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Sick Day Management

Health Care Checklist




After the DCCT (Diabetes Control & Complications Trials) were published in “93”, 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 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.

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Diabetes Foot Care ~ during the summer months

1. Be cautious when wearing sandals, the straps can rub and cause blisters.

2. Have a first aid kit with you, at hone and on vacations.
* Hydrogen Peroxide
* Johnson & Johnson antiseptic spray for minor cuts
* Bacitracin Ointment or Triple antibiotic ointment
* Bandaids
* 3x3 gauze pads
* Paper tape

If you notice a cut or a blister, stop what you are doing and clean the area with soap and water, apply
triple antibiotic ointment and call your Podiatrist or Health Care Provider.

Take 5 minutes at lunch to change shoes and check your feet, when you are on vacation. People walk
more on vacation and tend to wear sandals.

3. Don’t forget SUNSCREEN for the whole body, including your FEET!

4. Lotion and check your feet daily. Have another person check you r feet at least once per week.

5. Please don’t go barefoot.

6. Be cautious not to sit too close to campfires, especially if you have numbness (neuropathy) in your feet. You can cause burns and not even feel it.

7. Have a great summer and get out there and start moving; the best medicine for diabetes is being and staying active.

-Jan Smolen DPM





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 build up. 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?"

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With Type1 diabetes, the body is no longer producing any insulin. You need to take insulin injections, because insulin would be digested if it was taken by mouth. 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 it’s maximum strength. Duration: How long the insulin continues to lower blood sugar.

Different types of insulin:

* Rapid Acting: Begin to work about 15 minutes after injected. (Humalog orNovoLog) Should take 15 minutes before a meal. Make sure you don’t delay eating after injection. These insulins leave the bloodstream quickly, so there is less chance of hypoglycemia (low blood sugar).

* Regular or Short Acting: (Humulin R or Novolin R)Takes approximately 30 minutes after injection to reach the bloodstream. It peaks at 2-3 hours after injection, and it’s duration is 3-6 hours.

* Intermediate-acting: NPH (Humulin N or Novolin N) Takes approximately 2-4 hours after injection to reach the bloodstream. Peaks 4-12 hours after injection, and it’s duration is about 12-18 hours.

* Long Acting: Takes approximately 6-10 hours after injection, and is usually effective18- 24hours. (Human ultralente) does have peak action but is absorbed at different rates in different people. For some people it acts as an intermediate acting and for others, it’s long acting. (Lantus) a long acting insulin. Onset is 2-4 hours and has a continuous peakless action that mimics a natural basal insulin secretion. Many people use a rapid or short acting insulin before all meals as a bolus along with long acting basal Lantus.

* Premixed: A mixture of 70% NPH and 30% Regular (Humulin 70/30 or Novolin70/30) is the most typical mixture available in a prefilled pen, which is portable and replaces the traditional vial and syringe. (Humalog Mix 75/25) combines intermediate acting insulin and rapid acting mealtime insulin. (NovoLog Mix 70/30) is also available.

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. Insulin at room temperature will last about a month.

It is important that you get instructions on insulin and it’s delivery. There are classes available in the area on diabetes. See area classes.

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. (Diabinese, Amaryl Gluctrol, DiaBeta, Micronase)

* Biguanides: Keep the liver from releasing to much glucose, and also make muscle cells more sensitive to insulin. (Metformin or Glucophage)

* Meglitinides: Also stimulate the pancreas to secrete more insulin, but are shorter in action. May also cause low blood sugars. (Starlix, Prandon)

* Thiazolidinediones: (TZDs): Make muscle cells more sensitive to insulin. (Actos, Avandia)

* Alpha-Glucosidase Inhibitors: Slow the digestion of some carbohydrates. After meal blood glucose peaks aren’t as high. (Glyset)

Often people with Type 2 diabetes benefit by taking more than one diabetes drug affecting different parts of the body to help utilize the glucose by getting it into the cells of the body. Some drug companies are marketing combination drugs.

Combination drugs:
* Glucovance (Metformin and DiaBeta)
* Avandamet (metformin and Avandia)
* Metaglip (Metformin and Glucotrol)

You should know the name of the diabetes medication you are taking and from what category and how it is used in the body.

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Area Classes on Diabetes

Mercy Health Partners, Hackley Campus Program
1212 E. Sherman Suite 2 - Mercy Heart Center

 Day & Evening Classes — call Jennifer Langhorst, RD, CDE

Individual instruction and classes also available - call Jeanette Waite, RD, CDE

(231) 672-3648

North Ottawa Community Hospital, Sheldon Road, Grand Haven

Morning and Evening Classes — call Mary Willey Cunningham, RD, CDE
(616) 847-5332

Mercy Health Partners Lakeshore Campus Diabetes Program

Wednesdays and Thursdays
Lakeshore Hospital (231) 861-3018

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Let's Talk About Nutrition & Diabetes

Meal planning is a key component to managing your diabetes. You can make a difference in your blood sugar control through your food choices. To keep blood glucose levels controlled you need to balance the food that you eat at your meals.

By working with a Registered Dietitian, a meal plan can be created to fit your lifestyle, meet your bodies nutritional needs, and most important help maintain good blood glucose control. If you have not met with a Registered Dietitian or a Certified Diabetes Educator, speak to your primary care physician about a referral for diabetes education. The more that you know the easier it will be to manage your diabetes.

People with diabetes do not need to eat special foods. The foods that are good for you are good for everyone. Here is some meal planning tips to get you started on your way to managing your diabetes:

1. Eat 3 meals with an evening snack per day. Do not skip meals or snacks.

2. Try to space meals every 4-5 hours.

3. Try to eat the same amount of foods at each meal. The more consistent you are with meal times and the amount of foods at meals the better blood sugar control you can gain.

4. Watch your portion sizes. The Nutrition Facts label found on most foods will tell you what a serving size is of that food.

5. Choose a wide variety of foods from all the food groups. Choose more whole grains, fresh fruits and vegetables, and 100% fruit juices.

6. Choose lean cuts of meat, trim visible fat prior to cooking, and remove skin from poultry prior to cooking. Bake, broil, boil, or grill meats.

7. Prepare foods with limited amounts of fat such as butter, margarine, or oils. Add fats to foods after they have been prepared. A standard serving is 1 tsp, margarine, butter, or oil. Try using non-stick cooking sprays or non-stick cookware to help reduce the amount of fat needed when cooking. Limit all fried foods.

8. Avoid regular sweeteners such as sugar, candy, honey, syrups, jams, jelly, puddings, Jell-0, cakes, pie, cookies, doughnuts, pop, popsicles, sherbet, sorbet, pastries, sweetened fruit drinks, sugar coated or frosted cereals, and sweetened yogurts.

9. Artificial sweeteners such as Equal, Sweet-N-Low, and Splenda etc., are okay to use. You can also use sugar free jam, jelly, Jell-0, syrups, puddings, popsicles, Crystal Light, Sugar Free Kool-Aid, diet soft drinks, and light yogurt.

10. Avoid alcohol. It contains unneeded calories and can interact with some medications.

11. Exercise!! Daily activity improves blood glucose control and is an important part of a healthy lifestyle. Check with your physician before starting any new exercise program.

Remember that these are just a few tips to get you started. A Registered Dietitian can give you more specific guidelines for meal planning.

This information was brought to you by Jennifer Langhorst RD, CDE

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Sick Day Management

As you may know having Diabetes does not mean that you are unable to get other illnesses such as a cold or the flu. When you are sick blood glucose levels may increase. In addition, your appetite may change. Here are some tips to follow the next time you get sick:

1. Check your blood glucose levels every 4 hours or before meals and at bedtime.

2. Always take your usual dose of oral medications or insulin even if you are unable to eat.

3. If you are on insulin, check for ketones every 4 hours if blood glucose levels remain > 200mg/dl. You can use over the counter ketostix to dip in urine stream to test for ketones. Compare ketostix to color chart provided with product to determine if ketones are present. Contact physician if ketones are present.

4. If unable to tolerate solid foods or do not desire to have solid foods, you can use liquid or soft foods such as Jello, juice, broth, popsicles or pudding. It is important to still try to maintain a consistent amount of carbohydrates at meals even if you are only consuming liquid or soft foods.

5. Stay hydrated!!! Make sure to drink at least 6-8oz of fluid every hour especially if blood glucose levels are elevated. If you are nauseated small sips every 15-30 minutes is recommended. If unable to take liquids due to vomiting contact your physician to see if he or she can prescribe a medication to settle your stomach.

6. Do not exercise. Take it easy your body is already under stress from being sick. Activity can actually make blood glucose levels raise.

7. Eat small snacks every 2-3 hours if unable to eat your regular meals.

8. Look for signs that you need to contact your physician: continued vomiting for more than 2-4 hours, blood glucose levels consistently greater than 200mg/dl, ketones present (only applies to those that are taking insulin), signs of dehydration such as dry mouth, weight loss, or sunken eyes.

9. Have someone check in on you periodically throughout the day if you live alone or are alone when you are sick.

10. When in doubt call your physician!!!

If you are unable to eat solid foods here are a few ideas of some foods that you can try:

* 1⁄2 cup regular carbonated beverage = 15g carbohydrate
* 1⁄2 twin bar Popsicle = 15g carbohydrate
* 3 tsp granulated sugar = 15g carbohydrate
* 1⁄2 cup regular Jello = 15g carbohydrate
* 1⁄4 cup regular pudding = 15g carbohydrate
* 1⁄2 cup ice cream = 15g carbohydrate
* 1 cup milk = 12g carbohydrate
* 1 cup plain yogurt = 12g carbohydrate
* 1/3 cup cranberry, grape, or prune juice = 15g carbohydrate
* 1⁄2 cup orange or apple juice = 15g carbohydrate
* 1⁄2 cup tomato or V8 juice = 5g carbohydrate
* 1 cup soup = 15g carbohydrate
* 3 graham cracker squares = 15g carbohydrate
* 1⁄2 cup hot cereal plain = 15g carbohydrate

Pick up 1 or 2 items that you may want to have on hand in case you are sick the next time you go to the grocery store. Tuck them away in a cupboard with a copy of these sick day guidelines so that you are prepared the next time you get sick. Remember it is still important to follow your meal planning guidelines, especially consistent amounts of carbohydrates at meals, even if you are consuming only liquids.

Jennifer Langhorst, RD, CDE - Mercy Health Partners

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Health Care Checklist

Are you doing everything you need to control your diabetes?

  • I stay informed by reading diabetes related newsletters, books and magazines.

  • I eat a balanced diet daily and work at getting to and maintaining a desirable weight.

  • I read food labels before I purchase foods.

  • I understand my meal plan. If not see a dietician.

  • I understand what my medications are for and how and when to take them.

  • I check the expiration dates on my test strips and medication periodically.

  • Do you know when to call a doctor? Do you have a sick day plan? Know what to do when ill with a cold or the flu before it happens.

  • I visit my primary care physician every three months or as he/she recommends.

  • I exercise at least 3 times a week for 30 minutes (check with your physician before starting any exercise routine).

  • I weigh myself to check for fluctuations every 2 weeks or so unless directed differently by my doctor.

  • I check my feet for cuts and sores daily, and make sure my doctor examines my feet every visit.

  • I have a podiatrist examine my feet at least annually, unless otherwise recommended. This exam should include a check for altered sensation, decreased circulation and/or infection.

  • I wear properly fitted shoes, and avoid going barefoot.

  • I monitor my blood glucose at least twice a day or more depending on my type of diabetes and medication and what is recommended by my health care team.

  • I get a glycosylated hemoglobin (HbAlc) blood test and compare it to my last one to check my overall glucose control every 3-6 months.

  • I check my blood pressure every three months and every doctor visit. If recommended, I check my blood pressure at home.

  • I get a yearly dilated eye exam to check for retinopathy.

  • I get a lipid profile done annually which includes total cholesterol HDL/LDL and Triglycerides.

  • I get a yearly urine test for (microalbuminuria) which is a check for kidney damage. Also blood work to check kidney function.

  • I visit the dentist at least once a year or as recommended. My dentist should know that I have diabetes.

  • I talk to my doctor about getting the flu shot yearly, and pneumonia shot as needed.

  • I practice some form of relaxation or stress reduction that is helpful for me at least three times a week or as often as needed.

Hopefully you have checked all of the above. If not, take note of the ones you need to work on. Remember you are the key player on your diabetes team.

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When blood glucose levels are high, a person with diabetes is more susceptible to infections!!