The 7 principles for controlling your diabetes for life:

These principles, or steps, will help you manage your diabetes and help you live a long and active life. Every person who has diabetes has different needs. Talk to your health care team about a treatment plan that is best for you. Diabetes affects almost every part of the body and good diabetes care requires a team of health care providers. They include doctors, diabetes educators, nurses, dietitians, pharmacists, suppliers, mental health workers, eye specialists, foot specialists, dentists, and social workers.
It is IMPORTANT to control diabetes!

Taking good care of diabetes will make you feel better and can lower your chances of getting heart disease or stroke. Eye disease can lead to a loss of vision or even blindness, nerve damage that may cause a loss of feeling or pain in the hands, feet, legs, or other parts of the body and lead to problems such as lower limb amputation or erectile dysfunction, kidney failure, and gum disease and loss of teeth.

Principle 1: Learn as much as you can about diabetes.
The more you know about diabetes, the better you can work with your health care team to manage your disease and reduce your risk for problems. You should know what type of diabetes you have. If you do not know, ask your doctor whether you have type 1 or type 2 diabetes.

Type 1 diabetes: People who have type 1 diabetes need to take insulin every day. This type of diabetes is less common and used to be called juvenile diabetes.
Type 2 diabetes: Diet and daily physical activity help to control type 2 diabetes. Most people also need to take diabetes pills or insulin. Type 2 diabetes is very common and used to be called adult-onset diabetes. Diabetes is always a serious disease. Terms that suggest that diabetes is not serious, such as “a touch of diabetes,” “mild diabetes,” and “sugar’s a little high,” are not correct and should no longer be used.

Many People Who Have Diabetes Do Not Know It!
Finding and treating diabetes early can prevent health problems later on. Many people with type 2 diabetes have no symptoms and do not know they have diabetes. Some people are at higher risk for diabetes than others. People at high risk include those who are older than 45, are overweight, have a close family member such as a parent, a brother, or a sister who has or has had diabetes, had diabetes during pregnancy, had a baby that weighed more than 9 pounds, are African American, Hispanic or Latino, Asian American or Pacific Islander, or American Indian, have high blood pressure, have high cholesterol or other abnormal blood fats, and are inactive.

Principle 2: Get regular care for your diabetes.
If you have diabetes, it is important to see your health care team regularly and make sure your treatment plan is working. If it is not, ask your health care team to help you change it. And ask your family, friends, and co-workers for help and support when you need it. Work with your health care team to get the best help to control your diabetes. Ask your health care team how often you need to see them for check-ups.

Ask your doctor, clinic or office staff, or pharmacist to help you find resources if you have problems paying for food, medicines, and medical supplies. You should be able to get Medicare or other insurance to help you pay for diabetes supplies. Make a list of questions and concerns you want to talk about at your next visit to your health care team.

Principle 3: Learn how to control your diabetes.
Diabetes affects many parts of the body. To stay healthy, it is important to know how to eat the right foods, how to be physically active, and how to look after yourself.

How Active Are You in Controlling Your Diabetes?
It is important to my health care team about:
• my special needs to help control my diabetes
• ways to improve my ABC numbers: A1C, Blood pressure, and Cholesterol
• aspirin therapy to prevent heart problems
• getting regular physical activity
• quitting smoking, if needed

I learn from my doctor, diabetes educator, podiatrist, pharmacist, or dietitian how to
• follow a meal plan to control my diabetes
• check my feet every day
• take my medicines as prescribed
• check my blood glucose levels
*A1C (pronounced A-one-C) is a measure of your average blood glucose over the last three months. You should get this test at least twice a year.
I visit my
• doctor at least twice a year
• eye doctor each year and report any changes in vision
• dentist twice a year
• specialists as my doctor advises

Principle 4: Take care of your diabetes ABCs.
A major goal of treatment is to control the ABCs of diabetes: A1C (blood glucose average), Blood pressure, and Cholesterol.

You can do this in many ways.
• Follow a meal plan that was made for you.
• Be active every day.
• Take your medicine as prescribed.
• Before taking any non-prescription medicines, vitamins, or herbal products, ask your pharmacist how they may affect your diabetes or prescription medicines.
• Test your blood glucose on a routine basis.

Talk to your health care team about the best ways to control your A1C, blood pressure, and cholesterol and know your target numbers. Get involved in setting goals and making a treatment plan for your diabetes.

Principle 5: Monitor your diabetes ABCs.
To reduce your risk for diabetes problems such as blindness, kidney disease, losing a foot or leg, and early death from heart attack or stroke, you and your health care team need to monitor the diabetes ABCs: A1C, Blood pressure, and Cholesterol. Talk to your health care team about how to reach your target numbers.

Get the A1C Test
The A1C test is usually done by your doctor. It measures how well your blood glucose has been controlled over the last three months. This test is very important because it tells how well you are taking care of your diabetes over the long term. It should be done at least twice a year. The target A1C for most people with diabetes is less than 7. Ask your health care team what your A1C is and keep a dated record of the results. Discuss your A1C target with your health care team and write it down. Discuss what you need to do to reach your target.

Check Your Own Blood Glucose
You may need to check your own blood glucose on a regular basis to help control your diabetes. It will tell you what your blood glucose is at the time you test. Keep a record of your results and show it to your health care team. Some meters and test strips report blood glucose results as plasma glucose values which are 10 to 15 percent higher than whole blood glucose values. Ask your doctor or pharmacist whether your meter and strips provide whole blood or plasma results. The target glucose range for most people using whole blood is 80 to 120 before meals and 100 to 140 at bedtime. The target glucose range for most people using plasma is 90 to 130 before meals and 110 to 150 at bedtime. Talk to your health care team about the best ways to check your own blood glucose. Ask your health care team what your blood glucose targets are before meals, after meals, and at bedtime and write them down. Ask what to do if your blood glucose is often higher or lower than it should be. Ask how to get the supplies you need to do the tests. Most insurance companies, including Medicare, now pay for diabetes supplies.

Know Your Blood Pressure
High blood pressure makes your heart work too hard. This leads to strokes and other problems such as kidney disease. Your blood pressure should be checked at every visit. You may need to check it yourself. The target blood pressure for most people with diabetes is less than 130/80. Ask your health care team what your blood pressure is and keep a dated record of the results. Discuss your blood pressure target with your health care team and write it down. Discuss what you need to do to reach your target. Ask if you need to test your blood pressure yourself. If so, find out how, when, and what supplies you need.

Know Your Cholesterol
LDL is the bad cholesterol that builds up in your blood vessels. It causes the vessels to narrow and harden, which can lead to a heart attack. Your doctor should check your LDL at least once a year. The target LDL cholesterol for most people with diabetes is less than 100. Discuss your LDL cholesterol target with your health care team and keep a record of the results. Discuss what you need to do to reach your target. Keeping a record of your results helps you reach your targets. It helps you know when you and your health care team need to take extra action.

Principle 6: Prevent long-term diabetes problems.
People with diabetes must control their blood glucose, blood pressure, and cholesterol to prevent the problems of diabetes: heart attack, stroke, eye and kidney problems, nerve damage, impotence, foot or leg amputation, gum disease, and loss of teeth. Here are the key self-care activities to help you manage your diabetes and live a long and healthy life.

• Follow your diabetes meal plan with the correct portion sizes. Eat a variety of foods that are high in fiber and low in fat and salt.
• Be active every day.
• Take medicines as prescribed. If you have questions, talk to your pharmacist or doctor about your medicines.
• Look at your feet and wash and dry them well each day. Tell your podiatrist or health care team about any changes with your feet.
• Check your mouth daily for gum or tooth problems. Call your dentist right away if you have problems with your teeth or gums.

As Needed
• Test your blood glucose as prescribed by your doctor.
• Check your blood pressure as prescribed by your doctor.
• Reach and stay at a healthy weight.
• Stop smoking.
• Make sure your eyeglasses or contact lens prescription is up to date.

Principle 7: Get checked for long-term problems /treat them.
See your health care team regularly to check for problems that diabetes can cause. Regular check-ups help to prevent problems or find them early when they can be treated and managed well. Along with the checks of your A1C, blood pressure, and cholesterol (see Principle 5), here are some tests that you will need:

• Triglycerides -a type of blood fat. (Yearly)

• Dilated eye exam to check for eye problems. (Yearly)

• Foot check. (Every visit)

• Complete foot exam to check for circulation, loss of feeling, or sores. (Yearly)

• Urine test to check for kidney problems. (Yearly)

• Dental exams to prevent gum disease and loss of teeth. (Twice a year)

Ask your doctor about these and other tests you may need to have.

SELF-MONITORED BLOOD GLUCOSE (SUGAR)
Whole blood Suggested target range
Before meals: 80-120 _______ At bedtime: 100-140 _______

Plasma Suggested target range
Before meals: 90-130 _______ At bedtime: 110-150 ______

Talk to my health care team about my:
 ABCs - A1C, Blood pressure Cholesterol (LDL)  Medications  Meal plan Glucose self-monitoring plan  Physical activity plan  Foot care

Ask about:
 Aspirin therapy  Stopping smoking  Pneumonia vaccine  Resources
 Medicare or other insurance benefits

Make sure I get a:
 Dilated eye exam - once a year  Kidney function test - once a year
 Foot check - every visit  Dental exam - twice a year
 Complete foot exam - once a year  Flu shot - once a year

Source:
Sponsored by the National Diabetes Education Program.
A Joint Program of the National Institutes of Health and the Centers for Disease Control and Prevention NIH Publication No. 99-4343L December 2001.