Natural Disasters, how to be ready for them

During natural disasters, emergencies, and hazards people with diabetes face particular challenges to their health care. If you are an evacuee or are in an emergency situation, it is of prime importance to identify yourself as a person with diabetes and any related conditions, so you can obtain appropriate care. It is also important to prevent dehydration by drinking enough fluids, which can be difficult when drinking water is in short supply. In addition, it is helpful to keep something containing sugar with you at all times, in case you develop hypoglycemia (low blood glucose). To prevent infections, which people with diabetes are more vulnerable to, pay careful attention to the health of your feet, and get medical treatment for any wounds.

Emergency Preparedness

Emergency Preparedness and You
http://emergency.cdc.gov/preparedness

Ready—Prepare.Plan.Stay Informed.
http://www.ready.gov

Federal Emergency Management Agency
http://www.fema.gov

Insulin Advice

Switching Between Products in an Emergency
http://www.fda.gov/cder/emergency/insulin.htm
Patients should try to keep their insulin as cool as possible, avoiding direct heat and direct sunlight as well as freezing if placed on ice. Although a physician should supervise when switching insulin products, here are recommendations for emergency situations

Health Advice

Hand Hygiene in Emergency Situations
http://emergency.cdc.gov/disasters/handhygiene.asp
After an emergency, it can be difficult to find running water. However, it is still important to wash your hands to avoid illness or infection, especially when testing your blood glucose or treating a wound.

Keep Water Safe after a Natural Disaster
http://emergency.cdc.gov/disasters/foodwater.asp#water
Water may not be safe to drink, clean with, or bathe in after a hurricane or flood, which can be a particular problem for people with diabetes, who especially need to drink fluids and keep wounds clean.

General Hurricane Recovery Information

Hurricane Recovery Information from FirstGov.gov
https://www.usa.gov/disasters-and-emergencies


Preparing for surgery when you have diabetes

You may need surgery for a diabetes complication or for some other problem that is unrelated to your diabetes. Your diabetes may increase your risk for problems during or after your surgery, such as:

  • Infection after surgery
  • Healing slower
  • Heart problems
Before Surgery

Work with your doctor to come up with the safest surgery plan for you.

Focus more on managing your diabetes during the weeks before surgery.

Your doctor will do a medical exam and talk to you about your health.

  • Tell your doctor about all the medicines you are taking.
  • If you take Metformin, talk to your doctor about stopping it. Sometimes, it can be stopped 48 hours before and 48 hours after surgery to decrease the risk of lactic acidosis.
  • If you take insulin, ask your doctor what dose you should take the night before or the day of your surgery.

Surgery is riskier if you have diabetes complications. So talk to your doctor about your diabetes management and any complications you have from diabetes. Tell your doctor about any problems you have with your heart, kidneys, or eyes, or if you have loss of feeling in your feet. The doctor may run some tests to check the status of those problems.

During Surgery

Before surgery, talk to your doctor about maintaining a good blood sugar level during the operation. You may do better with surgery and get better faster if your blood sugar is controlled during surgery. You may be instructed to aim for a blood sugar between 80 and 150 mg/dL.

During surgery, insulin is given by the anesthesiologist. You will meet with this doctor before surgery to discuss the plan to control your blood sugar during the operation.

After Surgery

You or your nurses should check your blood sugar often. You may have more trouble controlling because you:

  • Have trouble eating
  • Are vomiting
  • Are stressed after surgery
  • Are less active than usual
  • Have pain or discomfort

Expect that you may take more time to heal because of your diabetes. Be prepared for a hospital stay if you are having major surgery. People with diabetes often have to stay in the hospital longer than people without diabetes.

Watch for signs of infection, such as a fever, or an incision that is red, hot to touch, swollen, more painful, or oozing.

Prevent bedsores. Move around in bed and get out of bed frequently. If you have less feeling in your toes and fingers, you may not feel if you are getting a bed sore. Make sure you move around.

After you leave the hospital, it is important for you to work with your primary care team to make sure your blood sugar continues to be well controlled.

When to Call Your Doctor

Call your doctor if:

  • You have any questions about surgery or anesthesia
  • You are not sure what medicines you should take or stop taking before surgery
  • You think that you have an infection

Hypertension and diabetes

About 70% of adults with diabetes have high blood pressure or use prescription medications to reduce high blood pressure. Maintaining healthy blood pressure—less than 130/80 millimeters of mercury (mm Hg) helps to prevent damage to the eyes, kidneys, heart, and blood vessels. Blood pressure measurements are written as a fraction, with the two numbers separated by a slash. The first number represents the pressure in your blood vessels when your heart beats (systolic pressure); the second number represents the pressure in the vessels when your heart is at rest (diastolic pressure).

In general, for every 10 mm Hg reduction in systolic blood pressure (the first number in the fraction), the risk for any complication related to diabetes is reduced by 12%. Maintaining normal blood pressure control can reduce the risk of eye, kidney, and nerve disease (microvascular disease) by approximately 33%, and the risk of heart illness and stroke (cardiovascular disease) by approximately 33% to 50%. Healthy eating, medications and physical activity can help you bring high blood pressure down.

Hypertension is the primary risk factor for cardiovascular diseases, which are the leading cause of death. However, there is a wide disparity in the number of people who are aware of their hypertensive condition, those who are being treated and are not controlled, and those who are being treated and are controlled. This makes it necessary to increase efforts to raise awareness and knowledge about hypertension, as well as initiatives to facilitate access to adequate and evidence-based treatment.


What is insulin?

Insulin is a hormone made in the pancreas, an organ located behind the stomach. The pancreas contains clusters of cells called islets. Beta cells within the islets make insulin and release it into the blood.

Insulin plays a major role in metabolism—the way the body uses digested food for energy. The digestive tract breaks down carbohydrates—sugars and starches found in many foods—into glucose. Glucose is a form of sugar that enters the bloodstream. With the help of insulin, cells throughout the body absorb glucose and use it for energy.

Insulin’s Role in Blood Glucose Control

When blood glucose levels rise after a meal, the pancreas releases insulin into the blood. Insulin and glucose then travel in the blood to cells throughout the body.

  • Insulin helps muscle, fat, and liver cells absorb glucose from the bloodstream, lowering blood glucose levels.
  • Insulin stimulates the liver and muscle tissue to store excess glucose. The stored form of glucose is called glycogen.
  • Insulin also lowers blood glucose levels by reducing glucose production in the liver.

In a healthy person, these functions allow blood glucose and insulin levels to remain in the normal range.

Types of Insulin

There are many different types of insulin. The type lets you know how fast the insulin starts working or how long it lasts in your body. Your health care provider will help you find the insulin that is best for you.

  • Rapid-Acting – This insulin starts working within 15 minutes after you use it. It is mostly gone out of your body after a few hours. It should be taken just before or just after you eat.
  • Short-Acting – This insulin starts working within 30 minutes to 1 hour after you use it. It is mostly gone out of your body after a few hours. It should be taken 30-45 minutes before you eat.
  • Intermediate-Acting – This insulin starts working within 2-4 hours after you use it. It reaches its highest level in your blood around 6-8 hours after you use it. It is often used to help control your blood sugar between meals. Some people use this type of insulin in the morning, at bedtime, or both.
  • Long-Acting – This insulin starts working within 2 to 4 hours after you use it. It can last in the body for up to 24 hours. It is often used in the morning or at bedtime to help control your blood sugar throughout the day.
  • Pre-Mixed – This is a mix of two different types of insulin. It includes one type that helps to control your blood sugar at meals and another type that helps between meals.
General Tips
  • Never share insulin needles (syringes) or devices.
  • Ask your doctor or nurse to show you how to inject your insulin.
  • Always wash your hands before you inject your insulin.
  • Do not inject your insulin in the exact same spot on your body each time.
    • The skin may get thick or thin if you use the same spot.
    • Inject in the same general area of your body.
  • Do not use your insulin if it looks cloudy or looks like something is floating in it. Take it back to the drug store for a new one.
  • Do not use insulin needles (syringes), pens, and injectors after the expiration date printed on the label or on the box.

Who should be part of your health care team?

 

Most people with diabetes get health care from a primary care professional. Primary care professionals include internists, family physicians, and pediatricians. Sometimes physician assistants and nurses with extra training, called nurse practitioners, provide primary care. You also will need to see other care professionals from time to time. A team of health care professionals can help you improve your diabetes self-care. Remember, you are the most important member of your health care team.

Besides a primary care professional, your health care team may include

  • an endocrinologist for more specialized diabetes care
  • a registered dietitian, also called a nutritionist
  • a nurse
  • a certified diabetes educator
  • a pharmacist
  • a dentist
  • an eye doctor
  • a podiatrist, or foot doctor, for foot care
  • a social worker, who can help you find financial aid for treatment and community resources
  • a counselor or other mental health care professional

When you see members of your health care team, ask questions. Write a list of questions you have before your visit so you don’t forget what you want to ask. Watch a video to help you get ready for your diabetes care visit.

You should see your health care team at least twice a year, and more often if you are having problems or are having trouble reaching your blood glucose, blood pressure, or cholesterol goals. At each visit, be sure you have a blood pressure check, foot check, and weight check; and review your self-care plan. Talk with your health care team about your medicines and whether you need to adjust them. Routine health care will help you find and treat any health problems early, or may be able to help prevent them.

Talk with your doctor about what vaccines you should get to keep from getting sick, such as a flu shot and pneumonia shot. Preventing illness is an important part of taking care of your diabetes. Your blood glucose levels are more likely to go up when you’re sick or have an infection. Learn more about taking care of your diabetes when you’re sick and during other special times, such as when you’re traveling.


What sexual problems can occur in men with diabetes?

Erectile Dysfunction

Erectile dysfunction is a consistent inability to have an erection firm enough for sexual intercourse. The condition includes the total inability to have an erection and the inability to sustain an erection.

Estimates of the prevalence of erectile dysfunction in men with diabetes vary widely, ranging from 20 to 75 percent. Men who have diabetes are two to three times more likely to have erectile dysfunction than men who do not have diabetes. Among men with erectile dysfunction, those with diabetes may experience the problem as much as 10 to 15 years earlier than men without diabetes. Research suggests that erectile dysfunction may be an early marker of diabetes, particularly in men ages 45 and younger.

In addition to diabetes, other major causes of erectile dysfunction include high blood pressure, kidney disease, alcohol abuse, and blood vessel disease. Erectile dysfunction may also occur because of the side effects of medications, psychological factors, smoking, and hormonal deficiencies.

Men who experience erectile dysfunction should consider talking with a health care provider. The health care provider may ask about the patient’s medical history, the type and frequency of sexual problems, medications, smoking and drinking habits, and other health conditions. A physical exam and laboratory tests may help pinpoint causes of sexual problems. The health care provider will check blood glucose control and hormone levels and may ask the patient to do a test at home that checks for erections that occur during sleep. The health care provider may also ask whether the patient is depressed or has recently experienced upsetting changes in his life.

Treatments for erectile dysfunction caused by nerve damage, also called neuropathy, vary widely and range from oral pills, a vacuum pump, pellets placed in the urethra, and shots directly into the penis, to surgery. All of these methods have advantages and disadvantages. Psychological counseling to reduce anxiety or address other issues may be necessary. Surgery to implant a device to aid in erection or to repair arteries is usually used as a treatment after all others fail.

Retrograde Ejaculation

Retrograde ejaculation is a condition in which part or all of a man’s semen goes into the bladder instead of out the tip of the penis during ejaculation. Retrograde ejaculation occurs when internal muscles, called sphincters, do not function normally. A sphincter automatically opens or closes a passage in the body. With retrograde ejaculation, semen enters the bladder, mixes with urine, and leaves the body during urination without harming the bladder. A man experiencing retrograde ejaculation may notice that little semen is discharged during ejaculation or may become aware of the condition if fertility problems arise. Analysis of a urine sample after ejaculation will reveal the presence of semen.

Poor blood glucose control and the resulting nerve damage can cause retrograde ejaculation. Other causes include prostate surgery and some medications.

Retrograde ejaculation caused by diabetes or surgery may be helped with a medication that strengthens the muscle tone of the sphincter in the bladder. A urologist experienced in infertility treatments may assist with techniques to promote fertility, such as collecting sperm from the urine and then using the sperm for artificial insemination.


What is hypoglycemia and how to treat it?

Hypoglycemia, also called low blood glucose or low blood sugar, occurs when the level of glucose in your blood drops below normal. For many people with diabetes, that means a level of 70 milligrams per deciliter (mg/dL) or less. Your numbers might be different, so check with your health care provider to find out what level is too low for you.

What are the symptoms of hypoglycemia?

Symptoms of hypoglycemia tend to come on quickly and can vary from person to person. You may have one or more mild-to-moderate symptoms listed in the table below. Sometimes people don’t feel any symptoms.

Severe hypoglycemia is when your blood glucose level becomes so low that you’re unable to treat yourself and need help from another person. Severe hypoglycemia is dangerous and needs to be treated right away. This condition is more common in people with type 1 diabetes.

Mild-to-Moderate

  • Shaky or jittery
  • Sweaty
  • Hungry
  • Headachy
  • Blurred vision
  • Sleepy or tired
  • Dizzy or lightheaded
  • Confused or disoriented
  • Pale
  • Uncoordinated
  • Irritable or nervous
  • Argumentative or combative
  • Changed behavior or personality
  • Trouble concentrating
  • Weak
  • Fast or irregular heart beat

Severe

  • Unable to eat or drink
  • Seizures or convulsions (jerky movements)
  • Unconsciousness
What causes hypoglycemia in diabetes?

Hypoglycemia can be a side effect of insulin or other types of diabetes medicines that help your body make more insulin. Two types of diabetes pills can cause hypoglycemia: sulfonylureas and meglitinides . Ask your health care team if your diabetes medicine can cause hypoglycemia.

Although other diabetes medicines don’t cause hypoglycemia by themselves, they can increase the chances of hypoglycemia if you also take insulin, a sulfonylurea, or a meglitinide.

What other factors contribute to hypoglycemia in diabetes?

If you take insulin or diabetes medicines that increase the amount of insulin your body makes—but don’t match your medications with your food or physical activity—you could develop hypoglycemia. The following factors can make hypoglycemia more likely:

Not eating enough carbohydrates (carbs)

When you eat foods containing carbohydrates, your digestive system breaks down the sugars and starches into glucose. Glucose then enters your bloodstream and raises your blood glucose level. If you don’t eat enough carbohydrates to match your medication, your blood glucose could drop too low.

Skipping or delaying a meal

If you skip or delay a meal, your blood glucose could drop too low. Hypoglycemia also can occur when you are asleep and haven’t eaten for several hours.

Increasing physical activity

Increasing your physical activity level beyond your normal routine can lower your blood glucose level for up to 24 hours after the activity.

Drinking too much alcohol without enough food

Alcohol makes it harder for your body to keep your blood glucose level steady, especially if you haven’t eaten in a while. The effects of alcohol can also keep you from feeling the symptoms of hypoglycemia, which may lead to severe hypoglycemia.

Being sick

When you’re sick, you may not be able to eat as much or keep food down, which can cause low blood glucose. Learn more about taking care of your diabetes when you’re sick.

How do I treat hypoglycemia?

If you begin to feel one or more hypoglycemia symptoms, check your blood glucose. If your blood glucose level is below your target or less than 70, eat or drink 15 grams of carbohydrates right away. Examples include

•four glucose tablets or one tube of glucose gel

•1/2 cup (4 ounces) of fruit juice—not low-calorie or reduced sugar*

•1/2 can (4 to 6 ounces) of soda—not low-calorie or reduced sugar

•1 tablespoon of sugar, honey, or corn syrup

•2 tablespoons of raisins

Wait 15 minutes and check your blood glucose again. If your glucose level is still low, eat or drink another 15 grams of glucose or carbohydrates. Check your blood glucose again after another 15 minutes. Repeat these steps until your glucose level is back to normal.

If your next meal is more than 1 hour away, have a snack to keep your blood glucose level in your target range. Try crackers or a piece of fruit.

*People who have kidney disease shouldn’t drink orange juice for their 15 grams of carbohydrates because it contains a lot of potassium. Apple, grape, or cranberry juice are good options.

Treating hypoglycemia if you take acarbose or miglitol

If you take acarbose or miglitol along with diabetes medicines that can cause hypoglycemia, you will need to take glucose tablets or glucose gel if your blood glucose level is too low. Eating or drinking other sources of carbohydrates won’t raise your blood glucose level quickly enough.

What if I have severe hypoglycemia and can’t treat myself?

Someone will need to give you a glucagon injection if you have severe hypoglycemia. An injection of glucagon will quickly raise your blood glucose level. Talk with your health care provider about when and how to use a glucagon emergency kit. If you have an emergency kit, check the date on the package to make sure it hasn’t expired.

If you are likely to have severe hypoglycemia, teach your family, friends, and coworkers when and how to give you a glucagon injection. Also, tell your family, friends, and coworkers to call 911 right away after giving you a glucagon injection or if you don’t have a glucagon emergency kit with you.

If you have hypoglycemia often or have had severe hypoglycemia, you should wear a medical alert bracelet or pendant. A medical alert ID tells other people that you have diabetes and need care right away. Getting prompt care can help prevent the serious problems that hypoglycemia can cause.


Questions to Ask about Your Diabetes Medications

Ask your doctor these questions when you get a prescription for a medicine. Make copies of this insert and use one sheet for each of your medicines.

  1. What are the names of my medicine?Brand name:

    Generic name:

  2. What does my medicine do?
  3. When should I start this medicine?
  4. This medicine is prescribed by:
  5. How long will it take this medicine to work?
  6. What is the strength (for example, how many milligrams, written as mg)?
  7. How much should I take for each dose?
  8. How many times a day should I take my medicine?
  9. At what times should I take my medicine?
  10. Should I take it before, with, or after a meal?
  11. Should I avoid any foods or medicines when I take it?
  12. Should I avoid alcoholic beverages when I take it?
  13. Are there any times when I should change the amount of medicine I take?
  14. What should I do if I forget to take it?
  15. If I’m sick and can’t keep food down, should I still take my medicine?
  16. Can my diabetes medicine cause low blood glucose?
  17. What should I do if my blood glucose is too low?
  18. What side effects can this medicine cause?
  19. What should I do if I have side effects?
  20. How should I store this medicine?

Diabetes Tests & Diagnosis

Your health care professional can diagnose diabetes, prediabetes, and gestational diabetes through blood tests. The blood tests show if your blood glucose, also called blood sugar, is too high.

Do not try to diagnose yourself if you think you might have diabetes. Testing equipment that you can buy over the counter, such as a blood glucose meter, cannot diagnose diabetes.

Who should be tested for diabetes?

Anyone who has symptoms of diabetes should be tested for the disease. Some people will not have any symptoms but may have risk factors for diabetes and need to be tested. Testing allows health care professionals to find diabetes sooner and work with their patients to manage diabetes and prevent complications.

Testing also allows health care professionals to find prediabetes. Making lifestyle changes to lose a modest amount of weight if you are overweight may help you delay or prevent type 2 diabetes.

Type 1 diabetes

Most often, testing for type 1 diabetes occurs in people with diabetes symptoms. Doctors usually diagnose type 1 diabetes in children and young adults. Because type 1 diabetes can run in families, a study called TrialNet offers free testing to family members of people with the disease, even if they don’t have symptoms.

Type 2 diabetes

Experts recommend routine testing for type 2 diabetes if you

•are age 45 or older

•are between the ages of 19 and 44, are overweight or obese, and have one or more other diabetes risk factors

•are a woman who had gestational diabetes1

Medicare covers the cost of diabetes tests for people with certain risk factors for diabetes. If you have Medicare, find out if you qualify for coverage. If you have different insurance, ask your insurance company if it covers diabetes tests.

Though type 2 diabetes most often develops in adults, children also can develop type 2 diabetes. Experts recommend testing children between the ages of 10 and 18 who are overweight or obese and have at least two other risk factors for developing diabetes.1

•low birthweight

•a mother who had diabetes while pregnant with them

•any risk factor mentioned in Risk Factors for Type 2 Diabetes

What tests are used to diagnose diabetes and prediabetes?

Health care professionals most often use the fasting plasma glucose (FPG) test or the A1C test to diagnose diabetes. In some cases, they may use a random plasma glucose (RPG) test.

Fasting plasma glucose (FPG) test

The FPG blood test measures your blood glucose level at a single point in time. For the most reliable results, it is best to have this test in the morning, after you fast for at least 8 hours. Fasting means having nothing to eat or drink except sips of water.

A1C test

The A1C test is a blood test that provides your average levels of blood glucose over the past 3 months. Other names for the A1C test are hemoglobin A1C, HbA1C, glycated hemoglobin, and glycosylated hemoglobin test. You can eat and drink before this test. When it comes to using the A1C to diagnose diabetes, your doctor will consider factors such as your age and whether you have anemia or another problem with your blood.1 The A1C test is not accurate in people with anemia.

Your health care professional will report your A1C test result as a percentage, such as an A1C of 7 percent. The higher the percentage, the higher your average blood glucose levels.

People with diabetes also use information from the A1C test to help manage their diabetes.

Random plasma glucose (RPG) test

Sometimes health care professionals use the RPG test to diagnose diabetes when diabetes symptoms are present and they do not want to wait until you have fasted. You do not need to fast overnight for the RPG test. You may have this blood test at any time.

What test numbers tell me if I have diabetes or prediabetes?

Each test to detect diabetes and prediabetes uses a different measurement. Usually, the same test method needs to be repeated on a second day to diagnose diabetes. Your doctor may also use a second test method to confirm that you have diabetes.

The following table helps you understand what your test numbers mean.

Which tests help my health care professional know what kind of diabetes I have?

Even though the tests described here can confirm that you have diabetes, they can’t identify what type you have. Sometimes health care professionals are unsure if diabetes is type 1 or type 2. A rare type of diabetes that can occur in babies, called monogenic diabetes, can also be mistaken for type 1 diabetes. Treatment depends on the type of diabetes, so knowing which type you have is important.

To find out if your diabetes is type 1, your health care professional may look for certain autoantibodies. Autoantibodies are antibodies that mistakenly attack your healthy tissues and cells. The presence of one or more of several types of autoantibodies specific to diabetes is common in type 1 diabetes, but not in type 2 or monogenic diabetes. A health care professional will have to draw your blood for this test.

If you had diabetes while you were pregnant, you should get tested 6 to 12 weeks after your baby is born to see if you have type 2 diabetes.


Friends, Family, and Diabetes

One of the best ways to predict how well someone will manage diabetes: how much support they get from family and friends.

Daily diabetes care is a lot to handle, from taking meds, injecting insulin, and checking blood sugar to eating healthy food, being physically active, and keeping health care appointments. Your support can help make the difference between your friend or family member feeling overwhelmed or empowered.

What You Can Do
    • Learn about diabetes. Find out why and when blood sugar should be checked, how to recognize and handle highs and lows (more below), what lifestyle changes are needed, and where to go for information and help.
    • Know diabetes is individual. Each person who has diabetes is different, and their treatment plan needs to be customized to their specific needs. It may be very different from that of other people you know with diabetes.
    • Ask your friend or relative how you can help, and then listen to what they say. They may want reminders and assistance (or may not), and that can change over time.
    • Go to appointments if it’s OK with your relative or friend. You could learn more about how diabetes affects them and how you can be the most helpful.
    • Give them time in the daily schedule so they can manage their diabetes—check blood sugar, make healthy food, take a walk.
    • Avoid blame. People with diabetes are often overweight, but being overweight is just one of several factors that can lead to diabetes. And blood sugar levels can be hard to control even with a healthy diet and regular physical activity. Diabetes is complicated!
    • Step back. You may share the same toothpaste, but your family member may not want to share everything about managing diabetes with you. The same goes for a friend with diabetes.
    • Accept the ups and downs. Moods can change with blood sugar levels, from happy to sad to irritable. It might just be the diabetes talking, but ask your friend or relative tell their health care team if they feel sad on most days—it could be depression.
    • Be encouraging. Tell them you know how hard they’re trying. Remind them of their successes. Point out how proud you are of their progress.
    • Walk the talk. Follow the same healthy food and fitness plan as your loved one; it’s good for your health, too. Lifestyle changes become habits more easily when you do them together.
    • Help them feel the power to manage their diabetes.
            • Shakiness.
            • Nervousness or anxiety.
            • Sweating, chills, or clamminess.
            • Irritability or impatience.
            • Dizziness and difficulty concentrating.
            • Hunger or nausea.
            • Blurred vision.
            • Weakness or fatigue.
            • Anger, stubbornness, or sadness.Know the lows. Hypoglycemia (low blood sugar) can be dangerous and needs to be treated immediately. Symptoms vary, so be sure to know your friend’s or relative’s particular signs, which could include

      If your family member or friend has hypoglycemia several times a week, suggest that he or she talk with his or her health care team to see if the treatment plan needs to be adjusted.

    • Offer to help them connect with other people who share their experience. Online resources such as the American Association of Diabetes Educators’ Diabetes Online Community[1.27 MB] or in-person diabetes support groups are good ways to get started.
Better Together

The most important thing is quality of life, yours and theirs. Sure, there will be highs and lows—blood sugar and otherwise—but together you can help make diabetes a part of life, instead of life feeling like it’s all about diabetes.

Content source: National Center for Chronic Disease Prevention and Health PromotionDivision of Diabetes Translation

What you need to know about smoking and diabetes

The 2014 Surgeon General’s Report has found that smoking is a cause of type 2 diabetes, which is also known as adult-onset diabetes. Smokers have a greater risk of developing type 2 diabetes than do nonsmokers. The risk of developing diabetes increases with the number of cigarettes smoked per day.

How smoking causes type 2 diabetes

Smoking increases in inflammation in the body. Inflammation occurs when chemicals in cigarette smoke injure cells, causing swelling and interfering with proper cell function. Smoking also causes oxidative stress, a condition that occurs as chemicals from cigarette smoke combine with oxygen in the body. This causes damage to cells. Evidence strongly suggests that both in inflammation and oxidative stress may be related to an increased risk of diabetes.

The evidence also shows that smoking is associated with a higher risk of abdominal obesity, or belly fat. Abdominal obesity is a known risk factor for diabetes because it encourages the production of cortisol, a hormone that increases blood sugar. Smokers tend to have higher concentrations of cortisol than nonsmokers.

What smoking means to people with diabetes 

Studies have confirmed that when people with type 2 diabetes are exposed to high levels of nicotine, insulin (the hormone that lowers blood sugar levels) is less effective. People with diabetes who smoke need larger doses of insulin to control their blood sugar.

Smokers who have diabetes are more likely to have serious health problems, including:

  • heart and kidney disease;
    poor blood flow in the legs and feet that can lead to foot infections, ulcers, possible amputation of toes or feet;
  • possible amputation of toes or feet;
  • retinopathy (an eye disease that can cause blindness);
  • peripheral neuropathy (damaged nerves to the arms and legs that cause numbness, pain, weakness, and poor coordination).

Even though we don’t know exactly which smokers will develop type 2 diabetes, we do know that all diabetic smokers should quit smoking or use any type of tobacco product immediately. The health bene ts of quitting begin right away. People with diabetes who quit have better control of their blood sugar. Studies have shown that insulin can start to become more effective at lowering blood sugar levels eight weeks after a smoker quits.


How can I be physically active safely if I have diabetes?

 

Be sure to drink water before, during, and after exercise to stay well hydrated. The following are some other tips for safe physical activity when you have diabetes.

Plan ahead

Talk with your health care team before you start a new physical activity routine, especially if you have other health problems. Your health care team will tell you a target range for your blood glucose level and suggest how you can be active safely.

Your health care team also can help you decide the best time of day for you to do physical activity based on your daily schedule, meal plan, and diabetes medicines. If you take insulin, you need to balance the activity that you do with your insulin doses and meals so you don’t get low blood glucose.

Prevent low blood glucose

Because physical activity lowers your blood glucose, you should protect yourself against low blood glucose levels, also called hypoglycemia. You are most likely to have hypoglycemia if you take insulin or certain other diabetes medicines, such as a sulfonylurea. Hypoglycemia also can occur after a long intense workout or if you have skipped a meal before being active. Hypoglycemia can happen during or up to 24 hours after physical activity.

Planning is key to preventing hypoglycemia. For instance, if you take insulin, your health care provider might suggest you take less insulin or eat a small snack with carbohydrates before, during, or after physical activity, especially intense activity.5

You may need to check your blood glucose level before, during, and right after you are physically active.

Take care of your feet

People with diabetes may have problems with their feet because of poor blood flow and nerve damage that can result from high blood glucose levels. To help prevent foot problems, you should wear comfortable, supportive shoes and take care of your feet before, during, and after physical activity.

What physical activities should I do if I have diabetes?

Most kinds of physical activity can help you take care of your diabetes. Certain activities may be unsafe for some people, such as those with low vision or nerve damage to their feet. Ask your health care team what physical activities are safe for you. Many people choose walking with friends or family members for their activity.

Doing different types of physical activity each week will give you the most health benefits. Mixing it up also helps reduce boredom and lower your chance of getting hurt. Try these options for physical activity.

Add extra activity to your daily routine

If you have been inactive or you are trying a new activity, start slowly, with 5 to 10 minutes a day. Then add a little more time each week. Increase daily activity by spending less time in front of a TV or other screen. Try these simple ways to add physical activities in your life each day:

  • Walk around while you talk on the phone or during TV commercials.
  • Do chores, such as work in the garden, rake leaves, clean the house, or wash the car.
  • Park at the far end of the shopping center parking lot and walk to the store.
  • Take the stairs instead of the elevator.
  • Make your family outings active, such as a family bike ride or a walk in a park.

If you are sitting for a long time, such as working at a desk or watching TV, do some light activity for 3 minutes or more every half hour. Light activities include

  • leg lifts or extensions
  • overhead arm stretches
  • desk chair swivels
  • torso twists
  • side lunges
  • walking in place
Do aerobic exercise

Aerobic exercise is activity that makes your heart beat faster and makes you breathe harder. You should aim for doing aerobic exercise for 30 minutes a day most days of the week. You do not have to do all the activity at one time. You can split up these minutes into a few times throughout the day.

To get the most out of your activity, exercise at a moderate to vigorous level. Try

  • walking briskly or hiking
  • climbing stairs
  • swimming or a water-aerobics class
  • dancing
  • riding a bicycle or a stationary bicycle
  • taking an exercise class
  • playing basketball, tennis, or other sports

Talk with your health care team about how to warm up and cool down before and after you exercise.

Do strength training to build muscle

Strength training is a light or moderate physical activity that builds muscle and helps keep your bones healthy. Strength training is important for both men and women. When you have more muscle and less body fat, you’ll burn more calories. Burning more calories can help you lose and keep off extra weight.

You can do strength training with hand weights, elastic bands, or weight machines. Try to do strength training two to three times a week. Start with a light weight. Slowly increase the size of your weights as your muscles become stronger.

Do stretching exercises

Stretching exercises are light or moderate physical activity. When you stretch, you increase your flexibility, lower your stress, and help prevent sore muscles.

You can choose from many types of stretching exercises. Yoga is a type of stretching that focuses on your breathing and helps you relax. Even if you have problems moving or balancing, certain types of yoga can help. For instance, chair yoga has stretches you can do when sitting in a chair or holding onto a chair while standing. Your health care team can suggest whether yoga is right for you.

Source: NIDDK