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The suggestions and information contained in this publication are generally consistent with the Clinical Practice Recommendations and other policies of the American Diabetes Association, but they do not represent the policy or position of the Association or any of its boards or committees. Reasonable steps have been taken to ensure the accuracy of the information presented. However, the American Diabetes Association cannot ensure the safety or efficacy of any product or service described in this publication. Individuals are advised to consult a physician or other appropriate health care professional before undertaking any diet or exercise program or taking any medication referred to in this publication. Professionals must use and apply their own professional judgment, experience, and training and should not rely solely on the information contained in this publication before prescribing any diet, exercise, or medication. The American Diabetes Association—its officers, directors, employees, volunteers, and members—assumes no responsibility or liability for personal or other injury, loss, or damage that may result from the suggestions or information in this publication.

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American Diabetes Association

1701 North Beauregard Street

Alexandria, Virginia 22311

DOI: 10.2337/9781580404426

Library of Congress Cataloging-in-Publication Data

Barrier, Phyllis, 1946-

Type 2 diabetes for beginners / Phyllis Barrier. -- 2nd ed.

p. cm.

Includes bibliographical references and index.

ISBN 978-1-58040-442-6 (pbk.)

1. Non-insulin-dependent diabetes--Popular works. I. Title. II. Title: Type two diabetes for beginners.

RC662.18.B37 2011

616.4’624--dc23

2011017907

eISBN 978-1-58040-402-0

To the people with diabetes

who have taught me so much

about combining life and diabetes care.

To my parents

and to my husband, Michael.

Contents

Foreword

Acknowledgments

Introduction

1 What Is Prediabetes?

2 Type 1 and Type 2 Diabetes: What’s the Difference?

3 Eating with Prediabetes or Type 2 Diabetes

Rate Your Plate

Carbohydrate Counting

Steps in Using a Food Label

Making Healthy Food Choices

Glycemic Index

Using Meal Planning Tools

4 Meal Planning and Shopping

5 Tips for Eating Out with Diabetes

Top Tips for Eating Away from Home

6 What to Eat When You’re Sick

Tips for Sick Days

Liquid and Soft Sick Day Foods

When to Call Your Health Care Team

7 Checking Your Blood Glucose

Using a Blood Glucose Meter

How Often Do I Check My Blood Glucose?

The A1C or eAG Check

8 Keeping Your Blood Glucose in Your Target Range

9 What Makes Your Blood Glucose Go Up or Down?

If Your Blood Glucose Is Too High

What Can I Do When My Blood Glucose Is High?

If Your Blood Glucose Is Too Low

What Can I Do When My Blood Glucose Is Too Low?

10 Get Up and Get Going

Get Ready to Be More Active

Get Set

Go for It: Making a Plan and Getting Started

Go for It!

11 Guidelines for Diabetes Care

At Every Diabetes Visit

At Least Twice a Year

Every Year

Things to Do before Each Diabetes Visit

Taking Charge of Your Diabetes Visits

12 Diabetes Medicines

What Kind of Pill Is It?

Injectable Diabetes Medications

Insulin

Insulin Shots

Taking Your Medicines

13 Do You Want to Lose Weight?

Ways to Lose Weight

Knowing When You’re Ready to Lose Weight

Making Your Plan to Lose Weight

How to Track Your Progress

14 Diabetes and Depression

Signs of Depression

How Is Depression Treated?

Your Risk for Depression

15 Stress and Diabetes

Are You Stressed Out?

Dealing with Stress

16 Smoking and Diabetes

Double Trouble

Are You Ready to Quit Smoking?

Making a Plan

17 Sex and Diabetes

For Men Only

For Women Only

Pregnancy and Diabetes

Birth Control and Diabetes

18 Alcohol and Diabetes

Guidelines for Drinking Alcohol with Type 2 Diabetes

19 Long-Term Diabetes Problems

Eye Problems

Foot Problems

Heart and Blood Vessel Problems

Kidney Problems

Nerve Problems

Skin Problems

Tooth and Gum Problems

Diabetes Problems: Putting It All Together

20 What It All Means

21 Diabetes Tools

Carbohydrate Choices

My Blood Glucose Log

My Medicines

My Meal Plan

My Shopping List

Resources

Foreword

by Barbara Anderson

When we read a book, we read “within the lines” and “between the lines.” “Within the lines” means that we pay attention to what the author has written, to the printed facts and the information. “Between the lines” refers to both the emotional tone in which the facts and information are given as well as the information that the author has not included. Type 2 Diabetes for Beginners, which has been written by a seasoned nutritionist with substantial diabetes experience, has the comprehensive information and facts “within” its lines—from carb counting to stress management—that a person needs in order to begin and maintain a life with diabetes. However, what is most unique about this book is that it also communicates “between the lines,” providing the essential emotional message that it takes determination, courage, and support to maintain the stamina to sustain this journey in living with diabetes. The experienced nutritionist who wrote Type 2 Diabetes for Beginners is also an experienced clinician and has worked for years with individuals with diabetes and their families. Phyllis Barrier understands that what patients and families need does not simply end at the information and facts, but also requires energy, optimism, and engagement to successfully apply diabetes facts and create and continue healthy lifestyle changes.

As to information that is not included in this book, you will find no mention of how easy it is to live with diabetes. You will not find misleading messages that say you can “do it all yourself.” In fact, you are assured that living with diabetes is a difficult challenge and that everyone on the road needs two teams—an experienced health care team and a family/friend support team. What I appreciate most about this book is its honest and reassuring tone. Within the lines and between them, the person with diabetes is guided to take small and realistic steps to create and continue needed lifestyle changes. And as Phyllis has said so strongly within and between the lines, building a long and healthy life with diabetes can be a realistic long-term goal for everyone with diabetes.

Barbara Anderson, PhD

Professor, Pediatric Endocrinology and Metabolism

Baylor College of Medicine

Houston, Texas

by Martha M. Funnell

I am honored to introduce this book and congratulate you on taking this important step in caring for your diabetes. If you are like many of the people whom I see as a diabetes educator and you just found out that you have type 2 diabetes, you are probably feeling somewhat overwhelmed. You may also be feeling angry, scared, or confused.

You probably also have questions. You may have concerns about taking care of a chronic illness such as diabetes. And you may have discovered that diabetes is different from other illnesses you have had. Having diabetes means that there are many decisions to be made each day about how you care for yourself. Making wise choices will make a difference in both how you feel today and your future health.

You may also want to begin to make some changes in your life that will help you take better care of yourself and your diabetes. As much as you truly want to make these changes, it is never easy, especially when it comes to how you eat, handle stress, and exercise.

It may help to know that you are not alone. This book is written to be a resource to help you learn how to manage and cope with diabetes. You may not know a lot about diabetes yet, but you do know about yourself and what is important to you. When you combine what you know with what your health care team knows about diabetes, you’ll have a powerful combination.

I often tell my patients that diabetes is a journey. It is probably not a journey that you would have chosen, and it is not an easy one. But even the hardest journey is made easier when you can lighten your load. This book can be a guide for you. The more you know, the more you will feel that you are in charge of diabetes, rather than allowing diabetes to control you. You can also learn how to make decisions that are right for you and make changes in your life so that you not only live long but live well.

Best wishes on your journey.

Martha M. Funnell, MS, RN, CDE

Michigan Diabetes Research and Training Center

Ann Arbor, Michigan

Acknowledgments

Len Boswell, former Vice President, Publications, American Diabetes Association, came up with the idea for a book that would help people who are just beginning to deal with type 2 diabetes, whether newly diagnosed or just starting to care for their long-standing diabetes. I am grateful that he asked me to write it.

Many other staff members at the National Office of the American Diabetes Association helped make this book a reality. Special thanks to Abe Ogden, Director of Book Publishing; Greg Guthrie, Managing Editor; Stephanie Dunbar, MPh, RD, Director of Nutrition and Medical Affairs; and the illustrators and graphic designers.

Thanks also to the many volunteers I worked with at the American Diabetes Association. They taught me so much through the years. I cannot possibly list them all, but I hope they know who they are! I do want to single out those volunteers who worked with me on the Program Publications Editorial Board: Martha M. Funnell, MS, RN, CDE; Virginia Paragallo-Dittko, MA, RN, CDE; Barbara Anderson, PhD; Patricia Barr, BS; Carol Homko, PhD, RN, CDE; Melinda Maryniuk, MEd, RD, CDE; Catherine Mullooly, MS, CDE; Robin Nwankwo, MPH, RD, CDE; Cecilia Boyer Casey, MS, RN, CDE; Richard Rubin, PhD, CDE; and Andrea Zaldivar, MS, ANP, CDE. Marion Franz, MS, RD, CDE, and Madelyn Wheeler, MS, RD, were my wonderful diabetes and nutrition mentors who always had time for a question or volunteer project.

And last, but not least, I want to thank my parents for their sacrifices and support through the years. I also want to thank my husband, Michael, who has been my best friend, sounding board, and “at-home editor.”

Type 2 Diabetes for Beginners

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