Diabetes: Staying Healthy

Diabetes: Staying Healthy Learn from the experts at Joslin Diabetes Center and Walgreens about: Eating well & being active Understanding your medicines Reducing your risks And more -! 4RUSTED 4EAM FOR $IABETES #ARE 4 3

Type 1, type 2 and YOU... -! 4RUSTED 4EAM FOR $IABETES #ARE 4 Our alliance Joslin Diabetes Center Joslin Diabetes Center has helped revolutionize the diagnosis, treatment and prevention of diabetes since its founding more than a century ago. Through its staff of renowned physicians, researchers and clinical specialists, Joslin, affiliated with Harvard Medical School, is a worldwide leader in cutting-edge research and pioneering approaches to diabetes education and care. Headquartered in Boston, Joslin has the nation s largest diabetes clinic, largest diabetes research program and 30 affiliated clinical care centers across the U.S. A Trusted Team for Diabetes Care Joslin and Walgreens Walgreens and Joslin have formed a powerful team to improve the health of people with diabetes. Together, we will develop and deliver nationwide programs for diabetes awareness, wellness, prevention and education to reach the estimated 21 million Americans with diabetes and the 54 million Americans at risk for the disease. Clinical content for this brochure was provided by Joslin Diabetes Center. Just the facts Having diabetes means that your body does not use glucose (sugar) well. There are two main types of diabetes. Type 1 diabetes occurs when a person does not make any insulin so people with type 1 diabetes must take insulin. People with type 2 diabetes, the most common type, still make insulin, but not enough to properly convert food into energy. Some people with type 2 diabetes can control their diabetes with meal planning and physical activity. Others may need to take diabetes pills and/or insulin. This booklet is aimed at adults with type 2 diabetes. If you have or are caring for someone with type 1 or gestational diabetes (diabetes occurring during pregnancy), see the resources at the back of this booklet for more information. Although more people are being diagnosed with diabetes, the good news is that people with diabetes are living longer and healthier lives than ever before, thanks to improvements in treatment and management. You may feel overwhelmed by having diabetes, but you don t have to manage it alone. 2 3

Taking control Step 1: Choose your healthcare team It s important that you have a healthcare team to help you learn the skills you need to control your diabetes. Think of it as a team of coaches you re the player, but your coaches make sure you know what to do to play the best you can. Along with your doctor, your pharmacist can help you, especially with questions about your medicines and how to take them. And ask your doctor for a referral to see a dietitian or a diabetes educator if you don t already have one. Step 2: Learn more Find out your A1C, blood pressure and cholesterol numbers. Learn to eat healthier and be more active. Use the Goal Tracker at the end of this booklet to help guide you. Step 3: Create an action plan Work with your healthcare team, or coaches, to create a diabetes treatment plan that s right for you. Because your diabetes can change over time, your treatment plan may need to change, too. Keep your appointments with your healthcare team and keep learning about new tools and medicines. Remember, though, that you re the center of your team. It s up to you to let your team know if something isn t working, if you have any questions about your diabetes or if you are interested in new medications or devices. Getting started In order to take good care of yourself you need to take an active role in your health. Maybe you re doing fine in some areas, but need help in others. That s where this booklet can help. Where should you start? take a moment to answer the following questions: Lifestyle: Eat Well, Be Active I have a meal plan to help me control my blood glucose. True False I use physical activity as a way to care for my diabetes. True False If you answered false to either of these questions, turn to the blue section of this booklet. Know Your Numbers I know what my target A1C and blood glucose levels are. True False I know what to do if my blood pressure goes up. True False If you answered false to either of these questions, turn to the pink section of this booklet. Taking Diabetes Medicines I take my diabetes medicines as my doctor has prescribed. True False I know why I am taking each of my medicines. True False If you answered false to either of these questions, turn to the green section of this booklet. Staying Healthy 4 3 I m taking action to reduce my risk of getting complications. True False I know what to do to prevent a diabetes emergency. True False If you answered false to either of these questions, turn to the orange section of this booklet. NOTE: Even if you answered true to both questions in any one category, you might want to read all sections of the booklet to make sure you are getting the most information you can. Talk to your Walgreens pharmacist about managing your diabetes.

LIFESTYLE: Eat well, be active Eat well Everyone benefits from healthy eating, but this is especially true if you have diabetes. Learning to control carbohydrates (carbs) is a first step. Foods containing carbs have the most impact on blood glucose but also provide energy and fuel for your body. It s important to eat more of the healthy carbs, such as whole grains, fruit and non-starchy vegetables and less of the refined carbs such as white bread, candy and desserts. If you are overweight, losing just 5 10 percent of your body weight can lead to a big improvement in glucose control. (That s 10 20 pounds if you weigh 200 pounds.) Weight loss can also help lower your blood pressure and cholesterol. The dinner plate pictured below will help you plan your meals and control carbs. Ask your healthcare provider for help in finding a Registered Dietitian (R.D.) who specializes in developing meal plans for people with diabetes. A meal plan can be designed especially for you based on your eating preferences, lifestyle and medication plan. Eat smaller portions. Weighing and measuring foods can help. Start by eating fewer carbs and fewer high-fat foods. CArBS ArE found in: Rice, pasta, noodles Beans, peas, lentils Breads, cereals Desserts, sweets Vegetables Fruit, juices Milk, yogurt Eat about the same amount of carb foods each day. Choose whole grain breads and cereals they contain more nutrients and fiber than the refined, white grains. Aim for 2 3 small servings of fruit a day, and choose whole fruit instead of juice or dried fruit. Fill half your plate with non-starchy vegetables, such as greens and salads. These are low in carbs and good sources of fiber. Choose lean meats and skinless poultry. Try to eat fish 1-2 times a week. Avoid fried foods. Vegetables Bread Starch Grain Beverage, fruit, dessert or other side dish Meat Protein Try to eat meals and snacks at the same time each day and don t skip meals. Read labels! Look first at serving size and total carbohydrates. One carb serving = 15 grams of carbs, the amount of carbs in one slice of bread. talk with a registered Dietitian to create an individualized meal plan. 7

Be active Physical activity is great medicine! Being active can help lower your blood glucose levels, blood pressure and cholesterol. Plus, it aids in losing weight and just helps you feel better in general. You can even lower your risk of certain diseases, such as heart disease, just by staying active. Try to include some type of activity in your daily routine. ACTiviTY ideas: Walking Dancing Swimming Yoga or tai-chi Bicycling Taking stairs Chair exercises Check with your healthcare provider to make sure it is safe to start being more active. Make a list of three activities that you already enjoy that you ll try to do more often. Then, list three new activities to try as well! Aim for 30-45 minutes of activity four to six times a week. It doesn t need to be done in one session. Three 10-minute walks a day have the same benefit as walking for 30 minutes. Talk with your educator about using a pedometer to measure your steps. The goal for most adults is to reach 10,000 steps each day. Being active and watching what you eat can help control 2 your diabetes. KNOW YOUR NUMBERS Monitor blood glucose Checking your blood glucose with a meter is a useful way to know if your diabetes treatment plan is working. This information helps you and your healthcare team make decisions about your daily diabetes management. Talk with your pharmacist or educator about different types of meters. If you have one, double check that you are using it properly. Ask your healthcare provider for your target blood glucose goals and how often to check your blood glucose. Goals for most people with diabetes are: Before meals: 90 130 Two to three hours after meals: less than 160 Bedtime: 110-150 Check more often if you: Are sick Make a change in the way you eat, your activity or your medicines Are pregnant (or thinking about becoming pregnant) See that your glucose levels run above or below target Travel to different time zones Keep a written record of your results. Look for patterns. Bring your record book to each visit with your healthcare provider. 9

A1C awareness The best way to know how your diabetes is doing is by taking a blood test called the A1C test. It is also called the hemoglobin A1C or glycosylated hemoglobin test. The A1C is a measure of your average blood glucose levels over the past two to three months. It gives you an even better picture of your glucose control than by just looking at your blood glucose numbers on your meter alone. For most people, the A1C goal is less than 7 percent. Someone without diabetes will have a result between 4 and 6 percent. And here s some good news: if your A1C is higher than your goal, lowering it by just 1 percent will greatly lower your risk for complications! Find out when your last A1C test was done and write down the result. Know your A1C goal. If your A1C is above your goal, talk with your healthcare team about making changes in your: 1. Activity plan 2. Meal plan 3. Medicines The [person with diabetes] who knows the most, lives the longest. Elliott P. Joslin, M.D., founder, Joslin Diabetes Center Blood pressure control Your blood pressure tells you about the pressures inside your arteries. The top number should be below 130 and the bottom number below 80. Both of these numbers are important for your health. Keeping your blood pressure below 130/80 not only reduces your risk of heart disease, it also reduces your risk of eye disease and kidney disease. s what Have your blood pressure checked at every visit with a healthcare provider and write down the result. If your blood pressure is above your target, consider buying a blood pressure home monitor. The more information you and your healthcare provider have, the better. Talk with your healthcare provider or your pharmacist about what you can do to help lower your blood pressure, including: Losing weight Eating fewer foods that are high in sodium; choose low-sodium foods instead Being more active Reducing stress by using techniques such as yoga, meditation and relaxation exercises Taking different types of medicines Taking the stairs instead of the elevator You can live a long and healthy life with diabetes. 2 11

Cholesterol counts If you have diabetes, you have a higher risk for heart and blood vessel disease. Knowing your cholesterol levels can help you take steps to lower your risk. Once a year, have a lipid profile (this is a series of blood tests that measure your cholesterol and triglyceride levels). Compare the results to the targets for people with diabetes: Target Cholesterol Levels for people with diabetes: LDL CHOLESTEROL (bad cholesterol): Under 100 HDL CHOLESTEROL (healthy/good cholesterol): Over 40 for men, 50 for women TRIGLYCERIDES: Under 150 Find out when your last lipid profile was done and write down the results. Watch your fat intake. Eat more foods that contain healthy fat, such as fish, olive oil, canola oil, nuts and seeds. Eat fewer bad fats (saturated and trans fats) found in beef, dairy products and processed and fast foods. Eat more high-fiber foods, such as oatmeal, whole grain bread, fruits and vegetables. Be more active. Regular activity can lower your risk of heart disease. Talk with your healthcare provider about medicines that can lower bad cholesterol or raise good cholesterol. Visit Walgreens.com/joslin for more information. 2 TAKING DIABETES MEDICINES Understand your diabetes medicines Diabetes medicines are often needed to help keep blood glucose on target. These medicines work along with a healthy eating plan and regular physical activity. Over time, glucose levels may rise naturally. This means your diabetes is changing and that other medicines may work better. If you have type 1 diabetes, you need to take insulin. If you have type 2 diabetes, there are a number of different treatment options, including pills and insulin. Types of medicines Diabetes pills There are several different types of pills. You may start with one type, but may need to add a second or third type. Insulin Insulin is a hormone made naturally by the body. You need to replace your insulin if you don t have enough or if the insulin you make isn t working. Insulin is usually injected, either with a syringe, an insulin pen or an insulin pump. A newer type of insulin has just been developed that can be inhaled. Other injectables There are new injectable medicines that replace other hormones that your body may lack. These work with your diabetes pills or insulin to help control blood glucose levels. They also can lead to weight loss in many people. 13

Ask questions about your medicine. Ask how your medicine is supposed to work, if there are any side effects and exactly how and when to take the medicine. Talk to your pharmacist or healthcare provider about new types of medicines available. Fill all prescriptions at one pharmacy so there is a central record of your medicines. Keep a list of each medicine you take, the dose and when you started taking it. Bring all medicines or a list of medicines to your appointments with your healthcare provider. This includes anything you take on a regular basis, such as vitamins, supplements and aspirin. Tell another person about your medicines so they can help you in case of an emergency. Find out if there are any lab tests (such as blood work) that need to be done while you are on medications. If you re going to have an x-ray or outpatient procedure, find out if you need to stop taking your diabetes medicine either before or after the procedure. Use Walgreens Free Personal Medication Manager to track your medications. Ask 2 for it in the pharmacy. STAYING HEALTHY Reduce risks for complications You may have heard of the complications of diabetes. Uncontrolled blood glucose levels over a long period of time can affect your eyes, heart, kidneys, nerves and feet. Some people with diabetes also may feel sad or depressed. Fortunately, there is a lot you can do to reduce these risks. If you already have been diagnosed with a complication, ask your healthcare provider about the most up-to-date treatments. Heart health Keep A1C, blood pressure and cholesterol within target range. Talk with your healthcare provider about having an EKG or stress test to monitor how your heart is working. Ask your healthcare provider about taking a daily aspirin and whether other medications may help. Eat foods that are lower in saturated and trans fats and higher in fiber. Stay physically active. Feet first Check your feet every day for cracks, cuts, redness or hot spots. Take off your shoes and socks each time you visit your healthcare provider so your feet can be checked for feeling and blood flow. File nails with an emery board. Keep your skin moist with non-scented lotion. Avoid putting lotion between toes, but use freely on dry skin. 15

Eyesight Once a year, have a dilated eye exam by an ophthalmologist to check the back of your eye (the retina) to look for small blood vessels which could be damaged by high levels of glucose in the blood. Kidney care Once a year, have a urine test to check for microalbumin (tiny amounts of protein in the urine). If the microalbumin number is above 30, ask what you should do. Talk to your healthcare provider about medicines called ACE inhibitors or ARBs and how they can help. Other steps to reduce risks Diabetes can affect nerves in your stomach. If you have stomach problems or trouble with digestion, talk to your healthcare provider. Learn more about how diabetes can affect sexual function in both men and women. Talk to your healthcare provider if you feel sad or depressed. There are different treatment options that can help. If you smoke, quit. Talk to your pharmacist, an educator or your healthcare provider about a nicotine patch or other products that help you stop smoking. Get a flu shot every year. Visit your dentist at least twice a year. Reduce your risk for gum (periodontal) disease by flossing regularly. Register at Walgreens.com and track your personal health history. Highs and lows: Be prepared It is important to understand the signs and symptoms of low and high blood glucose and what to do in case of an emergency. Always check your blood glucose before driving and during long trips. Wear a diabetes identification bracelet or necklace in case you become sick or injured and cannot speak for yourself. Talk with your family and friends about diabetes and what they can do if you ever need help. Call your healthcare provider if you are sick, have an emergency or are not sure what to do. If your blood glucose goes too low (below 70): You may feel shaky, confused, dizzy or have a headache. Check your blood glucose with a meter if you think you might be low. If you are, eat 15 grams of a carbohydrate food (1/2 cup fruit juice or soda, 3 4 glucose tablets). Wait 15 minutes and check your blood glucose again. Repeat the treatment if your blood glucose is less than 80. If you take insulin, ask about having a glucagon kit at home. If your blood glucose is too high (above 250): You may feel thirsty, tired, have blurry vision and urinate more frequently. Drink extra water. Rest. Ask if you should take extra insulin or begin taking insulin. If you take insulin, check for ketones. Call your healthcare provider if ketones are present. 17

Lifelong learning Check out some resources to learn about diabetes. There are books, web sites, classes, support groups and healthcare professionals such as diabetes educators to help you. Research shows that ongoing support and education are important for your success. Remember: you CAN live a long and healthy life with diabetes! How to find: A diabetes educator: www.diabeteseducator.org or 1-800-338-3633 A registered dietitian: www.eatright.org or 1-800-877-1600 Education program (ADA recognized): www.diabetes.org/recognition or 1-800-676-4065 A physician who specializes in diabetes: National Committee for Quality Assurance (NCQA) list of recognized physicians demonstrating quality in diabetes care. www.ncqa.org/physicianqualityreports.htm Other useful resources: Joslin Diabetes Center: www.joslin.org or 800-567-5461 Walgreens: www.walgreens.com/diabetes National Diabetes Education Program: www.ndep.nih.gov or 1 800-438-5383 American Diabetes Association: www.diabetes.org or 1-800-DIABETES (800-342-2383) National Joslin locations: www.joslin.org/locations My Personal Diabetes Goal Tracker Target goal A1C Under 7 percent Blood pressure Under 130/80 LDL cholesterol Under 100; under 70 for some HDL cholesterol Over 40 for men, over 50 for women Triglycerides Under 150 Microalbumin Under 30 Body Mass Index (BMI) Eye exam Foot check 18.5 24.9 Once a year Every visit My last result/date Keep track of the goals you want to set for yourself by writing them down. For example, walk 30 minutes a day My three action steps: Start date: Date completed! For children and families: Children with Diabetes Online Community: www.childrenwithdiabetes.com Juvenile Diabetes Research Foundation: www.jdrf.org or 1-800-533-2873 Joslin Disclaimer: Joslin Diabetes Center does not endorse products or services of any third party. 2 For more forms to track your progress, visit Walgreens.com/joslin

-! 4RUSTED 4EAM FOR $IABETES #ARE 4 To find the nearest Joslin Diabetes Center, visit www.joslin.org/locations Continue to learn about managing diabetes with Joslin books, cookbooks, DvDs and more at www.joslin.org/store use discount code: Walgreens for additional savings To find the nearest Walgreens or 24-hour location, call 1-800-WALGrEENS (1-800-925-4733) or visit Walgreens.com/findastore Walgreen Co. 2006. All Rights Reserved. 07ST6145 2