Diabetes Insulin Dependent Home Care
- Take your diabetes medication as directed:
- Avoid alcohol.
- Stop smoking
- Avoid exposure to secondary smoke
- Follow your diabetes diet as directed.
- Diabetes puts you at risk for coronary artery disease and heart attack:
- Eat a healthy heart diet
- Limit your intake of fat to 30% of your total calories.
- 10% to 15% of your total calories should be in the form of monounsaturated fats, such as olive oil, canola oil and peanut oil.
- Low cholesterol diet.
- Low salt diet.
- Eat foods rich in omega-3 fats
- Increase dietary fiber
- If you have high blood pressure:
- Learn how to take your blood pressure.
- Check your blood pressure every day.
- Keep a log of your results.
- Don't skip doses of your blood pressure medication
- Check your blood sugar every day.
- Keep a log of your blood sugar results.
- Follow an exercise plan as directed by your doctor.
- Get regular dental checkups and practice good dental hygiene.
- Get regular eye and foot examinations.
- Inspect the skin of your feet and your nails every day, in order to look for injury.
- Lose weight if you are overweight:
- Take prescribed medications as directed.
- Patients with kidney impairment should be advised to avoid nonsteroidal anti-inflammatory medications, aspirin, and other medications that are metabolized by the kidney.
- Wear a Medic Alert bracelet at all times.
Example of Sliding Scale Insulin Dosing
|Glucose Reading||Regular Insulin Dosing|
|140 - 160||2 units, re-check glucose in 2 hrs|
|200 - 240||4 units, re-check glucose in 2 hrs|
|240 - 300||6 units, re-check glucose in 2 hrs|
|300 - 400||8 units, re-check glucose in 2 hrs|
|400 - 500||10 units, re-check glucose in 2 hrs|
|> 500||See doctor now!|
Check with your doctor for specific adjustments in sliding scale doses. Your sliding scale dose will vary with your weight, diet, level of activity, and sensitivity to insulin.
Diabetes Insulin Dependent Diabetes Diet
It is important that you adhere to a type 1 diabetes diet.
Your daily intake of calories should allow you to maintain a healthy weight. Total calorie requirements vary according to your weight, height and activity. Your doctor and dietitian will recommend a total daily calorie requirement that is right for you.
Carbohydrates should account for 55-60% of your total calories. Carbohydrates include sugars, starches, and fiber. Whole grains, fruits, vegetables and fiber, are better sources of carbohydrate than sugars. Dietary fiber has been shown to prevent constipation, reduce the risk of colon cancer, reduce cholesterol levels, and assist with blood sugar control. A healthy diet contains 20-35 grams of fiber per day.
Protein should account for 10-20% of your total calories. Those who have normal kidneys should consume about 50 to 60 grams of protein per day. Those who have kidney disease should consume no more than 45 grams of protein per day.
Fat should account for less than 30% of your total calories. Consume only unsaturated fats that are low in cholesterol. About 10% to 15% of your total calories should be in the form of monounsaturated fats, such as olive oil, canola oil and peanut oil. Cholesterol intake should be limited to less than 300 milligrams per day.
Consider replacing sugar with artificial sweeteners. Saccharin (Sweet-n-Low), aspartame (Equal), and sucralose (Splenda) are acceptable alternatives.
Sodium intake should not exceed 3,000 mg per day. Those who have high blood pressure, heart disease, kidney disease or liver disease should consume no more than 2,000 mg of sodium per day.
Vitamins and Minerals
Diabetes does not require vitamin or mineral supplements.
Alcohol should be limited to two drinks per day.
Diabetes Insulin Dependent Fiber
Type 1 diabetes places you at increased risk for heart disease and stroke. A diet that is higher in can lower cholesterol levels, lessening your risk for heart disease. If you also have high blood pressure, fiber may be even more practical. Some studies have shown that people with hypertension who increase fiber in the diet for at least 8 weeks can significantly lower their blood pressure. You must keep up with the high fiber diet or the positive effect on blood pressure will go away.
Dietary fiber (particularly soluble fiber) can slow the body's absorption of sugars and help people with diabetes manage their blood sugar levels.
High Fiber Diet
Dietary fiber is a plant material that humans cannot digest. Fiber increases the amount of stool in your intestine. The most well known fiber is bran.
Fiber comes in two forms, based on whether it will dissolve in water: soluble and insoluble fiber. Most experts believe that about 3/4 of fiber intake should be insoluble.
Common fiber supplements include Citrucel and Metamucil. Regular use of these high-fiber products is safe. They are also more effective when used regularly. Drink plenty of water when taking extra fiber.
Water Soluble Fiber
|Pectins, gums, & mucilages||fruits, vegetables, oats, bran, barley, legumes|
|Cellulose, hemicellulose||vegetables, wheat bran, & whole grains|
Fiber tends to bind water, which leads to softer stools and a more rapid passage of material through the intestines. This rapid transit may reduce the exposure of the bowel to toxic substances and improve overall bowel health. Fiber can also bind fats and cholesterol. As an added benefit, high fiber foods usually contain important vitamins and minerals.
Use of a High Fiber Diet
Most people in developed countries do not eat enough fiber. A healthy diet should include more than 25 grams of fiber each day, or 10-13 grams per 1,000 calories. Some experts believe that every extra gram of fiber eaten each day can lower the risk of heart disease by as much as five percent.
This diet is often recommended for preventing or treating the following:
- Breast cancer
- Colorectal cancer
- Crohn's disease
- May help control blood sugar levels
- Diverticulosis (check with your doctor about eating seeds and nuts as a source of fiber)
- High cholesterol (up to 25 percent improvement)
- Irritable bowel syndrome
- Ulcerative colitis
In general, fruits, vegetables and whole grains are high in fiber. Check food labels of prepared products to see if there are at least 3 grams of dietary fiber per serving. Look for the term 'whole grain' as a major part of the food.
Raw foods tend to have more fiber than cooked, canned or pureed items. Even chopping and peeling skins removes some fiber. Dried fruits are especially high in fiber. Beans, black-eyed peas, brans and oatmeal are very high in fiber.
Unprocessed wheat bran can be added to many home meals and most baked foods. Bran is the outer layer of the wheat grain, and is present in 'whole grain' foods. Adding 2-3 teaspoons of bran per serving is a great way to increase the fiber content of casseroles, meat loaf, and baked goods. Whole grain flour has 6 times the fiber of standard, bleached flour. Oat bran can be used in place of about 1/3 of regular flour when baking.
Try adding nuts or bran to dairy foods such as yogurt or cottage cheese, which normally have very little fiber. Avoid white bread and flour pasta.
Change your diet slowly and drink plenty of fluids to allow the fiber to do its work. Rapid changes in the diet can cause bloating, gas and diarrhea. A varied, high-fiber diet is much better than taking fiber supplements.
Example High-Fiber Diet
Breads and Grains
Eat at least 3, and as many as 10 servings each day of various whole grain foods. Any grain food should say 'whole grain' and contain at least 3 grams of fiber per serving.
- Brown rice
- Oatmeal or oat bran
- Rye bread
- Wheat germ
- Whole grain bagels
- Whole grain breads
- Whole grain muffins
- Whole grain or bran cereals
- Whole grain pita bread
- Whole wheat crackers
- Whole wheat pasta
Eat at least 3-4 servings each day. All fruits are good, and dried fruits are especially high in fiber.
Eat at least 3-5 servings per day, preferably raw and unpeeled
- Green beans
- Green pepper
- Potatoes with skin
- Snow peas
- Sweet potatoes
Meat has no fiber and contains various amounts of cholesterol and saturated fats. There are many high-fiber foods that can partially or completely replace meat in the diet. Using several servings of meat substitutes each day will greatly increase total fiber intake.
- Brazil nuts
- Garbanzo beans
- Kidney beans
- Lima beans
- Peanut butter
- Pinto beans
- Sesame seeds
- Soybeans, but not tofu
- Split peas
- Sunflower seeds
- Veggie burgers
- Bean dip
- Cookies made with oatmeal, whole wheat flour, fruit and nuts
- Tortilla corn chips (baked)
- Trail mix
- Whole wheat pretzels
Diabetes Insulin Dependent Self Monitoring
Self monitoring is important for those with type 1 diabetes.
Blood Testing for Glucose
- Monitor your blood glucose as directed by your doctor:
- Measure your blood sugar before meals and at bedtime every day and record the readings.
- Review your glucose readings to see if your level is too high or too low several days in a row at about the same time.
- Learn to use your glucose monitor correctly.
- Daily home glucose monitoring is essential.
- Try to keep your glucose level between 70-110 mg/dl before meals.
- Two hours after meals, your glucose level should be less than 140 mg/dl.
- Check your blood sugar before operating a motor vehicle.
- Raise your blood sugar level by eating, if it falls below 70 mg/dl.
- Carefully monitor your blood sugars when you are ill.
- Blood glucose increases when you are ill or have an infection.
Good times to measure your blood glucose:
- Before meals
- Before bedtime
- 1-2 hours after meals:
- Helps you to decide if you need to supplement with regular insulin (sliding scale)
- 2-3 A.M., at least one night per week:
- Helps detect nighttime low blood sugar
Additional reasons to measure your blood glucose:
- After you have lost or gained weight
- Before you drive a motor vehicle
- Before and after periods of heavy physical activity
- When you have had a change in your diet, insulin dose, or activity level
- When you are pregnant
- When you are ill or under stress
- When you suspect low blood sugar
- When you develop increased urination, excessive thirst, or blurry vision
- When you feel confused
Urine Testing for Ketones
- In the past, urine testing was very useful and important. With the availability of rapid blood sugar testing, urine testing is usually not necessary.
- The main reason to perform this test is to check for early ketoacidosis. Small or trace ketones may mean nothing or represent the beginning of ketoacidosis. If you find this result, then perform the ketone test again in several hours.
- Notify your physician immediately if you discover moderate to large ketones present in your urine.
Diabetes Insulin Dependent Taking Control
The successful treatment of type 1 diabetes requires your participation. Here are answers to some important questions.
Do you have control over your health and wellness?
Many people believe they have no control over their health and wellness. Many ignore personal health decisions or simply leave them to their doctors, relatives, or friends. In reality, you have the greatest potential to determine your relative health.
How is this possible? Do people really have control of their own health? The biggest killers are heart disease and cancer. Although many of these diseases seem to strike at random, our lifestyle choices greatly influence personal risk.
How can you participate in your health care?
To participate you must:
- Learn to take responsibility for your own health.
- Learn to partner with your doctor.
- Learn how to make active decisions about your health.
How can you learn what you need to know?
- Educate yourself.
- Be skeptical: Learn to separate fact from fiction.
- Billions of dollars are spent each year marketing dietary supplements, vitamins, and new medical treatments. Much of this is unnecessary and wasteful.
- Be careful about where you get your health information.
- Some of the best sources for health information on the web are professional societies and non-profit organizations.
- Ask your doctor what he or she recommends.
- Examine the credentials of the authors.
- If you are reading about symptoms and disease, your best source is a licensed physician.
- Pay attention to when the content was last updated.
- Make sure the person is not just trying to sell you something.
Important questions you need to answer:
- What things in your control can increase your risk for disease?
- What can you do to decrease this risk?
- What are vaccines and how can they help you?
- How do your lifestyle choices increase your risk for disease?
- How can you reduce stress?
- What minor health problems can you treat at home?
- When is a medical problem "serious"?
- When should you call the doctor?
How can you find the right doctor?
- Everyone should have a primary care physician or family doctor. A primary physician is usually a family practitioner, internist, or pediatrician.
- Establish a relationship in advance with your doctor.
- Make sure you are comfortable with your primary care physician.
- The internet contains many resources where you can do research to locate the doctor that is best for you.
- You may wish to schedule a brief visit with the doctor to see if he or she is right for you.
- Be open-minded, and allow your doctor to know you well. This will improve communication.
Important information you need to make your decision:
- Physician credentials:
- Internship and residency training is usually best from respected institutions, universities, and major hospitals.
- Look for board certification in the specialty.
- Ask about membership in medical societies.
- Community and professional reputation are also important.
- Are other patients happy with the doctor?
- Has the doctor been disciplined by hospitals or agencies?
- How long has the doctor been in practice?
- In general, more than a few malpractice suits over a 5-10 year period should trigger caution.
- Does the doctor communicate well? Are your questions answered during busy times?
- Does the doctor welcome you to help make decisions about your care?
- Is the doctor available when you need care?
- What is the doctor's after-hours coverage?
- Is he or she a member of a large group?
- Do the doctors' cross-cover one another?
- Where do they admit patients?
What is shared decision making?
You and your doctor must work together to jointly decide the best course of action to manage your health. This process is called "shared decision making". Your doctor becomes a guide and teacher and helps steer you toward the best treatment. Most doctors welcome this partnership. You must learn about your illnesses for shared decision-making to work.
For any recommended test, medication, or surgery, remember to ask:
- How will this help me?
- How much will it cost?
- Is it covered by your insurance?
- What are the potential side effects and risks?
- What are my alternatives?
For tests, remember to ask:
- Is it done in the office or at another facility?
- Is it painful?
- How will the results of this test influence my care?
For surgery or other procedures, remember to ask:
- How long will it take to heal?
- How many cases has the doctor done?
- What would your doctor do if he or she were the patient?
- Where is it done?
- Who will perform it?
- What are the doctor's qualifications?
What should you expect?
Shared decision making becomes impossible if you do not know what to expect from your doctor.
The American Hospital Association has published a "Patient's Bill of Rights" that is a good guide. It states that you have the right:
- To be spoken to in words that you understand
- To be told what's wrong with you
- To know the benefits of any treatment and any alternatives
- To know what a treatment or test will cost
- To share in treatment decisions
- To read your medical record
- To refuse any medical procedure
What should you do before an office visit?
- Bring all important medical information with you to the visit.
- Make sure you can answer questions about the following:
- Allergies and side effects to medicines
- Current medicines you are taking. This includes herbs and vitamins. Make a list if necessary.
- Insurance information
- Marital and sexual history
- Past injuries and hospital stays
- Past medical problems
- Past surgeries and operations
- Pre-visit questionnaires
- Use of tobacco, alcohol and drugs
- Work history
What should you expect from the visit?
- You should plan to wait if you go without an appointment. Emergencies or sick patients in the hospital may interrupt your doctor.
- Bring along a book or toys for the kids. You may also have to wait during busy times.
- Tell your doctor about your problem in a clear manner. Start from the beginning and go through each symptom as it appeared.
- Before the visit, think about what makes your problem better or worse. Your doctor will probably ask you questions about this.
- Most doctors ask many questions about unrelated symptoms. These questions help assure that there are no other problems that need attention.
- Be sure to answer all questions truthfully. This includes sensitive questions about smoking, drug use, sexual activity, and work. Your history is the most important part of deciding what is wrong with you.
- If you have any difficulty communicating your concerns, bring a family member or friend to assist in this task.
- Talk to your doctor and do not leave the office without asking necessary questions. Your doctor can make you more comfortable if he or she understands your concerns.
What should you know about your medications?
Every year many people become ill because of problems with medications.
Remember to ask:
- What side effects to expect.
- What drug interactions are possible.
- Find out if a new medicine reacts with those that you are taking now.
- Many over-the-counter drugs and dietary supplements can also cause serious side effects and drug interactions.
- Some drugs interact with certain foods, vitamins, nicotine, and alcohol.
- Make sure you can drive or operate machines safely while taking a medicine.
- Ask your doctor how much a prescription costs.
- Is there a less expensive option or a generic version?
What is a treatment plan?
A treatment plan is what you and your doctor decide to do for an illness. A treatment plan cannot be effective without your participation.
Three simple questions can help you get the most from your treatment plan:
- What is my main problem?
- What do I need to do?
- Why is it important for me to do these things?
Other important points:
- Be sure you understand your treatment plan.
- Stick with the treatment plan and allow time for improvement.
- Don't stop medicines when you feel better; check with your doctor first.
- Call your doctor if your condition is becoming worse.
- Your doctor should tell you what to expect and when to follow-up or call the office.
Diabetes Insulin Dependent Warning Signs
Notify your doctor if you have type 1 diabetes and any of the following:
- Constant hunger
- Excessive thirst
- Difficulty breathing
- Frequent urination
- Glucose and ketones are present in the urine
- Blood glucose measurement over 300 mg/dl
- Repeated blood glucose readings over 200 mg/dl
- Repeated blood glucose readings over 160 mg/dl during pregnancy
- Repeated vomiting
- Worsening abdominal pain
- Severe fatigue
- Fever over 101 degrees F (38.3 C)
- Sudden, unintentional weight loss
- Unintentional weight gain:
- Over 10 lbs
- Excessive sleepiness
Continue to Diabetes Insulin Dependent Prevention
- Davis RE, Morrissey M, Peters JR, Wittrup-Jensen K, Kennedy-Martin T, Currie CJ. Impact of hypoglycaemia on quality of life and productivity in type 1 and type 2 diabetes. Curr Med Res Opin. 2005 Sep;21(9):1477-83. 
- Larsson K, Elding-Larsson H, Cederwall E, Kockum K, Neiderud J, Sjoblad S, Lindberg B, Lernmark B, Cilio C, Ivarsson SA, Lernmark A. Genetic and perinatal factors as risk for childhood type 1 diabetes. Diabetes Metab Res Rev. 2004 Nov-Dec;20(6):429-37. 
- Mannucci E, Rotella F, Ricca V, Moretti S, Placidi GF, Rotella CM. Eating disorders in patients with type 1 diabetes: a meta-analysis. J Endocrinol Invest. 2005 May;28(5):417-9. 
- Schlosser M, Strebelow M, Rjasanowski I, Kerner W, Wassmuth R, Ziegler M. Prevalence of diabetes-associated autoantibodies in schoolchildren: the Karlsburg Type 1 Diabetes Risk Study. Ann N Y Acad Sci. 2004 Dec;1037:114-7. 
- Steck AK, Bugawan TL, Valdes AM, Emery LM, Blair A, Norris JM, Redondo MJ, Babu SR, Erlich HA, Eisenbarth GS, Rewers MJ. Association of non-HLA genes with type 1 diabetes autoimmunity. Diabetes. 2005 Aug;54(8):2482-6.