From the world-famed Joslin Diabetes Center, here is the definitive guide to diabetes self-care--an indispensable resource for everybody with the disease. The center, affiliated with Harvard Medical School, is considered the preeminent diabetes research facility in the nation.

Richard S. Beaser, M.D., is a widely acclaimed diabetes author, lecturer, and clinician, the Chairman of the Patient Education Committee at the Joslin Diabetes Center in Boston, and Assistant Clinical Professor of Medicine at Harvard Medical School. He lives in Newton, Massachusetts.

Preface

ix

Join the Team!

1

(6)

PART ONE UNDERSTANDING DIABETES

Deciphering Diabetes: What Type of Diabetes Do You Have?

7

(15)

Goals and Tools for Treatment

22

(11)

PART TWO TREATING DIABETES WITH NUTRITION THERAPY AND PHYSICAL ACTIVITY

Nutrition and Meal Planning Basics

33

(29)

More About Carbohydrate

62

(17)

Heart-Healthy Eating

79

(10)

Dining Out

89

(10)

Losing Weight---Gaining Control

99

(22)

Physical Activity and Fitness Basics

121

(12)

Exercising Safely with Type 1 Diabetes

133

(10)

Successfully Making Lifestyle Changes

143

(10)

PART THREE MONITORING AND TREATING DIABETES WITH MEDICATIONS

Glucose Monitoring

153

(18)

Diabetes Pills

171

(12)

Insulin Basics

183

(22)

Physiologic Insulin Treatment

205

(15)

Insulin Pumps

220

(9)

PART FOUR ADJUSTING YOUR TREATMENT PROGRAM

Adjusting for Low Blood Glucose (Hypoglycemia)

229

(14)

Adjusting for High Blood Glucose (Hyperglycemia)

243

(12)

Managing Diabetes When You Are III

255

(13)

Long-Term Complications of Diabetes

268

(24)

Foot Care

292

(11)

PART FIVE SPECIAL CHALLENGES OF DIABETES

Diabetes in Children and Adolescents

303

(24)

Diabetes and Pregnancy

327

(17)

Sexual Issues

344

(13)

PART SIX LIVING WELL WITH DIABETES

Living Well with Diabetes As an Older Adult

357

(6)

Coping with Diabetes

363

(11)

Traveling with Diabetes

374

(10)

Good Diabetes Care: What Is It? ... How to Get It

384

(11)

Appendix: Food Choice Lists

395

(4)

Diabetes Words and Phrases

399

(12)

Index

411

What is included with this book?

The New copy of this book will include any supplemental materials advertised. Please check the title of the book to determine if it should include any access cards, study guides, lab manuals, CDs, etc.

The Used, Rental and eBook copies of this book are not guaranteed to include any supplemental materials. Typically, only the book itself is included. This is true even if the title states it includes any access cards, study guides, lab manuals, CDs, etc.

chapter 1

Join the Team!

When you have diabetes, you become a member of a very important team. Teams need players and coaches, and, in many ways, having diabetes is similar. It's hard to manage diabetes alone. You need a coach or coaches to help you learn the skills necessary to do the very best you can and to help guide your skill development. Others, such as family members, significant others, and friends, cheer your successes and provide support when things are not going well. But coaches and others can't do it for you.Youhave to learn about diabetes and be the one who controls your health and your diabetes care.

The first step in joining the team is to acquire the skills you need. Any time you want to learn about a medical problem or condition, it helps to approach it in two steps. First, learn how the body functions normally. Then learn what happens when something goes wrong. This is the best way to learn about diabetes too.The Joslin Guide to Diabeteswill help you learn how your body works -- what happens to it when you have diabetes -- and how to keep your body working as normally as possible.

If you have been diagnosed with diabetes, you may wonder: "Why doIneed to know about diabetes? After all, isn't my doctor the one responsible for my treatment?" The answer to this isn't as simple as it seems. The care provided by your doctor and your healthcare team is a very important part of managing diabetes. But to properly control your diabetes, you are the one who must be primarily responsible.

You will also need to know your treatment goals and how to achieve them. For many individuals this may mean acquiring some new skills so you can put into action the information you have learned. This action plan is called yourdiabetes treatment program.However, you also need coaches. That's where your healthcare team becomes important. It can help you take the information, goals, and skills you gain from reading and practicing and put them into an individual "game plan."

And once you understand the importance of a treatment program and your role in carrying it out, you're on the way to being a successful team player. The other players are only there to assist you to do the best you can. They are important because they have a lot to share with you.

Diabetes -- an Old Disease,

but Many New Remedies

Medical descriptions of diabetes date back to at least 1500 B.C., more than 3,500 years ago. Writings from ancient cultures in China and the Middle East describe the classic signs of diabetes, such as passing large quantities of urine through the body. The ancient Greeks gave us the namediabetes,which means "to flow through." Later the Latin wordmellitus(meaning "sweet urine") was added to form the present medical namediabetes mellitus.Physicians actually diagnosed diabetes in ancient times by tasting the urine, but modern physicians have developed newer methods to accomplish this!

Until recent times, people with diabetes could use only diet, exercise, or weight control for treatment. But in 1921, a major breakthrough occurred that changed the outlook and saved the lives of millions of individuals with diabetes -- insulin was discovered. Later in this book you will learn a lot about how insulin is used today. Research in diabetes has continued to make major strides. In the late 1970s it became possible for someone to check his or her blood glucose without the help of a doctor or nurse -- one of the most important advances in the care of diabetes since the discovery of insulin. Once self-monitoring of blood glucose became available, research studies of people with type 1 and type 2 diabetes were undertaken, and these studies proved that controlling one's blood glucose makes a difference. By maintaining near-normal blood glucose levels, you can prevent or slow the progression of the long-term complications of diabetes. These include problems with the eyes, nerves, kidneys, feet, skin, heart, and blood vessels. The list of advances in diabetes management goes on and on, and all of them help you to gain increased control of your diabetes and thus reduce the risk of developing complications.

Discovering Your Diabetes

If you think back to the time just before you learned you had diabetes, you may have noticed some physical symptoms and some changes in your health. For example, you may have felt very tired and sluggish because your body was unable to properly use food for energy. For some of you, the symptoms were severe enough to cause you to see your doctor to find out what the cause was. For others of you, the symptoms were mild and you had little reason to suspect anything was wrong. But what is important is that at some point you discovered you have diabetes and now you want to learn more about it.

No doubt, you felt some type of stress even before the diagnosis of diabetes. And once you realized that you had diabetes, the stresses associated with its symptoms probably didn't go away. Questions occurred to you, such as How did this happen? What causes diabetes? Can it be cured? How will it affect my daily life? Can I keep my job? What will it cost? What lies ahead? Will I still be healthy enough to do the things in life that I enjoy? Such questions are steps in the right direction. They mean you are concerned about your health. To help you with your feelings about diabetes, it's often a good idea to find someone in whom you can confide -- perhaps your physician, a healthcare professional, a family member, or a good friend.

It is extremely important that you gain a complete understanding of diabetes and methods of treatment. Diabetes is a uniquely personal condition. At first you may ask yourself, "Can I really handle this?" But your skills and confidence will grow as the weeks pass and as you learn about and have more experiences living with diabetes. Understanding diabetes will happen over time -- you don't have to learn it all at once. However, by becoming more actively involved in your diabetes management, you will feel more confident about your own ability to solve problems, less angry and fearful about diabetes, and more motivated to keep up the effort.The Joslin Guide to Diabeteswill help you develop that confidence.

This book is designed to be used as a reference tool for people with diabetes who are under the care of a physician and other healthcare professionals. It was written and reviewed by a team of experts in the field of diabetes care and education here at Joslin Diabetes Center in Boston, Massachusetts. Founded in 1898 by Elliott P. Joslin, M.D., a pioneer in diabetes research and care, Joslin Diabetes Center is affiliated with Harvard Medical School and has treated over a quarter of a million people with diabetes. Healthcare providers and educators at Joslin are dedicated to making sure that people with diabetes have the very latest information and know how to use this information to improve their diabetes care. We want you to live healthfully and well with diabetes, and we think this book will help.

Excerpted from The Joslin Guide to Diabetes: A Program for Managing Your Treatment by Richard S. Beaser
All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.