your hand. (see the protein food list.) Fill up on the lower carb foods to help keep your blood sugar in control. (see the lower carb food list.) 2 PART 6

21 For Supper: Here s how to put your plate together: 9-10 Inch plate Protein Foods Palm Size Servings Lower Carb Foods All you can eat Higher Carb Foods Servings You may have up to servings of higher carb foods at lunch or dinner. (see the higher carb food list.) Eat a serving of meat, chicken or fish about as big as the palm of your hand. (see the protein food list.) Fill up on the lower carb foods to help keep your blood sugar in control. (see the lower carb food list.) 3 PART 6

22 Higher Carb Food List (with serving size) Breakfast 1 small bowl of hot or cold cereal 1 Cup of milk (8 oz) 1 Small bowl of fruit 1 Small glass of juice (4 oz) 1 piece of bread or toast 1 small biscuit 1/2 small bagel 1/2 small muffin 1 Eggo waffle or 1/2 large waffle 1 pancake 1 small tortilla 1 small bowl rice 1 Tablespoon regular syrup or 2 Tablespoon sugar-free syrup 1 Tablespoon jelly or 2 tablespoons sugar-free jelly Yogurt (ask your dietitian about the serving size) 1 small glass regular cocoa or large glass sugar-free cocoa 1/2 of one Poptart 1/2 of a Breakfast bar 1/2 packet with 1/2 cup milk Instant Breakfast Lunch and Dinner 1 small bowl Potatoes 1 small bowl Rice 1 small bowl of pasta (noodles, spaghetti, macaroni, etc.) 1 small bowl Beans, like pinto or white 1 small bowl Corn 1 small bowl Peas 5 crackers 1 large pretzel stick 100 calorie bag Doritos 1 piece of bread or roll 1 small tortilla 1 cup of milk 1 small bowl of fruit 1 small glass of juice Sweets 1 small bowl of low-fat, sugar-free ice cream 1 small bowl of sugar-free pudding 1 small bowl of cake (no icing) 1 small cookie or 1/2 of a 3 cookie 2 pieces of hard candy 1/2 cup regular soda or 12 oz diet soda 1 small glass of sweet tea or 12 oz unsweetened tea 4 PART 6

23 For Lunch And Dinner You Should Divide Your Plate Into 3 Parts Fill up this part of your plate with Lower Carb Foods 1 Lower Carb Foods Alfalfa sprouts Artichoke, Artichoke hearts Asparagus Beans, green or yellow Bean sprouts Beets, boiled Brocolli Brussel sprouts Cabbage, any kind Cauliflower Celery Cucumber Eggplant Greens, any kind (Turnip, Spinach) Lettuce, any kind, Salad Greens Leeks Mushrooms, button, raw or cooked Okra, boiled Onion Peppers, any kind Radish Rhubarb Sauerkraut Snowpeas Spinach Spinach Sprouts, any kind Squash, yellow or spaghetti Tomato Sugar snap peas Turnip Water chestnuts Zucchini Diet Drinks, sugar free Kool-Aid 1

24 Use this part of your plate for Protein Foods 2 Protein Foods Lean Beef, Lamb, Veal and Pork Sandwich or Deli Meats Chicken, Turkey, Cornish Hen Fish, Tuna Fish, Shell Fish Eggs and Egg substitutes Low Fat or Fat Free Cheese Cottage cheese Peanut Butter Tofu Venison (Deer) and Game 2 3 Higher Carb Foods 3 1 small bowl Potatoes 1 small bowl Rice 1 small bowl Beans, like pinto or white 1 small bowl Corn 1 small bowl Peas 1 small bowl Noodles or macaroni 5 crackers 1 piece of bread or roll 1 cup of Milk (8 oz) 1 small bowl of Fruit 1 small glass of Juice ( 4 oz) 1 small bowl of low-fat, sugar-free Ice Cream 1 small bowl of sugar-free Pudding Use this part of your plate for Higher Carb Foods

25 PART 7 THE SCOOP ON USING SCOOPS Decide which carb foods you want to eat. Look up the carb foods on the list to see how much of each carb food you should have. Use the color scoop listed beside the food to serve your carb foods. (GREEN, YELLOW, BLUE, or RED) Fill the scoop as level as possible without piling the food above the scoop edge. If a food does not fit in a scoop, the list will tell you how much of the food equals one scoop. Foods listed in PINK are free foods. You can have as much free foods as you like. Try to fill up on free foods. Fast foods and restaurant foods are in a separate list. You do not need to use the scoops for the free foods or meats. 1 PART 7

26 PART 8 MY MEAL PLAN WITH SCOOPS Look at your scoop meal plan shown below. Eat only the number of scoops listed at each meal. This will help keep your blood sugar from being too high after eating. Decide which carb foods you want to eat. Look up the carb foods you are going to eat in Part 7 to see what color scoops to use to measure your food. If a food does not fit in a scoop, the food list will tell you what a serving size is. Fill up on free foods. The free foods are pink on your list in Part 7. Have lean protein with each meal. Use the protein food list in Part 5. Breakfast You can have scoops from the food lists. Lunch You can have scoops from the food lists. Supper You can have scoops from the food lists. 1 PART 8

27 PART 9 HOW TO COUNT CARBOHYDRATES (CARBS) You can help control how many carbs you eat by counting the carbs you eat. Carbs are counted in grams. Count the grams using the following steps: 1. Count all the carb grams in each carb food before you start to eat. 2. Use the food label or look the foods up in a reference book to figure out how many carbs are in the amount of food you are about to eat. 3. Add all the carb foods in your meal. Breakfast example: 1 cup Rice Krispies cereal 22 grams 1/2 cup of milk 6 grams 1 cup strawberries 16 grams TOTAL 44 grams for breakfast 1 PART 9

28 Carbs On A Food Label 1. Look for the serving size at the top of the label The information on the label is for one serving size. 2. Look for Total Carbohydrates in the middle of the label Total Carbohydrate has a g for grams to the right of the number. A B Make sure you count the right amount of carbohydrate grams CRACKERS A The serving size for this product is cup B One serving (1/2 cup ) of this product contains 13 grams of carbohydrates 2 PART 9

29 Practice One Serving Size Use the label below: What is the serving size? How many carbohydrate grams are in each serving? If you eat one serving, you will get grams of carb. 2 servings is crackers Add grams of carb from 1 serving + grams of carb from 1 serving = grams of carb from 2 servings 1/2 serving is crackers grams of carb from 1 serving divided by 2 = grams of carb from 1/2 serving 3 PART 9

30 How to Calculate Carbs in a Meal You must add up the carbs from all the foods in your meal to get the total carbs for that meal. Worksheet 1/2 cup of mashed potatoes grams 1/2 cup green peas grams 1 pork chop grams 3 cups of mixed greens salad grams 3 T fat free Ranch salad dressing grams 2 Pillsbury dinner rolls grams Total for meal Total grams Use the package labels or your Calorie King book to find the carb grams for each food. Then add all together to get the total carbs for your meal. 4 PART 9

31 Creamy Butter Mashed Potatoes Nutrition Facts Serving size: 1/2 cup prepared (25G) Servings Per Container 8 % Daily Value * AMOUNT PER SERVING PREPARED Calories 160 Calories from fat 70 Total Fat 1g 10% Saturated Fat 0.5g 10% Trans Fat 0.5g Cholesterol 0mg 1% Sodium 370mg 18% Potassium 310mg 11% Total Carbohydrate 19g 7% Dietary Fiber 1g 6% Sugars 1g Protein 2g Vitamin A 6% Calcium 6% Iron 2% Riboflavin 4% Niacin 4% *Percent Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs. 5 PART 9

32 Green Peas Serving Size 1/2 cup (80g) Servings Per Container 8 Nutrition Facts Amount Per Serving Calories 50 Calories from fat 5 % Daily Value * Total Fat less than1g 1% Saturated Fat less than1g 0% Trans Fat 0.g Cholesterol 0mg 0% Sodium 95mg 4% Total Carbohydrate 11g 4% Dietary Fiber 4g 16% Sugars Protein 3g 5g Vitamin A 8% Calcium 2% Vitamin C 20% Calcium 2% Iron 6% *Percent Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs. 6 PART 9

33 Pork Chop Nutrition Facts Serving Size 1 pork chop 4 oz (112 gms) Sevings Per Package 6 Calories 236 % Daily Value * Calories from Fat % Total Fat 15 23% Saturated Fat 5 27% Cholesterol 93 31% Sodium 66 3% Total Carbohydrate 0 0% Dietary Fiber 0 0% Sugar 0 0% Protein 33 32% *Percent Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs. 7 PART 9

34 Nutrition Information for: Mixed salad greens, raw Nutrition Facts Serving Size: 2 cup chopped or shredded. Calories 18 Calories from Fat 0 % Daily Value * Total Fat less than1g 0% Saturated Fat less than 1g 0% Polyunsaturated Fat less than1g Monounsaturated Fat 1 g Cholesterol 0 mg 0% Sodium 28 mg 1% Potassium 350 mg 10% Total Carbohydrate 3 g 1% Dietary Fiber 2 g 10% Protein 2 g 4% Vitamin A 60 % Vitamin C 30 % Calcium 6 % Iron 8 % Vitamin E 2 % Riboflavin 5 % Folate 32 % Vitamin B-12 0 % Magnesium 7 % Copper 4 % *Percent Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs. 8 PART 9

35 Fat Free Ranch Salad Dressing Serving Size 1 Tablespoon Servings Per Package 18 Calories Nutrition Facts % Daily Value * 17 Less than1% Calories from Fat 3 0% Total Fat less than 1g 0% Saturated Fat less than1g 0% Cholesterol 1 0% Sodium 106 4% Total Carbohydrate 4 1% Dietary Fiber 0 0% Sugar less than1g Protein 0 0% Vitamin A Vitamin C Calcium Iron *Percent Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs. 9 PART 9

36 Pillsbury Dinner Rolls Amount per Serving Serving Size 1 Roll (35 gms) Servings Per Package 20 Nutrition Facts Calories 100 % Daily Value * Calories from Fat 14 0% Total Fat 1.5 2% Saturated Fat 0 0% Cholesterol 0 0% Sodium 200 8% Total Carbohydrate 18 6% Dietary Fiber 1 4% Sugar 2 Protein 4 4% Vitamin A 0% Vitamin C 0% Calcium 0% Iron 6% *Percent Daily Values are based on a 2,000 calorie diet. Your daily values may be higher or lower depending on your calorie needs. 10 PART 9

37 PART 9b CALCULATING A RECIPE 1. Look up the carb in each ingredient on the recipe. Use a food label or book. 2. Adjust the carbs to match the amount called for in your recipe. For example if the label says the flour has 100 grams of carb in a cup and your recipe calls for 3 cups then multiply 100 grams by 3 cups to get 300 grams for the whole recipe. 3. Write down the carb grams for each of the ingredients on the recipe so you won t have to look it up the next time. 4. Add all the carb grams together to get the total grams for the whole recipe. 5. Prepare the recipe and cut the food into the same size servings. 6. Divide the total carbohydrate grams for the whole recipe by the number of servings from step 5. If there is a decimal, round down to the next whole number. 7. If you make a casserole, soup, or other food that won t cut into servings: a. Before cooking, fill the cooking pan or pot with water using a large measuring cup. b. Count the number of cups of water it takes to fill the pan or pot. c. Write down number of cups the pan or pot holds on your recipe so you won t have to do it again. d. Divide the total carbohydrate grams in the whole recipe by the number of cups to see how many carbohydrate grams are in one cup. e. Use the one-cup measuring cup when you serve the food. 8. For later use, write on your recipe card the number of servings you like for this recipe and the grams of carbohydrate in each serving. 12 PART 9b

38 Example Cocoa Pudding Cake 95 g. 1 cup all-purpose flour 0 2 tablespoons oil 50 g. 1/4 cup sugar 0 1 teaspoon vanilla 2 g. 2 tablespoons cocoa powder 0 Non-stick vegetable spray 0 1/2 teaspoon salt 6 g 1/2 cup skim milk 54 1/4 cup brown sugar 4 g. 1/4 cup cocoa powder 0 1 1/4 cup hot water Makes 8 servings. TOTAL 211 grams of carbs 8 servings = 26 grams carbs/serving. 13 PART 9b

39 Part 9C: Carb Counting Meal Plan Goal amount of carbs to eat at each meal: Meal: Grams of Carb: Breakfast AM Snack Lunch PM Snack Dinner Bedtime Snack Other important foods to eat: Meal: Amount to Eat a Day: Lean meat Carbs from vegetables Carbs from fruit Fat Calcium rich foods 14 PART 9c

40 PART 10 DIABETES PILLS Take Your Diabetes Pills Everyday! Breakfast Dose Take pills of. Take pills of. Take pills of. Lunch Dose Take pills of. Take pills of. Take pills of. Supper Dose Take pills of. Take pills of. Take pills of. Remember to take all of your other medicines just like your doctor or nurse told you to take them. Call your doctor or nurse at if you have questions. 1 PART 10

41 PART 12 HOW DO I USE MY INSULIN PEN Your pen will come with directions for your type of pen. These are basic directions only. Get your pen ready: 1. Pull off plastic cover or pen cap. 2. If insulin is cloudy, gently turn pen up and down10 times to mix insulin. 3. Wipe rubber piece on the end of pen with alcohol. 4. Screw on pen needle and remove cover. 5.Turn knob on end of pen and dial up 1 unit. 6. Shoot 1 unit of insulin into the air. 1 PART 12

42 How To Give Your Shot Using An Insulin Pen 1. Turn knob on end of pen and dial up correct insulin dose. 2. Pick a site to inject insulin and wipe off skin with alcohol. 3. Insert the pen needle straight into skin and push in all the way. 4. Press the button on end of pen and push it all the way down. 5. Let go of button but leave needle in skin for 10 seconds. 6. Pull needle out. 10 sec 7. Put cap back on needle. 8. Unscrew needle and throw it away. 2 PART 12

43 PART 13 SET DOSE INSULIN How Much Insulin Do I Take? My long lasting insulin is: (Brand Name) My short lasting insulin is: (Brand Name) Before Breakfast: Take units of insulin before breakfast (long lasting insulin) Take units of insulin right before breakfast (short lasting insulin) Before Lunch: Take units of insulin right before lunch (short lasting insulin) Before Supper: Take units of insulin before supper (long lasting insulin) Take units of insulin right before supper (short lasting insulin) At Bedtime: Take units of insulin at bedtime (long lasting insulin) Take units of insulin at bedtime (short lasting insulin) 1 PART 13

44 PART 14 INSULIN FOR SET DOSE PLUS CORRECTION How Much Insulin Do I Take? My long lasting insulin is: (Brand Name) My short lasting insulin is: (Brand Name) Before Breakfast: 1. Take units of (long lasting insulin at am) 2. Test blood sugar 3. If blood sugar is below 70, eat 4 glucose tablets If blood sugar is to take units of (short lasting insulin) If blood sugar is to take units of (short lasting insulin) If blood sugar is to take units of (short lasting insulin) If blood sugar is over take units of (short lasting insulin) Before Lunch: 1. Test blood sugar 2. If blood sugar is below 70, eat 4 glucose tablets If blood sugar is to take units of (short lasting insulin) If blood sugar is to take units of (short lasting insulin) If blood sugar is to take units of (short lasting insulin) If blood sugar is over take units of (short lasting insulin) 1 PART 14

45 Insulin For Set Dose Plus Correction Before Supper: 1. Take units of (long lasting insulin) 2. Test blood sugar 3. If blood sugar is below 70, eat 4 glucose tablets If blood sugar is to take units of (short lasting insulin) If blood sugar is to take units of (short lasting insulin) If blood sugar is to take units of (short lasting insulin) If blood sugar is to take units of (short lasting insulin) At Bedtime: 1. Take units of (long lasting insulin) 2. Test blood sugar 3. If blood sugar is below 70, eat 4 glucose tablets If blood sugar is to take units of (short lasting insulin) If blood sugar is to take units of (short lasting insulin) If blood sugar is to take units of (short lasting insulin) If blood sugar is over take units of (short lasting insulin) 2 PART 14

46 PART 15 FLEXIBLE DOSES OF INSULIN (SCOOPS AND CORRECTION) TM You can use your InsuCalc Wheel to help determine how much insulin to take with your meals. Just follow these steps: 1. Test your blood sugar. 2. Determine how many scoops you are going to eat. 3. Find the number of scoops on the outer part of the Wheel (See A). Turn the inner wheel so the open triangle is under the number of scoops you plan to eat. 4. Now look on the smaller wheel in the middle and find the range that includes your blood sugar (See B). 5. Read the line in the empty triangle across from your blood sugar range (See C). 6. This is the amount of insulin to take before your meal. C: Insulin to Take 1 PART 15

47 TM InsuCalc Wheel For Scoops 1/2 SCOOP A: # of scoops B: Blood Sugar 9 SCOOPS 10 SCOOPS 1 SCOOPS TM 2 SCOOPS 3 SCOOPS C: Insulin to Take 8 SCOOPS 4 SCOOPS 5 SCOOPS 7 SCOOPS 6 SCOOPS C: Insulin to Take 2 PART 15 The images above have been provided as a courtesy by InsuCalc, Incorporated. InsuCalc insulin dosage calculators are protected by U.S. Patent No. 6,543,682 B1. See for product information.

48 PART 16 INSULIN FOR FLEXIBLE DOSAGE (CARB GRAMS AND CORRECTION) TM You can use your InsuCalc wheel to help know how much insulin to take with your meals. Just follow these steps: 1. Test your blood sugar. 2. Determine how many grams of carbs you are going to eat. 3. Find the number of grams on the outer part of the Wheel (See A). Turn the inner wheel so the open triangle is under the range of grams of carbs you plan to eat. 4. Now look on the smaller wheel in the middle and find the range that includes your blood sugar (See B). 5. Read the line in the empty triangle across from your blood sugar range (See C). 6. This is the amount of insulin to take before your meal. 1 PART 16

49 TM InsuCalc Wheel For Grams Of Carbs A: Grams of Carbs B: Blood Sugar C: Insulin to Take TM 2 PART 16 The images above have been provided as a courtesy by InsuCalc, Incorporated. InsuCalc insulin dosage calculators are protected by U.S. Patent No. 6,543,682 B1. See for product information.

50 PART 17 LONG LASTING INSULIN DOSING CHARTS Start with units of insulin at: Check your blood sugar before you eat breakfast everyday Use this form to change your insulin 3 days as directed dose by units every Take no more than units of your insulin? Call - - ext if questions.? 1 PART 17

51 2 PART 17

52 Instructions For Logbook Worksheets Part 18A: Not On Insulin-Counting Carbs 1. Write down the date in the Date box on your logbook worksheet. 2. Write down the time you eat in the Time box on your logbook worksheet. 3.Test your blood sugar. 4. Write the blood sugar result in the 4 Blood Sugar box on the logbook worksheet 5. Write down how many grams of carb you ate in the Carbs Eaten box on the logbook worksheet. 6. If you were asked, check your blood sugar 2 hours after meal. Write down the blood sugar in the 4 Blood Sugar 2 hours After Meal box on your logbook worksheet. 7. Write down how many minutes you exercised during the day in the Minutes of Exercise box at the bottom of your logbook worksheet. 8. If you eat a snack between your meals, write down the time you ate it and the grams of carb in the Snack box.

53 Part 18A. Log Book (No Insulin-Counting Carbs) Name: Date Goal Bedtime Dinner Snack Lunch Snack Breakfast Time Blood Sugar before meal Carb Servings Eaten Blood Sugar 2 hours After Meal Time Carb Servings Eaten Time Blood Sugar before meal Carbs Eaten Blood Sugar 2 hours After Meal Time Carb Servings Eaten Time Blood Sugar before meal Carbs Eaten Blood Sugar 2 hours After Meal Time Blood Sugar at bedtime Carb Servings Eaten Minutes of Exercise Please fax completed worksheet to:

54 Instructions For Logbook Worksheets Part 18B: Not On Insulin-Using Scoops 1. Write down the date in the Date box on your logbook worksheet. 2. Write down the time you eat in the Time box on your logbook worksheet. 3.Test your blood sugar. 4. Write the blood sugar result in the 4 Blood Sugar box on the logbook worksheet 5. Write down how many scoops of carb you ate in the Scoops Eaten box on the logbook worksheet. 6. If you were asked, check your blood sugar 2 hours after meal. Write down the blood sugar in the 4 Blood Sugar 2 hours After Meal box on your logbook worksheet. 7. Write down how many minutes you exercised during the day in the Minutes of Exercise box at the bottom of your logbook worksheet. I8. If you eat a snack between your meals, write down the time you ate it and the number of scoops in the Snack box.

55 Module 19B Part 18B. Log Book (No Insulin-Using Scoops) Name: Date Goal Breakfast Time Blood Sugar before meal Carb Servings Eaten Blood Sugar 2 hours After Meal Snack Time Carb Servings Eaten Time Bedtime Dinner Snack Lunch Blood Sugar before meal Carb Servings Eaten Blood Sugar 2 hours After Meal Time Carb Servings Eaten Time Blood Sugar before meal Carb Servings Eaten Blood Sugar 2 hours After Meal Time Blood Sugar at bedtime Carb Servings Eaten Minutes of Exercise Please fax completed worksheet to:

56 Instructions For Logbook Worksheets Part 18C: Not On Insulin-No Carb Tracking 1. Write down the date in the Date box on your logbook worksheet. 2. Write down the time you eat in the Time box on your logbook worksheet. 3.Test your blood sugar. 4. Write the blood sugar result in the 4 Blood Sugar Box on the logbook worksheet 5. If you were asked, check your blood sugar 2 hours after meal. Write down the blood sugar in the 4 Blood Sugar 2 hours After Meal box on your logbook worksheet. 6. Write down how many minutes you exercised during the day in the Minutes of Exercise box at the bottom of your logbook worksheet. 7. If you eat a snack between your meals, write down the time you ate it in the Snack box.

57 Part 18C. Log Book (Not on Insulin) Please fax completed worksheet to: at Vanderbilt Research * For study use only. please do not copy.

58 Instructions For Logbook Worksheets Part 19A: Set Dose Insulin-Counting Carbs 1. Write down the date in the Date box on your logbook worksheet. 2. Write down the time you eat in the Time box on your logbook worksheet. 3.Test your blood sugar. 4. Write the blood sugar result in the 4 Blood Sugar Box on the logbook worksheet 5. Write down how many grams of carb you ate in the Carbs Eaten Box on the logbook worksheet. 6. Look at the amount of insulin listed on your logbook worksheet in the Goal box. 7. Write the amount of insulin taken in the Insulin Dose Taken box on your logbook worksheet. 8. If you were asked, check your blood sugar 2 hours after meal. Write down the blood sugar in the 4 Blood Sugar 2 hours After Meal box on your logbook worksheet. 9. Write down how many minutes you exercised during the day in the Minutes of Exercise box at the bottom of your logbook worksheet. 10. If you eat a snack between your meals, write down the time you ate it and the grams of carb in the Snack box.

59 Part 19A. Log Book (Set Dose Insulin- Counting Carbs) Name: Date Goal Time Snack Lunch Snack Breakfast Blood Sugar before meal Carb Servings Eaten Insulin Dose Taken Blood Sugar 2 hours After Meal Time Carb Servings Eaten Time Blood Sugar before meal Carbs Eaten Insulin Dose Taken Blood Sugar 2 hours After Meal Time Carb Servings Eaten Time Dinner Blood Sugar before meal Carbs Eaten Insulin Dose Taken Blood Sugar 2 hours After Meal Bedtime Time Blood Sugar at bedtime Carb Servings Eaten Minutes of Exercise Please fax completed worksheet to:

60 Instructions For Logbook Worksheets Part 19B: (Set Dose Insulin - Using Scoops) 1. Write down the date in the Date box on your logbook worksheet. 2. Write down the time you eat in the Time box on your logbook worksheet. 3.Test your blood sugar. 4. Write the blood sugar result in the 4 Blood Sugar Box on the logbook worksheet 5. Write down how many scoops you ate in the Scoops Eaten Box on the logbook worksheet. 6. Look at the amount of insulin listed on your logbook worksheet in the Goal box. 7. Write the amount of insulin taken in the Insulin Dose Taken box on your logbook worksheet. 8. If you were asked, check your blood sugar 2 hours after meal. Write down the blood sugar in the 4 Blood Sugar 2 hours After Meal box on your logbook worksheet. 9. Write down how many minutes you exercised during the day in the Minutes of Exercise box at the bottom of your logbook worksheet. 10. If you eat a snack between your meals, write down the time you ate it and the number of scoops in the Snack box.

61 Module 19A Part 19B. Log Book (Set Dose Insulin - Using Scoops) Name: Date Goal Time Breakfast Blood Sugar before meal Carb Servings Eaten Insulin Dose Taken Blood Sugar 2 hours After Meal Dinner Snack Lunch Snack Time Carb Servings Eaten Time Blood Sugar before meal Carbs Eaten Insulin Dose Taken Blood Sugar 2 hours After Meal Time Carb Servings Eaten Time Blood Sugar before meal Carbs Eaten Insulin Dose Taken Blood Sugar 2 hours After Meal Bedtime Time Blood Sugar at bedtime Carb Servings Eaten Minutes of Exercise Please fax completed worksheet to:

62 Instructions For Logbook Worksheets Part 19C: Set Dose Insulin 1. Write down the date in the Date box on your logbook worksheet. 2. Write down the time you eat in the Time box on your logbook worksheet. 3.Test your blood sugar. 4. Write the blood sugar result in the 4 Blood Sugar box on the logbook worksheet. 5. Look at the amount of insulin listed on your logbook worksheet in the Goal box. 6. Write the amount of insulin taken in the Insulin Dose Taken box on your logbook worksheet. 7. If you were asked, check your blood sugar 2 hours after meal. Write down the blood sugar in the 4 Blood Sugar 2 hours After Meal box on your logbook worksheet. 8. Write down how many minutes you exercised during the day in the Minutes of Exercise box at the bottom of your logbook worksheet. 9. If you eat a snack between your meals, write down the time you ate it in the Snack box.

63 Part 19C. Log Book (Set Dose Insulin) Name: Please fax completed worksheet to: at Vanderbilt Research * For study use only. please do not copy.

64 Instructions For Logbook Worksheets Part 20A: Correction Dose Insulin-Counting Carbs 1. Write down the date in the Date box on your logbook worksheet. 2. Write down the time you eat in the Time box on your logbook worksheet. 3.Test your blood sugar. 4. Write the blood sugar result in the 4 Blood Sugar box on the logbook worksheet 5. Look in Part 14 of your notebook to see how much insulin you should take. 6. Write this in the Insulin Dose Taken box on your logbook worksheet. 7. Write down how many grams of carb you ate in the Carbs Eaten box on the logbook worksheet. 8. If you were asked, check your blood sugar 2 hours after meal. Write down the blood sugar in the 4 Blood Sugar 2 hours After Meal box on your logbook worksheet. 9. Write down how many minutes you exercised during the day in the Minutes of Exercise box at the bottom of your logbook worksheet. 10. If you eat a snack between your meals, write down the time you ate it and the grams of carb in the Snack box.

65 Part 20A. Log Book (Correction Dose Insulin - Counting Carbs) Please fax completed worksheet to: at Vanderbilt Research * For study use only. please do not copy.

66 Instructions For Logbook Worksheets Part 20B: Correction Dose Insulin-Using Scoops 1. Write down the date in the Date box on your logbook worksheet. 2. Write down the time you eat in the Time box on your logbook worksheet. 3.Test your blood sugar. 4. Write the blood sugar result in the 4 Blood Sugar box on the logbook worksheet. 5. Look in Part 14 of your notebook to see how much insulin you should take. 6. Write this in the Insulin Dose Taken box on your logbook worksheet. 7. Write down how many scoops of carb you ate in the Scoops Eaten box on the logbook worksheet. 8. If you ve been asked, check your blood sugar 2 hours after meal. Write down the blood sugar in the 4 Blood Sugar 2 hours After Meal box on your logbook worksheet. 9. Write down how many minutes you exercised during the day in the Minutes of Exercise box at the bottom of your logbook worksheet. 10. If you eat a snack between your meals, write down the time you ate it and the number of scoops in the Snack box.

67 Part 20B. Log Book (Correction Dose Insulin - Using Scoops) Please fax completed worksheet to: at Vanderbilt Research * For study use only. please do not copy.

68 Instructions For Logbook Worksheets Part 21A: Flexible Dosing of Insulin- Counting Carbs 1. Write down the date in the Date box on your logbook worksheet. 2. Write down the time you eat in the Time box on your logbook worksheet. 3.Test your blood sugar. 4. Write the blood sugar result in the 4 Blood Sugar box on the logbook worksheet. 5. Write down the number of carbs you plan to eat in the Carbs Planned box on your logbook worksheet. 6. Look at your wheel and read how much insulin to take for your blood sugar and carbs planned. 7. Write this in the Insulin Dose on Wheel box on your logbook worksheet. 8. Write down how many grams of carb you actually ate in the Carbs Eaten box on the logbook worksheet. 9. Write down the amount of insulin you took in the Insulin Dose Taken box on the logbook worksheet. 10. Write down how many minutes you exercised during the day in the Minutes of Exercise box at the bottom of your logbook worksheet. 11. If you eat a snack between your meals, write down the time you ate it and the grams of carb in the Snack box.

69 Part 21A. Log Book (Flexible Dosing of Insulin - Counting Carbs) Name: Please fax completed worksheet to: at Vanderbilt Research * For study use only. please do not copy.

70 Instructions For Logbook Worksheets Part 21B: Flexible Dosing of Insulin-Using Scoops 1. Write down the date in the Date box on your logbook worksheet. 2. Write down the time you eat in the Time box on your logbook worksheet. 3.Test your blood sugar. 4. Write the blood sugar result in the 4 Blood Sugar box on the logbook worksheet. 5. Write down the number of scoops you plan to eat in the Scoops Planned box on your logbook worksheet. 6. Look at your wheel and read how much insulin to take for your blood sugar and scoops planned. 7. Write this in the Insulin Dose on Wheel box on your logbook worksheet. 8. Write down how many scoops you actually ate in the Scoops Eaten box on the logbook worksheet. 9. Write down the amount of insulin you took in the Insulin Dose Taken box on the logbook worksheet. 10. Write down how many minutes you exercised during the day in the Minutes of Exercise box at the bottom of your logbook worksheet. 11. If you eat a snack between your meals, write down the time you ate it and the number of scoops in the Snack box.

71 Part 21B. Log Book (Flexible Dosing of Insulin - Using Scoops) Please fax completed worksheet to: at Vanderbilt Research * For study use only. please do not copy.

72 PART 22 HOW MUCH INSULIN DO I TAKE WITH A SNACK Before-Lunch Snack Take units of insulin before your snack. Before-Supper Snack Take units of insulin before your snack. Bedtime Snack Take units of insulin before your snack. 1 PART 22

73 PART 23A HOW TO TAKE SYMLIN- PAGE 1 (TYPE 1 DIABETES) 1 Your insulin must be lowered when you start Symlin. 2 Your insulin (mealtime) should be changed to: Breakfast units Lunch units Supper units Change your insulin (long-lasting) to units in am, units in pm. Symlin is only taken with meals. Take it before each regular size meal but not before a very small meal. Do not mix it in a syringe with insulin. Use a special syringe to measure 1/2 units. Symlin may make you feel sick to your stomach. Day 1 Take 2-1/2 units of Symlin before each meal. Day 2 Take 2-1/2 units of Symlin before each meal. Day 3 Take 2-1/2 units of Symlin before each meal. Day 4 IF YOU HAVE NOT FELT SICK TO YOUR STOMACH - Raise Symlin to 5 units before each meal, and go to page 3 for the rest of the instructions IF YOU HAVE FELT SICK TO YOUR STOMACH - continue to take 2-1/2 units before each meal, and go to page 2 for the rest of the instructions. If you have severe sickness in your stomach, a lot of vomiting or 1 low blood sugars, call at. PART 23A

74 PART 23A HOW TO TAKE SYMLIN- PAGE 2 (TYPE 1 DIABETES DAYS) Day 5 Take 2-1/2 units of Symlin before each meal. Day 6 Take 2-1/2 units of Symlin before each meal. Day 7 IF YOU FEEL SICK TO YOUR STOMACH, call your nurse at. IF YOU are not having an upset stomach now, raise Symlin to 5 units before each meal and follow directions for days 8-10 below Day 8 Take 5 units of Symlin before each meal. Day 9 Take 5 units of Symlin before each meal. Day 10 IF YOU STILL HAVE NOT HAD upset stomach, raise Symlin to 7-1/2 units before each meal. IF YOU HAVE an upset stomach, keep taking 5 units of Symlin before each meal Day 11 Call at to update how you are doing. If you have severe sickness in your stomach, a lot of vomiting or low blood sugars call at. 2 PART 23A

75 PART 23A HOW TO TAKE SYMLIN- PAGE 3 (TYPE 1 DIABETES DAYS) Day 5 Take 5 units of Symlin before each meal. Day 6 Take 5 units of Symlin before each meal. Day 7 If you feel sick to your stomach, call your nurse at. IF YOU STILL HAVE NOT HAD AN upset stomach, raise Symlin to 7-1/2 units before each meal and follow directions for days 8-10 below Day 8 Take 7-1/2 units of Symlin before each meal. Day 9 Take 7-1/2 units of Symlin before each meal. Day 10 IF YOU STILL HAVE NOT HAD upset stomach, raise Symlin to 10 units before each meal. IF YOU HAVE an upset stomach, keep taking 7-1/2 units of Symlin before each meal Day 11 Call at to update how you are doing. 3 PART 23A

76 PART 23B HOW TO TAKE SYMLIN (TYPE 2 DIABETES) Only take Symlin with meals. Take it before each regular size meal but not before a very small meal. Do not mix it in a syringe with insulin. Symlin may make you feel sick to your stomach. Day 1 Take 10 units of Symlin before each meal. Day 2 Take 10 units of Symlin before each meal. Day 3 Take 10 units of Symlin before each meal. Day 4 IF YOU DO NOT FEEL SICK TO YOUR STOMACH, raise the Symlin to 20 units before each meal. If you feel sick in your stomach, keep taking 10 units of Symlin and call at. Your mealtime insulin must be lowered when you start Symlin. Your insulin (mealtime) should be changed to: Breakfast units Lunch units Supper units Change your insulin (long-acting) to units in am, units in pm. If you have sickness in your stomach, vomiting or low blood sugars, call at. 1 PART 23B

77 PART 24 HOW TO TAKE BYETTA Byetta is taken up to 1 hour before breakfast and up to 1 hour before supper. Always keep your Byetta pens in the refrigerator. You may feel sick at your stomach at first, but try to take the Byetta for a few weeks to see if the feeling goes away. Day 1 Take 1 shot of the Orange Byetta pen (5mcg) before breakfast and 1 shot of the pen before supper. Date Day 2-30 Take 1 shot of the Orange Byetta pen before breakfast and supper. Day 30 If you have felt OK for the past week, start using the Yellow Byetta pen. (10mcg) Take 1 shot before breakfast Date and 1 shot before supper. Call at to let them know how you are doing 1 PART 24

78 Your diabetes pills might need to be lowered when you start Byetta Change your diabetes pills to: in the morning. with lunch. with supper. If you have bad sickness in your stomach, vomiting or you have low blood sugars, call at. 2 PART 24