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Diabetes Management

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Diabetes Management


What if I told you that there was a prescription available that could provide numerous health benefits like:
  • Keep your weight in check
  • Lower you blood pressure
  • Decrease your risk of Type 2 diabetes
  • Decrease our risk of some cancers
  • Improve your blood sugar
  • Improve your immune system
  • Decrease the risk of heart disease and stroke
  • Improve blood lipids (by increase HDL and decreasing LDL)
  • Strengthen the heart and make it pump more efficiently
  • Increase you muscle strength, mass and tone
  • Stimulate and strengthen bones and help improve balance
  • Decrease body fat
  • Improve energy level
  • Increasing your oxygen supply and blood circulation
  • Provide cognitive benefits and improve creativity
  • Reduce stress and anxiety and make you feel good
I’ll bet you would want your doctor to give you that prescription right away. Does it sound too good to be true? Well that prescription has been available since the beginning of time. What is this magic potion? It’s walking. Our bodies were made to walk and be active. Less than 1/3 of Americans meet the minimal recommendations of 30 minutes of moderate activity daily. Walking is easy and doesn’t require a lot of equipment, other than a good pair of shoes. It can be done in your own time frame and/or shared with others. With all those health benefits why not give it a try? Walking can be done anywhere. You could take the stairs more often, walk the dog, walk during lunch time or after dinner. Walk at the mall or the schools. Use a treadmill or just walking tapes in front of the TV. Some people like to use a pedometer or any activity tracker like a fit bit, or just keep track of the minutes they spend walking. It can be fun and social if you walk with a family member or friend. The faster, farther and more frequently you walk will increase the benefits. Remember to warm up and cool down and stretch Talk with your doctor as to how he/she would like you to proceed. In the spring and summer, it will feel so good to get out and enjoy the warmer days. Keep in mind all the walk/run events throughout the summer. In the colder months have a plan , a place to go to walk indoors. So enjoy and take advantage of this prescription for health.


Diabetes is a chronic disease that requires a person with diabetes to make a multitude of daily self-management decisions and perform complex care activities. Diabetes self-management education and support (DSME/S) provides the foundation to help people with diabetes to navigate these decisions and activities and has been shown to improve health outcomes. DSME/S helps facilitate the knowledge, skill and ability necessary for diabetes self -care, as well as, providing support required for implementing and sustaining coping skills and behaviors needed to manage this disease on an ongoing basis. DSME is typically provided by a health professional and is designed to address the patient's health beliefs, cultural needs, knowledge of the disease, physical limitations, emotional concerns, family support, and other factors that influence each person's ability to meet the challenges of self-management.
All individuals with diabetes should receive DSME/S at the time of diagnosis where nutrition, education and emotional health are addressed and as needed thereafter. Annually again for a review or if the HbA1c is out of the target range, for support or weight/nutrition concerns, or because of new life situations or demands. DSME/S should always be considered if there is a change in your health condition, physical limitations, emotional factors, or change in living conditions (inpatient rehabilitation, or living alone or age related cognition problems etc.).
DSME/S has been shown to be cost-effective by reducing hospital admissions and readmissions, as well as, health care costs overall. It is also reported to reduce the onset and /or advancement of diabetes complications and improve the quality of life. Improving lifestyle behaviors like a more healthful eating pattern or engaging in regular physical activity etc. clearly reaffirms the importance and value of DSME. Better outcomes have been shown to be associated with the amount of time spent with a diabetes educator.
Historically, DSME/S has been provided through a formal program where patients and family members participate in class conducted at a hospital/health facility. DSME/S is now being incorporated into office practices and other convenient settings like pharmacies. Diabetes topics that are typically covered are treatment targets, taking medications, purchasing food, planning meals, identifying portions sizes, physical activity, checking blood glucose, understanding possible complications and more.
Communication with your health care team is critical to ensure that goals are clear and progress is being made towards those goals. This ongoing education and communication can help the person with diabetes to overcome barriers and to cope with the ongoing demands of the disease. The ultimate goal of the process for the person and his family, is that they are more engaged and informed about the disease and its management.

Reimbursement for DSME/S is available from the Centers for Medicare and Medicaid Services and many private insurers. The number of people with type 2 diabetes who receive DSME/S despite its proven benefits, is low. That is why we want you to be aware that this program is available. Why not use this tool in your arsenal of care. It is available for you. So talk with your doctor about what you can do to get involved with DSME/S. He/she can refer you. Remember you are the center of your health care team and education and support are key to the proper management of diabetes. Take that step to a healthier you. 
Source: A Joint Position Statement of the ADA, AADE and the Academy of Nutrition & Dietetics


After the DCCT (Diabetes Control & Complications Trials) were published in 1993, it was found that keeping your blood sugars as close to normal as possible was the best way to reduce the risk of serious complications from diabetes.
Self-Monitoring your blood glucose with a glucometer is an option today that wasn’t available prior to the “80’s”. Advancements in the technology, ease of use, accuracy and size of meters is happening rapidly.
Checking your own blood sugar is a matter of getting a very small drop of blood usually from your finger tip and placing it on a test strip that is inserted into a glucometer that gives you a reading of what your blood sugar is at that moment. The frequency of testing depends on what you want to learn by it, what type of diabetes you have, what treatment your on, and how stable your blood sugars are. By taking more frequent checks throughout the day you can get a better pattern of what your blood sugars are doing during your daily activities. 
In order to interpret these patterns, it is important to keep track of your readings as well as other factors that affect your blood sugars, (activity level, food intake, stress, and timing that would indicate a variation from normal) so that you and your physician can make better adjustments in your diabetes care.
Self monitoring your blood sugars will let you and your doctor know if your levels are becoming dangerously high or low, or if changes need to be made with your diet, exercise or medication to better control your diabetes.
There are many different glucometers on the market. You need to find the one that works best for you. Education on the use of these monitoring devices is important. Talk to your doctor or attend an instructional class. Know what are normal blood sugar levels, what is too high or low. Remember that high blood sugar levels over a long period of time can cause complications to develop.

With the availability of testing today, it makes sense to be aware, be knowledgeable, and be in control.


This blood test taken at the lab lets you and your physician know what your blood sugar levels have been on average over the last 2-3 months. How does this test work? Hemoglobin is a protein that carries oxygen around the body and is within the red blood cells. Red blood cells live in the bloodstream for 60-90 days. The glucose or sugar that is circulating in the bloodstream attaches to the hemoglobin and stays attached. By taking a blood sample they can measure the amount of glucose that is attached to the hemoglobin molecules (glycohemoglobin). Because glycohemoglobin remains in the blood for 2-3 months it gives an average of what your blood sugars have been during that time frame.
An A1c of 6 percent corresponds to an average blood glucose of 120. An A1c of 7 percent reflects an average of 150. An A1c of 8 percent, an average of 180.
The ADA recommends taking action to control the blood glucose if the hemoglobin A1c is 8 percent or greater with the goal being less than 7 percent ideally closer to 6. The ADA recommends that with Type1 diabetes this test is done 4 times/year; with Type2 diabetes 2 times/year.
This test is a good tool along with self-monitoring blood sugars to give you a better knowledge of where you are in your diabetes control and what changes if any you need to keep on top of your diabetes care.
Talk to your physician about your A1c goals.


Your insulin plan depends on your food and activity level.
Three things you need to know about your insulin:
Onset: length of time it takes the insulin to get into the bloodstream and start lowering the blood sugar Peak Time: The time when the insulin is at its maximum strength.Duration: How long the insulin continues to lower blood sugar.
  • Never store insulin in extreme temperatures like the freezer, direct sunlight or leave in your car. Always check the expiration on the bottle. Store extra bottles in the refrigerator. Injecting cold insulin can be painful, many providers recommend storing the bottle you are using at room temperature.
  • Once a vial or pen is opened it is usually good for 28 days even if kept in the refrigerator. There are exceptions, so ask your doctor or pharmacist.
  • It is important to get instructions on insulin and it's delivery.


Type Onset: Peak: Duration:

Rapid Acting:
(Humalog, Novolog, Apidra) 

10 - 30 minutes 30 minutes - 3 hours 3 - 5 hours
Regular or Short Acting: 
(Humulin R or Novolin R)
30 minutes- 1 hour 2-5 hours 3 - 6 hours
(NPH -Humulin N, Novolin N) 
2 - 4 hours 4 - 10 hours 10 - 16 hours
(Lantus, Levemir, Basaglar, Toujeo, Tresiba) 
2 - 4 hours Constant " baseline" BS control 20 - 24 hours
Mixed (Rapid-Acting & Intermediate):
(Humalog 50/50 Mix, Humalog 75/25 Mix, Novolog 70/30)
15 - 60 minutes roughly 3 hours
Inhaled Insulin (Rapid Acting):
Within 5 minutes of being inhaled 1 hour roughly 3 hours


With Type 2 diabetes, you may be making some insulin, but not enough. Or the insulin you produce is not getting into the cells of the body to give you energy. Many people with Type 2 diabetes take pills instead of insulin. At some point they may need to take insulin.
There are many types of diabetes pills to take to control your blood sugars.
  • Sulfonylureas: Stimulate the pancreas to secrete more insulin. Be aware that these drugs can cause low blood sugars, weight gain, or upset stomach. Diabeta and Micronase (Glyburide), Amaryl (Glimepiride), Glucotrol & Glucotrol XL (Glipizide), and Glynase
  • Biguanides: Reduces the amount of sugar made by the liver, and also makes the body's cells more sensitive to insulin. Some side effects include nausea, gas, diarrhea and loss of appetite. Glucophage (Metformin).
  • Meglitinides: Also stimulate the pancreas to secrete more insulin quickly. May also cause low blood sugars. Prandon (Repaglinide), Starlix (Nateglinide), PrandiMet (Tepaglinide & Metformin)
  • Thiazolidinediones:(Glitazones or TZD's) Makes muscle cells more sensitive to insulin as well as, reduces the amount of sugar made by the liver. Can cause fluid retention/swelling. Actos (Pioglitazone), Avandia (Rosiglitazone)
  • Alpha-Glucosidase Inhibitors: Slows the digestion of some carbohydrates. After meal blood glucose peaks aren't as high. Can cause gas, bloating, diarrhea, or stomach pain. Glycet (Miglitol), Precose (Acarbose)
  • SGLT-2 Inhibitors: Increases the elimination of blood sugar through the kidneys. May cause urinary frequency or urinary tract infections (UTI)/yeast infection. Invokana (Canagliflozin), Faxriga (Dapagliflozin), Jardiance (Empagliflozin)
  • DPP-4 Inhibitors: Causes the pancreas to make insulin when blood sugar levels are high. Also reduces the amount of sugar made by the liver. May cause upper respiratory infection or diarrhea. Januvia (Sitagliptin), Nesina (Alogliptin), Onglyza (Saxagliptin), Tradjenta (Linagliptin)
  • IncretinMimetics: Causes the pancreas to make insulin when blood sugar is high. Can cause nausea, headache, loss of appetite, or weight loss.Byetta and Bydureon (Exenatide), Tanzeum (Albiglutide), Trulicity (Dulaglutide), Victoza (Liraglutide). [Injectable medication: Victoza (Liraglutide), Byetta (Exentatide), Bydureon (Exenatide),Tanzeum (Albiglutide) and Trulicity (Dulaglutide)]
  • Amylin Anologs: Works with insulin and glucagon to maintain normal blood sugar levels. It also slows the movement of food through the stomach so sugar enters the blood more slowly. Can cause nausea, weight loss. Symlin (Pramlintide)


An important part of taking care of yourself is managing your blood pressure. High blood pressure, also called hypertension, raises your risk for heart attack, stroke, eye problems, and kidney disease. As many as 2 out of 3 adults with diabetes have high blood pressure. You can prevent or delay diabetes problems by having your blood pressure checked regularly.

What is high blood pressure? Blood pressure is the force of blood flow inside your blood vessels. If your blood moves through your vessels with too much force, you have high blood pressure. 
When your health care team checks your blood pressure, they report it as 2 numbers, such as 120/80. You’ll hear them say this as “120 over 80.” Both numbers are important.
  • The first number is the pressure as your heart beats and pushes blood through the blood vessels. It’s called the “systolic” pressure.
  • The second number is the pressure when the vessels relax between heartbeats. It’s called the “diastolic” pressure. Your heart has to work harder when blood pressure is high, and your risk for diabetes problems goes up. High blood pressure is a condition that won’t go away without treatment.
What should my blood pressure target be? Both diabetes and high blood pressure raise your risk for heart attack, stroke, and eye and kidney disease. The American Diabetes Association (ADA) recommends a target blood pressure of below 140/90 for people with diabetes. When you keep your blood pressure below 140/90, you’ll help lower your risk for diabetes problems.

How will I know if I have high blood pressure? High blood pressure is a silent problem. You won’t know you have it unless your health care provider checks your blood pressure. The ADA recommends that you have your blood pressure checked at every routine office visit. Keep track of your blood pressure by writing the results down. 

What should I do? Both lifestyle changes and medicines help control blood pressure. Treatment varies from one person to the next. Some people can reach their blood pressure targets with lifestyle changes. Other people need medicines and lifestyle changes. Work with your health care provider to find a treatment that’s right for you.

Lifestyle changes can help control your blood pressure, blood glucose (sugar), and blood lipid (cholesterol and triglyceride) levels. Here are some options to try.
  • Make wise food choices
  • Focus on including several servings of fruits and vegetables per day. Have at least one serving at each meal.
  • Switch to low-fat or fat-free dairy products (such as fat-free milk, nonfat yogurt, and reduced-fat cheese).
  • Select whole-grain, high-fiber foods such as 100% whole wheat bread, brown rice, and oats.
  • Eat unsalted nuts and other healthy fats in small portions.
  • Choose lean meats and meat substitutes (such as beans, lentils, fish, chicken or turkey without the skin, lean beef trimmed of visible fat, or pork tenderloin).
  • Use healthy cooking methods that require less fat such as baking, roasting, broiling, or grilling.
  • Add very little or no salt to your food during cooking and at the table.
  • Season your food with salt-free herbs and spices instead of salt or try citrus juices or garlic. Use the nutrition labels to compare foods and choose those with less sodium.
  • Lose weight or take steps to prevent weight gain
  • Cut down on calories by limiting sugary drinks, sweets, and salty snacks.
  • Try to be more physically active than you are now. If you feel unsure about your health, check with your health care provider before making big changes in your exercise plan.
  • Aim for a total of about 30 minutes of aerobic exercise, such as brisk walking, most days of the week. In addition, do some sort of resistance training 2 or more times per week.
  • Talk with your health care team about whether it’s wise to have alcoholic beverages. If you choose to drink, do so in moderation. Limit yourself to 1 serving a day (for women) or 2 servings a day (for men).
  • If you smoke, quit smoking. Talk with your health care team about how to quit. Go to a “quit-smoking” class.

Not everyone takes the same blood pressure medicine and many people take two or more medicines. The ones you take will depend on your blood pressure numbers and other factors.
  • ACE (angiotensin-converting enzyme) inhibitors. These medicines lower blood pressure by keeping your blood vessels relaxed. ACE inhibitors prevent a hormone called angiotensin from forming in your body and narrowing your blood vessels. These medicines also help protect your kidneys and reduce your risk of heart attack and stroke.
  • ARBs (angiotensin receptor blockers). These medicines keep the blood vessels open and relaxed to help lower blood pressure. Like ACE inhibitors, ARBs also protect your kidneys.
  • Beta blockers. These medicines help lower blood pressure and relax your heart by allowing it to beat slower and with less force. Beta blockers help prevent heart attack and stroke.
  • Calcium channel blockers. These medicines help the blood vessels relax by keeping calcium out of your blood vessels and heart.
  • Diuretics. These medicines, sometimes called “water pills,” help rid your body of extra water and sodium through urine.
Anyone with diabetes and blood pressure higher than 140/80 should take either an ACE inhibitor or ARB. People with diabetes and high blood pressure also may need a diuretic medicine. However, pregnant women should not take ACE inhibitors or ARBs. If you’re pregnant, talk with your health care provider about what to do about high blood pressure. Talk with your doctor about what is best for you.


We all know the importance of knowing and regularly checking our blood pressure. High blood pressure is considered the" Silent Killer" because high blood pressure often has no symptoms we tend to not think about it until something happens like a heart attack or stroke. 
Blood pressure is a measurement of the force of blood pushing against the walls of the arteries as the heart pumps blood. The top number or Systolic Pressure is when the heart beats while pumping blood. the lower number or Diastolic Pressure is the pressure when the heart is at rest between beats. Our blood pressure changes throughout the day (watching an exciting TV show or sports game, eating a meal, being stressed at work, exercise). Normally your pressure can rise, but will return to normal again. 
High blood pressure (hypertension) is a disease in which that force is too high and stays high, causing damage to your arteries. If you have no idea what your blood pressure is or haven't been checked in awhile, you should do so. Have you been diagnosed with hypertension? Are you on medication? Are you getting checked regularly? Getting regular BP checks help you and your doctor know if your medications or lifestyle changes are working. Ways to help you maintain a good blood pressure is to eat right and lose weight if needed. Stay away from saturated fats, trans fats, and simple sugars. Eat more whole grain foods, exercise daily, and relax regularly in whatever manner works for you. 
Do you have your own blood pressure equipment? Do you know how to accurately take a blood pressure reading? 
  • Relax for 5 minutes before taking a blood pressure reading.
  • Sit with your feet uncrossed. Don't talk, stay quiet
  • The blood pressure cuff should beat heart level. Make sure your arm is resting comfortably at that level.
  • Make sure the cuff is the right size. Too large of a cuff can cause a false low reading. Too small a cuff a false high reading. The cuff should cover 2/3's of the arm from shoulder to elbow.
  • Preferably the cuff should be over bare skin, not heavy clothing.
  • Take BP at the same time and the same arm , if checking at home on a regular basis.
  • Stay away from caffeine or tobacco prior to BP reading
  • Use the bathroom before BP reading. A full bladder can raise BP
  • Check BP on both right and left arms. If there is a difference of 15 points or more it could be a warning sign of a possible blocked blood vessel.
  • Checking your blood pressure at home can sometimes help alleviate the problem of " white coat syndrome" (a spike in BP as soon as you see the doctor or nurse).
  • Take 2 or 3 readings at least 2 minutes apart. You may find that the readings continue to lower as you relax and quit worrying about what the number will be.
If you do have hypertension, talk with your doctor about your goals and where he/she would like your BP to be, how often you need to check it, and what you need to do to get it down to where it needs to be. Checking at home can be an important part of managing your blood pressure.
Be smart: Get checked: Know your blood pressure numbers!!


Managing your cholesterol and other blood lipids (also called blood fats) can help you prevent other problems.
If your blood lipids are off target, your risk for heart disease, heart attack, and stroke goes up. Managing blood lipids includes both lifestyle changes (such as choosing foods wisely) and, sometimes, taking medicine. You can take steps to manage your blood lipids.
What are the different kinds of blood lipids and what do they do?
There are several kinds of lipids in your blood.
  • LDL cholesterol is sometimes called bad cholesterol. It can narrow or block your blood vessels. Blocked vessels can lead to a heart attack or a stroke. Reaching your LDL target is the best way to protect your heart and blood vessels.
  • HDL cholesterol is sometimes called good cholesterol. It helps remove deposits from the insides of your blood vessels and keeps your blood vessels from getting blocked.
  • Triglycerides are another kind of lipid. High triglycerides raise your risk of a heart attack or stroke.
How will I know if my blood lipid levels are off target?
A blood test can tell you whether your lipid levels are off target. The American Diabetes Association (ADA) recommends that you have your levels checked at least once a year if you have diabetes or if your lipid numbers are off-target. Have your blood tested at least every 5 years if you don’t have diabetes and your numbers are on target.
What are the recommended targets for blood lipids?
See the chart below for targets suggested by the ADA. Write the results of your latest blood lipid check in the box below.
*If you already have heart and blood vessel disease, your target for LDL levels is below 70.

What treatments are recommended?
Both lifestyle changes and medicines help control blood lipids. Treatment differs from one person to the next. Some people can reach their blood lipid targets with lifestyle changes like healthy eating and physical activity. Other people need lifestyle changes plus medicines. Work with your health care provider to find a treatment that’s right for you.
What can you do to improve your numbers?
Here are some steps you can take to improve your cholesterol. Place a check mark next to steps you’re willing to try. You can learn more about how to make these changes by asking your health care provider for more information.
  • If you smoke, quit.
  • Lose weight if needed.
  • Exercise most days of the week. Brisk walking for 30 minutes a day, 5 days a week is a good goal.
  • Switch to a low-fat, low-cholesterol diet.
  • Your doctor may also prescribe cholesterol-lowering medicine.
Not everyone takes the same blood lipid medicine and many people take more than one kind. The ones you take will depend on your blood lipid levels and other factors.
  • Statins. These medicines lower LDL cholesterol, boost HDL levels, and lower triglyceride levels. Studies have shown that they are the best type of medicine for lowering LDL cholesterol. But if you’re pregnant, you should not take statins.
  • Fibric acid derivatives, also called fibrates. These medicines lower triglycerides and raise HDL levels. They may either lower or raise LDL cholesterol, or not affect it at all.
  • Nicotinic acid, also called niacin. These medicines lower triglycerides raise HDL levels, and lower LDL cholesterol.
  • Cholesterol absorption inhibitors. These medicines lower LDL cholesterol and triglycerides and raise HDL levels.
  • Bile acid sequestrants. These medicines lower LDL cholesterol and can raise HDL levels. They either have no effect on triglycerides or, in some cases, they can raise triglyceride levels.
Cholesterol is also affected by blood pressure and blood glucose (sugar). If your blood glucose and blood pressure are high, it’s likely that your cholesterol numbers may be off as well. All of these are risk factors for diabetes and heart disease, and the more risk factors you have, the greater your risk. Talk to your doctor about whether you may be at higher risk for diabetes and heart disease. 
Talk with your doctor and know how often he/she wants you to have your blood lipids checked. Write down your results. Know what your goals are, and work on a plan for you to achieve those goals.


Too much glucose in the blood and elevated blood pressure for a long time can cause diabetes problems. It can damage many parts of the body, such as the heart, blood vessels, eyes, nerves, and kidneys. You can do a lot to help prevent or slow down these complications.
Your kidneys act as filters to clean the blood. When kidneys are healthy, blood and waste from the bloodstream go into the kidneys. The glomeruli filters clean the blood. Then wastes and extra fluids go out into the urine through the ureter. Clean blood leaves the kidneys and goes back into the bloodstream.
When these kidney filters are damaged, proteins leak out of the kidney into the urine. The Albumin test detects this loss of protein. Damaged kidneys aren’t filtering out wastes and extra fluids as well and these wastes build up in the blood instead of leaving the body in urine.
Kidney damage can begin long before you notice any symptoms. That is why the albumin test should be done at least yearly. You may not feel sick for many years, not even when the kidneys are only half functioning. Once your kidneys have failed you may feel sick to your stomach and tired all the time. Your hands and feet may swell from extra fluid in the body. If kidneys fail, dialysis is a treatment or kidney transplant sometimes is an option.
It is important to have your urine and blood checked yearly so that attempts can be made to stop or slow down the progression of diabetic kidney disease.
Be proactive and take good care of your diabetes. Talk with your doctor if you have any questions or concerns.

Preventing Kidney Problems:
  • Keep blood glucose as close to your goal as you can.
  • Keep blood pressure below 130/80 to help prevent kidney damage. Ask your doctor where he/she would like your blood pressure to be. Keeping your pressure under control also helps prevent damage to other areas like eyes, heart, and blood vessels.
  • As your doctor about pills you can take to help slow down kidney damage.
  • Follow a healthy eating plan that you have worked out with your doctor or dietitian. If you already have kidney problems a dietitian may suggest you cut back on protein, like meat, cheese and eggs.
  • Have your kidneys checked at least once a year by having your urine tested for protein (albumin test).
  • Have your blood tested at least once a year for creatinine. The result of this test should be used to find your glomerular filtration rate (GFR), a measure of kidney function.
  • Avoid taking pain killers regularly. Daily use of pills like aspirin or acetaminophen can damage the kidneys. Taking a single dose of aspirin every day to protect the heart, however, should be safe. Taking acetaminophen for occasional pain should also be safe. Talk with your doctor if you are dealing with chronic pain to find a way to not put your kidneys at risk.
  • See a doctor right away for bladder or kidney infections.
  • Some symptoms of infection are:
    • Pain or burning on urination
    • Frequent urge to urinate
    • Urine that looks cloudy or reddish
    • Fever or shaky feeling
    • Pain in you back or on your side below the ribs


Imagine buying a home. What would you think if you walked into a house that had cracks in the walls, the foundation was failing, and the overall structure of the house was unstable? Would you want to live there? How about the inner workings of the house, would you want to live in a home with poor plumbing? What would you think if you saw rusted, corroded pipes that were clogged with years of sediment? There's a disaster waiting to happen!
I'm sure we all want to live in a home that is structurally sound where we feel safe and secure. A place with a strong foundation, sturdy walls and adequate plumbing that provides us with the basic essentials and comforts of home. It's said that our home is our castle but where do we really live?
We live in the most incredible structure ever designed! An architectural wonder! A dwelling so amazing that not even Home Depot can build such an extraordinary design. Our primary residence is truly our body.
Like the frame and foundation of a house, our skeletal system provides us with structural support. To keep the foundation strong we must expose our bones to resistance and weight bearing activities that stimulate bone growth and increase bone density. Activities such as walking, running, jumping and weight training keep bones strong and dense.
Our plumbing is actually our circulatory system. To maintain proper blood flow and oxygen delivery, we must keep our "pipes" (blood vessels) free from plaque buildup. Cardiovascular exercises such as walking, biking, and aerobics work to improve circulation and oxygen delivery by strengthening the heart so that it can deliver more blood to the body with each beat in a more efficient manner.
For many, the home is considered to be our most valuable asset. I believe that the greatest asset we will ever have the responsibility to take care of and invest in is our body. The next time you think about a home improvement project, take time to invest in yourself too. After all, "if you don't take care of your body where will you live?"


  • Wash your feet daily with lukewarm water and soap.
  • Dry your feet well especially between the toes.
  • Apply moisturizing lotion, but avoid between the toes. Bacteria can grow in warm moist areas.
  • Check your feet for blisters, cuts, redness, etc. Use a mirror to see your feet better or have someone else inspect them. If a problem is present consult your podiatrist or primary care physician.
  • Trim your nails straight across and file the edges with a nail file. If you can't see or reach well enough arrange to have someone else like your podiatrist or primary care physician do it for you.
  • Change your socks daily. Avoid dirty or tight fitting socks that can cut off circulation.
  • Never walk barefoot either indoors or out. If you have any neuropathy in your feet, you may not be able to feel a cut, sting, etc. that could cause a problem if undetected.
  • Check your shoes daily for cracks, stones, anything that might have gotten in them.
  • If you do find a cut or blister wash the area with soap and water and apply an antibiotic ointment and call your podiatrist or primary health care physician.
  • Always wear good fitting shoes with plenty of support as well as room for your toes.
  • Every time you visit your doctor, take off your shoes and socks and have him/her examine your feet.
  • Not only will he/she be looking for cuts, sores etc, but will be looking for altered sensation in the feet and decreased circulation.
  • Keep your blood sugar in control to lessen chances for infection, it also helps lessen the skin and nail changes, and can lessen neuropathy issues.


Our site is a special gift. The eyes are both delicate and complex. We need to take special care of our eyes, especially as we get older, when vision starts to decline.
Getting regular eye exams, getting and using glasses, contact lenses, or surgery to correct refractive errors like myopia (nearsightedness), hyperopia (farsightedness), astigmatism (distorted vision at all distances) and presbyopia that occurs between 40-50 years (loss of ability to focus up close) is important. Refractive errors left untreated can lead to headaches and eye strain. Another way to take good care of your eyes is to wear protective eyewear when working with machinery or playing sports. Don't forget sunglasses to protect your eyes from damaging rays in any season.
Cataract is a clouding of the eyes lens causing cloudy or double vision, fading colors, sensitivity to light, difficultly driving at night, or the need to increase the strength of your glasses or contacts, and is the leading cause of vision loss and blindness worldwide. Treatment for removal of cataract is widely available.
Glaucoma occurs when the normal fluid pressure inside the eyes slowly rises. This fluid buildup can damage the eyes optic nerve causing tunnel vision. Regular eye exams can protect your eyes against serious vision loss. There are two major categories "open angle" progressing slowly over a long time or "closed angle" appearing suddenly and is painful.
Age Related Macular Degeneration is associated with aging and damages sharp and central vision (macula) that allows you to see fine details. The person is able to see around the edges, but not straight ahead. Early detection and treatment is key in preserving remaining eyesight.
Double Vision can be from nearsightedness or farsightedness or something more serious like diabetic retinopathy which is a common complication of diabetes. Diabetes damages tiny blood vessels in the retina of the eye. Diabetic retinopathy is a progressive disease and the leading cause of blindness in adults. The disease can cause you to see flashing lights, blank spots or dark spots. The risks can be reduced through good management of blood sugar, blood pressure, and lipid abnormalities.
Floaters and Flashes The annoying little specks that drift about in your field of vision are usually the cause of the aging process. Parts of your inner eye shed and clump together. Most are harmless, but if you notice a sudden increase or flashes of light, call your doctor right away. These symptoms could be a sign of a retinal tear or detachment.


Inflammation is a vital healthy short- term response of the body to heal injury and fight infection. Whether you have a cut or a sore throat, your body sends out an immune response of white blood cells to the site where they produce chemicals to protect you and begin the healing process. You may get redness, pain or swelling at the site. As your body heals, these symptoms subside.
But sometimes the immune system engages and doesn't shut off. What causes this differs from person to person. The endless attack of immune cells begins to interfere with the body's healthy tissues and internal organs. This chronic inflammation can play a role in numerous chronic diseases like, cancer, heart disease, diabetes, depression, Alzheimer's and allergies. 
Some triggers for chronic inflammation include:
  • Excess weight:Chronic inflammation is linked to weight gain. As you gain weight and fat cells expand, the added stress can send out the immune system response and inflame the cells and overtime making them resistant to insulin (The hormone that regulates blood sugar). The consumption of a lot of high sugar, high carb and high fat foods can also up your inflammation risk. Your body fat distribution is important too. If you have most of your body fat around your waist it can indicate an inflammatory state.
  • Stress: Inflammatory activity usually increases under stress, both physical and emotional.
  • Smoking and smog: Smoking is such an assault on the lungs that the immune system can rush to fix the damage and can over compensate causing more damage than good.
  • High blood pressure and high blood sugars cause inflammation that over time, can cause damage to the lining of blood vessels of the body.
  • Lack of sleep: Not getting a good night's sleep can weaken the immune system. Lack of sleep is also linked to weight gain.
How to fight and reduce inflammation:
  • Diet: Lose weight if needed.Eat foods high in omega 3's the "good fats" like salmon, flax, seeds, avocado, and walnuts. Foods like fruits and vegetables of all colors, and green tea have antioxidants and polyphenols which help inflammation by reducing free radical damage that is produced by the body's state of stress. Add spices like turmeric, garlic, cinnamon, and ginger that have all shown anti-inflammatory properties.
  • Exercise: Moderate exercise is important. Walking or some sort of exercise daily at least 30 minutes will release anti-inflammatory proteins to the cells throughout the body. Exercise also causes, especially muscle cells, to increase their sensitivity to insulin, which in turn reduces chronic inflammation and helps in the management of diabetes.
  • Reduce stress, incorporate things that are relaxing into your daily routine. Seek treatment if needed for anxiety or depression.
  • Get plenty of sleep
  • Keep high blood pressure, and blood sugars, under control.
  • Take measures to quit smoking.
  • Talk with your doctor about any medications like statins for cholesterol, that have an anti-inflammatory effect.
  • Assess yourself: Take action and make any lifestyle changes to prevent or reduce chronic inflammation.


Diabetic neuropathy is a peripheral nerve disorder caused by diabetes or poor blood sugar control. The most common types of diabetic neuropathy result in problems with sensation in the feet. It can develop slowly after many years of diabetes or may occur early in the disease. The symptoms are numbness, pain, or tingling in the feet or lower legs. The pain can be intense and require treatment to relieve the discomfort. The loss of sensation in the feet may also increase the possibility that foot injuries will go unnoticed and develop into ulcers or lesions that become infected. In some cases, diabetic neuropathy can be associated with difficulty walking and some weakness in the foot muscles. There are other types of diabetic-related neuropathies that affect specific parts of the body. For example, diabetic amyotrophy causes pain, weakness and wasting of the thigh muscles, or cranial nerve infarcts that may result in double vision, a drooping eyelid, or dizziness. Diabetes can also affect the autonomic nerves that control blood pressure, the digestive tract, bladder function, and sexual organs. Problems with the autonomic nerves may cause lightheadedness, indigestion, diarrhea or constipation, difficulty with bladder control, and impotence.
The goal of treating diabetic neuropathy is to prevent further tissue damage and relieve discomfort. The first step is to bring blood sugar levels under control by diet and medication. Another important part of treatment involves taking special care of the feet by wearing proper fitting shoes and routinely checking the feet for cuts and infections. Analgesics, low doses of antidepressants, and some anticonvulsant medications may be prescribed for relief of pain, burning, or tingling. Some individuals find that walking regularly, taking warm baths, or using elastic stockings may help relieve leg pain. Don't hesitate to contact your doctor if you have any symptoms. Remember with diabetes, the best way to help prevent any complications is to keep blood sugar in control and stay as healthy as you can with diet and exercise too.


Have you been trying to lose weight?  Remember that losing weight if you are overweight is an important step towards better heart health.  Losing 10% of your body weight with healthy eating and exercise can help decrease your risk for heart disease and stroke.  It will help lower your cholesterol and blood pressure, give you more energy to get out and exercise more and even help control diabetes. 
Body fat has a lot to do with heart health.  The more fat the higher the risk for heart disease, stroke, diabetes, high cholesterol, and hypertension.  Do you know your BMI? (Body Mass Index)  This is a measure of body fat.  A normal BMI is between 18.5-24.9.  Overweight is between 25.0 – 29.9.  Obese is considered 30 and over.   To know your BMI, get out your calculators and multiply your weight in pounds by 703, then divide that number by your height in inches, then divide again by your height in inches.  Now you can plan a goal for yourself.   
Another reason heart disease is so prevalent is that Americans tend to carry too much belly fat.  Research has shown that belly fat not only squeezes your internal organs like the kidneys and liver but it can increase inflammation in your arteries and even block the hormone insulin from its ability to work.   Do you know what your waist measurement should be?  Take your height in inches, divide by two and that number should be your waist measurement.  
So if you know your BMI and are actively trying to lose weight, eating a balanced diet, getting plenty of exercise, plenty of sleep, know your cholesterol, blood pressure and blood sugar, and are talking with your doctor  to improve all of the above, then you are on the road to a healthy heart.


A lot of taking care of your health is up to you. You decide what to eat and how much to eat. You choose whether to exercise and what to do. You make choices all day long. Maybe you’d like to do something to improve your health. Perhaps your goal is to lose weight. But to reach your goal, you know you’ll need to change what you eat, what you do for exercise, or both. You will raise your chances of reaching your goal by making a plan that’s specific, realistic, and practical. Start with 2 or 3 small steps. Make sure the changes fit with your likes, dislikes, and schedule. Choose things you’re sure you can do.
Changing Habits: Getting Started
Think about your health and your habits. Then fill in your answers.
  • What’s my goal? ___________________________________________
    Example: I want to lose 10 pounds.
  • Why did I choose this goal? ___________________________________________
    Example: I want to stay healthy and be around for my grandchildren.
  • What change would help me reach my goal? ___________________________________________
    Example: I’ll take a brisk walk for half an hour 5 days a week.
  • How important is it to me to reach my goal? ___________________________________________
    Example: It’s very important.
  • How sure am I that I can make this change? On a scale of 1-10, how sure are you that you can make the change? "1" means you don't think you can do it. "10" means you are very sure you can do it. _______
  • What part of the change would be hard for me? ____________________________________________
  • Why haven't I made the change before? ____________________________________________
  • How can I work around these problems?____________________________________________
  • How ready am I to make this change? Again on a scale of 1-10, how ready are you? _______
Making my Plan
To change a habit, make a plan that's as specific and realistic as possible. Take a look at these examples: 
  • Not specific: I will eat less
  • Specific: I will eat 1 slice of toast for breakfast instead of 2 slices
  • Not specific: I will walk for at least 2 hours every day.
  • Realistic: I will walk for 30 minutes, 3 days a week
If you need help making a plan, talk with your health care team. Write down your plan, and make a copy for your health care provider. Talk with your doctor again in a month about how you are doing with your plan.
  • Here's what I'll do: __________________________________________
    Example: I'll take a brisk walk for 30 minutes 3 days a week
  • Here's when I'll do it: __________________________________________
    Example: I'll walk after breakfast
  • What might get in my way of my plan __________________________________________
    Example: If it's raining, I won't be able to walk outside
  • If that happens, I'll do this instead: __________________________________________
    Example: I'll go to the recreation center or shopping mall and walk around inside.
  • Here's when I'll start: __________________________________________
    Example: I'll start my walks on Monday
Ask the support of family or friends, and keep track of your efforts. You can always vary your routine to make it interesting too.
It takes time to make new habits, but your patience and persistence will pay off in the long run. If you sometimes slip up and go back to your old ways, don't despair. Start fresh tomorrow. You can do it!!


What is depression?
Depression is a medical condition that’s more than just feeling sad, stressed, or irritable once in a while. It’s especially common in women. Men go through depression too, but may be less likely to seek treatment. People who have certain conditions, such as heart disease, cancer, or diabetes, sometimes also are depressed. The good news is that treatment can help.
What are the symptoms of depression?
  • Most people with depression will have several of these symptoms for most of the day, almost every day, for at least 2 weeks:
  • feeling down and depressed
  • losing interest in their usual activities
  • feeling that things that used to make them happy no longer do
  • weight loss or gain
  • trouble sleeping (insomnia) or sleeping too much
  • feeling agitated and nervous or feeling sluggish, like they’re moving slowly
  • having crying spells or being very emotional
  • feeling very tired and having no energy
  • having trouble focusing or making decisions
  • thinking about death or suicide
Symptoms like these are normal after major losses, such as the death of a loved one, diagnosis of a new medical problem, or losing a job, but people should start feeling better after a few weeks. People with depression can’t trace their symptoms directly to medicines, medical conditions, or loss of a loved one. Contrary to what many people used to believe, depression is not a sign of personal weakness or failure. Telling someone “Pull yourself out of it!” can’t cure depression.
What causes depression?
Researchers think depression is caused by a mix of physical, psychological, and genetic factors. Differences in how the brain works, how a person reacts to stressful events like chronic illness or divorce, and a history of depression in the family can all make someone more likely to get depression.
What should I do if I think I have depression?
If you have symptoms of depression, get help as soon as you can. The sooner you get treatment, the sooner you’ll feel better. Make an appointment to see your health care provider. Explain how you’ve been feeling and ask whether you might have serious depression. After asking about your symptoms and doing other checks as needed, your health care provider will discuss treatment options with you, such as starting treatment right away or seeing a specialist.
Diabetes and depression.
Depression is common in people with diabetes. In fact, diabetes doubles the risk for depression. People with diabetes are at high risk for depression throughout life. As many as 1 in every 3 people with diabetes has symptoms of depression.
How is diabetes related to depression?
It isn’t clear whether diabetes causes depression or exactly how depression is related to diabetes. But we do know that diabetes can make people to feel overwhelmed by the demands of day-to-day care. It’s common for people with diabetes to worry about long-term complications, costs of diabetes care, and the effects of diabetes on family and work life. People wonder, “Why did I have to be the one to get diabetes?”
How does depression affect diabetes?
Depression can make it hard for you to focus on taking care of yourself. You might feel that it’s too much trouble to check your blood glucose (sugar) or try to choose healthy foods. Things can seem hopeless. When you don’t take care of yourself, blood glucose levels can rise. Frequent high blood glucose levels over time raise your risk for diabetes-related complications. Studies have shown that depression can even make aches and pains seem worse.
What is the treatment for depression?
Depression is treated with medicine and counseling. Some people use both treatments; others find that either medicine or counseling alone helps them. Your health care provider can explain both kinds of treatments to help you choose what to do. There are several types of medicines that treat depression, called antidepressants. Some antidepressants take several weeks to help change the way your brain works and improve your mood. But after a while, medicine can help you feel back to normal and can restore your sense of well-being. Counseling can teach you the skills you need to cope with the stresses in your life. Sometimes it helps to talk about problems with someone. A counselor can offer a fresh look at what’s going on in your life. Many people find that having the support of family and friends can be a comfort. Find someone to talk with about what’s going on. Or if it’s hard for you to talk about your feelings, just spending time with family and friends can help you feel better. Physical activity can also help you feel better both when you’re depressed as well as when you’re feeling better. So find an activity that you enjoy and do it. (walking, swimming etc). Activity can lift your spirits.
Remember your risk for depression.
Depression can come and go throughout life. Knowing the symptoms and taking action to get help when depression occurs will help you return to “your old self” as soon as possible.


With diabetes, there is so much we need to know and remember and incorporate into our daily lives. Along with the proper food, medication, exercise, regular blood sugar testing, regular checkups, proper foot wear and exams, A1C checks, etc., it is still very important and we can’t forget to wear some kind of visible and recognizable medical ID. (especially if you are on some kind of medication that could lower your blood sugar) It could save your life. Any kind of ID (bracelet, necklace, as well as a wallet ID) is important to have on your person at all times. We tend to be out and about more in the summer months. Especially when exercising: What if:
  • You became sick or confused or passed out due to a very high or very low blood sugar
  • You fell, or were in an accident and unconscious
In these cases, you can’t communicate to those who come to your aid. Medical personnel are trained to look for some visible form of ID. Medical ID should say:
  • You have diabetes and whether you take insulin
  • If you are on an insulin pump
  • In addition, carry an ID card that has your name, address, phone, doctor, and any medications and doses you are taking
So if you don’t have any form of Medical ID, check out your pharmacy, the web, or even some jewelry stores, for something that will work for you. Don’t overlook this simple yet valuable part of your diabetes care. It doesn’t have to cost much and it doesn’t hurt to be prepared.