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Healthy new year! 5 steps to getting back into your routine.

What healthy habits went out your window over the holidays? Portion control? Enough sleep? Getting your steps? The entire vegetable category? It's easy to wake up in January and realize that your routine isn't quite a routine anymore. So how can you get back on track? 1. Give up the guilt. You may have eaten too much, tested too infrequently or chosen eggnog over the treadmill. But that's in the past. Be glad you enjoyed the holidays, then let it go and look forward. 2. Go to bed early. Give yourself the extra energy it often takes to get out of a slump. 3. Clear out the...

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How to Talk to Your Doctor

Whether you’ve been living with diabetes for years or you’re newly diagnosed, communicating with your health care team is one of the best things you can do. If you’re nervous about opening up to your doctor or pharmacist, there are some good reasons to conquer these fears. Less communication leads to measurable increases in your stress, anxiety, and possible depression. It also leads, inevitably, to less frequent and less successful diabetes management.1 Since communicating with your health care providers is proven to be good for your health, here are some guidelines for starting the conversation and keeping it going. Know who’s on your health care team? If you don’t already know the people involved in your health care, get to know them. Your healthcare team could include: • Primary care provider • Pharmacist • Nurse or certified diabetes educator • Dietician • Endocrinologist • Eye doctor • Therapist • Podiatrist You may not need to see everyone on this list, but it is a good idea to know who to turn to when you have specific questions. Informed consent The most important member of your health care team is you! Other than doing what it takes to manage diabetes day-to-day, this also means that you have a say in your treatment. In fact, your health care provider should explain your diagnosis and all of your treatment options to you so that you can make an informed decision with regard to your health. The World Health Organization provides a great overview of informed consent , including which treatments require written consent (like surgery) and what you should expect to happen during the informed consent process.2 How much do you want to know? Sometimes the medical details can be overwhelming or intimidating. If you would rather not know these details right away, feel free to tell your doctor or pharmacist. Just make sure you find a comfortable balance between what you want to know and what you need to know in order to successfully manage your diabetes. If knowing every clinical detail puts your mind at ease and makes you feel more in control, tell your doctor this, too. What to discuss You will likely have general questions you’d like to ask your health care provider when you see them—new symptoms, any changes to your treatment, etc. It’s best to get those out of the way first. Make sure you also ask questions about sensitive topics or any other issue that is important to you. And if you’ve decided to add alternative medicines or treatments to your regimen, be open and honest with your team. These conversations are for a good cause: your health! Medical tests It’s important to take the medical tests your health care provider requests, but make sure you ask questions about them too. Some questions to ask: • Is there anything you need to do before the test? • What will the test measure? • How will the test influence any changes to your treatment? • Are there risks to taking the test? • How will you be informed about the results? Before and after your appointment If you know there are issues you need to discuss with your health care provider, organize your thoughts ahead of time. Jotting them down and bringing the list of questions to the appointment can keep the meeting on track and make you feel confident that you’re getting the information you need. After your appointment, don’t hesitate to follow up if you have questions about your treatment. For example, if you received test results that you don’t understand, make a phone call. Problems talking to your health care provider? Yes, doctors are busy, but they are there to serve you and there is no reason for you to delay or forego getting the information you need about your health. If you can’t seem to get a clear answer from your doctor on an issue, try saying, “I don’t understand [this topic]. Can you take a few minutes to explain it to me?” If your health care provider can’t make the time for a conversation, offer to make an appointment for a phone call to discuss your concerns. An “advocate”, a friend, or family member that understands more about diabetes can also help by going to medical appointments with you. Never give up on getting the knowledge you need. a

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Assigning A Value To Blood Glucose Numbers

When it comes to diabetes, you’re constantly told to monitor your blood glucose closely. But what exactly are you supposed to be monitoring—and why? Good diabetes management involves knowing target values, which are the numbers where the blood glucose level is said to be normal. Fasting or preprandial (pre-meal) blood glucose: between 4.0 and 7.0 mmol/L Postprandial blood glucose (two hours after a meal): between 5.0 and 10.0 mmol/L Anything below these values is considered to be hypoglycemia; the reverse is hyperglycemia. Both involve health risks. Note that the amount of glucose per litre of blood is expressed in millimoles per litre (mmol/L). (It’s important not to confuse these numbers with values measured in milligrams per decilitre [mg/dL], which are mostly used in the United States.) As for A1C levels (a.k.a. HbA1c, or glycated hemoglobin—average blood glucose levels for the last two to three months), which are obtained from a blood test, they should be 7% or less. A value greater than this points to risks of long-term complications. Your own target values Based on factors such as your age, your health (including the presence or absence of cardiovascular disease), or how long you’ve had diabetes, for example, your physician can set target values specifically for you that are slightly different from those listed above. Similarly, target values will differ if you’re pregnant. Keeping a (more or less private) diary Blood sugar levels vary daily depending on food intake and physical activities, but also on factors such as stress—whether psychological or physical (injury or illness)—alcohol intake, and so on. As a result, it is strongly recommended that you keep a diary (paper or electronic) that includes not only the results of your tests, but also your meals, snacks and physical activities, in addition to measurements such as your weight or blood pressure. Also consider writing down what’s going on in your life and what you’re worried about. That can also help you understand your blood sugar fluctuations. Being diligent When should you test your blood glucose? Often enough to be able to determine how different elements affect it, and regularly enough to see if this influence is constant. If you are insulin-dependent, you should do this when you wake up (while you’re fasting), before meals, before each injection and before going to sleep. Of course, your health care provider can help you determine how often you should be testing your blood glucose. If you have a cold or are feeling stressed, for example, you should be testing your blood glucose a bit more often: these stressors can affect it to some degree. Going for a healthy lifestyle Ideally, you would not only avoid major deviations (hypoglycemia and hyperglycemia can both cause damage) but also learn to identify and predict the effects of various factors on your blood glucose levels. With all this information in hand, you’ll be better able to adapt certain elements of your lifestyle and, with the help of a health care professional, adjust your medication. Careful monitoring of your blood glucose will also help you spot anomalies early and avoid any problems that they may cause. Knowing your target values is of course fundamental, but so is knowing what to do when you stray from them. Talk to your health care professional about this. Conclusion Beyond all the numbers, keep in mind that the whole point of this approach is to get to know yourself better and maintain a good quality of life for a long time.

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Preparing for pregnancy—good reasons to start today

Let's think into the future. Imagine sitting in a rocking chair playing with ten brand-new, tiny toes. That's the image you can remember every time you check your blood glucose, visit your doctor or say no to a glass of wine. And it's absolutely worth it. Not ready for parenthood yet? Here's what you can do now. There are several things you can do to prepare for pregnancy well before you're ready to conceive. Read about it—just not too much. When you understand the risks, you can take steps to reduce them, but it could be overwhelming if you dwell on them. Stay confident knowing that many women with diabetes have happy, healthy pregnancies. Find a great doctor. Seek out an obstetrician/specialist who has cared for other women with diabetes. You two are going to get pretty close throughout your pregnancy, so make sure it's someone you feel good about. Ask about your targets. Your doctor may want you to aim for a tighter blood sugar range when you're trying to get pregnant and throughout your pregnancy.1 Fine-tune your blood sugar. Keeping your numbers in range is incredibly important for your healthy pregnancy—even before you conceive.1 Why start early? You never know. Once you start trying to conceive, it could happen any time. High blood sugar can affect your baby in those first few weeks, before you even know you're pregnant , so make it a habit to stay in range. You may find that more frequent blood glucose checks help you improve control by guiding insulin doses, helping you identify patterns in your numbers, and helping you quickly respond to high or low blood glucose. Once you're pregnant, you'll have more advice than you can handle—from your doctor as well as family, friends and strangers on the street. Try to stick to the more reliable information sources and keep smiling. After all, there's a baby on the way.

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Hypoglycemia (or “low blood sugar”) occurs when blood glucose levels fall below 4 mmol/L. At first, symptoms may be benign—irritability, mild nausea—but if the situation is not addressed, hypoglycemia can lead to fainting or even coma. Signs Some of the symptoms, termed “adrenergic,” are due to adrenaline being secreted: Tingling in the tongue or lips Hunger Shakiness Sweating Paleness Nausea Rapid heartbeat Other symptoms, termed “neuroglycipenic,” are due to a lack of glucose in the brain: Difficulty coordinating your movements and focusing Headaches Irritability Weakness Drowsiness Dizziness Speech difficulties When it occurs at night, hypoglycemia can manifest through strong perspiration and restless sleep. You may also experience headaches when you wake up. Causes Psychological or physical stress, alcohol, dietary choices, physical activity or certain medications can cause your blood sugar level to drop. So can taking too large a dose of insulin compared to what you ate or drank—for example, if you skipped a meal or snacked later than usual. It’s a good idea to note what you ate or drank and what activities you performed before a bout of hypoglycemia. Note that people taking insulin or a medication that increases insulin production by the pancreas are at higher risk of hypoglycemia. How to prevent it Eat regularly, and always have a snack or source of sugar with you. Keep your glucose meter with you, and measure your blood sugar often, especially before and after meals or before and after physical activity. Adjust your insulin dose based on what you ate or drank and depending on your activities. Make sure those around you can recognize the signs of hypoglycemia. Wear something, such as a bracelet, to indicate that you are diabetic. What about glucagon? The purpose of this hormone, which is produced by the pancreas, is to increase blood sugar levels. A person being treated with insulin who experiences an episode of severe hypoglycemia may require an injection of glucagon. If your doctor prescribes it to you, make sure your relatives know where your medical kit is and how to administer the substance. What to do in case of hypoglycemia  At the very first signs, check your blood glucose. If you can’t use your meter, don’t take any risks: treat your symptoms anyway.  Take 15 g of fast-acting glucose. E.g., three or four glucose tablets, ¾ cup or 175 ml of fruit juice or soda, or a tablespoon of honey or maple syrup.  Wait 10 to 15 minutes, then check your blood glucose again. If it is still low, repeat the process. In conclusion We’re all in a hurry or distracted sometimes. It’s easy to forget to take a snack or think we can wait a little longer. But even if a meal is coming up soon, you’d better have a bite to eat and, as always, measure your blood glucose just in case.  

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Taking Good Care Of Your Skin

Living with diabetes means being more susceptible to dry skin. One reason is that high blood glucose causes more frequent urination, leading to dehydration. Given that hyperglycemia affects nerves and capillaries, you may also observe a decrease in sweating. The problem is that dry skin gets injured or cracked more easily, making it more vulnerable to infections that can create serious complications. Besides, if you’re falling prey to neuropathy, you may not notice the problem early enough. Various complications Dry skin and poor blood circulation can create itching sensations—in the legs, among other areas. Various types of rashes, blisters, bacterial infections—accompanied by symptoms such as redness, swelling and pain—or fungal infections may also occur. A bacterial infection affecting a hair follicle can result in folliculitis or a boil. Your eyelids or the area around your nails can also get infected. The most common culprit for those infections is the staphylococcus bacteria, and antibiotics are often required to fight it off. Humid areas of your body—between your fingers or toes, at the corners of your mouth, on your underarms or around your groin—are subject to fungal infections such as eczema, athlete’s foot or yeast vaginitis, among others. As for less common complications… Capillary damage can lead the skin, particularly on your legs, to become covered with pale brown spots which are often confused with normal signs of aging. This is a harmless condition known as diabetic dermopathy. People living with diabetes also sometimes develop scleroderma, a thickening and hardening of the skin. If you experience any similar symptoms or discover you have an injury or an infection, consult a health care professional as soon as possible. Prevention is king! Often, the only way to treat these problems is to manage your blood glucose properly, which means it’s also the best way to avoid them. Drink water regularly to stay hydrated, and exercise! Physical activity doesn’t just make you feel good through endorphins; it also stimulates blood circulation and helps maintain glucose levels within target values . And since the skin of your feet and legs is particularly at risk, examine it every day. Softness is the watchword Avoid long showers or baths, and beware water that’s too hot, as it tends to dry out your skin. Use a mild soap, and make sure you rinse well! Soap residue causes dry skin. After showering or bathing, apply moisturizing cream or lotion to your face and body—preferably a fragrance-free, hypoallergenic, non-comedogenic product. Wear clothing and underwear made from natural fabrics such as cotton. Synthetic fibres don’t let your skin breathe as well. In summer… Avoid sun exposure without adequate protection. Reapply sunscreen every two hours or so, and when you go swimming, use a water-resistant variety. Keep in mind that you shouldn’t let your guard down just because it’s not a sunny day. UV rays can pass through clouds and even fog. …and in winter Cover your hands and face well. Don’t overlook the need for sunscreen. Sure, it’s cold outside, but the sun is still there! Build yourself an arsenal of moisturizing creams and lotions, lip balm and the like. Keep them in your purse or coat pockets. A note on indoor conditions: the ideal humidity level is between 35% and 45%. Use a hygrometer to check the humidity level in your home, and if the air is too dry, you might want to use a humidifier. Conclusion Your skin is your largest organ. Make sure you take good care of it!

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Understanding Type 2 Diabetes

What is it? Type 2 diabetes is by far the most common: it’s the one affecting up to 90% of people living with diabetes. It is mostly found in adults (hence its nickname, “adult diabetes”), particularly in those 40 years and older. However, with the obesity epidemic currently raging around the world, it has been occurring in younger and younger people. This type of diabetes is associated with a sedentary lifestyle, obesity and excess weight—especially in cases where there is fat accumulation in the abdomen area—but uncontrollable factors such as heredity and age play a significant role in the equation. Note that gestational diabetes and polycystic ovary syndrome also increase the risk of developing type 2 diabetes. What’s happening? Type 2 diabetes occurs when the body is unable to properly use the insulin that gets released (a phenomenon known as insulin resistance) or when it doesn’t produce enough of the hormone. As a result, sugar accumulates in the blood instead of being used as energy. What should you watch for? Type 2 diabetes is characterized by hyperglycemia, the symptoms of which include: frequent urination, dry mouth, increased hunger and thirst, fatigue and drowsiness, blurred vision, a tingling sensation in the fingers and feet, and slow-healing injuries. At first, this type of diabetes has few, if any, symptoms. That’s why you should be vigilant and see a health professional as soon as possible to know what’s going on. How do you manage type 2 diabetes? It requires a sometimes significant change in lifestyle: adopting a healthy diet and doing physical activity, of course, but also closely monitoring your blood sugar. When a balanced diet and active lifestyle are not enough to maintain normal glucose levels, medication or insulin have to be used. What are the potential complications? Continuously elevated blood sugar levels can damage the heart and blood vessels as well as the eyes and kidneys. Nerve damage can also occur, which means such things as a foot injury, for example, may go unnoticed and worsen. Neuropathies (nerve disorders) can also cause digestive problems or erectile dysfunction. In conclusion Being diagnosed with type 2 diabetes can be destabilizing, to say the least. As you become familiar with the disease and change your habits little by little, you’ll find that it is actually an opportunity to focus on your well-being day after day.  

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Diabetes: A Primer

Glucose, or blood sugar, is an important source of energy, especially for the brain, and insulin is a hormone produced by the pancreas which allows cells to use it and regulates how much of it your blood contains. Diabetes means the pancreas doesn't produce enough, or any, insulin, or that the hormone is not doing its job effectively. This causes blood sugar levels to be too high—a state known as hyperglycemia. Symptoms include: Frequent urination Fatigue or drowsiness Increased hunger and thirst Unexplained weight loss More frequent infections Blurred vision Etc. Those are the symptoms of hyperglycemia. Symptoms of type 1 diabetes can appear progressively or suddenly. Those of type 2 diabetes are so minor that they often go unnoticed for several years. Some figures Prediabetes or diabetes may be diagnosed when blood sugar levels reach the following values:     Prediabetes Diabetes (type 1 or 2) Fasting blood glucose Between 6.1 and 6.9 mmol/L (abnormal fasting blood) 7.0 mmol/L and over Blood glucose two hours after ingesting 75 g glucose* Between 7.8 and 11.0 mmol/L (glucose intolerance) 11.1 mmol/L and over Blood glucose at any given time of day -- 11.1 mmol/L and over + Usual symptoms of diabetes * To diagnose prediabetes or diabetes, physicians will induce hyperglycemia in their patients by having them drink a liquid containing 75 g of glucose.   Types of diabetes  Type 1 diabetes This is an immune system problem that mostly occurs in children and young adults: pancreatic beta cells (those that produce insulin) are attacked and destroyed.  Type 2 diabetes The most common form of diabetes, it is mostly found in adults. Insulin production is insufficient, or the body is resistant to insulin. In both cases, the disease is chronic and incurable. It can be managed, however, through proper nutrition, an active lifestyle and adequate blood sugar monitoring.  Prediabetes Blood sugar is higher than it should be, but it’s not a case of diabetes yet.  Gestational diabetes This type of diabetes occurs late in pregnancy and usually disappears when the baby is born. Prediabetes and gestational diabetes can resolve if measures are taken to stabilize blood sugar, but they are still risk factors for type 2 diabetes. There are other, rarer types of diabetes; in all of those cases, the problem lies with the body’s production or use of insulin. Stubborn myths It is a common misconception that eating too much sugar causes diabetes, or that being overweight or obese will necessarily lead to type 2 diabetes. In fact, genetics weigh heavily in the balance. Of course, a sugar-rich diet can lead to overweight and obesity, which are associated with type 2 diabetes. But an overweight or obese person may very well never develop diabetes, while a person with a healthy weight might. Conclusion You hear the word “diabetes” so often that everyone feels like they know the subject well. However, taking some time to really learn what it’s about can help avoid many problems.  

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Understanding type 1 diabetes

What is it? Type 1 diabetes affects 5 to 10% of people living with diabetes. You may know it as “insulin-dependent diabetes” or “juvenile diabetes.” Yes, type 1 diabetes requires insulin treatment, and yes, it occurs mostly in children and teenagers. But what many people don’t know is that it can develop at any age, and that it unfortunately cannot be prevented. Even today, the exact causes of the disease remain unknown. Genetics can play a role, and some environmental factors, such as viruses, can trigger the onset of the disease. What’s happening? Normally, the pancreas contains beta cells that secrete insulin, the hormone that synthesizes the carbohydrates (sugars) that the body produces or extracts from food. This allows the level of sugar in the blood, also known as “blood glucose,” to remain stable and safe as carbs are converted into energy or stored as fat. But with type 1 diabetes, the immune system attacks and destroys the beta cells to the point where the body no longer receives the insulin it needs. As a result, glucose accumulates in the blood and can cause serious complications—sometimes fatal—if no treatment is undertaken. What should you watch for? Several symptoms can point to type 1 diabetes, including unusual thirst, frequent urination, intense hunger, unexplained weight loss, mood changes, weak spells or blurred vision. In any case, only blood tests in a laboratory can confirm the diagnosis, so it’s important to see a health professional as soon as suspicion arises. How do you manage type 1 diabetes? Type 1 diabetes is first treated with insulin administered daily using a syringe, a pen or a pump. Once a diagnosis is made, the physician and the patient work as a team to determine the type of insulin needed (rapid-acting, short-acting, intermediate-acting, long-acting) as well as the dose and frequency of treatments according to various factors such as age, lifestyle and overall health. This life-saving treatment has other key components: measuring blood glucose using a glucose meter, establishing a proper diet plan, calculating and spreading out carbohydrates, and exercising, for example. What are the potential complications? If it isn’t adequately controlled, type 1 diabetes can bring about consequences such as heart, kidney, eye or mouth disease as well as foot and skin disorders, which is why it should be managed effectively from the outset to prevent such risks. In conclusion Type 1 diabetes is incurable, but fortunately, people living with the disease can still lead a long and fulfilling life. The important thing is to take it one day at a time, seek out information, ask for support and find a good action plan so you can go about your daily activities with diabetes without letting it dictate your life.  

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