Download How do I stay healthy?

How do
I stay
healthy?
Diet and exercise info
www.withyoualltheway.info
At Novo Nordisk, we are changing diabetes.
In our approach to developing treatments,
in our commitment to operate profitably and
ethically and in our search for a cure.
With you all the way is a patient
support programme created by
Novo Nordisk, providing practical
information on diabetes and its
management for children and
young adults with diabetes.
This material has been reviewed by
a panel of experts:
Lead Diabetes Specialist Nurse –
Nicola Lewis, UK
Paediatric Endocrinologists –
Prof Thomas Danne, Germany
and Dr Nandu Thalange, UK
This information is not designed to
replace the advice of a healthcare
professional. Please consult your doctor
or nurse if you have any questions or
concerns about managing your diabetes.
1
Staying
healthy
Diet and exercise are important, whether
you have diabetes or not.
The key to managing diabetes is getting
the right balance between your food
intake, insulin dose and physical activity.1
When you learn how your body reacts
to different types of food and exercise,
it will get easier to manage your diabetes.
This leaflet provides information on diet
and exercise. If you have any questions
or concerns speak to your doctor, nurse
or dietitian for advice.
2
Physical activity is an important part of
diabetes management. Activity helps to
lower your blood glucose levels and has
other health benefits.
Benefits of regular exercise:2
Makes you feel better
Helps you stay at a healthy weight
Improves physical fitness
Improves cardiovascular health
How often should
I exercise?
You should try and be active for 30 to 60
minutes each day.2 Even if you are not
sporty, there are lots of other enjoyable
ways to stay active, such as walking or
dancing, or getting a part-time job.
You could try taking the stairs instead of
using a lift or escalator, or getting off the
bus a stop earlier so you have a longer
walk than usual.
3
Staying
active
Testing your blood
Before exercise – you should always
test your blood before exercise. If your
blood glucose is too low, you may need
an extra carbohydrate snack before
exercise. If your blood glucose is very high,
particularly if you have elevated ketones,
you should avoid exercise, otherwise you
may develop diabetic ketoacidosis.2,3
After exercise – sometimes blood
glucose levels decrease after activity, so
it is a good idea to test afterwards too.4
During exercise – you may need to
test during activity, especially if you are
exercising for a long time. You may need
a snack during exercise if your blood
glucose levels are low.2
4
Preparing for exercise
Nearly all activities lasting 30 minutes or
more (such as a sports lesson at school
or a football match) will require an
adjustment of your food intake and/or
insulin dose.4
Depending on how active you are
going to be, you can do some or all of
the following:
Your doctor or nurse will advise what to
eat and teach you how to adjust your
dose for the activity you are going to be
doing. If you have an insulin pump,
you may choose to disconnect this for a
short time (maximum of 2 hours).4
Reduce your insulin dose for the meal
before exercise
Have a carbohydrate-containing snack
just before exercise
Include long-acting carbohydrate in the
meal after exercise (to reduce your risk
of hypoglycaemia afterwards)
Reduce your long-acting insulin the
evening after exercise, particularly after
strenuous ‘endurance’ type exercise
Make sure you have a fast-acting
carbohydrate snack with you when
you exercise to treat hypoglycaemia
should it occur.
5
Ayse Naz Baykal,
Turkey
Ayse has type 1 diabetes
Examples of fast-acting
carbohydrate snacks:3, 4
Sports drinks
Fruit juice
Glucose tablets or sweets
If you feel like you have low blood glucose
(hypoglycaemia) while you are exercising, you will
need to stop to have a fast-acting carbohydrate
snack or drink before you resume.4
Examples of long-acting
carbohydrates:3,4
Fruit, such as a banana
Cereal or fruit bar
Biscuits
Bread
Milk
If you are planning longer activities you may need
an additional long-acting carbohydrate snack.
6
althy eating
He
A balanced diet
It is important to try and maintain
a healthy balanced diet, along with
regular exercise and taking insulin.1
You should have three balanced
main meals with snacks in between,
depending on your insulin regimen.1
Different types
of food
No single food group provides you with
all the energy and nutrients you need.
You should aim to have a healthy
balance of different food groups.5
Carbohydrates
7
Foods that contain carbohydrates
provide your body with energy. When
carbohydrates are digested they are
broken down into sugars, increasing your
blood glucose levels if they are not used
up as energy. Some carbohydrates act
slowly, some quickly.6
Different types
of carbohydrates
There are three main
types of carbohydrates:5
Sugar (simple carbohydrates)
Starch (complex carbohydrates)
Fibre (complex carbohydrates)
Simple carbohydrates
Complex carbohydrates
Simple carbohydrates are short-acting
carbohydrates that will increase your
blood glucose levels quickly.6
Complex carbohydrates are long-acting
carbohydrates which take longer to
digest (you may hear people call these
low GI carbohydrates). They increase your
blood glucose levels slowly over time.
These are used when you have a
hypoglycaemic episode. These are
sometimes called high glycaemic index
(GI) carbohydrates.
Ideally, the majority of carbohydrates
should come from complex carbohydrates.
These types of carbohydrates can help to
prevent hypoglycaemia.6
What foods contain
carbohydrates?
Sugar
(simple carbohydrates)
Starch
(complex carbohydrates)
Fibre
(complex carbohydrates)
Common foods that contain carbohydrates:
Fruits and juices
Potatoes
Fruits and vegetables
Cakes
Bread
Whole grain bread
Cookies
Pasta
Whole grain/oat cereals
Some cereals
Rice
Lentils and beans
Peas
Nuts
Corn
Lentils and beans
8
Carbohydrate counting
There are two main ways to count carbohydrates:
Changing insulin dose to
match carbohydrate intake
(“carb counting”)
With this method, you can eat different
amounts of carbohydrate and will need
to change the insulin dose to match.7 This
may make it easier when you are eating
out or eating at someone else’s house.
Your doctor, nurse or dietitian will
advise you how to work out how much
carbohydrate you need to match your
insulin dose.
9
You will have your own insulin-tocarbohydrate ratio to help you calculate
how much insulin you need.7 This will
depend on your age and weight and will
change as you get older and may also
vary at different times of the day. Some
people, especially during puberty, will
need a higher carb ratio (more insulin)
at certain times of the day – particularly
at breakfast time.
If you are not very good at working out
your insulin dose in your head, talk to your
doctor or nurse about tools, such as apps
for your mobile phone, that can help.
Planning carbohydrate intake
to match insulin dose
With this method, you need to try and
eat the same amount of carbohydrate
at each meal to match your insulin dose.7
Your doctor, nurse or dietitian will
advise how much carbohydrate you
need each day and what insulin dose
you should take.
How do I know how
much carbohydrate
is in food?
Lots of foods show how much carbohydrate they
contain on the label. Food labels often show how
much carbohydrate is in each serving and per 100g
(this may be different in some countries).
Reading food labels:
Check the serving size:
8 Crackers
Is that how much you are
going to eat?
Nutrition Facts
Serving Size 8 Crackers (28g)
Amount per serving
Calories
120
Fat Calories
Some foods also have a traffic light system on their
labels which shows foods with low, moderate or
high sugar.
30
% Daily Value
Total Fat 3.5g
5%
Saturated Fat 1g
5%
Trans Fat 0g
Polyunsaturated Fat 1.5g
Monounsaturated Fat 0.5g
This number (28g) is the
weight of the crackers,
not the amount of
carbohydrate in the serving.
Serves 2 – half pizza provides
cals
495
sugar
9.0g
fat
18.3g
sat fat
9.2g
salt
2.0g
25% 10% 26% 46% 33%
Cholesterol 0mg
0%
Sodium 140mg
6%
Total Carbohydrate 22g
7%
Dietary Fiber less than 1g 3%
Sugars 7g
Protein 2g
Vitamin A0%
Vitamin C
0%
Calcium10%
Iron
4%
Count total carbohydrate.
You do not need to count
sugars separately because
they are already counted
as part of the total
carbohydrate.
of your guideline daily amount
Your doctor, nurse or dietitian will advise you
how to work out how much carbohydrate different
foods contain.
10
Timing of meals
Eating out
Your doctor or nurse will help you to
plan when is best to eat and when to
take your insulin. Depending on your
insulin regimen, they may recommend
that you try and eat each meal at
around the same time every day.
It is not always easy to eat healthily, time
meals and count carbohydrates when
you go out for dinner. It’s OK to treat
yourself occasionally, as long as you
adjust your insulin dose to balance your
blood glucose levels.
However, if you are out and about,
at after school activities or at a friend’s
house, it isn’t always possible to plan
your mealtimes.
If you would like to check the carbohydrate
content of foods, many restaurants will
provide nutritional information if you ask
them. Some restaurants also show this
information on their website so you can
look before you go.
If you are going to eat much later than
usual, you should test your blood and
have a snack if your blood glucose levels
are low. If you eat much earlier than
usual, you may need to increase your
insulin dose or take an extra dose.
If you are unsure how to do this, speak
to your doctor or nurse.
11
Sometimes it can be hard to time your
insulin dose if you are unsure of when
your meal will arrive. On these occasions,
it is better to wait until your meal arrives
before injecting your insulin.
Weight and insulin
It is normal for a teenager’s weight to
increase over time due to growth.
However, you may notice that you put
on weight once you start taking insulin.8
This may be some of the weight you may
have lost before you were diagnosed.
It is important that you continue your
insulin regimen and eat healthy meals as
advised by your doctor or nurse. Skipping
insulin or meals or going on ‘crash diets’
is not good for you. Poor glucose control
can lead to long-term complications.9
Prolonged high blood glucose levels
have been shown to increase the risk of
problems with your feet, eyes, kidneys,
nervous system or heart.10
If you are concerned about
weight gain:
It is important that you speak to your
doctor or nurse if you are concerned
about your weight. They may be able to
suggest ways to help maintain a healthy
weight, including altering your insulin
regimen, dietary intake or activity level.
Sometimes using an insulin pump will
help you to manage your weight better,
as usually you won’t need as much
insulin when you are using a pump.
The best approach to maintain a healthy
weight is to keep up a healthy lifestyle,
with a balanced diet and regular exercise.
12
13
References
1. Smart C et al. ISPAD Clinical Practice
Consensus Guidelines 2009 Compendium:
Nutritional management in children and
adolescents with diabetes. Pediatr
Diabetes 2009; 10(Suppl. 12): 100–117.
2. Silverstein J et al. Care of children and
adolescents with type 1 diabetes. Diabetes
Care 2005; 28(1): 186–212.
3. Sydney Children’s Hospital. Physical activity
and diabetes. Available at: www.sch.edu.
au/health/factsheets/joint/?physical_
activity_and_diabetes.htm
Accessed October 2012.
4. Robertson K et al. ISPAD Clinical Practice
Consensus Guidelines 2009 Compendium:
Exercise in children and adolescents with
diabetes. Pediatr Diabetes 2009; 10(Suppl.
12): 154–168.
SUDE IĞDIR,
Turkey
Sude has type 1 diabetes
5. American Diabetes Association. Food and
Fitness: Planning meals. Available at:
www.diabetes.org/food-and-fitness/food/
planningmeals/ Accessed October 2012.
6. NIH Medline Plus Library. Diabetes diet
– type 1. Available at: www.nlm.nih.gov/
medlineplus/ency/article/002440.htm
Accessed October 2012.
7. International Diabetes Foundation.
A parent/caregiver guide: Carbohydrate
counting for children with diabetes.
Available at: www.idf.org/sites/default/
files/attachments/HI62553-CarbohydrateCounting-for-Children.pdf
Accessed October 2012.
8. American Diabetes Association News.
Deborah Young-Hyman, PhD: Evaluating
the risk of eating disorders in teenagers
with type 1 diabetes. Available at:
www.diabetes.org/news-research/research/
research-discoveries/in-the-news/evaluatingthe-risk-of-eating.html Accessed October
2012 Accessed October 2012.
9. Rewers MP et al. ISPAD Clinical Practice
Consensus Guidelines 2009 Compendium:
Assessment and monitoring of glycemic
control in children and adolescents
with diabetes. Pediatr Diabetes 2009;
10(Suppl. 12): 71–81.
10.NIH Medline Plus Library. Type 1 diabetes.
Available at: www.nlm.nih.gov/
medlineplus/ency/article/000305.htm
Accessed October 2012.
11.Novo Nordisk website. Available at:
www.novonordisk.com
Accessed October 2012.
14
About Novo Nordisk
This information was developed by Novo Nordisk,
a global healthcare company specialising in the
care of people with diabetes.
Since then Novo Nordisk has grown to become a
world leader in the provision of diabetes products
and support for patients of all ages.11
Novo Nordisk was started up almost 90 years ago
by a Danish couple with a passion for changing
diabetes. August Krogh was a professor at the
University of Copenhagen and Nobel Prize winner
and his wife Marie, a doctor and researcher into
metabolic diseases, suffered from type 2 diabetes.
They learned of insulin being developed in Canada
and were determined to ensure access to insulin
for everyone with diabetes, hence in 1923
Novo Nordisk was born.
We fully understand the challenges that children
with diabetes face and are working together with
parents, schools and healthcare professionals to
improve the care of children with diabetes, as they
grow up and develop.
For more information about Novo Nordisk,
please visit: www.novonordisk.com
This information is not designed to
replace the advice of a healthcare
professional. Please consult your doctor
or nurse if you have any questions or
concerns about managing your diabetes.
APROM ID#4601; approval date: December 2012.
Changing Diabetes® and the Apis bull logo are registered trademarks of Novo Nordisk A/S.
Novo Nordisk A/S Novo Alle 2880 Bagsværd Denmark
www.withyoualltheway.info