Patient Guide

Diabetes AssociationVersion 1 - 2018

Living everyday with Type II Diabetes

© 2018 Diabetes Association.

This document contains proprietary information that is protected by copyright. All rights are reserved. Reproduction, adaptation or translation wihout prior written permission is prohibited, except as allowed under the copyright laws.

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About this guide

Audience : You have just learned that you are diabetic? This guide is intended for Type II Diabetes patients.The information of this document is aimed at active and busy patients so that diabetes remains as light as possible in their schedule.

Purpose :

This guide will help you manage the disease on a daily basis. It contains guidelines to balance your nutrition, introduces glucometer use and assists you in your medical and physical follow- up.

Related documents:

• Your glucometer manual

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Table of contents

Adjusting easily to your new lifestyle 7

What can affect blood sugar levels? 8

How to incorporate exercise in your daily life 10

How to check your blood sugar 12

How to engage in your medical follow-up 14

Changing your buying habits 17

What healthier alternatives can substitute your pantry basics? 18

How to read nutritional labels 20

Building your meal plan 23 What to eat for breakfast ? 24

Chia seed pudding 25

What to pack for lunch ? 26

Summer rice salad 27

Where to indulge ? 28

Apple pumpkin softies 29

What’s for dinner? 30

Beef and broccoli stir fry 31

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Adjusting easily to your new lifestyle

What can affect blood sugar levels? 8

How to incorporate exercise in your daily life 10

How to check your blood sugar 12

How to engage in your medical follow-up 14

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What can affect blood sugar levels?

Numerous exterior factors affect your blood sugar levels. Discover how to counter their effects.

• Hormones released while fighting an Illness

• StressIn stressful situation, the adrenal glands release glucose in several organs. You blood sugars goes up.

• Short- or long-term pain

• Menstrual periods

Diabetic women become less sensitive to insulin the week before their period. Your blood sugar can rise above normal.

• A fuller meal heavier in carbohydrates

• Artificial sweeteners

The pancreas reacts in the similar way towards sugar and artificial sweeteners. When you consume artificial sweeteners, your blood sugar increases.

• Alcohol consumption

When you consume alcohol, your blood sugar can be affected up to 48 hours.

• Caffeine

Consuming important amounts of caffeine may cause blood sugar levels to spike in diabetic people.

• Side effects from medications

Combined with diabetes, medications such as steroids and anti-psychotic medications, may increase your blood sugar.

CONSUMPTION

HORMONES

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• Lack of physical activity

Sedentarity can increase your glucose and insulin levels.Include at least 30 minutes of light exercise each day.Workout one to four times a week.

• Lack of sleep

Deep-sleep deprivation have negative impacts on blood-sugar involved hormones and can bear risks for weight gain.Schedule your bedtime like you would schedule a meeting, in order to get 8 hours of sleep. Avoid eating, watching screens and working out at least 1 hour before you go to bed.

• Dehydration

Your blood sugar concentration is higher with insufficient water intake. Drink around 8 glasses of water per day. Report your water intake on your phone or on your blood sugar reporting notebook.

• Important weather changes:

Diabetic organisms are often reactive to temperature variations. Anticipate any weather changes.Dress to adjust accordingly.

• Travel and routine disruption

When you disrupt your routine, your body takes more time to regulate.Be more aware of your biological needs. Pay special attention your daily medication schedule.Stay hydrated and keep an adjusted diet when you travel.

• Pollution

Air pollutants increase the risk of developing Type 2 Diabetes.They also cause blood sugar spikes when exposed for an extended period. To reduce your exposure time, wear a mask when you commute and work out outside.

PHYSICAL SHAPE

ENVIRONMENT

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Starting with 30 minutes daily • Take a brisk walk around your

neighborhood while calling a relative or a friend.

• Play at the local field with your children.

• Bike to work and back. • Do a pilates or fitness workout at

home with a youtube video.

How to incorporate exercise in your daily life

Exercise:

• regulates your blood sugar even after your workout• prevents long-term diabetes complications• helps weight loss• increases basal metabolism• stimulates the heart and muscles• shows the right path to your relatives

Incorporating slight changes

• Take the stairs whenever possible. • Commute using public

transportation. • Walk to run close errands such as

the bakery. • Go grocery shopping to your local

market without a car. • Drop your kids to school by bike.

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But with exercise, if you are not used to it, it can be hard to know where to start. Here are some examples to get you started.

Plan activities on week-ends to discover alone or with your family

• Climbing indoor or outdoor (with supervision)

• Dancing classes or ball • Hiking • Skating • Bowling • Swimming

Workout twice a week for an hour

• Look for a fun class at work or in your neighborhood.

• Go for a run. Invest in good music and sport gear to motivate yourself.

• Deep clean one area of your home such as the fridge or your closet.

• Sign up to your local gym and have the coach guide you.

How to check your blood sugar

When diagnosed with diabetes, your family doctor will prescribe you a device to measure your blood sugar concentration.

Typically your doctor advises you to check your blood sugar three times a day, and every time you feel like your blood sugar is low.

Finger-pricking represents the most accurate method yet.

You will need:

- Your glucometer device - A needle (called ‘‘lancet’’) - A clean paper towel - A test strip

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Preparing

1. Thoroughly wash your hands.

4. Insert a test strip in your device.

3. Charge a lancet on your device.

2. Prepare your device on a flat surface.

Measuring

6. Prick your finger with the lancet.

7. Get a drop of blood out.

8. Put the test strip on the drop of blood.

The results appear in a few seconds.

How to engage in your medical follow-up

Diabetes involves the need for frequent medical check-ups. First and foremost, meeting your family doctor regularly is crucial, but it is not enough to ensure adequate knowledge of the state of the disease and good reaction to the treatment.

Everyday

Blood sugar monitoring:

• self-monitor your blood pressure with a device • take your medication• exercise at least 30 minutes

Recording your results:

• Using a notebook:

1. Buy a small notebook. 2. Divide pages in three columns: - date - glucose level- how I feel3. Everytime you check your blood sugar levels, enter accordingly.

• Using apps on your smartphone:

If your device is recent, chances are it is connected.

1. Find the app available for your device and your smartphone. 2. Download the latest version to your smartphone. 3. Open the app. 4. Follow the instructions to connect your device.

The device transmits the date, time and glucose level to your smartphone automatically.

• Using the camera of your phone:

When in a hurry and unable to report your result, simply take a clear picture of your device’s screen with your phone. It will store the date and time automatically as well as your levels.

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Once every three months

Family doctor: • pursues a clinical examination • measures your blood sugar levels• ensures your blood sugar is stable • checks your objectives and progress and reassesses them if

needed• exchanges on your difficulties and motivations

Once a year

Renal check-up: diabetes can act silently on the kidneys: • have a blood sample tested

Funduscopic examination: done by your ophthalmologist• consists in a mirror examination of the back of the eye• prevents diabetic retinopathy

Dental check-up: done by your dentist• prevents tooth and gums complications

Heart check-up: done by your cardiologist: • hypertension examination • lipid check-up• electrocardiogram (or ECG): 24 hour exam with an electrical device measuring the heart activity

Twice a year

Diabetologist: • checks your objectives and progress and reassesses them if

needed• orients the patient once a year toward specialists• discusses new methods for blood sugar tests

Endocrinologist: hormones and glands specialist: • assesses the role of hormones in diabetes• measures hormones level • ensures hormonal balance and dysfunction

Tip : Appointments with specialists have to be booked early on. Try to plan the next appointment each time you meet with your specialist.

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Changing your buying habits

What healthier alternatives can substitute your pantry basics? 18

How to read nutritional labels ? 20

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What healthier alternatives can substitute your pantry basics?

Diabetes condition can feel restrictive on a dietary basis. Do not think you need to toss parts of your diet to be healthy. Treat yourself on a regular basis and try to swap some items for healthier options.

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Instead of: Try:

White rice Brown rice

Chips Light popcorn

French Fries Baked sweet potato fries

Butter Peanut butter/mashed avocado

Cookies Fruit

Soda Water

Sour cream Nonfat plain yogurt

Fried chicken Grilled chicken

Red meat Fish or chicken

White flour tortilla Whole wheat or corn tortilla

Cream 2% milk

Mayonnaise Mustard

Salami Lean turkey or roast beef

Bagel English muffin

Orange Juice Small orange

Milk Chocolate Dark Chocolate

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When you have to buy prepackaged food, trust nutritional label to have an idea of the nutritional content of the product.To choose food items in a rush, follow these guidelines:

• Focus on full ingredients.

• Prefer high fiber foods if possible such as vegetables and complex

carbs.

• Avoid ingredients that sound chemical.

Sugars take many forms and hide in harder to read terms.

• Watch out for serving sizes.

It might deceive you, they do not always represent the entire

content of the package.

• Avoid food items that contain more than:

- Ten ingredients per product

- 100 calories per 100g of product

- 20g of sugar per 100g of product

- 400mg of salt per serving

Your maximum daily intake must be lower than 2,300mg.

• Aim for 25g or more fibers in your daily intake.

• Aim for between 12 and 30g of protein per 100g.

How to read nutritional labels

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The right quantity in a serving

of the product.

Percentage of Amino Acids in a

serving.

Calorie content of a single serving

(or for 100g of product).

Percentage of carbs and sugars

in a product. Prefer complex carbs.

Percentage of sodium in a product.

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Building your meal plan

What to eat for breakfast ? 24

Chia seed pudding 25

What to pack for lunch ? 26

Summer rice salad 27

Where to indulge ? 28

Apple pumpkin softies 29

What’s for dinner? 30

Beef and broccoli stir fry 31

What to eat for breakfast ?

Your breakfast has to be consistent and be consumed around the same time everyday to ensure stable blood sugar levels.

Before breakfast, make sure to drink a glass of water.

To compose your breakfast:

• Choose a source of lean protein. • Choose a source of complex carbhoydrates such as oats. • Add a piece of fruit.• Add your choice of unsweetened hot beverage.

Optional: Add a healthy fat, such as nuts and seeds.

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Chia seed pudding

• For the Chia gel:

1. Combine the milk and chia seeds.

2. Set aside for 20 minutes.

3. Place the dates in a bowl and pour hot water over.

4. Set aside for up to 20 minutes. Drain.

5. Pit the dates.

6. In a blender, combine the pitted dates with the

cashews, cinnamon, vanilla and salt.

7. Pour in the chia gel.

8. Puree until smooth.

• For packing:

1. Serve individual portions of pudding in portable

containers.

2. Top with your desired garnishes.

3. Store leftovers in the refrigerator.

You will need:

• 1 ½ cups milk• ¼ cup chia seeds• 6 large dates• ½ cup raw cashews • ½ teaspoon ground cinnamon• ½ teaspoon pure vanilla extract• Pinch of sea salt

Optional toppings

• Fresh fruit: berries, sliced bananas, chopped pineapple, etc.

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What to pack for lunch ?

You can prepare lunches ahead on weekends.

Build your meals around the plate method :

Pack: • a portion of protein• a portion of grain or starches, preferably complex. • two portions of vegetables. • (optional) a dairy product • a piece of fruit

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Summer rice salad

1. In a pot, put the rice and 3 cups of water. Bring to a

boil, then let simmer covered for 10 minutes.

2. Dice the tomatoes, cucumber and mozzarella into

half a centimeter cubes.

3. Spread the rice on a large plate to cool it faster.

4. Combine the rice, the vegetables and cheese.

5. Drizzle over olive oil, salt and pepper.

6. You can make this recipe in batches. It keeps three

to four days in the fridge.

Pack your lunch along two slices of ham of smoked

salmon.

Bring a piece a peach or an apple.

You will need:

• 1 Mozzarella bowl • 2 ripe tomatoes • half a cucumber • 2 cups of basmati rice • 1 tablespoon olive oil

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Where to indulge ?

Dietary recommandations advice people suffering from diabetes to eat for snack a source of protein or a source of fiber.

But if you feel like indulging: prefer homemade recipes and replace some ingredients as specified in the food swaps sheet.

Here is an example recipe, if you need an afternoon treat.

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Apple pumpkin softies

1. Preheat oven to 350°F. Line a cookie sheet with

parchment paper and set aside.

2. In a large bowl, combine all-purpose flour, whole

wheat flour, oats, wheat germ, baking powder,

baking soda, cinnamon, salt, ginger, and nutmeg.

3. In a medium bowl, combine egg, shredded apple,

pumpkin, brown sugar, and oil.

4. Add egg mixture to flour mixture. Stir just until

combined.

5. Fold in pecans.

6. Drop batter by a measuring tablespoon onto the

prepared cookie sheet.

7. Sprinkle tops with dried cranberries.

8. Bake for 10 to 12 minutes or until firm to the touch

and lightly browned on top. Transfer to a wire rack

to cool.

You will need:

• ½cup all-purpose flour • ½ cup whole wheat flour• ¼ cup rolled oats• ¼ cup toasted wheat germ• 1 teaspoon baking powder• ½ teaspoon baking soda• ½ teaspoon ground cinnamon• ¼ teaspoon salt• ¼ teaspoon ground ginger• ½ teaspoon ground nutmeg• 1 egg, lightly beaten• 1 cup coarsely shredded apple• ¾ cup canned pumpkin• ½ cup packed brown sugar• 2 tablespoons vegetable oil

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What’s for dinner?

You can cook tasty and healthy dinners in 15 minutes. Find the most convenient day in your schedule to go grocery shopping.

For dinner, build your meal around fibers and protein. Reduce your portion of starches.

Choose a lean meat or fish. Choose a portion of vegetable.

(Optional) : On weekends, try to pre cut your meats and vegetables and pre cut your starches. To change flavor, use different cooking methods, spices and seasoning during the week.

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Beef and broccoli stir fry

1. Season the beef with salt and pepper, to taste.

2. Place the seasoned beef and cornstarch in a resealable

gallon-sized bag and shake it to coat each piece.

3. In a small mixing bowl, whisk together the ginger, soy

sauce, and orange juice and set it next to the wok or skillet.

4. Over high heat, heat a wok or large nonstick skillet with

tall sides. When hot, add the oil and swirl it around to coat

the surface. The oil will look like it is rippling.

5. Add the garlic and red pepper flakes to the wok, and stir

them around until fragrant. Take them out, reserve on a

plate.

6. Add beef to the skillet, stirring it around for 1-2 minutes.

7. Add the broccoli, and stir around for 2-4 minutes until

tender-crisp.

8. Add the set-aside sauce, garlic and red pepper flakes.

Cook until the sauce is slightly thickened.

9. Serve with rice.

You will need:

• ¾ pound pre-cut stir fry beef strips • salt, to taste• black pepper, to taste• 2 tablespoons cornstarch• 1 teaspoon fresh grated ginger• 2 tablespoons less-sodium soy sauce• ½ cup light orange juice• 2 tablespoons peanut or canola oil• 1 tablespoon minced garlic• pinch of red pepper flakes (add more for more heat)• 2 cups broccoli florets

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Index

A

Appointmentsbook 15check 15doctor 15follow-up 15

B

blood sugarcheck 10feel 10monitor 10record 10

blood sugar levelsdevice 14glucometer 14

breakfasteat 18

C

checkblood sugar 10blood sugar levels 10lancet 10results 10test strip 10

D

dietalternatives 18calories 18fats 18fiber 18nutritional labels 18pantry basics 18protein 18serving 18

doctorappointments 14family doctor 14medication 14specialists 14

E

eatingbreakfast 18dinner 18ingredients 9, 18lunch 18pantry basics 18serving size 18snack 18

exercisebike 10incorporate 10regulate 10stairs 10swim 10walk 10

F

factorsconsumption 8environment 8hormones 8physical shape 8

G

glucometerblood sugar 15check 15monitor 15results 15

Llifestyleadjusting 8

luncheat 18pack 18

M

medical follow-upcheck-up 14clinical examination 14diabetologist 14endocrinologist 14hormones 14monitoring 14

P

packbreakfast 18lunch 9, 18

proteinbreakfast 18dinner 18label 18lunch 18snack 18