On the Road to Diabetes Health
On the Road to
Diabetes Health
An Information Book
for People with Type 1 or Type 2 Diabetes
May2016
www.fraserhealth.ca
book
StoreThis
# 392626
has been developed by certified diabetes educators in Fraser Health. Content has been
the Road
to Diabetes
Health Guidelines, 2016.
ciation
Clinical
Practice
updated to reflect the Canadian Diabetes AssoOn
1
Table of Contents
Table of Contents
Table of Contents.............................................................................. 0
Table of Contents..............................................................................0
Introduction
..................................................................................... 1
Introduction
.....................................................................................1
Your Diabetes
Health Care Team ........................................................ 1
Your
Diabetes
Health Care
Team ........................................................1
Emotions
and Feelings
.......................................................................
2
Emotions
and Feelings
.......................................................................2
What
is Diabetes?
.............................................................................
3
Type
of Diabetes
Do You Have? ................................................. 4
What is
Diabetes?
.............................................................................3
What
of ...................................................................................
Diabetes Do You Have? .................................................4
Blood Type
Glucose
5
BloodFacts
Glucose...................................................................................5
About Blood Glucose Levels ................................................ 5
Facts About
Glucose
Levels
................................................5
Target
BloodBlood
Glucose
and A1C
Levels...........................................
6
Target
Blood Glucose
A1C Levels...........................................6
Blood Glucose
Testingand
................................................................
7
Blood
Glucose (Low
Testing
................................................................7
Hypoglycemia
Blood
Glucose) ............................................. 8
Hyperglycemia(Low
(HighBlood
BloodGlucose)
Glucose).............................................8
.......................................... 10
Hypoglycemia
Hyperglycemia
(High Blood Glucose).......................................... 11
10
Healthy
Eating ................................................................................
Healthy
EatingGuidelines
................................................................................
General
................................................................... 11
General
Guidelines...................................................................
How
Does
Food Affect Blood Glucose ......................................... 11
12
How
DoesMeals
Food........................................................................
Affect Blood Glucose ......................................... 12
Planning
13
Planning
........................................................................
ManagingMeals
Carbohydrates
.......................................................... 13
14
Foods and Carbohydrates
Portions ..................................................................
Managing
.......................................................... 15
14
Foods Ideas
and Portions
..................................................................
Menu
for Diabetes
.......................................................... 15
16
Menu
Ideas
forIdeas
Diabetes
.......................................................... 16
Healthy
Snack
................................................................
17
Healthy
Snack
Managing
BloodIdeas
Fats ................................................................ 17
18
Managing
Blood
Fats................................................................
About Blood
Pressure
............................................................... 18
19
About
Blood
............................................................... 19
Reading
FoodPressure
Labels ................................................................
20
Tips for Eating
Away From Home .............................................. 20
21
Reading
Food Labels................................................................
Tips
From
Home .............................................. 21
Ideasfor
forEating
LosingAway
Weight
...........................................................
Ideas
for Losing
Weight ........................................................... 21
Physical
Activity
..............................................................................
22
Physical
..............................................................................
DiabetesActivity
Medication
........................................................................ 22
24
Diabetes
TypeMedication
2 Diabetes........................................................................
Medications..................................................... 24
Type
Diabetes Medications..................................................... 24
Insulin2....................................................................................
25
Diabetes
Identification ..................................................................... 25
Insulin....................................................................................
Diabetes
Identification ..................................................................... 25
Sick Day Management
26
Sick Day
.....................................................................
SickManagement
Day Management
for Type 1 Diabetes ................................. 26
Sick Day Management for Type 1
2 Diabetes ................................. 26
27
Sick
Day
for Type 2 Diabetes ................................. 27
Foods
forManagement
Sick Days .................................................................
Foods for.................................................................................
Sick Days ................................................................. 27
Complications
28
Caring For Your
Feet ....................................................................... 28
30
Complications
.................................................................................
Caring
Forand
Your
Feet ....................................................................... 30
Diabetes
Driving
31
Diabetes
and Driving
.......................................................................
31
Making LIfestyle
Change
................................................................. 32
MakingTips
LIfestyle
Change ................................................................. 33
32
Travel
.....................................................................................
Travel Tips
.....................................................................................
33
Staying
Healthy
Reminders............................................................... 34
Staying Healthy
Reminders...............................................................345
34
Conclusion
...................................................................................
Resources
36
Conclusion......................................................................................
................................................................................... 345
Resources
Books......................................................................................
..................................................................................... 36
Books.....................................................................................
Cookbooks
.............................................................................. 36
Cookbooks..............................................................................
36
Physical
Activity Resources ....................................................... 37
Physical Activity
Resources
.......................................................
Nutrition
Composition
Resources
............................................... 37
Nutrition Composition
Resources
............................................... 38
37
Organizations
and Websites
......................................................
Organizations
and Websites ...................................................... 39
38
References
.............................................................................
References ............................................................................. 39
Introduction
This book was written by Fraser Health Diabetes Educators. It provides information for
people with type 1 and type 2 diabetes, their family members and others involved in their
care. We know that taking care of diabetes involves the entire community.
This book will start you on the road to diabetes health. While the information applies to most
people, make sure that you discuss your individual needs with your doctor or diabetes health
care team.
Copies of this book are available from your Diabetes Education Centre and
on the Fraser Health website:
www.fraserhealth.ca/health-info/health-topics/diabetes
Note: This book is not intended for women with gestational (during pregnancy) diabetes.
If you have been told that you have gestational diabetes, please talk to your doctor.
Your Diabetes Health Care Team
You are the most important member of your diabetes health care team. Team members can
include your family doctor, diabetes nurse, dietitian and pharmacist as well as foot care
specialist, exercise specialist, psychologist, social worker and eye specialist.
Your Diabetes Education Program is shown below. Its purpose is to provide you with
education and current information to help you manage your diabetes and to provide support
for you to make lifestyle changes.
Your Diabetes Education Program:
HealthLink BC and the Canadian Diabetes Association are good resources for
reliable information about diabetes:
HealthLink BC: www.healthlinkbc.ca
Phone: 8-1-1 for non-emergency health information. Registered nurses,
dietitians and pharmacists are available
Canadian Diabetes Association: www.diabetes.ca
English/French Information Line: 1-800-BANTING (226-8464)
Mandarin/Cantonese Information Line: 604-732-8187 or toll free 1-888-666-8586
On the Road to Diabetes Health
1
Emotions and Feelings
I Have Diabetes?
Finding out that you have diabetes can come as a shock. It may cause a stress response. It
is important for you to know that if you do not take care of your diabetes, it may cause some
health problems in the future.
What Does It Mean?
It is natural to feel angry or be frightened. Improving your eating habits and being more
physically active will help improve your health, help your diabetes and prevent problems that
diabetes can cause.
Well Being and Stress
Our bodies are in a state of well being when our basic needs are taken care of and we are
emotionally relaxed. When we become overly excited or upset, the result is stress.
The body responds to stress by putting extra glucose (also called sugar) into the blood. This
may occur with a sudden fright, anger, an ongoing problem that is upsetting or an illness,
especially if serious. Learning ways to manage stress is important. Talk to your
diabetes health care team about tools that can help.
Depression
30% of people with diabetes have symptoms of depression. Depression makes it harder to
manage diabetes. Loss of energy can make it harder to eat healthy, exercise and test blood
glucose. Spotting depression is the first step. Getting help is the second.
General symptoms of depression
Loss of interest or pleasure in things you usually like to do
Feeling sad, down or hopeless
Loss of energy
A change in your sleep pattern
Change in appetite
Trouble concentrating
Nervousness and/or worry
If you have 2 or more of the symptoms listed or wonder whether you may have depression,
talk to your doctor or diabetes health care team about how you are feeling. Getting help
early can help you feel better and make it easier to take care of your health.
On the Road to Diabetes Health
2
What is Diabetes?
When you have diabetes, your body cannot use food properly. This results in your blood
What
is high.
Diabetes?
glucose (also called blood sugar)
going too
Diabetes can occur at any age.
When you have diabetes, your body cannot use food properly. This results in your blood
glucose
(also called
blood sugar)
going
too high. Diabetes can occur at any age.
Why does
blood
glucose
go too
high?
Whyeat,
does
blood
glucose
go too
high?
When you
your
body
breaks
down
many foods into glucose. The glucose enters your
blood and is carried to the millions of cells in your body. The glucose enters the cells with the
When you eat, your body breaks down many foods into glucose. The glucose enters your
help of blood
a hormone
produced
the pancreas.
This
hormone
is called
and is carried
to the in
millions
of cells in your
body.
The glucose
entersinsulin.
the cells with the
help of a hormone produced in the pancreas. This hormone is called insulin.
Glucose can then be used for energy or be stored for later use.
Glucose can then be used for energy or be stored for later use.
The glucose cannot enter the cells if:
1. your body does not make insulin or
The glucose cannot enter the cells if:
2. your body does not make enough insulin or
1) your body does not make insulin or
3. your insulin does not work properly (this is called insulin resistance).
2) your body does not make enough insulin or
When the glucose cannot enter the cells of the body, it begins to build up in the blood.
3) your insulin does not work properly (this is called insulin resistance).
Symptoms
diabetes
maythe
include:
When the
glucoseofcannot
enter
cells of the body, it begins to build up in the blood.
feeling tired
hunger even though eating well
increased thirst
nausea or feeling ill
Symptoms offrequent
diabetes
may include:
urination
skin, gum or urinary tract infections
slow
cuts,
and sores
• blurred
feelingvision
tired
• healing
hunger
even
though eating well
weight loss for no reason
tingling, burning or pains in feet
• increased thirst
• nausea or feeling ill
If you
these urination
symptoms and have not yet been
yougum
have or
diabetes,
youtract
needinfections
to see
• have
frequent
• told
skin,
urinary
your doctor to have a blood test done. This blood test will show if you have diabetes.
• blurred vision
• slow healing cuts, and sores
• weight loss for no reason
• tingling, burning, or pains in feet
On the Road to Diabetes Health
3
If you have these symptoms and have not yet been told you have diabetes, you need to
What Type of Diabetes
What Type of Diabetes Do You Have?
Do You Have?
The
three
common
type 1 The
diabetes,
type 2
diabetes
and
gestational
(during
There
aremost
many
types ofare
diabetes.
three most
common
are:
type
1 diabetes,
type 2 diabetes
pregnancy)
diabetes.
This
booklet
will
discuss
type
1
and
type
2
diabetes.
If
you
are 2not
sure
and gestational (during pregnancy) diabetes. This booklet will discuss type 1 and type
diabetes.
what
typeare
of diabetes
have,
diabetes
careyour
team.diabetes health care team.
If you
not sure you
what
typeask
of your
diabetes
you health
have, ask
Type 1 Diabetes
Type 1 Diabetes
You had symptoms when you found out you had diabetes
• You had symptoms when you found out you had diabetes.
Most often occurs in people younger than 30 years old
• Most often occurs in people younger than 30 years old.
Your body stops making insulin
• Your body stops making insulin.
You will need:
You will need:
injections of insulin
• a injections
of insulin.
healthy, balanced
diet
• regular
a healthy,
balanced
blood
glucose diet.
testing
• information
regular blood
andglucose
supporttesting.
• exercise
information and support.
•
exercise.
Type 2 Diabetes
Type 2 Diabetes
You may not have any symptoms
You may not have any symptoms.
Most often diagnosed in people 40 years of age or older
• Most often diagnosed in people 40 years of age or older.
More common in people who are overweight
• Your
Morebody
common
people
are overweight.
doesinnot
makewho
enough
insulin and/or the insulin does not work properly
• Your body does not make enough insulin and/or the insulin does not work properly.
You will need:
•
a healthy,
You will
need: balanced diet
exercise
• a healthy, balanced diet.
regular blood glucose testing
• exercise.
information and support
• regular blood glucose testing.
You may need:
• information and support.
to lose weight
You may need:
•
to lose weight.
•
diabetes medication (pills or insulin).
diabetes medication (pills or injections)
eating
As you
though,
your pancreas
will while
make with
less and
less insulin,
have and
typeexercise.
2 diabetes,
you get
mayolder
be able
to manage
for the first
healthy
If you
soand
you exercise.
will likelyAs
have
take
medication
such pancreas
as pills orwill
insulin
later
eating
youtoget
older
though, your
make
lesson.
and less insulin,
so you will likely have to take medication such as pills or insulin later on.
On the Road to Diabetes Health
On the Road to Diabetes Health
4
4
Blood Glucose
Facts About Blood Glucose Levels
Blood glucose levels go up and down throughout the day and night. Long periods of high
blood glucose can damage your body. It is important to keep your blood glucose as close to
target levels as possible.
Things that lower blood glucose:
regular balanced meals and snacks
exercise
reducing body fat
relaxation techniques
diabetes medications (pills or injections)
Things that raise blood glucose:
too much food or not having meals and snacks on
time
not enough exercise
weight gain above your healthy weight
emotional or physical stress and illness
not taking enough diabetes medication
some prescription and over the counter medication*
certain hormones which cause the liver to leak
glucose into the blood when it is not needed (“leaky” liver)
* It is best for you to use the same pharmacy all the time. Tell the pharmacist that you have
diabetes when you are filling any prescription or buying any over the counter medications.
Talk to the pharmacist first if you are buying cold medicine, vitamins, herbal products or any
product like these. Ask if the product is o.k. for someone with diabetes.
On the Road to Diabetes Health
5
Target
Target
Blood
Blood
Glucose
Glucose
Levels
Levels
The amount
The amount
of glucose
of glucose
(sugar)
(sugar)
in blood
in blood
is measured
is measured
in “millimoles
in “millimoles
per litre.”
per litre.”
The The
abbreviation
abbreviation
for this
foris this
mmol/L.
is mmol/L.
Keeping
Keeping
your blood
your blood
glucose
glucose
levels levels
withinwithin
the target
the target
range range
will will
keep you
keepfeeling
you feeling
well and
wellwill
and
reduce
will reduce
your risk
yourofrisk
developing
of developing
other other
healthhealth
problems
problems
that are
that are
relatedrelated
to diabetes.
to diabetes.
TheseThese
“diabetes
“diabetes
complications”
complications”
are discussed
are discussed
on page
on 28.
page 28.
The target
The target
blood blood
glucose
glucose
levels levels
listed listed
belowbelow
are forare
most
for adults
most adults
with type
with1type
or type
1 or2type 2
diabetes.
diabetes.
Talk toTalk
your
todiabetes
your diabetes
healthhealth
care team
care about
team about
the target
the target
that isthat
rightis for
right
you.
for you.
TargetTarget
BloodBlood
Glucose
Glucose
TargetTarget
BloodBlood
Glucose
Glucose
Fasting
Fasting
or Before
or Before
MealsMeals Two Hours
Two Hours
After Meals
After Meals
4.0 - 7.0
4.0mmol/L
- 7.0 mmol/L
5.0 - 10.0
5.0 -mmol/L
10.0 mmol/L
TargetTarget
A1C A1C
7% or 7%
lessor less
You may
Yoube
may
asked
be asked
to keep
to your
keepblood
your blood
glucose
glucose
2 hours
2 hours
after meals
after meals
between
between
5.0 and
5.08.0
and 8.0
mmol/L
mmol/L
when:when:
your A1C
your(explained
A1C (explained
below)below)
is above
is above
7% 7%
you are
you
not
are
atnot
riskatforrisk
lowforblood
low blood
glucose
glucose
Youexpect
can expect
your blood
glucose
rise
2.0 mmol/L,
- 3.0 mmol/L,
2 hours
after eating.
You can
your blood
glucose
to riseto2.0
- 3.0
2 hours
after eating.
Target
Target
A1C A1C
Levels
Levels
The chart
The above
chart above
showsshows
a target
a target
A1C level.
A1C level.
The A1C
Thelevel
A1C islevel
measured
is measured
by a blood
by a blood
test. Your
test. Your
A1C shows
A1C shows
you how
youclose
how to
close
target
to target
your blood
your blood
glucose
glucose
has been
has over
beenaover
3 month
a 3 month
period.period.
When When
your blood
your blood
glucose
glucose
is highisthere
high there
will bewill
more
be glucose
more glucose
coating
coating
your red
your
blood
red blood
cells and
cells and
your A1C
yourwill
A1C
gowill
up.go
People
up. People
who have
who an
have
A1C
anhigher
A1C higher
than 7%
thanare
7%
more
are likely
more to
likely
develop
to develop
healthhealth
problems
problems
causedcaused
by high
byblood
high blood
glucose.
glucose.
Your doctor
Your doctor
or diabetes
or diabetes
healthhealth
care team
care may
teamgive
mayyou
givea you
different
a different
target.target.
For some
For some
peoplepeople
a
a
targettarget
of 6.5%
of 6.5%
or lessorwill
less
bewill
recommended.
be recommended.
For others,
For others,
a target
a target
of higher
of higher
than 7.0
than
%7.0
is % is
best. You
best.can
Youkeep
can your
keepA1C
yourlevel
A1C inlevel
check
in check
by keeping
by keeping
your blood
your blood
glucose
glucose
levels levels
withinwithin
the the
targettarget
range.range.
A1C
(%)
5
6
7
8
9
10
11
12
13
14
A1C Average
Average
BloodBlood
(%) Glucose
Glucose
(mmol/L)
(mmol/L)
5
5.4 5.4
6
7.0 7.0
7
8.6 8.6
8
10.2 10.2
9
11.8 11.8
10
13.4 13.4
11
14.9 14.9
12
16.5 16.5
13
18.1 18.1
14
19.7 19.7
Your A1C
Yourtest
A1Cresult
test result
corresponds
corresponds
to your
to your
average
average
glucose
glucose
level before
level before
and after
and after
meals meals
over the
over
previous
the previous
3 months.
3 months.
On the Road
On the
toRoad
Diabetes
to Diabetes
Health Health
6
6
Blood Glucose Testing
Checking blood glucose levels can give you information about how food, exercise and
medication affect your blood glucose. This can help you see where changes are needed to
improve your blood glucose. Talk to your doctor or diabetes health care team about:
if you need to test
when you need to test
how often you need to test
Fair Pharmacare: based on your family’s annual income
the BC Ministry of Health may help pay for test strips.
You must:
register with Fair Pharmacare (call 604 683-7153 or̀
visit: www2.gov.bc.ca/gov/content/health/health-drug-coverage/pharmacare-for-bc-residents)
attend a Diabetes Education Centre to be “certified” and learn about blood glucose
testing
Getting started:
obtain a blood glucose meter from your pharmacy
have the pharmacist show you how to use your meter (you may need to make an
appointment)
purchase any supplies you need (test strips, lancets, disposal container)
blood glucose testing requires a drop of blood, usually from the side of your finger.
People taking insulin need to check their blood glucose every day. Those not taking insulin
may check less often. It can help to test more often when you are getting started to see why
your blood glucose goes up and down. Talk with your diabetes health care team about how
often to test.
You may be asked to test your blood glucose levels one time per day or just before and again
2 hours after a meal. This may be for one, two or three meals each day. What foods make
your glucose level go up or down? What time of day is your glucose level higher or lower?
Enter the blood glucose test results in the log book provided with your meter. Bring the log
book to your visit with your diabetes health care team.
This example shows a log book for someone who tests before and after one meal each day.
Making notes helps you learn what foods or situations affect your blood glucose level.
Date
May 10
May 11
Breakfast
Lunch
Before
2 hr after
Before
6.9
14.7*
Comments
Supper
2 hr after
Before
2 hr after
*juice
3.5*
7.8
May 12
*running
5.4
On the Road to Diabetes Health
8.4
7
Hypoglycemia (Low Blood Glucose)
What is hypoglycemia?
Hypoglycemia is when your blood glucose drops below 4 mmol/L.
Who is at risk for hypoglycemia?
People who take insulin or some types of type 2 diabetes medications (see page 24). Check
with your diabetes health care team to see if you need to be concerned about hypoglycemia.
What are the symptoms of hypoglycemia?
Hypoglycemia can happen quickly and there may be warning symptoms.
Why does hypoglycemia happen?
not enough food or a late meal
unusual increase in exercise
too much insulin or too many diabetes pills
alcohol without food
diarrhea or vomiting
Let your doctor know if low blood glucose occurs often,
such as 3 times or more per week.
Alcohol may cause hypoglycemia for up to 24 hours after drinking. Always
eat a meal or a snack if you are drinking alcohol. Discuss the effects of
alcohol with your diabetes health care team.
It is very important to treat hypoglycemia quickly!
Carry fast acting carbohydrate and wear diabetes identification!
On the Road to Diabetes Health
8
Treatment of Hypoglycemia
Use the 'Take 15 - Wait 15' rule to treat hypoglycemia.
Call 911, if you are confused or cannot follow the instructions listed here.
1. Test your blood glucose.
2. If your blood glucose level is less than 4.0 mmol/L or you have symptoms of
hypoglycemia and cannot test, you need to take one of the following 15 grams of fast
acting carbohydrate:
15 g of glucose
3-5 tablets
(check label)
Best Choice
¾ cup
(175 mL)
of juice or
regular
soft drink
3 teaspoons
(15 mL) or
3 packets of
sugar
1 tablespoon
(15 mL) of
honey
6 Life
Savers®
Note: if you take acarbose (Glucobay®) you must use glucose tablets. If not available then
use honey or 1½ cups (375 mL) milk.
3. Wait 15 minutes
4. Test your blood glucose again.
5. If blood glucose is still less than 4.0 mmol/L, take another 15 grams of fast acting
carbohydrate. Wait 15 minutes and test your blood again.
6. If your blood glucose is still less than 4.0 mmol/L on the third test, call 911 or have
someone take you to the nearest emergency department.
DO NOT DRIVE IF YOUR BLOOD GLUCOSE LEVEL IS LESS THAN 5.0 mmol/L!
7. If your blood glucose level goes back up into your target range, eat your meal. If your
meal is longer than 1 hour away, eat a snack that contains 15 grams of carbohydrate and
protein such as one of the following:
¾ cup (175 mL)
yogurt
1 cup (250 mL)
milk
½ peanut butter
sandwich
On the Road to Diabetes Health
6 soda crackers
and cheese
9
Severe Hypoglycemia
Blood glucose less than 2.8 mmol/L
Can occur in any person taking insulin but more common if you have type 1 diabetes
20 g carbohydrate is needed to treat severe hypoglycemia (for example, take 5
Dex4® glucose tablets instead of 4)
If you have type 1 diabetes you need to talk to your doctor or diabetes health care team
about:
your risk for severe hypoglycemia
how this can affect you
how to prevent it
having glucagon available for emergencies
Hyperglycemia (High Blood Glucose)
If your blood glucose level is above your target range, this is called hyperglycemia.
Hyperglycemia can be caused by illness, infection, eating too much, lack of exercise, stress,
or not enough type 2 diabetes medication or insulin.
You may feel:
hungry
extreme thirst
You may have:
frequent urination
blurred vision
fatigue
weak
If you have symptoms, check your blood glucose level within an hour or 2, and make sure to
check it before every meal for the next 2 days. Some people who have hyperglycemia
have no symptoms at all. You may only know you have hyperglycemia from your blood
glucose testing. The occasional high reading is not a concern. If your blood glucose is above
the target level once, then drops to within your target level the next time you check it, don’t
be concerned.
If your blood glucose is high (greater than 14 mmol/L for type 1 diabetes and greater than
20 mmol/L for type 2 diabetes) for longer than 8 hours follow the instructions listed in the
section: Sick Day Management (see page 26).
When your blood glucose is above your target range for more than a week, even if you are
not sick, you need to contact your doctor or diabetes health care team to work on ways to
lower your blood glucose.
On the Road to Diabetes Health
10
Healthy Eating
Healthy eating is an important part of taking care of diabetes. With planning and help from
the dietitian at your Diabetes Education Centre, you can learn how to enjoy your favourite
foods and keep your blood glucose levels within the target range. Making healthy food
choices will help your family too! Plan to attend Diabetes Education Classes for more
information on the many topics introduced in this section.
General Guidelines
These tips will help you keep your blood glucose within the target range, manage your
cholesterol, reduce your risk of heart attack and stroke and stay at a healthy weight.
Always eat 3 meals each day.
Eat your first meal of the day within 1 to 2 hours of waking up.
Eat your meals every 4 to 6 hours.
If your meals are more than 4 - 6 hours apart, have a healthy snack.
An evening snack may be recommended. Check with your diabetes
health care team.
Good food and drink choices:
Choose high fibre foods like 100% whole grain breads and cereals,
barley, brown rice, whole wheat pasta, fresh fruit, vegetables, beans and
lentils, oat bran and wheat bran
Choose lower fat sources of protein like lean meats, chicken, fish, low
fat cheese and tofu
Drink lower fat milk and soy beverages
Drink plenty of water
Eat less of the following foods and drinks:
sweet foods including sugar, honey, jam, regular pop, juice, candy,
chocolate bars, pie, cookies and cakes. They raise your blood glucose.
high fat foods including fried food, butter and margarine, especially those
high in saturated fats or containing trans fats. They can cause weight gain
and increase risk for heart disease.
alcohol is high in calories and may contribute to weight gain. Limit alcohol use to no
more than one to two drinks per day. One drink is 150mL (5 oz) wine, 45mL (1.5 oz)
hard liquor or 360mL (12 oz) of beer. Avoid drinking alcohol on an empty stomach.
Sugar substitutes that do not raise blood glucose can be used in moderation (acesulfame
potassium, aspartame, cyclamate, neotame, saccharin, sucralose, stevia, tagatose, thaumatin
and sugar alcohols such as erythritol, isomalt, lactitol, maltitol, mannitol, sorbitol and xylitol).
On the Road to Diabetes Health
11
On the Road to Diabetes Health
12
Planning Meals
Planning your meals ahead of time will help to make sure that you have the foods you need
for healthy eating. There are two meal planning methods that will make it easier for you to
get the right amount of different kinds of foods. These two methods are the “Plate Method”
and the “Handy Portion Method.” You can use either of these methods for any meal.
The Plate Method
Examples:
Vegetables (1/2 of your plate) – green beans, broccoli, carrots, spinach, zucchini
Grains & Starch (1/4 of your plate) – whole grain bread, whole wheat pasta, barley,
corn, brown rice, cereal and roti. Note: starchy vegetables like potatoes, yams and
sweet potato count as starch not as vegetables).
Meat & Alternatives (1/4 of your plate) – lean beef, pork, chicken or other meat, fish,
beans, lentils, eggs, peanut butter, unsalted nuts, lower fat (light) cheese and tofu.
Fresh fruit (1 medium) – apple, pear, orange
Milk & Alternatives (250 mL/1 cup) – skim or 1% milk, fortified soy beverage or yogurt
The Handy Portion Method
This is called the “handy portion method” because you use your hands to measure the
amount of each type of food for your meal. The guide below shows you how to do this.
FRUIT/GRAINS
& STARCHES
Choose an amount
the size of your fist
for each of Fruit and
Grains & Starches.
VEGETABLES
Choose as much as
you can hold in both
hands.
MEAT &
ALTERNATIVES
Choose an amount
up to the size of the
palm of your hand and
the thickness of your
little finger.
FATS
Limit fat to an
amount the
size of the tip
of your
thumb.
MILK & ALTERNATIVES: Drink up to 250 mL (250 mL) of low-fat milk with a meal
Source: Canadian Diabetes Association, reprinted with permission, www.diabetes.ca
On the Road to Diabetes Health
13
Managing Carbohydrates
Keeping track of carbohydratesManaging
is important.Carbohydrates
Foods containing carbohydrates turn into
glucose and raise your blood glucose levels. You do need to eat foods containing
carbohydrates
to carbohydrates
give you energy,
but it is important
that you eat
the right type
Keeping
track of
is important.
Foods containing
carbohydrates
turnand
intoamount
at each meal
to help
keep
your
blood levels.
glucoseYou
within
your target
glucose
and raise
your
blood
glucose
do need
to eat range.
foods containing
carbohydrates to give you energy, but it is important that you eat the right type and amount
at each meal
to helpofkeep
your blood glucose within your target range.
Keeping
Track
Carbohydrates
Keeping
Track
of Carbohydrates
1. Know your
carbohydrate
foods
Carbohydrates are found in grains and starches, fruits, milk, yogurt and sugary foods. See
1.
Know
your
pages
12 and
15carbohydrate
for examples. foods
Carbohydrates are found in grains and starches, fruits, milk, yogurt and sugary foods. See
pages
12 and 15
for examples.
2. Glycemic
index
or GI ranks foods containing carbohydrate by how much they raise
blood glucose levels. Foods with a high GI raise blood glucose quickly. Foods with a low GI
raise
blood glucose
Lowerfoods
GI foods
can help
you managebyblood
cholesterol
2. Glycemic
indexslowly.
or GI ranks
containing
carbohydrate
how glucose,
much they
raise
and
bloodweight.
glucose levels. Foods with a high GI raise blood glucose quickly. Foods with a low GI
raise blood glucose slowly. Lower GI foods can help you manage blood glucose, cholesterol
and
Lookweight.
for these lower GI carbohydrate foods:
Breads – sprouted grain, whole grain, pumpernickel/whole meal rye
Cereals
steelGIcut
oats, quick foods:
oats, oat bran, high fibre cold cereals (e.g. All Bran®,
Look for
these –lower
carbohydrate
Bran Buds
with Psyllium®)
Breads
– sprouted
grain, whole grain, pumpernickel/whole meal rye
Grains ––barley,
wildoats,
rice,quick
brown/white
rice,fibre
parboiled
Cereals
steel cut
oats, oatbasmati
bran, high
cold cereals (e.g. All Bran®,
rice, bulgur,
quinoa,
buckwheat, pasta
Bran
Buds with
Psyllium®)
Starchy–Vegetables:
potatoes, yams,
corn,rice,
newparboiled
potato
Grains
barley, wild sweet
rice, brown/white
basmati
Fruitsbulgur,
– apples,
grapefruit,
oranges,
pears, berries, stone fruits
rice,
quinoa,
buckwheat,
pasta
(apricots,
peaches, plums)
Starchy
Vegetables:
sweet potatoes, yams, corn, new potato
Other – apples,
milk, yogurt,
legumes
(chickpeas,
Fruits
grapefruit,
oranges,
pears,kidney
berries,beans,
stone lentils)
fruits
(apricots, peaches, plums)
3. Learn
to –count
carbohydrates
Other
milk, yogurt,
legumes (chickpeas, kidney beans, lentils)
A.
Plate Method
Handy Portion Method (see page 13)
3. Learn
to countorcarbohydrates
A simple way to track carbohydrates is to keep the portion size of Grains & Starch to 1/4 of
A. Plate
or of
Handy
Portion
(see the
pagesize
13)of your fist. Then add milk (250
your
plateMethod
or the size
your fist,
plus 1Method
fruit serving
mL
or 1 cup)
your meal. Ifisthis
method
keeping
your
blood glucose
A simple
way to
to balance
track carbohydrates
to keep
the isportion
size
of Grains
& Starchwithin
to 1/4target
of
levels,
you or
can
keep
it. If
not,
using
theserving
Carbohydrate
or add
counting
your plate
the
sizeusing
of your
fist,
plus
1 fruit
the sizeChoices
of your method
fist. Then
milk (250
grams
carbohydrate
better
formethod
you. is keeping your blood glucose within target
mL or 1ofcup)
to balancemay
yourwork
meal.
If this
levels, you can keep using it. If not, using the Carbohydrate Choices method or counting
grams
of carbohydrate
may work
B.
Carbohydrate
Choices
and better
Gramsfor
ofyou.
Carbohydrate
Using “Carbohydrate Choices” is another way to count carbohydrates. Carbohydrate Choices
B. Carbohydrate
and15
Grams
are
portions of foodChoices
that contain
gramsofofCarbohydrate
carbohydrate. The amount of carbohydrate
listed
grams for a food
item is
can
also beway
found
on thecarbohydrates.
Nutrition FactsCarbohydrate
table found on
Using in
“Carbohydrate
Choices”
another
to count
Choices
packaged
foods,
in resource
books,
fact sheets and
internet
Page 15 lists
are portions
of food
that contain
15 restaurant
grams of carbohydrate.
The
amountsites.
of carbohydrate
common
foods for
equal
to 15item
grams
carbohydrate.
20 showsFacts
you how
counton
listed in grams
a food
canof
also
be found onPage
the Nutrition
tabletofound
carbohydrate
on food
labels using
Nutritionfact
Facts
table.and internet sites. Page 15 lists
packaged foods,
in resource
books,the
restaurant
sheets
common foods equal to 15 grams of carbohydrate. Page 20 shows you how to count
carbohydrate on food labels using the Nutrition Facts table.
On the Road to Diabetes Health
14
On the Road to Diabetes Health
14
Foods and Portions
Equal to One Carbohydrate Choice or About 15 Grams of Carbohydrate
Grains & Starches
Fruit
1 slice bread
3/4 cup (175 mL) cooked cereal
1 medium apple, orange or pear
1/2 banana
1/2 - 3/4 cup (125mL-175 mL) cold cereal
1 cup (250 ml) melon or fresh fruit
1/2 cup (125mL) corn
1/2 cup (125 mL) pasta, barley, couscous,
quinoa or buckwheat (cooked)
1 cup (250 mL) blueberries
2 cups (500 mL) blackberries, raspberries,
or strawberries
1/2 cup (125 mL) potato or yam
15 small cherries or grapes
1/3 cup (75 mL) rice or millet
1/2 English muffin
1/2 cup (125 mL) cooked or canned fruit
1/2 medium mango or pomegranate
1/4 bagel
1/2 hamburger bun
3 small guava or 2 small kiwi fruit
3 prunes or apricots
1/2 medium pita or tortilla
1 small roti (6 in/15 cm)
2 Tbsp (15 mL) raisins or dried cranberries
1/2 cup (125mL) unsweetened fruit juice
Milk & Alternatives
(lower fat choices recommended)
Other Choices
(sweet foods & snacks)
1 cup (250mL) milk
1 cup (250 mL) yogurt, no sugar added
3 cups (750mL) popcorn (popped)
1/2 small muffin or 2 plain cookies
1 cup sweetened, fortified soy beverage
(carbohydrate varies, check label)
1/2 cup (125 mL) ice cream, frozen or
sweetened yogurt or chocolate milk
1 cup 250mL (raita) or unsweetened lassi
1/2 cup (125mL) pop
Note: unsweetened soy beverage, cottage
cheese and plain Greek yogurt are low in
carbohydrate
3 tsp (15mL) sugar, honey, jam, molasses
or syrup
Most people need:
3 to 4 Carbohydrate Choices or 45 to 60 grams of carbohydrates per meal.
1 to 2 Carbohydrate Choices or 15 to 30 grams of carbohydrates per snack
(but remember snacks are not necessary for everyone).
Legumes (dried beans, lentils and peas) are a good source of protein and have less effect on
blood glucose than other foods containing carbohydrate. They can be counted as
1/2 cup (125 mL) cooked = 15 grams of carbohydrate
Most vegetables are low in carbohydrate. If eaten in larger amounts, beets, parsnips, peas
and winter squash can be counted as
1 cup (250mL) = 15 grams carbohydrate
On the Road to Diabetes Health
15
Menu Ideas for Diabetes
Menu Ideas for Diabetes
Small Appetites
Small Appetites
45 grams carbohydrate per meal
45 grams carbohydrate per meal
(1200 calories)
(1200 calories)
Breakfast
Breakfast
1 orange
1 orange
1 slice whole grain toast or
1 slice whole grain toast or
¾ cup (175 mL) cooked oatmeal
¾ cup (175 mL) cooked oatmeal
1 tbsp (30 mL) peanut butter, nuts or 1 egg
1 tbsp (30 mL) peanut butter, nuts or 1 egg
1 cup (250 mL) skim or 1% milk
1 cup (250 mL) skim or 1% milk
Lunch
Lunch
2 slices whole grain bread
2 slices whole grain bread
2 slices (60 g/2 oz) meat
2 slices (60 g/2 oz) meat
1 tsp (5 mL) soft margarine or mayonnaise
1 tsp (5 mL) soft margarine or mayonnaise
tomato and lettuce
tomato and lettuce
salad with low fat dressing
salad with low fat dressing
1 apple
1 apple
Supper
Supper
3 oz (90 g) chicken or fish
3 oz (90 g) chicken or fish
½ potato with light sour cream
½ potato with light sour cream
1 tsp (5 mL) soft margarine or oil
1 tsp (5 mL) soft margarine or oil
½ cup (125 mL) carrots
½ cup (125 mL) carrots
broccoli
broccoli
1 cup (250 mL) mixed fresh fruit
1 cup (250 mL) mixed fresh fruit
1 cup (250 mL) low fat milk or yogurt (no
1 cup (250 mL) low fat milk or yogurt (no
added sugar)
added sugar)
Bigger Appetites
Bigger Appetites
60 grams carbohydrate per meal
60 grams carbohydrate per meal
(1500 calories)
(1500 calories)
Breakfast
Breakfast
1 orange
1 orange
2 slices whole grain toast or
2 slices whole grain toast or
1½ cups (375 mL) cooked oatmeal
1½ cups (375 mL) cooked oatmeal
2 tbsp (30 mL) peanut butter, nuts or 1 egg
2 tbsp (30 mL) peanut butter, nuts or 1 egg
1 cup (250 mL) skim or 1% milk
1 cup (250 mL) skim or 1% milk
Lunch
Lunch
2 slices whole grain bread
2 slices whole grain bread
2 slices (60 g/2 oz) meat
2 slices (60 g/2 oz) meat
2 tsp (10 mL) soft margarine or mayonnaise
2 tsp (10 mL) soft margarine or mayonnaise
tomato and lettuce
tomato and lettuce
salad with low fat dressing
salad with low fat dressing
1 banana
1 banana
Supper
Supper
5 oz (150 g) chicken or fish
5 oz (150 g) chicken or fish
1 potato with light sour cream
1 potato with light sour cream
1 tsp (5 mL) soft margarine or oil
1 tsp (5 mL) soft margarine or oil
½ cup (125 mL) carrots
½ cup (125 mL) carrots
broccoli
broccoli
1 cup (250 mL) mixed fresh fruit
1 cup (250 mL) mixed fresh fruit
1 cup (250 mL) low fat milk or yogurt (no
1 cup (250 mL) low fat milk or yogurt (no
added sugar)
added sugar)
Notes:
Notes:
Coffee, tea, water or other sugar-free beverages may be taken throughout the day.
Coffee, tea, water or other sugar-free beverages may be taken throughout the day.
Beans, lentils, soy products or paneer can be substituted for meat, chicken and fish.
Beans, lentils, soy products or paneer can be substituted for meat, chicken and fish.
To meet your calcium needs, make sure you have 2-3 servings per day of Milk and
To meet your calcium needs, make sure you have 2-3 servings per day of Milk and
Alternatives.
Alternatives.
Eating Well With Canada’s Food Guide (available online or from your diabetes health
Eating Well With Canada’s Food Guide (available online or from your diabetes health
care team) is helpful in learning about different food groups and alternatives.
care team) is helpful in learning about different food groups and alternatives.
Remember to eat a meal every 4 to 6 hours during the day. If your meals are spaced
Remember to eat a meal every 4 to 6 hours during the day. If your meals are spaced
more than 4 to 6 hours apart, have a healthy snack between meals. (See page 17 for
more than 4 to 6 hours apart, have a healthy snack between meals. (See page 17 for
ideas.)
ideas.)
On the Road to Diabetes Health
On the Road to Diabetes Health
16
16
Healthy Snack Ideas
If you need to snack it is often recommended to have 15 grams of carbohydrate. Some snack
ideas that contain about 15 grams of carbohydrate are listed below.
1 fist sized fresh fruit or 1 cup (250 mL) of cut-up fruit or berries
½ cup (125 mL) unsweetened, cooked or canned fruit
7 small (e.g. soda), 4 medium (e.g. melba toast) or 2 large (e.g. rye crisp) with lower
fat cheese (20% milk fat or less), peanut butter or hummus
1 cup (250 mL) skim or 1% milk or low fat yogurt (no sugar added)
½ cup (125 mL) high fibre cereal with ½ cup (125 mL) skim or 1% milk
1 small homemade muffin (made with less sugar and a healthy oil)
3 cups (750 mL) of hot air popped popcorn or light microwave popcorn
½ sandwich or 1 slice of whole grain bread or toast with nut butter
1 cup (250 mL) hot chocolate (no sugar added)
½ cup (125 mL) cottage cheese/plain Greek yogurt and ½ cup (125 mL) fruit
2-3 plain cookies or ½ cup (125 mL) regular pudding, yogurt or ice cream (less often)
Unsalted nuts and seeds also make a healthy snack but keep in mind they are high in
calories. Limit your serving to ¼ cup (50 mL) per day if trying to lose weight.
Feel free to add foods that contain low amounts of carbohydrate and calories to your snacks.
These include:
raw vegetables
water, clear broth, coffee, and tea and beverages with less than 5 grams of
carbohydrate (e.g. Crystal Light®), Jell-O® with no added sugar
On the Road to Diabetes Health
17
Managing Blood Fats
The kinds of fats that you eat and the kinds of fats found in your blood are related but
different. When we talk about “blood fats,” we’re talking about low-density lipoprotein
cholesterol (LDL-cholesterol), high-density lipoprotein (HDL-cholesterol) and triglycerides.
Diabetes is a major risk factor for heart disease and stroke. To stay healthy, you need lower
levels of LDL-cholesterol and triglycerides in your blood and higher levels of HDL-cholesterol.
Eat more fibre and choose the right kind of fats to improve blood fats. See Blood Fats on
page 28 and blood lipid targets listed on page 34.
Fat
Eat less saturated fats such as high fat dairy products (butter, cream, whole milk,
cream cheese, sour cream and ice cream), meat fat, lard, palm oil and coconut oil.
Choose small portions of lean meat; low fat milk and yogurt; and cheese with less
than 20% milk fat (M.F.).
Avoid trans fats found in hard or hydrogenated margarine or shortening and many
deep fried foods and baked goods.
Choose unsaturated fats such as liquid vegetable oils, nuts, seeds, nut butter,
avocados and fish. Examples of oils are olive oil, canola oil, peanut oil, soybean oil and
sunflower seed oil. Salad dressings usually contain unsaturated fats.
Limit foods high in cholesterol such as organ meats (like liver or kidneys), shrimp,
squid and egg yolks (up to 3 per week is o.k.).
Prepare foods with little or no added fat. Healthier cooking methods use lower
temperatures and liquid for cooking; for example, stew, steam, poach, microwave,
and pressure cook.
Limit the amount of added fats to between 3 and 6 teaspoons (and ¼ cup of nuts) per
day, if you are trying to lose weight.
Fibre
Try to eat at least 25 grams of fibre each day. Small changes can help you increase fibre.
Low Fibre Meal (grams of fibre)
High Fibre Meal (grams of fibre)
2 slices white bread (1g)
2 slices turkey (0g)
Tomato and lettuce (1g)
2 cookies (1g)
2 slices sprouted grain bread (10 g)
2 slices turkey (0g)
Tomato and lettuce (1g)
1 apple (4g)
Total Fibre = 3 g
Total Fibre = 15 g
On the Road to Diabetes Health
18
Fats:
To do this...
•
1 teaspoon of fat = 5 grams of fat.
•
TotalThings
suggested
fat intake
for most
people is about
50 Blood
– 60 grams
per day.
You
Can Do
To Improve
Your
Fats
•
Total saturated fat intake should be no more than about 12 grams per day.
do this...
• Try to eat very little
trans
and avoiding
fat fats;
altogether
is best.
Lower LDL-cholesterol
Eat
lessfat,saturated
andtrans
trans
choose
unsaturated fats
• There are differentinstead
kinds of fat. Consuming more “healthy” fat (usually coming from
Eat less foods containing cholesterol
ing to your weightEat
loss more
goals. fibre
(See page 18 for more about healthy fats.)
Be more physically active every day
• Talk to your dietitian
to learn amore
aboutweight
the amount of fat you should eat.
Maintain
healthy
Increase HDL-cholesterol
Avoid trans fats; choose unsaturated fats instead
(this will lowerSodium:
your total
Be more physically active every day
cholesterol/HDL-cholesterol
Maintain a healthy weight
• “Salt,” “Sodium,” and
“Sodium
Chloride” are all the same thing.
ratio)
Stop
smoking
Lower Triglycerides
Reduce or avoid alcohol use
• 1 teaspoon of salt = 2,300 milligrams (mg).
Eat less sugars and sweets
Eatthan
2 or2,300
more
• Limit salt to no more
mgservings
per day. per week of salmon, sardines,
mackerel, herring and trout
• Too much salt canBe
raise
your physically
blood pressure
to anevery
unhealthy
more
active
day level.
Maintain a healthy weight
Be sure to check condiments like ketchup, HP sauce, and mayonnaise, for sodium
content!
About Blood Pressure
About Blood Pressure
Keeping your blood pressure in a healthy range is also important. People with diabetes often
Keeping your blood pressure in a healthy range is also important. Diabetes and high blood
have high blood
pressure.
Lifestyle
canLifestyle
help keep
your
blood
pressure
down in
pressure
are often
found inchanges
the samethat
people.
changes
that
can help
keep your
the healthy range
blood include:
pressure down in the healthy range include:
daily physical activity
• daily physical activity
reducing
body fat
•
reducing
sodium body fat
• reducing
limiting• alcohol
reducing salt
limiting alcohol
quitting• smoking
•
managingquitting
stresssmoking
• managing stress
following the DASH diet. This eating plan encourages
more fibre
and 28
less
saturated fat and
See page
for fat,
moreespecially
information.
cholesterol. It includes lots of vegetables and fruit,
whole grains and low fat dairy products. It is moderate in meat, fish and poultry and
On the Road to Diabetes Health
17
includes nuts, seeds, beans and lentils several
times per week.
Sodium:
“salt,” “sea salt”, “sodium” and “sodium chloride” are all the same thing
1 teaspoon of salt = 2,300 milligrams (mg) sodium
limit sodium to less than 2,300 mg per day
if you have high blood pressure try to reduce to 1500 mg or less per day
too much salt can raise your blood pressure
Be sure to check condiments like ketchup, HP sauce and mayonnaise for sodium content!
On the Road to Diabetes Health
19
Reading Food Labels
Food labels, including the Ingredients list and Nutrition Facts table found on packaged foods,
can help you keep track of the amount of carbohydrate you are eating and make heart healthy
choices. Some key points are listed below.
The Ingredients list is found on most food packages. Ingredients are listed in order from
highest amount to least amount. For example, if the Ingredients list reads, “Sugar, flour, spices,”
this means there is more sugar than flour and more flour than spices.
The Ingredients list can help you make heart healthy choices. Look for foods that
contain whole grains and healthy (unsaturated) fats.
The Nutrition Facts table is found on most foods. The
table lists the amount of carbohydrate, fat and sodium,
among other things, found in a specific amount of the
food. This amount is called the “Serving Size.” When you
are planning food choices based on the Nutrition Facts table,
be sure to make note of the serving size you plan to eat.
Carbohydrates:
The table will list “Total Carbohydrates” first, then Fibre,
Sugars and maybe Starches, underneath. While fibre is a
carbohydrate, eating fibre does not raise blood glucose, so
you do not have to count it. Since fibre is already included in
the Total Carbohydrate number, you can subtract the amount
of fibre from the total carbohydrate number. The result is the
number you would count for 1 serving size.
Example: The Nutrition Facts table shows that there are 13
grams of Total Carbohydrate and 2 grams of Fibre in 4
crackers. 13 – 2 = 11, so count 11 grams of carbohydrate for
4 crackers.
Fats:
You will find information about the type and amount of fat on the Nutrition Facts Table. Look for
foods with smaller amounts of saturated fat and 0 grams of trans fat. You can see how much
total fat is in your serving and how much of that is saturated and trans fat.
Suggested daily amounts for some nutrients:
Nutrient
Calories
Total Fat
Saturated Fat
Trans Fat
Cholesterol
Sodium
Carbohydrate
Fibre
Suggested Daily Amount (50-60 year old)
1700-2500 (1200-1800 may be needed for weight loss)
50-60 grams
Less than 12 grams
0 grams
Less than 200 milligrams
1500-2300 milligrams
130-250 grams
25-50 grams
On the Road to Diabetes Health
20
Tips for Eating Away From Home
When you eat away from home, ask for:
drinks such as water, sugar-free drinks or coffee/tea with milk rather than cream
gravy, sauce, dressing and butter on the side
foods that are baked, steamed, poached, grilled, roasted or stir-fried rather than fried,
breaded and battered
fresh or steamed vegetables and salads rather than French fries
little or no mayonnaise or butter on sandwiches
tomato based pasta sauces rather than cream sauces
Other suggestions:
If you are at a restaurant, ask how foods are prepared before ordering
If you are at an event or a friend’s house, ask how foods have been prepared
Use the plate or handy portion method
If you can, check your blood glucose level 2 hours after you eat to see what effect it
had, especially if you have eaten foods that you don’t usually eat
Ideas for Losing Weight
If you are above your healthy weight, losing 5 - 10% of your weight will improve the way
your insulin works and reduce your risk of heart disease (e.g. if you weigh 200 lb that would
be 10 – 20 lbs). The suggestions below can help with weight loss.
1. Healthy Eating: follow the guidelines in the Healthy Eating section of this book, reduce
foods high in fats, sugar and alcohol.
2. Increase physical activity: it may be necessary to exercise 60 minutes 5 days per week
to be successful with weight loss. Try to incorporate both aerobic and resistance
exercise. Talk to your doctor about safe types of exercise for you.
3. Take a fresh look at some of the reasons why you eat. Do you eat only when you feel
hungry or do you find yourself eating when you are upset or bored? Do you always
stop eating when you feel satisfied or do you eat until you feel too full? Paying more
attention to your eating habits can help you make changes so you can reach your
weight loss goal.
4. Sleep is important, aim for 7 to 9 hours each night.
5. Use a notebook to keep track of everything you eat and drink, time, reason for eating
and how you are feeling. Bring the notebook with you when you meet with your
diabetes health care team.
6. Look for a weight management program that includes exercise, nutrition and
behaviour change support.
On the Road to Diabetes Health
21
Physical Activity
The information in this book provides general suggestions about physical activity. It is very
important for you to talk to your doctor or diabetes health care team to create an activity
plan that is safe for you. For most people, simply going for a walk is a good way to safely
increase physical activity.
Keep these important notes in mind:
talk to your doctor if you have not been active or you plan to increase
the intensity of your exercise, an ECG stress test may be
recommended
talk to your doctor before starting resistance training such as lifting
weights, some people with diabetes should not do resistance training
Some medications (see page 24) and insulin may increase your risk of
hypoglycemia. Carry a fast acting carbohydrate such as glucose
tablets with you in case you develop signs of hypoglycemia.
Carry diabetes identification (see page 25).
Stop exercising immediately if you:
have chest pain, shortness of breath or rapid heart beat
feel faint, dizzy, nauseated or sick to your stomach
have any signs of hypoglycemia (see page 8)
have any unusual pain.
Physical activity is an important part of staying healthy with diabetes
Regular physical activity provides many benefits for people with diabetes. When you are
more physically active you can:
lower blood glucose
improve insulin sensitivity (may need
less medication)
improve circulation
increase physical strength
strengthen your immune system
reduce risk of falls and injuries
reduce risk of heart disease
lower blood pressure
lower cholesterol
improve sleep
improve mood and brain function
reduce tension and stress
lose weight
Getting Started
Talk to an exercise specialist who can also advise you about how to get started and
maintain an exercise program. See page 37 for resources.
Test your blood glucose before and after to see what effect exercise has.
Avoid vigorous exercise within 1 hour of a large meal.
On the Road to Diabetes Health
22
Aim for 30 to 60 minutes of activity at a regular pace (when just starting your exercise
plan, start with 5 to 10 minutes twice a day working up to 30 or more minutes.
Stick to activities that you have been told are safe and suit your abilities.
Set aside a specific time each day for physical activity. Mark it in your calendar like
you do for other plans and appointments.
Planning tips for exercise
An exercise session includes warm-up, aerobic training, cool-down and stretching. Aerobic
activities are brisk walking, cycling, swimming, dancing and exercise classes.
Warm-up: 5 to 10 minutes of light to moderate intensity aerobic activity.
Aerobic: 150 minutes of aerobic exercise per week. This should be spread over at
least 3 days per week at moderate intensity. This could be a 30 minute brisk walks 5
days per week or 50 minutes 3 days per week. You will get even more benefit if you
increase to 300 minutes per week or a higher intensity. Avoid gaps of more than 2
days between sessions.
Cool-down: 5 to 10 minutes of light to moderate intensity aerobic activity.
Stretching: 10 minutes or more of stretching exercises after warm-up or cool-down.
Include resistance training using weights, resistance bands or exercise machines.
Recommendations for resistance training:
2 to 3 days per week with 2 days in between
for the same muscle group.
2 to 4 sets at light to moderate intensity
10 to 15 repetitions per set
start with 10 to 20 minute sessions
gradually increase resistance or repetitions
Activity ideas to discuss with your doctor or diabetes health care team include:
walking, running, mall walking
swimming
aquasize
cycling
On the Road to Diabetes Health
joining a fitness centre
dancing
chair exercises
23
Diabetes Medication
Type 2 Diabetes Medications
Healthy eating, exercise and weight loss (if you are overweight) may be all you need to
control your blood glucose in the early stages of type 2 diabetes.
If you are doing all that you can and your blood glucose remains above your target you may
need to take type 2 medications as well.
There are many kinds of type 2 medications and each kind has a different action. You might
end up taking more than one kind. The kinds are:
Glucophage®, Glumetza® - (metformin), decreases the release of stored glucose
from the liver and helps insulin work better.
Avandia® (rosiglitazone), Actos® (pioglitazone) - improves the way glucose moves
into your cells.
Glucobay® (acarbose) - helps slow down the digestion of starches and some sugars
to glucose so that glucose enters your blood more slowly.
Januvia® (sitagliptin), Onglyza® (saxagliptin), Trajenta (linagliptin), Victoza®
(liraglutide), Byetta® (exenatide) - helps you make insulin when you eat and
decreases the release of stored glucose from the liver.
Diabeta® (glyburide), Diamicron® (gliclazide), Gluconorm® (repaglinide),
Amaryl® (glimepiride) - helps you make insulin. Caution: these pills increase
your risk of hypoglycemia (low blood glucose). When you take these pills you
need to carry fast acting carbohydrate in case you need to treat hypoglycemia
suddenly.
Points to remember
Carry a list with you at all times of all medications you are taking. Include the name of
the medication, how often you take it and the amount you take each time.
Take your medication as ordered by your doctor.
Do not miss or delay meals, even if you are busy.
Tell your doctor if you:
start having hypoglycemia (low blood glucose)
get an upset stomach or diarrhea
get a skin rash
are planning a pregnancy
want to drink alcohol (alcohol increases the risk of low blood glucose)
Your dose of type 2 medication may need to be changed depending on your blood glucose
levels. See your doctor regularly and more frequently, if you are having difficulty keeping
your blood glucose within the target range.
On the Road to Diabetes Health
24
Insulin
If you have type 1 diabetes, you must take insulin every day.
If you have type 2 diabetes, you may need to take insulin to help you keep your blood
glucose at target.
If you have type 2 diabetes, you may need insulin:
as well as type 2 medications
instead of type 2 medications
temporarily while you are sick, stressed, pregnant or having medical problems or
surgery
There are many types of insulin. Insulin is given by injection (syringe, pen or pump ). Your
diabetes health care team will:
help determine the type(s) best for you
spend time teaching you how to use insulin
Diabetes Identification
Health care providers need to know immediately if you have diabetes. In case you are unable
to speak or get confused in an emergency situation, it is important that you wear a medical
ID such as a bracelet or a necklace at all times.
MedicAlert® is one of the best known emergency health information providers. When you
register with MedicAlert® they will send you an ID bracelet or necklace that tells others that
you have diabetes. Your health information will also be available by phone to emergency
health care providers 24 hours a day from anywhere in the world.
Call: 1-800-668-1507 (toll free) or register online at
www.medicalert.ca
On the Road to Diabetes Health
25
Sick Day Management
A bad cold, the flu or a serious injury can make your blood glucose too high. People not
usually taking insulin may need to take insulin when they are sick. On the other hand when
you take diabetes medication (pills and/or injections) and cannot eat your usual foods, your
blood glucose may go too low. Follow these guidelines to help you stay out of hospital.
Sick Day Management for Type 1 Diabetes
Be prepared – before you get sick ask your doctor for sick day insulin guidelines or have
your diabetes nurse educator review the handout Type 1 Diabetes: Sick Day
Management and Insulin Guidelines. Ask your pharmacist how you can test for
“ketones” if you do become sick.
Continue to take your insulin even if you are not eating your normal meals. Your insulin
requirements may increase when you are sick. Talk to your doctor or refer to the handout
Type 1 Diabetes: Sick Day Management and Insulin Guidelines.
Continue to follow your meal plan. If you are unable to eat your usual foods, try to follow
the Foods for Sick Days ideas in the next section.
Drink plenty of sugar-free fluids such as water, weak or caffeine-free tea and sugar-free
pop. Try to drink at least 8 to 10 cups of fluids each day.
Test your blood glucose and ketones every 4 hours. (See the handout Type 1 Diabetes:
Sick Day Management and Insulin Guidelines).
See your doctor today or go to emergency for help if any of the following occurs:
Your blood glucose is greater than 14 mmol/L before meals or bedtime on 2 tests in a row
and your urine ketones are moderate to large or blood ketones are 1.5 mmol/L or higher.
You are unable to eat or drink due to vomiting for longer than 24 hours. You need to
drink 8 cups or 2 litres of fluid in 24 hours.
You have diarrhea lasting longer than 24 hours.
What can happen when your blood glucose is high?
High blood glucose on 2 tests (4 hours apart) can quickly become Diabetic Ketoacidosis
(DKA).
You do not have enough insulin and are unable to use glucose for energy.
When glucose cannot be used, your body burns fat.
Burning fat makes ketones. Ketones are toxic to your body and can cause weakness,
fatigue, weight loss, stomach pain, nausea and vomiting.
DKA must be treated immediately! Failure to do so may lead to shock, coma, and
death.
On the Road to Diabetes Health
26
Sick Day Management for Type 2 Diabetes
Be prepared – before you get sick, ask your pharmacist how you can test for “ketones” if
you do become sick.
Continue to take your type 2 medication, or insulin, as usual.
Continue to follow your meal plan. If you are unable to eat your usual foods, try to follow
the Foods for Sick Days ideas in the next section.
Drink plenty of sugar-free fluids such as water, weak or caffeine-free tea and sugar-free
pop. Try to drink at least 8 to 10 cups of fluids each day.
If you test your blood glucose, test 4 times each day (before meals and before bed)
If your blood glucose is greater than 20 mmol/L for more than 8 hours you need to test
your urine or blood for ketones.
See your doctor today or go to emergency for help if one of the following occurs:
Your blood glucose is greater than 20 mmol/L for more than 8 hours; and your urine
ketones are moderate to large or blood ketones are 1.5 mmol/L or higher.
You take type 2 medication and/or insulin and are unable to eat or drink due to vomiting.
You are unable to eat or drink due to vomiting for longer than 24 hours. You need to
drink 8 cups or 2 litres of fluid in 24 hours.
You have diarrhea lasting longer than 24 hours.
What may happen when your blood glucose is high?
You may become dehydrated.
Dehydration can cause an increase in blood glucose and may lead to shock and coma.
Foods for Sick Days
Drink plenty of sugar-free fluids such as water, weak or caffeine-free tea, sugar-free pop,
Crystal light® or broth. Try to drink 8 to 10 cups of fluid per day.
Continue to eat your usual foods as much as possible. If you are not able to eat your usual
foods, have one of the following every 1 to 2 hours, even if your blood glucose is high. (Each
of these servings contain about 15 grams of carbohydrate.)
½ cup (125 mL) fruit juice
½ cup (125 mL) regular pop (not
sugar-free)
1 cup (250 mL) Gatorade®
½ cup (125 mL) regular Jell-O®
1 twin popsicle
1 cup (250 mL) milk or yogurt
1 cup (250 mL) cream soup
½ cup (125 mL) ice cream, custard or pudding
6 soda crackers
1 slice toast with margarine/butter/jam
½ cup (125 mL) applesauce
½ cup (125 mL) milk shake or liquid meal replacement
On the Road to Diabetes Health
27
Complication
Risks
Having diabetes increases your risk for long term
complications involving your blood vessels and nerves. Risk
factors often seen in people with diabetes are high blood
pressure, high blood glucose and abnormal blood fats.
These cause damage to your blood vessels and nerves over
time. Regular exercise, eating healthy foods, avoiding
smoking and taking your medications help to avoid these
complications.
High Blood Glucose
In this book we have talked about many ways to get your blood glucose levels to target. Talk
with your diabetes health care team about how you want to get started and how they can
help you make an action plan.
High Blood Pressure (Hypertension)
High blood pressure can damage your blood vessels which leads to eye, kidney and
circulation problems. Have your blood pressure checked regularly. Try to keep your blood
pressure below 130/80 or the target suggested by your doctor. Along with being active,
healthy eating and less salt, many people need to take medications to lower blood pressure.
Blood Fats (Lipids)
Blood fats should be checked every year because they can contribute to blocked blood
vessels. This will include your total cholesterol, LDL-cholesterol (bad), HDL-cholesterol (good)
and triglycerides. High levels of LDL-cholesterol and triglycerides, and low levels of HDLcholesterol are common in people with diabetes. Exercise, weight loss, eating more fibre and
the right kinds of fat will help to improve blood fats. If you cannot achieve your blood fat
targets talk to your doctor about medication.
Smoking
Quitting smoking is one of the best ways to lower your risk of
complications. It is also very hard to do. There are many resources that
can help. Talk to your diabetes health care team about what help is out
there for you.
One great resource is the QuitNow program. This free program is available
by phone or online. You can talk with others who are also quitting, create your own plan,
track how you are doing and get expert help.
Visit www.quitnow.ca or call HealthLink BC at 811
Remember, the things that help to delay or prevent diabetes complications are
the same things that promote a long, active and enjoyable life!
On the Road to Diabetes Health
28
Complications
Heart and Stroke
People with diabetes are at very high risk of heart disease and stroke. If a blood vessel
becomes blocked in the heart, it may cause a heart attack. If a vessel is blocked in the
brain, it may cause a stroke. If this happens in the heart, it is called cardiovascular disease
cerebrovascularaccident
accident(CVA).
(CVA).Being
Being
(CVD) and if it happens in the brain it is called acerebrovascular
overweight (especially around the stomach) and low levels of exercise are also risk factors.
People who smoke or have a family history of heart disease or stroke are at even higher risk.
Retinopathy (Eye Complications)
The tissue that lines the inside of your eye is called the retina. Over time, high blood glucose
can damage the tiny blood vessels in the retina. If this is left untreated it may cause vision
loss. People with diabetes are more likely to develop cataracts at a younger age or to
develop glaucoma. It is important to have your eyes checked by an eye doctor
(ophthalmologist or optometrist) every one to two years.
Nephropathy (Kidney Complications)
High blood pressure and high glucose levels can cause damage to the kidneys. Your kidneys
contain over a million tiny filters called nephrons. These nephrons filter your blood keeping
the useable products in (protein) and remove the waste products (creatinine). If these filters
are damaged they do not filter properly. Kidney damage is detected by finding protein in the
urine and measuring creatinine in the blood. In the early stages of kidney disease most
people will not have any symptoms. You need to have a urine test for protein and blood test
for creatinine levels at least once each year to check your kidney function.
Neuropathy (Nerve Damage)
Over time, high blood glucose levels can damage the nerves in your hands and feet, as well
as nerves that affect your blood pressure and digestion. Signs of neuropathy are often first
detected in the feet. The first signs may be a numb, tingling or burning sensation. If you are
unable to feel light touch, pain or heat, damage or injury may not be noticed. Severe burns
or ulcers can occur without any pain and infection can quickly follow. See your doctor if you
have numbness, tingling or burning in your feet. You should have your feet checked for
sensation at least once a year.
Sexual Dysfunction (Erectile Dysfunction; ED)
Diabetes may affect sexual function in both men and women because of physical and
emotional concerns. Men may experience erectile dysfunction (ED) where they are unable to
maintain an erection. Diabetes may cause damage to the vessels which affect blood flow to
the penis. Nerve damage can affect erection quality. Erectile dysfunction can also be a side
effect of some medications. Temporary problems with erection may be caused by stress or
drinking too much alcohol and is more common in men who smoke. This is a real medical
problem and should be discussed with your doctor or diabetes health care team. There are a
number of treatments available and changes can be made to your medications.
On the Road to Diabetes Health
29
Caring For Your Feet
Foot care is an important part of diabetes management. High blood glucose can damage the
nerves and blood vessels in your feet.
Symptoms of nerve damage can include:
loss of feeling, numbness
burning or pain in feet or legs
tingling
trouble with balance
Symptoms of blood vessel (circulation) problems can include:
cold feet
leg and calf pain when walking, at night or at rest
changes in skin color
sores that don’t heal
dry cracked skin
DO...
You can prevent serious foot problems by taking care of your feet.
DO check your feet everyday for cuts, cracks, bruises, blisters, sores, infections or unusual
markings. Use a mirror if you need to, to look at the bottom of your feet.
DO see your doctor or go to emergency that day if you have signs of infection such as pain,
redness, swelling or oozing pus.
DO see your doctor within a few days at the first sign of any other problems.
DO wash your feet with soap and water daily, especially between toes and dry them well.
DO put cream or lotion on your heels and soles every day, but never between your toes.
DO change your socks every day and wear a good supportive shoe.+
DO trim your nails straight across.
DO see a foot care specialist if you need advice or treatment including orthotics.
DO clean cuts or scratches with mild soap and water, cover with a dressing for sensitive skin.
DO buy shoes in the afternoon (feet swell slightly by then), choose heels under 2 inches
DO keep your feet warm-avoid extreme cold and heat, keep your feet out of direct sunlight.
DO follow your physical activity plan to improve the blood flow to your feet and legs
DO keep your blood glucose within target levels.
On the Road to Diabetes Health
30
DON’T...
DON’T smoke.
DON’T cut your own corns or calluses or use products to treat corns or
warts. They are dangerous for people with diabetes.
DON’T treat your own in-grown toenails with a razor or scissors.
DON’T apply heat to your feet with a hot water bottle or electric
blanket. These products can burn your feet without you realizing it.
DON’T put cream or lotion between your toes.
DON’T take very hot baths or soak your feet in hot water.
DON’T walk barefoot inside or outside.
DON’T wear tight socks, garters or elastics, or knee highs.
DON’T wear tight shoes. You should be able to wiggle your toes in proper fitting shoes.
DON’T wear high heels that squish your toes.
DON’T sit for long periods. Get up and walk at least once every hour during the day.
Inspect your feet daily and see your doctor within 2 days if anything of concern.
Diabetes and Driving
Diabetes can affect a person’s ability to drive safely. Insulin and some types of medication
used to treat diabetes can cause low blood glucose, which may result in a sudden loss of
consciousness (fainting) or changes in consciousness. Since each person is affected
differently by diabetes it is important to monitor your own fitness to drive and to take action
if needed. If you are at risk for hypoglycemia always carry glucose tablets with you and know
how to treat hypoglycemia. (See page 8.)
Each time you are planning to drive, check your blood glucose level first.
If your blood glucose is less than 4.0 mmol/L or if you have any signs of
hypoglycemia, do not drive! You need to treat your hypoglycemia first. You must
wait 45 to 60 minutes after you treat hypoglycemia before you drive.
If your blood glucose is 4.0 to 5.0 mmol/L, eat a snack containing carbohydrate before
you start to drive. “Be 5 to DRIVE”
If you have had severe hypoglycemia, hypoglycemia unawareness or you are a
professional driver, your blood glucose needs to be 6.0 mmol/L or higher.
Talk to your diabetes health care team for more information about driving and diabetes.
Note: you must disclose on the driver’s license renewal form that you have a disease which
may interfere with the safe operation of a motor vehicle.
On the Road to Diabetes Health
31
Making Lifestyle Changes
Changing behaviour is difficult for most people. If you are ready to make a change it is
important to decide on a realistic goal that is important to you, and then make plans that
break down what you need to do into small steps. If you have committed to a long term goal
such as losing 10 pounds in the next 6 months, the next step is to make an action plan. This
may be to start walking for 15 minutes Monday, Wednesday and Friday after dinner or it may
mean eating breakfast every day. You will be more successful achieving your long term goal
if you commit to small steps that you keep track of daily and review weekly.
Example of a goal and action plan
Goal: Lower my blood glucose to 10 mmol/L after dinner within 3 months.
Action Plan:
What? Walk
When? After dinner, Monday, Wednesday, Friday
Where? At the nearby park
How long? 15 minutes
Rate your confidence: on a scale of 0 – 10, rate how sure you are that you will have
success with your action plan. If your confidence is less than 7 out of 10, you need to change
your action plan to increase your chance of success.
Barriers: list the things that might get in the way of your action plan; for example, you
might be too busy or it might be too dark after dinner in the winter.
Solution: write down things you can do to make sure you can achieve your goal in spite of
barriers; for example, I will not make other plans until after 7 p.m. so I will have time to
walk; in the winter months I will walk during lunch hour.
To increase your success with your goals and action plans, talk to your diabetes health care
team to learn more about resources, including:
Diabetes or Chronic Disease Self Management Program, which you can also call
directly at 1-866-902-3767, or check their website:
www.selfmanagementbc.ca
On the Road to Diabetes Health
32
Travel Tips
See your doctor or diabetes educator 4 to 6 weeks before your trip
Get a letter stating your full legal name, that you have diabetes, describing your
treatment and the medications and supplies you need (lancets, syringes, pens,
pumps).
Discuss treating minor illness while away (anti-nausea/anti-diarrhea medications).
Have required vaccinations at least 4 weeks before travel.
Wear a MedicAlert®, especially if you are at risk of hypoglycemia (see page 25).
Be prepared for emergencies
Buy travel insurance and be sure to let them know you have diabetes.
Carry extra medications and supplies (twice as much as you think you need) in case of
lost baggage or other accident.
Know where to access English speaking resources in case you need medical care or
medications.
Know the generic names of any medications you use.
Carry a local language phrase book so you can get help such as, “I need juice”, “I
need a doctor”. You can get a list of English speaking doctors through the
International Association for Medical Assistance to Travellers (IAMAT) at
www.iamat.org
At the airport
Before screening begins let them know you are carrying diabetes supplies.
Carry all your diabetes supplies in one bag for
easier inspection. Have all medications in their
original containers, with labels showing your name
as it appears on your passport.
Insulin should not repeatedly be X-rayed as it may
not work well.
When driving
Check local laws for blood glucose levels and driving for people with diabetes.
Check your blood glucose regularly (at the start of the trip and then every 4 hours).
Make sure you are taking breaks to stretch and eat.
Treat hypoglycemia at first sign and don’t drive until blood glucose level is at least 5
mmol/L or more (or what the local limit is) and all signs of hypoglycemia are gone.
This could take 45 to 60 minutes.
If you use insulin
Do not store insulin in checked baggage, it can freeze in the cargo hold.
Keep your insulin in its safe temperature range. You may need cooler bags and ice, or
to carry it in an inside jacket pocket.
Inspect insulin before using. If it looks any different than usual (different colour,
anything floating in the vial or cartridge) throw it away.
Adapted from Canadian Diabetes Association, Travelling with Diabetes, see page 39, reference 2
On the Road to Diabetes Health
33
Staying Healthy Reminders
Promoting a Healthy Lifestyle
Healthy Eating
Physical Activity
Target
As recommended
Moderate intensity exercise at least 150 min per week
as recommended on page 23
Foot Care
Daily
Stress
Manage appropriately
Smoking
Quit
Taking Medications
Take as prescribed
Monitoring the Effects of Your Lifestyle
Blood Pressure
Less than 130/80
Healthy Weight
Body Mass Index (BMI) less than 25
Waist Circumference (lower targets in
Men: less than or equal to 102 cm (40 inches)
Asian, S. Asian, Ethnic South & Central
Women: less than or equal to 88 cm (35 inches)
American)
Blood Glucose Testing
Regular Examinations
Dilated Eye Examination
(Ophthalmologist/Optometrist)
Dental Examination (Dentist)
Foot Examination (Doctor)
Visits to Doctor and Diabetes Education
Centres
Regular Laboratory Testing1
A1C
Lipid Targets (Cholesterol):
LDL - Cholesterol
Other Lipids:
Total Cholesterol/HDL Cholesterol ratio
HDL - Cholesterol
Triglycerides
Kidney Function
eGFR
Urine Albumin/Creatinine Ratio (ACR)
Check Meter Accuracy
Electrocardiogram (ECG)
Vaccinations
Flu shot
Pneumonia
As recommended, see page 7
Every 1 - 2 years
Every 6 - 12 months
Every medical visit
As recommended
Less than or equal to 7% or as advised
Check every 3 months
Check every year
Less than or equal to 2.0 mmol/L
Less than 4.0 mmol/L (suggested)
Men: greater than 1.0 mmol/L (suggested)
Women: greater than 1.3 mmol/L (suggested)
Less than 1.5 mmol/L (suggested)
Check every year
Greater than 60 mL/min
Less than 2.0 mg/mmol
Fasting blood glucose in laboratory (once per year)
Meter to laboratory comparison: within 20%
Talk with your doctor
Every year
Talk with your doctor
1 Talk to your doctor about your laboratory tests. There may be reasons for your targets to be different.
On the Road to Diabetes Health
34
Conclusion
This booklet provides an overview of ways for people with type 1 and type 2 diabetes to stay
healthy. There’s a lot to learn! No one expects you to learn it all at once, and there are a lot
of people to help you. If you have questions talk to your doctor, or other diabetes health care
team members; or call the Canadian Diabetes Association.
Involve your family and friends too. The more they learn about diabetes, the more they can
help and support you. Listed on the following pages, are books and websites where you can
find more information.
On the Road to Diabetes Health
35
Resources
Resources
Books
Books
1. Brand-Miller, J et al. The New Glucose
Revolution for Diabetes. Marlowe & Co.,
1. 2007.
Brand-Miller, J et al. The New Glucose Revolution for Diabetes. Marlowe & Co.,
2007.
2. Canadian Diabetes Association. Beyond the Basics: Lifestyle Choices for
Prevention
and Management.
Diabetes Assoc.
2008
2. Diabetes
Canadian Diabetes
Association.
Beyond the Canadian
Basics: Lifestyle
Choices
forand
Beyond the
Basics: Meal
for Healthy
Eating,
Diabetes
Prevention
Diabetes
Prevention
and Planning
Management.
Canadian
Diabetes
Assoc. 2008
and
and Management.
Diabetesfor
Assoc.
2010.Eating, Diabetes Prevention
Beyond
the Basics:Canadian
Meal Planning
Healthy
and Management. Canadian Diabetes Assoc. 2010.
3. Lorig, Kate. Living a Healthy Life with Chronic Conditions, Canadian Edition,
rd
Edition.
Bull Publishing,
2012.
3. 3
Lorig,
Kate. Living
a Healthy
Life with Chronic Conditions, Canadian Edition,
rd
3 Edition. Bull Publishing, 2012.
4. Rubin, A. & Blumer, I. Diabetes for Canadians for Dummies. John Wiley and
4. Sons,
Rubin,2013.
A. & Blumer, I. Diabetes for Canadians for Dummies. John Wiley and
Sons, 2013.
5. Walsh, John, et. al. Using Insulin: Everything You Need for Success with
Insulin.
Torrey
Press,
2003. Everything You Need for Success with
5. Walsh,
John,
et. Pines
al. Using
Insulin:
Insulin. Torrey Pines Press, 2003.
6. Walsh, John, Roberts, Ruth. Pumping Insulin. Torrey Pines Press, 2012.
6. Walsh, John, Roberts, Ruth. Pumping Insulin. Torrey Pines Press, 2012.
Cookbooks
Cookbooks
Diabetes
andRobert
Management
1. Burkhand, Johanna & Allan,
Allan, Barbara.
Barbara.
Diabetes Prevention
Comfort Food.
Rose, 2006.
1.
2.
2.
3.
3.
4.
4.
5.
5.
6.
6.
7.
7.
8.
8.
9.
9.
Cookbook.
Robert Rose,
2013.
Burkhand, Johanna
& Allan,
Barbara. Diabetes Comfort Food. Robert Rose, 2006.
Finlayson, Judith. Canadian Diabetes Slow Cooker Recipes. Robert Rose, 2007.
Finlayson, Judith. Canadian Diabetes Slow Cooker Recipes. Robert Rose, 2007.
Graham, Karen. Canada’s Diabetes Meals for Good Health. Robert Rose, 2012.
Graham, Karen. Canada’s Diabetes Meals for Good Health. Robert Rose, 2012.
Hollands, Marjorie & Howard, Margaret. Choice Menus (new ed): Low Sodium
Version. Marjorie
Harper Collins
Canada,
2012. Choice Menus (new ed): Low Sodium
Hollands,
& Howard,
Margaret.
Version. Harper Collins Canada, 2012.
Hollands, Marjorie & Howard, Margaret. Choice Menus: Cooking for One or Two
Canada,
2011. Choice Menus: Cooking for One or Two
(2nd ed.). Harper
Hollands,
MarjorieCollins
& Howard,
Margaret.
nd
(2 ed.). Harper Collins Canada, 2011.
Kalina, Laura & Christian, Cheryl. Low-Glycemic Meals in Minutes. True Health
Global
2011. Cheryl. Low-Glycemic Meals in Minutes. True Health
Kalina, Publishing,
Laura & Christian,
Global Publishing, 2011.
Lindsay, Anne. Lighthearted at Home: The Very Best of Anne Lindsay, John
Wiley
& Sons,
Lindsay,
Anne.2012.
Lighthearted at Home: The Very Best of Anne Lindsay, John
Wiley & Sons, 2012.
Selley, Barbara. Canada’s 150 Best Diabetes Desserts. Robert Rose, 2008.
Selley, Barbara. Canada’s 150 Best Diabetes Desserts. Robert Rose, 2008.
Younker, Katherine E. Complete Canadian Diabetes Cookbook. Robert Rose, 2005.
Younker, Katherine E. Complete Canadian Diabetes Cookbook. Robert Rose, 2005.
10. Zeiler, Sharon. Canada’s 250 Essential Diabetes Recipes. Robert Rose. 2011
10. Zeiler, Sharon. Canada’s 250 Essential Diabetes Recipes. Robert Rose. 2011
On the Road to Diabetes Health
36
On the Road to Diabetes Health
36
Physical Activity Resources
1. Act Now BC. Move for Life. DVD: easy to do, stay healthy activities for older adults.
Available from B.C. public libraries or online at:
www.seniorsbc.ca Health & Safety > Active Aging > Move for Life DVD
2. Canadian Diabetes Association. Diabetes Physical Activity and Exercise Toolkit.
A resource manual for diabetes educators which includes worksheets and brochures
to help clients get started with physical activity and exercise. Brochures include
aerobic and resistance exercise. To order, contact: [email protected]
Website: www.diabetes.ca/clinical-practice-education/professional-resources/physicalactivity-exercise
3. Hayes, Charlotte. The I Hate To Exercise Book for People With Diabetes.
McGraw Hill, 2013.
4. Telephone Helplines : Active Choices – coaches use telephone and email.
Phone: 604-522-1492 or 1-877-522-1492,
www.selfmanagementbc.ca/activechoicestelephonesupportprogram
Physical Activity Line (PAL) – free phone and online resource, certified exercise
physiologists are available to assist with physical activity related needs. Monday to
Friday, 9:00 am - 5:00 pm. Phone: 604-241-2266, toll free: 1-877-725-1149
Nutrition Composition Resources
1. Calorie King (USA): www.calorieking.com
2. Canadian Nutrient File: www.webprod3.hc-sc.gc.ca/cnf-fce
3. Dietitians or Canada: www.eatracker.ca
4. Health Canada. Nutrient Value of Common Foods, 2008 (order or download):
www.hc-sc.gc.ca/fn-an/nutrition/fiche-nutri-data/nutrient_value-valeurs_nutritiveseng.php
5. US Department of Agriculture (USDA) Agricultural Research Services,
Nutrient Data, Laboratory Home Page: https://ndb.nal.usda.gov
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Organizations and Websites
1. American Diabetes Association: www.diabetes.org
Phone: 1-800-342-2383
2. Canadian Diabetes Association: www.diabetes.ca
Pacific Area Office, #360-1385 West 8th Ave., Vancouver, B.C. V6H 3V9
Phone: 604-732-1331 Toll free in BC: 1-800-665-6526
National E-mail: [email protected]
National Information Line: 1-800-BANTING (226-8464)
3. HealthLink BC: www.healthlinkbc.ca
Phone: 8-1-1 for non-emergency health issues and advice from registered nurses,
dietitians and pharmacists. Email a registered dietitian also available.
4. Joslin Diabetes Centre: www.joslin.org
5. Nutrition Action Health Letter, The Centre for Science in the Public Interest,
www.cspinet.org/nah/canada/
6. The Juvenile Diabetes Research Foundation: www.jdrf.ca
Vancouver Chapter, 150-6450 Roberts Street, Burnaby, B.C. V4G 4E1
Phone: 604-320-1937
7. Heart and Stroke Foundation: www.heartandstroke.bc.ca
BC & Yukon, #200 - 1212 West Broadway, Vancouver, B.C. V6H 3V2
Phone: 604-736-4404
8. Health Canada Quit Smoking: www.quitnow.ca
BC Quitline 1-877-455-2233
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References
1. American College of Sports Medicine. ACSM's Guidelines for Exercise Testing and
Prescription (9th edition). Lippincott Williams & Wilkins, 2013
2. Canada’s Physical Activity Guide to Healthy Active Living. Public Health
Agency of Canada, 2008.
www.phac-aspc.gc.ca/hp-ps/hl-mvs/pa-ap/index-eng.php
3. Canadian Diabetes Association. Beyond the Basics: Lifestyle Choices for
Diabetes Prevention and Management. Travelling with Diabetes – Trains,
Planes, Automobiles, Canadian Diabetes Assoc. 2007, 29-32.
4. Canadian Diabetes Association Clinical Practice Guidelines, 2013.
http://guidelines.diabetes.ca/
5. Canadian Journal of Diabetes Care. Canadian Diabetes Association’s Clinical
Practice Guidelines for Diabetes and Private and Commercial Driving, 2003.
27(2);128-140.
6. Durstine, J. Larry et al. ACSM's Exercise Management for Persons with Chronic
Diseases and Disabilities (3rd edition). Lippincott Williams & Wilkins 2009
7. Eating Well With Canada’s Food Guide Health Canada, 2007.
www.hc-sc.gc.ca/fn-an/food-guide-aliment/index-eng.php
8. Office of the Superintendent of Motor Vehicles, Fact Sheets, Drivers with
Diabetes (Class 1 – 4 License) and Drivers with Diabetes (Class 5 – 8
License) July 2012. www.pssg.gov.bc.ca/osmv/publications/index.htm
9. Nathan, D. et al, Diabetes Care. Translating the A1C Assay Into Estimated
Average Glucose Values. 31: 1473-1478, 2009
10. National Sleep Foundation : www.sleepfoundation.org/article/how-sleepworks/how-much-sleep-do-we-really-need
11. Sick Day Management. Reviewed by:
Dr. Dave Shu, Regional Division Head of Endocrinology, Fraser Health Authority,
Undergraduate Clinical Teaching Director, Royal Columbian Hospital
10. U.S. National Institutes of Health, National Heart, Lung, and Blood Institute. Your
Guide to Lowering Your Blood Pressure With DASH. 2006.
www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf
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