Do Not Reproduce

Living with DiabetesLiving with diabetes can be a challenge, but you can stay healthy and live a long life. The key is to have and follow a written action plan that keeps your blood sugar under control. Develop a written plan for your needs with your health care team. As your treatment guidelines change, make changes on your written plan.

Use this calendar to:• Remindyoutofollowyourtreatmentguidelines.• Scheduleandkeeptrackofappointmentswithmembersofyourhealthcare

team for health care visits, tests, and exams.• Notewhenitistimetore-orderyourmedicationsandsupplies.• Keeptrackofyourweight.

Medicine Log.(Recordinpenciltokeepthislistcurrent.)

Medicine Name Dose Frequency Reason to Take

© 2008 American Institute for Preventive Medicine. All rights reserved.

Do Not Reproduce

Telephone Numbers Emergency Contact Name: ___________________ Number: _______________

Health Care TeamPrimary Care Physician: ____________________________________________Endocrinologist: __________________________________________________Dentist: _________________________________________________________Certified Diabetes Educator: _________________________________________Opthalmologist / Eye Doctor: ________________________________________Podiatrist / Foot Doctor: ____________________________________________Pharmacist: ______________________________________________________Registered Dietitian: _______________________________________________Care Specialist: ___________________________________________________

Things I Need to Keep Track of:

_______________________________________________________________

_______________________________________________________________

Do Not Reproduce

December 2008Sun. Tues. Wed. Thurs. Fri. Sat.Mon.

22 Chanukah25 Christmas Day26 Kwanzaa Begins

1 2 3 4 5 6

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30 31

19 Winter Begins

Do you have a written action plan?

________

________

________

________

This is the last month of the year and the beginning of the rest of your life.Use your written action plan and this planner to help you reach goals for controlling your diabetes. These include:• Checking your blood glucose and keeping track of results. • Being physically active.• Following your eating plan for meals and snacks. • Taking your diabetes medications every day.• Keeping track of your weight, physical activities, etc.• Following your sick day guidelines.• Having tests and exams to diagnose and monitor other problems that

affect your diabetes.

Write your weekly weight on the lines given. Do this for every month.Do Not Reproduce

Controlling your weight helps keep your blood sugar under control. If you are overweight, losing 5-10 percent of your weight helps lower your risk for heart disease, stroke, arthritis and other health problems.• Set a goal weight with your health care provider. Write it here: ____ pounds.• Follow your health care provider’s advice for physical activity, diet, and

behavior changes to achieve and maintain a healthy weight.• For children, meal and activity plans may be needed to reduce or prevent

overweight, but ensure proper nutrition for growth.• Record your weekly weight in this pocket planner.• Follow your eating plan’s portion sizes for meals and snacks.

1 2 3

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

Sun. Tues. Wed. Thurs. Fri. Sat.Mon. 1 New Year’s Day 19 Martin Luther King, Jr. Day

January 2009 Do you know your healthy weight?

________

________

________

________

________

Do Not Reproduce

Having diabetes puts you at an increased risk for heart disease and stroke.To help lower the risk, control the “ABCs of Diabetes.”• *A1C (blood glucose average over 3 month’s time). Target numbers for A1C for persons with diabetes are: • < 7 for adults (non-pregnant). • < 7.5 for ages 13-19 years. • < 8 for children ages 6-12 years. • < 8.5 (but > 7.5) for children age 6 years and under.• *Blood pressure. Target blood pressure (BP) goal is < 130 / 80 for most adults

with diabetes. Get your BP tested at every office visit. Test it at home, as advised. • *Cholesterol. (See “Target Blood Fats (Lipids)” at the end of this calendar.)* Follow ABC target goals as advised by your physician.

February 2009Sun. Tues. Wed. Thurs. Fri. Sat.Mon.

1 Groundhog Day 6 Wear Red Day14 Valentine’s Day

16 President’s Day25 Ash WednesdayAmerican Heart Month

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

Have you had your ABC tests?

________

________

________

________

Do Not Reproduce

What you eat and drink plays a major role in controlling your blood sugar.Follow the meal plan for breakfast, lunch, dinner, and snacks as advised by your registered dietitian or health care provider.• Review your meal plan often. Get more information and help from your

registered dietitian, certified diabetes educator, www.diabetes.org, and www.eatright.org.

• Eat meals and snacks at regular times.• Read food labels to guide your choices.• Strictly limit saturated fats. Eliminate trans fats. These may be labeled as

hydrogenated fats or oils in some cookies, chips, etc.• Limit alcohol as advised by your physician.

March 2009Sun. Tues. Wed. Thurs. Fri. Sat.Mon.

8 Daylight Saving Time Begins17 St. Patrick’s Day20 Spring Begins

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30 31

Have you checked your portion sizes lately?

________

________

________

________

Do Not Reproduce

Regular exercise helps control your blood sugar and weight.It improves blood cholesterol, blood pressure, and heart disease risk, too.• In general, adults should do at least 150 minutes a week of moderate-

intensity aerobic physical activity.* Children and teens should be physically active, as advised by their physicians.

• Adults should do resistance exercise 3 times a week.*• When you exercise, have a carbohydrate source with you. Examples are:

4 oz. fruit juice, 6 hard candies, 1 tube Glucose gel, or 3 or 4 Glucose tablets.Always talk to your physician before beginning or changing an exercise program.* Source: Standards of Medical Care in Diabetes 2008; American Diabetes

Association.

April 2009Sun. Tues. Wed. Thurs. Fri. Sat.Mon.

1 April Fool’s Day 9 Passover10 Good Friday

1 2 3 4

5 6 7 8 9 10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 12 Easter22 Earth Day

Remember to track your daily exercise.

________

________

________

________

Do Not Reproduce

Controlling your blood sugar and blood pressure lowers your risk for stroke.• Follow your diabetes written action plan for diet, exercise, and medications.• Take your medications, as advised.• Keep a current list of your diabetes and other medications. List over-the-

counter medicines, vitamins, minerals, and other supplements, too. When you have a change in medications, update the list.

• To help remind you to take your medications, use pill containers, a daily checklist, or this planner.

• Let your health care provider know if and why you don’t take your medications.

May 2009Sun. Tues. Wed. Thurs. Fri. Sat.Mon.

1 2

3 4 5 6 7 8 9

10 11 12 13 14 15 16

17 18 19 20 21 22 23

24 25 26 27 28 29 30

31

25 Memorial DayHigh Blood Pressure Awareness Month

5 Cinco de Mayo10 Mother’s Day16 Armed Forces Day

Always carry a list of all your medications.

________

________

________

________

________

Do Not Reproduce

June 2009Sun. Tues. Wed. Thurs. Fri. Sat.Mon.

1 2 3 4 5 6

7 8 9 10 11 12 13

14 15 16 17 18 19 20

21 22 23 24 25 26 27

28 29 30 8-14 Men’s Health Week14 Flag Day21 Father’s Day; Summer Begins

Remember to check your feet daily.

________

________

________

________

Take good care of your feet.• Do not go barefoot indoors or outdoors, even when you walk in the sand.• Wear shoes and slippers that fit well. Wear cotton or wool socks.• Wash your feet daily with soap and warm water. Dry them well, especially

between the toes. If your skin is dry, apply lotion, but not between the toes. • Keep toenails trimmed. If it’s hard for you to do this, have a foot specialist

trim them. See a podiatrist (foot physician) regularly.• Inspect your feet daily for cracks, cuts, redness, sores, or swelling. Use a

mirror to look at the bottom of your feet. Ask for help, if you need it. • Let your health care provider know about any foot problems.• At every health visit, remove your shoes and socks and get your feet examined.

Do Not Reproduce

July 2009Sun. Tues. Wed. Thurs. Fri. Sat.Mon.

4 Independence Day 1 2 3 4

5 6 7 8 9 10 11

12 13 14 15 16 17 18

19 20 21 22 23 24 25

26 27 28 29 30 31

Do you need to schedule an eye exam?

________

________

________

________

Protect your vision.• Keep your blood sugar and blood pressure under control to help prevent

damage to tiny blood vessels in the retinas of your eyes. Blindness can occur if the damage is left untreated. Finding eye problems early and getting treatment right away helps prevent more serious problems.

• See an eye physician at least once a year to have a dilated retinal eye exam.* He or she will put drops in your eyes to dilate your pupils to help see the backs of your eyes and look for signs of problems.

• Call your eye physician right away if you have any vision problems.* CheckyourplandocumentsorcallCustomerServiceforyourspecificplan’s

coverage.

Do Not Reproduce

Sun. Tues. Wed. Thurs. Fri. Sat.Mon. 1

2 3 4 5 6 7 8

9 10 11 12 13 14 15

16 17 18 19 20 21 22

23 24 25 26 27 28 29

30 31

22 Ramadan Begins

August 2009 Schedule time to relax.

________

________

________

________

________

Manage stress to help keep your blood glucose under control.Ways to DE-STRESS:• Develop a personal exercise plan with your physician.• Express your creative side. Write. Paint. Join a book club.• Stretch muscles to relieve tension.• Take deep breaths. Meditate.• Relax with soothing music, a warm (not hot) bath or shower, and relaxation

exercises, such as deep breathing.• Enjoy a massage.• Sip a cup of warm, herbal tea.• Share your feelings with others.

Do Not Reproduce

Sun. Tues. Wed. Thurs. Fri. Sat.Mon. 1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30

September 2009 1 Labor Day21 Ramadan Ends21 Autumn Begins

28 Yom Kippur

Get more information from www.jdrf.org

________

________

________

________

Back-to-School Checklist:qGive updated, written diabetes care plan copies to your child, the school

nurse, teachers, coaches, and the school office. qDiscuss how your child’s needs will be met for glucose testing; insulin;

storage of medication, supplies, and snacks; physical activity; special events; and after-school activities.

qDecide how to meet your child’s meal plan needs with cafeteria foods and ones brought from home.

qPrepare kits of supplies, as needed, to be kept in classrooms, the nurse’s and principal’s offices, and available to the coach.

qPlan how to communicate about emergencies and day-to-day concerns.

Do Not Reproduce

Sun. Tues. Wed. Thurs. Fri. Sat.Mon. 1 2 3

4 5 6 7 8 9 10

11 12 13 14 15 16 17

18 19 20 21 22 23 24

25 26 27 28 29 30 31

12 Columbus Day31 Halloween

National Breast Cancer Awareness MonthHealthy Lung Month

October 2009 Have you gotten your flu shot?

________

________

________

________

________

Protect yourself from the flu and pneumonia.People who have diabetes are more likely to be sicker longer and have more serious health problems when they get the flu or pneumonia.• Get a yearly flu vaccine* (if not contraindicated). Get information from the

CDC at www.cdc.gov/flu or 1.800.CDC.INFO (232.4636).• Wash your hands often. Keep them away from your nose, eyes, and mouth.• Use alcohol-based hand rubs when you can’t wash your hands.• Avoid contact with persons and their things when they have the flu.• Get a pneumonia vaccine* as advised by your physician.* CheckyourplandocumentsorcallCustomerServiceforyourspecificplan’s

coverage.

Do Not Reproduce

Sun. Tues. Wed. Thurs. Fri. Sat.Mon.

1 Daylight Saving Time Ends 3 Election Day26 Thanksgiving Day

American Diabetes Month

1 2 3 4 5 6 7

8 9 10 11 12 13 14

15 16 17 18 19 20 21

22 23 24 25 26 27 28

29 30

November 2009 Schedule screenings you have not yet had.

________

________

________

________

It’s not too late for screenings and exams. You still have time left this year.Check off, below, if you have had all your screenings.* qA1C test.qDilated retinal eye exam.qUrinary protein / microalbumin test.qBlood pressure screening.qCholesterol screening.qSerum creatinine test.qRegular dental checkup.* CheckyourplandocumentsorcallCustomerServiceforyourspecificplan’s

coverage.

Do Not Reproduce

Sun. Tues. Wed. Thurs. Fri. Sat.Mon. 1 2 3 4 5

6 7 8 9 10 11 12

13 14 15 16 17 18 19

20 21 22 23 24 25 26

27 28 29 30 31

December 2009

25 Christmas Day26 Kwanzaa Begins31 New Year’s Eve

12 Chanukah19 Winter Begins

Call your Care Specialist for healthy tips.

________

________

________

________

Plan for the hectic holidays.• Plan for changes in meals, exercise, daily activities, etc.• Choose foods wisely. Bring your own snacks and foods, as needed.• You may need to monitor your blood sugar more often.• If traveling by plane, carry your insulin and other medications; syringes;

glucagon emergency kit; and self-testing equipment with you at all times. • If traveling by car, check your blood sugar before you begin. If it is lower

than 100 mg/dL, have something to eat or drink to raise your blood sugar. • Have a quick sugar source within easy reach at all times.• If you do not feel well, contact your health care provider. Don’t put it off

until next year because you are too busy.

Do Not Reproduce

Symptoms of Hypoglycemia (Low Blood Glucose)*• Hunger. • Sweating.• Confusion. • Irritability.• Anxiousness. • Dizziness.• Blurred vision. • Extreme fatigue.• Slurred speech. • Slow reaction time.• Rapid heartbeat. • Assistance is needed.

Options for consuming 10 to 20 grams of carbohydrates or sugar to treat hypoglycemia (low blood glucose) include:• Four ounces of regular sweetened fruit juice, such as orange,

apple or grape juice. Avoid grapefruit juice, if possible.• Six ounces of regular soda.• Six Life Savers candies.• One tube of glucose (Glutose) = 15 grams per tube.• Three to four glucose tablets = 4 or 5 grams per tablet.• Two to three teaspoons of sugar or honey.

* For symptoms of hypoglycemia, follow your diabetes action plan and consult your physician as directed.

Symptoms of Hyperglycemia (High Blood Glucose)*• Headache. • Increased thirst.• Increased urination. • Fruity breath.• Blurred vision. • Weakness.• Increased appetite. • Rapid heartbeat.• Stomach pain. • Dry mouth.• Hiccups. • Weight loss.

To avoid or address hyperglycemia (high blood glucose):• Identify your target blood glucose levels and maintain them.• Monitor your blood glucose regularly. For example: Before meals, after

meals, at bedtime.• Exercise, follow your meal plan and take your medication as prescribed.• Increase insulin dose or take extra doses as needed, per your physician’s

direction.• If symptoms persist, call your physician.

* For symptoms of hyperglycemia, follow your diabetes action plan and consult your physician as directed.

Do Not Reproduce

Health Tests & ExamsThese are general guidelines for adults.* Follow your physician’s advice for tests and exams. For your child, follow his/her physician’s advice for tests and exams.

Exam or Test How Often**

Checkup At least 2 times a year.

Blood pressure and weight Every office visit. Test at home as advised.

Dental exam 2 times a year.

Cholesterol blood test (fasting lipids) 1-2 times a year as advised.

Foot exam Every 2-3 months.

Blood test for A1C 2 times a year; more often if not at target goal or you have a change in medication therapy.

Urine test for protein (microalbumin) Yearly.

Blood test (serum creatinine) Yearly.

Flu vaccine Every year during flu season.

Pneumonia vaccine 1 or 2 lifetime doses as advised.

Dilated retinal eye exam Yearly.

Breast exam by physician or nurse Every 3 years (ages 18-40); yearly (age 40 +).

Pap test Every 1-3 years to age 65; as advised age 65+.

Chlamydia screening Discuss with your physician.

Mammogram Every 1-2 years age 40+ as advised.

Osteoporosis screening Starting at age 65 (60 if at increased risk for fractures) as often as advised.

Colorectal cancer screening Starting at age 50 or as advised.

Prostate cancer screening As advised by your physician.

Abdominal aortic aneurysm screening Once for men age 65-75 who have ever smoked.

* Sources: 1 The Guide to Clinical Preventive Services, 2008, Recommendation of the U.S. Preventive Service Task Force.

2 Standards of Medical Care in Diabetes 2008; American Diabetes Association** Check your plan documents or call Customer Service for your specific plan’s coverage.

W

O

M

E

N

MEN

Do Not Reproduce

Helpful Web SitesAmerican Diabetes Association | www.diabetes.org

American Dietetic Association | www.eatright.org

American Heart Association | www.americanheart.org

Children with Diabetes Online Community | www.childrenwithdiabetes.com

Juvenile Diabetes Research Foundation International | www.jdrf.org

National Council on Alcohol and Drug Dependence | www.ncadd.org

National Institute of Diabetes & Digestive & Kidney Diseases | www.niddk.nih.gov

National Institutes of Health | www.nih.gov

National Kidney Foundation | www.kidney.org

National Safety Council | www.nsc.org

Smokefree.gov | www.smokefree.gov

Do Not Reproduce

Living with DiabetesLiving with diabetes can be a challenge, but you can stay healthy and live a long life. The key is to have and follow a written action plan that keeps your blood sugar under control. Develop a written plan for your needs with your health care team. As your treatment guidelines change, make changes on your written plan.

Use this calendar to:• Remindyoutofollowyourtreatmentguidelines.• Scheduleandkeeptrackofappointmentswithmembersofyourhealthcare

team for health care visits, tests, and exams.• Notewhenitistimetore-orderyourmedicationsandsupplies.• Keeptrackofyourweight.

Medicine Log.(Recordinpenciltokeepthislistcurrent.)

Medicine Name Dose Frequency Reason to Take

© 2008 American Institute for Preventive Medicine. All rights reserved.

Do Not Reproduce