FOR PEOPLE WITH DIABETES€¦ · When you have diabetes, you have too much glucose in your bloodstream. When you consume sweetened foods and carbohydrates (breads, pasta, etc), the

This health information is being provided for general educational purposes only. Your health care provider is the single best source of information regarding your health. Please consult your health care provider if you have any questions about your health or treatment.

FOR PEOPLE WITH DIABETES

Living a Healthier Life

Remember–you are the center of a healthier life with diabetes.

All the elements of good care begin and end with you.

TABLE OF CONTENTSKnowing Your Diabetes Terms . . . . . . . . . . . . . . . . . . . 3

A Circle of Help to Live a Healthier Life . . . . . . . . . . . 4

Diabetes, Glucose, and Insulin . . . . . . . . . . . . . . . . . . . 5

Types of Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

Type 1 & Type 2 Diabetes . . . . . . . . . . . . . . . . . . . . . . . 7

Gestational Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

High and Low Blood Glucose . . . . . . . . . . . . . . . . . . . . 9

Symptoms of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9

What to Do About Low Blood Glucose . . . . . . . . . . . 10

A 2- to 3-Month Look—the A1C Test . . . . . . . . . . . . . . 11

Physical Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12

Taking Your Medicine . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

Coping With Stress . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Injections . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14

Traveling With Diabetes . . . . . . . . . . . . . . . . . . . . . . . . 15

Managing Your Diabetes . . . . . . . . . . . . . . . . . . . . . . . . 16

Myths About Type 2 Diabetes and Insulin . . . . . . . . . 17

KNOWING YOUR DIABETES TERMS

QUICK DEFINITIONS

Term What It Means How It Affects You

A1C(also called

HbA1C)

A test your health care provider gives. Shows the glucose level in your blood over the last 2-3 months.

Lowering your A1C may lessen problems caused by diabetes. Discuss your A1C level with your health care provider.

Diabetes

A disease that occurs when your body cannot use or produce insulin as it should. It is a chronic illness that requires medical care and self-management.

If not controlled, diabetes may lead to serious healthproblems. You can take steps to help control blood glucose and lower the risks ofcomplications.

Glucose

A type of sugar found inyour blood that is the body’s main source of energy.

Treating diabetes is based on balancing insulin and glucose levels in the blood.

Insulin

A hormone that helpsyour body use blood glucose for energy.

Without insulin, glucose cannot go to your cells.

Type 2Diabetes

The most-common form of diabetes. Formerly called “adult-onset diabetes,” but you can get it at any age.

Being overweight or inactive increases your chances of getting diabetes.

L i v i n g a h e a l t h i e r l i f eF O R P E O P L E W I T H D I A B E T E S2 3

A Circle of Help to Live a Healthier Life

All the elements of good care begin and end with you.

You Have DiabetesFor many people, receiving this diagnosis can create questions,

concerns, and anxiety; and that’s no surprise. Diabetes often seems like it is a great unknown. But you are not alone. Thanks to recent

advances, managing diabetes—and its effects on your health—is a goal within reach, especially if you work closely with your health care team.

Educating yourself is a good start, as you learn about what diabetes is and the importance of controlling the amount of sugar (also called glucose) in your bloodstream. You will also discover how managing your diet, physical activity, stress, and medicine all work together to

help control blood glucose

YOU

Monitor andRecord Your

BloodGlucose Level

Talk To andVisit Your

Health CareTeam Regularly

Reduce theRisk of DiabetesComplications

BePhysically

Active

Take YourMedicine asPrescribed

Plan YourMeals

Diabetes, Glucose, and InsulinWhen you have diabetes, you have too much glucose in your bloodstream. When you consume sweetened foods and carbohydrates (breads, pasta, etc), the body breaks them down into sugars.

Here’s what happens:

You eat, and the food breaks down into sugar, or glucose. This glucose goes into your bloodstream.

Your body senses that blood glucose levels are rising. It tries to produce insulin, which normally moves glucose from the bloodstream into the cells, where it is used for energy.

Your body cannot produce enough insulin or cannot use the insulin it does produce.

Without enough insulin, the extra glucose stays in your bloodstream instead of going into your cells, building to a level that is higher than normal.

Your cells don’t get the energy they need, and the higher level of glucose in your blood puts you at risk for the complications of diabetes.

1

2

3

4

5


A1C

DIABETES

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6.5%

6.4%

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5.7%>−

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5.7%<

DIABETES

PRED

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126 mg/dL

125 mg/dL

>−

100 mg/dL>−

<

100 mg/dL<

FPG

DIABETES

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200 mg/dL

199 mg/dL

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140 mg/dL>−

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140 mg/dL<

OGTT(Oral Glucose

Tolerance Test)(Fasting Plasma

Glucose)(Primary test used for

diabetes management)

Type 1 Diabetes is usually diagnosed in children and young adults. Type 1 diabetes is when the body does not produce enough insulin. Insulin is a hormone that is needed to convert glucose, starches, and other foods into energy. If you have type 1 diabetes, insulin injections are needed to control your blood glucose.

Risk Factors• A family history (also called a genetic tendency)

• Immune system irregularities

• Chemical reactions in the body

• Recent sickness caused by some type of viruses

Prediabetes. Before a patient gets type 2 diabetes, they almost always have prediabetes. This is when blood glucose levels are higher than normal, but not high enough to be diagnosed as diabetes.

Your health care provider may refer to prediabetes as impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) depending on what test was used when it was detected. If you have prediabetes, you are at higher risk of developing type 2 diabetes and cardiovascular disease.

Types of Diabetes


Type 2 Diabetes is the most common form of diabetes. It is when your body does not use insulin properly (also called insulin resistance). Your pancreas makes extra insulin at first, but then, over time, can’t keep up and is unable to produce enough insulin. Type 2 diabetes is managed by lifestyle changes in diet, exercise, stress levels, and medications for diabetes.

Risk Factors for developing type 2 diabetes, all quite different from those of type 1• Women who have given birth

to a baby that weighs over 9 pounds

• A family history of diabetes, or being from ethnic groups more prone to diabetes (Asian American, African American, Latino, Native American, and Pacific Islander backgrounds)

• Being overweight

• Age 45 and older

• An inactive lifestyle

Gestational Diabetes occurs around the 24th week of pregnancy and usually goes away after the birth. In gestational diabetes, the mother’s increased levels of hormones may change the way her body normally responds to insulin. It appears only in women who have never had type 1 or type 2 diabetes and increases the chance of developing type 2 diabetes in the future.

If you have diabetes, getting your blood glucose under control and keeping it that way is an important goal. Sometimes, people don’t even realize that their blood sugar level has changed (too high or too low), because they don’t feel anything or experience any immediate symptoms. It is important that patients with diabetes check their blood glucose levels regularly.

Keeping your blood glucose at a healthy level—daily and over the long term—can help you reduce your risk of developing diabetes related complications. Together, with your health care team, you can learn to take special care of yourself.

Symptoms of…

High Blood Glucose (Hyperglycemia)

• Getting up at night to go to the bathroom

• Increased thirst• Increased hunger• Moodiness• No energy• Irritable• Tired• Depressed

Low Blood Glucose (Hypoglycemia)

• Shakiness• Dizziness• Sweating• Hunger• Headache• Seizure• Tingling sensations around

the mouth• Pale skin color• Sudden moodiness or

behavior changes, such as crying for no apparent reason

• Clumsy or jerky movements• Difficulty paying attention,

or confusion

Types of DiabetesHigh and Low Blood Glucose


If you think you have low blood glucose, test your blood. If your blood glucose is below 70 mg/dL, most health care providers want you to treat it with some form of sugar or simple carbohydrate.

Then, test your blood glucose again 15 to 20 minutes later. If it is still low, repeat the above steps.

Blood glucose levels that are high for a long time can cause medical problems down the road.Keeping your blood glucose at a healthy level—daily and over the long term—can help you reduce your risk of developing diabetes-related complications. Together, with your health care provider and health care team, you can learn how to take special care of your eyes, feet, and heart, and ways to combat everyday illness. You’ll also discover new, healthy ways of eating and how to build exercise into your day. Smoking is particularly dangerous for people with diabetes. If you smoke, consider discussing ways to quit with your health care team.

An A1C is a blood test done by your health care provider or in a lab. The result shows your average blood glucose level over the past 2 to 3 months. An A1C over 8% (average blood glucose is 183) means your average blood glucose—counting both before meals and after meals—has been over 200 mg/dL. You should discuss your A1C goals with your health care provider. Many patients with diabetes may have an A1C goal of less than 7%. However, your individual goal may be more or less depending on your age and/or health history. For example, some seniors may have a goal of less than 8% depending on health history.

Talk to your health care provider about your A1C level. If you are not sure whether your health care provider is doing an A1C test, ask about it. Find out what your numbers are. Keep a record of them to track your progress and how well you are doing. Cigna Medical Group recommends to have the A1C test at least two times every year to help make sure of good control.

Did you know...the glucose in your blood

goes up when you eat. How much it goes up

depends on:

The amount you eat

What you eat

The amount of insulin your body produces in

response to food

What to Do About Low Blood Glucose

A 2-to 3-Month LookThe A1C Test

High and Low Blood Glucose

Some choices are• 3 to 4 glucose tablets (check

the Nutrition Facts label for carbohydrates per tablet; most tablets are 4-5 grams—at least 15-20 grams are needed). Note: this is a good, quick source of glucose.

• ½ cup (4 oz) of juice or regular soda (not diet)

• 8 ounces of nonfat or 1% milk

• 2 tablespoons of raisins

• Hard candies, jellybeans, or gumdrops (see package to determine servings size)

• 1 tablespoon of honey, sugar, or corn syrup


Regular exercise plays a big part in keeping your blood glucose under control, in helping to reduce the risk of complications, and in keeping you healthier.

Exercise Lowers Your Blood Glucose Levels Blood glucose is stored in muscles. When you are active, your muscles work harder, and, as they work, they use the stored blood glucose. As the blood glucose stored in muscles runs low, blood glucose is “pulled” from the blood to be used as energy.

Watching what you eat and exercising regularly are basic steps to managing type 2 diabetes. If diet and lifestyle changes alone are not enough, your health care provider may prescribe medicines which are also powerful tools in controlling your blood glucose. When you first start on your diabetes medication, your health care provider may need to adjust the type or dose until the treatment that works best for you is found. Your particular treatment plan may work well for months or years. However, over time your diabetes may progress and your health care provider may need to make a change. This happens in diabetes—and it does not mean that you’ve done anything wrong.

Diabetes medications that your health care provider prescribes can help control your blood sugar in different ways.

Some medicines may:• Help your body’s insulin work

more effectively

• Increase the amount of insulin your body produces

• Slow the breakdown of the sugars and starches you eat

• Reduce the amount of glucose your liver releases

Diabetes medications help your body make more insulin, or use it better. Over time, your body makes less insulin, and you may need to add another oral medication or insulin to treat your diabetes.

Physical Activity Taking Your Medicine

If you do not exercise regularly, start slowly—but do start. Try working up to 30 minutes of activity, 5 times a week. Make it part of your ordinary routine—when you go to the mall, park far away; use the stairs instead of the elevator; when you mop or garden, do it with gusto!

150 minutes of moderate-intensity aerobic exercise per week (brisk walking is recommended).


Everyone is stressed from time to time—the grocery line is too long, nobody listens, the job is hectic—and you have diabetes, an added stress. These pressures can affect your blood glucose in many ways.

On a normal day, your blood glucose rises in response to stress. And that’s just on a normal day! An extraordinary day—you’re moving, starting a new job, visiting family—these can cause even more stress. Many people react to stress by eating more or eating less wisely, by exercising more or exercising less, causing blood glucose to go up and down in an uncontrolled way. Even getting sick can be stressful to your body and can send your blood glucose out of control. Since there’s no hiding from all stress, it’s important to find a way to handle it. Decide on an action plan with your health care provider to handle stress. See a counselor to discuss problems. Consider exercise! Having a plan to combat stress is the best defense against it.

InjectionsYour health care provider may prescribe insulin injections to keep your blood glucose from getting too high. The extra insulin replaces the insulin your body is no longer making naturally, or is unable to use effectively. Patients with type 1 diabetes only take insulin. However, patients with type 2 diabetes may take insulin along with other diabetes medicines.

It is important to plan and prepare for your trip whether you are driving, cruising, or flying. If you are planning a long trip, schedule an appointment with your health care provider.

You May Need…• Immunization shots (if you are leaving the country)

• A letter explaining your medication, if you have allergies, or have food sensitivities

• A prescription for any medication or devices you are taking

• Medical ID (worn as a bracelet or necklace) in case of an emergency

What to Pack• Twice as much medication as you need, and always keep your

medication and supplies with you in your carry-on bag

• Blood and urine testing supplies (batteries for all meters)

• Other medications or medical supplies (antidiarrheal, antinausea drugs)

• Well-wrapped airtight snacks, hard candy, or glucose tablets

Other Tips• If you are flying, request a special low-sugar, low-fat, or low-

cholesterol meal before your flight (check with the specific airline for options and advance notice requirements)

• If crossing time zones, consult with your health care team about the timing of your insulin injections while you travel

• Check your medication amounts at least 1 week prior to leaving – Work with your pharmacist to ensure you have enough for your trip

Traveling with DiabetesCoping With Stress


Remember toq Test your blood glucose (A1C) as directed

q DO NOT smoke. If you do smoke, discuss ways with your health care provider to help you quit.

q Examine your feet daily for cuts, calluses, and ulcers

q Take your medications as prescribed

q Work with your health care team to monitor your ABC’s (A1C, blood pressure, cholesterol)

q Make healthy lifestyle choices with your diet

q Get regular diabetic retinal eye exams

q Set an exercise goal and make a plan

q Discuss with your health care team: any symptoms you have had of low or high blood glucose, your daily blood glucose diary, a list of your physical activity, a list of foods eaten and medication taken

q Check and maintain a healthy weight

q Work with a diabetes educator

q Check your cholesterol and blood pressure levels

Below is a helpful list detailing some of the things you can do to help manage your diabetes. Begin by checking off what you’ve already been doing and review the next steps you can take to achieve your diabetes goals. Review this list in a week or so to see how many more things you can now check. Remember, even one or two things can make a big difference in managing your diabetes.

Managing Your Diabetes Myths About Type 2 Diabetes and Insulin

Myth 1: Insulin will make me gain weight.

Fact: People may put on weight when they start taking insulin because allows glucose to move from the bloodstream to the body’s cells where it can be used as energy. Following a healthy meal and exercise plan may help keep you from gaining excess weight.

Myth 4: Insulin is addictive.

Fact: Insulin is not addictive like narcotics. It replaces a hormone your body once made naturally.

Myth 2: Taking insulin means I’ve failed with pills or my diabetes is getting worse.

Fact: Diabetes is a progressive disease. Over time, some people who start on pills may need to add insulin later to help control their blood glucose. Everyone’s body is different. Your HCP will work with you to determine what works best for you.

Myth 3: Injecting insulin is very painful and will interfere with my schedule.

Fact: The insulin needle is small and thin. Insulin is injected into the fatty layer just under the skin, where there are fewer nerve endings. Many patients taking insulin say it has become a part of their daily routine.

It is not always easy to separate myths from facts, especially when it comes to your health. But knowing the truth about diabetes and insulin may help you manage your blood glucose. This information is not a substitute for professional medical care. Only your health care provider can diagnose and treat a medical problem.

Sources – American Diabetes Association (ADA) & Stop Diabeteswww.diabetes.org | www.stopdiabetes.com


NOTESNOTES


Cigna Medical Group (CMG) is the medical group practice division of Cigna HealthCare of Arizona, Inc. All CMG services are provided exclusively by or through Cigna HealthCare of Arizona Inc., and not by Cigna Corporation. The Cigna Medical Group name, logo, and other Cigna marks are owned by Cigna Intellectual Property, Inc.

05/19 © 2019 Cigna. Some content provided under license.

Whether you have just been diagnosed with diabetes or have had it for a long time, there is a lot you can learn about diabetes

to help you live as healthy as possible. After all, the more you know the better you can control it.

Additional Resources

Self-help diabetes education resourcesNational Institute of Diabetes and Digestive and Kidney Diseases1.800.860.8747 NIDDK.NIH.gov

National Diabetes Education Programs:Diabetes HealthSenseAn online resource for living well. YourDiabetesInfo.org/HealthSense

Academy of Nutrition and Dietetics1.800.877.0877 eatright.org

American Association of Diabetes Educators1.800.338.3633 diabeteseducator.org

American Diabetes Association1.800.DIABETES (1.800.342.2383) diabetes.org

Quick tips:Diabetes is more common than

most people realize because many people will not talk about it.

Take your medications every day as recommended by your doctor.

Be active every day to help keep your blood glucose down. Walking is a

good form of exercise.

Learn to eat right and avoid sugary foods. Focus on eating lots of fruits, vegetables and lean meats, such as

fish, chicken and turkey.

Stop smoking – it causes poor blood circulation.

Talk with your doctor about how to check your blood glucose and what to do when it is too low or too high.

Get your eyes checked every year to help protect your vision.

The websites to the right have much more information about

diabetes. So start learning, and take control of your diabetes instead of

letting it control you.

Sources – American Diabetes Association (ADA) & Stop Diabeteswww.diabetes.org | www.stopdiabetes.com

Documents

FOR PEOPLE WITH DIABETES€¦ · When you have diabetes, you have too much glucose in your bloodstream. When you consume sweetened foods and carbohydrates (breads, pasta, etc), the